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HomeMy WebLinkAbout7147-zFOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. ?-60fl5[ ..... Date ............ ,~u..ly.... 1 ?. .... , 19..~.. THIS CERTIFIES that the building located at t;illett~. ~rive ........... Street Map No. ~.~]~,on. :~anctilock No ........... Lot No...8 ..... Els.l; .~.iar~,o~z...~. ,¥., ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............IvJar. · 29, 19. ~.~. pursuant to which Building Permit No. ?l.l+~Z.. dated ...........P, er....31 .... , 19..7.~+, was issued, and conforms to ail of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . P~lva.t.a. one..£a~J,3.y. ~.~-;LJj~g ...................................... The certificate is issued to .. l(I1 .~. ~;I~'{$. Rc~ber.t..'~e~-;Lz ... (~r~e.r$ .................. of the aforesaid building. Suffolk County Department of Heaith Approval (owner, lessee or tenant) -- J. uly..1.0.. ~.97~+...b~...2.. V;L~la. UNDERWRITERS CERTIFICATE No~..t67.972 ........ ;~tme..28...1.9~- ............. HOUSE NUMBER .... 26~0 .....Street . .G:[ll~tte. 'P.~ ........................... Building Inspector BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PT~E/~AISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7147 Z Permission is hereby granted to: ..C~.~..~..E!,~. ........ .~..o.~!~.~ ....... Z.~..c..... Bull~in~ Inspector ' THE NEW YORK BOARD OF FIRE UNDERWRITERS ~Rb BUREAU OF ELECTRICITY .~ [--- 85 JOHN STREET, NEW YORK. NEW YORK 10038' ~.,~June ~, l~?~ ,~,,~,,~.,io,~o.o.~,le ?~ N 167972 THIS CE~IFIES THAT onl~ t~ e~t~ ~ipment ~ ~sc~ ~ a~ i~c~ ~ t~ appli~nt ~ on the a~e ~plicatio~ n~m~r ~n t~ p~mlses of Robert Wells, w/s Gillette Drive, BOO' n/o Cleaves PozntHo., East ~arlon, L.I. in the followlng location; ~ ~ement ~ 1st Ft. ~ 2nd Ft. Out Side Section Block Lot ~ examined on J ~ n ~ ~ ~ ~ ~ ~ '~ ~ and found to be in compllance with the requirements of thls B~rd. FIXTURE OUTLETS 2 4 DRYERS 26 SWITCHES i9 BXTURES RANGES OVENS DISH WASHERS EXHAUST FANS FLUORESCENT MULTI-OUTLET SYSTEMS NO. OF FEET OTHER APPARATUS: E R v I C NO. ~ HI*LEG OF HI-LEG NO. OF NEUTRALS Of NEUTRAL 1/o Water Heater: 1-~.SKW Motor/s: 1-1/2hp Electric Room Heaters: 3-2.0KW o-i.0KW 2-.75KW 4-.SKW W.B.Huland Mattituck, N.Y. O~qlRAL MANAGER Per 11 ,' , COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number Y7~-~ ~ ~ d~ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant~~~-~ Phone'i~-~S-~<~ Address I~--¥ k ~,~ ~ c_ ~~ ~ 2. Property Location ~,~k~ ~ Village ~ ~ Township ~~ 3. Public Water Company~me 4. Lot size: Width/~J fe~t Length /~0 feet 10. Sewage Disposal System: 11. A. 900-gallon septic tank: Precast ~Equivalent Block B. Leaching pools: Number of pools ~ Precast ~/~Block Special If private well, fill in the following blanks: A. Tank capacity ~-~/ gallons B. Pump G.P.M. 5. Subdiv. ~v/~yom 6. Section 7. Lot Number 8. Private Well 9. Public Water Distance to main (For Health Dept. Use) 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 local Building Department Permit is in effect. 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 p)ot. S-15 Rev. 4/1/73 TOWN OF SOUTHOLD , BUILDING DEFARTMENT _ , ~ TOWN CLERK'S OFFICE ; .... ~_. ~,~ ~ ........................ ............................................. / .................... ........................ {Suildi~ In--tot) ~ INSTRUCTIONS ~ a. This application mUst be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sete of plans, accurate plat plan to scale. Fee according to schedule. b. Plat plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o~ areas, and giving a detailed description of laYOut ofpraperty must be drawn on the 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 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 Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the coHstruction of buildings, additions or alterations, or for removal or demolition, as herein descr bed 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. ........ ....... (Address of applicant) State whether applicant is owner, IF~agent, architect, engineer, general contractor, electrician, plumber or builder. .................................. :ant is a/~.~rporat/e~ si~of duly authorized officer. (Name and t,tle of corporate off'er) Builder's License No ..................................................... / Plumber's License No. ~ Electrician's Licen.~ No ............................................. Other Trade's License No ............................................... 1. Location of land on which pr~qi~ose, d~.o~ork...~l be done. Map No.: ...... ~....~..~.~... .............. Lot No....~.. ............... Street and Number ...... ~'.'~.~.../.../...~. ......... ~.~./..~..~ .................. ~....~..~...~ ...................... Municipality 2. State existing use and occupancy of premisej and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ............ use and occupancy ..............x..~.~..~ .................................................................................. b. Intended 3. Nature of work (check which applicable): New Building ........ Addition .................. Alteration .., ............... Repair .................. Removal .................. Demolition .................... Other Work ...................................... ~ ........ . ..... (D~scriptlon) ......f) ~-~ (~'"~X~..e....~....~...~..~:~ .......................... Fee (to be paid on filing this applicatio~ 4. Estimated Cost 5. If dwelling, number of dwelling units .....7......I .............. Number of dwelling units on each floor ............................ If garage, number of cars .................... L.t(--~.....~.C~.- ...................................................................................... 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 ....... ~..~q. ....... Number of Stories .......................... .I. .......................................................................................... 9. Size of lot: Front ............. .(,..~..~ ............................ Rear ............ ~(..Q..~... ............... Depth ..... ./....O....~ ............... 10. Date of Purchase ........................................................ Nome 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 regradect .........~...~ ......... Will excess fill be removed from premises: ( ) Yes (/~ No 14. Name of Owner of premises .~.~,..6Jll2~....:~.L~....~.(.~ddress ................................ Phone No. ...................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ~'~'f~...~.~....."~.,L~R... Address .~..]...~.¢~...~..~.~.C-Phorm No. PLOT DIAGRAM Loco.te clearly and distinct y.a. II .building. s, whet.her existing or p._mpo~d, and indicate all set-back dimensions from property lines. ~ive street aha o aCK numoer or oescription according to deed, and shaw street names and indicate whether interior or comer Jot. STATE OF Nm-:~V YORII~.. .................. ~~g~ ............. b~in~ duly *worn, d~oses ond s~y~ t~t h~ i~ th~ ~pplicam (~~i~) sighing c~trac~ above nam~. He is the ...................................................... ~~ ........................................................................... (~ntmct~, ag~a~ officer, etc.) of ~id owner or ~ners, and is duly authorized to perform or have perfo~ed the said work and to ~ke and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application filed therewith. Swam to ~ this ~oto~ ~ublic, ~~~ ...~....~......~ ............................. ~ (Signatur$ of applicant) ~UDITH T. BOKEN Not, er Public, Slate of New York No.~2-0344963 Surfak Courtb~ Commi~ion Expire~ March~30, 19~. L.©T- ~ LOT · ~v~:~,~'r) i ii, LOT' N.64'$1'10"1~'- - LoT. ~V~NT) 'a ~ ~] tJNALrTHORIZED ALTERATION OR ADDITION TO THJ$ SURVEY IS A VIOLATION OF SEC3'ION 7209 OF THE NEW YORK STATE ,Y APPROV£D AS NO"lED DATE: NOTIFY BUIJ,~I~NO DEPARTMDNT ~.2660 ~ ~0 4PM FOR REQUIK-