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Home My WebLink About1370-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ~./.fi.. }~r.~h. ~ea. ~)~ ....... Street Map No. ~ ........ Block No....IGC.. ..... Lot No....X.~.. .... 89~1.%~0.].a...1~.o ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... lpr~,l...~., 196~. pursuant to which Building Permit No. dated ........... Ap.r.:[],., ,~.., 19.61., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is Pr, iva~e..one, ,family .dwe. lling ........................................ The certificate is issued to .. John. ,1.,..;ra~,ta .&. ~.fe ...... Owners ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. $. ~.~;. ~!./t9~59...DY..R.~.. Y;[J,.3:a .... UNDERWRITERS CERTIFICATE No .................................................. ttOUSE NUM BER...~2~' ....... Street... }I. or~h..Sea. Dr~.V~ ............................ Bktildiag Inspector FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. TE~4POP, AR¥ Certificate Of Occupancy THIS CERTIFIES that the building located at .. ~,(.$...~.9.l'.t.h. .~e.a..D.V.i.V.e' Street Map No. xx Block No ........... Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... 4P~.J:~.. ~.., 19~'].. pursuant to which Building Permit No..~.Q .~. dated ........ .~pV~ . . ~ ..... , 19 {{~.., was issued, and conforms to all of the require- menls of the applicable provisions of the law. The occupancy for which this certificate is issued is ~;~v~lo o~, ~a~i).,' ~.~. ~ '~ ~;,~ The certificate is issued to Joh~ J, Jaz~a ~ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of ~ealih Approval .. FOR,ag NO. 2 TOWN O~: $OgTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, FI. Y. BUILDING PERMIT (THIS P. ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 1370 Z Date ......................... ~:~'Z'""5 ............. I v6.~... Permission is hereby granted to: ..... ~oh._n..&.. i~eten....,~az~ .............................. ................ 6g..E...3dth.-.H.~ .................................. ................. ~1~ oOlt>ty~.....~l+.r.....l{.,,.~.s .................. to..Bull, d-.ne.~., one..~, mat. l.¥...d.~e.l.1 i~§ .................................................................................... at premises located at ....N/8..-t~crrthS~a-'~rtare .......... ("'~'l~0'"~P'""~ff~"#~.) ................. ............................................. Seu.$hetd.~..... :~.~ :~. ~ ................................................................................ pursuant to application dated .............................. .~10X.:J:.~. ....... ~'. ........... 19.~.]2.., and approved by the Building Inspector Fee $.~.0, O0 ........... ~' ~" ']~uild~ng Inspector SUFFOLK COUNTY DEPARTMENT OF HEALTH Riverhead, New York Application for Approval to Construct Private Sewa~e Disposal Systems To the Suffolk County Department of Health Date '~>~A/ /~L ?%~J~,, Application for approval to construct private sewage disposal system iS hereby requested concerning which the following information is submittedl Name of applicant %~) d/J -Y, ~ Z W'~ Address /,C~ ~ f~.~' 'r 3~ I/~ /~. y. (a) Deed location of property ~/~ (b) Hamlet or Village o~ ~WoZ ~ Cellar ~/~ Slab Water Supply - (a) Public,System Name Distance to nearest main Crawl Space Private Wel]~ Proposed System,, 6. Septic (a) Number of pools (b) Blocks below inlet I11 2 (c) Block size-L ...in. ;W.-'--~. (d) Precast pool[---~ I [(e)No.Sections (f) Square feet per section (a) Inside width ~ft;(b)Length ~ft. (C) Liquid depth ~I Tota~ (c) Number of trenches (d) Depth from bottom of seepage pipe to ground water I hereby certify that I am familiar with the requirements of the latest bulletin of the Standards for Private Sewage Disposal Systems and will construct this system in conformance with these standards, or revisions thereof, prevailing at the time of construction. (~ ./ ~ .~ ~ Applicants Signature .................................................. ~' ....... .~/_~..~'- ...... ,- FOR USE OF THE HEALTH DEPARTMENT ONLY Based on information preeented hereon it is the opinion of the depart- ment that an adequate and satisfactory sewage dlsppsal system can~ b,e~ con- structed on this ~lot. Date. ~/~37&/ Signature SC~DS-15 (Revms.) ~ 50 CAPACITY. 