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Home My WebLink About2827-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No..,~.....2~J.~. ......... Date ........................... ~.q.lt.~.~.~.e..~....3....., 19.~..~... THIS CERTIFIES that the building located at ....~./.~.......~..~..~.~.~g.~..~..~.O..~..~. ..................... Street Map No ...... ~ ............ Block No .......~ ........... Lot No...~ .......... .~...e..~...~..t~..?..'.O..~..~..L...~..~..¥..*.....: ..... conforms substantially to the Application for Building Permit heretofore filed Jn this office dated ........................................ ~1.~. ....... ~.0...., 19.6.~.. pursuant to which Building Permit No ..... ~..~...~.?...Z dated ............................ ,~l,J~t.t.....~. ...... , ] 9..~., was issued, and conforms to oil of the requirements of the applicable provisions of the Jaw. The occupancy for which this certificate is issued is ........ · .~.lva~..one...£amil~...d~e l.ling ............................................................................................... The certificote is issued to ~.eO~.g~ ,T~.a,~. 0~.~. .................................. (owner, lessee or tena,nt) of the aforesaid building· H.D.app~oval ~ov 1, 196% by R. Villa .......................... .......................... FOI~M NO. 2 TOWN OF SOUTHOLD 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.o 2827 z Permission is hereby granted to: Gr~iX],.....Con, Jr'.,, .. Cot p.....A~.C..... Geo~.~Je~. ............... .~.34)(~ ...... ~...I:1,2 ................................. ............... ~l~6fo~4~.....l,..l, ............................... to ....... ~lri,:l,d..ae~..one.,£~,~.t.l~r...d,,~l. IL~ ............................................................................... at premises located at ..E/.S.....(Jr~.t, ht4oJ~,..JJ~. .................................................................................. ............................................... N~w..l~u~.ff-eLll:~ ........ I~,.¥.o ...................................................................... pursuant to application dated .............................. ,]'tl~. ....... .~.0 .......... 19...~, and approved by the Building Inspector Fee $... ,,1,Q.e.d. ........ S-R SUFFOLK COUNTY DEPAHTMENT OF HEALTH Date m~. Pe~t No.~~ TO WHOM 1T MAT CONCE~tN: The sewage disposal facilities for a structure located at have been inspected by this Department and found to be satisfactory. District Engineer 0 C. AI:)AC I TY T~'5'T t./o1..£ DAT"'A , 0 ,, /4- H lC` /NO/CWT-~ ~o~.r~ , /:)LOT PLA N 7-1 SUFFOLK COUNTY DEPARTMENT OF HEALTH Riverhead, New York ~p~lication for Approval to Construct Private Sewage Disposal S[stems ..TY, PE 0H ,~RINTLE~IBLY IN INK To the Suffolk County Department oS Health Date -~-~- q Application for approval to construct private sewage lsposal system is hereby requested concerning which the following inf_qr~atig~ is_s~bm~tted~ ~ ~.,, ~ m.~ ~,~ ~_, ,, Z..~e of applican~,'.~e~ ~%~AP~/Address ~U~ ~, (a,) Deed location of property (~) Hamlet or Village Cellar Slab Water Supply - (a) Public System Name Distance to nearest main (c) ~o~ ,~, ,~/, Crawl Space Private Well 5. Cesspools~ (a) Number of pools ~)~ ('~ Blocks below inlet (c) ~lock si.e-~ I~ in Proposed System 6' Septic tankl I *~ (a) Inside width ,ft;(b)Length 7. Seepage fleldl'..",'I (d) Precast poolI I (a) Trench-W in.;(b)L ft. I I ,,,(e)No.Sectlonsl "' Total--' (f) Square feet per section (c) Mumber of trenches (d) Depth from bottom'of seepage ~ pipe to ground water I ,ereby certify that ! am familiar with the requirements of bulle~in of the Standards for Private Sewage Disposal Systems and will construct this system in conformance with these , revisi thereef, prevailing at the time of construction. Applicants Signature FOR USE OF THE HEALTH DEPARTMENT ONLY Based on informatlon"presente~ hereon' it is the opln~on of the depart- ment that an adequate and satisfactory sewage disposal ~ystem can be con- Signature struc~ed on this plot. ~/61 140,0 FOEM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved .. , 19 ........ Permit No. Disapproved a/c .... Date .......................... , INSTRUCTIONS~ a. This a~plication 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 property must 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 o¢ t.he 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. ...... ..... ................. (Signature of applicant, or name, if o corporation) (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 [and on which proposed work will be done..Map No.: ........................................ Lot No.: ........................ Street and Number ..~.~.-.//~..~F~.~...~..~.~.~..~`?~..~./~.~)~/~./..~./.~.~......~.~...~...~.q~.~Z~ ................. Municipality ~/~,.~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~..~..¢~'.~../ '~'/~ b. Intended use and occupancy ..~...~...L~..~...~.....~....*~ .............................................................................................. 3. Natu~ of work (check which applicable)~ New Building .................. Addition .................. Alteration ................ P, epaF . ................. Removal~j~ ,,.,,-~ .................. DemoHtian .................. Ot~ Work (Describe) ...................................... st m ,ted Cut .......... ......................... Fee ...... ./..U .......................................................................... ~ , z (to be paid on filing this application) 5. If d~ ~lling, number of dwelling units ....... J. ......... ' ......... Number of dwelling units an each floor .......................... If gaiage, number of cars ...... ./...~.~.~.~ .......................................................... ; ......................................................... 6. if business, commercial or mixed occupancy, specify nature and extent of each type of use .......................... 7. Dime nsions of existing structures, if any: Front .~.~'.'~-~. ........ Rear ................................ Depth .................... Heigl~t ........................ Number of Stories ............................................................................................................... Dime ~sions of same structure with alterations or additions: Front .................................... Rear .......................... Deptl ................................ Height ............................ Number of Stories ................................ 8. Dime ,sions of entire new construction: Front ..... ..,,~..~., ................... Rear .~.~... .............. Depth ~..~..:....~....,.~ Height ,./...~....~. ....... Number of Stories ....... .~../14....~. ............................................................................................ 9. Size Of lot: Front ........~..,,.~ ./.-..~.~.. Rear ..... /...~..-.-~'..,....~...~.. ....... Depth ...~..~...~.~....'7~?......~.~.~, 10, Date Jot Purchase .~.~..~'./.,~...~...------ -- .............................. Name of Former Owner~...~.~.,~',~/.~..~..~.~.~.~..~4/~..~/..~,~. 11. Zonejor use district in which premises are situated ................................................................................................... 12. Doesjproposed construction violate any zoning law, ordinance or regulation? ....~..~l.....~,_..,,.:.~.~:..~.j .................... 13. Nami of Owner of prem ses~'.~4~(:~...~.. ~.~..~../~.,~ Address,~.~. ~...~J~'.¢~.~/.~.~... ~(z~..~.~.~.~ Name of Architect ............................... ~ ........... ~.$....Address ............................................ Phone No .................. Name of Contracto~./~.~/~.l..C.~ ..~.~...'~.,~0..~..~.~.~.../~....~.Address~..~...~..~.?~ /J..,~.~-.~.~/'/~.../~Phone No~ PLOT DIAGRAM kocatejclearly and distinctly ali buildings, whether existing or proposed, and indicate all set-back dimensions fro property lir~es. Give street and block number or description according to deed, and show street names and indica whether interior or corner lot. STATE OF NEW~Y'gP~K,,~ ........................ ~ ................................... ' g y we n deposes and says that he is the applic¢ I Name of individual ~gning application) above nambd. He is the .... ~ ............................................................................................................... (Contractor, agent, corporate officer, etc.) of said owl~er or owners, and is duly authorized to perfdrm or have performed the said work and to make and this applic( tion; that ail statements contained in this application are true to the best of his knowledge and belief; that the wc rk will be performed in the manner set forth in the application filed therewith. Sworn t~g~b ff~e me this ...... · ~. ~. day of ........ Notary Pu,~H~,..~.:-~~C~n~/ ~v~ ' / (Signature of applicant) FORM NO. 1 TOWN OF $OUTHOLD ~. BUILDING DEPARTMENT TOWN CLERK S OFFICE 3' SOUTHOLD, N. Y. Examined .. Approved "~' ~i!i '19 ........ Permit No ..... ¢~..~!i.¢L.;/., .-~-- Disapproved a/c ........................... ~.~;~.) ........... r~.,~4';.~.~. ;.... ~. ............. ,~..: ..