Loading...
HomeMy WebLinkAbout7901-zFO~bl NO. & TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, 1~. Y. Certificate Of Occupancy No. Z6~,.~2 ...... Date .............. 0~.~. .....8. .... , 19 THIS CERTIFIES that the building located at .. D.o~dlas.~ .$.tr.e.e.$ ........ Street Map No. ~ ........ Block No.. ~ ..... Lot No, . .~.. .... .0.~%e..n.t...~.~.,.Y.? ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ¥~y.. ~..., 19. -7.~ pursuant to which Building Permit No. 79.0.lZ.. dated ........ P~...8 ...... , 19.7.~., was issued, and conforms to ~11 of the req,~ire- ments of the applicable provisions of the law. The occupancy for which this certificate is ~.ssued is ...P..r.~v.a~.e.p.n.e....e.~.~.~..1~..d.¥.e.!.l%.n.g .................................... The certificate is issued to I~d. lionel. I~¢ ..... . .O~ar .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .0.c.~...~ S..~.77~..b.,v..R.,...V.~.~.~.~ ....... UNDERWRITERS CERTIFICATE No..I~.2.~.b. 6..1~.2...J..u.~.y... ~...~. c.)?.~. ................. HOUSE NUMBER ... ~b~ ...... Street ...D. 9.u.g~..a.s.~..3..~.r.e.e..t ..................... ........................................ iiiiiii.iiiiiiii iii'.".i'.i'.' Building Inspector ~0I~ NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~ N9 7901 Z Date ..................... ~ ......... 8 ............... , 19..~.~. Permission is hereby granted to: ...~...~...... ~.~.e.. ..................................... ............... ~.~.~k ...................................... at premises located at ..];1~1~...1~.t~.~.1~. .................................................................................. .............................................................. .~.r;~....~.,.~.,. ..................................................................... pursuant to application dated ........................~ ....... ~. ............... 19...~., and approved by the Building Inspector. Fee $...~..~.~...(~.. ......... 22~8 FORM NO. $ TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcation must be filled m typewriter OR ink, and submitted in DUPLICATE to the Budding Inspector with the following; for new buddings 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 dmposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwr,ters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buddings and installations, a certificate of Code comphonce 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 buddings 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: I. Certificote 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 ..~ ......... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ~D~'~U:~]~?~s~~9~~%~ .............................................................. Owner Or Owners Of Property ...,~..~,.,3-,~.zT:,,.~,...,~,,°.,~,,.e,,s,.~....~..~,:. ......................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No...,3.~,5.. Permit No..?,,?,.O.,~,,g, ....... Date Of Permit ...5,./.,,8,./,7..,5,..,.Applicant ..~,~,.1...~.,~,.~..,H,.°,m,,.e.,s,,,s...~.,~..c.,.' ...................... Health Dept. Approval 5..T..S..O...-..-5..~....~...O../...~../..?..5. ......... Labor Dept. Approval ................................................ Underwriters Approval .N2-34~2......?../..?../..?..5. ......... Planning Board Approval .....Y..e..s.. ............................. Request For Temporary Certificate ...... .~...o. ............................. Find Certificate yes Fee Submitted $ ..5.:..0..,C). .......................... Construction on above described building g.nd, permit meets all applicab.l~e codes on~d regulations. ............... Kenneth W. Thuzbez, Sworn to before me this INLAND HOMES, INC.. (stamp or seal) ~O~.- ~7 ~OFFOLK COUNTY ~EPARTMENT OF HEALTH SERVICES Health Services Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant Address 2. Property Loca'tion])amm~m Village ~1~ ~ Township ~--~ 3. Public Water Comp~n~j(Name 4. Lot size: Width~'~ feet Length. 17~ feet 10. 11. 5. Subdiv.~~ 6. Section 7. Lot Number 8. Private Well 9. Public Water Distance to main Sewage Disposal System: A.{/~gallon septic tank: Pre'C~ast 3(X Equivalent Block B. Leaching pools: Number of pools ~ PrecastlO{~")Block Special__ If private well, fill in the fol- lowing blanks: A. Tank capacity ~ gallons B. Pump G.P.M. ~ C. Total well depth ~gO D. Depth to ground water_~-/¢~;~7~/ E. Amount of water in well (For Health Services Dept. Use) lhe undersigned CERTIFIES: "Construction of authorized installations will be in accordanc= with the Suffolk County Departn~nt of Heal th 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 ~;~3. 