The URL can be used to link to this page

Home My WebLink About4445-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy Bio. Z' '373® .... Date ..... January... 12., ........ , lg..7.0 THIS CERTIFIES that the building located at . OrchM~d. S .t.~ut .......... Street Map No ............. Block Bio ........... Lot Bio.. Or4en~; .ue~ .Yor]~ ............ conforms substantially to the Application for Building Pemit heretofore filed in this office dated ..... September .. 3~.., 19~9. - pursuant to which Building Permit Bio..4445 .Z dated ..... September"4;", 19'69, was issued, and confoms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .... 'prlvate' one' fura~ly 'dwe'll~ng ................................... The certificate is issued to ... T~noo,. Rohlo~£ ..................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval -Januer~, .g~..~..970;- Houee ~ 28?0 Orchard Street l~'O~t~ 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? 4~45 Z Permission is hereby granted to: ..... ~m,~.....~.ex'~v~....A~......~,LIk~l,,~ at premises located at ....................... R/i~J.....J~j~-. II:~ ................................................................ ................................................................ · O~l,,e~t. ........ il,..~,, .............. : ............................................... pursua:n~c to application dated ............................ .J~Jl~ ....... ,~ ............ , 19...J1~., and approved by the Building Inspector. Fee ~.~*...~.. ........... Building Inspector Approved .................... ,19 .... Permit No .................... Disapproved a/c .................................................... · ,,, ....... i ............. INSTRU(~rlONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspecix~. b. Plot plan showing location of lot and of buildings o n premises, relatimmhip in adjoining premises or public streets or areas, and giving a detailed description of layout o1~ property must be drawn on the diagram which is part of this application. c. The work covered by this application may n~t b e com,rnenced before issuance of Building Pemit. d. Upon approval of this applicati,~n, the Building Inspector will issue a Building Permit to the applicant. Such pemit shall be kept .on the premises available fo r inspection throughout the progress of the work. e. No building shall be occupied or used in whole Occupancy shall have been granted by the Building Inspectm'. APPLICATION IS l-l~a~Y MADE to the. Building Department for the issuance of a Building Permit pursuant to the Building 7~one Ordinance of the Town of Soathold, suffolk Oounty, New York, and other applicable Laws, Ordinances or Regulations, for the construction of build lngs, additions or alterations, or for removal or demo- lition, as herein described. The applicant agrees to corn ply with all applicable laws, ordinances, building code, (Signa~u~atu~/ofof applicant,, or name if a corporation) 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 authorize d officer. (Name and title of corporate officer) · 1. Location of land on which propos_ed work will,~e done. Map No ................. Lot No. ~ .......... Street and Numar .. ~ .................................. ~ / __ ~ ~ y ~ ~l Municipaity 2. State exis~g use and occup~cy ~ p~mi~s ~ d iniended ~e ~ ~cup~ of ~ ~ction. a. ~isting use ~d ~p~cy . ~.~. t ......................................................... b. Int~ded u~ ~d ~cup~cy .~ ........................................................... 3. Nature of work (check which applicable): Ne~v Building .../-A'.... Addition ........ Alteration ........ Repair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... 4. Estimated Cost ..~. ?.,..~. ,o...&. ................... Fee ................................................. (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 cms .... ~ .................................................................... 