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Home My WebLink About5073-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy May 19 Date ......... THIS CERTIFIES that the building located at Breitstadt Court Map No. Smthfl.d PkBlock No.. Lot No. ll .. Southold ,1971 Street ~; .Y. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOv 21+ , 19.7.0. pursuant to which Building Permit No. ~QT~Z . dated I4ov.. 2.7 , 197Q , 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 .Priv. at..e.p.n.e..fam, i.ly..d)~.e.ll.i, ng ............................ The certificate is issued to Richard Tess. i.t.o.r.... .0w.ner ........ (.owner, lessee or tenant) NOTE: second floor xncomp.ke~e at this time of the aforesaid building. Su~olk County Department of Health Approval M. ay.. 11 . 1971..by 1.4.. Villa .... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~ SOUTHOLD, N. Y. BUILDING PER~IT CFHIS PERMIT MUST BE KEl:rr ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5073 Z Permission is hereby granted ,to: to ...... .JatXa..,.~.. ~,...z',J,a.~...a~:ta~ ................................. ~ ........................................... at premises located-at .Ji~J;.4jl...J.lL ........... Jj~JL~z~;~j~..jj~[ .............................. ~.....~ ....... _...' ......... pursucu~t to application dated ....................... JJ, ll~' ...... -j[Jl- ................. , 19..~J~J., and approved by the Building Ins ~pecto-r. S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg, Permit No. TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located (Give deed location) ~ ' have been in~spected by this department and found to be satisfactory. Chi sC of General ~ngineerin~ Servioo~ AVE. .~80°ig'2D"E. O~ F-F 50UTHOLG row ~ OF 50UTktOLP, SCALE-40'. I" ,MONUMENT (D, t¢40R PIPE SUFFOLK COUNTY DEPARTMENT OF HEALTH EASTERN DISTRICT ,, RIVERHEAD, N. Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS H.D.Reference NO~--~ ~ Approval to construct said systems is requested,pertinent data herewith: l-Applicant ~,~ · I~ ~ 7 ~_. Address Date 2-Detai!ed property location, / ~ , Hamlet -'~ Towu ~-P~blic water supply name -- - 4-Lot Size: Width ~l ft. Length ~ft. Phone x~-Sub div ,/ 7-Section ~ ~ ~ 8-Lot No. /~ - ~ ....... 9-Private well? Distance to nearest main ~, (also enter on center plot plan below:) 5-Dwelling: Single Family I I TwoFamily? f ! Cellar? ~ ~?r~%? I I Crawl Space? / ~ 10-Proposed system: Septic tank f fPrecast ~ yGe~fpools/ /Shallow pools / /Other / 11-Septic tank inside dimensions: Volume Gals.Length ft. Width ft. Liquid depth, 12-Precast sections: / fNumber/"~Square Ft, Cesspools: Block sizef' incs.D ,ins. H Total blocks below inlet: ~1__~2 __~3 , -,]~ PLOT PLAN Capacity',,~Gal: G.P.M. W.L, Street The Undersigned CERTIFIES: Data ~eet ~ 0 10 12 No~th "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments~thereto, covering Private Sewag~ Disposal Systems". Date ~' Signed , /, z~ /77t~ ~1~ , 1~ !1,.- ,, z Owner or Builder FOR HEALTH DEPARTMENT USE ONLY. Based on the~information presented herewith, it is the opinion of the Health Department, that an adequate and satisfactory gew~ge D%gpd~A1 System can be installed on this Plot. Date ~'~t~ ~'t~ (10/65 Revis.) S-15 Signed Approved ........................................ , 19 ........ Permit No ................................ TOWN OF SOUTHOLD ,r/ L /~ -.. BUILDING DEPARTMENT/~'~£;! v,?,. ,? ~ 1~ TOWN CLERK'S OFF~CE ~ ~ ~' ~ ~' ~ ~ Application Disapproved a/c,,. ................. ~ ~,,.,~v~i,,~f ,::~,"~ ?/-~e APPLIGATION FOR BUILDING PERMIT INSTRUCTIONS a. This application 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 c areas, and giving a detailed description of layout of propertymust be drawn on the diagram which is part of this applicatior c. The work covered by this application may not be commenced before issuance of i3uiJding Permit. d. Upon approval of this application, the Building 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 building shall be occupied or used in whole or in part For any purpose whatever until a Certificate of Occupanc shah have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The apphcant agrees to comply with all applicable laws, ordinances, building code and regulations. (Signature of applicant, or name, if a corporation) ...... ......... D '. ............. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde, Name of owner of premises .....~...J...~...~....~....~....~.. ...... ...Z..~.~?...~..~...°...~...~Tz... ............................................................................. X If applicant is a corporate, signature of duly authorized officer, q (Name and title of corporate officer} ~ zJ ? 7 0 1. Location of land on which proposed work will be done Map No.~..~.I..I.?..!,'J..~..!..~..~...~......~....R....~-.. .... Lot No' ...J..[ ........... Street and Number ............................................................................................................... :..~ ................... .....~ ...... '1 Municipality ~ 2_. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .............. .~....O..~..~ .............................................................................................. b. Intended use and occupancy ............ .~....~,.~....V~.. ..... . .~...~ ...~.~...~...C..I..?..~ ............................................................... 3 Nature of work (check which applicable): New Budding ....... ~Addition .................. Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ..................................... 4 Estimated Cost .... ,....=.~ .......... .' .................................... Fee ......................................................................................... (to be prod on filing this application) 5. If dwelling, number of dwelling units ...... ~ .................. Number of dwelling units on each floorZ~,~..,....?.../Z'..~..x.../Z'..x.~.(£ If garage, number of cars ................. L...~..~...I...~T.. ....................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .......... : .................... 7. D~mens~ons of existing structures, Jf any: Front .......................... Rear .......................... Depth ........................... Height ............................ Number of Stories .............................................................................................................. Dimensions of same structure with alterations or additions: Front ........ (~C~ ......... Rear ....¢~ ................. Depth ....~ec:~.~..~ ........... Height .............................. Number of Stories ........................................ 8. Dimensions of entire new construction: Front ...... (,~,C~..'. ........... Rear ........ ..~....~....' ......... Depth ...~:....~..~..~...~.i ....... Height ..... ~.~.~ .............. Number of Stories ...... [.~..~.g.~ ' ...... l..~.f).'. ............ Depth ......i..~.~ ............... 9. Size of lot: Front ....... ~.~..~ ............ Rear 10. Date of Purchase ........................................................ Name of Former ~ner ....................................................... ]1. Zone or use district m which premises are s~tuated ................................................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation? ........ ~J..~?. .................................... 13. Name of ~ner of premises ~l&~')....~.'..~Address ..~.~.~.~.~ ................. Phone No.~:~ Name of Architect ...................................................... Address ................ ~ ........................... ~one No~ ............ Name of Contractor ~.~.~...,~.~ ................ Address .~.L~..~.~-~..~.~.~..~one No.~E.~.f.~ PLOT DIAG~M Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fror prope~ lines. Gwe street and block numbers or description according to deed, and show street names and indicat whether interior or corner lot. STATE OF NEWYORK. S.S COUNTY OF .... ~.c:..~..~....~...trz...~- · ...~ ~¥4.~i')J~-c-M--~ ~10 ~ h~ ~ duly sworn, deposes and says that he is the opplica, (Name of individua signing app cation) above named. He ,s the .............................. ~,~.~(.~.~.~Y.~ .............................................................................. (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and is duly authorized to perform or have performed the said work and to make and fi this apphcation; that all statements contained in this application are true to the best of his knowledge and belie and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this