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HomeMy WebLinkAbout3343-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at W /.JJ..~J~JfJ~l.~.~L~.~..]~:~ ............. Street Map No -:Z;I~ .............. Block No...X~IZZ: .......... Lot No :Z~....8.ct~t~o~l,~l...~.,~...*. ..................... conforms substanhally to the Apphcahon for Building Permit heretofore filed in this office dated ............................ ~1~,...1~t ........... , 19 (~6.. pursuant to which Building Permit No..~.Jl',~..~.. dated ........................... .]~...~..~ ..... .~.~. ....., 19....~, was ,ssued, and conforms to all of the requ,rements of the applicable provisions of the taw The occupancy for which thru cerhficate ~s issued ~s ....... .... P~.i. va.te...~me...f.~m$1-y.. ~%wett~.n~ .................................................................. The certificate is zssued to .~[ehex, d...F.lc~x, el~ee ...................0~m,6~ ....................................... (owner, tessee or tenant) of the aforesaid building H.D?Approval June FOI/.M NO, · 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? 33~3 Z Permission is hereby granted to: l~:[chard F~-orence ................ .~.~.~..o..~.d. ............................................. ct premises located at ~//S OaKlawn Ave Eztentlon .................................................... .S,,o.,u.t..h...o. ~.d. ......................................................................................... pursuant to application dated ....................... P.e~.t ........ .~.~. ............... , 19...~...~.., and approved by the Building Inspector. SUFFOLK COUNTY DEPARTMENT OF HEALTH EASTERN DISTRICT County Center, Riverhead, New York PA 7-4700 H.D.Ref. No. ,~Q-~¢~ 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 .~/~,~/;.,9~f/ .,'~'~.,'/.,~ ~-~- 3-Subdiv. Address ~Z~~:' ~ Phone 4-Section No. 2-Name of Builder ~/~ ~ ~ ~ ~ Phone 5-Lot Number Address /~~ ~,~ 6-Bldg.Pe~it No. 7-Sewage System installed ~y ~ ~ /~. Phone Address ~ ~ ~~ 0 ~/ 8-(a)Deed location ~f property ~/~. ~Z~/~ ~ ~ (b)H~let or Village ~~ ~ Z ~ ~ ~ (c)Town 9-Septic tank-Gal__L__ft.W ft.Liquid Depth ft. 10-Cesspools-(a)No.pools ~ (b)Blocks below (c)Block size-L tn.W tn.H tn.(d)Precast pool (e)~2__3__ (f)H ~ ft. .in; Di~ ~ft.__in.(g)Finished grade to cover ~ ft. (h)Backfill Material ll-Water Supply: Public Syst~ ; Private Well If Private, the following questions are to be answered: ~ 12-Private Water Supply Syst~ install~ by ~ ~ Phone Address. ~~ 13(a)-Total Depth of Well (b)Depth to Static Water Level 14-Diameter of well pipe 15-Name of LaboratorX 16-Method of Disinfection 17-Date ready for tnspectio~ 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 Signed /~/~~ ~,-- Owner - Builder 19-Insert sketch of location of Water & Sewerage Facilities with accurate dimensions. ~R~H~ARTbfR ~ ARTMENT USE ONLY Inspected by ~ ~"/ ~----- Date ~/'-- ~ /'-~ ~) Based u~ the information stated above, satisfactory functioning of the above systems can be expected with proper maintenance and care. District Engineer S-Se S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal fa~qilities for a structure located (Give deed have been inspected by this department and found to be satisfactory. ~ Dls%riet Engineer District Engineer FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No .............................. Dtsapp roved a/c ................ ' Application No ............................ APPLICATION FOR BUILDING PERMIT Date December 19 19.....6..6... INSTRUCTIONS a. Th~s applicahon must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildin Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and g,wng a detailed description of layout of propertymust be drawn on the d~agram which is port of this applicat,or c The work covered by this application may not be commenced before issuance of Building Permit. d Upon approval of th,s application, the Build,ng Inspector will issue a Building Permit to the applicant. Suc permit shall be kept on the premises available for inspection throughout the progress of the work. e No build,rig shall be occupied or used in whole or m part For any purpose whatever until a Cert,f,cate of Occupant 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 tt Building Zone Or&nonce of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, ad&t~ons or alterations, or for removal or demolition, as herein describec The apphcant agrees to comply w~th all apphcable laws, ordinances, budding code and regulations. Richard T. Florence (Signature of applicant, or name, if a corporation) (Address of applicant) State whether opphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buildc Name of owner of premises ..... ~.