'TE'~7' NO£~ DAT"A 0 /o /4- /NO/CA ~IOR'FH PLOT PLA N S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. Permit No. TO WHOM at IT MAY CONCERN: The' sewage disposal facilities for a structure ~ocated (Give deed loca~-ion) /~ have been inspected by this department and found to be satisfactory. Distriot Engineer District Engineer TOWN OF SOUTHOLD TOWN CLERK'S OFFICE APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink end submitted in duplicate to the Building Inspector. b. Plot p~an showing Iocation of lot and of buildings on premises, relationship to ad}oining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is port of this location. c. The work co~ered by this application may not'be commenced before issuance of Bui(ding 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 progress of 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, pdditions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. 6-' (SignaturfJof~bl~plKc6nt, or name, if a corporation) 64 ............. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, e[ectrician, plumber or builder. O~e~ Name of owner of premises ................... .~.o.~.~.......J...~.~.¥~ ...... ,&......~..e.~.e...~.....~.~.~.~...~. .............................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ....~. ~.c]..~.q..o...~a~ ................. Lot No: 5 Street and Number ....... T~ ./.fl...~.q~..~,.~...~D,l~,~.~.~...~o.ut~b, Ql.d. ......................................................................... ~1'~ ~.P~,~?~ ~f"' Municipality ~'r ,c/ 2. State existing use and occupancy of premises and intended use and occupancy of prol~osed construction: Vacant lot a. Existing use and occupancy ..................................................................................................................................... ......... One family, dwellin~ b. ~ntended use end u~uu~u,,~¥ ............................................................................................................................ 3. Nature of work (check which applicable): New Building......X~... ........... AdditiOn .................... Alteration .................... Repair .................... Removal .................. '..Demolition .................... Other Work (Describe) .................... 4. Estimated °.................................... Fee .$..1..0.: .0...0. ................... (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 .........o.n~..car......a...t..t...a..c..h..e..,d. .......................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 7. Dimensions of existinfl 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 ........... .4...2..'. .......... Rear ............. .4...2..'. ........ Depth 37' Height ............................ Number of Stories ......... ~:....s..t..o...r.y... 9. Size of lot: Front ........ ?D..0. ............. Rear ........... .1..0..0. ........... Depth ...... .3,3...0.../..3..1...8. ..... 10. Date of Purchase ...... ~.a,IA..~-.f}.~..0. .............................. Name of Former Owner ..Ha.y..d.e...n. ....................................... 11. Zone or use district in which premises are situated ......... ~.~..A..j.~....R...e..s...~..d...e..n...t..i..a...~.?...A.cJ...r..i..c...u..~.~.t.~.~9~ .................... 12. Does proposed construction violate any zoning law, ordinance or regulation? .......... ..n..o. ..................................... 13. Name of Owner of premises..J..~..h...n..~..J..a...z'.w..a.....&...~.H.'.e..~.~eAt~JdreJssa'z...w.,a. ............ BrD. ok. Ly~.....Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor .................................................... Address ............................................ Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly oll buildings, whether existing or proposed, and indicate oil set-bock dimensions from property lines. Give street and block numbers or description acco~Jing to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ) S S. COUNTY OF ..... Suffolk ...... ) John Ja.z..w...a.. . be ng duly sworn, deposes and says that he is the applicant (Name of individual signing application) Owner above named. He is the ............................................................................................................................................................. (Cantractor, agent, corlborate 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 that the work wi be performed in the manner set forth Jn the application filed therewith. Sworn to before me this JUDITH lf. 80KEN 5~.h ~'1'1 ar~F~blic, State of HeW York · . day of ........... ..~.~ ......... ..--~..../h.. ~'t~"'~*."~,~163. Suffolll Cou,ty ~S~gpature.,of ~pphcant) ........................ ~ ~ : ~/ ~/~. ~ ~,~,, ~, t~ ~ ~, ~ Nota~ Public, ~&G~..~,:.~~--'-C~ ~ ~ ~~