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Home My WebLink About4727-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~1~., ..... Date ............. THIS CERTIFIES that the building located at . (~SlU- -l~. ~1~, ~e ...... Street Map No..aeA..~llh .~lock No ........... Lot No.. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... A]~X*~.-. ~j~ 19 .~. pursuant to which Building Permit No. ~1~.. dated .......... &]~'~l.... ~9, 19 .~0., was issued, and conforms to ali of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .~S,%~lte. se. ralt~..dw~l~Ll~ ...................................... The certificate is issued to ..... PSat]Ap · 'Gl,el*rialto -&- if~f'!a .... O~lo~ ........... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ·. FOBM NO. ~' TOWN OF 5OUTHOLD 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) lq? 4727 Z Permission is herebygrant at premises located at ............. ~l~J...L~J.....~l~kl'...J~.t~l#.~.JIj~ ................................................... .......................................... l~......~..l~. ~t,...~t.: ~. ........ ,lJ~t,~.~ ............................... & F...~.......~ ., 19...~...., approved by the pursuant to application dated ........................... '~. ..................... and Building Inspector. Disapproved a/c ........ ..................................................................... ...... ................................. APPLICATION FOR BUILDING PERMIT ~:~ / Date ................. , ........ .A. ~,.~ ~.~.:..2.?. ............... , 19...,/....0....' ,Ns'rR , :r,ONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plat plan showin~ location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is port of this application. 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 part 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 Building Permit pursuant to the ~' Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or~r Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant c~3rees to comply with all applicable laws, ordinances, bui!ding cede, housir)g code, and regulations. (S,enature of applicon~'~'i~-~'~'l;rporatlon) ~ICAI~' I{01~ CONSTI:IOUTZO~ CO. ............. .... (Addres~ of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If ~pJicant is a co~omte, signa~re of duly authoriz~ officer. ~0 ' (Name a~ title of co~orate officer) 2. State existing u~ and ~cu~n~ of promises and intended u~ and ~cu~ncy of p~ con~m~i~: a. Existing use and occupancy ................................................................................................................................... Intended use and occupancy ...... .QI~..F. AF~T~..])~____:_T_;TIJt~ ............................................................................ 3. Nature of work (check which applicable): New Building ........ ~.. ....... Addition .................. Alteration .................. Repair ................ ~ Removal ..................Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ..... .~....~....~ ................................... Fee /0 ~ (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 cars ....~ .................... 6. If business, commercial or mixed occupancy, specifl/ 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 ...... ~1. ......................... Rear ........ .~I, .............. Depth ...~,.[~ ........... Height ....... ].S ......... Number of Stories ........... .], ............... 9. Size of lot: Front ..... .9.Q .................. Rear ...... 9.Q ......................... Depth ......... ..~.~ .................. 10. Date of Purchase ...........~ ............................................ Name of Former Owner ........................................................ 11. Zone or use district Jn which premises ore situated ..................................................................................................... 12. Does.proposed cOnstruct on v o 6te any zon ng aw, ord nonce or regu at on~ ~'OO · ' ........ ~,~N ............ ~q'2 .............. 13. Name of Owner of premises ~.~I~T.]~...GI.O~DA~TO....Address ~,63~..~(]..]~Dl{A__T_,~..~.V~o Phone No..~7...~..-.3.~.~ Arch tectLAWR~l~OE ..F~T~ 1 2 ~T nd T No.~,~70~. Name of ............................................ Address .~ ........ ,.~.~ ....... ~...~...~,~.... Phone Name of Contractor &~l~,T,~AN..l~'t~..D.O~....D,4~:lress~,9...~2',~.~..,s~Dl~,D.~~ne No...,~.;R.-.9.CIOD PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate oil 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 corner lot. STATE OF NEW YORK, COUNTY OF .......... .................................... · .V:..'~....Z.~.~...~..4S~...n..'.4~.~ ................. beir~g duly sworn, d~oses and says that he is the applicant (Name of individual signing application) above named. He is the .................................. :...A~ ....................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~:ke and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application, fil~ therewith. Sworn to before me this ~8 of ., 19~.O... // ' ', // , Coun~';'~ ;';'~' ........ ~~~ ........................... SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. P~rmit No. TO WHOM IT MAY CONCERN: The sewage disposal faciliti&s for a structure located (Give deed location) have been ~nspected by this department and fQund to be satisfa~toryo Chie~ of General Engineerir~g Services DIlls t ric t Eng'~ne---~ r SUFFOLK COUNTY DEPARTMENT OF ~EALTH EASTERN DISTRICT~ R1VERHEADj'N.Y. AP~,ICATION FOR APPROFAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEKS ~pproval to'c'onst~mct said systems i's request~d',perttnent ~ata 'herewith: Date__ . i-Applicant /~///~/~ ~.d~42~A/O - Phone-WT~2 6-Sub div Address /~3~ /~d ~/~D A~3, ~,,~,~f~ k',u' ','~' 'Y'~.;' ?-Section 2-Deta~led, propsrtyJ, ocatmon~_~.~ C~D~Z ~ D~.~ ffg~ 8-not No./3~ ]-~bllc ~tSr supply nam~ ...... DistanCe %o nearest main l$-Loh Sizo: Width ~ ft. Length. 87 ft. (also enter 6n center pi. et plan below:)' 5-~elling: Single Family ~T~ Family? ~Cellar? ~lab? / lO-Pro~s~ system: Septic tank ~Preeast ~Cesspoo~s ~Shailow pools I~-Septic ta~( inside dimensions:.~olume Gals.Length~ ft. Width ft. Liquid depth__ft. !~-Preoast sections: ~Number~Square Ft. Cesspools~ Block size~/6 incs.D 4 ins,H~ ins. Total blocks below ~nlet: ~1~ ~2~6~ PLOT PLAN \IA .- ~ o ~apa~lty~ G.P.M.. ~ ~t~0 Feet -. .~' 0 ~' - 6 12 Street 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 S~stems", . Oate signed. '"'"'"' or ~Bu~ lder FOR FEALTH .DEPART~NT USE .ONLY." 'Based on the inFo~ation ~resented here~.th, it is the opinion of the Health De~rtment, that an adequate and sat~sfacto~ Se~ge Dis~sal System can be installed on this Plot. . PKIVIIT{i I{{:)P, ll S. 5~)° CZ' 4 0" C-. - 4 /ADP-Ol:" L,q H D - SURVEYED I~OR PLtiLIP., JOI2N SLOP, 50_Ut'Li 0 [13 TOVdI~ OF $OUTT4OL{2 , LI C ;N 5 [:,'l LRND S~JRVEYOKS B 21; l~ 8 DRYERS FURNACE MOTORS .fUTURE FL~ DIMMERS SERVICE ~SCONNECT , ~Purntce~: 1-1/8bp., 1-1/~hP., Water Heaters: 1-q. SkW., Motors:' 1-B/"hP-, S R I C E Lawrence M. Harte 70 Orandvlew La. Smithtown, N.Y. 11787 This certificate must not be altered in any manner~ return to the office of tl~e Board if incorrect· Insoectors may be identified by D /credentiaJs. P~ILIP I^~P O~ SU&VEY~II ~ JOJ~N 50UTWOLB TO~ OF ~OUTI~OLrJ , N.Y. r~ - J d L.~F-T 'c/7-)c- ~,'~r HT- ¥ID£ d F.,4,/,~d~7~ ¢ -T