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Home My WebLink About2237-zFO~M NO. 4 TOWN OF SOU~HOI. D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ..H~,~'£1owe~...Rc~..&.~.es.tvSe.~...D~. ..... Street Map No..~ .......... Block No ......~ ....... Lot No ......... ~ ....... ~9,~.ti~ll~:~...N~.y~ ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....................................... [JO~r~'J~l?...~..., 19~3... pursuant to which Building Permit No...22..~.~. dated ............................. ~:¢.~,~L~ler...~..., 19.~3.., was.issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ............ ~.:Lv~,~ e...o~e...~.a~:~. · ~we 1. ~.r~ .................................................................................... The certificate is issued to ....~'~:~es..~.~.~.~l~t ............. ,, ........... (~,~ ............~ ................................ {owner, lessee or tenant) of the aforesaid building. H.g. Approval June 1, 196L~ by Ro Villa Buildin~ Inspector [ FO]~NI NO. ~ TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWbl CLERK'S OFFICE SOUTHOLD, N. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 2237 Z Date ...................... l~v. emb~ ....... 1 ........ , 19..~]. Permission is hereby granted to: ]~.e~.. ~te3-.~;~,~.....,~/~.....,Te~es.. ~$~.~.~.. ........ ,,. · ..Ne ~. · -,S~'o;g~--. ~ .................................... to ..~u~;l,~,..~m~..eae...t.a~$.~.¥..~e.:L.]:~ .................................................................................... at premises located at .......~,~[~e,~,,~j~Oa4j..~,,~,lS,e~.,~.~e~..~ ............. .................................... ..................... , .......................... ~-t~ts- .~.~,e~.. · ~ ~. ~ ~ ................................. ~ ........................................... pursuant to application dated ........................ ~..~.~. ....... ]J ........ 19..~., and approved by the Building Inspector Fee $..&O,O0 ......... Building Inspector 8~ND SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Jone ll~ 196h Building Permit No. TO WHOM IT MkY CONCERN: The sewage disposal facilities for a structure located at ~estview Drive ~md Mayflower Place~ Mattituck (Ki~ins) (Give deed location) have been inspected by this Department and found to be satisfactory. District Engineer SUFFOLK COD?~TY DEPARTMenT OF HEALTH ~iverhe~d~ New York A. pplication fo? Ap.p..yoval to Construct Private_ _ Sewage D~s~posal System~ TYPE OR EtINT LEGIBLY IN INK' To the Suffolk County Department of Health Date Application for approval to constr~ct private sewage disposal system is hereby requested concerning which the following information is submitted~ 1. Name of appliaan~ ................. Address.. 2, (a) Deed location of property ............ (b) tIamlet or Village ..... (c)Town 3. Cellar 4~ Water Supply - (a) Public System: Distance to nearest main Slab (Name) Crawl Space ,$ Pr~ate Well F__rop9 s_e~ .S~stem Cesspools 6, Septic tank (a) Inside width __ft; (b)Length... (b) Blocks below inlet (1) (s) 0)_ _ (c) Block size-L~in,~W, ......... in, (d) Precast pool (e)No,Sections . (f) Square feet per section ft. (c) Liquid depth~ .... 7e Seepage field L (a) Trench - W ino~ (b)~ft, (O) 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. Applicant~ s Signature ..... FOR USE OF THE P~EALTH 1.DEPA~TME~NT ONLY Based on infoz~ation presented hereon it is the opinion of this department that an adequate and satisfactory sewage disposal system can be constructed on this plot, Date Signature .) ........ ............. 4/61 Indicate North Well Data P ~ / I-- ~apacity ....... G.P.M. Test Hole Data _Feet PLOT PLaN 0 2 16 18 2O SUFFOLK OOUNI~Z DEPART14~T OF HEALTH Riverhead~ New York Appl±,cation for App~wage Disposal Systems TYPE OR PRINT LEGIBLY IN INK To the Suffolk County Department of Health Date Application for approval to constructmprivate sewage disposal system is hereby requested concerning which the following information is submitted: 1. Name of applican~ 2. (a) Deed location of property (b) ttamlet or Village 3. Cella~ Slab 4. Water Supply - (a) Public System: Distance to nearest main 5. Cesspools (a) Number Jf poo--~ls (b) Blocks below inlet (1) (2) (3)L,",',', (c) Block size-L in,~W, .... in, (d) Precast pool (e)No.Sections,, (f) Square feet per section Address , Crawl Space .......... ~ Pr~ate Well (Neme) ............. .Proposed__System 6, Septic tank (a) Inside width ft~ (b)Length_._~ft. (e) Liquid depth_ ..... 7. Seepage field (a) Trench - W_~ ......... in~ (b)~ft. (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 "Staudards for Private Sewage Disposal Systems" and will const~et this system in confozmance with these standards, or revisions thereof~ prevailing at the time of coustruetion. Applzcant s Signature... , FOR USE OF THE HEALTH DEPARTMENT ONLY Based on information presented hereon it is the opinion of this department that an adequate and satisfactozfff sewage disposal system can be constructed on this plot. Date Signature . G~ade '~ G r~nd___ Well Data I --~apacity Gals, ........ G,P.M, T~t,Hole Data Indicate North ' PLOT PLAN , O 2 10 12 16 18 2O FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFF~CE SOUTHOLD, N. Y. Examined ......../~....! ........... , 19.....0.-~ Approved .............................. ~ ......... , 19 ........ Permit No ................................. Application No APPLICATION FOR BUILDING PERMIT Date .................... ......... ,19..6.3 .......... \ INSTRUCTIONS .,.:,, o. This application must be completely filled in by typewriter or in ink and submitte~ in dul~lidqte to the Building . nspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premisesi'~.public streets or areas and giving a detailed description of layout of property must be drawn on the diagram which is part ~f }~.is application. c. The work covered by this application may not be commenced before issuance of 8pi[d, ing Permiti d. Upon approval of this application, the Building Inspector will issue a Building ~r~it to the ~pplica~t. 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 ci Certificate~ of Occupancy shall have been granted by the Building Inspector. '~"~ APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Build)/~g Permit pur~suant to the Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other app [,Cable Laws, O~dmances or Regulations, for the construction of buildings, additions or alterations, or for removal or demol.itiOn, as hereir~ described. The applicant agrees to comply with all applicable lows, ordinances and regulations. E:ug.ene. Hot .t. on, .:' ...... '.~.":, . ................... (Signature of applicant, 'Or name, if,,o',~corporation) New Suffolk ' ,1, (Address of oppl cont)l' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,'plumber' or builder. ............................ O.or~l~cact.%o~' ......................................................................................................................... ~,~.... ............... Name of owner of premises .......~T~I/(~$.. ~.*t ~&.ris...~¢.. ~.~.lP..e ............................................................... ~ ........ ,,i...!?....). ........... If applicant is o 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: ..............~ ................ Lot No: .~.L..~ .... ii ' i' Street and Number ....~;F-fZowe~..&..~[e~t,...¥;law..Ro.~d ................ ~.¢.t~;~.~3~.~.k ........................ ~ ............... Municipality , , 2. Sl'ote existing use and occupancy of premises and intended use and occupancy o~ proposed constr,ucfion: a. Existing use and occupancy V~%Oalq~3 10~ ' b. Intended use and occupancy ......... O~e...~'&t~...C~,~,"k].~g ...................................................... i.. ................. whether interior or corner lot. 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost .......... ~,~l.t.~00 ................................... Fee ......:'LO (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... OIJ~ ............Number of dwelling units on each floor If garage, number of cars ........... 6. If business, commercial or mixed occupancy, speci fy nature.end 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 ....... li,l~ ................... Rear ............ tJ~,......i' .... Depth ..... 60 ............. Height ............................Number of Stories ............ ~l~ .............. 9. Size of lot: Front .......... .~1.(~) .............. Rear ........~(~) .............Depth .....'1~0 ...............~),. ........... 10. Date of Purchase ........................................................Nome of Former Owner .......... ';....~ 1 1. Zone or use district in which premises are situated ...... .]J, tt"'j~' ' ' 12. Does' propose, d construction violate any zoning law, ordinance or regulation? ..... 13 Name of Owner of premises ...~Ti....j~4r,ll~ll. ff ............. Address .................................... . ........ Phbne No. Name of Contractor ....']~e'~'..}[~ll ................ Address ........................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate.~all set-back dimensions property lines. Give street and block numbers or description according to deed, and sho~. street names and indic .) STATE OF NEW YORKi ) COUNTY OF~.~,O.'I.~ ............ ) S.S. ................. ][~,~....}[O~t,O~. ..................................... being d~jly ~worn deposes and says that he is the (Name of individual signing application) ~ above named He s th" .. . .~,~.,~,, ..................................... ..1. ...................... ~' (ContractOr, agent, corporate officer, retc ) of said owner or owne,rs and Is duly authorized to perform o~ have.? performed the said work and tp make ~and this application; that.glt statements cgntai~d~linr tJ~E~pplical~ion are true to the best of his knowledge ar~'d bel and that the work wil b~e performed l~!~,hb~H~er0s~wf~t~h n the application filed therewith. Sworn to before me t}9~s r ,hr, ~sro~ ,~ ".- ; ~