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Home My WebLink About5470-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .S.~..~.....~.Ah~E....-~.1~! k(/~. Street MapNo../.Z[.~... BlockNo...~'~ ..... LotNo ..... Z..~..~. .................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ ~. ~ 19~pursuant to which Building Permit No.~.~.~ dated ........ .~..~.q.&.., 19~., 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 ..... 4 ~.~ ..... 5~ ~../..~.~ ..... ~.~ ~. ~ h ./.~ ~. ................. The certificate is issued to... ~ VS.k[ .... ~,D.~ ~. ~ ~ ~ ............... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~./.Y.Z~.y .~..~ UNDERWRITERS CERTIFICATE No .................................................. ttOUSE NUMBER .... ~"2~...Street .... /~/~ ..... ~:/~. ! t(.~-..,.. ~ ~ .~V.~..~k-S ~o~TH o~ Building Inspector FOBA~ NO, 2 TOWN OF SOUTHOLD 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) NV 5~70 Z Permission is hereby granted to~ .... ~,~/.. ~ .~.~ ....... ..... ..~-.......E~.~.~; ....... ~.~.~g..¢..~.~.~. et premises located at ..................................................................................................................... :~ ............................................................... .~..~..T..~.q.~.i~.........~..:..~ ................................................ ............ ~.~.~..~....!.~.~.~ ........ ~.~..Ts......Z....~.~ .......................................................... i: .......... pursuon¢ to application dated ................................... /..~......~J.J./.,.~.., 19.~.]..., and approved by the Building Inspector. Building Inspector SUFFOLK COUNTY DEPARTMENT OF HEALTH j/ H.D.Reference No ~'- ,~ EASTERN DISTRICT, RIVERHEAD,N.Y. AP~CAT~ON FOR APm~AL TO CONSTRUCT PR~ATE S~AS~ D~S~SA~. S~ST~ . ~atJ~Z~/R /?? ! Approval t~ construct said sy.s, tems is. requested,pertinent data herewith. ~ 1-Applicant~.~ ~/,~. ~ _,/'_~-. Phone~ ~..~6-Sub.d. tv~ Address ~ ~-~ ~.F~ ~2"~_~ ~ ~ 7-Sec~mon_~~m~__ 8-Lot No. ~ 2-Detailed property loQat~ion ~ ~ , . Hamlet ~,e~ ~ TgSD~ 9-Private well? ~-~ .. ~ Public ~ate~ supp. ly~ name/-~w* ~z/~.76'~ Dzstance to nearest ~in ~ ~ ~ Lot Size: Width~ ft. L~h~ft. (also enter on center plot plan below ) _ 5~llin~: Single Family ~T~ F~ily? ~ /Cellar? ~ ~lab? ~Crawl S~e? ~ 10-Pro~s~ system: Septic tank ~ecast ~ess~olS ~ /Shallow ~ols y~yOther ~ g 11-Septic ta~ inside dimensions. ~ol~e ~Gals.Length ft. Width f~. Liquid depth ft. 12-Precast sections: ~Number~Sq~re Ft. Cesspools: Block sizeL zncs.D ins. H ins. Total blocks below inlet: ~1 $2 ~. ~~ ~ ~ ~ Capacity~Gals. Street No~tb Data ~eet Qo~ 0 ~.o~ ~ 2 8 10 12 ~6 18 The Undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, andamendments thereto, covering Private Sgwage Disposal S~stems". Date_~_~/~[~./~/ Signed ~/~_ ~~z~'. ~~m.-~Builder FOR HEALTH DEPARTMENT USE ONLY.. Based on the information presented herewith, it is the opinion of the Health Department, that an adequate and satisfactory Sewage Disposal System on Date ~/?( Sign (10/65 Revis.) S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located ~(Give dried location)/ J have been inspected by this department and found to be satisfactory. &O'"F W 0 o .0 L_o"r Z. L ~zo.o /w T4°oo' W. Z.O-F I ~.4 Y w/~ w TOWN OF sOUTHOLD BUILDING DEI~ARTMBNT TOWN CLERK'~ OFFICl SOUTHOLD, No ¥o Ex mln ~ o ,, ......................... ^pp ,ed ........... ,72.... Disapproved o/c .......................... ~ ......................................................... .:~ ............. (Building Inspector) ^pplle.~tion No. ~.,., .