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HomeMy WebLinkAbout8975-ZNO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certific;,te Of Occupnncy · No. Z?~.~.8 ...... Date .............. lqo.~. .... 2~..., 19.76. THIS CERTIFIES that the building located at .~/~. ,~Ou~d .¥2~m .,tvs ..... Street Map No. ~X ......... Block No. XX ....... Lot No..~ ."'.P®eonio:...I~oY~ .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. NOV...22, 19..76 pursuant to which Building Permit No.. ~. dated ............ .N.0? .....25, 19..?6, was issued, .and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . l~riva~e, ac.c~sso~y, bnlldlng ... (~.~orage .$~,O.[ .................... The certificate is issued to .. of the aforesaid building. Suffolk County Department of Health Approval · Owner ............................ (owner, lessee or tenant) .. N,R, ............................ UNDERWRITERS CERTIFICATE No.. N·o.R*. ................................. HOUSE NUMBER .... ~6~ ..... Street ...... gerund..~iew. Ave .... Peeonie ....... FOltM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8975 Z Permission is hereby granted to: .~._...oL~.~.e.,,z..~.....~?..~.~.d..?.F...~e....~./.~,.~:~.~.l....~a' ,T. Keener C ~'Le hog, ge at premises located at ...]~.O.~.~.p.....~/~..~.~l~...~.i.e. le'...~Y.& .......................................................... ................................................... 2.ec~om~.c..... Ti.¥. .............................................................................. pursuant to application dated .......................~.?V. ......... ..~..~. ............ 19..~.~..., and approved by the Building Inspector. Fee $.,~,O,,,e..,,O~,, .......... FORM NO. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Officu Southoid, 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 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.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. 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 .... ~...~....~/......./....~'. ............ New BLlilding .....~.. ....... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .... .~....~..~.....~..q~....~9~...~~__/_~/~....~/.~....~~....~.y. Owner Or Owners Of Property .~'~..~.~x~....~.....,~~.' .............................................................. Subd,v,sion Lot No .... B ack No Hou~ No ~ '"--/~'~" ' · . . ...................................................................... ... _/,.., ............. . ........ ~,.~ Permit No. ~..~..7.5.~..~.. Date Of Permit .................... Applicant ..... ~..~c~......~ ....... i ..... Health Dept. Approval ............................................ labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fin~ Certificate ...~.. ................................ Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. Sworn to before me th~. ~:~'~" / ~.~- ~-5 ........ .~....~/'. day of~//~ .~' '.,~ ..... ~...2~ ............... (sta~or~,) ~ Nota~ Public .....~//~.. ....... Coun~ COUNTY OF SUFFOLK DEPARTMENT OF' HEALTH SERVICES June 23rd, 1978 Mr. Charles Krull 338 Atlantic Avenue East Rockaway, New York Dear Mr. Krull: 11518 Re: Board of Review Hearing Applicatien to Construct an ~dividuai Sewage Disposal System w/o Willow Terrace Lane, Orient Town of Southold At the hearing held on ~arch 17th, 1978, you had an opportunity to present your appeal of the department's ruling on the subject property. In accordance with the provisions of Section 220 of Article 2 of the Suffolk Count~ Sanitary Code, the determination of the Board of Review is as follows. Based on the information submitted, the application for the proposed individuaI sewage disposal system be approved provided that a reverse osmosis water treatment unit be installed, capable of processing 450 gallons per day and the system be provided with a storage tank with a minimum capacity of 1,000 gallons. Further, that the sewage disposal system is to be installed 100 feet from Orient Harbor. Since the determination of the Board of Review submitted to the Commissioner's office on June 13th, 1978, has not been reversed or modified by him, it is therefore deemed to be the determination of the Commissioner. Very truly vours, HWD/ist cc Mr. Robert A. Villa, P.E. ownEdWin Gerrity of Southold Building Department H. W. Davids, P.E. Chief Engineer Bureau of Environmental Health 0 '~0' W. j. C;,O ',-) No. S-$Z69Z Or: p p..O p ~' I~TY SUP~VEYED FOP.- TNEODORE SIMON hELEN KENNY SIMON SUFFOLK CO., L~. Y. 3C, AL.E:: I00' ~ I" I:~ -~- C/ONE. TO~VN OF $OOTHOLD BUILDING D£PA~TMENT TOWN GLE~K'S OFFIGE ~UTHOLD, N. Y. ......... ............ ~proved .................. ~.'. ........ .~..~].., 192.5. ~rmit No...~Z~.~ ........ Dimpproved o/c ............................................................................................ ............................. ................... ............................ ........................... ~l~TlO~ ~OR 8~l~l~ ~lT ................. ...... ..... 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 plot plan to scale. Fee according to schedule. b. Plat plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, ond giving o 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 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 Jn 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 code, housing code, and regulations, and to admit authorized inspectors on premises and jr~ buildings for necessary inspections. (S'gnature o~applicant, or name, if a corporation) ............... (Address of applicant) ~' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... / ./~..~..~..~.....~...~,..~'..~..q~-,~<..: ....................................................................... If applicant is a corporate, signaJ~ure of duly authorized officer. (Nan~ and title of corporate officer) Builder's License No .......... ,~..../. .................................. Plumber's License No .... ~..~F,,~.. .............. Electrician's License No. ../~..~ ........... Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.:.. ................................ ~ ...... Lot No ......................... Street and Number .~..~.~.:~.~..~-~c~/~.~4~r~..~r~.~...~.~..v~....~: ................... - VMunlcipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: 3. Nature of work (check which applicable): New Building .~.. ............ Addition .................. Alteration .............. Repair .................. Removal .................. Demolitior .................... Other Work ................................................... / / .~, __._..____-~ 0-o (Description) 4. Estimated Cost ..... t(..~.: ................................................. 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 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 .................................................. : ...................................................... , ........... 9. Size of lot: Front ........................................................ Rear ....... :'.'~.~...~ ......................... Depth 10. Date of Purchase ........................................................Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ..... ../~.. ........................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... ./..'f...~ ......................................... 13. Will lot be regraded ..... ::'../...~'.. .............. Will excess fill be removed from premises: ( ) Yes (~ No 14. Name of Owner of premises .~: ........ .¢..:r:....~.'..:.: .......... : .......... Address ..; .................... ./. ....... Phone No ....................... Name of Architect .............................................................. Address ................................Phone No ....................... Name of Contractor '~{ ..~.; z ,,~,i, _ ,~ ~. ............................................... :....:~. Address :.L:;'......:..;./. .......... ';... Phone No.~.L;,'....;;...C::... PLOT DIAGRAM 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. c-q-ATE OF NEW~,~ ~ ~ S S COUNTY OF~ ...... f ' ................................................................................................ being duly sworn, deposes and soys that he is the applicam (Name of individual signing controcf) above named. 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 make and file this application; that ali statements contained in this application are true to the best of his knowledge and belief; and tk, a~ the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........ ............................... (Im~Tt ~y~ (Signature of applicant) .:: :',.