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HomeMy WebLinkAbout8132-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office South&d, N. ¥. Certificate Of Occupancy THIS CERTIFIES that the building located at .. ttoI~se, t~hoe. II,lye ....... Street Map No..0rego~t. Vl~lo~[%o ........... Lot No... ~ ..... ~*,~q~...~,~., ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. A~g,..6.., 19..~ pursuant to which Building Permit No.. 81~2Z. dated .......... ~.. ~ ..... , 19.7~,, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occup~cy for which this certificate is issued is .P~i~e. ~O. $~ilY. !~l!!~g ....................................... The certificate is issued to ~O~lS..H~O~ ..... ~ .................... : .......... (owner, lessee or ten,t) oi the Moresaid building. Suffolk County Department of Health Approval ~a~.. ~lO...t97~. · .by. ~,]il~ ..... UNDERWRITERS CERTIFICATE No. a2~l ..... ~19~,. J.~...1t7~ ................. HOUSE NUMBER ...... ~7.~ .... Street .... ~0~..~9~..~ .................. Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Yo BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8132 Z Permission is hereby granted to: p~.~.~.~£C~..P.......~....~.~?...'.~... 1¢o~ .../~..~:,r~.~.~ ....... ~..~..7 ....................... ............... ~.~.~..~..~.....~..~./.z ................. ~o ~.~ ~ ~.r.~.C fi~.~b..~ .~.~.~:. ~.~ ..................... pursuant to application dated ...................... ~.......~.. ........... , 19.~.~.~.., and approved by the Building Inspector. ..... FORM ~0. 6 TOWN OF~ $OU~HOLD ~ Building Depmtment 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: ]. 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 $l.00 .... ........ New BHilding ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Prgpjerty Z~""~';"~/ ~"~,l-.~,~/-/ J'~'O~? ..~..~..~.~.~.~..$ ~,.~.,.~..~..~(..~ ~-/.~ ~';~'~'~'~;:7~;~-'~'a-~"~;7~,'"-~'~'~.;.~. ..... ~ . . Owner Or ~ners Of Prope~y ....................................................................................................................... Suba~,~o. .~.~.~ g~ ~-!~.~.:~,~ Lo~No~. mo~kNo '~: Ho,,, No~O ............ ~ ............. , .... ~ ........ ............ =_....~ ................ ~ ........ ~.,~ H~ th Pept App~o~l~ 5 ~- a ,~ L~bo~ ~t Approval . . Un~e~rlters Approval .............................................. Planning B~rd Approva ........................................ Request For Tempor~w Ce~ificate ........................................ Fin~ Cert f cat~ Fee Submitted $ .................................... Sworn to before me tJ3i~ Notory Public .........~g~/~L.. Coun~ Construction on above described building and pem~L~ meets all ol~plicable r.,~x~es_~nd reEulations. (stamp or ~OTARY St~e of N~W York '] HENEW YORK BOARD OF. FIRE UNDERWRITERS ~'L," - ~ - ~ .... BUREAU OF ELECTR C TY, , , ' .... r ~- ,I~= _-: !~ ~-~ = ~ = =- ,85 jOHN STREET NEWi~ORK NEW YORK~ lO0~e ....... ~ I'TUAT~ $T 5OU,$NOCP e: IIZON PiPE NO rE': · -- MONUAtENr ~I~DIVI$10N 1~4P PI£~D /N TH~ OP THK ~£~RK O~ ~U~OLK COUNT)' ON At~IL 4, I~Y~ AS PI~E NO, ~1 el?ION OF W~L! ~ AND Cgss~O0I~ REWS~O'S YOUNG &;YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR: LAWRENCE EKSTER ~t AIVIV EKSTER LOT NO 20, "OREGON VIEW ESTATES" /,: /~s' , CU TCHOGUE ~u~Z~/ ~S~, ~ TOWN OF ~CUe/~ T~LE SOUTHOLD ~ .~ ,k, su~o~ ~o., ..~. v~~:/ SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department 'Reference Number APPLICATION FOR APPROVAL TO ~ONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicantx~]~?~oa~ //~,e-% ,~ Phone?~- Address/~m>~F~W ~-1~ A/~'~"~ .~S ~ ~ ~ Propert~ L~gation Vi'l 1 age(~ ~ 7 e n ~ ~ u E Townsh i ~ ~,~ ~Z ,~ 5. Subdiv ~m,m ~ 6. Sectio~'~' ~ ..... 7. Lot Number 8, Private W~ll 9. Public Water 3. Public Water. Company Name 4. Lot size'. Width l~.a ~, ~ feet 10. Sewage Disposal System: A. allon septic tank: Distance to main Length,~ ~ feet .~!tv '~ (For Health Dept. Use) Precast~ Equivalent~ Block B. Leaching pools: ll. Number of pools / Precas tsa0 Block Special If~privat~.~'wqll, fill in the f~,.l:~'~wi ng b~ ~nks: capacity . . gallons B-,~ PUmp G~P.M. ~.'" Tota~ell depth' ~0 D. Depth ~' ground water ~,o 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 ~ter Supply can be installed on this plot. ^PP OVA DATE _ SI NEK - S-)5 Rev~ 4L!/73. j BUILDING DEP&RTMENT SOUTHOLD, N. Y. Examined .................. , 19. ..~. Approved ........................................ ,Ns ucr,o.s a. This alg~cation must be completely filled in by typewriter o~..in ink and submlt~ in triplicate to the Building Ir~p~r~or~ ~ 3 set~ of pka~,,,acculL~L-e, plgt~lan to acale. Fee acrt~! .n~o sc .ll~ule: '. · I~: P~ ~n showing i6~ion~t~G~rd~¥buiklings o~ p.emisa~'ril&,-bnshi~t2,.~0i,i .np. ,l~.mises o~ .,l~b. lic str. ee~.. areas, and giving a detQiled clescription of layout ofpropert~ must be drown on the d~agram wh,ch ,s part of th,s apphcat,on. ' c. , The _WOL-k covered by ~hLs,~l~ica~t~sc~' n~aY not be comn~,r~e~ before\i~,ue~,~ce~of, ,I,~:_'?~ling Permit. d: ' L~rovol of this.~'l'..c~_..i~.~'~,.~'~tiilding Inspecto~'~lt issue a B~tcling P~r~it~'o the applicant. Such permit shall be kept on the premise~-a'~ilbb~e l~'~.