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HomeMy WebLinkAbout7050-zTOWN OF $OUI'IIOLD BU~.nING DEP~ Town Cl~k'~ O~i~ Soud~d, N. Y. Certificate Of Occupency THI~ CERTIFIF_~ that the bugd~.~ located at .~.. /~JO~,~.~. led Map No ............. Block No.. ~ .Lot No, ? '~ ; conforms sub~mtially to the Application for Bufl&~ Permit heretofore filed in tl~ ofllee ~....q.~ ~.. ~ ......... , ,~f. ~.u~, ~ .~ ~,~ ~.o.?~.e ~ ,J~J '/ . ~/ . dated ....................... , lg. ].., was issued, ~nd canforms to m'l of the reqlgre- ments of t~e applicable provisions of the law. The occupancy for which thl, certificate i~ ................ ;~ ............. .~.~ .... ....... = ......... ., .............. ~o ~,,~ ~, ~ ~.1.~..¢..~ ~ .T..~.e..SI ~.~..re ~., .o.. ~..o. ~ t.~../ .... .o....om~..... (owner, lessee o~ temnt) of the aforesaid building. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOW'N CLERK'S OFfiCE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 7050 Z Permission is hereby granted to: ~.. ~ t.[a.....~..g...~,~.T.~a.~a..l~er~..~.. J~. ......... ....... ~,~ho~,u~ .................................................. ~ .. ~3.3.~ ..z~e~, ..mie...~.'n~L~..A~;~ 3~1,~ ................................................................................... at premises located at ..~'-/.~....t4oJ~r.t...JJOl~ .................................................................. ~ ............... ........................................... ~,,,a'u.t,h.cJ.~d. ........... ~.,,.~... ............................................................................ pursuant to application dated ...................... ~.~J~' ......... ~. .............. , 19.~..1f..., and approved by the Building Inspector. PERMIT INCLUDES APPROVAL TO REMOVE EXCESS F~L FROM ABOVE PREMISES :(EGRADING LOT ORtVEWAY CONSTRUCTION CESSPOOL CONS, RUC]'ION CELLAR C,.~NSIRUC1 iON OTHER THE NEW YORK BOARD OF FIRE UNDERWRITERS -~k BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK, NEW YORK !003B ~:u~, ~8, ~7~ Ap~,~.,.~o.o.~,. 726o9~ .~ N 171136 THIS CERTIFIES THAT in the following location; [] Eas~rnent ~.~.m~.~o" July 15, 197~ [] Ist Fl. [] 2nd FI. OI/~S~dO Section Block Lot anglo.nd to ~e in compliance wit~ th~ req~irement~ o~ thi~ Board. DRYERS FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS DIMMERS Water heater~ 1-~.Skw Elee.room heaters~ S E R V I C 2/0 3-2.0kw, ~-l. Skw, 2-1.25kw, 3-1.Okw, 13-.75kw . Si~vestro Morin, 285 Hobart ~venue, Southold, b.I. Per 11 COPY FOR BUILDING DEPARTMENT. THIS COPY OF BE ALTERED IN ANY FORM NO. $ TOWN OF SOUTHOLD , Building Deportment 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 disposol--(S-9 form or equal). 3.Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences end 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 and "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 a 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 New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ....... ..-~....~....~.~. ....... ~.~..~...~...'~....?~,. ....... ,--~....~...~...1..~.~ ...... ,S..O,.~.,..T.....~...o....L...~. .......................... Owner Or Owners Of Property ...,,~...!..L....V...~..~..~....~...~......?........~..~...-~.....~..'~...~...~........~...~...T~..!...~.. ............................ Subdivision ................................................................ Lot No.....w. ..... Block No. -- House No....~...~....~... Permit No......'~..~...5...t).~, Date Of Permit .d../t...U...?~.(.q..7..~pplicant ..... 6.~..?. ....... ..~../....~....R. ............................... Health Dept. Approval ...'gf..U....L..Y.....~..!.....!.~.]..~.-~....Labor Dept. Approval .............. .~....'..!..~T.. ..................... Underwriters Approval ..~.-(7. ......................................... Planning Board Approval ....... .... ....................... Request For Temporary Ce~rtificate ........................................ Final Certificate ......~ ............................ Fee S Submitted $ .......... [..~.. .................... Construction on above described building and permit meets ail applicable codes and regulations. Applicant .~. ~'~./,~'Ct ..... ~... ~..~ .......................................... Sworn to before me this f///5/7~- NOtary Public .~. County (stomp or S,OI)~~ 77 H.D. Reference No. -- APPLICATION FOR APPROVAL TO Mol*xn 1. Applicant 811VOft~O IdOF~fl & Phone A d d r e s s GF~OMO Path. S~ld. N.Y. CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 2. Property location_~ fl. eo tth of Rood, 80u 61d q-e4,-¥m. 4. 10. ~6{-~'].O~ubdiv. ~ m~ 6. Section ~O 7. Lot No. 8. Private well .. Village $o~thold Township~~ 9. Public water .v~, Public Water Company name ~F~~CO. Distance to main Lot size: Wid~feet Length ~ feet (E~er on center plot Sewage Dispos~ S~stem: ~ A. f900/gallon septic tank: Precast Equivalent Block below) If private well in blanks below: Tankp/~"~ Pu~ G.P.M. Total well depth Depth to G.W. Amount of water in well Test Hole Data Feet 0 2 4 6 8 10 12 14 16 18 fill Gals. The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current stand- ards thereto." c Da te Signed ~..~/~P/~-~ ~ '- Ow~'er or Builder FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it Disposal System can be installed on the opinion of the Health Department, that an adequate and satisfactory Sewage this plot. Sign~ _ ~ -'~ ...... S-15 Revised 4/]/72 ............................. ............ APPLICATION FOR BUILDING PERMIT4~$//,75- Date ..... ,..,: ................... ; .................. ,19.....