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HomeMy WebLinkAbout8024-zFOB~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.. 2;6771 ..... Date ............ ~lov. :..? ........ , 19.. THIS CERTIFIES that the building located at . Wl~kh~ .Ay® .............. Street Map No. lta%t;..liteS. · Block No ........... Lot No, . .1~.~ .?&8 .... i~ttttu, ok.. Ii.l/... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. June .. ~19..7~ pursuant to which Building Permit No.. dated .......... Jltne.. 26..., 19..'?5, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...Priv,-'~.e..on~.· c~.*r,,!~.?, .~h,~e-].~ll'~g ..................................... The certificate is issued to .... James. · r,, .~a-ly/iey ..... Owae.1, ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...~¢t;...2}L..19~[[..by. lt, .Viii.&.. UNDERWRITERS CERTIFICATE No, 1~, .~2~.~ ..... 0O~., .2~,..1.9~. ............. HOUSE NUMBER .. ].1+.30 ....... Street ...ldio, kha]~ A'~® .......................... ..... ~suilding Inspector ~ FOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8024 Z Date ....................... ~1:1~ ......... 26 ........ , ] ~j?.~ .... Permission is hereby granted to: ..~oticlc..C. on-~.....C~..,..A/C..~.arae~...B~.maey ......... ~.~....~t~,.~ .............................................. ........................ ~A,1;L~...~.~c~ ........................... to .b..u..~ .Z..qt....n..~.W... gB~ ...f. ~ :L]L~....~,w.~l:L i~g ...................................................................................... at premises located at .~O.~...l:Lt...7...~-..-~...-.I~tzLtt~k-.~LtS, ..................................................... ............................................... ~Lickh~m..~L~ ......... ~:,~at~,.L~,~ck.....~.Y, ......................................... pursuant to application doted .......................~:L~v~......~(~ ............. , 19:g~:..., and approved by the Building Inspector. Fee $...~.. J..'.):,~g, ......... Building Inspector / FORM NO. 6 TOWN OF $OUTHOLD , Building Depo~tment 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: ]. 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 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 ]957), Non-conforming uses, or buildings and 'pre-ex~sting" land uses: ]. Accurate survey~of property showing ~11 property lines, streets, buildings end unusual natural or topographic features. 2.Sworn statement of owner or previous owner es to use, occupGncy Qnd condition of buildings. 3. Date of any housing code or s~fety inspecHon of buildings or premises, or other pe~inent in- formation required to prepare ~ certificate. C. Fees: ]. Certificate of occupancy $5,00 2. Certificate of occupancy on pre-exisfi~ dwelling or land use $5.00 3. Copy of certificate of ~cu~ncy $1.00 ~te ....... / NewB~ dng / Addton Od P ................ , ' ' · ............... or re-existing building ................ Vacant Land .............. L~at on Of Pro err /'~ / .................................................... ............... ............. ........ .............. Owner Or ~ners Of Prope.y Health Dept. Approval ...... ~..:...,~... ........................ Labor ~pt. Approval ................ ........................... U.d.,..,.,, .~,o~ ...~./.~.~---- ...... ;?.~% .............. ~...~.. ,~rd *~.,~o~ ....... .8.:..~= ................... Request For Temporaw Ceffificate ........................................ Find Certificate ...... ~ ................ Fee Submitted $ t':~, Sworn to before me this .... ~ ~ day of...~.~.,../ Notary Public ....../~~ County Construction on above described building and permit meets a I applicable codes and regular ons (stamp or seal) ~,/~ ~ 7~ C~ARL~NE DeCAmp ~ Nota~ Pub~i~ S~a~e of Ne~ York ~o. 82. 5982~8~, Suffolk County Commission Expi~s March 30, 1976 / SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Appl i I. cant ~ Address ~ 2, Property Location Vi 11 age :l . ,/. F~. Township 3. Public Water '~ompany Name 4. Lot size: 10. ll. 5. Subdiv. 