~q~ection throughout the work. e. No building shall be occupied or used in whole or in part for any pu~oose whatever until a Certificate of Occupancy ~J shall have been granted by the Building Inspector. . APPLICATION IS HEREBY MADE to the Building Departrn~n.t for the .i.s~a. nce .of .a Build!ng .P.e?t pu~ ~m~ont to the( ~Build!ng Zon.e Ordinance of t~e.T,o~n~ ~f. ~S6~t~h.~.!d,~..C~l~...N...ew~ ~;~ .~2a..om. er.;~m.~o~s,. Kegulations, ?or the constructlDn o? ouim~ngs~ OOOltlOns or alterations, pr Tar removal or oer~llTJOrl~.o~ The applicant agrees to comply with all applicable laws, ordinances, b~lil.dlng code, housing co, de, and admit authorized inspectors o~ premises and in buildlng~ for ~respectior~. State whether applicant is~Wner, lessee,, agent, ar~hitec~'~ eol~ine~r, ?~eneral contractor, elect~ian, plumber or builder. ........................ ............................... t...:. ........................................ ,+ ......... ............................................... Name of owner of pr ~t~l ses ..~a/~.~.~ ....... ...~...~7~'.'.'.'.'.'.'.'.'.~....~.~:....:....:: If applicant is a corp'g~ate~ §~glillJ~d~l~ g~j~uly authorized officer. ......... .... ~/(Name and title c~f corporate officer) Budders /~c~se No ..... .. .......................................... Plumber's Ucense No.. Electrician's License No~..'~..:~...~C-~ Other Tr~le's Licer~ No ............................................... 1. Location of land on which prolL~ work, ~iK he done./J~ap No.~.~.~Lo,t 1~,411~ .............. Street and Number ~............~........... ............... ........................................... ,~iclpall~ 2. State existing use and occupancy of premises and intended use and acc/ul~p ..r..~,V oR, Rrc~x~!~ construction: a. Exisiting use and occupancy .......... ~-4~,,~.~....~,.~,~.~ ................................................................................ · b. Intended use a~d occupancy ........... /......~..~./:il~l~....../~.(d~. ............................................................ Ordinark~ or ....... ~. (Address of aj~,llcant) I IC:~ u / 3. Nature of work'(check which applicable): New Building .......~... ....... Addition .................. Alteration .............. Repair .................. Removal .................. Demolition .................. Other Work ................................................. ....................................................................................~. ~ ~ (Description) 4. Estimated Cost ............. v~..*~,..~t~{2 ......................... 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 c~f Stories ................................ 8. Dimensions of entire new construction: Front .......... ~...~ ................. Rear ...... ~..~ ............. Depth ....~....~.. ............. Height ..; ...... /....~..... Number of Stories ............ ./. ....................................................................................................... 9. Size of lot: Front ..........: \-:~'"/'~'~' ........................... Rear ......... /.~..~..'~.. ...................... Depth ..~..~./.. ................... 10.' CDate of Purchase ....... ~:*....n%. ..................................... t. Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ........ ~l. ....................................................................................... 12. Does proposed construction violate any zoning law, ordinance' or .regulation: .... ...~...~. ........................................... 13. Will lot be regraded ....~.~..~. ............... Will excess fil be removed from premises: ( ) Yes (dJ~) No 14. Name of Owner of premises ...~...~./4~,~. ......~..~.~./...~ .............. Address ~/~1~l~'l~.~t.~.~....~....~Phone No. ~..~.....7..?./../... Name of Architect .............................................................. Address ................................ Phone Nau ...................... Name of Contractor ...~.~....~...~...~....~.~...C...'~.........~...~... ........ Address ~.7'~.1~./~..~...~... Phorm No.~didL~...~...~.-... PLOT DIAGRAM //~iOP',~' ~ 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 descrip:Hon according to deed, and show streelL names and indicate whether interior or corner lot. ~ ~ ~ COUNTY .,C~-F.,~. ~....,.. ~'. ' ................. ~.~...~.'..~.'.';t*.;P.~.'il] .~....;:.: ................ being duly sworn, deposes and says that he ,, the applicon! (Name of individual signing controct~ above named. He is the ...................... !~.../~..,:~.~.~.~ ............................................................................................................................... (contractorr .a~,t, ~omg~ r~? or, igor, etc.) of said owner or owners, and is duly authorized t~ p~rfor~ or ~'~ve ~edormed the said work and to ~ke and file this application; that all statements cgot~n~>j~s a~i~i~e t~e to the best of his kn~ledge and belief; and that the work will ~ performed in the ~anner ~t fo~h in the application filed th~r~ith. Swo~fom me this ..... ...... ....... .............. .,,. H/7 . ................. .... ...........