HomeMy WebLinkAbout9631-zFORM NO. 4,
TOWN OF SOUTHOLD
BIf/LDING DEPARTMENT
Town Clerk's Office
Southold, N. Y,
Certificete Of Occupancy
No...Z 9159 .... Date .......... AugUst· 9., ........ , 1978. ·
THIS CERTIFIES that the building located at . ~,650. Gillette. Df. ire .... ~H~X
Map No... 2.(~38 ..... Block No .... XXXXX.Lot No... 3.7 ............................
conforms substantially to the Application for Building Permit heretOfore filed in this office
dated .... ~.ei~=ua=¥. 9, .... , 19.78. pursuant to which Building Permit No. 9.631z..
dated .... ~4arch .3,4, ........ , 19.7~., 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 .. P~X.V. ATK .01~. F. AMILY. DWELLING ......................................
The certificate is issued to . .WA¥~I~.. L....It~,ZZAFERRO ..............................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval Auguat .8 ,. 1978.-.8-.SO.-.12 / .......
/
UNDERWRITERS CERTIFICATE No ................................... / .........
....
Budding Inspector
"PRIVATE WELL WITH HIGH NITP~kTES - SEE HEALTH DEPARTMENT NOTE ON
FINAL SURVEY."
BuILDiNG DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N., Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FbLL
COMPLETION OF THE WORK AUTHORIZED)
N? 9631 Z
Permission is hereby granted to:
........................................ :.::....,:.~:..e..~ ........ {:~..,.).S~ ~/~ ~ ~i-e o
~: L~ ~'.~ r,4 ~, , , ~,.,'
,ct ~7 I,~,/~ ~,. ~ c ..,.
pursuant to opplicotion dated .........................
Building Inspector,
]FORM NO. S
TOWN OF $O~T~OL~
Building Deportment
Town Clerks Office
Southold, N. Y. 11~71
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instr,ctions
A. This application must be filled in typewriter OR ink, and submitted in triplicate 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:
1. Accurate survey o'f 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 occupanc¥ on pre-exist[n§ dwei[ing or lend use $5.00~ ~ ',~,
Date .¢..~ .......... ' .................
New Building ....~..~.~.... Old o~r~e~s~ng Bui~ing ..; ............ ~ ........ V~?nt Land ~,.:. ....... , ......... : ....
o, ,,opert .....
Subdivision ......~ ......................................................... Lot No..,.~..... Block No .............Ho No ....... ) .....
.... ........ .................................. ...........
Underwriters Approval ...... ~/..~]~ .............. Planning Board Approval ........................................
Request For Tempora~ Ce~ificate ........................................ Final Certificate ..........................................
Fee Submitted $ ....................................
Construction on above described building and permit meets all applicable codes and regulations.
Apphcant .............................................................................................
Sworn to before me this
................ day of ............................................
Notary Public .................................... County
(stamp o~, seal)
COUNTY OF SUFFOLK
DEPARTMENT OF HEALTH SERVICES
The attached approval was issued subject to the notation contained below
our approval stamp. Would you please type the following condition of
approval on the final C of 0 as this will ensure that any future owner
will be made aware of the nitrate problem.
"Private well with high nitrates - see Health Department note on final survey".
Thank you,
~obert A. Villa, P. E.
OFFICE OF BUILDING INSPECTOR
TOWN I~--LERK'S OFFICE
SOUTHOLD, N. Y. "11~J'71
THE NEW YORK BOARD OF FIRE UNDERWRITERS
.u.,Au o,
--- 85 JOHN STREET, NEW YORK, NEW YORK 10038
THIS CE~IFIES THAT
in the ~ollowing location; [] Bemernent E~ ist Fl. [] $nd Fl. Section Block Lot
wasexarninedon ~ep~{Ytb~* ~, 1~7~ andfoundtobeincompliancewlththerequirementsofthi~l~mrd.
fiXTURE NXTURES RANGES OVENS DISH WASHERS EXHAUST FANS
OUTLETS SWITCHES
19 ~9 29 19
DRYERS FURNACE MOTORS K/TURE APPUANC! FREDRES TIM~CLOCKS
SERVI~ DISCONNECT
1-3make Detecto~
l-~.Skw Hot Water He&ret
glee. Room He&te~/s:~-l.Skw,
~oto~/s~-Fr hp
1
1/o
?-l.Okw, 4-.65kw
Salav~to~e C. Prato
~reenport, L.I. 119~
Llc. IO~&9-E
This certificate must not be altered in any manner;, return to the office of the Board if incorrect. Inspectors may be identified
COPY FOR BUILDING DIPARTMINT, THIS COPY OF CERTIFICATI MUST NOT BI ALTERED IN ~
credentials.,
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, H. Y.
