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Home My WebLink About2747-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~1~3~.9 ...... Date .............Sep.t. .... ~1...., 19.7~. THIS CERTIFIES that the building located at .P. VT. P,D.West. ~e. Exg... Street Map No.. ~ ....... Block No... ~ .... Lot No..~. ~T. ~. ~9~ .~...~ghol~ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ ~g' ' '~9" 19. ~ pursuant to which Building Permft No.. ~. dated .......... }~ay-- .]~ ..... , 19.6~, was issued, and conforms ~o all of the require- ments of the applicable provisions of the law. The occupanw for which this cemificate is issued is . Private .one 'fam$1y' ~e]~¢'ng ...................................... The certificate is issued to .. J~bm. Gamble ...... Owne~ ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Hea]~h Approval .Aug.. ~ .. ]969' · by .R~..V$t~ ... ....... ..... Building Inspector NO~ ~is covers building completed to date, Further additions er other buildings ~ill require ~other pe~it, F01~I ~0. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE sOuTHOLD, N. Y. f N? (THIS PERMIT MUST BE KJ~PT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 2747 Permission is hereby granted to: ,~ohn...(~amt~e ................. : .............................. ....... ............. XO..~tte...Av* .......... : ................ : ..... .................. Smi.t~W~,..~,,.Z, .......................... to ....... ~i~..ae~..oae...f. a~,.1.7. - ~el.~l~ ................................... ,: .......................................... at premises located at ....... ........................ .......: ...................... ~.~ho~,.....l~,~. .............................. : ...................................... ... pursuant to"applica{ion dated .................................. ~.to~e~,.....~LC~, 19~.~..., dlnd approved by the Building Inspector Fee $.:[Qe'O~ ........... Building Inspbctor ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerhficate Of Occupancy No. Z38~3. ...... Date .............. June..30 ...... , 19. T0 ' E/S Sunset Lane THIS CERTIFIES that the building located at . .West..Lane .(PVT.) ...... Street Bay ¥1ew Road Map No. Xx .......... Block No...XX ...... Lot No. , XXX .... Southold..N,Y., ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ Oct ...... t 9'" 19.61+. pursuant to which Building Permit No..27~,.~Z. dated ........ May...11+ ...... , 19.6~, 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 ... Priva.te. one. family, dwellin~ .................................... The certificate is issued to .... ~:ohn. Galnbl~ ...... 0lvner ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval -Aug' '$8' 1969'" 'By' R',' 'Vi~J:a ..... ...... ......... Building Inspector House ~1120 S-9 SCHD DI!P I ,' ,IT'L,. ?, SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. ?--7 z~'-] '~ TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deed location) have been inspected b~ this department and found to be satisfactory. District, Englnee~ ~ District Engineer SUFFOLK COUNTY DEPARTMENT OF HEALTH EASTERN DISTRICT H.D.Ref. No. ~ County Center, Riverhead, N~s~[(~ ! \/~ F~ APPLICATION FOR APPROVAL OF INSTALLED PRIVATE SEWAG~g~0~N~, ~ATER SUPPLY SYST~S Address~~~ Phon~ ~,~ 4-Section No. S-(a)Deed location of property 'SI~ ~u~~.~,%o~' eA~ ~%~s,,r z~,.,,~ rz ~, 9-septic tank-Gal~ ~7~c.W'~' ~t.Liquid DepthS, 5~ ft. (f)H ~ f~. - in; Di~.~3~. - in.(g)Finished grade t~ cover~ ~ ft. (h)Backfill Material~' 6-- _. If Private, the following ~uemtions are ~o be answered: 12-Private W~e~u~ply~ SYSCO, i~talled by. ~ · ~p~u 9ON Phone 13(a)-Total Depth of well ~L~ ~epth to Static Water Level ~4 aS-Name~6~ Labo%atoryA~,~~_~lp-Me~hod of Disinfection i7-Date ready for inspectiom~/f;/(~?~'~,~~' ~. The undersigned CERTIFIES: Aboye sys~s have been constructed and are in compliance wit~ the Suffolk County Health~par~ment's current Standards, Bulletins and ~endments thereto. - ~- -~ / ; ~ f ~ 19-Inser~ sketch of location of Water '~-,~e~erage Facilities with accurate d~ensions. STREET ~ ~ --~ _ , r ¢ _ . ............................................. ~f 2I'T_ _ _ ~_ J3-.-qZ -' _ -~'-',-~ ~a~ ~-L - ~x-~ ~ ......... FOR P~LTH DEPARTMENT ~SE ONLY ~ ~ Based upon the i~tion stated above, satisfactory functioning of the above systems can be expected with proper maintenance and care. Distriot ~g~nee~ S-5e Instructions for Submission of Installed Private Sewa_Ke Disposal and Water System Application Applications are to be submitted in duplicate, Required information should be type~, or legibly printed in ink. Inspectors are not permitted to make inspections of installations until applications have been submitted to and accepted by this de- partment. The item number on the application form and item number listed below are the 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 gap. 