6. If business, commercial or mixed occupancy, spec ify 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 ox additions: Front .............. Rear ............... Depth ................ Height ................ Number of S~ories ..................... 8. Dimensions ,of entire new construction: Front . .~.'. ~. ;; ....... Rear ...~..~'.'.'(;; .... Depth . ~.~.; ...... Height ...l ~7. ! ..... Number of Stories ..... /. ....................................................... % Size of lot: Front .... .~.ff.~;. ;?..~. Rear . .?-.q..f.0?..9'.... Depth /.~.'~.;.~.~. ..... 10. Date of Purcl~ase ............................... Name,~£ Former Owner ............................. 11. Zone or use district in which premises are situated ......... ~ ; ......................................... 12. Does proposed construction ~o~ing law, ordinance or r,egulati~n?. ~ ................... 13. Name of Owner,of premises ~, ,~g~~ ...... Address ....~..-'~y~.. .......... Phone No.~?.~. 7..~..-~~. Name of Architect ........................... Address Phone No. ~..z~.. ,..z.~.a/ 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 qr description acoording to deed, and show street names and or em-her lot. -5'0' --~ STATE OF NEw-Y-Q.~, )S.S. COUNTY OF ?.~?.~.~.~..t~ .... ) ......... .Tf.~.~..~'../~(~.~ff~..~. .................... being du sworn, deposes and says that he is the appl (Name of individual signing named. He is the ........ ~.~/~/.~.~ .............................. of said owner or owners, and is duly auth~orized to perform or have perf~K'med the said work and to make and file this application; that all statements ~ntained in th is application are true to the best of his knowledge and belief; .and that the work will be performed in the mann er set fortl~ in the application filed therewith. Sworn to before me this Notary Public Ckmnty U(Signtfre of applicant) ~OYD F, KING, ~R~ ROTARY PUBLIC, State of New Yo~ No. 52-7267800 SuffoLk County ~'~ Exo/r~ March 30, 19~ SUFFOLK COUNTY DEPARTMENT OF HEALTH EASTERN DISTRICT County Center, Riverhead, New York PA 7-4700 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_ -/-/)~>r.~:~b~ f~)O~ /r~/z.~_ 3-Subdiv. Address .~ ~ ~, ~ ., ~/.~/. Phone 4-Section No. 2-Name of Builder ~7~5~ ~,~/~/~a Phone~3-~O~m/ 5-Lot Number Address f'p~ ~ ~ ~ ~ ~ .. 6-Bldg.Pe~it N~ 7-Sewage System installed by 5~?,~,~,- ~,c~ ~o. Phone Address ~ ) ~-, ~ ~ ~ ~/. 8-(a)Deed location of properffy ~9 ~')ro~ ...... ~ f~ 9-Septic tank-Gal L __ft.W ft.Liquid Depth ft. lO-Cesspools-(a)No.pools~ (b)Blocks below inlet-i)/.<; _2)/;~f 3).__ (c)Block size-L /~__in.W ~ in.H f in~(d)Precast pool (e)l 2 3 (f)H ft. in; Diam ft.__in.(g)Fiuished grade to cover / ft. (h)Backfill Ma t er ia ll?c~,~., . ll-Water Supply: Public System /'/o ; Private Well~$~ If Private, the following questions are to be answered: 12-Private Water Supply System installed b~_~.,, ~,_ ~-/~,~ Phone ~3- 13(a)-Total Depth of Well ~ (b)Dept~ to Static ~ater Level /~ ~ 14-Diameter of well pipe r~ in. 15-Name of baboratory 5~...~ f~,~.~ /~./~,.;zZ~6-~ec~oa of Disi-fection/~,,,c/) ~7-~ate ready for inspection The undersigned CERTIFIES: Above sy~t~s have been constructed and are ~n compliance with the Suffolk County ~ealth Department's current Standards, Bulletins and .e.dments thereto. ~'~'/ ::'¢~~,' - Builder / lc. c, o 19-Insert sketc of location o~Water & Sewerage Facilities wit~ ~ ,' -~-, . f ~ STREET c ~- ..................... l_fz~,~_ ............. ~_~_~_~ f ............................. In~pected by ...... <. ~i ~ ~ ,., Date :~ Based upon the info~ation stated above, satisfactory functioning of the above systems can be expected with proper maintenance ~q~..~arer .... C..-~-- / ,', Dlotrict ~n~em accurate dimensions. S-Se S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date / : q~ ?0 Bldg. Permit No. TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure ---- (Give ~ed location) located have been inspected by this department and found to be satisfactory. District Engineer