~'.. ........... Application No. (J/ r~ ~' ' Date. . ~f ............................. , 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 property must 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. (Signature of applicant, or name, if a corporation) ............................... ........................ .... State whether applicant is owner, lessee, agent, architect, ~ngineer, general contractor, electrician, plumber or builder. Name of owner of premises . ,~.¢.~t~.,~,x~. ............................................................................................. 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..Mop No.' ........................................ Lot No.: ........................ Street and Number ~`~.~.~.~.~¢~7~%~t/~*~.~/~~D~/.u~`~/,.~.~/~~e~ /~., 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...~:.6.f~.,~..(..~.~(.~r..~-: ....................................................................................... b. ,,t nde o c,p , y ............................................................................................. 3. Natu~'e of work (check which applicable): New Building .................. Addition .................. Alteration ................ P, epair .................. Rej~ovxal~.~. ........ :~ ..... Demolition ............ z....~,her Work (Describe) .................... ~i....~ ............ 4. Estimated Cost ............................................................ Fee ../..q ................................................................................. (to be paid on filing this application) / §. If d~elling, number of dwellin~? ............................ Number of dwelling units on each floor ......................... If garage, number of cars .......................................................................................................................................... 6. If business, commercial or mixed occupancy,~,specif'z' nature and extent of each type of use ......................... 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ............................................................................................................... L Dime~nsJons of same structure with o.lteratJons or additions: Front .................................... Rear .......................... ~mber D t' Dept? ................................ Height .................... '~ '"'L~'"~ ............... Stories 8. D me~nsio,~/~f entire new construction: Front ~/.~/~)...~.~ ..................... Rear ............................ ep n ................... Height .................... hJu~b~,r ,of Stories ....... ,.~..,~.....~,.,f .............................. ....~ ............................... 9. Size of lot: Front ....~./.~.../.,v..,,..,/ Rear .................................... Depth ............ ~.~ .................. ' 10. Datei of Purchase ........................................................ Name of Former Owner .......... ~. ....................................... Zon~ or use district in which premises are situated ............................................. ~'7' ................................................. Does proposed constr ct,on ...... S'"Z ..... 12. 13. NaJe of Owner of premises .......... '~. ................ '.~...~.'...Address~..J ......................................... Phone No.*~...'....~.i....~... Norde of Architectb*/~/jlt, t-£'c,~L.q//~h,d~c~'Pa~:'"'~ .......... .~ ....... ~m...... ~....(~ ~ ,~zAdd ress ~ ~ ,~5 ~/~Z~ ................ ii~_//j¢.~//~, .............. Phone ,N Nar~e_ of Contractor .................................................... Address .................................... .~,.~y Phone p~o .................. PLOT DIAGRAM kocot~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fn property li~es. Give street and black number or description according to deed, and show street names and indic( whether interior or corner lot. / STATE OF COUNTY '(Name of individual signing above no?ed. He is the of said this applk Sworn to I: Notary Pu ........ being duly sworn, deposes and soys that he is the opplk Jlication) (Contractor, agent, corporate officer, etc.) nar or owners, and is duly authorized to perform or have performed the said work and to make and that all statements conta,ined in this application are true to the best of his knowledge and belief; ~rk will be performed in the manner set forth in the application filed therewith. of JUI)JTH T, BOKEN fldt~Y Publlo~ State of New York No. 5~ 0,~44963, Sl~ffolk C~unty g~mm~lml Exp~es M~rch 30~ (Signature of applicant) ~" g,O S S ~'~ECTIOJN 0 1', .I ¸'i