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HomeMy WebLinkAbout8136-zlrOll, M NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Z.73~.6. ..... Date ............. N.0~.....~. ...... , 19. THIS CERTIFIES that the building located at . .~.a.l~..b.o.r..~ .~g.h.t.s.. &...~..~g.a.n.¢~tr~et Map No. ~a. ,l'.b,o.r...L.~.gl~ck No ........... Lot No, 20. ....... BO~.t, hO~d .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. Aug.. 8., 19.7.~. pursuant to which Building Permit No.. dated ........ A~,g.. [~ ........ , 19.7~., was issued, and conforms to all of the require- fnents of the applicable provisions of the law. The occupancy for Which this certificate is issued is .P~'i.v. ate..one. Sa~il~ .d'~ellin[; ..... (&pp~o.v..~.d..blt. ~, .App. e.a.]..s.) ...... The certificate is issued to ...aa..th.o.n. 1~. &..J.e.a~..$.t.t.e..p~...ia.e..ip.e. ....... o. ~..e.r. $ ........ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N.o.y...~..] ~.6....by. .1~. :. y.i.1..1{~ ....... UNDERWRITERS CERTIFICATE No. tt~0~]9~ .... Q~;,. 2~,,. ~[9,~.~ ................ HOUSE NUMBER ...8.00.. t~.ai~bo~t~ghl;$ ....................................... Building Inspector 1 ! FOI~M NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF TH£ WORK AUTHORIZED) N? 8136 Z Permission is hereby granted to: .~tbxa~...&..~e~e.~ta ........ ~.tae~e ....... .......... · 1,3~-~o.....~a~a.-.A~ ........................ to .~:kl~..a~w...t~e.. J:m~.LT.. ~1~ ..................................................................................... at premises located at ~(~...L~it ......~bo~...~:l.~l~;~l..~,ll.t, ............................................................. ....................................................... ~a~.b ~... Yb~ g.h.~s-. D~.. &..Bt-~-g~,~%~,~ -. D~ .............. .Se~ld pursuant to application doted ................. ~,l~ibl~...,.~ ............ ............ , 19.7.~.,, crud approved by the Building Inspector. Fee $.~1 L~.~O ........ FOI~.~I NO. 6 TOWN OF $OUTHOLD , Building Depmtment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Insfructlons 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 dispasal--(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 end "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. Dote 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 ...... l: ......... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property /..'.~/~/3~.,'~ .~..~? ,~ ~ ~';~.~ ,,~'F, ,-~- ................. . .................... ,..:~.%l,/.,,,.e4.,r.,,'.,/../..t.c~.(.,-...Z~.(f .............................. Owner Or Owners Of Property .~....~.J'/..J;./~.A/ .~. ~JfT'~49~./Y/~;~..~.~ /..D.,./~6}/,~,/~ ~¢~ Subdivision ................................................................ Lot No ............. Block No ............. House No...~..°..~... Perm,t Do,e Of ..... Health Dept. Approval .~. .......................................... Labor Dept. Approval r"V ~/~, Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fin~ Certificate Fee Submitted $ .............. D.. .................... Construction on above described building aj:~ permi~ meets all_.~opJicabl~, codes and regulations. ^pp,,co.t ........ ................ day of ............................................ (stamp or seal) Notary Public ..................................... County SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number~9~'~(/ 10. APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Applicant ~,~ ~_ ~, Phone~ 5. Subdiv. ~,~ ~,, -: -~ .......... ~ ~-~ ~ - Section~ Vi~--~,$~L~ .......... To'~ns~F]i~,~-~-' 9. Public Water Public W~-C6~ny Name DiStance to main Lot size: Width ~?~? feet Sewa~isposal System: A. O~g~l~eptic tank: Precast r~Equivalent Block ~ Leaching pools: [["~ Num_~r of.pools ~cast__~° ~lock ~ Special 11. ~:~ig privage well, fill in the fol- ~l~OWl ng ~Janks. "A. Tan~capacity~__.gal lons B. Pump G.P.M.~ C. Total well depth D. Depth to ground water E. Amount of water in well Length m~} feet (For Health Services 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. FOR THE DEPARTMENT OF HEALTH SERVICES' USE ONLY. Based on the information presented here- with, it is the opinion~Rf the Department of Health Services that an adequate and satis- be this plot. installed factory Sewage Dispos~y~ and Water Supply can on S-15 Rev. 4/1/73 , N - tO0.O LoT .P-O ANTI4ONY E /Y~ P Of ~uI~Y~Y~D FO~ ~ JEANNE??E/YI. 4 Nov. '- INSTRUCTIONS ~a a.. This application must be completely filled in by t~ew~iter oe in ink and submitted in triplicate to the BuUding~~ b. /~M plan.showing location of lot and ~ buildings on pren~lse~, relatlonshiP to adjoining prernises or public streat~ al areas, and giving a detailed'desc.rLot!on df layout ofpr0perty mu~be drawn on the diagram which is ~ of tJ~is ppplicatian.._c c. The work covered by this application may na~ be commenced before issuance ~ Building Permit. u'.T. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit/~ shall be k~pt on the premises available f~r Inq~ectian throughout thru work. / e. No building shall be occupied or used in whole or in part for any propose whatever until a Certificate of Occupancy shall have ~ granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit purSUant to the Building Zorn_ Ordinance of the Town of Southold, Suffolk .~.,, New York, and other applicable Lav~ Ordtnaflc~ or Regulatiom, for the construction of buildings, additions or alfmahons, or for removal or demolition, a~ herein described, The applicant agrees to comply with .all applicable laws, ordlnancel, building code, housing code, and ragulatiom, and to admit authorized inspectors on premises and in butldingl for n6ce~ary inspections. State whether applicant is (Signature of~olicant, or name, If~ cmporation) ~. owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................ Name of owner of premises ......... Ja:l,l;J3~X~..,~:t~...~T,~mq~q:b,~e...[:~.:Ll:te~14~e .................................................................. If applicant is a corporate, signature of duly authorized officer. Other Tmde's Licr~ No ............................................... Hiz'boz* T~t.~A~I Rrb&res Location of la~ ~ which p~ ~ will ~ ~e. Map No.: ..~.~..~. ............. ~ ~.....~ ............... Street and Numar .~...~...~g~..~.~..~.~'~~'3~~~. State existi~ use and ~cu~ of pmmis~ a~ inte~ed u~ and ~cu~ncy of p~ c~ti~: a. ~isiting u~ a~ ~cu~n~ ................. ~e ...................................................................................................... b. Inten~ u~ a~ ~c~y ................ ~ga .......................................................................................... 3. Nature of work (check which applicable): New Building-...~, ............ Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) 4. Estimated Cost ...... ~I~Q~.~0~ ..................................... Fee .......................................................................................... (to be paid on filing this application) 5. If dwell~ng,~umber 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 ...,1~1~ ........ Number of Stories ...................... ~. ........... ~ ............................................................................ Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height .....' ....................... Number of Stories ................................ Height .....0...~.... Number of Stories ~. ........ ~ .......................................................................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation: ....... ..~..O. ............................................ 13. Will lot be regraded ....~'.~.11 ................. Will excess fill be removed from premises: ( ) Yes (~) No Name of Contractor 0111~Z~ Address Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimension~: from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. HaRC oR CLoR N' K ,LoT · ~30I STATE OF NEW' YORK '"' l-e r2 · COUNTY OF ......................... :.....)' ;'~ ................ ..~..:.~..~. ~ P..~/.~... ~...; .. ,/...~./, · .~..C: (~]~- ~. ...................... being (Name'of--mdividual sigr~g c6ntr6bt0 above named. duly sw0m, deposes and says that he is the opplicam He is the ................. ~.....~...~%/....~.I~ .................................................................................................................................... (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 ore true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this . I¢OTA No. 41.452&917 (~4gnature of ~).~l;fied in Oueen$ County THE NEW YORK BOARD OF FIRE UNDERWRITERS  BUREAU OF EL. ECTRICITY l' I' 8S JOHN STREET, NEW ~YORK, NEW YORK t0038 THiS CERTIFIES THAT : ~ Anthony Principe, BOO Harbor Lights Rd., Southold, L.I. was ex'amined on , October 21, 1~76 and.foundtobdlncompllancewlththerequlrementsoythlsBoard. FIXTURE OUTLETS 36 DRYERS 4? SWITCHES 33 FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS FLUORESCENT OTHER APPARATUS: 2-G.F.C.I. 1-Smoke Detebtor 1 l/O - A. W.O. NO. OF N~UTRAL$ OF HI-LEG 1 OF NEUTRAL 1/0 Paul Burns Town Harbor Lane Southo!d, N.Y. 11971 Lic.#282E D be identified by This certificate must not be altered in any manner; return to the office of the Board if incorrect, inspectors credentials. ,].