The URL can be used to link to this page

Home My WebLink About5465-zFORM NO. 4 TOWBI OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, BI. Y. Cerlificate Of Occupancy THIS CERTIFIES that the building located at . ~a~l~ebl. & .Miek~. M.. Street Map No..~ ......... Block No. ~ ...... Lot No .... ~ .... ~eW. ~g~...~.~,... confo~ substantially to the Application for B~g Pemit heretofore f~ ~ ~is office dated .......... ~...~.~..., 19 .~]. p~su~t to which B~ld~g Pemit No..~. dat~ ......... ~.. ~.~ ..... , 19~.., was issued, ~d conforms to a~ of the ~quir~ men~ of ~e applicable prov~ions of the law. The occupancy for wMch this ce~ificate is issu~ ~ .~te. ~e. f~l~ .dV~ ....................................... The certificate is issued to ...~.,..& N~S. ~..PL~ ...... ~e~ ............ (o~er, levee or ten~t) of the afores~d buffing. Suffo~ Co~ty Department of He~ Approv~ J~ .%0~. ~.9~. · .By. ~, .~a... :: )3~ 0~a~ M~ .<~. :~ ..... ~: ............. B~d~g Inset FOF. M NO. ~ TOWN OF $OUTHOLD 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) N? 5465 /? ~,~ 71 D~e ........................................................ ,19 ........ Permission is hereby granted to: ~q., ~. ...... .~,~ ............ to ........................................................................... Y.. .................................. 7.. ...................................... ct premises located at ............................................................................................................................ pursuant to application dated ............................................................ , 19 ........ , and approved by the Building Inspector. Fee $ ........................ Building Inspector BUILDING DEPARTMENT~ ~ TOWN CLERK'S SOUTHOLD, N. Disapproved a/c ..... ~'i ......... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No. ~'~/'~'-'~-- 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 ofproperty 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. Building d. Upon approval of this application, the Building Inspector will issue a 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 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, ordi nonces, building code, housing code, and regulations. (Signature of applicant, or name, if o corporation) (Address of applicant) I I '7~t' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........... ...................................................................................................... Name of owner of premises ... ,~,,...I~..,,~Z,.I~,,.I~....~,'L'~.O...I~....,~,..-~.....~,~..~.,..,r~....~'...~... ............................................................ ~ If ~p~ co, rate sig~ ~ authorized off icer. 1. k~otion of land on whip_proposed work will b* done. p .: ........................................ o ~o ......................... ~ ~)- ff Municipali~ 2. State existing use and occupancy of premises and intended use and ~cupancy of proposed const~ction: a. Exisiting use a~ ~cupancy .......... ~m.~....~.~~ ....... ~ ................................................. b. Intended use and occupancy ....... ~.~...~.~.~..~..~ ...................................................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alterotion .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ....... ~...~...~r....0....O.:...O....¢~ ...................... Fee ......~....L~l.n../.~.. ............................................................. (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, specify nature and e~tent 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 ..... ~ ....................... Rear ......~....O.. ............... Depth ..... ~..~...~.. ....... Height .....I.~.: ......... Number of Stories ................... L~.~... ..................... .~... ................................................................ 9. Size of lot: Front ...... Z.~..~..~.. .......... Rear ........... ./...~..~....O. .............. Depth ....~.~....~'......?....../..z...7 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ..... ..~....O.. .............................................. 13. Nome of Owner of premises ~"...~.....~'.....-~....Lu......~&./.Address?P.'.~:.).~..~.....~...~.,..~J~..~r--. Phone No.~..~...~....~...~../'.,~' Name of Architect ............................. ~ ................. Address ....... .~.....~ ....................... Phone No...~ ................. Name of Contractor~.~:lGl~O.~.~C~.-~.Z~..Address .~...~...~ ........ ~t ........... Phone No. ~.,j~...~....?...?. 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 occordJng to deed, and show street names and indicate whether interior or corner lot. I EW YORK, ! e ¢ COUN~ OF ..~:~)~ ........ ~'~ ............. ~~g~..~.z.....~.~..~ ................. ~ing duly ~om, ~o~s ond say~ t~ h~ is the ~pplicont (Nome of individuol signing o~lication) obove nome& He is th~ .............. ~~.~.~ ........ ~..~....~.~ ......................................................... (Controctor, og~t, co~mte officer, etc.) of said owner or owners, ond iS duly outhoriz~d to pe~orm or h~e pe~o~ed th~ ~id work ond to ~ke ~nd fil~ this ~pplication; thor ~11 stotements contoined in this oppli¢~ion ~ tm~ to th~ best of his knowl~dg~ ~nd belief; ~nd that the work ~ill be performed in the m~nner set fo~h in the ~li~oti~. fil~ th~with. Sworn to b~ore me this ~ ~, ~] ..... ......., .............. (Sig~mre OT applicant) No. 52-81258~, Sulf~k S-9 SOI~D SUFFOLF COIE~TY D£P_iRT~E~,E OF Bldg. Permit No~.~~ ~--- The sewage disposal facilities for a structure located at have bcsn i~pected by this ~epa~ment and fo~d to be satisfacto~. SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No~.~ '~// EASTERN DISTRICT, RiVERHEAD, N. Y. APPLICATION FOR APPRO~rAL TO ...CON, S. TRU. C.T PRIVATE SEWAGE DIS. POS. AL ,S. YSTEMS Approval to construct said systems is requested,pertinent data herewith: AddressfO, ])~ ~ 3~-~uw._ ~ ~Y~ ?-Section 2-Detailed property loca{'ion"~¢"~'r~'oJ~;' ~/¢t~ RD S-Lot No. Date Hamlet /'/¢-~'~ $~,F~oz.~ Town ~oor~o 9-Private well? 3-Public ~.ter supply name Distance to nearest main 4-Lot Size. Wtdth/~-%~ft. Lengt~ft. (also enter on.c~er plot plan ~below:) 5-Dwelling: Single Family ~.~'Two Family? ~ /Cellar? ~.S~lab?~.~_~Crawl opace? ~_/ 10-Proposed system: Septic ~ank ~ fPrecast y /Cesspools /_~hallow pools ~ /Other 11-Septic tank inside dimensions: Volume Gals.Length ft. Width ft. Liquid depth ft. 12-Precast sections: /Z~Number_~&~Square Ft. Cesspools: Block size~ ~,] .incs. D ins. H , ins. Total blocks below inlet: ~i , , .~2 ~3 , PLOT PLAN Street Capacity~ ~,Gals. G.P.M. The Undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Health Depar. t~ents' current Standards, Bulletins, and amendmentythe~to, covering PrivatLSe~z~~y~~. FOR ~ALTH DEPART~NT UoE ONLY. Based on the info~ation presented herewith, it is the opinion of the Health De~rtment, that an adequate and satisfacto~ Se~ge Disposal System can be installed on this Plot. Date (10/65 Revis. ! FR, oHT LEYAT I0 - I' I b _1 h T .I