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Home My WebLink About5494-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..l~...~. ....... · Date ........... 01l~..~. ......... , 19. THIS CERTIFIES that the building located at ¢l®&v~s. Pt. lload .......... Street Map Nol4.a~lOl~. l~&l~O~lock No ........... Lot No. 2 .... ~11~;. ~'a~iol~ .l~,¥., ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... 8®1~; .. 8 .... , 19.7]. pursuant to which Building Permit No. dated ............ S~I~. · 8 .., 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 . Private .one..fa~i.ly .dwelling ....................................... The certificate is issued to .. l~r~k. ~o~$1~1 ....... (~l~®r. ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .J'.une..! ~...~.972...by. I~.~ .Vil~.a .... UNDERWRITERS CERTIFICATE No... P~l~li~.~ ...................................... HOUSE NUMBER.. 290 ....... Street .....(~.~.O&~O8.1~;. i~O&¢l .......................... ' .... Building Inspector FOll,M NO. ~ TOWN OF $OUTNOLD 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) 5~19~1 Z D~o .................... ~ ......... m .............. , ~9.~.t.. Permission is hereby granted to: ..~......~.s..,.......~.........~....~......!~ ....... at premises located at ...... .~..~ ........~11,T~1.~3..,~;~i3:1~1, ..................................................................... ............................................... gteave e...Pe..Remli .............. &e~t"llaa~el~ ................................... pursuant to application dated ............................... ~l~pt~.i..l~ ............ , 19..~.~., and approved by the Building Inspector. Fee $...~.~..~.~ ....... FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.~. l+~rl 8 ...... Date ............. ,]',~y... ~.1~... 19 THIS CERTIFIES that the building located at -~/l~ .~]],e&ve~. Pt .R~-... S~et Map No.l~alr~ .Ii--lock No ........... Lot No.. ~ ..... l~,~t~ -l~a~,:~o~...1~ ~¥.,. conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... g~p,g.. ~..., l0 ~.. pursuant to which Building Permit Bio. ~-~4.Z dated ........... ~,p~;...$..., 10.?I., was issued, and conforms to all of the requi~e- ments of the applicable provisions of the law. The occupancy for which this certifiea~ ~s issued is .. 'P~'±~rai;e' 'one' f'a~.]_7 'd~.~,~_~:5_¥ig ........................ ~' ........?" The certificate is issued to ..~r~ .~oma,~.~.~:l ..... 0}.'~ ....................... .~ \ (owner, lessee or tenant) of the aforesaid building. :. Suffolk County Department of Health Approval ' 0'm~o' ' '~'~' ' ~19~.. by. ~' ~:l,l].&' ' · UNDERWRITERS CERTIFICATE No .... ~O111~.:~.~ ......................... :,: ............ HOUSE NUMBER. '~0 ........ Street.. P-,']'Oa¥~' '~'~' ~Oa0, ............................. Iy ,- ,./ ....... , / Building Inspector / S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date June 15, 1972 Bldg. Permit No. 5494Z TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure at Map of Marion Manor, Lot 2, S/S Cleaves Point Road, East Marion located (Give deed location) Town of Southold Owner - Frank Tommasin. i have been inspected by this department and found to be satisfactory. un,er or uenera£ ~gineering ServiGes JUN 1 5 OF HEALTH H.D.Ref. No. APPLICATION FOR APPROVAL OF INSTAT-T-~n PRIVATE SEWAGE DISPOSAL AND WATER SUPPLY SYST~iS Inspection for approval is requested, pertinent installation data herewith, 1-Name~Jdress '~ A~c~.~.t~ ~,7- . Phone l~/~ 2-Name of Builder ~ l~c~.t~one 5-Lot N~ber ~ / '~ ~-Bldg.Pe~tt No. Address installed by ff~ ~ ~ ~ 7-Sewage ~dr~s ~( ~ T: ~/_~ , ~ ~ 8-(a)Deed location of property ~~ ~ ~~ (b)H~let o~ Village 9-Septic tank-Oal~~ft.~ft.Liquid Depth lO-Cesspools-(a)No.pools~(b)Blot~ belov inlet-l) 2) (c)Block size-L ln.~ in.H in.(d)Precast pool (e)1~2 (f)~ ~ft.~n; Di~ ~_ft~in.(g)Finished g~ade to cover (h)Backfi11 Haterial ll-~ater Supply: Public Syst~ ~,,; Private Well If Private, the /ollo~int questions are to be answered: 12-~rivate ~ater Supply Syst~ installe~ by~ ~8~c~/~ Phone Address ~~ ~ 13(a)-To~al Depth of Well ~ ~)Depth to Static Water L~el il-Diameter of veil pipe ~ 15-Name of ~boratory 16-Hethod of Disinfection 17-Date ready for inspection The undersigned CERTIFIES: Able syst~s have been constructed inc~plianceviththeSufiol ountyHealthDepar,men,~cu~Standard-s,'~le'ins and 'endments 'here'°' ;f~7~Ysi,ne 18-Dat~ ' ~er - Builder 19-Insert sketch of location of ~ater & Sewerage Facilities with accurate d~ensions. STREET Based upon the info~ff~ati~n sta~ above, satisfacta~y Date UN 15 ~ ApProved Unie~ o~ General.~gineerin~ ~ervi~e~ ...... pti lity d by : , o! ', v:>or from owner acce ng water q~ ~-OT ,xj-~ I Z~O~,,,M NO. I i//.'/ ~ . 1_ _ TOWN OF SOUTHOLD ~/7/' .~.~'? ~ BUILDING DEPARTMENT ~ ~~~/~ ~OWN CLERK'S OFFICE'~*/~/ ~'.~ ~ , ~ ~ ~_/ ~THOLD, N, Y, ~ ~ ' ~ '--- ~ .......... ' ' ~/IO//~ ro ~~ ~ ~~ ~pr~ ~ " 19..~.... PemitNo ~..~.]-~'~'~' ~ ~ ~ ~ ~ * ........................................ , .. ...................... ~,~ ~ ~ ~ ~ ~ e~roved a/c .: ..................................................................................... '....~~. ~ ~ ~ ~ ............................................................................................................. · ~...~ ~ ~ ~ ~ APPLICATION FOR BUILDING PERMIT~. ~ ~ ...................... ~......