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Home My WebLink About3908-zFORM NO. 4 TOWN OF SOUTHOLD~ BUILDING DEPARTMENYF Town Clerk's Office Southold, N. Y. Certificate Of Occupancy no. Z39bO ...... Date .......... Alag ..... ~1~ ..... , 19.70. THIS CERTIFIES that the building located at h~//1 01e-.JUly..La ....... Street Map No. :~X ........ Block No .... Xx... Lot No..:1~i:... ~l&tt;].tllek.. l~,~ conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ~Iay.. 27. .... , 19, .68 pursuant to whic~h Building Permit No.. dated .......... &tln~ ' 'l'0' ' , 19 68., 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 . .Prt~ate..one. £amlly .~l~e:l,~.lng ...................................... The certificate is issued to . .C~rl~s. & .Cotlette.. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval · ~uildiag ~aspe~tor FOP~I NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'$ OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CrHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ; 3908 Z Permission is hereby granted to:~: ' ~'~ ~e~.. &.. ,~o~ ..A/C..~.h~..&.. Ch~3~t.te..~lta at premises located at .0.~....~.~.~...~{~ ........................................ i ......................................................... ................................. ~*~t~L~ ....... ~,Z,, .............................. i; ........................................................ pursucm¢ to application doted ....................... ,~,a.~ ....... ~ ............ i:....., 19 -f.~..., and. approved by the Building Inspecto'r. ~1~:~ ,. &p[~l~l ~)~' ~ ~;~ ~J Building Inspector/ SUFFOLK COUNTY DEPARTMENT ~F HEALTH EASTERN DISTRICTI County Center, Riverhead,!New York PA 7-4700 APPLICATION FOR APPROVAL OF INSTALLED PRIVATE SEWAGE ~ISPOSAL AND WATER SUPPLY SYSTEMS Inspection for approval is requested, pertinent ~nstallation data herewith. 1-Name of Owner G!~arios itiVo~a Address f ~ ~i~u~l~ Phone 2-Name of Builder]~t~holaS ~nl Sons PhoneA~ ~ 8964 Address l~O Done~an Av8.~ t~;~Fa~eho~u~ ~'~Y~ : 7-Sewage System installed by ~'V;O D~o~h~s Address Cooks Eoad. E. Fmtoho~ue. ~mw ~k 8-(a)Deed location of property ns/ ~1~-Jui~ (b)H~let or Village '~'~a~'bi%u~k ~ (C)Town 9-Septic tank-Gal~OO L ft.W fi.Liquid Depth ~ ft. 10-Cesspools-(a)No.pools--(b)~lock~ below tnlet'l)~2) "3) (c)Block size-L in.W in.H tn~recas~ '"pool ~ (e) 1__2~3~ (f)R fi,, .... in; Diam__ft.__in.(g)FSnished grade to cover ] ft. (h)Backfill Material ll-Water Supply: Public Syst~ ; Pri~ate Well If Private, the following questions are to be answered: 12-Private Water Supply System installed by OaMola Phone~ Address ?,~gs~iok~ N~V; l'o?k 13(a)-Total Depth of Well ~0~ (b)Depth to Static Water Level 14-Diameter of well pipe ~ in. 15-Name of Laboratory t~DV;IT~ 16-Method of Disinfection m~,~.~ 17-Date rea for inspection o'~ · '* - ~ z The undersigned CERTIFIES: Above syst~ have been constructed and are in compliance with the Suffolk County Health ~epartmeRt's current Standards, Bullet{ns and ~endments thereto~.. ~ ~ ~ ' ' ~ - Builder 3LSubdiv. 4gSection No. 5gLot Number 6-Bldg.Permit No. C~ Phone /FOR HEALTH DEPARTMENT USE O] Inspected by / _ ~ ~ .~==== Based upo~_~heCSi~formation stated abo~e, above systems can be expected with proper maintenanc~ JUL 3 0 Date S-Se ,., Approved STREET Instructions for Submission of Installed Private Sewage Disposal and Water System App!~cation 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 and accepted by this partment. The item number on the application form a~d 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 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 exemple: 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. i1. Indicate by check if water supply is public or private. 12. Name of person or firm who actually installed 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 dimensions on sketch. FOR~ NO. I I TOWN OF SOUTHOLD i BUILDING DEPARTMENT TOWN CLERK'S OFFICE i SOUTHOLD, N. Y. APPLICATION FOR BUILDING PERMIT Dote ...~.,/~./~......~. ~ ..................................... INSTRUCTIONS a. This application must be completely filled in by typewriter or in i~.k 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 c~n the diagram which is part of this application, c. The work covered by this application may not be commehced befor~ Jssuonce of Building Permit. d. Upon approval of this applicaHon, the Building Inspector will issue ~e Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progreJ~s of the work. e. No building shall be occupied or used in whole or in part for any pu!pose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. ~ APPLICATION IS HEREBY MADE to the Building Department for the i~uance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New Y~rk, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or f~r removal ~or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordin~,5~s,ikbuilding code, ~h,ousing code, and regulations. -' FiY notui ' g:f j'i'f'i; cg; 'i,' bVii,' 3 ....... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contracto6 electrician, plumber or builder. Name of owner of premisos .~..~g, le.s ,c_ c2_o11,.i~.? ; }.4....~ .................................................................. If applicant Js 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.: .,..~....x. ............... Municipality State existing use and occupancy of premises and intended use andi occupancy of proposed construction: a. Existing use and occupancy ....... ~..~...~.....~r.. ................................................... b. Intended use and occupancy ........................... '1 ..................... i'""f .................................................................. 3. Nature of work (check which applic~): New Building ...... ~ .... AddidoO ............... Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...... l.."~...~'~.?....~. .................................. Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwellipg 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 of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .....~..,;/.: ........................ Rear ....... ~...~ ............... Depth ..~..~.. ............... Height .....~..0...~. ...... Number of Stories '.~q¢.. ......................................... 9. Size of lot: Front ........ ~..J~. ............ Rear ......... /...~...~. .................. Depth ....... /.~.~ .................. 10. Date of Purchase ....~.¢..~ ......./.~ ....... /..~.~'..~ ............. Name of Former Owner ../.~'/'~"'~ ....... .O...~..~..~..~..~-.~(. ........ 11. Zone or use district in which premises are situated ........ ~......~.~..(~'. .......................................................................... 12. Does proposed constructio6' violate any zoning tctw, ordinance or regulation? ..... ..~. '~. A ~.~ ~'....../~/. ~t/~'~/Add resst , ~ ,, .~ 13. Name of Owner of premises ....~..'r.....~.....~.¢..~.........Z~..)/..,. Phone No ..................... Name of Architect ...~..q~./.~. ....... ~....Z~...~..~...i..Adclress ............................................ Phone No ..................... Name of Contractor ......~..f..~./x/.~./~f....~.i/~r.~'.....~...cC'-Address ...../..2..~..~..e..~.R~? .~'.....~...u..~... Phone No. ~..J.;.~...~..~.~.¢.. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ................................ ~' ¢'¢' ~'.~..'~.~.¢. ,~. ,~..~.e ~. bein sworn, ...... ~ .............. ~., ....................................................... g duly deposes and says that he is the applicant (Name of individual signing applicatien) abow~ named. He is the ............ ~.~.~..~.~..~.~.¢..~ ........................................................................................................ (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 t~erewith. Sworn to befgre me this ...... .... ...... ..... ;% ............................. ~otarv ~ubli~¢~b~..'..~ ....... ~~... Cou y ~o. 52.3233120 Suffolk ~rm ~pires ~ch 30, ./