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HomeMy WebLinkAbout8810-zNO. 4 TOWN OF $OUTHOLD BU~.DINC. DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . .B~. ,~.1..o~...L.. ,al~. ........... Street Map No. ~ ........ Block No.. ~ .... Lot No, , .~ .... .1~. ~.t.~..~.ll.e.k. .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... AUg. ..23 .. , 19..7~ pursuant to which Building Pemit No. 8.8.~..0~... dated ................ dug 25 , 19 ..76, was issued, and conforms to nl! of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .P.~.~,?a.t~..o.rl.e..f.a~.~r..d.w.e..~.l.~ng ..................................... The certificate is issued to .B: ....~')~. e..h~..?n.o. .... 0~.e.r. .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~ 13...~c)?~.....by. .R. :..V.~.i..1.a... UNDERWRITERS CERTIFICATE No...p.?~d..$?.g ................................... HOUSE NUMBER .. :lf~+;~ ..... Street ....BA~..,g.a.l..c~.. ~,.~ ........................ '7, FORI~ NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERJ~IT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N9 8810 Z Permission is hereby granted to: ..~......~.Z.~/..Z...z..~.: ...... ~ ..... ~.....~..~% ........ ........ ~ ..... .~..,....-C.~.~.~..!...4..~.9. ............. -al-premiSes located at ................................... ~.~...~!...~..~l.).....O....b~.. ......... /-~..~.....~..~..~.~ .................................. ...................................................................................... ~..~..~ !....-c..~.~.~. ................. .~ .................... pursuant to application dated ............................... .~......~..., 19 and approved by the ,,: B~uilding Inspector. Fe~ $ ..................... ' ~' Building Inspector ~0~ ~0, $ 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 buddings 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 buddings 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. Certihcate 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 B~tildmg ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Locat,on Of Property ....~../~.~ ..... ~ ~...~....~.f.~.. ~..c....~.. ...... ..~..~.~....~....~.' ............. .../~...../~.....~..~ ./.....~'...~.. ~../..f......../~../.~. / Owner Or Owners Of Property ...... .~.: ..... ..~...~.:...~....~'.~.~.../...~...~.?..~ ................................................................. Subdivision ............................................................... Lot No ............. Block No ............. House No ........... PermitNo. ~,~'/~-' Date Of Permit ~/z.~/,)(; Applicant Health Dept. Approval ...¢/../.~?./2..~.. ...................... Labor Dept. Approval ............................................... Underwriters Approval ..................... .~.. ..................... Planning Board Approval ...... ~..~ ..................... Request For Temporary Certificate ........................................ Fined Certificate .......~:....,~.....,,~ ................... Fee Submitted $ ....... ~.~..~...~. ................ Construction on above described building and permit meets all applicable codes~,ond regulations. ...... ................................... Sworn to before me t~ ....... L~ day of .~~_/~ 7 ~ Cstamp or seal) ...... ..................... Notaq Public ...... ~. Coun~ SOUTHOLD, N. Y. _ 3 ,o7/O ^ ,,co., Examin~ .......................... , ............ , .......... ~ ' '~ o ................................. .,. ........ : ......... ...................................... ............... ' ~ "i~ ................... ~ *. lhi~ ~lic~i~ mu~ ~ ~ompl~l~ fill~ in b~ ~wri~*r o~ in ink ~ ~mi~ in b. Plot plan ~h~in~ I~fion of lot ond of buildin~ ~ premises, r~l~tion~hip to ~joinin~ pr~mi~ or public oreos, and ~ivi~ ~ d~t~il~ d~rlption of I~o~ ofpr~ mu*t be drown on tbe di~omm ~hich c. ~:~ w~k ~r~ ~ thi~ .