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HomeMy WebLinkAbout7293-z· 0~'~ NO. & TOWN OF $OUTHOLD BUr~.nlNG DEPART~k~IT Town Clerk's Office $outhold, N. Y. Certificete Of Occupancy No. '7- (~ I t~..~ Date q Of_ 7 ~9.T..~/ _. 1350 ~ woo ~ ~IS C~T~S ~at the b~g l~a~ ~ ............................ S~t ~57~~ ~ Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in. this office dated o~ MAY, 19./.~/-~'' pursuant to which Building Permit;-N°? dated ............ ..?.~ 19.~..~., was iss,ed, and confo~ to a, oi the ,e~r~ ments of the applicable provisions of the law. The occupancy for which this certificate is issued is The certificate is issued to /:~V~ .~0~"6 L*C /4- (owner, lessee or tenant) of the aforesaid building. su~o~ Co.nt, DepOnent o, UNDERWmTERS CERTiFiCaTE No ..... .A.L.. (.7./~. ~ .~..~...~. .................. HOUSENUM~ER 1~ 50 Street ~EP~O0_~ .-~..7~,, Building Inspector FORM NO. :B TOWN OF 5OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, N~ ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P'EEMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7293 Z Permission is hereby granted to: Riverhead at premises located at ...[...~..tf....1.~ ....... ..J~....~..~.....O~........~....~..e...J. ..................................................... i ............... 8oavoed Dr~ve 8°Uthold li.Z. pursuant to application dated ........................ ...~..Z ....... .~...~. ............ , 19..~....., ancl approved by the Buildin~ In~:tor. TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~UTH~D, N.Y. /~/,~ ..... ........... , APPLICATION FOR BUILDING PERMIT Date ~ ......................... /. ................. , .... I NSTEUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wi~I~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Pict plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, a giving a detailed description of layout of property must be drawn on diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zo~ Ordinance of the Town of Southold, Suffotk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction~ff buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable lav~ ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspectiorl~ (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder; ............ ....................................................................................................................... Name of owner of premises .~'..A~.~.~..~' ........ ...~..~../.~..~../~.Z~..~ ................................................................................ if applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ..~...-~...~..~.'.. Lot No ......... (...~.. .............................. Street and Number ........................................................................................................ ~../'.~.~...~-.,4~. ...................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........... .~..~..~..~.~.. ..................................................................................................... b. Intended use and occupancy .... ~,.~.4......,~'..xc2~z:~,./k'. ~... ' ...... .......................................... 3. ~rlq~ur~ of work (check which applicable): New Building ....................... Addition ..................... AIteration....?..,7 ..... Repair ......................... Removal ......................... Demolition ........................ Other Work (Description) 4. Estimated Cost P-- ~ ,(~O ~:) Fee ~ © ' ............ '~f'"~' .......................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .....~ ......... Number of dwelling units on each floor ......................................... If garage, number of cars .........~/.-a.~..(..~~. ................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front .....................Rear ........................... Depth ................................... Height ........................................................... Number of Stories ............................................................................. Dimensions of same structure with alterations or additions: Front .......................... Rear ..................... Depth ............................................. Height ......................................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front ...... x~,~q..: .......... Rear ........ ~.~/..: ........... Depth ....-.-~..~..: ................... Height ............. ~.J~..,....~ ...................... Number of Stories o ' . ............ /.. .......................... Depth .......... /..~ .................................. 9. Size of lot: Front ........./..g ........................ Rear o o ' -o ' Height .................................... ..... ........ Number of Stories ...................................................................................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning'law, ordinance or regulation: 13. Will lot be regraded .... ~./.P. ................. Will excess fill be removed from premises: [ ] Yes [~ No 14. Name of Owner of premises ..... ..~..x~.~.~.../~........~.~..~.(.~-..~.~-.~.~.¥. ........ -.~-..'~.-(~'~f~a~"&-?'" "~'"/'C:'" "~"'"'"~" (Address) (Phone No.) Name of Architect (Address) (Phone No.) Name of Contractor ..../~..?.xY,'J..~.Z~./. ......... ~..~..~...'. ....... /./..~-..~. ......... -~.~..~:~-....-~.~..'~'.. ....................... ~' ........ (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. ~ /Oo~ ~ STATE OF NEW YORKr~ _ ~ ) COUNTY OF ............. .~. ~ .~. ,~--~..../. J~. ............. ) ~.[.~l...ml~l~lll~l)~m.~lll~(l~m............................... being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract) He is the ............... .~....~..'~...~.~...~-.~..~.*..~.*-./~. ............................................................................................ , ...................................................... (Contractor, agent, corporate o[~cer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that ell statements contained in this application are true to the best of his knowledge and belief; a~i~h~k will be. performed in the manner set forth in the application filed therewith. NOT~Y Notary Public, ~ ~' /~ .~.? ~.../~.. C~unty .......................................... .................................................. FOR~ NO. ~ Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings end "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare o certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date 0 C ;- Z / New Building ....... ,,,~..... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. ,,, ...................... Location Of Property ................................... ~....~.. ./../...,~. Owner Or Owners Of Property ..~7..~.~.../t/./£ Subdivision '~).~ .~(..~.~..~.....,~...~'.~f?~..~.......~...4~..~..../~..Lot No.../w'~...... Block No..~..~.~..?.~."House No../.~?.,J~.. C~ Permit No..7..~..~...~......~... Date Of Permit ./.~..~.;,~....~../....Applicant ..~...~...~..~4~...~.-7......Z~......~c.....~...~. ....... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ....~. ................................... Fee Submitted $ ~ ~...& ................. Construction on above described building and permit meets aIJ applicable codes and regulations. App,,cant .......... Sworn to before me this /'~" ~/~¢~ ~-~:' ................................... o, lemur-7 (stamp or seal)/~ Z SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant/~¢~' ~,~,.F Phone 7~ l- / ~ ~ 5. Subdiv. ~£~v~ Address '//j~ ~ ~1~ ~ ~ /~~ 6. Section 2. Property Locat~on~/J ~'~op~ ~/~j-m~ ' 7. Lot Number ~o 7/~ ~v~y~ k~ 8. Private Well Village ~ ~p~ Township ~ ~ ~+ m~ 9. Public Water 3. Public Water Company Name e~ ~ ~,x ~ Distance to ~in 4. Lot size: Width y u 0 feet Length y~ feet lO. ll. Sewage Disposal System: A. (900~gallon septic tank: V Precast ~Equivalent Block B. Leaching pools: Number of pools / Precast j~OBlock Special If private well, fill in the following blanks: A. Tank capacity ~ B. ~P~np G.P.M. C. ~otal well depth gallons (For Health Dept. Use) D. D~]pth to ground water E. An~punt of water in well The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current standards thereto. This application will be vml~d for one year from the date of approval indicated below and may be renewed if a current 16cal Building Department Permit is in effect. Date Signed .~__~ ~ ~ FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department that an adequate and satisfactory Sewage Disposal System and Water Supply can be installed on this plot. S-15 Rev. 4/1/73 THE NEW YORK BOARD OF FIRE: UNDERWRITERS 8..W BUREAU OF ELECTRf(~ITY -- 85 JOHN STREET. NEW YORK, NEW YORK 10038 ~t. Au~ust ~3,197~, .~,.,.,,...t,o.~o.o./,. 7~:~2.~8 N 178525 THIS CERTIFIES THAT only the e~ctri~al e~lu~.ment as descr/bed before a~d i~trod~ed by the Fra~ Sokoltch, e/$ leawood Dr., ,~outhold,h.I. inthe/ollmvingloeatlon; [] Basement ~[] lstrl. [] 2nd Fl. OUtSide Section mo~k lot wo~ ..~.i.*d o. August 19.197 o.d~Loa.d to be in compliance ~eith the requirements o/this Board. 1AC I IT [ RXTURES RANGES AMT. K.W. [ A~T. K.W. , MT. K.W. EXHAUST FANS SERVIC~ D~SCONNE~T NO. O~ S E R V I C aFu~naee3: 1-1/Shp, 1-1/12hp ~Puture Appliance Feede~s=l-3~6,1-2~l~ Oeorge Zimllinghaus Park Pl. Patohogue,L.I. 11772 COPY FOR L. C3T · I~ NOT - 14 U LOT, r J Lo'f IS "'Z b ~ JO/-% Nl r--ore.. '::; ITUAT,L- AT ~OLJT I-lC)Lb TO THIS SURVEY I$ A VIOL;ATION OF EDUCA1 ION LAW. ~C,,~L&- BO'= 1" r~ ,,/,~ONU/&&NT SUFFOLK COUNTY MEALTM Chief of ~ ...... z'a! EnG~neerin~ So~'v~cos DATE: EEE: NOTE