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Home My WebLink About3365-zFORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z..360~ ·. Date .......... Q.e.t,,.,..~.? ......... , 19 6.~. THIS CERTIFIES that the building located at ~f~. 8aflo~v .Lar~ .(p.v.t) Street Map No.l~assat~ .Po.i~lock No .......... Lot No. x~... C~tCho~ue . ~,~, ........ con£orms substantially to the Application for Building Permit heretofore filed in this office dated ...... ,t~_~ .... t9 ' ' ' ' 19 67' pursuant to which Building Permit No. ~36~'Z... dated ....... ,~1~ .. 23 · .., 19 67, 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 .Priwat~e. one. t'ami;~y..dwe.l, li~g ..................................... The certificate is issued to .~Tolm .Cla~'ke .. ~q~e~'..when. .b,ai~Lt ................. (owner, lessee or tenant) o£ the at%resaid building. Suffolk County Department o~ Health Approval . .14~ .~1 ,..~96~...by. ~..t/ilia .,. ..... ....... Building Inspector~ FORM NO. 4. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~PO~ (~)en~ing final property l~:ne adjustment) CERTIFICATE OF OP.E:UPANP. Y No. ~; 27~ Date .... ,1%~1~'.~,~) -- , 196~. THIS CERTIFIES that the building located at ~/8 8aIlO~ ~~) Street Map No. ~SS&~ ~lock No. .Lot No.~ ~teh~i. .~.,. ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated Ea~ ' '19 , 19 '6~ pursuant to which Building Permit No. 336~ ~ dated ~e~' ~ ,19 (7 , was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is i~sued is ~t~a%e oae f~m~ly-.dwe~-~g .................................. The certificate is issued to Jo~ ~!a~e ~ner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval 1~ ~1-~ 1~--b~-R~. ~. Building Inspector% FORI~ NO. l~ 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? 3365 Z Permission is hereby granted to: Geo. Ahlers A/C John Clarke .................... ~u~.~.o.~..,,.e. ...................................... to lh,~ !d...'lew..~rie..£~:Lly..l~t~ ............................................................................................... at premises located at ~l~.],~,tl...I~.....~.P. lg~...]~D.)....~il~:l~3l~.~ ................................................. ...................................... Ilassau..P~tatt....Cut~ho~e ................................................................ pursuan¢ to application dated ........................ ,l'~zllle. l~. ....... ~ ....... , 19~..., end approved by the Building Inspector. Fee $ .~..O.~.~J~. ........... S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH I~A¥ 3 I Date Bldg. Permit No. TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located ~Giv, e deed location) / have been inspected by this department and found to be satisfactory. SUFFOLK COUNTY DEPARTMENT OF HEALTH EASTERN DISTRICT County Center, Riverhead, New York PA 7-4700 H.D.Ref. No. 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 ~m~., C~A,ke, .. 3-Subdiv. ~ ,l~, Address 94,,~sf~,~ ~d C~t~ l~c~ ~t Phone 4-Section No. 2-Name of Builder [/~ ~)A~ .... Phone 23v 5~ ~o 5-Lot Number Address ~c~ e,,, ~ ~d .... ~,f~c,] ~ ~ ,,¢ 6-Bldg .Permit No. 7-Sewage System*installed by K,,e~L~ ~ < ,,, .... ~ ~.~/A' Phone ;Z 7 M~z Address A'?~,,,~~ .~-~ ~ ~c.h 8-(a)Deed location of property ~a,;~ ~,~ ~ (b)Hamlet or Village ~,~ L~,,( (c)Town 9-Septic tank-Gal L ft.W ~ ft.Liquid Depth ft, 10-Cesspools-(a)No.pools l (b)Blocks below inlet-l) ~%-2) (c)Block size-L ;~ in.W ~' in.H ~'. in.(d)Precast pool_____(e)l 2 3__ (f)H....) .ft.. ~ in; Diam___~ft. o in.(g)Finished grade to cover / ft. (h)Backfill Material ll-Water Supply: Public System ; Private Well If Private, the following questions are to be answered: 12-Private Water Supply System installed by ~, }~,~,~ Phone Address ~,~ ~ ~ ~ ~ ~/~ 13(a)-Total Depth of Well ?.~ (b)Depth to Static Water Level . 14-Diameter of well pipe ~ in. 15-Name of Laboratory &~, ~. ~ . 16-Method of Disinfection . 17-Date ready for inspection -'~i ? 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. O~er - ~iilder 19-Insert sketch of location of Water & Sewerage Fac~l~ities with accurate dimensions. STREET ,'2'~- ====================== ............... : .............. Based upon the information stated above, satisfactory functioning of the main ce nd care. Date i___. roved · _ _ S-5e S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH HAY Da£e Bldg. Permit No. TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure lgcated (Give deed loc~Ztion) ~ ~ have been inspected by this department and found to be satisfactory. District Em~lne er District Eng tnee't FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ^ ved ........................................ , Permit No. Disapproved a/c ......................................................... (Budding Inspector) I Application No ...~...,~...,~...~.. .......... APPLICATION FOR BUILDING PERMIT Date ..... ~,~.,1 ........ ,/.2 ................... INSTRUCTIONS 19 /;7 a. Th~s apphcotion must be completely filled in by typewriter or m ink and submitted in duplicate to the Buildin, Inspector. b Plot plan showing location of lot and of buildings on premises, relat~onship to adjoining premises or public streets c areas, and g~ving o detaded description of layout of property must be drawn on the d~agram which is part of this applicat~or c The work covered by thru application may not be commenced before ~ssuonce of Building Permit. d Upon approval of this application, the Building Inspector will ~ssue o Building Permit to the applicant. Such perm shall be kept on the premises avadable 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 Occupanc shall have been granted by the Building Inspector. APPLICATION tS HEREBY MADE to the Budding Department for the ~ssuance of a Budding Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alteratmns, or for removal or demohtion, as herein describe~ The apphcant agrees to comply with all apphcable laws, ordinances, building code and regulot, lo/ns. .......... ,j ........ :]' ............... State whether applicant is owner, lessee, agent, orchitec.~jengmeer, general contractor, electnc~an, plumber or budde ,.-~..,¢~ c ~v'~z/ , ,, l) .......................... Name of owner of premises .................... ~):¢:..~...?. .......... · .~.. -:.~..'[~ ........ If apphcant ~s a corporate, signature of'-duly authorized officer (Name and t~tle of corporate officer) 1. Location of land on which proposed work wdl bo done Map No . ,.. ~ .. · Lot No .... ./...~. ............ Street and Number '~ .~. · ' M c,p ',ity 2 State existing use and occupancy of premises and intended use and occupancy of proposed construction a. Exmting use and occupancy ...................................... . .................................................................. U an * ~' ~"~-'"~¢~'~ b Intended use and acc p cy ................................................ ~.~. .................................................................... 3. Nature of work (check which apphcab[e). New Budding .................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................. Other Work (Describe) ....................................... 4 Estimated Cost ........... .~...~.?...(--4..O...°. .................................. Fee ......................................................................................... (to be paid on filing this apphcation) 5. If dwelling, number of dwelhng units ........... .~... ........... Number of dwelling units on each floor .~:;.a..../~..~. ............ If garage, number of cars ..........~ ........................................................................................................................... 6 If bus~ness, 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 add,hans Front ' Rear ........................... Depth ................................ Height ........................ Number of Stones ............................... 8. D~mensions of entJre new constructJon: Front .... .~..~.~ ......................... Rear ....... ?.~. ................ Depth ..... '~...3. ............ Height ....... ~..~. ........ Number of Stories ..................... .'.2v. .................................................................................... 9. Size of lot' Front ........ /...7.]. ............. Rear ...... ~...6:5'~.. .............. Depth ......... ./(.~ .~ .......... 10. Date of Purchase ....................................................... Name of Focmer Owner ....................................................... e'istn t in h~ ' e i e arestuat ' 7~ 11 Zone or us a c w cnpr ms s ea ............................................................................................... 12 Does proposed construction wolate any Tatung law, ordinance or regulat~onP ..... ~ .......................................... 13 Name of Owner of premises ....... Address ...~.~.x.Q.s..~.~...?~......C_v.~FCv..e. Phone No .................... Name of Architect ............................................. Address .......................................... Phone No ............... Name of Contractor ..~..e..~. ......... ..~...~..//.~ ................. Address .-A-z--~.e-q.e.~....~..~....C..u..~.~.~.°.~?.CPhone-- '' - No .................. PLOT DIAGRAM Locate clearly and d~st~nctly all buddings, whether exmting or proposed, and indicate all set-back d~mens~ons fror property lines. G~ve street and block number or description accord,ng to deed, and show street names and ind~cat whether interior or corner lot ~c~,~e '. k l;Cl , 2. 6 .tI ~ q STATE OF NEW YORK, tee COUNTY OF ............................... ~ .... ................................................................................ being duly swot% deposes and says that he is the apphca (Name of individual s~gnlng apphcatlon) above named He is the .......................................... ..~...~...~.~.~ .......... ~~ ........................................................... 'J (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 this application; that all statements contained ~n this apphcation are true to the best of his knowledge and behef, a, that the work will be performed Jn the manner set forth m the application filed therewith Sworn to before me this day of .......................... , .............. .... ;'" "." 'i" '. ................ ............ ......... Notary Pubhc, ~..~ ...... ~ount~ ........... i~'Aature of appmic;nt) ................ No 52 3233120 Sm,oik County Term Explre~ March 30, 19~")