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HomeMy WebLinkAbout3058-zFOR~ NO. 4 ' "TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Z..3442 ...... Date ....... Apl:il... 14, ......... , 19 .6.9.. THIS CERTIFIES that the building located at . . r.een ay ......... Street Map No. Green ...... Block No ........... Lot No. 31l,...O~ient, .Ne.w .Yo~.~; ...... Acres conforms substautially to the Application for Building Permit heretofore filed in this office dated ....... April.. 19, .., 19.66. pursuant to which Buildin§ Permit No..3.O~{~..Z.. dated ....... Apt. il.. 1~,. ., 19.6~., was issued, and conforms to all of the require- ments of the applicable prowsions of the law. The occupancy for which this certificate is issued is ... pr. irate, on~ .fa~.ly. d~ellin~ The certificate is issued to (owner, lessee or tenant) of the aforesaid building. SuffoIk County Department of Health Approval .~lo.v.e. mbe~:..14,..1.9~.6.,..R..o.b.o.l;t..V.l.J,, la Building I~pector FORM ~0. 2 TOWN OF SOUT~OLD I~UILDING DEPARTmEnT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, BLIBLDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 3058 Z Date ......................... ~.~.~1 .......... ~..~ ........ , 19~6... Permission is hereby granted to: ...... ~T~a ,~ e~..~.~e~ .......................................... .......... ~2...Ge.:[~n.i-at...AYe ................................. ................ ~.~.~ .~ ~ ...~ .~. ~ ................................. to ~'a:L ],O,.. =e~*. · .o~.. ~.ara ~..1.~.. ~.~we :,~,.~&.~ ...................................................................................... at premises located at ..... ~.~....3~.~......F~.~..~,(~:F~8 ......................................................................... ........................... ~/'~ .....G~.~m~...~e ~.~ ~. ....... ~.~.~.....~&.~ ................................................... pursuant to application dated .......... ....................... .~.~......~..~. ..... 19~.~.., and approved by the Building Inspector Fee $'"~-'0~ ©0 ......... Budding Inspector s-9 SUFFOLK COUNTI DEPARTMENT OF HEALTH Date Bldg. Permi% No. WHOM 1T MAY CON~E~N: The sewage disposal facilities for a structure located at (Give deed location) -" have been inspected by this Department and found to be satisfactory. D~s~riog Enginoe~ -~-'~ " ..... District Engineer SUFFOLK COUNTY DEPARTMENT OF HEALTH EASTERN DXSTRICT County Center, Riverhead, New York PA ?-4?00 APPLICATION FOR APPROVAL OF INSTALLED PRIVATE S__EWA~E DISPOSAL A~D WATEE SUPPLY SYSTEMS Inapection for approval ia requested, pertinent installation data herewith. ~' 2-Name of Builder~o~/~ ~l~ Phone~/~-~7~ 5-Lot Number ~ . 8-(a)Deed location of pr%perty~SG~m~M 9-Septic tank-Gal L__ft.W ft.Ltquid Depth lO_Cesspools-(a)No.pools~(b)B19cks be%~,w in!et-l) __2) _ 3) (c)Bl?~k siz~L .~ i~.W~ '~n.H ~ ~ imJ(d)P~ecast pool M~ '(e)1~2~3 (f)~ft.~i~Y. ~ 'in'.'(g)FXnished g~ade ?o 'coV~{ ' (h)Backfill ~a~erial~, ll-~aCer Supply: Public Syst~ , ; ~rivat~ ~ell~ , If Private, the following questions are to be~nswered. . 13(a)-Total 9ep'Yh ~f'~ell ~ ~ '.' (b~Depth Co Static Water Level , / 15-Name of Laboratory~ ~ / ~j 16-Method 0f Disinfection The undersigned CERTIFIES: ,~bove syst~s have been constructed and are in complianc~ with the Suffolk County HeaLth Department's current Standards, Bulletins and ~endment.s 19-Yns~t sketch of location of ~aCer ~ Se~era~ Facilities with accurate d~en~ons. STREET F~ ~AL~ DE~ENT USE ONLY .. ased up~ the info~a~ion stated abo~e, satisfactory functioning of ~he above syst~, can be expected with proper m~na~ care.~ -- ~ Eng'Jneer Approved ........................................ , 19 ........ Permit No. TOWN OF SOUTHOLD BUILDING DEPARTMENT SOUTHOLD, N. Y, Disapproved a/c .......... APPLICATION FOR BUILDING PERMIT Date ...................... ~p]~JL1 .......... 1.9. ............ t9..66 ...... 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 drown 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 o 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. Mrs M. ...................................... ~t' ('') (Signature of applicant, or name, if a corporation) ........... ola.,...L.,.I., ...... / (Address of applicant) whether applicant is owner, lessee, agent, architect, engi~/0~', general contractor, electrician, plumber or builder. State ........................................... :'::....... ............ ................................................... ' ............................................ Nome of owner of premises ........ ~.o.~e.~'l..~...2o. zz,.O ........................................................ :"iF' ':": ........................................ applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work wilt be done. Map No.: ...0r.e~n..,~e~.es ........... Lot No.: ....~.~. ............... Street and Number ..... G~.e.enu. a~.....~,~.e~¢,.....O~.~.e~.¢t...~T.,:Z. ........................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ .~.~o. az~...].~d ................................................................................................ Intended use and occupancy ......... o.~'le..,~.9,,m~.],.~r...el~e.t.]:.~.~§ .......................................................................... 3. NatUre of work (check which applicable): New Building' ...:K,3LXZ3;... Addition .................. Alteration Repair .................. Removal .................. Demolition ............ ' ...... Other Work (Describe) ........................... ;... 4. £stirhated Cost ,~L6.~.QOD.,.~/..~ .................................. Fee ,.~0 ...... i (to be paid on filing this application) 5. If d~elling, number of dwelling units ........ .a~e. ............ Number of dwelling units on each floor If g,~rage, number of cars ................................. ~. 6. If us~ness, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dim ~nsions of existing structures, Jf any: Front ............................ Rear ................................ Depth He~ht ........................ Number of Stories Dim ~nsions of same structure with alterations or additions: Front .................................... Rear ' Dep'h ................................ Height ............................ Number of Stories ................................ 8. Di~ ensions of entire new construction: Front ...... ~.~..~.,.~ ................ Rear ..~.~...~...6 ............ Depth ...~6~..~.~.. Hei~lht .................... Number of Stories ..~ff ........... 9. Size of lot: Front ........ [6~ ............. Rear ................... [6~ .......... Depth ....... ~..&26 ..... 11. Zon~,e or use district in which premises ore situated ...... 12. Doeb proposed construction violate any zoning law, ordinance or regulation? .......... ~...~. ................................. NaCe of Architect ...................................................... Address ............................................ Phone No. / Na~e of Contractor ..... S'~¢ ...................................... Address .....s&~e .............................. Phone No. PLOT DIAGRAM ' l_ocot~ clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-back dimensions property I nes. Give street and block number or description according to deed, and show street names and' whether in erior or corner lot STATE O~ NEW YO~K, ~ ~ ~ Name of individual signing application) abow~ nan~ed. He is the ..................... ~.~.~...P.~...~fl~.. ~ (Contractor, agent, corporate officer, etc.)] of said o~ner or owners, and is duly authorized to perform or have performed the said work and to make; and this application; that all statements contained in this application are true to the best of his knowledge and belief; that the ~ork will be performed in the manner set forth in the application filed therewith. Sworn to ~efore me this , ~e m Expires ~arck 30, 19~9 Approved ........................................ , 19...~... Permit No. 'TOWN OF SOUTHOLD ~ c~-,.~ s ~',~,., "'7~,..~-.~ BUILDING DEPAR?MENT TOWN GLERK'S OFFICE S~THOLD, N. Y. ........ Disapproved a/c.~ ............... APPLICATION FOR BUILDING PERMIT Date ...................... ~,]~rll .......... :L9. ........... , 19..66 ...... 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 5outhold, 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. Mr~ M. Gre~.~;klg.~...A~..q...J.a~.e.]~h..~z',e~;.~z ...................................... '-T~, C'~ (Signature of applicant, or name, if a corporation) ~ ........... .~..8~..g.~ lanlal ..&v.e.....Minao 3a, ...L., .h ...... ~ / (Address of applicant) State whether applicant ~ner, lessee, agent, architect~r.,...general~ '~'-- contractor, electii~ian, plumber or builder. ....................................................... JLge~..o.f-.~.~ ................................................... ' ............................................ Name of owner of premises .......,IQ~e;z.h..,Zr,~z~.o ........................................................ i;.,!:~-..~.-; ........................................ 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.: ...Gz'.ee.n..J~¢r.e~ .......... Lot No.: ....3~Z ............... Street and Number ..... t]~.ee.n~a¥.....l~e~t~.....O~..~r~t,~...N,.~ .......................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ .~.~.c.l~..~aJ3C~ ............................................................................................... b. Intended use and occupancy ......... o~e...~ca~.4..].¥.,d~e3.Z..¢n8 .......................................................................... 3. Nature of work (check which applicable): New Building ...~.~... Addition .................. Alteration ............. ~... Repair .................. Removal .................. Demolition .......... ..':.::.. Other Work (Describe) .................................. .~... .!... 4. Estimated Cost .'I6,.Q0~)...P~.~ .................................. Fee ..].C) ........................................................................ .~.. ...... (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... ~ ............ Number of dwelling units on each floor ............................ If garage, number of cars ................................. .~o. ............................. i .................................................................... ~. 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 of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ...... .~'~...::...6 ................ Rear ..~,~....-....~ ............ Depth ...2~/....Li'.~ ...... Height .................... Number of Stories ...~ ............................................................................................................ 9. Size of lot: Front ........ ~.~.br. ............ Rear ................... 3~6.~. ......... Depth ....... ~..~...12~ ..... 10. Date of Purchase .................. ..]:.~.~..~'.. ........................... N~ne of Former Owner ...... ..G..~...e..e..D...~..~.~....~...e..~...]:~.. ............. 1 1. Zone or use district in which premises are situated ...... !~.AJ.~...~i,~t ............................................................................ 12. Does proposed constr~ction violate any zoning law, ordinance or regulation? .......... ,0,1t ............................................. ~ Mineola, N.Y. 13. Name of Owner of premises ..~,~e~)]~..~l~e.~z.~l ...... Address ..~2..D. oLen~aL..A~.e.,.... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ..... ~'~. ..................................... Address .....sa~e .............................. Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fram property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW YORK, ~ e c COUNTY OF ....~f.f~lk .......... ~'~' .............................. ~r~....~l,~]~. ..................................... being duly sworn, deposes and says that he is the applicant (Name of individual sigr~ng application) above named. He is the .....................~,~.~....~.~...~1~'. .................................................................................................. (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 before me this .................. day of ................ ............... ..... / / --~,,,~ , ~ ,.,,~_ _ ~/- ...,//,,-'7~/,~.....,,~..~.,...~~ ................ Notary Public, .~.¥..~.~....~...:....~.... County (Signature of applicant) MAR]ON A. :TeTm Expires ~rch 30,