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Home My WebLink About5474-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No...~..0 ...... Date ............. $~....1]~ ..... , 19.~I~. THIS CERTIFIES that the building located at .Ma~! s. Ro~ .............. Street Map No. ll&l~i, ][lal... Block No ........... Lot No. I~6. &~,? .... M$1;.tl~'lle~ ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ~,.~1~...1.6..., 19.~1... pursuant to which Building Permit No. ~ .. dated ......... &~...2.~. ..... , 19..7~.., was issued, and conforms to all 'of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is l~lvate olin family ~Wellt~g The certificate is issued to P~bel'.~ .8~e:i~el.~a,l~ ....... Ovllel.. ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . ~.~$..~.~.l. 9.~... bY. .R .. ¥~,ll& ..... UNDERWRITERS CERTIFICATE No. Il. ~.1~ ........................................ HOUSE NUMBER..111..~.5 ...... Street ..... .~..1,~..l.~...~..1:1~.. ............................... ...... Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION O~, THE WORK AUTHORIZED) N? 5~7~ Z Permission is hereby granted to: (~l~i~t411~ ~lL11l~l~;~ll~) ...... ~em~..~ta~ee~..-.~be~.~~ ........... ~,,r.~.-...~-.~ ..................................... .................. · ~e~4~ ...... ~'~' ...................... to .~..a~-.e~..Cem~..4~l~l~ .................................................................................. at premises located at ..... ,~t~iL..~3.~&..~.~......~ifL12.(tlD33..[t,d~ ................................................... i ........ ........................................................ ~.,.,..~ .............. %~t:~tm~ ......................................... pursucm~c to application dated .............................. ~.....e~ ............. , 19.....~% and approved by the Building Inspector. Building Inspecto~'~ k BUILDING DEP~RTMENT TOW~ CLERK'S OFF,CE~,~.~ SOUTeO~e, N. Y. ~/~/~ ........ ~~ ~/~/~ ~ ~'""~'"'~'~ ~proved ........................................ , 19...*.~.... Pemit ~o~.~/..E..L.~ .......... Disapproved a/c ..... ~ ........ ~.. ~-- ........ ............................ ............ 7~ ~ ~ ~ 5 Dote ~.....~.~ ........................... , 19 ...... (. .... ,I, ~J , ~ INSTRUCTIONS a. ~is ~ Jc~tion must be completely filled in by ~pewrite~ or in ink and submitted in duplicate Inspe~, b. Plot plan showing location, of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving o detailed description of layout ofproperty 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 app icat on, the Building Inspector will issue a Building Permit to the applicant. Such permi~ ~ shall be kept on the premises available for inspection throughout the progress of the work. · k~i 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 Deportment for the issuance of a Building Permit pursuont to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable 1~3ws, Ordinances or .... r~. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber o ................................................. fp · Name of owner o rem~ses ........................................................................................................................... If applicant is o corporate, signature of duly authorized officer. ~._~_/~ .................. iKi;;;;;";;~;~";i~'~;";;~";;;';~';';;i;,'";iii;';';i ......... 1. Location of land on whicb proposed wor. k will be done MapNo'~r'.~.~.~.......~..- --~-.?'~.-.~. LotNo .~..~'~c2'.~. Municipality , 2. State existing use and occupancy of premises and intended use end occupancy of proposed construction: a. Exisiting use ond occupancy .............. U~..~.~ ..................................................................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair ................. ./j?mo.~val//~¢ .................. Demolition .................. Other Work (Describe) .............~ .......................... 4. Estimated Cost ....F..~/~../:.?...O. ....................................... Fee .......................................................................................... (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 extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Nurnher of Stories ............................................................. j ................................................... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ....................... ~... ,N/.umber of Stories .............. ,...?, ............ 8. Dimensions of entire new construction: Front }~.....~.,~. ....................... Rear .......~...~... .............. Depth .~.....~.. ............ He ght Number of Star es t. ....... 9. Size of lot: Front ...... ..d~.. .............. Rear ...... l~....~. ................... Depth ....~.~ ............. ~-- I Date of Purchase ,0 .... ........ .:, .l. ................... ........ 1 1. Zone or use district in'which premises are situated ....................................................................... /.... ! 12. Does proposed construction visatex. ~.-~-- ~"~Y-~,~ ~any z~on~ng law, ordinance,~-- /~, L / ~-__ //ar regul)a, tion? ....................... ! .................................... 13. Name of Owner of premises/~..~..~/..ec.~,(.~ress (...~.(~..~Z'~_~..~.~-./...~..'.~.....6~hone NO of Architect ~...~...~J~..-~.(.,.~..~. .......... Address-~?.~-..fl.~//.~'....~.'-.~'..'.. Phone No?~...iZ~.~T....~. Name Name of Contractor~.~../~...~.~../.(..~. ........ Address .~...~.~..~..-- L.,;(~ Phone No~"7-.~..~...'~..~. Locate clearly and distinctly all buildings, whet'h~r~"exi~'~tii"~ or"~"~raposed, and Jnd cate all set-back dimens'~s from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot./(~ I I. /00' 2.o STATE OF NEW: .YOJ~K_,, ~ S S COUNTY OF ..hC,~k~.1~\.~ .......... .~ ' .~ .............. ....-~'C~1~.......~..-~- .c~.l~. .........................being duly swam, deposes and says that he is the applicant (Name of individual signing application) ~ above named. He is the ........................ ~ ..................................... ..~ ....ny~..~.j.-~T~ .................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have'l: rformed the said work and tn rnnL,, ,~,,,~ ~'~o thru apphcat on; t at all statements contomed m this application are~ ue to the best of his know e,~ge and belief; and that the work will be performed in the manner set forth in the applicalj¢~ r filed therewith. [~ Swam to before me this /~ / ~ · Nota~ Publtc · · ..~......~-.~.¢~L.~ .... " . · ............ .}w -., .... .~:..-..y .... .. ........ ~ .................... · , , · ..................... ~ .................... ~ounry /x ~:~ignature of applicant) DORIS J. GLA~SEMANN, ("-'"N ' A \ ~ ~ No. ~2 - 6534~)~ ~' "~'-'~v-'7 S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date ~ Bldg.~Permit No TO WHOM IT MAY CONCERN: /The sewage ~sposal facilities for a strz~acture located (Give deed location) ff~ have been inspected by this department and found to be satisfactory. Chief of General Eagineering Services District Engineer ~JN ~ 6 lg72 0 0--90' -- SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference No EASTERN DISTRICT, RIVERHEAD,NoY. APPLICAT I~N FOR APPROVAL TO CONSTRUCT PNIVATE SEWAGE DISPOSAL SYSTEMS , ' " ,~ '" . .... . .... .' · g~Le · Approval t~ ~ons .~T-a~t sg~d system.__~,s islreq~ue.~ted,pert]ment dat,~ herewJ~th. ~ ~ ~ .-,, Hamlet /;t~ ~,(t~ T6~ ~ ~ 9-Private w~ll? '' / ('/ ~_.ter supply name ,~ -- ,Distance to nearest main .... ] J . 4-Lot Size: ~i~Length/~Oft. (a!~n center plot plan below.) lO-Propos~ system: ~eptic tank ~Precast ~ssp~ ~Shallow pools I /Ot~er l / il-Septic ta~ inside dimensions. Vol~e _ga~'th ft. Width i~t. Liqu~. depth~ ft. 12-P~ecast sections: ~ /Numbe~Square F~. Cesspools: Block size~ incs. D ~ins. H ~ns. Total blocks below inlet: ~OT PLAN Ca~city~ Gals ~ ~ G.P.M. ~ ~ ~ ~rade Data 0 2 6 8 12 ~ ~ ~ Indi ;ate ~ ~ No 'th The Undersigned CERTIFIES: "Construct~n of authorized installations will be in accordance with the Suffolk County Health De~rtments' cu~rreq~ Stand,ods, B~ulletins, and amendments thereto, covering Pri~ate Sew~e Disposal Sys~e~s%~ -, .... / t / FOR ~ALTH DE~ART~NT USE ONLY. BaSed ~n th~ info~ation presented herewith, it is the opinion of the Health Department, that ah~dequate and satisfactory ~Sewage Disposal System can be installed~/// on this Plot. ~.~-~.,~ ~ ~j~ (10165 Revis. ) OFFICE A~ I~IAP r',lO. 577, ,SUI:EVEYE D FO~ , ,AT TC;,,'¢N OF ~ '~' ' :' ' 50U~ UNAUTHORIZED ALTERATION OR AODITION TO THIS SUgVEY IS A VIOLATION OF S[CTION 7209 OF THE NEW YO~ STATE EDUCATION ruRw COEIES OF THIS SURVEY MAP NOT B~ARING // // GU/~,H-..~NTEEL) TO THE TITLE ,4 .J ~¢,,{ b.E COt',lPAbi Y AND VAN 'I'UYD TYPICAL TRUSS CONS TRUCTIOM