6. Section'" 7. Lot Number 8. Private Well 9. Public Water Distance to main Width/,i ~ feet Length ,,,~ ,~ feet Sewage Disposal System: A. ~gallon septic tank: Precast ~ .Equivalent Block B. Leaching pools: Number of pools Precast ~ Block _Special__ ~'~=~ow.i n g~T p ri v'a%'~e_. ~.~n ksWell': fil l~in:. ,, the fol- ~ ank~apacity gallons ~ Tot~ well depth ;,' i~' De~ to ground water · E. Amount of water in well ~ // (For Health Sgrvices Dept. Use) The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health Services' 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. Date ,' , , Signed FOR THE DEPARTMENT OF HEALTH SERVICES~ USE ONLY. Based on the information presented here- with, it is the opinion of the Department of Health Services that an adequate and satis- factory Sewage Disposal System and Water Supply can be installed on this plot, APPROVAL DAT SI NEO __-- S-15 Rev. 4/1/73 ' , , J . , 85 JOHN STR~T, N~W YORK, N~W YONK *"~October 2%[.~975 .'..: .'8~8 2~ ..,..~ . ~m.(Wickham?'Av'eJ)~300' w/o:Mar~s"Ave 3ames,' FIXTURE SW TCHES T ~ _ I :OQKING DECKS 'L OVENS Trash WASHERS 'EXHAUST FANS ' 1.'il/8 "¢' '?7 ........................... ' I~I~S o. This application must be completely filled in by typewriter o~ in ink. and submitted in triplicate to the B~illding~,~ Inspect. or, with 3 set~ of plans, accurate ~ plan to ~ale. Fee according to schedule. b. Plot plan showing Iocqtion of lot and of buildings on premises, relationshipto adjoining ..... premises or public str.~., al, areas, and giving a detailed description of'k~out ofpra~erty must be drown on the diagram which is port of this application. c. The work covered by this applicqtibn may not be commenced before issuance of Building Permit. d. U.pon app .royal of tiffs application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall oe v, ept on the premises avallab e'for Jrl~p~Jo~l throughout the work. e. No building shall be*occupied or used in whole or in 0art for any pbrpose whatever until a Certificate of O~cupancy shall have Eieen granted by the Buildihg Inspector, "1 APPLICATION IS HEREBY MADE to the Buildi-~ r~,~rt--~-t ~-~]~--- - Buildin,, Zone ~.~; .... ~ ~.. -r .... z e_-u-_~'~,"~ ~,, ~:.~.~.~L~.-'~r~e .ot:.a. au,a..mg t'erml~ pursuant to the .:~ y~,,~-,-. -u.r.~s ro commy w,m .a, app, ca~e.~a~, ormnances, Outlding code, housing code, and ~ and to aam~r amnonzeo inspectors on Pmm,ses and in b~ldings fornecessary Jrt~ions. --' ........ · ~(.S~q..tu_m~q~f .Ol~ican~ or name, if a corporation) P~'~. (.OM,.~, ~,~_ , ,~.t'.,~.C.. . ' (Address of applicont) If ap~zn~!~ ~co ~. ~_at~.s. ignature_of duly authorized officer. ...... ................. ... t~ome and title at corporate officer) ~ Builder's License No ..................................................... Plumber's License No ........... l...~..~..~.......~..i .......... ii..' Electrician's License No ....... .~..~....~........~... ......... ".. ~ ~ ~ '~ ~her Tree's Licen~ No ...................................... ' / ~ t _, ~ ~ L~ati~ of ,a~ on which p.~ ~r;:;';;;'~ ~;: Map No.: .-.~-~.~.....~SJ~ No. ~.~..~.. Street and Numar [~1. ~.~. /~ ~' ~~ State existing use and ~cu~n~ of promises and inte~ed use and ~cu~ncy of p~ ~i~: a. ~isiting u~ a~ ~cupan~ ~ ~ ~ ~ 0 b. ~nt~nd~ ~se ~ ~cu~.~ ................................................. ~. ....................... ....~. ...................... pproved" tZ2 TOWN OF SOUTHOLD . . :/ o~,.. BUILDING DEPARTMENT~"~"~ ~'~' -./'~-~ TOWN CLERK'S OFFICE ~ ~ ~ 19 ....... ~ ~[ d~l ~ ~ ~ '..Application No...~.~. ~..~ ..... 19/..~. rermt No.C~...~: ~ t.~ ~/,~/~' ~,~ ~ . u ~ -" ............................. /~ /~ ~ ~,~ Disapproved a/c .......... ~ ........... ~ ..................... ~ ................ ~ ~ ~ APPLICATION FOR BUILDING PERMIT ~_~ ~. Date INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building~.,~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. ebc~ aPnl~l a?v~nn~Sha°d~'t~? ~Cc~et~r~ ~il°t_°~n .... t i© ,d_ of b.u,l, dmgs on prem,.ses,.relat,onship t.o. adjoining premises or public streets or ar s, u ~ p on o. ,ayour ovproperty must De arawn on the d~agrom 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 construction of buildings, additions or alterations, 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.o.f'applicant, or name~ if a corporation) (Address of applicant) State whether applicant is owner~ lessee, agent, tarchitect, en,gineer general contractor, erectrician, plumber builder. me of owner of premses ~ ~ } u ~ : :- / I /~,-- ~ f If applicant, s a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ....... L...;..;.~..~... t . ............. Electrician's License No ....... %...L~ ........ L..: ............... Other Trade s L cense No , , .' ........................................... Locahon of land on which proposed work w be done Map No ' / / Street and Number ~ /~.c_ ~z_ ~- t~. .,~,~ .... v .......................................................................................... e..,4..,Z.4. ~,.~.(-;..:..~; ..... Municipali~ 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 .................. Alteration ................ Repair .................. Removal .................. Demolition .................... 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 ........................................................ i .................................. ~ ..... ~ ............. Dimensions of same structure with alterations or add tans: Front ...... ~ ................. Rear ....~ .............. Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions/) ,}of e~tire new construction: Front ........ .~..~..~..:, ................ Rear ....,.~..~...: ............. Depth .....~....~...: ......... Height ...af..~2~... ........ Number of Stories ...............~... ..................................... : ............................................................ 9. Size of lot: Front .....~..~.,...~...~...!.....~ ........................... Rear ...... ~..~..;.../....~.....'. ............... Depth ....~.....~....~...~....O. ........... 10. Date of Purchase ............ /..~'.L?....~.... .......................... Name of Former Owner ...~./'..~...~...~..~.....~...6/..~...~..~,./....~... ............ 11. Zone or use district in which premises are situated ..................................................................................................... 13. Will lot be regraded .....,c_ .~.... ........... Will excess fill be removed from premises: ( ) Yes (L~No 14. Name of Owner of premis.~es~ .....?J/~. .. .~'.~....'~.4~'. .~...X/....~"..Z....~ .~.~. ~ / Address ~f.'~".'~"'2_- ........ Phone No.~..~...~...,~....~.. Name of Arch tect .... ...... Address /~...~.~...~..4~) Phon~ No~.h~.~.,("~ -7''~/~ ................. ,...: ............................ , ...................... Name of Contractor .~..~.~../..~...'....~.~..~..?..'.~.:....~..!..L~..~:, ....... Address .'..~../....~....~.'..~....~...~....~. Phone No.~...~...Z...~'....~....~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fram property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW COUNTY OF ....~.....f~'~ (Name~-individual signing co~trac~ above named. 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 statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the m~nner set fo~h in the application filed therewith. Sworn to before me this ..... Nota~ Public,. ........................ ~. Coun7 ..~.....~...~~ .................................. ~n ' ~=~ f~_~ ~ ' ~ ' (Signature of applicont) k/1AP OF PI~ OP~'I~'TY / / / / ! .? ~4" *= JlrO~ -5~_co,o¢ fcoo~_ pu,,:,,,o /.¢,.:,,.,:,,, L , CO, ' :'! ,'q C: J I