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Home My WebLink About2107-zFOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate ,Of Occupency No. Zl~..~ ...... Date .............. I{O.V.... THIS CERTIFIES that the building located at . .P.¥.~..l~.0.a.d..~. }il/.65~. ..... Street Map No. ashby. 01)4. Block No..X~ ...... Lot No..:aXX .... Qret~lripo~.t .. N.,.~, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... J~rie.. ~.~.., 19.6.~ pursuant to which Building Permit No. 2~0.~.. dated ........... Jlme.. aB.., 1963., 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. riva.te, one .family. dweZllng ..................................... The certificate is issued to .Joaeph. & .Eve..1.yri. B~atffi ..... 0wrt~r.s .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. $.e.p~. 1.6. Building Inspector/ FORM NO. 2 'l'OWbi OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, bi. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2107 Z Permission is hereby granted to: ...... ................. ............./ ~ -~ ~. r..z.L:,..:..~,..,~/.....~L.I.: ..................... ..l(.,/~.~:.~.z...~...~..~,~.,.;: ........... ,4.,..z,~ ..................... pursuant to application dated ........... .~.bt. Lb.~.l::.~.. ~...~.. 19 .~.~, and approved by the Building Inspector ouilding Inspector ......... / ......... THE SOUTH SHORE ANALYTICAL. &' RESEARCH LABORATORY, Inc. e'Servi~sg SNffolk C Olillty Stnce 1 1481slip Avenue, lslip, N.y. 1]75} · (516) JUniper 1-2710 WATER REPORT ~-234o Laboratory Accession No.: 97] SubmiHed by: d* BRAUN (H. UACOBI) Date: Source of Sample: R-O~d. 9//S ~TH ~T~ ~R~r~PO~T~ NY Distance from possible sources of pollution: Collected by: H. ~OLDMAN Date started: / Date completed: c~ ~, (1) STANDARD PLATE COUNT/mi 24 hoursat 35°C. ' , . Cc~ ( Multiple Tube Fermen*atlon. Incubation at. 35OO C. Lactose broth ~24 hqprs ,4B he,Is BrJllim~t Green Broth .... (3) M.P.N./I00ml of sample ....... ' ...... - · · Results of the Bameriol~ical ~xaminatJon of this SampJ~ indicate that ff was of B~etertoJ~jcal Quali~ when r~eJved.I / CHEMICAL EXAMINATION Component Nitrate (N) .'~, ~2. ppm pH value ~,. (/ Chloride (CI) 50'., O. ' Free Ammonia (N) Detergents .j(~q~ ~1 Q ~t ~, ~ All examinations are in accordance with procedures given Jn Standard Methods for the ExominafJo~ of Water a~ Wastewater' 13th Edition 1971. A.P.H.A.A.W.W.A.W.P.C.F. FORM NO. I TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No..~...L..0....~. .......... (Bu/lding Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot' and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving o detailed description of layout of property must be drown on the diagram which is part of this application. c. The work covered by this application rnoy 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 progress of the work. e. No building shall be occupied or used in whole or in pa rt for any purpose whatever until a Certificate of Occupancy shall hove 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 oic 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 and regulations. , ~rure ~ app ' , e, if o corporation) .... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. owner of premises ...~~/'...~....~,w~..-~.. ............................................................................ Name of [f applicant is a corporate, s~gnature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... Street and Number ...t/~Z.~....(~. ~,~~.. .~__ ~ .'.~..~./. ~~ .................. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy ................................................................................................................................... b Intended use and occupancy ................................ /~.~' ' 3. Nature of work (check which applicable): New Building .~..,~..'~... Addition .................. Alteration Repair .................. .~Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Est!mated Cost ...... ~.~...~...~.., ..................................... 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 natureand extent of each type of use 7. Dimensions of existing structures, if any: Front .......................... Rear .......................... Depth Hei~ght ............................ Number of Stories Dim.'ensions of same structure with alterations or additions: Front ................................Rear Decth ............................ Height ................................ Number of Stories ........................................ 8. Dimensions of entire new construction: Front ........ .~..~.~ ........... Rear ...~,~..*~.. ............ Depth ......~...~....~..~., .... Height ..... ~/~..~..~.~ ........... Number of Stories .......~.~.~ ................ 9. Size of lot: Front ..... /~.~'..,~..~., .......... Rear .../,~..~'.../~...'. ........ Depth ...... ¢.~..Z~:..., ................ 10. Dot? of Purchase ....,,,~¢~.....L~..~..[ ....................... Name of Former Owner .~..~.....~ 11. Zone or use districtL/in which premises are situated .......... 12. Do~s proposed construction violate any zoning law, ordinance or regulation? ..... //~..1~. ................ 13. Name of Owner of premises ...~'J..~~ressL..~..¢~.,4~d~. ....... Phone No. Name or ,~rcnitect ..................................................... Address ............................................ Phone No. ...~, ~ PLOT DIAGRAM Loca~e clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions fr property lines. Give street and block numbers or descriptig~ according to deed, and show street names and indic whether irfferior or corner lot. STATE OF NEW/;C'ORJ(/ ,,// COU NTY/7OF :z~~ S.S. · "~'¢'~'-~ bern' d I ............. ~'_~.? ............................................ g u y sworn, deposes and says that he is the applic ~/(Nar~e of individual signing application) above named. He is the ........ ..~..¢~ ! (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have perforrned the said work and to make and this application; that ail statements contained in this application are true to the best of his knowledge and bel and that (he work will be performed in the manner set forth in the application filed therewith. Sworn to I~efsre me this JUDITH T. Notary Public, State of New York ---~' ~ NO, 52'0344963 %~0 ........... of