................ w ...........
Approved ............... .~.../~...~ ...... /..Z ,;~rmit No ..... .~......~....?..,Z....~
Disa roved a'c
.......... ~' (l~'~'il'~Jing Inspector) ......
APPLICATION FOR BUILDING PERMIT
Date ............................................... , 19 ............
INSTRUCTIONS
. a. This application must be completely filled in by typewriter or~ in ink and submitted in triplicate to the Building
Inspector, with 3 sets of plans, accurate pl6t 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 drown 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 this application, the Building Inspector will issue a 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 o Building Permit pursuant to the
Building Zone Ordinance of the Town of Southald, 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 oil applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and ir~ buildings for necessary inspections.
...... g;'iF Zo'; g';g g g'i ........
...... ...... .........
(Addr~/of applicant) /
State whether appli~/~4jo~/~ lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
WA 'K /v' E '7- PfA Z z A F E. O
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 .....................................................
Plumber's License No .................................................
Etectricion's License No .........................................
Other Trade's License No ............................................... r-'~ ~-, ~ ,/~>
Location of land on which groposed work will be done. Mop No.: ......,...~T ............ v ......._ .......... Lot No.........~ ...... ..........
Street and Number ..... ~..~.~..~ ........... .~.~ ....... ~,)i~ ....... ,,~.~Z ./. ......................................
j ~ ~0 ~' "~' ~ ' ~ '- Municipality
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
o. Exisiting use and occupancy ................. ,~...~.. ~'.~i.../. · · · · .~. ·...m~. ......................................................................
b. Intended use and occupancy ............... ..~.....~..~ ........ ~.~.~.: ............................................................
3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ........
Repair .................. Removal .................. Demolition .................... Other Work ....................................................
2: Cji/ U ~/~ ~ (Description)
4. Estimated Cost ........................................................... Fee ..........................................................................................
(to be paid on filing this applicat~)
t umber o dwel m umts on each floor
5. If dwelling, number of dwellin~n' s ............. Z ............. N f ' g ' · ..........................
If garage, number of cars ..........................................................................................................................................~
6. If business, commercial or rnixed 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 ~
Height .................... Number of Stories .................................................................................................................
~' ~ ~ ~ De t
9. Size of lot: Front ......... ~ ........................................... Rear ......~ ............................... pt~ .... ~....~. ........ ~ ......
Date of Purchase ....... ~ ~.~...~.y~.¢...~.~. .......... Name of Former Owner ...~¢.~.~.....~.~X:~-~. ......
10. ~ ----~-- , ~
11. Zone or use district in which prem~es are situated _..~¢...~,.¢,~ ....... ~..~.¢.~.,.~% ......
12, Does proposed construction violate any zoning [~w, ordinence or regulation: ....... ~.~. ....................................
13. Will lot be regraded ........ ~ ....... Will excess fill be removed from~premises: ( ~s ( ) No
14. Name of Owner of premises~,.:.~ ................ ::~ d ess ................... : .........
Name of Architect ..... ~....~~ ...... f ........AddressZ~.~..~.~ Phone No,
Nome of Contractor ....:.~: ....... ~¢.~ ..... Address ..~ ................ Phone No..Z2.2 ........
~ P~ DIAGRAM ~r~" ~ ~
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.
(NgCr/e of individual signing c,¢¢racf)
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duiy 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
that the work will be performed in the manner set forth in the appiication filed therewith.
// JO EP ~ // ~bJgnoture or op¢~nf)
/ / No, 52-9366335 ~/
t/ Qualified in Sulfa k County ~¢
( ommission Expires March 30, 1~
N ~
17'
(I)
0 0
19..
~-- " I I f,r~,,.,~ s,.~-~- J L AppROVED--"~
-~ ~'~ ~=- = =~ - ~=~ ~ I AS NOTED
L- - --I --' ?- ] 7~.-~6o 9A~ to 4PM FO" R~QUIR'
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