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Home My WebLink About5095-z! I ~ FO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Occupnncy No. 2~5~+66 ...... Date ...... Bep.~.e~ber..19,. %973., 19 THIS CERTIFIES that the building located at .. ZA.~;tle. l~{¢k. Road ....... Street Map No...XX ........ Block No.. ;~X ...... Lot No..?~X...gu~;¢hogmm ................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... D~¢emb.e~..~,! 19..7.0 pursuant to which Building Permit No.. dated .......... D.qcemb.~'..1+$19.7.0., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .l~ei.v.~te. one. f~i~y..~wv~;~.n.g ....................................... The certificate is issued to .C.$¥.o..J., & FAleen R, (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . I~.ated.~..Feb.,..2~,..].97~ ........... UNDERWRITERS CERTIFICATE No. ~ HOUSE NUMBER... 88.5 ...... Street .... IA.t.t.~,e. ~.e.~k. Ro. .......................... ....................................... g~tohogue ............................... l~uilding Inspector'~ ' FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN_~GLERK'$ OFFICE SOUTHOLD, N, Y. BUILDING PER~IT . (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL ? COMPLETION OF THE WORK AUTHORIZED) N? 5095 Z Permission is hereby granted to: ................. g.&z~...JT~.eata3.a ................................ to .... ~..~~..a~~..a.-bu~a.-=a..aaet~.-~..~ ............................. at premises located at ........ ~.~..,~/~.t~L~...~IJJ..AT~I.I~. .................................................................. ............................................................. ~11~ ....... lt.X. ............................................................ pursuant to application dated ........................... ~1~ ........... ~ .......... , 19....~Jj and opptoved by '~he Building Inspector. ~ee $..3~,~t0 .......... ul mg nspecor / 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 ~ ~/~, >-,Z/ ~-- 3-Subdiv. Address /j/,~. ,..~ /~¢/ .~-~z-~.~.hone ~.~.~4-Section No. 2-Name of BUilder ~ .,~.. ~ ~ .~ ,~ P~o~e ~' -~-Lot N~ber ~-~ewa~e Sys~'~a~J~ by. Phone Address 8-(a)Deed location of property / ,,v?'/. ~ ~c. / .~ ~ -~,~ / ~_- (b)Hamlet or Village C ~] ..... ~ z~ (c)T6w6~ 9-Septic tank-Gal~ ft.~ .... ~q~d Depth _ft. 10-Cesspools-(a)No.pool~(b)Blocks~elow inlet-l)- '. 2) (c)Block size~ im.W~,H SD.(d)Pr~ast pool (e)l 2 (f)H ft. in; ~ ~ in.(~)Finished grade to cover (h)Backfill Material ll-Water Supply: Public Syst~ ; Private Well If Private, the foll~img questions are to be answered: 12-Private Wa~er Supply Syst~ installed by ~~, Phone Address ~,~ /~/ 13(a)-Total Depth of Well (b)Depth to Static Water Level 14-Di~eter of well pip~ in, 15-Name of Laboratory 16-Method of Disinfection 17-Date ready for inspection ft. The undersigned CERTIFIES: Above systems have been constructed and are in compliance with the Suffolk County Health Department's current Standards, Bulletins 19-Inser~ ske~qh of location of Water & Sewerage Facilities with accurate dimensions. STREET FO1~HEALTH DEPARTMENT U_!SE ONLY J Inspected by -, ate Based upon the in~ation stated above, satisfactory functioning of the above systems can be expected with proper maintenab~d.~andcareT.' ~ Date q I972 Approved .... S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date ~' ~ ''~ Bldg. Permit Ho. TO WHOM IT MAY CONCERN: at The sewase disposal faciliti'es for a structure (C~ve deed location)/ ~ ~ located have been inspected by this department and found to be satisfactory. ' ~ ~ 3 2 ~972 Chte£ of General En~ineerin.T Services Examined APPLIGATION FOR BUILDING PERMIT .,.. Dote .................. ' ........... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und 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 dMalled description of layout of pmparty must be drawn on the diagram which c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such 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 port for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a B-Ildlng Permit pumuant to the Building Zone Ordinance Of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, al hareln deKrlbed. The applicant agrees to comply with all applicable lows, ordinances, building code, housinl~de, and regulations. ,~.,~ % ~ = / (Sign ant, orname, State wh r applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......... ......................................................................................................................................................... Nome of owner of premises ..... .~.,.~.~......~.....,~..a~.....~........~.~.~..: .~-~.,~' .~......~.,........~../.~',.~-~-..~..~ ............................ If applicant is o corporate, signature of duly authorized officer. (Name and title 'of corporate officer) t~ n lan n hi r ill one Ma N ~ ~ 1. Loca 'o of d o w ch proposed wa k w be d . p o.: .......... ~...., .................... Lot hJo.: ..:....'..~ ............ ~/-~( _ ??.~ Municipality 2. State existing use and occupancy of premises and Intended use and occupancy of proposed comtruetlon: ' a. Existing use and occupancy ..L~....c~...~. ............................................................. /41) / > "'1 ............... Nature of wo~k (check which applicable): New Building ............ Addition (~) C'~ Alteration ........... . Repair .................. Removal .................. Demolition .................. Other Work (Describe) ..................................... : 4. Estimated Cost ........... .~ ......................................... :Fee ................................................................................. (to be paid on 'fi~ing this application) 5. If dwelling, number of dwelling units ........................... Number of dwelling 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 ................... E..?. ........ Rear ......... ..~'....~. ........... Depth ../..~.zS~.~'.... Height .................... Number of Stories .............~ ............................................................................................ 9.. Size of: lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ...: .................................................... 1 I. Zone or use district in which premises are situated .......... ~.~ ........................................................................................ 12. Does proposed construction violate any zoning law, ordinanc~ or regulation? ............................................................ 13. Name of Owner of premises ..~.....~ddress~'~' ~-,- ,n n ..... ..~....,7.....~...~:Z.~:? .................. Phone No ..................... Name of Architect ...................................................... Address ...................... ^ .................... Phone No ..................... Name of Contractor ............. ~ ...................... Address ............................................ Phone No ..................... , 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 comer lot. STATE OF NDvVeY~R~ ,~{ tee COUNTY OF ~,;.~..~d~ .......... .f.~.,a. . ........................ ~ ....... ~..~ ............... :being duly sworn, d~es and says t~t he is the applicant (Name of individual signing application) above named. He is the ................................... ~..~. .................................. '~ ................ ~ ....................................... (Contractor, ag~t, co~orate officer, etc.) of said ~ner or owners, and is duly authorized to peHorm or have perfo~e~ the said work a~ to ~ke and file this ~plication; that all statements contained in this application are tree to ~e ~st of ~ knowledge and belief; and that ~e work will be perfo~ed in the manner set fo~h in the application filed t~r~ith~ ~ Swom to ~re ~ ~is ~ - ~ / ~ dd,, of // / ' ...................... '-' ....... Notae, Public,~~..h ~~~,g"a~re of ap~n,, No. 52-812~50, SuffoLk Co~ ~' ~ ~m ~pires ~rch 30, 1~