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HomeMy WebLinkAbout8310-z - F08M NO. 4 TOWN OF SOUTHOLD BUI[.DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~?a$3 Date ~'4t;'le...1 19. ~6 THIS CERTIFIES thpat~the building located at Mailer •Ct• & .Cl.easviexa •At~treet Map No. . Smithf3.elc~I'oc-k No.. Lot No. 2$ Sc?r~•tho~d.. H.Y......... . conforms substantially to the Application for Building Permit heretofore filed in this office dated .NOY .2© 19.?~. pursuant to which Building Permit No. X31 off. . dated . ?Q... , I9 . , 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 ..Px~,7&te. PX1S..~~u#.1.y.dw.et~.~.~.~g. The certificate is issued to .Gar1,Q Gat~.leti.oh.. ..owner . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval May . 25~..1.~?b, ..by. :.v~.i~&t... . UNDERWRITERS CERTIFICATE No. .19276~+~5. . , .I~ax...31 • • .197• • . • • • • • . • • • • • • HOUSE NUMBER ...1735....... Street G.learvi,ew. Aue . 100 Mailer Ct ~~r~:l:.C r. ~ . Building Inspecto~ FORM NO. 2 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ' SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date 19;1~!~f . N° 8310 Z , , Permission is hereby granted to: ' ' ' ~ttKe to ..13l1'~K..131~•• ~ • 1 . >>~.••T~'••~~r'7•~' at premises (orated at . aw.~...:.=r.........s...~..............._.....::. s.................. 1~~..., and approved by the pursuant to application dated 1 _ . Building Inspector. , , _ . _ , Fee $'rft,i........... ` ^`'•e''a -Building Inspect ~ s i , . FORM NO. 6 TOWN OF SOUTHOLD Building Department 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 al! buildings, property lines, streets, and unusual natural or topographit 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: 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. 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 Date ..~.y.,~.~.~.......... New Building Addition Old or Pre-existing Building Vacant Land Location Of Property ~~6:.....~'jo....~.~~.l~z.f~:L':~!Q...~'.~....?:...~~rT.~.~c...~/..~~..~7'1..!~~....... Owner Or Owners Of Property .~e9..~.1:.~....1....~~..~V..~.G...~.l..l..~.fib Subdivision ~.l.1f1.1,.! /l,.l.%./..~:~:.Il........1~%.......Lot No..~:.~.. Block No.~f..7.H..`.~ House No.,l ~3~ , Permit No.(Y.3.~ D L Date Of Permit ~~.~.~7:?~Applicant O..! : % ~ t~,,J.~f. , l /./9..~ Health Dept. Approval ............................................Labor Dept. Approval Underwriters Approval ..............................................Planning Board Approval Request For Temporary Certificate Final Certificate Fee Submitted $ ..CS.c.(~....~ Construction on above described building an pe mit me s II applicable codes and regulations. . J~lL..~~IY~ . /~~Q/'r' . . Applicant ` Sworn to before me this i'! ~~•iGL~-~~~~,'3-~.L~ ..r........ ..1..~t~.t..efu day of ~~.°t,,,/.... ~ ~.d ~ (stamp or seal) ~G~(y` I LSD $-3 'Notary Public ................~.LLE,t;~c.~7~I~County ~l ~ €utat3Etr+ ANN NEVtuE 1~.~ _ NOTARY MIIBLIC, State of NeW YofR ~ i(/~~/~CJ No 52~Sk2585D, Suffolk Bounf tern[ 1lebltps March 30, ltl~ SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number ,L'S'D ~ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1 . Applicant ~ ~ 7"" p Phonei r", ~ I :r 5. Subdiv;~, ~ ~ ~~.<.rri Address-= ~ . r - ~ 6. Sectiomr, </; 7 2. Property Location,? t , • reG • ~ 7. Lot Number ~ ~ 8. Private We -r ~ age owns ip ~ • 9. Public Water 3. Public Water Company Name Distance to main 4. Lot size: Widthl feet Length feet 10. Sewage Disposal System: (For Health Dept. Use) A. 0 gallon septic tank: Fr~ H ~ / Preca tf Equivalent Block B. Leaching pools: Number of pools ~..d Precast~Block Special ~ ~/,L,.~ 11. If private well, fi17 in the following blanks: ~ ~ c~ A. TahJ~ capacity gallons B. Pur~p G.P.M. ~ ~ ` „ 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 accordant with the Suffolk County Department of Health's current standards thereto. This applicatio 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. r M•+'•' r t Date ~,i : ~ Signedl : r.