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HomeMy WebLinkAbout7519-zNO. ~ TOWN OF SOUTHOLD BU1LDI~G DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . .Dog. od. La ..............Street Map No~&~[,. ~,. Block No ........... Lot No..~79 .....h.*~. ~.~$~ .......... conforms subst~tially to the Application for Building Pe~t heretofore ffl~ ~ t~ office dated ............~pt ....~, 19. ~ p~su~t to w~ch B~g Petit No.. 7.~1~. dated ............~pt ....~., 19 7.~., was issued, ~d co~orms to ~1 of ~e req~ ments of ~e applicable pro~sio~ of the law. The occup~cy for which t~s certificate ~ ~sued is Pr~Y*~. 0~. ~. ~g .. ~r~..f~O~. ~ ............. The ce~ificate ~ issued to . ~. J. :F~ .J~ ......... ~. ................ (o~er, lessee or ten~t) of ~e ~ores~d b~d~g. ~~ S~o~ Co~ty Deponent of He~th Approv~ ~ ~. ~. ~.~ .... I~. 7.C ...... UNDERWRITERS CERTIFICATE No...~. ~.0. ~ ~. 0 ~ ........~ ~ ~. J ~;. ~. ~ ........ HOUSE ~ER ... 3~0 ....... S~eet ~9~9~. ~ ............................. Building Inspector lrO~ bO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT ~OUTHOLD, N. Y. BUILDING PIRMIT (THIS PER~IT ~UST BE KEPT ON T~E PREMISES UNTIL FULL COMPLETION Of: THE WORK AUTHORIZED) 7519 Z Date ~e~t ti' 19.~,.. Permission is hereby granted to: ......... ................................................... at premises located at ,~0.~...~2~ ....... ;(~'~[.~.ile3'.s..~li~Y...1~.s)~-~.~s ................................................ · Do oc~ La East I~'.~.gG ~. pursuant to application dated .......................... ~eT).l;......~ ............. , 19..~.~.., and approved by the Building Inspector. Broil pOll~.t f~ f'J.Tl'l~ fPJ. OOT e~l.~t &ddAt, J. ea~l pend. t Toq~.~d ~o flJd. sb ar eeewpy fte6ond fleeT, ~ ............... B~iigln~' InspeCtor ~ ............ Examined Approved ......... ............. ...,. .......... , 19...,../ Permit No. Disapproved a/c~< ....... APPLICATION FOR' BUILDING FERMIT Application No. Z..~...(f .............. INSTRUCTIONS t~ in by typewriter oe in ink and submitted in triplicate to the Building~ to ~cale. Fee acoo ~rcl~ng to ~:hedule. a. This application must be completely filled Inspector, with 3 sete of plans, accurate plot plan b. plot plan showing location of lot and of buildings on premises, i. elatlonship to adjoining premises or public streets os areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. c. The work covered by this application may nat be commenced beJ[om issuance of Building Perm t. d. Upon approval of Mis application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on 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 Perm t pursuant to the B_uild!n.g. Zen,e Ordinance of ~.he T,?n.o.f. Southolcr,, Suffolk County, New York, and other applicable Laws, Ordinances or ~(egu,at~ons, tar the construchon at buildings, additions~or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable lawsj'ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises croci in buildings for necessary Jnspoctions. (Signature of applicant, or name, if a corporation) (Address of applicant) / I ~ 7/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................... ..................................................................... Name of owner of premises ~4~.....,~.....~.n....~"~./.~/.....~.,~,~ ...................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ....... ~.~.~',,~ ................... Lot No...~...~..~. .......... Street and Number ...... State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ............ ~.,~,,~...'~... ................................................... b. Intended use and occupancy .................................. ~ ..................................................................................... 3. Nature of work (check which applicable): New Building......~. ........ Addition .................. Alterati ............. Repair .................. Removal .................. Demolition .................... Other Work ..................................................... ...~.....~. ~ (Description) 4. Estimated Cost .......... /~.~.h.CZ'BT~. ................................ Fee ..... : ........~..~.~.*..~ .......................... - (to be?aid on fi!lng this appli~fation) .5. If dwelling, number of dwelling units ............ ~ .......... Number of dwelling units or~ each Ioor ...: ........................ If garage, number of cars .........41,,~n.,~-~ ........................................ .~ ...................................................................... 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. D mens ons pf ent re new construct on Front . .~.(~. Rear : .~..~.. ...... Depth Height ...... .(.~. .......... Number of Stories., ....... (...~..~. ............................................. ,....L ............................................ 9. ~Sze of at Front . ..~..~..~..~ Rear ............ ...~......~..~ ........... Depth ..~..c~....I.... 10. Date of Purchase ...... .................................................. Name of Former Owner ........................................................ 1 1. 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 .........~.....~.. ........... Will excess fill be removed from premises: ~ yes ( ) No Name of Architect .............................................................. 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 whether interior or corner I~ ~[ ~0 ~' ~-~ ':~:~J~ ~~a'~: ........... bein'u,y-- epo~nd soys that he is the applicon, ,x ~{. ~,.; {Contrnc*or, o~'~nt, corporate c~er, etc.) ................. of mid owner or owne~,'/~lnd is duly authorized to per{arm or hove performed the ~id work and to make and file this application; tlmt all statements contained in this application ore true to the best of his knowledge and belief; and that the work will be per{armed ~ tbe manner set forth in the application filed therewith. Sworn ta be.~ore me thi~ ~ , . ....... o ... ....... ~ (Signature of applicant) JUDITH T, BOKEN Commission Expires March 30, I~ SUFFOLK COUNTY DEPARTMENT OF HEALTH Heal th Department Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant ~:~j3~ ~-~o°hone~G~-/~--~ 5. Subdiv.~~~ Address~ ~ qS~>Xf~p>~ '~e~>-~ 6. Section ~ 2. Property LoqationL~-F~ ~'~I. ~'~ 7. Lot Number ~7~ ~ ~m ~'./~J~-~_~-.~ .~m~.~ ~ 8. Private Well w~_~. village ~~/~ /ownsn~p ~x2~,~_,~ 9. Public Water ' 3. Public Water Company Name Distance to main 4. Lot size: Width ~¢~?~feet Length 2~/ feet 10. Sewage Disposal System: (For Health Dept. Use) A. 900-gallon septic tank: Precast~//Equivalent Block B. Leaching pools: Number of pools ~ Precast ~Block Special 11. If private well, fill in the following blanks: A. Tank capacity ~ gallons B. Pump G.P.M..~nr) C. Total well depth D. Depth to ground water E. Amount 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 valid for one year from the date of approval indicated below and may be renewed if a current ]ocal Building Department Permit is in effect. Date Signedl~ 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 pl~ot. APPROVAL DATE SIGNED S-15 Rev. 4/1/73 FORM NO. 6 TOWN OF SOUTHOLD 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 and "pre-existing" land uses: I. 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 .............. Owner Or Owners Of Property .~...x:(.(~4,(.~)......~./~....x~.../.~..~r../. ........................................................ Subdivision ...~...'..~Z.~.~/~'~.~...4~..~..~..~T~,~.~,~.Z'-.~:~ ....... Lot No..../.~...~... Block No ............. House No ............. Permit No.....~...~.../..~......~Z.. Dote Of Permit ../../?..~'....~.......Applicant ~..(~..~...x...x(~.~.........~..../~....~...~:......~...,~....C¢.. ......... Health Dept. Approval ..?.~..Y../_.~........~..~.5.:.~..~T./...~.c~.Labor Dept. Approval ............ ..,~./...~.. .......................... Underwriters Approval ./;~./.~....~...~..~.~.~,, ............. Planning Board Approval ..... ..,~.../..~. .......................... Request For Temporary Certificate ..... ~ ........... Final Certificate .......... ,,~ ........................... Fee Submitted $ .....~..:.~..~.. ................. Sworn to before me th,~ ......... ~..~ay of ...... ..t~./~........~...... ~.. ~..~.......~ Notary Public .......~/~.(~.L. County Construction on above described building and permit meets all applicable codes and regulations. (stamp or seal) ! rTM L4/,,/£ "t,r'1.'~"5 .'FA "3 OLfl LA t4e , 'I SUFFOLK COUNTY HEALTH DEP~LE~.f,IEi?T FRONZ V1 APPRQVED AS NOTED DATE: N©IIF¥ BUILDING DE~^RTM~NT .~1 765-2660 9AM TO 4PM FOR REQUIR- ED INSPECTIONS: '). BEFORE BACKFILLING FOUNDA- TION OR START FRAMING 2. BEFORE COVER NG P P~:L NE 3. FINAL WHEN JOB COMPLETED NOT RESPONSIBLE FOR DESIGN OR CON- I. Fz,~f 'F-~ N .[. ! ¸,% I