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Home My WebLink About5538-zFORM NO. 4 TOWN OF SO17THOLD BUILDING DEPARTMENT Town Clerk's Office South~hl, N. Y. Certificate Of Occupancy No.~2$ ....... Date ............ THIS CERTIFIES that the building Ioeated at .. Ha2w&t~l.s. R~a~ ...... Street Map No. I'I&SB.. l~,..p~k No .......... Lot No.. 3~'~ .... ¢lltChOg',Ae...1~ .¥.. ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ I/~ep% .... 30, 19.~. pursuant to which Building Permit No.. ~. dated .......... ~e1~; .... ~0", 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 .Pri~a~e. o~e. family' ~wel.l. ing ...................................... The certificate is issued to . ,,Xehn. & .l~r~ees. Bi, ca ..... (~ners .................... (owner, Iessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval 'April" '~ ]' ']'9~2'' 'b~" R'.' -¥:~].~&. · UND[.:RWRIT[!RS C|!RTIFICATI No...]~. ]'~20~ ....................................... [IOUSli N U M B[ R.. 22}4.~ ...... Street...H&~tws, terl~. P~o~.~l .............................. Building FORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5538 Z Permission is hereby granted to: ................... p.,.O.,.bo,x..r~,6 .................................. .... ttaap~m...t~.e .......... ~.~.~- ........................... to ~ll,tlr~...~e.w...em..ta,~t~...~ ~ r,~ .................................................................................... at premises located at ........;[~t~...~-....~i~$~ti...~..P~p. ............................................................ ............................................ ilaln~,t,e~,~..IM ............ Cetehegue ..................................................... pursuant to application dated ........................... 'qe~t, ....... .~) ........... , 19..~1.., and approved by the Building Inspector. Fee ~0.,,.~O ............. SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Re£erence No~ EASTERN DISTRICT ,~ RIVEBHEAD, N. Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval tn construct said systems is requested,pertinent data herewith: Date__~.$~~ 1-kpptioant~ohn S. S~a a~ Frane,m Shem Phone 6-Sub div N 2-Detailed proPer%~ location~{ ~ Ha~e~u~.~%~ D-Public wa~'s~u-p%l~y~r~a~e .......... 'Distance to nearest main ~-Lot Size: Width~ft. Length ~50ft. (also enter on center plot plan beiow:) 5-Dwelling: Single Family ~ I~ Two Family? / /Cellar? ~_~.Slab? lO-Proposed system: Septic tank · /Precast ~ /Cesspools ~__/Sha~low pools / /Othe~ / / il-Septic tank inside dimensions: Volume Gals.Length ,, ft. Width ft. Liquid depth f 12-Precast sections: ~ ·Number~$$Square Ft. Cesspools: Block sizeE"' incs.D,. .ins. H in Total blocks below inlet: #1 , ,,~2 ,, ~ .,, PLOT PLAN U) O.r-I ~ Street HA][WATERS ROAD !ndi No ;ate 'th The Undersigned CERTIFIES: Data ~ee~ ~ ' :.' I ~z -- -' 1~6 "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private ~ ~Y~8~."'IN0. o. DateSept. 14 !971 Signed~A,~mn.~ ~, ............. ~.. FOR HEALTH DEPARTMENT USE ONLY. Based on the, information presented herewith, it is the opinion of the Health Department, that an adequate and satisfactp~.y~Sewage Disposal Syste~ can be installed on this Plot. / / S-15 S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH AP~ 1 1 197~ Date Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at Map of Nassau Poih%, Lo% 3??, E/S Ha~wa%ers Road, approx. 300' S/O Old Menhaden Rd.~ (Give deed location) CutchoKue~ Town of Southold have been inspected by this department and found to be satisfactory. Chief of ~ ...... ,1 r APR 1 ! 1972 THE NEW YORK BOARD OImr FH~ UNDERWRITERS m'k 1 ~206 M,~IP 0~. L 07- JOHN J. ~; FR. AN(.£~ 25'0.0 ........................................ , 19 ...... Pemi~ No ..................................... Disapproved o/c ...~ ...................................................................................... TOWN OF SOUTHOLD ,~/~/-~/ ,.~.~-//'~.,,V- ~/~' BUILDING DEPARTMENT , ~'~ -/,/~r' ~/~'~, ~,/~ ' TOWN CLERK'S OFFICE SOUTHOLD, . Y. / ApplicatiOn No. '~. ............................. ................... .......... ''Bil~' I '-" APPLICATION FOR BUlLDIN~ tE~IT ~te ...~,.~ ............................. 19~,~ ....... INSTRUCTIONS 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 ofpraperty 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. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. hfo building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall hay; been granted by the Building Inspector. APPLICATION IS HEREBY N~DE 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, Ord nonces or, Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as here n descr bed The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (Signature of applicant, or nome, if a corporation) TIANA QU,~L .I.~¥-. ~gtm8.1 ...I. NG, ........................................................ P. O. BOX 576 ~Address of applicant) HAHPTO]~ BAYS, ~ Y01~ 11946 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..iohzg.~..,~hea-~.d..~.~--~oe~qhe~ ................................................................................... If applicant is a corporate, signature of duly authorized officer. ~ ...................................................................................... d~lex Pass - P~'esMent. ~ (Name and title of corporate officer) ~-~'- ~ Location of land on which proposed work will be done. Map No.: .~!,,'~e,l~.~,l~.,,l~.g~13~tl~ ........ Lot No.....3.~. .......... Street and Number ..~..m. at~g'~.~,o,~L.~ ........................................ To.wa..o~.~3~l, th~]d.,...No.Y ...................... Municipality State existing use ~nd occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................................................ b. Intended use and occupancy ...~.~].¥~.~.h~m.e .................................................................................................. whether Interior or comer lot. ! / 3. Nature of work (check which applicable): New Building .... ~.~...,~. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ........................................................... JFee .......................................................................................... (to be paid on filing this application) 5. if dwelling, number of dwelling units ......... 3. ................. 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 some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ......................... ~..Number of Stories ................................ 8. Dimensions of entire new construction: Front ...40!.e0~! .....................Rear ...A(}!.?.0~~. ............ Depth .'Jl&~..-.I).:. .......... Height ....[4.~..-.J)~.... Number of Stories ......1 .............................................................................................................. 9. Size of lot: Front ...~.00,..0.0 ........... Rear ..... [0~}..Ol) .................. Depth ...... 2~Q..~).0. ............ 10. Date of Purchase ..3,~me..~3..~=g.9~) ............................ Name of Former Owner .~-~e~r.~....C.l~.~ ....................... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction~ violate any zoning law, ordinance or regulation? J ......... ]~O ............................................. 13. Name of Owner of premises .~T~h~o&.ff..r~z~c~..Address .;.32..~o~'le}r. JD.~..~....~... ~o~e~No ..................... Name of Architect ..... .~.T~,~.Q~T~.~.~.~'..~)u~.8.i..~ss ............................................ Phone No ..................... P. 0. BOX §?6 Name of Contractor ....... ,. es ~L'~0~I' ~L~S, ~ ~'0~L ~.tt~ ............................................ Phone No. ~/~8,~l.Z~/... 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 according to deed, and show street names and indicate STATE OF NEW Y bP y£ t ................. ~ .................. ~ ................................................... oemg duly, sworn, d~s and says t~t he is t~ applicant (Nam'e of individual signing application) a~ve named. He is the ............... ~.~~ ........................................................................................................... (Contractor, agent, co~orote officer, etc.) of said ~ner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contained in this application am true to the best of his knowledge and belief; and ~a~ the work will ~ performed in the manner set forth in the applicafi6n filed therewi~.. Swo~ to ~fore me this.~, ~~--~ //Y "" 1~2~~ ~ ~ ~.~ ............................. NOT~ ~BLIC, State of New York No. 52-8t258~, Suffolk Cou~ Term ~l~l March 30, FOUH D,nTiOt. i ~ - /,._~, i¸, TIANA QUALITY HOLIES, P. 0. BOX 576 ItAMP~0N BAYs, NEW ¥OllK'llgt6