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: s/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 if precast sections are used. (e) Give number of leach- ing 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. il. Indicate by check if Water supply is public or private. 12. Name of person or firm who actually installed the water supply facilities° 13. (~) 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.'i~esc~ibe 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. 1~. Application must be signed by builder or owner. Signatures of subcontractor, superintendent, etc., will hot be accepted. 19, Indicate location of Water & Sewerage Facilities with accurate dimensions on sketch. FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .................................. , 19 ........ Approved..~ /'~L/ , 19 ~'~...~ermit No ~ ?~'~ 7 ~~- ............................ ........ A ............. ............... .................... .................... ................................. Application No..,?....Z,.~..(i...~ ......... 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 a detailed description of layout of propertymust be drawn on 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 or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. . (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............... .............................................................................................................................................. Name of owner of premises ......... : ....................................................................... .................................................................... 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: ................................ j'~ .......... Lot No: ..~...J .... Street and Number .~.../~../~.../..~ .A!.....4~...~......~......~.~.~.~ii~y .......... ~..G.~,.-Z....~.~.....4...~. .................. 2. State existing use and occupancy of ?re~ses and intended use and occupancy of proposed construction: a Existin use an' occu anc .~.../:~... ~____,,~:~,//~x · g a p y ...... i....~..~. ........................................................... ~ ................................................. b. J nte nd ed use and acc upancy -..... ,~...~....-~..../.~r~. ~.~........~......'~.........~..........~......~....'~...~.....//~.......~..~ .................... 3. Nature of work (check which apl New Building ........... ~ .................. Alteration .................. Repair .................... Re,.~val ............... ~.~,~Demolition .................... Other Work (Describe) ...................................... 4. Est mated Cost ~..~.~---~---~. (to be paid on fi lng 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 nature and extent of each type of use ................................ 7. Dimensions of existing structures, if any: Front ............ ~ ............. Rear .......................... Depth ............................ Height Number 0f Stories Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ........................................ 8. Dimensions of entire new construction: Front ....~,~.....~ ........ Rear ...~...~m.. ............ Depth .....~....I1~...~. ......... Height ......,~,_.~. ............ Number of Stories .......... .J. ................ 9. Size of lot: Front ..../..~..~......: ...... Rear ...... /.....~......~....~. ..... Depth .......~,....~.....~......~ .......... 10. Date of Purchase ............/...~...~...~.. ....................... Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ........ ,,~ .............. Does '~ co r~__~.iviolate any zoning law ordinance or re ulat on; Name of Owner of premise~/~.~.~4...~.~.~t~..Address/~J~...~.~...~.~.~.~..~..~...~.?./~. ..: ................. whether interior or corner lot. 13. Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor~.//.,~it.,~..l...~,.~../r'_/,Z.'../.'~..~...Address ...'~.~.~..~../.~...~../c....~...~.. ......... Phone No.~..~..~.?....~...~.,~' PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate J STATE OF ~,. COU NW ~~~ above name~ isthe ............................................................................. (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 application; 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 application filed therewith. Sworn to bef~ me this ~ ~ ~~ ~ / ..... ../.~day of . /0 ......... c..,