HomeMy WebLinkAbout7051-zNO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificnte Of Occupnncy
THIS CERTIFIES that the building located at . 14al'&t;noka. Lane .......... Street
Map No..x~x.. ......... Block No...x~x.. ...... Lot No....x~X.... ~t~;.i.t.u..c.k..N;.~... .......
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ........ J..aB... ~. ....., 19.7..15. pursuant to which Building Permit No..7.0~7..
dated .......... .J.a.n .... 7 .... , 19.7.1~., was issued, and conforms to all of the require-
merits of the applicable provisions of the law. The occupancy for which this certificate is
issued is .P.r~..®. .o.n.e...f.a.m~.l.y..d.¥~..1.1..~. g .......................................
The certificate is issued to .P.~I~..d.e.~'~. ~o..me~..I. 2C ...... .0x~.e.~ .......................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval .g..un..e...3...!9.?~...b~'..R. :..V.~.i.1..a ....
UNDERWRITERS CERTIFICATE No..N...~ ~.8..~3~ ...... .b~. ~'...~... ~ ~.~. .............
HOUSE NUMBER ..... .~2~. ..... Street .....P~.r..a.t.o.o.k..a..L..a~..e ......................
Building Inspector
FORM NO. 9
TOWN OF ~O~JTHOLD
BUILDING DEPAR?MBNT
TOWN CLERK'~ OFFI~E
SOUTHOLD, N~ Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 7051 Z
Date 3'-3~ ~.. .......... , 19 ..~...
Permission is hereby granted to:
........... ~.q.'~g&':..: ~'.~ .. ~.q~.e L,~ ~. .........................
~ O
........................ ~.~..q$~..:J,~. .....................................
to ....~ufl~L..~w...~...~.~,L~...~fl,:tJ, n~ .................................................................................
at premises located at .J~/.~....)~l~a.~cJg~rdL...~,}l,~. .......................................................................... N~: t tit~ck N,Y.
pursuant to application dated ...........................~..~.~..~......~. ............... , 19~..~,...., and approved by the
Building In~ector.
'" ~ ' Building lnspt(c'~ ..................
FO~,~[ NO. 6
TOWN OF SOUTHOLD
Building Deportment
Town Clerks Office
Southoid, N. Y. 11971
APPMCATION 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:
I. 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 and 'pre-ex'sting"
land uses:
]. 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
Date .~. .......... /. ..................
New Building ..... · ..~....... Addition ................ Old or Pre-existing Building ................ Vacant Land ..............
Location Of Property .~...~....J..~...~..~...~..~..~..~...~....~....z~.~...x....~....~....~....Z~...~...~.~.~.~.~.
Owner Or Owners Of Property ......................................................
Subdivision ................................................................ Lot No ............. Block No ............. House No .............
Permit Date Of Permit ............
Health Dept. Approval .,~.~..~..,.,,'~......~.~.."1...~ ............ Labor Dept. Approval ............../...~...~ ....................
Underwriters Approval .....~..../.~...~....-~..~..,,,~. ............. Planning Board Approval .......... I..~..:....'~.. ..............
Request For Temporary Certificate ........................................ Final Certificate ...~ ................................
Fee Submitted $ ..,..~.,......C....~.~.. ................
Construction on above described building~'~ ---"* '"~and~ermit~,meets all applicable codes and regulations.
Applicant..,.~z,~.rr~........-~....: ... ~...~-~.. ~ .~........~.~..-..~1~ .................
Sworn ,o before me ,~ ~
........ /~. day of ..~ ........ ~ ...... ¢ (stamp or seal) ~¢~
Notary Public ......~ ....................... County ~ / .
THE NEW YORK BOARD OF FIRE UNDERWRITERS
ak BUREAU OF ELECTRIC~'Y i -
~- 85 JOHN STREET, NEW YORK, NEW YORK 10038
..t. May ~. 197~, .~pp.ca.o. No. on/ile 7~o35~' N ,158335
THI~ ~IFI~8 THAT
Pounde~s Homes, Ma~toka Rd., s/side Main Hd., Mattituck, L.I.
in the following location; [] So~.~nt [] z,t ~l. [] 2nd ri. outside S~ction Block
wu e,ami,~d on May 6 ~ 19 7~ ,nd found to be in compliance with the requirements o/this ~oard.
FIXTUnE L'~'~q'ACI_~[ SWITCHES I HXTURRS I RANGES
17 [ 37 23 17 I.
DRYERS FURNACE MOTORS PUTURE APFUANCE FEEDERS G~.CIAL REC'PT TIME CLOCKi BELL IUNITHEATEBS
I 3O
SERVICE DISCONNECT S R I
1 :~00 CB 1 0
OTH"L~ ~GF~A~I~TUS, '
Water heater: 1- 4,Skw
~oto~r/8: 1-1/2hp
1
COOl(lNG DECKS OVENS DISH WASHERS
o 1 1.5
MULTI-OUTLET
SYSTEMS
E
Lot
EXHAUST FANS
Charles M. Hall,
Box ~17
Southold, L.I. 11971
Per ll if?A/
COPY FOR BUILDING DEPARTMENT. THI N ANY ~NER.
