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HomeMy WebLinkAbout7722-zTOWN OF SOUTHOLD BUrLr~ING DEPAR'I~tfl~T Town Clerk's O~ice Southold, lq. Y. Certificate Of Occupancy TttlS CERTIFIES that the b~!!dlng located at . ~au~ .V~.~ .DrSvs ....... S~ ~p No. ~r~a. ~ No...0~.A,.~t No. ~... ~en~... ~,~. ........... co~o~ su~y ~ ~e App~cafi~ for B~g ~t h~fo~ ~ ~ thl, ~ da~. ........... Feb... 1~.., 1g.7~. p~t ~ w~ B~g Pe~t No...~ .~ da~ ........ ~b.. '1~ ......, lg. ~, w~ ~u~,. ~d co~o~. ~ ~ of ~e ~ m~ of ~e app~ble pro~io~ ~ ~e hw. ~e occup~ for wM~ ~is ~ca~ ~ ~ ~ .. ~iva~ .o~ .fa~y. ~ellin~ ...................................... ~e ~ca~ h ~ ~ ... T~$. ~d ....... ~er..; ..................... (o~, I~ or ~t) of ~ ~o~d b~d~g. S~o~ Cowry Dep~t of He~ App~v~ ... ~g.. ~.75..i97g..by. ~.. ?~la ~~I~S C~T~CA~ No..N. a~36~ ..... J~.. ~.. 1~% ............. HOUSE ~ l~ S~ tou~h Vie~ gri~e ........... FO~M NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N~ Y. ,/ BUILDING prERJ~!T (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FUlL COMPLETION OF THE WORK AUTHORIZED) N.° 7722 Z Date ............................ ~b ........ t.~'. ......... 19.~.~.. Permission is hereby granted to: ~ o~... Ro~kZum... ~f.~..~ho~.,,~l~&r~t ....... :. at premises located at ...... ~OUth..¥i~...D~£v.e .................................. i ............................................ .................................................. t~z~o~s--.H.~.~ t.s ......... O.~'~ke~----...-......... ........................................ pursuant to application dated ................ ~ ....... Feb.....lb,. .............. , 1~9.~'.~'..., and approved by the Building Inspector. Fee ~ .'..~.Q. .............. FORM NO. $ TOWN OF $OUTHOLD ~ 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 {ollowlng; for new buildings or new Use: 1. Final survey of property with accurate location of oil buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disp0sal--(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 r o,e ........ New Building....../ ...... .... Addition ................ Old or Pre-existing Building ...~.. ......... Vacant Land .............. kocotion Of Property ...................................................... Subdivision ,/:::~/,~...j'.~iL~(~/~:~. ....... : .......... ..Lot No ............. Block No ............. Ho, u, se~.o..'.~.....~ Permit No..~..~..'.~.....:~.....-~.. Date ?f P:rmit .~.Z./,///i'..~,Applicant-- .. '.~...~,...~...~7/~ ......... Health Dept. Approval ~.~.: ~.: ......... : .................. Labor Dept. Approval ................................................ Underwriters Approval ../~.,..?Z....~....~....~, .~.....z-/... ............ Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fined Certificate / Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. / - Sworn to before me this ~ ~ Coun ~XF~F~yD F. KING, J~ No, 52-7267800 Suffolk ~un~ Term ~pires M~rch 30, 19~, (stamp or ¥/ SUFFO[~K COUNTY DEPARTMENT OF HEALTH Health Dep~rtment Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant ~r~ /-//~,~.~.~-~ Phone 5. Subdiv.FJ~-~v~,~ Address ~.~ /~,~ ~ ~/.~ 6. Section 2. Property Location ~.5, <'~J ~/~.~ .~,, ~ , 7. Lot Number .~,,~,~,~ /~y/~ ~.~ ~ . 8. Private Well ~lla~e ' ~)~/~'~ ' Township ~~/~ 9. Public Water 3. Public Wa~r Compah~ Name ~'~,~ ~ /~//~ '~ ~ Distance to ~i~ 4. Lot size: Width ~F) fee~ Length /F~ feet 10. Sewage Disposal System: (For Health Dept. Use) A. 900-gallon septic tank: PrecastZ~E~quivalent Block B. Leaching pools: Number of pools ~ Precast / Block ~pecial ll. If private well, fill in the following blanks: A. Tank capacity gallons B. Pump 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 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 Water Supply can be installed °n this pl°tsi APPROVAL DATE S-15 Rev, 4/1/73 x., = facilities for this .ocli!on hav~-b~en inspected by this dei,,artu:ent and found ' Chi~f of General Fmgin~er~u~ Services THIS CERTIFIES THAT 795~30 ~nomas ~oa~a~ South Side-Southview Drive 300~ West of Main Private Rd., Ori~t-Browns~iiils~L.i. 18 J29 ~ 15 18 j FIXTURES RANGES :COOKING DECKS i OVENS i DiSH WASHERS i EXHAUST FANS i 1 i12 4: I ! ; It l~ FUTURE APPLIANCE ~EED~R$ ;SPECIAL EEC'PT. TI~AE 6LOCKS i BELL ',UNIT HEATER5 1MULT -OU~:LAT [ I ' , j SYSTEMS I ~ SERVICE DISCONNECT , JNO. O~: i FurnaceZs: 1-1/Shp, i-i/i2hp NO OF CC COND I A. W O i NO, OF Hi-LEG j A, W.O. I ' i/O I I 1 I Theodore Ronzo~z Orchard St. Orient, L.i. 11957 credentiols APPUe_~TIOH FOR BUILDING PERMIT Date .......... ~,........~..........