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Home My WebLink About4733-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occup hcy No. ~l~bgl~ ..... Date ...... ' ...... December..1.~.., 19~ .71 THIS CERTIFIES that the building located at . 'R&0',~ '8~ '141d~le' Roa~l Street Map No.. x~ ......... Block No...XX ...... Lot No...~ .... 0~toh~g~ -. ~L.~', ...... conforms substantially to the Application for Building Per, mit heretofore filed in this office dated ......... I~ay ....~ ...., 19.70. pursuant to which Building Permit No..1+73~Z. dated ......... ~ay .... ~ ..... , 19.70, was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is · P~'~at~' '~' '£am~y ' ~elltt~g ....................................... The certificate is issued to . · ~i~s 'Fra~lces' ~xxho'stt~; ' .... ~.~ ................... (oWner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Ho~se ~18210 ~O~ NO, ~ TOWN OF ~OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERAAIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 4733 Z Permission is hereby granted to: ...... ,~ o..~e~l~e~k$....~.. ~r~oe&..~o ski ....................... J4a.~.f~,,~oh ................................... to ........ .~td&.4 .. F~...o~e...f.. m~ &.]..y.. ~we ;~ .],L~ ........................................................................... at premises located at .................... ~.,,O.~'~.,.....-ct]$...l/~.~..~cl.~o....n,~d ................................................ .......................................................... ~'0ehog~ ................. ~.~.~ ..................................................... pur~uc~t to oppli¢otion dotal .............................. ~ ..........~. .......... , Ig....r~ and appro¥~d by the Building Inspector. Building Inq~ector SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference N EASTERN DISTRICT, RIVERHEAD.N.y. APPLICATION ~OR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS ~Approval tn construct said systems is requested.pertinent data herewith: Date 1-Applicant ~-~,7~3¢~., ~._O/~og~, Phone 6-Sub div 2-.D. etailed~ ?ropert~ location-~'~_, ,, ~v~ -~d. ,,~O9' ~/O~?,~)~B-not No. namlet/~- £~--db~O~z~_~ Town g),~d~%D 9-Private well? ~-Public ~ater supply name/ Distance to nearest main ~-Lot Size: Width ft. Length ft, (also enter on center plot plan below:) ~-Dwelling: Single Family ~ ~ Two Family? L~Cellar? ~ ~.Slab? ¥~O-Proposed syste~: Septic tank, ,Precast, ,Cesspools,,Shallow pools , ,Other, , il-Septic tank inside dimensions: Volume Gals.Length ft. Width ft. Liquid depth ft. 12-Precast sections: /2~Number~_~SqUare Ft. Cesspools: Block sizeL incs.D ins. N ins. To~al blocks below inlet: ~1/~2 PLOT PLAN Street IndJ Nc The Undersigned CERTIFIES: "Construction of authorized installation. C~. pacityP.M. ~ ?_..~ls. .Gade ~~ tie ;h will be in Data Feet 0 2 6 8 10 12 ~6 18 accordance with the Suffolk County Health Departments' current Standards, Bulletins. and amendments thereto, covering Private Sewage Disposal Systems"-. Date /llz l7~ Signed / ,-- .~/ O~ne~ or . BuiiderfC~ FOR ~ALTH DEPART~NT USE ONLY. Bashan the info~ation present~ here~th, it is the" opi~on of the H~lth De~ment. that an ad~te a~ satisfacto~ Se~ge Dis~sal S~tem ~n be i~tall~ on this ~ot. Date (10165 ~evis.) Signed~- IPOBZf NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLEI~K'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ....................................................... APPLICATION FOR BUILDING PERMIT ~'~ Date ....................... ............ ............... .... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and 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 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 o Building Permit pursuant 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, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. Joseph Deerkoski (Signature of applicant, or name, if a corporation) Mattituck (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................................... .s. .......................................................................................................... Name of owner of premises ...~..?..s...~...~..a...n..~...e..s.....~....l~...p.s.~..~ .................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: .......~. ...............................Lot No.: .....~... ................ ~'l 1~;>~ / 0 ~ ~, O,J~I- ..~Muni¢il~lity .................. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... .~.~,.~.~,T~..~,~T~I, .............................................................................................. b. Intended use and occupancy ........ O.-'n.e...fnmt ] ~..~[e/L.l~.-'~ .......................................................................... 3. Nature of work (check which applicable): New Building ..~..~...~ Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ............ ~..~.~.Q.~.(~..~+ ............................ Fee ...... .1...0.....0...0. ........................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... .o.b.e. ................ Number of dwelling units on each floor ............................ If garage, number of cars ............. o~te ......................................................................................................................... 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 ........ _,..~...,.,~..1.,-,..8..... Rear ...... ,6..,1.,-..,8, ............ Depth ..~..6..-,.,8....,/,....2,.2..,-8 Height .................... Number of Stories ......... Q~ ...................................................................................................... 9. Size of lot: Front ....... .~,g.e~.gf~,.,, Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ ] ], Zone or use district in which premises are situated ............. ?..~)...c]i,S,l; ..................................................................... ]2. Does proposed construction violate any zoning law, ordinance or regulation,;) ............ .t'tO. .......................................... 13. Name of Owner of premises ,~..~,,,~..~,..c,.e.,.S...,~,.,,~,,,.°,.S.~.~....,Address ....,C,.,~.,l;..,c..~,.,o.~,,~.,e. .................. Phone No ..................... Name 'of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ......... ..~,.,.....~..e...e..z',..~..o,,.s,,~...~. ............. Address ..,...~.,a.,,,~,~..~,~,~..,c.,~,. ................. Phone No ..................... PLOT DIAGRAM Locote cleorly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street ond block number or description occording to deed, and show street nomes and indicate whether interior or comer lot. J I STATE OF NEW YORK, ! e e COUNTY OF ...8~f.olir ............ ~'a'a' Jc~seDh Deerkoski beina duly sworn, deposes and says that he is the applicant (Name of individual signing a.l~oli.cation) above named. He is the ........................ (~3.~6.e~.~.0.3~ ......................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to rnake and file this application; that all statements contained in this application are true to the best of his knowledge and belief; end thoz the work will be performed in the manner set forth in the applicatlon filed therewith. Swam to before me this ................... ~":~'-t,, , .~./_ / j_. ~ )_._ .~ ...~:~4r~..~day of ........... "~'*..~.'a'~...~w ....... ;.., 19......?0 ~j' ~LIZABETH ^1~ NEVILLE iNOTARY pUBLIC, St~l~e o! New York No. 52.8125850, Suffolk Cou~.Jy.., Term Expires March 30,