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HomeMy WebLinkAbout2466-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at -~.~,..~]l,~-e ........................................ Street Block No. ...................... Lot No.10~.i......I~.O.~O~:J,~t.$..A~J .~,~. ........................ conforms substantially to the Application fpr Building Permit heretofore filed in this office dated ...................................... ~1~1~......23 ........ , 19..~.. pursuant to which Building Permit No...~.~...6.~...g. dated ............................ ~.1,1~.....2~ ........ , 19...(~.~., 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 ........ ....... ~.r.i.v.a.~a ..~:~ne... f.e~d, ly...~.welli~ ......................................................................................... The certificate is issued to ..... .~],Z~.~L./L~..~,~,ll~,~,O ............ t0~el~. ............................................. (owner, lessee or tenant) of the aforesaid building. H,D,Approva~ July 6, 1966 by R.Villa ...... ....... Building Inspector FOI~M NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2466 Z Date ............................... Zll.~T. ....... 2~t ....... , 19.(~.. Permission is hereby granted to: ....... WJ. ll:~. J~....1~3..:1.~, ............................... ................. ~.9~+.~ ....... ~,v~ ............................... ................... J~l~zeat..Hil].~.,~l. :~. ............... to ...... ~l~:Ll.~,.rmw...one..£~m~.~,~..4we],~.~.~ ................................................................................. at premises located at ...... :Lot.....ZO~.t......~..~.~..~o~.e..~t~ve$ ........................................... ................................ ~/S.....~s...~ee, ............. l~*'om:l;c.t......N'~.L~ ........................................ pursuant to application dated .................................. ~1~1.~ .......~ ..... 19.(~.., and approved by the Building Inspector Building Inspectlr SUFFOLK COUNTY DEPARTMENT OF HEALTH EASTERN DISTRICT County Center, Riverhead, New York PA 7-4700 H.D.Ref. No. SO-~ APPLICATION FOR APPROVAL OF INSTALLED PRIVATE SEWAGE DISPOSAL AND WATER SUPPLY SYSTEMS Inspection for approval is requested, pertinent installation data herewith. 1-Name of Owner WilliamA. Mull~o Address 99-4~ 66th. Ave. Forest 2-Name of Builder ~afeway Cumto~,l Bldrso0Or~Phone281~280 Address BOX B, ~birle~. M. ¥. 7-Sewage System installed by H & ~ Dra'~l~e Addressl?60~Street~ Deer Pa~k. N, Y, 8-(a)Deed location of property Bl,2'%~M Lar~. Peoor~os ~. ~, (b)Hamlet or Villag~ .(c)Town 9-Septic tank-Gal L__ft.W ft.Liquid Depth ft. lO-Cesspools-(a)No.pools ~ (b)Blocks below inlet-i)__2)__3)- (c)Block stze-L ~ in. W16 in.H 8 in.(d)Precast pool (f)H ft. in; Diam__ft.__in.(g)Finished grade to cover (h)Backfill Material ealld ll-Water Supply: Public System ; Private Well yes If Private, the following questions are to be answered: 12-Private Water Supply System installed by 8we~ay & Address ~3~ ~d~ ¥~k, ~. Y. 13(a)-Total Depth of Well (b)Depth to Static Water Level 14-Diameter of well pipe in. 15-Name of Laboratory T.~mmn t~b. 16-Method of 17-Date ready for inspection 3-Subdiv.~ 4-Section No. ~ 5-Lot Number 107 6-Bldg.Pemit No.2466 PhoneMO,?-~l~2 3 Phone-~Jk~Am_~k_ The undersigned CERTIFIES: Above systems have been constructed and are in compliance with the Suffolk County Health Department's current Standards, Bulletins and Amendments thereto. 18-Date 3/2~/66 ._Signed/~%~/~., ~ ,,. ~,~z ~Z~ tl .~, -~,"/.~,/-,, ~ 19-Insert sketch of location of Water & Sewerage Facilities with accurate dimensions. % I Inspected by //-~./.f~ /~-~ff 2~ Date~'-/~-~'~. Base'upon the info~ation stated above, satisfa~or~[u~oning ~ ~ JUL ~ ~ ~~ ~ ~ Date Approved ~t~iot~ineer ~ S-5e Instructions for Submission of Installed Private SewaKe Disposal and Water System Application Applications are to be submitted in duplicate. Required information should be typed or legibly printed in ink. Inspectors are not permitted to make inspections of installations until applications have been submitted to end accepted by this de- partmenm. The item number on the application form ahd item number listed below are the same: 1. Owner's name and address - if owner and builder are same, so indicate. 2. Builder's name and address - approvals will be mailed to this address. 3. Give name of filed realty subdivision map. 4, ~ Section number of realty subdivision map. 5. Lot number of plot on which disposal unit is constructed. 6. Building permit number assigned by the Building Department. 7. Name of person or firm who actually constructed the sewage disposal facilities. 8. (a) For example: 8/s Jones St., 100' e/o Smith St. (b) Hamlet, (unincorporated area in township), for example: East Moriches. Village (incorporated area), for example: Northport. (c) Township, for example: Brookhaven, etc. 9. Give inside length and width in feet. Liquid depth is measured in feet from bottom of outlet pipe to bottom of tank. 10. (a) State number of pools. (b) State number of blocks below inlet pipe for each pool. (c) State length, width, and height of cesspool blocks in inches. (d) Indicate by check ti precast sections are used, (e) Ctve number of leach- lng sections per pool. (f) Give height and diameter of each leaching section. (g) Give depth in feet from finished grade to cesspool cover. (h) Describe backfill material used. 11. Indicate by check if water supply is public or priD~te. 12. Name of person or firm who actually:.in~talled the water supply facilities. 