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Home My WebLink About4817-zFOPt~I NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No .... ~-. 4050.. Date .. Iiovem~er. 30, ........... , 19.70 THIS CERTIFIES that the building located at .. ]Bayberry. Road .......... Street Map No.~e~t~Cre~k Block No .......... Lot No. 15. &. 16~..Soul:hold,..~..York oet~zopa~nt conforms substantially to the Application for Building Permit heretofore filed in this office dated .... June .... 23, ..... , 19 7.0. pursuant to which Building Permit No. 4817B. · dated .... J~ne .... 23, ....... , 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 .... prtva~ .one..family. chtelllng .................................... The certificate is issued to ...~7er~me. Naztoach:~a ................................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval I~o~e~r. 25.,..].970~. Rol~rt. ~/:t].~a House # ~.80 Bayberry Road I~OKM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PEP. Mir (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 817 Z Permission is hereby granted to: to ...... .~.J~ .. JJl~ · ~l...~.lJ,J,~.. ~il~ ~nld~ ............................................................................. at premises located at ..................... j~j..jJ~ ......'~'~"&"~J6 ......... ~lJ~'JJJ~JJJ"JllJ~lJJ.J~llJJI~'' pursuant to application dated ......................... 11'J~ .......... ~ .......... , 19...~0., and approved by the Building Inspector. - =ul aing nspector ~ S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH D.t~ J/~¢'~7 0 Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located deed location) have been inspected by this department and found to be satisfactory. Chief of General Engi~e~,-~ Services District Engineer 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. 2-Name of Builder ~ ...... ~ Phone ~,,,~0 5-Lot Number Address ~ - 6-Bldg.Pe~i~ No. 7-Sewase Sys~ ins~alled by ~,~ Phone Add=ess ' 8-Ca)Deed locl~lon of property ~mu~E ~ 0 (b)H~ale: or Village ~9'~ ~Z~~ 4 Cc)Town 9-Septic ~ank-Gal L ft.W it.Liquid Depth ft. - lO-Cesspools-(a)No.poo~s~(b)Blocks below lnle~-l)' 2) 3) Cc)Block size-L ;1 in.W ~ in.~ ~ in.(d)~r~cast poo~ (e)~2 3__ (f)H ft. tn; Diem ft. tn.(g)Flntshe~ grade to cover Ch)Backfill Material ,~A ~ W-1~' Il-Water Supply: Public Syst~ ' ; Private Ii Private. the foll~inI questions are Co be answered: 12-Private Water Suppl~ System installed by ~,-z~)R~'~,e'o ]~Rq Phone ?& Address ~ e ~"~ ~L/'~ . _ l~(a)-Total Depth of Well ~ ~' Cb)Depth to Static Wa~er Level ]~ 1A-Diameter of well pipe ,~ '' in. ' ' 15-Name of Laboratory 16-Method of Disin'fecCton 17-Date ready for inspection /~//~,/?~ ' The undersigned CERTIFIES: Above syst~s have been constructed and are tn compliance with the Suffolk County ~ealth Department's 6urrent Standards, Bulletins and ~endments thereto. 18-Dare ~et - Builder 19-Insert sketch of location of Water & Sewerage Facilities with accurat~dimensions. STRUT . FOR "~LTU DEPAR~ENT USE ONLY Inspected by ~ ~, Date //~ ~ ~ Based upon the info~ation stated above, satisfactory functioning of the above syst~s can be expect~ ~i:h proper maintenance a~re.~ TOWN CLERK'S OFFICE /'A~ ~ F,..,r'- ~,. ~'-i - ~ .... ........................ App, .on Na. .............. ", ....... Approved ........................................ , 19 ........ Permit. Na. Disapproved a/c ....................... APPLI~ATION FOR BUILDING PERMIT // Date ..~s,~.....~..~...? ........................... , 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 Iocatio~ of lot and of buildings on premises, r~lationship 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 part 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 port for any purpose whatever until a Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the~ Buildin~ Zone Ordinance of the Town of Southold, Suffolk County, New York, ~nd other applicable Laws, Ordinances or Regulahons, 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. ~ (Signature cf apphcant, or name, if a corporation) ..... .............................. /(Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner o{ premises ........................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) 1. location of ,and on Whlch.~ '....."~.Opr°p°sed work will be done. Map "o.:/<(~,.~-.~-.~.~.:--'-~__~ '--//L°t'°':'-"',/,.~,,,./~,. .............. Street and Number ...;~.~.~,~n/.....-.~.. .................................................... ~.-~...-~,~-~ ............................... ~:>/ -- /' ~0-- ._..~/ Municipali~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy ............ .~.~e~... ................................................................................................... use and occu. pancyI ....... ;../....~./..~,: ~..~ ................................................................... Intended 3. Nature of wOrk (check. which applicable): New Building ~ ............. Addition .................. Alteration ....... ~....,t .... Repair .................. Removal .................. Demolition .................. Other Work (Describe) .............................. '.: ........ 4. Estimated Cost ~..~. c~sz.,d Fee .Z ~. , ~ (to be paid on fi!ing this application) 5. If dweflrng, 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 ..... 7...~'.~. ..................... Rear ...~...~..::.~... ........... Depth ~;~..~'.....-...~/.. ..... Height .................... Number of Stories ...................................................................................................................... Size of lot Front ../...o..-.-.-.-.-.-.-~... Rear ./. ~. .................... Depth .../.....~........-~.. ............. Date of Purchase · ../~-'~-~-.../.~.~.../...~..~..~ .......... Nome of Former Owner ~...~..~d,~..~'~ ..... Zone or use district~i'n which premises are situated ............................. . ............ ~ ............... Does proposed construction vi~te any zoning law, ordinance or regulation? ....~....~. ............................................... Name of Owner of premises~t..~ddress ../.~..~~..x~.~.. Phone Nd~.Z.~..:.,~..../..~..~) Name of Architect ...................................................... Address ............................................ Phone No ..................... Nome of Contractor ..... ~.~~...~.. ................ Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all 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 indicat'e whether interior or comer lot. 10. 11. 12. 13. STATE OF NEW~L"OJ~/ COUNTY OF ...... ................. '~'~'~'_*'""'/"'*~..~*.~ ~y ,~rn, d~o., and says t~, he ,, the applicant a~ve nam~. He ~ the .~ .......... ~. .T..~.~.~ ........... '~: ............................................. (Contractor, ag~t, co,rate officer, etc.) of ~id owner or ~ners, and is duly authorized to peHorm or have perfo~ed the said work and to ~ke'~d file this application; that all statements contained in this application are tree to the ~st of his ~owledge and belief; and that the work will be perfo~ed~ the manner ~t fo~h in the application ther~lth. Swom ,~f~e ~ this .................... day of ...... ~Z ................. , 19 ........ .Notary. Public, . ........................................................... County (Signature of applicant)