SUFFOLK COUNTY DEPARTMENT OF HEALTH //~
H.D. Reference No. --~
APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM
1. Applicant i",.~,~,;m~5 ~.,ma~ ;~ Phone~-'i~5. Subdiv ....... ~ .~. ~
Address ,il~ ~,~ i~i~ ,~-~9 6. Section
2. Property locationi~ ~,~,~, ~, .... ,~; ~{~ ~ ,~,,~ 7. Lot No.
~ .;~ ~,. ~ ~ ! 8. Private well ~, ~
Village .'~,~T~_~ Township ~,,~2 9. Public water ~
3. Public Water Company name ~.~ Distance to main
4. Lot size: Width ~ ~ feet Length ~ feet (Enter on center plot below)
10. Sewage Disposa~-~ystem: /
A. /0/U gallon septic tank: Precast / ~uivalent Block__
B. ~A/eaching pools: Number /Precas~ Block Special
If private well fill
in blanks below:
Tank capacity y~Gals.
Pump 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
The undersigned CERTIFIES: "Construction of authorized installations will
be in accordance with the Suffolk County Department of Health's current stand-
ards thereto."
Based on the information presented herewith, it
FOR HEALTH DEPARTMENT USE ONLY.
is the opinion
Disposal
Date
of the Health Department, that an adequate and satisfactory Sewage
this plot.
Signed
S-15
Revised 4/]/72
System can be installed on
BUll. DING DIFAIITMENT
TOW~ CLERK'S OFFICE
~OUTHOLD, No ¥.
Approved .. ... .~.. .. .. i .............. Z...-...., 19.?.~... Permit No. Z~'....~..../..:.~ ......
Application No .........
Disappr~ed~ '":
................................................ ::::::::::::::::::::::::::::::'
~ :~ ~ . ~'~ ..... v ., .,'Y:~'f: ......................, .....
I~RU~I~S
a. ~is a~icati~ must be c~pletely fill~ in by ~wr ter ~ Jn J~ and s~mi~ in triol~ to
In ~tr J ..............
~ o,wt~a~tsotp~,accu~pl~pl~l~.F~co~i~[~le ~ "~
- h~ ~owmg I~ ~ ~ ~T~u~ ~e~, ~at~,p to a~o~ni~ premiss or public str~ o~
areas, and ~vJ~ a d~ail~ d~ripti~ of I~ ~p~ must ~ dm~ on the d~gmm which is ~ of ~is ~li~i~.
c. ~e work cover~ by ~is a~lication ~y n~ ~ c~me~ before i~e of Buildi~ Pe~it.
d. U~n h~p~al of ~is ~l~J~, t~e' Buildi~ In, tar will i~e a Building Permit to the a~licant. S~h permit
shoU ~ kept ~ ~e premi~ ~il~le for in~ti~ ~ t~ ~rk.
e. No buildi~ shall be ~cupi~ or ~ in who · or in ~ for any pu~o~ whoever until a ~ific~ of ~c~n~
~all have ~en grant~ by the Buildi~ Ink,tar.
APPLI~TION IS HEREBY ~DE to ~e BuildJ~ ~ment for the i~a~e of a Buildi~ Pe~it pu~nt ~ ~e~
Buildi~ Z~e O~ina~e of the T~n of ~ld, Suf~k C~n~, N~ Yo~, and ~her ~phc~ ~ ~I~ or~
R~ul~ons, for the co~t~t~ of build,~s, a~iti~ or al~mti~s, or for m~al or ~liti~, ~ ~n ~ri~.
~e applicant agr~s to c~ply with all a~licable I~, ordi~s, buildi~ c~, h~si~ c~, a~ ~1~, a~
admit au~oriz~ in~t~ ~ promises a~ in ~ildi~s ~r ~ i~ti~.
(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.
............................................ ,
Nome of owner of premises ~.-:..q~, ~ 0~/~-% ' Hor'l~.~ I~JC.
If o~rate, signature of duly authorized officer.
(Nome and title of co/J)orate officer)
Builder's License No .....................................................
Plumber's License No .................................................
Electrician's License No .............................................
Other Trade's License No ...............................................
1. Location of land on which proposed wOrk w I be done Map No.: .............. Lot No .
Street and Number .~, ou L~ BOO - ...
· .... .............. , ............
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Exisiting use and occuponcy .................................................... . ....
b. Intended use and occupancy ......................................... ~.. .. ....................................
3. Nature of work (check which applicable):. New BUilding ~,.Z ...... Addition
.................. Alteration .................
Repair .................. Removal .................. DemOlition..., ...... i .......... Other Work ......................................................
' ~ '"'O (Description)
4. Estimated Cost .~..¢.¢~.~. .................. Fee ,-'~ 7' .~..
(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 ..... :.~.....-.....~.,~...~...~...~. ............ ;; ...............................................................................................