13. (a) Give depth in feet from top of well pipe or casing to well point. (b) Depth in feet from top of well pipe or casing to water level in well. 14. Inside diameter of well casing. 15. Name of laboratory performing the examinations. 16. Describe method of disinfection, for example: quart of laundry bleach in ten gallons of water poured into well and allowed to stand six hours. 17. State date on which installation will be ready for inspection. 18. Application must be signed by builder or owner. Signatures of subcontractor, superintendent, etc., will not be accepted. 19. Indicate location of Water & Sewerage Facilities with accurate d/mensions on sketch. TOWN OF sOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Disapproved a/c ..., ........ ....................................... (Building I~lCpect~r) Application No. ~V ~ ~' APPLICATION FOR BUILDING PERMIT Date .... ~T .u..1.~..2,3 19 6b' INSTRUCTIONS a. This application must I~e 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 a detailed description of layout of propertymust be drawn an 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 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, additions or alterations, or for removal orxd, emolition, as herein described. The applicant agrees to comply with oil applicable laws, ordinanc~e'~ builcj,igg code c~c]/r~gulations..¢~, J~ignature of,pp', ?~[nam, 'fa corporation) ... z. ?. ] (Address of applicant) State whether applicant is ,owner, lessee, ag~r~t, architect, engineer, gene'rol contractor, electrician, plumber or builder. Agent Name of owner of premises William A, Mullio ~ 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: ...2z..P.9..c..o..n..i.9....S..h..o.,r.e..s. .......... Lot No: ...1..0..7. ........... Street and Number Burtis Place . Municipality 2. State existing use and .occupancy of premises and intended use and occupancy of proposed eons;trl~ctian: None ,. , . ='*:-~x,s,.n~ use and occupancy ..................................................................................................... , ........... ¢..?....~ ....... b. Intended use and occupancy ~Jwez±zng 11. 12. 13. Nature of work (check which applicable): New Building ..... .z. ........... Addition .................. Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ...................................... 000 Estimated Cost .......................................................... Fee .......................................................................................... (to be paid on filing this application) C~e If dwellin§, number of dwelling units ......... ................... Number of dwelling units on each floor ...... .' ..................... If garage, number of cars ........................................................................................................................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use .......... ~. ..................... 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 ........... ". ............................ · Dimen~!ons of entire new construction: Front ...... ~..~f~.'b ........ Rear 24 feet Depth 28 feet Height .....~..~.e..e.~ ......... Number of Stories ..O~...e....w./.~.?;..a..o..n.[..8' x 24' Siz~ of lot: Front ......... ~.~...,~e.e..¢...... Rear ...... ~,~...~..e.,e.~ ........ Depth ...,1.~,l...~.e..e..¢. ............. Date of Purchase ........................................................ Name of Former Owner Zone or use district in which promises are situated ................................................................................................. ,, . . p ................................................ ~To .. Does proposed construction violate any zoning law, ord,nanmq,r~reg~Latjqp.~: Name of Owner of' premises !..~..i..1..1..i.~...A..:..~.u..1..1..i..°.....Address ~..oz'.e.$.-h.~id.].s.,...~Y ........... Phone,No..I..L...~..-.~.~..1.~... Name of Architect ...................................................... Address ............................................. J~hone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM [_acute clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block numbers or~ description according fo deed, and show street names and indicate whether interior or corner lot. Lc)'/ STATE OF NEW~YO. gI~J//~J/~' 1 SS ~ ~.e].l~ T~. MUllJ..o., be n dui,) sworn, 'dep'o~es and says thatene is the applicant (,Nam~db_Oef individual signing application) above narqed. I~t is the ........ .A.~;.e..n.~ ....................................................................................................................................... : (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 applicgtJon; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the a,p$1ication filed therev/ith, -3 , a . Ju . , ......1964 '. ~-t, lew york] · . .... Notary Pubhc, . ~ ............ .~.. County oture of ...................................... · xO~' MAC or LANO WILLIAM /~. ~V~ULLIO A~ '~c~le : .,,40 '= I"