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Home My WebLink About5517-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 . l[l~. ~th- tiavb~ .~. · · Street conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... llel~t.. 2~.., 19~.. pursuant to which Building Permit No...~ ~. dated .......... liSp.t:. .... il.., 197.1.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for Which this certificate is The certificate is issued to .Rsn~ .(~sntl'~l~ ....... O~r ....... ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk county Department of Health Approval '~" '2~' ~97~' · ~-'~'~' '~l.l~.~ ..... UNDERWRITERS CERTIFICATE No... pSndil~ ...................................... HOUSE NUMBER. ~ ....... Street...Soath. R~bor. ' Building Inspector l~OKM NO. ~ 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) N? 5517 Z Permission is hereby granted to: at premises located at ........lt.~i~..l~,e..,l~,~l:14lZ..~i4114~ ........................................................................ ........................................................ ~m~NG4.....11~.¥~ ....................................... ............................... pursuant to application dated .............................. ~tl~t~....~ .......... , 19..~.$., and approved by the Building Inspector. :Fee $...11~.~ ......... SOUTHOLD, N. Y. Examined ~- I [ 'Approved .......... '..! ........................... , 19...! .... PemitNo. -~--'~/' 7 ~--- 'FOBM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE Application No ............... ~.~ ............... Disapproved a/c ........................................................ · (Building I ns~/e~tor) Date. ................... , ...... o. Thi~ ~pplicotion mu~t be compl~t~l~ flll~ in b~ ~writor or in ink ond *ubmitt~ in duplic~t~ to b. Plot plan showino Iocotion of lot ond of buildin~ on promise~ relotion~hip to od~oini~ premise~ or public ~tr~t ~re~s, ~nd OivinO o d~t~iled d~ription of la,out o{prop~ mu*t be drown on the die, rom which i~ ~ o{ thi~ c. lbe work cowr~d b~ thi~ opplic~tion m~ n~ be eomm~ed befor~ i~uonco o{ 8uildin~ P~rmit. d. Dpon ~pprovol o{ this applicotion, the Buildino In~t~r will i~sue o Buildino ~rmit to th~ ~l~nt. ~eh sh~ll be kept on the pr~mise~ ovoil~bl* {or in~*etion thr~hout th~ p~r~ o{ th~ work. e. ~o buildino ~bell be ~cupied or used in whol~ or in p~ for on~ purpose whatever until ~ ~ific~t~ sholl h~v~ been ~mnled b~ th~ Buildin~ In*p~tor. ~PPklC~IIO~ IS H~RfiBY ~D[ to tbe Buildin~ D~p, rtm~nt {or tbe i*~uanc~ of o Buildino ~it pu~u~nt to ~h~ 8uildin~ Zon~ Ordinanco o{ th~ lown o{ ~u~hold, Suffolk County, ~ew York, ond other ~pplic~bl~ ~w*, O~in~nc~, or ~Oul*tion~, {or th~ construction o{ buildln~, ~ddition~ or ~lt~mtlon~, or {or rom~l or demolition, ~, h~r~in The ~pplic,nt oOr~ to comply with ~1~ ~pplicabl~ I~w~, ordi n*nc~, buildin~ c~, hou~in~ c~, ~nd m~ul~tion~. ....................... (Si~n~tur~ of applicont, or ~me, i{ ~ corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of If applicant is a corporate, signature of duly authorized officer. ..................... .................................................. (Name and title of corporate officer) Location of land on which prgposed work. will be_ done.~Map _No.: ..:~...~......~.....i.~, Lot No. ~ ........ Street and.Number State existing use and occupancy of premises 'and intended use and .~ of proposed construction. a. xis,ting use and occupa y ...... ................ ' .......................................................... b. Intended use and occupancy .~~..~~ 3. Nature of work (check which applicable): New Building ,~. Addition .................. Alteration .................. Repair .,.~-2..------~ Removal ~ Demol t on .................. Other Work (Describe) ...~.......~~.. 4. Estimated Co~...~.<~.~..~. ........................................ rFee .......................................................................................... (to be paid on fiting 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, Jf 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 ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 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? ............................................................ 13. Name of Owner of premises ...~...~..~.../.(~..~f~/~.0~.....Address~'~z~J~.,~/(.~.~/~P~. Phone No.~..Z...~..T..~..~..~ Name of Architect ...... ...~.....:..~ ....... ~.Address ............................................ Phone No ..................... Name of Contractor ..~ddress ............................................ Phone No ..................... PLOT DIAGRAM locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NE'W.~Y~,~ ~.. COUNTY ,..Q,F ~".~. J./~, ............ .... , ......... ~-~/~.:.....~.~/~/~/~t~.~-.....~. ............................. being duly sworn, deposes and says that he is the applicant (Name of individual sign~/,~,,///~ above named. He is the .............. i~r....~,(...~.....'.~~...-. ................................................................ ~ (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 iq the application filed therewith. Swam to before me this(~ ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS P.k BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 v.,eJu!y 3, ~¢~ ~ 63~23q THIS CEEIFIE$ THAT o~y t~ e~t~ ~uipment ~ ~sc~ be~ ~ int~ by t~ ap~t ~m~ on t~ a~ ~pl~at~n numar in t~ p~m~ of in the following ~ation; ~ B~ement ~ 1st FI. ~ 2nd Fl. O U g ~ ~ ~e ~ction Rl~k w~ examined on ,~ ~ ~1~ ~ ~ , ~ ~ ~ ~ a~ found to be in complla~e with the requirements of this B~rd. FIXTURE I RXTURES OUTLETS ECEPTACLES SWITCHES INCANDESCENT FLUORESCENT · ~.,. 12 18 J,""L. I o,L 'uT.?' 1°f°"s..,. I "'Lu," A""2C' * 2 3 8 RANGES SPECIAL REC'PT COOKING DECKS OVENS DISH WASHERS AMT. K.W. A/RT. K,W..'~T. K.W. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET SYSTEMS A,V.T. ~Aps. TRANS. NO, OF FEET SERVICE DISCONNECT I KO. OF I s E ~ ~0~ ~B METER X OTHER APPARATUS: ~Furnace~: Oil 1-1/Shp, 1-1/12bp R V I C E EXHAUST FANS DIMMERS A, W.G. NO. Of HI-LEG A, W.G. NO. OF NEUTRALS Of CC. COND. OF HI-I~G 2 Geo,'Me Zimlinffhaus, Park Place, Patchogue, L.I. II COPY ALTERED IN ANY MANNER. 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 d~ed location) have been inspected by this department and found to be satisfactory. Chief of General Fa~{ineerinp~ Service~ SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No J~ - c~j} ~/ EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date~//j~/7/ Approval to construct said systems is requested,pertinent data herewith: Address ~)~ ~/~Mk- ~/~3~Fr /~Y' 7-Section ~ ......., 2-Detailed property location 8-Lot No. .·w~$nYC · Hamlet ~D~ ~c£ D Town JWL;~/~4D~. 9-Private well? F~ '~3.Z./¢ , , ~-Public water supply name~/~:/Wu{/{Yg/i~M6z~ Dzstance to nearest main ,~ {~7~,~-'7 S-Lot S.ize: Width ~(~ ft. Length~ ft. (also enter on center plot plan below.~,' 5-Dwelling: Single Family ;~ Two Family? ~,/Cellar? ~ /Slab? ~ ~Crawl Space? 10-Proposed system: Septic %ank ~ /Precast ~ /Cesspools ~/Shallow pools / /Other / / il-Septic tank inside dimensions: Volume Gals.Length ft. Width ft. Liquid depth ft. 12-Preoast sections: / ~.Number/ /Square Ft. Cesspools: Block sizeL--7~ incs. D~ ins. H ~-~ns. Total blocks below inlet. ~1 ~2____~ ~ PLOT PLAN The Undersigned CERTIFIES: Capacity Gals. Ind~ "Construction of authorized installation ,th Data ~eet 0 2 4 6 8 10 12 ~6 18 will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Systems". Date ~ ~,/~/ Signed .~ /6~ ~-¢~ ~/~'~'~- Owner or ~ FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department, that an adequate and satisfa~ewage Disposal System be installed on this Plot. Date/ / /7/ Signed (10/65 Revis.) S-l~ "South Harbor Homes. . ~ S. 85*09'50 400 OSTRANI B. SURVEY FOR REN~ GENDRO~ SOU THOL TO~N OF ~OUTk SUFF. /31_5 ?o/~_ ~P II I I II III III -I 1 I t