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Home My WebLink About5668-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No.~l~ ....... Date ............. J~lla$.. ~.? ..... , lg .~. THIS CERTIFIES that the building located at . Ii.~ .]~al~. t~la~ ........ Street Map No... ~ ....... Block No .... ~ ..... Lot No.. lt~ -.. II~ .8~f.f. Sl]~ ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... D~I' ' I~ ..... , 19.~. pursuant to which Building Permit No. ~(~.. dated .......... t)~...%~ .... , 19.~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ... P~$va~ .~1® .fala$.l.7· ~lYell~ll~ ..................................... The certificate is issued to ~g~. ~l~&~ ....... ~1~ ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. UNDERWRITERS CERTIFICATE No...~[. ~,l~t~ ...................................... HOUSE NUMBER.. ~[g)O ....... Street ..... ~'8.1'llltJ~g' '~11~ .............................. Building Inspector FORI~! 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) Building I~spector [ S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date jUN 1 $ 1972 Bldg. Pe~rmit No. 5668Z TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at S/S Fanning Road~ ~75' E/O Grathwohl Road, New Su%folk (Give deed location) have been inspected by this department and found to be satisfactory. Chief of Gcnerat E~gineering Services SUFFOLK COUNTY DEPARTMENT OF HEALTH APPLICATION ...... FOR APPROVAL.TO CONSTRUCT PRIVATE. S~AGE D!SPOSAL~ SYSTEMS . Date NOV, ~0, 971 Approval to construct sazd systems is requested,perti~.~i.~ata herewith. - Address 27 .BOr hem .ave,, .Yonke g, N,Y. 1 ? 41! . 7-Sectzon 2-Detailed property location ,~/8 F~ ~a-~ 47~'$/~C:Z~ NO. ~,~wo~l Hamlet ~e~ ~uffolk To~h~ld ~ 9-Private well? 3-~blic ~ter supply name ~$~$ Distahce to nearest main 4-Lot Size: Width ~00 ft. Length ~t. (also 'enter on center plot plan below:) 5-~elling: Single Family ~ T~ Family? ~Cellar?~f ~f~lab? ~Crawl S~ce?~/ lO-Pro~sed system: Septic tank ~Precast ~ yCesspoo1s ~/Shallow pools il-Septic ta~ inside dimensions: Volume ~Gals. Length , ft. Width ft. Liquid dept~ft. 12-Precast sections: / ~Number~Square Ft. Cesspools: Block stzeL16incs.~ _ins. H~,,,ins. Total blocks below inlet. PLOT P~N ~, ~ Street ~amming Road Ca pa city 4 ~.Gal s. Indi No Data_ The Undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County~ Health. Departments' current $tanda~,~ ,,~%l~$i~n,~,,-,,,,:~: ~,, ,c,~, m,-~:~,,~'~: and amendments thereto, covering Private Sewage Disposal ~ystems". 32~9 Valets!is ~/l:~o::al Hwy. Date~ Signed ' ~er or ~' Builder ~88-18~Q FOR ~ALTH DEPA~T~NT USE ONLY, Based on the info~ation presented here~th, it is the opinion of the Health De~rtment, that an adequate and sa~i~sfacto~ se~ge Disposal System can be installed on this Plot. 10/65 S-15 ~S 447~$~' ,0 7"/--/ W O/-/ C ,~0,0 D BUILDING DEFARTMEKT ....... .......... _ .............................................................................. ........ .................... ~ls a~licati~ must be c~ple~ly fill~ In by ~.writer or in Ink und .ubmitted In ~llc~ ~ ~e Buildi~ O. I~r. b. PI~ plan s~ing I~ation of I~ .~ of ~ildi~s ~ pr~ml~, mlatl~ip o~,, .~ glvl~ a ~aH~ ~ri~l~ of I~ ~ p~ must ~ d~n on t~ dl~mm ~]~ I, ~ ~ ~1~. c. The wink covered by this application may not be commenced before iuuanea of Building Permit. d. Upon approval of this application, the Building Ir~pector will I#ue a Building Permit to the c~k:ent. Such permlt,,~ shall be kept on the premises available for inspection throughout the progre~ of the work. ' _~. e. No building shall be occupied or used in whole or in part for any purpose whatever un?il a Certificate of Oecuppflcy,~ shall have been granted by the Building Inspector. ~. APPLICATION IS HEREBY MADE to the Building Depp.rt~ent for the issuance of a Building Permit Pumu~nt to the ,Building Zone Ordinance of the Town of Southold, Suffolks~County, New York, Grid other .al~llc~ble ~ Ordinancee m ! Regulation.