6. If business, commercial or mixed occUpancy, specif~ nature and extent of each type of use ............................
7. Dimensions ef,~j~structures, if any: Front ....... .~...L....~.. .......... Rear ...~.~:.....~.. ................... Depth ~..~....?. ........
10.
12.
property lines. Give street and
whether interior or corner lot.
Height ...... /.4 .............. Number of Stories ....... ./. .......................................................................................................
.--..e'%':?-_' ;f ..... :-_..--:.u::"' ' -'. ..... u;,~,u,,u,,~ ~, --" F,~,,l Rear
Ol,,,~,,~,u.~ _. _-_-._'..'c .,c. ~,~,o[,,~,,u,,. r,u,. .................................... Rear .............. ; ............. Depth ........................
Height .................... Number~ of Stories .................................................................................................... ~, ...............
Size of lot: Front ....... ~.~.,.,~. ........................................ Rear ....~.~...~....~ .......................... Depth ,.../...~...O.. ...................
Date of Purchase ..J..~/~Li..:l..~..~...~. ...................... Name of Former Owner C~..~...~...~...~...~.......,,~,.~..~.....c~.....~....L..
Zone or use district in which premises are situated ......................................................................................................
Does proposed construction violate any zoning law, ordinance or regulation: ..... ~ ............................................
Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes (~) No
Name of Owner of premises .F..~.~...~l...O..~....~e..~l...I.'.~...J.~.~ddress ~..l..s..S..~...~...~..T.~...~../."....~hone No.--~.~...~..~.~..~.
Name of Architect ~ · ..... Address t ' Phone 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
block number or description according to deed, and show street names and indicate
'"' ,-,,**.o-- ,,.
........ ~, ~. ~~~~:'~' ............. :. ................ being duly ~ornl d~oses and says t~t he is the applicant
(NOme of individual"sig~g c~trocO ....
above name.
He is the ............................................... ~ ............ : .........................................................................................
(Contractor, agent, corporate 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 ~atements contain~ in ~is a~lJc~ion am true ~o ~e ~st of his knowledge and belief; and
that t~ work will ~ perfor~ in the manner ~t fo~h in the application filed therewith.
Sworn to before me this [ I ~
..................... .......... .,,....X -- -.
~ . ~ (Signature o~applicant)
~DffH T. BOKEN
N~ Public, State of New Y~ /
No. 52-0344963 Su~fol~ cou~
Commi~ien ~pir~ March 30, I~
KO~,,/A L E.SIx-,Y .o
MAFT!i'UCK
.Low~ or Sour,oLR
_SCALE-40', l"
SUFFOLK COUNTY NEALTH DEPARTMENT
The sewage disposal and water supply
facilities for this location have been
inspected by this department and found
%o be satisfactory.
Services
CODES
ALL FEDERAL, STATE AND LOCAL
CODE5 ORDINANCES~ REGULATIONS
El'C,, SHALL BE CONS DERED AS PART
OF SPECIFICATIONS FOR THIS BUll.D-
ING AND SHALL TAKE PREFERENCE
OVER ANYTHING SHOWN, DESCRIBED
OR IMPLIED WHERE SA~E AR~ AT
¥
ALR~ WOOl} FRASER ARCHITECT
234 Clinton PI., I~ackensack, N, J,
N~'~I'I~' COt-,rrRACTOR TO VERIF~ AL.~
Ult.., DIMENSIONS. AND CONDITIONS
234 Clinton PI,, Hackensack, N, J~
ALAN WO0~ F~ASER ARCHITECT
234 Clinton PI., U~ckensack,
,
ALAN WOOD FPJ, SE~ ARChITECt'
234 CJJnton PI., HackensacK ~ &
ALAN woen FRASER ARCHITECf
234 Clinton PI., Hackensack, Al. J.
f
'ALAN WOOD 'FRASER ARCHITECf:" ,
"CODerS
ALL FEDERAI~ ' ,STATE ' AND ' LOCAL
CODE~ ORDInANCeS,. REGULATIONS
ETC., SHALL BE CONSIDERED/kS pART
OF SPECIFICATIONS FOR THIS BUILD-
lNG AND SHALL TAKE PREFERENCE
OVER ANY'I'HI~G SHOWN, DESCRIBED
OR IMPLIED WHERI~ SAME ARE AT
VARIANCE.-- ·
~li~Tr CONTRACTOR TO VERIFY ALL
p/r DI. MEN$~ONS. AND COND~TION$
~0
I~LD/ATION$ OF GARAGF~, PORCH,, 'tERRACES,
tJ'~OP~ ~DI LINM SHOWN ON PLANS, ETC;
ARI IU~I~"T TO ~HANAI TO MEET TOPOGHAPH-
I~h ~NDITION$,
ALAN W(]§9
234 Clinton PI.,
ALAN IN~)09 D:R~S~R ARCHITEC~y
234 Clinton Pl., [-lacko~l~R N, J,
ALAN WOOD FRASER ARCHIT~C'~"
234 Clinton PI., Hackensack, N, J.