~ i „f 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.instal7ed on this plot. APPROVAL DATE ~~~~~~r SIGNED 5-15 Rev. 4/1/73 r THE NEW YORK BOARD OF FIRE UNDERWRITERS d I BUREAU OF ELECTRICITY 8S JOHN STREET, NEW YORK, NEW YORK 10038 Date March 31, 1976 ApphcationM1oonfrlel337735 N 276455 THIS CERTIFIES THAT only the electrical equipment as dearribed below and introduced by the oppliranY named on the above application number in the premiaea of Carlos Canal itch, n/e/cor. Clearview Avenue & Mailier Court, Southold L.I. rn [he follnuing Location; ~ Baaement ®IRt FL ? 2nd Fl OU t S i d e Section Slock Lot uas examined on March 29 , 1976 ¢nd found to 6e in compliance with the requrrements of this Board. FIXTURE ECEP7ACLE5 SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT FLUORESCENT yAppR AMT K W AMT K W AMT K W AMT N W AMT H P 13 29 12. 13 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS AMl K W Oll H P GAS H P AMi NO AWG AMT AMP AMT AMPS TRANS q,V,7 H P SYSTEMS AMT WATTS NO OF FEET 2 F SERVICE D15CONNECT NO OF S E R ~ V 1 C E AMT AMP TYPE METER I% YW T NO OF CC COND AWG AWG A W G EQUIP ,i<3W 3 % 3W 3,if IW pER % Df CC COND NO OF HI-LEG OF HI lEG NO Of NEUTRALS Of NEUTRAL 1 100 CS x 1 2 i 4 OTHER APPARATUS I GFi L~z~ -E'~''l George Ziml inghaus G/%~~ 4 Park Place Patchogue, L.I. 11772 LIC# 273E GENERAL MAN GE D Per_._~~ _ This certificate must not be altered in any manner, return to the office of the Board if Incorrect Inspectors may be identified by eir credentials, 1/~•.. ..L, ~ A / • Y ~•h1~ h~,~ ~••/V1 ~'l ..t TM ~ /1~~V ~ I 1 4 J ~f ~ 'l^ ~ ~ ~ O`~~ T ~4 Y ~ a '44,~,. , ~ ~ ~ ~'tir ~ 4~ '~l i c r~ ~`J I. o - - ~ - - ~ ~ . fit r`v ~ ~ ~ Q~~ a a, • ~ q ~ ~ ~ ~ ~ Y ~ 'L~. p 26 ~ m ~ > ~ ~ m O ~ ~ ~ > !lIVVV ~ G: > ins D in > p Z C ~ '1 ~ 11 c> paper D oo tea" 4 ~ Z > ~y /^y ~ z O y ' ~ C , x? i C D C? ti x a> ~Z c~ L C -'a ~ w •~Oo T ~ ~ O b D ~ ; ~ p~= p< r C C O Z m T o, > < z n • i m z ~ O . ~ ~ R ~t _ - y ~ J ~ ~ tea,,,; ' ~ f... 4ti ~ o r ~ 4 tl~ ~ ~ ~ is 1 C 'r~`"f t`` ~J ~ , , ~ ~ ~ ~ ~ ~ ~ M ~1 rnpl { ~ ~ ~ rn ~ `~1 ~ ~ y. ~ ~ ~ ~ ~ ~ ~ ~ ~ CJ iv i SU£L~ JLK COUNTY I~EALTA DEP14~T"ENT £ u ~ v i. -f ~ ' ° ~ ~ i ~ lF ~ _ C c" ~ z`~coa ~ t 'r. DATPs MAY 2 51a76x. D. fiE~. ~`-..3~s~~ ~ ~ _ - - ' ' _ > tl < o The se~••age disnosal an9 water supply N: m> £oZ i~ ~ .'scilit'.cs fer this lo~:~~ion i:avo beer = - ~ ~'.rn ~ < in-'~,eted by th'_a dd~mcn d fot~ld z _ . J n ~ o t/.~) mac, ooA +,o b, satiafacto~- Z~s o ~ ` " ~ x ~n O ° > ~ G r ~ m Chief of General Engineering ~ " - ' A° ° p Z i n C C ~ Services 2i m _ _ _ _ WILDING DEPARTMENT ~ F ~ s~ ,a; a/,,,.~, ~ TOWN CLERK'S OFFICE y ~ a fi C o~ ">ep ~<d ~ SOUTHOLD, N. Y. G ~ ~ l_ a«~ c~Cfan a-taa.~ s Yls cnxn .or'^ / . ~ Examined 19.~b '~,a OKj Co. ~bc~ation No.~~6..~...~ 'I' 7 Approved 19.7 s. Permit No....~~~.Q.lr-.... Disapproved a/c (Building Inspectod APPLICATION FOR sU1LD1 G PERMIT ~ ~q~ Date .....,/..ift!..(!.....~~ 19.7..:'..^ovi INSTRUCTIONS y ~ ~a a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildin~'~ Inspector, with 3 seM of pions, accurate plot plan to scale. Fee according to schedule. n b. Plot plop showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or`j areas, and giving a detailed description of layout ofpropery must be drown on the diagram which is port 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 o 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 Oniinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as heroin described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and rogulations, and to admit authorized inspectors on premises and in buildings for rbcessary inspections. (Signature of~~"7>""'t, or name, if a corporation) 4 /4„o~cy...S..j'...~`~%i~C,p,.ot.