~ .......... , INSTRUCTIONS a. This application must;be completely fiUed i~ by t,~mwrit'm' or in ink and submitted in triplicate to the Building Insl~tor, with 3 r. et~ of plans, ~curate plot plan to acale. Fee according to schedule. b. PI~ pl~n~l~oWlng Iocafior~ of lot and of bui~ on premises,' telatio~;~shlp fo adjoining premises areas, and giving a detailed description of layout ofpeqlerty must be drawn on the diagram which IS c..T~., w~rk cover .~. ~ th~ .a. ppl?a._ti _o~. ma_y ~ be commenc...e~, befg~ issuance, of B.'_ ~uit~ling Permit. d, b~_PO~e .ppr?l et fft.~ appl?at,on, the B~tdkljelg .Impoctor wdl iss..u~_'.~a Building:Permit to the al:~icant Such permit ~ shall kept on the premises available for impectlan throughout the 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. Bui~dPiPL~' zCAOnTelON~S__H__E_RE~Y., _MA~DE to .the B..uil.di.,rlg.,i~l~o~..rt~mont. fol[ .th~,i,ssu, anc, e of a Building Permit pursuant to the -. ........ ; .ur Trm cQr~.TFI, I~TI4~I eT QuiIOlngS, O(MltJ~ or OlteJ~O~. Tl~,e appli?nt agrees to comply with all applicable law~, ordinances, I~ulldina code' aamit authorized inspectors on premises and in bulldlngl for ne~ _~__ry i~ion~. (Sigr~Fure of.applicant, or name, ifa co~looration) (Address of applicant) State whether applic=ot is owner, lesseeS'agent, architect, engineer, general Cohtractor, electrician, ~lumber or builder. Name of owner of pr&mises .. ,....~'.............:.e~r._._Af~' -~ '"'" ' -~ If appficant is a corporate, signature of duly authorized officer.~ (Name and title of corporate officer) Builder'S LicenM No...~ ~'f//.... . ... .. ...... ~ Plumber's License No. ~1~ ~. }:7 Electrician's Lic e . .. ............................ .. . Other Tmde's License No ......................................... ;;:... .~ ._ /,/,'/;_ a/' ~ 1. Location of IGnd on wh~ich propane, work. w!!l be done. ~ap No.: .....~:Z..~./.~ . Lot NO ,.~......~... 2. 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 .... :.~. ........... .. .. ' 10. 12. 3. Nature of work (check which applicable): New Building ..... ~ ....... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work ....................... ~ .............................. ..~....~.. --- -- .,~ (DJescription) 4. Estimated Cost .........~. ............. (to be paid on filing this ap~J?~ation) 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 entire new construction: Front ...... .~..~ .................... Rear .....~..~..:. ............. Depth .....~'.~...~ .......... ' I Height ..../...~. ......... Number of Stories ...................................................................................... 1 .................. '_' .......... ~ - ~ , ' 0 ~' Rear I~0 I.. . Depth I '~9"!..~,~. S.~, of lot: Front .....~...'.....'./..../~. ......................................................... ._'. .... ~h '~'"J"~~''''~''' ........... Date of Purchase ......... .~'~....../...~...~...~. ................. Name of Former Owner ~ ................... .~ Zone or use district in which premises are situated ...~,.: ................................................................................. Does proposed construction violate any zoning law, ordi ~ance or regulation: ...~ ......................................... Will lot be regraded ....~ ............ Will excess fil be removed from premises: (~') Yes Name of Owner of premises ~..~..~ ................. Address .....~ ........ Photo Name of Architect .............................................................. Address .. .............................. Phor, Name of Contractor ,.....~...~. Address ..... ~ ....... Pl~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or p..rpposed, ar~. indi,ca,te all set-)Dc property lines. Give 'street and block number or description according to deed, Dna sn,m~ street, whether interio~' or comer lot. )No :k dimensions from ~ames and indicate ~(- 2..V- '/> STATE OF NEW,,YORK, COUNTY 0 F~. ,~'/~. ~. · .~. · .~....-'"~-.. ;.... )' ''''''' , ~ ... ~..~'~....L.....~. ~.... be ng , sworn, deposes and says tha he is the applicant ..................... .............. ................. duly, (Name of individbal signing contract] above named. He is the .................................................. ~.. ........................................................................................................ (Contractor, agent, corporate off, i~er, etc.) of said owner or owners, and is du y authorized to perform or have performed the said work a~ to make and file this application; that all statements contained in this application are true to the best of his knowl;dge and belief; and that the t~{'k will be performed in the manner set forth in the application filed therewith. Swam to before me this ....... of ........ ..=..:.. Notary Public,. ..................... , .............................. ~/"~i~notur~'~"appJic~i '1~')' .............................