~..... a. lhis application m~st b~ completely filled in by typewriter o~ in i~ Insp~tor, with 3 ~ of pl~, accmte pl~ plan ~ ~ale. F~ ~co~i~ to ~h~. b. Plot plan showing I~ation 6f ~dt ~ 0f ~ildi~s ~ premi~;~jo~ or~s, and givi~ a detail~ description of I~o~ ~p~e~ must be droWn on the diagram which is ~'of c. The work cover~ by this application may n~ be comme~ed before i~ua~ of Building Pe~it. d. Upon approval of this applicati~, the Building Insp~tor will issue a Buildi~ Permit to the ~licant. Such ~rmit shall be kept on the premises available for insp~tion through~ the work. e. No building shall be ~cupi~ or u~d in whole or in pa~ for any pu~e ~ever until a Ce~ificate of ~cu~ shall have been gmnt~ by the Building In~tor. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursu,a, nt to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordmanc..es or Regulations, for the construction of buildings, additions or atterations or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or ~ame, if a corporation) ..... ; ................. .......... ................ Store whether opplicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumbeF 'Or builder. ......................................... ................................................................ : ............................................. ii':'"":" :" Name of owner of premises ...t~ 1TIKI~I~t...~,.A31.t~I~IJ,.III.....~.3[';~II, ......................................................... i ....... i; ........ ?~!... If applicant is a corporate, signature of duly authorized officer. (Name and title of ¢0rporate of'tiger) Builder's License No ..................................................... Plumber's License No ................................... Z...:....~. Electrician's License No .... ~ ............................. "~ Other Trede's License No ............................................... Location of land on wh,ch p~/oposed work w,II be done. Map No ........................................... ~0 ......................... r~,,,,.,~,o, g/~ ~.~ebart Rea~ 5..~.,thold N.Y. -" Street and .................. ~. .................................................................................................. . ........ , .............. ~ .... . : =:-.t MuniCiPalitY State existing use and occupancy of premises and in:ended use and occupancy of p~onstruction: a. Exisiting use and occupancy b. Intended use and occupancy .......... .~3~ll...~.~l~l,~y...~.~,3,-~l,~ .................. Z~';~';::[~:.~ ...................................... 3.' N~re of work (check which applicable): New Building: ....~ ...... A~Jition .................. Alteration .... Repair .................. Removal .................. Demolition .................... Other Work ...................................................... (Deecription) 4. Estimated Cast ....................... ~...0~......+_ .............. Fee ...~...~...~ ................................................................... (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 ..... .2....~. ............................................................................................................................ 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 ........... .~ ................... Rear .....,~.~. .................. Depth ...... ..~. ............ Height .................... Number of Stories ....... .~.~. ......................................................................................................... 9. Size of lot: Front ..... ~.~ ............................................ Rear .......... .~]~)9. ........................ Depth .....~..~..,4~1~:l ........ 10. Date of Purchase ...............~J~..~ ................................ Name of Former Owner ..... ~.]-...e..l!.. .................................... 11. Zone or use district in which premises are situated .......... ~lJ.....Ij~[~ ......................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... J~ ............................................ 13. Will lot be regraded .........;l:;Z .............. Will excess fill be removed from premises: (Z) yes ( ) No 14. Name of Owner of premises .JJ,~,l,.~r. lll.J~Z'~....~l~3',:;J-lL.&..~,J~l~ddress ...I~/.I~..]~I~LII~~.~l'l Name of Architect .............................................................. Address ................................ Phor~ No ....................... Name of Contractor ........ ~.~.. ........................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from properl~ lines. Give street and blOCk number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEV~ Y,.~;~,~ /~- I~ S.S COUNTY OF .~JlJlJlJLIIjlJ4r~.. .......... ~' ........................ ]elJ~lil...~'~.J,a ..................................................... being duly sworn, deposes and says t~ he is the applicant (Name of i~ivid~l signing c~t~ above name. ~l~e~ ....... He is the ... ~.~ ~ ................................................................................................................................ (Contractor, agar, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contained in this application are tree to the best of his ~owledge and belief; and tha~ the work will ~ performed in the manner ~t fo~h in the applicati~ fil~ ~er~with. Swom~methis ~_ ~ -,_, ~ ~ d., ............. , _ , ,oto ........ ...... ......................... .................. ~,,,~,eu u IDII1:~ ~ ~ Nolart Public, State of New ¥o~ ~ "~ ~ ' - ~ '~- No. 52-034496~ Suffolk ~ ~~ ~mm~i~ ~p~r~ March 30, 19~ t 'I SUFFOLK HEALTH DEPAR~T / The sewage disposal and water facilities for this location have inspected by thi~e~a~tmenta~lfottl~t~ 4?