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Home My WebLink About2503-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. 'Z"'JL~ ............ Date ...................... ~T~I~L~'.~.,...2~ ....... , 19..6.~. THIS CERTIFIES that the building located at ..0~...~l~.e....~.~e .................................... Street Map No ...... ~ .......... Block No .... :~ ...........Lot No .'~1~1~ ......... ~%.~.t1~O~:~...J~,.~, ........... conforms substantially to the Apphcatlon for Building Permit heretofore filed in this office doted ............................................ A~t~t~,' ...~ff19...~b~ pursuant to which Building Permit No .... ~'(~]..~ dated ............................ A~s~,'""~8'"" 19. (:~, was issued, and conforms to all of the requirements of the apphcable provisions of the Iow. The occupancy for which th~s cerhficate is msued is ........ ........... t~ ~v~ce.. ~n~.. ~am~ .~-. d~e.]: !i~g ..................................................................................... The certificate is issued to ..... jia,~.i~i~.~...~'~.C~t'l~[~i~ ..J~lt.~;;J,,l~lJC ..................... QW!~:,S ............... (owner, lessee or tena,nt) of the aforesaid building H.D.Approval Ja~. 20, 1965 by R, Villa vuilding inspector ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TO~.VN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2503 z Date .................... ...~1~.~..... ~1 ................ , 19~ .... Permission is hereby granted Te~ & ~le~el A/C]Barne~ A~eroniea ~'sflek .......... ~..*.~..~.'.~ ..... ~....~:. ........................ Itutld new one £amIl~r dwelling at premises located at~j~l~ 0~.~, ~a].e ~ ........................................ ~.~.~.,. ..... ~.,..~.,. ................................................................................. pursuant to application dated ......................... .A....t~....t~....~.........~. ............ , .~......., and approved by the Building Inspector ............. Bu,lding Inspectd~ SUFFOLK C0~fY DEPARTMENT OF HEALTH Date JAN 2 0 1965 Building Permit TO ~,~qOM IT MAY CONCERN: The sewage disposal facilities for a structure located at District Engineer SUFFOLK CO~fY DEPJ~qTME~ OF ~ALTH Riverhead~ New York Application for Approval to Construct Private Sewage Disposal Sys~em~ To the Suffolk County Department of Health Date .... Application for approval to construct private sewage disposal system is hereby requested concerr~g which the .... follou~ir~ information i~ sub~tte 2~ (~) Deed loc~tion of prope~y ..... :. ~..~.~, ~q.~ ..~ Cellar Slab C ra~zl Space Water Supply . (a) Public System: ; Private Well~__~ "' (Name)' " Distance to nearest ~ ......... ~, Cesspools (a) Numbor o~ pools ,Pr~posed,...S~stem,, (b) Blocks below inlet (1), (c) Block size-L t[~ in.;W. '~, in. (d) Precase pool (e)NooSections (f) Square feet per section 6. Septic tank (a) Inside widt.h~ft; (b)Length , ft, (c) Liquid depth Seepage field (a) Trench ~ W~ , in.; (b)~f%o (C) Number of trenches (d) Depth from bottom of seepage pipe to gro{f~d water .... I hereby certify that I am familiar ~.rith the requirements of the latest bulletin of the "Standards for Private 3e~zage Disposal Systems" and will construct this system in conformance with these standards, or revisions thereof~ prevailing Applicant,s Signature ' /~. ~,: ~ ,, , FOR USE OF TH~ HL.L%~H DLPAR~I~ ONLY an adequate and satisfactory s~wage, disposal system ca.~..~co~structe~.o~' thO"plot, $CH~-~.15 (:evi's,)/ / ..... \ / / h/6l / / [Tant . Capacity~, Gal~. ,~ Test Hole Rata F~t 6 8 12 lndicate PLOT NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ............................... , 1c) ........ Permit No ................................ Disapproved a/c ............................. /'""(Budding In APPLICATION FOR BUILDING PERJv~T // Date ............ , ..... INSTRUCTIONS o Th~s apphcahon must be completely filled in by typewriter or ~n ~nk and submitted ~n duplicate to the Buildm_~ Inspector. b Plot plan showing Iocahon of lot and of buddings on premises, relationship to ad,among premises or public streets o~ areas, and gw~ng a detaded description of layout of property must be drawn on the d~agram which is part of this opphcation c The work covered by this apphcat~on may not be commenced before ~ssuance of Building Permit d Upon approval of th~s opphcation, the Building Inspector wdl ~ssue a Budding Permit to the opphcant. Suck permit shall be kept on the premises available for mspechon throughout the progress of the work e No building shall be occupied or used in whole or in part for any purpose whatever untdo Certificate of Occupanc~ shall hove been granted by the Budding Inspector APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Budding Permit pursuant to thc Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances or Regulations, for the construction of buddings, additions or alterations, or for removal or demoht~on, as hereto described The apphcant agrees to comply with all applicable laws, ord~na~gc~s and. regulat~o~,~ , ,~ ~ , /) / ~lgn~ture ~)f applicant, or name, if a corporation) (/~/dress of al~lphcant)~ ~/ State whether applicant ~s owner, Lessee, agent, architect, engineer, general contractor, electrician, plumber or budder Name of owner of premises ... , ....................... tf apphcant ~s a corporate, s~gnature of dub/authorized officer (Name and title of corporate officer) Location of land on wh.ch proposed work wdl be done Map No~.~/~.~ Lot No ...~. ............ Street and Number .~'/-~ .... ~ ...~-~.. ~ ~~. ~/.~~,...~..,. ~.,. O Mu~lc~palit~ ~ State existing use and occupancy of premises and ~ ntended use and occupancy of proposed construction'/ a. Ex~sting use and occupancy ........ ~ ................................................................. b Intended use and occupancy ...... ~ ...................................................................... 3. Nature of work (check which applicable)' New Building ..... .~. ..... Additton ............. Alteration ............ Repair .................... Removal ............. Demohtion .............. Other Work (Describe) .............. 4. Estimated Cost ......... ~ (~t..~...a~....f.....l~.. ................Fee 5 If dwelling, number of dwelhng units .. ! .. Number of dwelhng units on each floor ./. ................. If garage, number of cars ...... ~ ........................................................................................... 6. If business, commercial or m~xed occupancy, specify nature.and extent of each type of use . . ./~...~ ......... 7 Dimensions of ex~st~ng structures, ~f any Front. '" - Rear ................... Depth ..................... Height ...................... Number of Stones ........ Dimensions of same structure w~th alterations or addmons Front ........... Rear Depth ........................ Height .............................. Number of Stones ....................................... 8 D, mens~ons of ent,re new construct,on Front... ~.~.. ...... Rear. .~ .~.. ............. Depth ..... .~..~ ............. Height ..... ~.~.. .............Number of Stories I. .... 9 Size of lot Front ...... ~....~.. .......... Rear .... ~'.9 '].~ . Depth.../...~. j ...................... 10 Dote of Purchase ..~/..~'.~..~. ................ Name of Former Owner ~~ ........ 1 1 Zone or use district m which premises are s~tuated .................................................................... Does proposed construct on o ~ any zon aw, ord nonce r regular on2 ~['/~ t ................ 12 ~.:'~~' .... ~l~ ...................... 'l..~. ,_ho~e"~l'o 13 Name of Owner of prem ses. ~ Address (~.D~ ~~~ .......... Name of Architect ...................... , .......... Address ................ ~ ............ Phone No ............... Name of Contractor ..~.~..~r~ t~ ·Address .~~~ ......... Phone No.~. · PLOT DIAGRAM Locate clearly and d~stmctly all buildings, whether ex~stmg or proposed, and ~nd~cate all set-back d~mens~ons fro property hnes Give street and block numbers or description according to deed, and show street names and ~nd~ca whether ~ntenor or corner lot STATE OF NEW~R~,J ~ ) ~-c ......................... ~.M~.. being duly sworn, deposes and says that he ,s the oppli¢~ (Name of fnd~vidu' la signing apphcat,on)~_~ ~~ above named He ~s the ...................................... .- ~-c..~..,z~4~.~,-..~ ...................................................... (Contractor, agent, corporate officer, etc ) of said owner or owners, and ~s duly authorized to ~erform or have performed the sa~d work and to make and this apphcat~on; that all statements contained m th~s application ore true to the best of his knowledge and beh and that the work w~ll be performed in the manner set forth in the apphcat~on filed therewith Sworn to before me this ~ ~~ ................ day of .................................. , 19 . r ~ Notary Pubhc, . .................................... County (S~gnature of apphcant)