~.....:~,. ............. Z APPLICATION FOR BUILDING PIKMrT · ./ . .......... £ .................. , ,,.TZ... INSTRUCTIONS a. This application must be completely filled in by typewriter Or in ink -,nd submitted in duplicate to the Building~ Inspector. b. Plat plan showing location of lot and of buildings on premises, m!atlon~hip to adjoining premlee~ or public streets or areas, and giving a de, ailed description of layout of property must be drawn an the diagram whlch c. The work covered by this application may not be commenced before i~tiance of Building Permit. d. Upon approval of this application, the Building Inspector will Imue 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 pumuant to the~'H~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, Gnd other applicable L.awl, Ordinances Regulations, for the COnstruction of buildings, additions or alterations or for removal.or dernolltion, al herein d~crlbed.~ The applicant agrees to comply with all applicable laws, ordin~:es, building code,/~buslng co~, and regulations. - (Sl~natur~cf applicant, or name, If a coqaoratlon) ~ v (Address of applicant) / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, eleCtrician, plumber or builder. Name ..~..~ ......... of owner of premlse~ '7' ........... ~"'~ ............. If applicant~l~a corporot~e, slgn~(ure of_d. ly~authorized officer. /~ ~ ~-~ ........... (Name and title 'of corporate offlosr) ' . 1. ,o~a,on of ~ond o, which p~am ~rk ~,,~ be dan.. ~op Na.: ./..~,..>~.... .................. ~ No.:,g,,~.~ ............ .~'.D. ~ Munlclpall~ 2. State existing use o.nd occupancy of prergises and intended use and occupancy of prpposed comtruaticfl: a. Existing use and occupancy ........ .~'.~ .......................................................................................... b. Intended use and occupan:, ......~ ..................................................................................... 3. Nature of walk (check which applicable): New Building ......~........... Addition ................. Alteration ............. Repair ............ ._.~g~_~Removal .................. Demolition .................. Other Work (Describe) ..................................... Est mated Cost '~'j~:2&~ Fee ' ~...~. ~ . (to be paid on fi!lng 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 .~..~....~ ................... Rear .......~.....'.~.. ........... Depth./,..=....... .......... I . Height ..J..~'.. .......... Number of Stor~es ..... ~ ............................................. ~' .............. / ................................. 9. Size o~: lot: Front ....~..~ ............ Rear ...... /.'....~... ................. Depth ...~.~.~'.....~.....~-/.~. 10. Date of Purchase ........................................................ Nome of Former Owner ....................................................... ! 1.. Zone or use district in which premises are situated ...~.~--,-~-~.: ................................................................................... 12. Does proposed construction~,;_ ~ -, ' ~ ~ ,~vi°l°!'e~onY zoning law, ordinance or regulation.;> ..~ ................................................... 13. Name of Owner of premiselr~',&t..~.i~.Address~'~'_,~'_~.~.~-.~ Phone No Name of Architect .................................................... Address ............................................ Phone No ..................... Name of Contracto ..Addres . Phone No. PLOT DIAGRAM locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-back dimensions fram property lines. 'Give street and block number or description according to deed, and show street names and indicate whether interior or corner Jot. STATE OF NEW YORK, COUNTY OF .............................,f ................................ ,.....being duly sworn, deposes ond says thot he is the opplicant (Nome of indFgidual signing application) ' above named. He is the .............. J ............................. ~ .................. 'jL ....................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make 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 forth in the appli~:~tion filed therewith. Swam to before me this ~ /-~ ~~.. ........................ day of ............................................ , 19 ........ hlotar'! Public, . ........................................................... Count~ (Signature of applicant)