~a~'~l...~.~..~.l.o.:~.~g.e ............................................................................................... If applicant ~s 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 .......... ~ ........................ Lot No: ....~ ..... Street and Number .... .~/.,q ..... C}~::la~.~...~.e..~]~t, ..........~qoz~J~c~.'L~L? ............................................................. Mumcipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Existing use and occupancy ...... .Y.&~.at~t..3~&z:Lcl. .............................................................................................. b Intended use and occupancy ........ .qlg. e...~.~.~:~...~WP~.~.i~.~ .................................................................... 3. Nature of work (check which applicable). New Building ...,~%~ ....... Addition ................. Alteration ................ Repmr .................... Removal .................... Demohtion .................... Other Work (Describe) .................................... 4. Estimated Cost .............. ~.Q0.0...]~,/~ ..................... Fee .......... l0 ......................................................................... (to be pa~d on filing this application) 5. If dwelhng, number of dwelling un~ts ....... .O.~ .............. Number of dwelling un,ts on each floor .......................... If garage, number of cars ........ ~te .......................................................................................................................... 6. If bus,ness, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 7. D~mens~ons of existing structures, ~f any: Front .......................... Rear .......................... Depth .......................... Height ........................... Number of Stones ............................................................................................................. D~mens~ons of same structure w~th alterations or addmans: Front ................................ Rear .............................. Depth .............................. Height .............................. Number of Stories ........................................ 8. D,mens,ons of ent, re new construct,on: Front ..... .LF'I .................. Rear ....... ~...~.. ................ Depth ..... Height ............................ Number of Storms ....o..~...e....s..~.o..~.....- 9. Size of lot. Front ..... 15.Q ................ Rear ...... 1,~.0 ............... Depth ........ ~.Sg ................ 10. Date of Purchase .......... ~..9..~..0. .................................... Name of Former Owner ...~Q~,~...~.f~l:~k13~.~fi~ ...................... 11 Zone or use d~strict in which premises are situated ..... .~).~,!!...~.~,~.~. ...................................................................... 12 Does proposed construction wolate any zomng law, ordinance or regulation? ........ ~q ...................................... 13. Name of Owner of premises ...~.~.o...~..~.~.~....~.~.q~.~.:~.g.f~Address ...... [~.0.~¢,~9~C~ ................... Phone No .................. Name of Architect ...... .Tg~.o..9.~..~...~..o..~..~.fJ ................. Address ............................................ I~one No .................. Name of Contractor .... .D.g..~.~L...~..~.~.]9.~....&....~.O.D. ......... Address ...... ~.~g~0~lJ,e ................. Phone No .................. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~sting or proposed, and indicate all set-back dimensions fro property hnes. G~ve street and block numbers or description according to deed, and show street names and indica whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ...... ~'.Q].1¢ .........( S.S. ~o~z'ct. ~'toz*ez~¢~ ................... being duly sworn, deposes and says that he ~s the applk (Name of individual s~gning application) above named. He is the ............ .Qwzzez'. .......................................................................................................................... (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 thru application; that all statements contained m this apphcat~on are true to the best of his knowledge and be and that the work will be performed in the manner set forth in the apphcat~on filed therewith. Sworn to before me th,s ........................ - ,- ...... .............. ....... ....... ........ Notary Pubhc, ./.~4-~.....~/~...~~,t~'~;.,,' ~d~z~y (Signature of applicant)