~, for ~eco~structiOn of building,, additions o~al. terations, or for removal or demallti~n, al herein dmcribed. ~ The app c~nt agr~e's to comp y w th a app cab · aws, oral nances, bud ng code, housing cade, and reguletlam ;~ (Slg~um ~f aPP/l¢c~, or name, If a c:o~oration) 27 Boroher Ave., Yonkers, N.Y. 10704 (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Owner n I r t I n tur f ul uth rized officer ~, _.~ I. Location of land on which proposed work will be dane. Map r~o.: .................. ; ..................... ~.m ,m.. ........ !...: ....... t'~,' 2.State existing use a.nd occupancy of premises and Intended use and occupancy of proposed comtructlon: a. Existing use and occupancy ................................................................................................................................... 3. Nature of walk (check whicl~ applicable): New Building ~..~ ............ Addition ................. Alteration ............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) .................................... ...... .l..~,4o.9~.,~ ........................... Fee ..L~.....~T... .......................................................................... 4. Estimated Cost (to be paid on fi!lng this application) 5. If dwelling, number of dwelling Q,?~ts ........................... Number of dwelling units on each floor ........ 1 If garage, number,of cars ............................................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of ea~:h type of use ............................ 7. Dimensions of existing structures, if any: Front. ........................... Rear ................ t' .............. Depth ............. Height Number of Stories Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ......................... ~..Number of Stories ........... ~ .................... 6 8. DimensiOns of ,e, ntire new construction: Front ...... .0. ............................ Rear ....... 6i~I ................. Depth ...26 ................ · 16 1 Height .......... ~ ....... Number o~ Storms .................~ ......................................................... 9. S ze of at' Frc~nt ..~..0,..0. .......... Rear ...]:.0...0.....Ii ........... Depth ...... .~..' .J. ................ 10. Date of Purcha~ie ...~r.~.T.~.,.,~.~.~ ....... ..................... .',,'.Name of Former Owm ~Z'e~ or use dist';itt in which premises are situated--.,'... ...... .....~..?,.~.~.?..~...t;...;~....~. ........................... 11. Zone 12. Does proposed constr~c~;~n violate any zoning law, ordinance or regulation? .~ ................................ (9~4~) ...... ...... V:[FK::I~:I.& Spoe&t~O -,, 27 BoZ~hE AYe. Phone No 13. ~ame or uwner or ~,;:m:::: ........................................ /~aaress ............ , i Yoiil ~ir;'"W;T. · ~;'~' ................ Name of Architect ...................... Address\ ~ ........ Phone No ........... Nome of Contractor ..~.~,.t~...A.~.~.~.....~.l;.~])~.~l.~ll~icl~l~ ,...5~.9...~.iI.~¢1~,!.111 ...... Phone No PLOT D A~'~ ~.onkoalr~o~o Locate clearly and distinctly oil buildings, whether ex,st,rig 0rlproposed, and ~.,~'n'~t. all .t-bock dimens ons from property lines. Give street and block number or description ac~cording to deedS' an~ {how street names and indicate whether interior or corner lot. , -~ STATE OF NEW(~OP-~¢,~ ~ ~S¢ COUNTY OF ~ ........... $ "~' ,.,; ................... :....../...7.......~....a;~,..~.]r.~.......~..~. ............................... being daly sworn, (Name of individual ~ignmg application) above named. He is the '-/75' and says tho1 he "ii agent, of said owner or owners, and is duly authorized to perforn ~r have the said and to this application; that all statements contained in this tion are true to th~ best of hi~ thor the work. wild be performed in ~Hi~n"~i'w~r~set forth n th~ adp icat on f ed thi~rdwith. Swam tG ~re me this -'----'--- ', / / / ..... o, ............ ........ ....... :..., , ~/ ELIZAB~H ANN N~ ~ ~ ~ NOTARY PUBLIC, State of ~ Y0rR ~ ~ ' J No. 52-8 25850 Suffolk ~ounW ~ ' Term Expires Ma~ch 30 lg~ ', / ' the Lpli~ and file belief; and