30, lg~ 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 DATE SIGNED (_ ~-- ~ S-15 Rev. 4/1/73 RIVE:RHE,~.D,,N',~. -.:< ,-/_~. ~ I t ~ --~ TUTION GUARANTt~S ARE NOT TAANSFERA~ 6,0 . s.4o'~'oo'E. ELEVATIO~._Q~ LOT. < t4~.P OF PROPERTY -J SUi:i. VFYE ~ 0~ ~r UNAUTHORIZED ALT,~ATION OR THE NEW YORK BOARD OF FIRE UNDERWRITERS '~' BUREAU OF ELECTRICITY · 85 JOHN STREET, NEW YORK.NEW YORK 10038 ,~ui~ 9. ].975 *,,,,,.,,,,..'~,,.o,,~,,, ~o~95~ N 234642 Inland HomesR e/s Douglas St., 300'$/o Kings St., Orient, L.I. -- ~ ~ ~ ,- ,~ ---*~---[---- T = * PuPates, Oil: 1-1/8. 1-1/12hp.' * Futu~ appli~ce feeders: 2-.3~8, 1-2~1~. OVENS -D~SH'WASHER$ BUILDING DEPARTMENT ~/~ / K S ~FICE ~ N. Y. Examned...~~. ..... r/ ............ ~ .............. .................... ..... ................ ............ ............................... ..................................... ..................... ............................... ~B~ldi~ Im~r) APPLICATION FOR BUILDING(FE~IT Dote INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the BuildingS, Inspector, with 3 sete of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing.lOCation of lot and of buildings on premises, relationship to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram 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. fhls application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises ;~vailable 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 cede, housing cede, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) Box 117, 315 Westphalia Road, Mattituck ............................... ..... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises .......... ~ .......... ,,.~.,,.~ ............... ..~..:~..[....~...~ ............................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........ ..5..3:.?..-..P.. ................................ Plumber's License No. 273-~-- Electrician's License* No ............................................. -T- ~. - ~ D Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.:D../...s.-......l~....o.~..e..z'..!:~. .......... Lot NO...~ .......... Street and Number ...D. eg, g3,&s~...~.l;~:~e.t,~...O~,ezzt~.oia.t, .................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. ~L, dsiting use and eccupancy ..~..~.~~ ~ ' ~; ............. ][~:~ . _~ .................... [ ............................ . . / / ......................... 3. · Nature of work (check which applicable): New Building....~... ....... Addition .................. Alteration ............ ~ .... Repair .................. Removal Demolitior ..................... Other Work (Description) 4. Estimated Cost ...~..~...5.~...O.O..O..:..O...O. .................................. 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 ~pe 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 .56,.~ .............................. Rear ..... .5...6.. Height....................20* Number of Stories ........ ],...3./.~ ................................................................................................. 9. Size of lot: Front 1OO Rear .....~ ............................. Depth ...... .~..5.i.~ ................ 10. Dote of Purchase ..A.~..z'...~..]:.....4..L..]',.RT...5. ...................... Nome of Former Owner 11. ' ZOne or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded ...y...e.,s.,~. ................ Will excess fill be removed from premises: ( ) Yes (x) No 14. Name of Owner of premises .Z..?..3:...a.?...~....~...°?...e.?..L...Z..?..c...' ......... Address .l'~,.~.t,~,.t,~,g~,L~^]fehone No ...~.9.{~.~.~..~.9.~ Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ......... .z..?..~.?rz.d'.....~...?..e..?..s....~..?C.'. ........ Address ....]~.....t..t..3'.'..t..~....c~...l..~'..'...YPhone No...3...D..8..-...D..0..~.. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock 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. ....................... ~....~ ........... ~.....being duly sworn, deposes and says that he is the applicam (N~of i~ividual signing contrac~ above name. 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; t~t 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 manner set fo~h in the application filed therewith. to before me this ~~/ Sworn ~ay of ........... ~ .... 192~ " (Signature of applicant) Nota~ Public, .............. ~ .................................