~ .......... ~..Z~. ...... o. This o~licotion must be completely fill~ in by Wpewriter or in ink and submitt~ in duplk~e to the Building Inspector. b. Plot plan showing location of lot and of buildi~s ~ premises, relationship to adjoining premises or public streets or areas, and giving o detoil~ description of layout ofpr~e~ mu~ be drawn ~ the diagram which is ~ of this application. c. The work c~ere8 by this o~lication may n~ be comme~ed before i~uonce of Building Permit. d. UpOn approval of this application, the Building InspeCt will issue o Building Permit to the opplic~t. ~ch ~rmit shall be kept ~ the premises available for insp~tlon thr~gHout the pr~re~ of the work. e. No building shall be ~cupied or u~d in whole or in po~ for any pu~ose what,er until o Ce~ificate of ~cuponcy shall hove be~ granted by the Building In~ector. ~ ~PPLIC~TION IS HEREBY ~DE to the Building Depodment for the issuance of o Building Pe~it pumuont to the Building Zone Ordinance of the Town of ~ut~ld, Suffolk CounW, New York, and other applicable ~ws, O~inonces or Regulations, for the construction of buildings, o~iti~s or alterations, or for ~movol or demolition, os he,in de~rib~. The applicant agrees to comply with oil applicable lows, ordinances, ~uilding c~e, Housing c~e, and ~ul~s. Denald Dennis (Signature of applicant, or name, if a corporation) Riverhead (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................ .~..c.~.~.~.~..~. ........................................................................................................................... Name of owner of premises ..~...r...B~...~.~ll~sq,~.;TI, D~ ............................................................................... i ............... ' ................. If applicant is a co~omte,., signature of duly authoriz~ officer. ~ ~ .................. ~"~j'~',~"~F~J~'JJJ'~*~i~'J~ ......... ~ ~ o ~ ~ 1. L~ation of la~ on which pr~osed work will be done. Map No.: ~ar~nor t 2 Strut and Number ..... ~.~. ....... ~.~.~..~...~D.~ .............. ~,..~.~ ....................................................... ~ ~ 0 ~ ~nicipati~ 2. State e~sting ~e and ~cu~nay of premises and intended ~e and ~u~ncy of p~os~ c~st~tJ~: o. ~isiting use a~ ~cupancy ..... ~....~ ........................................................................................................ b. Intended use and ~c~ncy ............ ~...~..~.~g .............................................................................. 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...........~.,~..~.~ ..................... , .........Fee ....... ..~,0..,..0. Q. ...................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ..17~ ...................Number of dwelling units on each floor ............................ If garage, number of cars .........~Dne .......................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extentof each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ....... ' ......................... Depth .................... Height ........................ Number of Stories ................................................. ~....i .......................................................... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ....... 6.1 ........ ~ ................ Rear ..... ~ .................. Depth ..~.~/...~. ....... Height .................... Number of Stories ....~. ................................................................................................................. 9. Size of lot: Front ....... ~..~. ................ Rear .......... 9.~. ..................... Depth ...... ~..LI:.2 ................... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ......... .~..A.~....~..~...S.~ ......................................................................... 12. DOes P~°P°Se~i construction violate any zoning law, ordinance or regulation? ........... DO. ........................................... 13. Name of Owner of premises~....~.~.~...e.~..a...S...~..~. .......... Address ............................................ Phone No ..................... Name Of Architect ]). Dez~is _·, ...................................................... ~aaress ............................................ Phone No ..................... Name of Contractor ....01~e~. .................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearlY and distinctly oil buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer See filed plans ~/· ~.~'~--~- .-~ ,' ._~STATE OF NEW Y..OI~ .. ~¢¢ 1)ill D~c~" -- ~ 1~ ~ ,~ / ~OUN~ OF ...... ~.~ ......... S"' ~ -- ~ . ~~ / ......................... D~i~ D~i~ ...... ~ uly sworn, ~ and t~t he is the applicant ...... .............. he is the applica,. . 'above named. He is the ............ A~D~te.Q~ ....... -- ~f~-~..~.~¢~ ....... : ............... ~t~~o~ra~ce~ etc.) of said owner or ~ners, and is duly authorized to perform or have ~e~formed the said work a~ ~ke and file this application; that all statements contoined in this application are~r~ to the best of his know~edg~ and belief; and that the work will be performed in the manner set fo~h in the opplicati~Jled therewith. /~ ~ J Swom to before me this ~ /I J // ~ /~1 ................. .......... ....... ............ , 4 f/,' 6 ~ I I 'l L_ ~ ~ ..... ~..~..~G~.~.~..~...~~ ......... cou. ~ ELIZABETH ANN NEVILL rk ~ NOTARY PUBUC, State of ~York No. 52-8]25850, Suffolk Cou~ Term ~pires March 30, ~9~ ./ A --r- Jr r- r r