~lie~ti~ m~y n~ ~ commenced before ~uance of Buildi~ ~ermit. d. ~ opp~ol o{ thi* ~pplicotion, ~ Buildi~ Ink, tot will i~sue ~ Buildin~ P~rmit ~o th~ ~llc~nt. S~h parmi~ sh~ll b~ ~pt ~ th~ pr~mi*~ ~il~bl~ {or in~ti~ thmu~h~t ~ work. e. ~o buildi~ ~1 be ~cupi~ or u~d in whol~ or in pa~ for ony pu~o*~ wh~v*r until ~ APPLI~TION IS HEREBY ~DE to the Building Depa~ment for the i~u~nce of e Building Pe~it pu~u~nt to the Building Zone O~inonce of the T~n of ~thold, Suffolk Count, New York, end ~her opplicdble ~s, O~i~ or R~uletions, for the constru~ion of buildings, oddities or alterations, or for mm~el or de~liti~, os heroin ~ri~. The applicant ogrees to comply with ~11 applicable I~s, ordinonces, building c~, h~si~ c~e, end ~ul~i~s, o~ to admit authorized in~to~ ~ promises ond in buildln~ for n~e~off i~ti~s. ........... ~ ......................... ~ ............................................. (Signature of applicant, or ~, ........................ '~X~;~';i';;;ii~gg;~ ............. Store wh~th~r ~pplicont i~ ~n~r, I*~e, ~Oont, omhit~ct, ~n~ineer, Oenerol c~tractor, el~ctricion, plumber or builder. ..................................... ~.v.~e~ . ~ o, o~of pr,~se~ ....... ~:....~z.d.~..o ............................................................................................... If applicant is a corporate, signatu~ of~d,~ly authorized officer. ............... ................. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No .... .*fl....C.../.7~..O..'-. ....................... Electrician's License No.....~....~.....~...?...o..x~....~. .............. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number ...... .ff../...J'......~..?....~'....~..4....~..°....~.........~'...-'~....~...~. ...................... .,./~.......~....~....77../.4~..I,</..9,.~':~...~...~. ...... -- Municipali~t 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ............................ ; .................................................. : ................................................. b. Intended use ond occupancy ............................... ~ ................................................................................... 3. Nature of work (check which applicable): New Building~· ................. ~" Addition .................. Alteration .............. Repair .................. Removal .................. Demolitio~ .................... Other Work ................................................... ~ (Description) 4. Estimated Cost ..................................... ..~.....~...°...~..°...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 ............................................................................................................................................ 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.~e~ntire new conStruction: Front ........... ~....~ ................... Rear ...?......~. ................. Depth Height .... ./..5' ~ .......... Number of Stories ...... ./.. ........................................................................................................... 9. Size of lot: Front ............ /...0...~ ................................... Rear ........ ...2:~.......~'..?. ................... Depth ................................ ? ? 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: ........ Z~.. .......................................... 13. Will lot be regraded . .......~..~ ............... Will excess fill be removed from premises: ( ) Yes ( 14. Name of Owner of premises ..~.'..?'.?'. ............. ..~...~...?. ................. Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ../~.:.~..e.../...C..:~ .................................. .,~...~. ]'o/t/S' Z/J(: 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 lot. / t ?TATE OF NEW YORK, [ ¢ ¢ COUN-r¥ OF ................................ ~ .... ............. Jd..~.~..-~....~..4c'.....d.:....z~...e...Z.~.~..~.z~.. ......................... being du~y sworn, deposes and says that he is the applicar,~ (Name of individual signing e'ontracf) above named. He is the .................. . .~.~..../...~T.....~....~'....~..: ................................................................................................................................ (Contractor, agent, corporate officer, 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 all statements contained in this application are true to the best of his knowledge and belief; tha~ the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........................ day of ............................................ , 19 ........ ~ , /? ,,~* ,,~ - / / q.' Notary Public,. ................................................... Count/ ......................................... :....64..~ ........................ (Signature of opplicont)/ terns for this resMence wifl conform to standards of the Suffolk Coun~ DePart- msnf of Health Services, Unaufh,~zed alteration or addition fo this s~u~vey fl a vio~ahon o~- section 7209 of t~e New Yo~. State Educo~n Law. Copies of this lurvey map not bearing the land surveyor's seal or embossed seal shah not be considered to Een ,,,! d Guar~nlees or ca~t.fications ~adlc~l~d he~eo~ shalJ mn only to t~o person [or whom the survey ~ prepared, and on his beholF Io the hfle co~lnpany, governmental agency and lending institution lisled hereon, ,and to the assignees of the lend,n0 mstituho~. Guarantees or ceftdicahons are not transferable to add,tional Institutions or ~ub~eclu~mt / ?/ / ./ BuN~AL. OW (o,o 'SUFFOLK COUNTY DEPARTHENT OF FOR APPROVAL OF CONSTRUCTION ONLY HOL £ LANE SANDY LOAM $ 3' 'I GRAVEL SAND $ TRACE OF GRAVEL I?' NO WATER SURVEY FOR BERIVA RD M. TURCHIA NO AT MATT/TUCK TOWN OF SOUTHOLD SUFFOLK COUNTY~ N.Y. SCALE': i"= 40' JUL Y ~'3~ 197'6 REFERENCE eUARANTEED N.Y$. LIC. NO. t$TYt$ RIVERHEA D~, No Y, Unauthonzed alterahon or addmon to th~s survey ~s a wolotlon of sechon 7209 of the Ne? Yq, r,L ~,~c "' Copies c~f this sup, fy mep r,cl I", ~ ~- d'~ I ' I ~ur,,eyor's inked person For whom th~,,;urv? ~: ~'r ~ - t, ~,_ ~ en I,s ~hcF to the ~ hereon, and lo tho as:~gnces of the Lndmg m:hluhon Guarantees ~ ~7,? ,~ ,, or cerhfJcahans are not tmnsFerabb lo add,hanoi mshtuhons or · ,rn-,~' r' ' '"-~t~p ,,%~,-~1~ ~ / ' ~'ef 0f Cc,%r~z ~ ~.iL: . ~ ~~ ~;; ,/, . / ~ ,' _; ~%'.Jr: / ~ I ~ I / / ~ '~ X~ ! _ ~ I ~'1 ~ . ~' / l_O LOAM B i' / ~7 ~'~;// - /.~ "~ .... / I ~- -/ ~ ~c~o~  ~4~.50' ~e ~ t00.00 GRAVEL cbse~ahons, ~mce most wells and ces~- I~' pools are not ws~ble these &mens~ons NO W~TER ~ ~ 11~ - ~11 cannot be cerhfled 8UR VE Y FOR REFERENCE, BERNA RD M. TURCHIA NO AT MATT/TUCK TOWN OF SOUTHOLD ~ARANT~D 1 9UFFOLK COUNTY~ N.Y. , 8CALE = I"= ~' JUL Y 13, 19 76~e~s 287~°/me s 287~ JAN. 4~ ~9 77 ~IVE~HEAD~ N.Y. , f II- 5 H / /,J ~ /_E,~ Ix4'h ~ T~m ,~F~ ~L~T~ -' EL. oto" F FOLLOW DIMENSIONS-DO NOT SCALE DRAWINGS I0 -'l APPROVED .~ N~C)] ED ~OTIFY BUILDING DEPARTMENT 765-2660 9AM TO 4PM FOR 'Eh INsPeCTIONS: FINAL WHEN ~OB COMPLETED SAMUEL PAUL, ARCHITE'CT ,o7-4o QUEENS BLVD.. FOREST HILLS. N.Y 11375 J JOB NO c~ ~ ,~,q i SHEET NO. To,' o~ ~LLT* ] .,il I j I IOi~s, LIE~T ~Loo~ T,L~s T~leu II-I~ST~ 5~I~LF ~ ~o~ ~ ~. CLoT~S cLoseT s s~l~Lv~s ~ ¥ I I I ' Tiffin?AL I I IJ L F__F:,. T- F_. L F 'F~---m L_I J FOLLOW DIMENSIONS-DO NOT SCALE DRAWINGS. c.s,s. .,, ,: ,,I SAMU~EL PAUL, ARCHITECT " d W©0j;?LAMP" ,,:osrl..~o ~f~:~ I[*'[r"Ol DATE 3/G./'7~ 107-40 QUEENS BLVD. FOREST HILLS, N.Y. 11375 ~PE FOLLOW IDIMENSION$-DO NOT SCALE DRAWINGS. DRAWN BY 1],~ c.[~cm, 8,t,ae, SAMUEL PAUL, ARCHITECT _ J DATE ~',,,, ]~ ,'l 107-40 QUE~NS BLVD. FOREST HILLS, N.Y. 11375 i, lTyJOB NO. ql~'q __J SH£ET NO. '- PE~[l'~¢l~*riokl~Oo$El ~ OF Il ,' - c.~c,t~.,',. SAMUEL PAUL, ARCHITECT ., ~ 00~ It '~---- ' 1072 ~/~/:~ :o~-4o ~UeeNS BLVD, eorest roLLS, n.Y. l:3~s '0 ToP ~L, o ~.o°' :~oo F= oP I'L O vJ¢.c. ET ToP OF: ]~L,O'-o" ' .5 ~=_C ~ I 0 l',J"/'~ _ A" 74"= r I'.o."[ 3'_G" ~0o~ DE~IM~ TO ~E ~,,'~ $TUO~; I~,' o,~, =,'g' V~Po~ ~,e~ - ,Z~,, D:~. ~oLT T~u, ~- ~ 2~4 ~ 4x4 4x4 ' ~ ~ - , ~Cl~' ~7-40 ~E~N~ BLVD FOREST HILLS N.~. 11375 W00DLAWP" ,I ,I L J .FOLLOW DIMENSIONS- DO NOT ~CALE DRA~t~1NGS. D F:,-T-A I L% I~,lT c ~l F', ~ 'I' ' ~;ql ' --- '""'-~-- .... C.ECKEDS'.'~, SAMUEL PAUL, ARCHITECT CO'¥RIGHT_ ~ DATE ~/G~7 107-40 QUEENS BLVD., FOREST frILLS, N.Y. 11375 SHEET NO. 6o 7 L IL~J' -'2£8'" ~ To~ FOLLOW DIMENSlO_N$--D~..~NO~T~.,ALE DRAWINGS. I CHECKED BY ~i~.,i S A M U E L P A U L, A R C H I T E C T DATE ~//(~/7~', J 10~-40 QUEENS BLV~), FOREST HILLS. N.Y. 11375