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Home My WebLink About5082-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupancy No. Z~2.~.3 ...... Date ............... 1,f~y.. ~8 .... , 19.71. THIS CERTIFIES that the building located at .ltebart. Real .............. Street Map No..1.05~; ....... Block No ........... Lot No..4.. Southeld. · .I~,Y, ............ confoms substantially to the Application for Building Permit heretofore filed in this office dated ......... l~ov....30...., 197Q. pursuant to which Building Permit No.. ~.0.~2~.. dated ............1;o¥. · .~0.., 19 70', 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 . l~ivate, one .family. dwel.~.$n~ ...................................... The certificate is issued to ... P. atrJ. ck. 0.'.GracLy..&. 2.h~ .V.. Ollelt .... Owners · (owner, lessee or tenant) of. the aforesaid building. Suffolk County Department of Health Approval ~taF..?.~. '~97t-- .by. ....... ........ ............. Building Inspector ~0~ NO. ~ TOWN, Of: SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT ? · (THIS PERMIT MUST BE KEPT ON THE PREMISE',~ UNTIL FULI~ ~COMPLETION OF THE WORK AUTHORIZED) 5082 Z Permission is hereby gronted o:'- .... ~2 ................. ;' ............... ~ ................................. ..... pursuant to application dated ..................................... .~.....~...:/..Y..e..~...., 19~....(Z.., and approved by the Building Inspector. ~ Fee $...../....0...~'. ~OtJTHOLD ,StJFFOLK COtJNTY. N.Y. SUFFOLK COUNTI DEPARTMENT OF HEALTH EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROYAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval to construct said systems is requested,pertinent data herewith: Date 1-Applicant ~'~;~;~}f, .{' ~Z&='~ Phone~YZ#~6-Sub div Address~"~-2~ ~'~z B~D. ~' . ~.~. 7-Section 2-Detailed property location /Y/$ ~/~8,;~ ~. ,~/~wF~-Lot No. ' Hamlet ~/,~.~ ' Town .~~. ' 9-Private well? ~-Public w~ter supply name. Distance to nearest main 4-Lot Size: Width/o~- ft. Length~z~a f{.. (also enter on center plot plan below:) 5-Dwelling: Single Family ;~ Two FamilY? / /Cellar? ~ /.Slab? ~ /Crawl Space? 10-Proposed system: Septic tank ~ /Precast y~(/Cesspools / /Shallow pools / /Other il-Septic tank inside dimensions: Volume Gals.Length ft. Width ft. Liquid depth ft. - ecast sections: /2/ umber 'X Sq re Ft. Cesspools: Block si .eL incs.O 8 ins. H~2_ins. Total blocks below inlet.'~' --~1 ;g,~2 ;~ .$3 PLOT PLAN O0 Street HoD. Reference ~o Data ~$et 0 2 6 8 10 12 The Undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Systems". · · ~ 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 Sewage Disposal System can be installed on this Plot. .. Date ( ~0/65 Revis. Signed~ Capacity'_~_Gals. O W.L. l ~ (h"// ,,-, o, .: ,,..:,,z', - -- ,.- , V' II~ { ~'~ ~ - ' TOWN CL~.~K"S OFFICE ~ ~'~ ~- . .~?~'~ ~'-~ Examined ~197 ................. :,,. ...... ,._, [~BI~IOWN LDING ...................................... ..... '. 'o, ~ ~(Build~ Inspect) ~ ~, APPLICA~QN FOR BmLDIHG ~RMIT ~ 7 , ~oo~ ~, ~ ~ D~te . ~0~. ~.O ................. ~9~0.. This application must be ~mpletely filled ~n b7 type~iter or ~n ink and submi~ ~n duplicate to the Bufldin~ Ins~. b. P}otplan showlngloeationof I~ and~ build~ngson premis~, relatio~ip ~ adjoin~g pmm~ or public street~ ~ m~, .~d giving a detailed deseripti.on of layout of p~opo~7 must be drawn on the d~a~am whi~ is pa~ of ~is appHeat~,n. e. ~o work ~ve~ b~ ~is applieat[~ ma7 ao~ be ~mmeneed before issuance of ~ilding Pemit. d. H~ ap~v~ of this applie~i~n, the Building In spear will ~sue a Buil~g ~mit ~ ~e applicant. Su~ pemit shah ~ kept ~ ~e Premiss available fo r ins~ctl~ throughout the p~ of the work. e. No building sh~l be occupied or u~ in whole o~ ~ p~ ~ ~y pu~e wh~v~ ~tfl a Ce~icate ~ Occup~cy ~ ~ve ~n ~ted: by the Building ~sp~. ' - ~CA~ON IS ~Y M~E to ~e Building Depa~ment f~ the issuan~'of ~ ~ding pe~t~rsu~t the Building ~ne O~in~ce of ~e ~wn of S~uthold, ~Ik ~nty, New Y~k~ ~ o~er a~li~ble Laws, d~nces or ~latwns, for the ~ns~mn ~ build m~s, add~t~, ~ alt~ationd, ~ f~ ~v~ or dem:~ lition, as h~in descried. The applicant agr~s ~ comply ~ith all ,applicable laws, i o~nces, budding e~e, h~sin~ c~e, ~ regulations. (Signature of aplflicant, o~ name if a corporation) 49 VETERANg MEMORIAL HIGHWAY (Address of ;applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ............ ~.U-~ ~ER. ................................................... : ......................... Name .of owner of premises . .P.A..T~..~ .C~. 0.'.qt~Al~.Y..155. E,. 179.~J~..qt o,..B~.onx~. ~ .................. :.. Thanas V. 0llen 53-26 Bell Bld., Queens, NY If applicant is a corporate, signature of duly auth,orize d officer. (Name and title of corporate officer) 1. Local~on of land on which proposed work will be done. Map No .... ],05,,~ ........ Lot No..1 ........... Street and Number /~/P~Qbs~.t. Rd..~. a~ap~nx. 100!..W/.~er~y. ~e · SPU$tlolCl ............... ~( _._ ~ ~ ~/~ ' ~cip~iity 2. State existing use and occupancy of premises an d intended use and ~ccupancy of proposed construction. Existing use and occupancy .................................................................... Intended use and occupancy .. 0R~. ~'.e~],y. ~.N~].~O~ ........................................ 3. Nature of work (check which applicable): New Building ...x. .... Addition ........ Alteration ........ Repair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... 4. Estimated Cut .................. Fee ................................................. (to be paid on filing this application) 5. If ,dwelling, number of dwelling units . .~l- ....... Number of dwelling units on each floor ... i1 ......... If garage, number of cars ...... ................1 ... ................................................. 6. If business, commercial or mixed occupancy, spec ify nature and extent of each type of use .............. 7. Dimensions Of existing structures, if any: Front .............. Rear ............. DePth ............. Height ................ Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front .............. Rear ............... Depth ................ Height ................ Number of Stories ..................... 8. Dimensions of entire new construction: Front .... l~.~ .......... Rear . .~-~.~. ........ Depth ... 3.9 .~ ..... ~! ~ .~ Number of Stories Height ....... 9. Size of lot: Front ..... ~L0~. ...... Rear .... 1]-6 ....... Depth ... ~1.20 ........ 10. Date of Purchase .~.e.p.~ ,~...1.9.7. Q ............... Name of Former Owner . .1{$.1.1.$..i~...C.o.z. ~..e.~ ........ 11. Zone or use district in which premises are situated...A..R..e.~. ,. .......................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ...N..o. ..................... 13. Name of Owner of premises . 0tlen. ............. Address ~3 .-26. Be il.Bl~rdo. Phone No..Ha8.521~9 Name of Architect LAY/HENCE.FRANK ......... Address 152..W.k2.S.t. ...... Phone Name of Contractor AI~IOA~I. I~QI~ .QQ}IST.. Address ~9..V.e$~..H.w~. ....... Phone No..51~3.-.9D.00 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 whother interior or corner lot. STATE OF NEW YORK, )S.S. ' COUNTY OF . .~LI~F/3LI~.. ) .......... I~IAt~.C.¥. ~.I~O.~TER ......................... being duly sworn, deposes and says that he is the appli- (Name of individual signing application) cant .above named. He is the ...... ¢/1NTRACT.0H ......................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and ~s duly authorized tO perform or have periormed the said work and to make and file this application; that an statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the mann er set fortt/in the application filed therewith. Sworn tO before me this ///_.~, ~, ~ ~' (~i~_ NOTARY PUBLIC, State ut New Yom ~]~ of appllc~t) Term Expires ~larch 30, 1972 ,t [-