~c~, y,y ~r7.4..5.' (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......................:~u..1.~.,P..~!J~/..~....................................n...................................................................................................... Name of owner of premises 4..~.~.~I...oL..~...........4.~.~?.?.Cl~...~:..C:.T .~..~r..f.`f If applicant is a corporate, signature of duly authorized officer. (Name and title of co rate officer) Builder's License No . Plumber's License No. .....~~.7...P Electrician's License No. ..4F..4..~.. L Other Trade's License No ~y 1. Location of land on which proposed work will be done. Map No.:......~.~..~. ~ Lot No... ~..rl.............. Street and Number ...~j14....~ttR.~.~l~.~,:.G.r......X.........~..lr..~.fl.~R..F~I.I~.~kY....... Munk( li.......... / 1'13 S ~ ~ 2. State existing use and occupancy of premis/es and ingte~,nde~d use and occupancy of proposed construction: a. Exisiting use and occupancy ' .............................~..7.............................................................................. b. Intended use and occupancy ......../...~~.~llf.. ~~.~1'.......P.1~.~6...1~f/.S(..~.L J v1 3. Nature of work (check which applicable): New Building ....v....... Addition Alteration . Repair Removal Demolition,.................... Other Work (Description) 4. Estimated Cost ~:~..7 A Q A ..............................:..Fee (to be paid on filing this application) 5. If dwelling, num6er,of dwelling units ........L .................Number of dwelling units on each floor..... Vic................... If garage, number of cars ...............1............................................................................................................................ 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 .......\(~.G Rear t ~-G........... Depth Sl........... Height ....l..sE~.... Number of Stories 9. Size of lot: Front .........,,~>r?..4~. ~ Rear Depth ....02.1...G. 10. Date of Purchase .......//~f..! ......................Name of Former Owner ..:,(..:....~~:~?:..~.lv.rl:~t'..1....... 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation: i1!..~ 13. Will lot be regraded ......~i!TF~.5.....::.. Will excess fill be removed from premises: ( )Yes (k9 No 14. Nome of Owner of premises~~•lcif.Q.......~e~l.?!/.t.~..FT.I.V~ddress ~~79. A....~.NP...~Y.Phone No Nome of Architect Address ~:::a.`i`.2.C.f."t..K..N~}ion® No..f4 f;,-a.Pto Name of Contractor1~~ .1.ri.@:11.r......R3.~:,0...1~..[.......... Address .Q. ~il..Q/eZ>~...?Pfi'one No. ~~P...~~.l~.Z PLOT DIAGRAM ~~c? ! ~ • ~ j 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. 9~' ~ °T 2f - d ~ ~ Lvr~9 ~a r STATE OF NEW y~g~ / ( e~i9 ~ Yes f"'• CQUNTY OF ,~e~` (~.....~.Lx..fS.S .......Qf1.Q!_........~u~.~O.L°N...(;~.QJ~.! ....................:.being duly sworn, deposes and says that he is the applicam (Name of individual signing contract? above named. He is the ..........................................~r?~.!'.b!!:~/.~'~~!.................................................................................................... (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; and than the work will be performed in the manner set forth in the application filed therewith. Swam to be/fore me this A' ...!7..... day of .~cx.k.er.~............. 19.~. Notary Publjc . ................................~L~'~punty ....~~-N..o`.`.^^............... (Signature of applica t) ELIjABETN ANN NEVILIE MOtMY PUBLIC. Shte of New YorM Jio. -52.8125850, SuNOIk County ~ ierm Expires March 30, 19~(. - ~ ' 'NOJ a saovaa Nolnnais ~ ~ A o Nolsaa and ateisNOdsav ioN !,:N~ O3131dW00 gOf N3HM lVNli 'E . '":f 3NIl3dld 9NIN3~00 3a0i3f7 '7 _ 'r:Y.i- 9NI;~iVBi 1NV1S HO N'71! ~ ~y'~! _ ~ i ' ~NIIIIdNJVB 3H ~ 1 ' - i Od39 i ' 41i ~SNOI1~arSNl n~ i~,' it ice'., IG+.~ ~ I^s i. 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