Loading...
HomeMy WebLinkAbout5596-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No..~.'..~.0. ...... Date ............. A~.. '8 ....... , 19 ~ I THIS CERTIFIES that the building located at . .HoZ~.mn. &.~.e .&. t$.ml~fl~ (;~o~8~re~e Map No.. xx ........ Block No. ~ ........ Lot No.~....0~..~..h. Og~....~ ~.Y.* ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ ~ ... 29 ..... , 19..~.l pursuant to which Building Permit No. 559(:~ .. dated ......... 0~.'~... 7-9 .... , 19..Fl, 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 ... Prl'~;e..one..~a~ik~*..~w.ell~g ..................................... The certificate is issued to . ~.e~;r~m. $~,.ul. Jr ........ ~)~x~e~ ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .3.ul~r. :~1.,. l ~2.. h~ .h...V. lll& ... UNDERWRITERS CERTIFICATE No...I~'. 2.61. 55 ....................................... I-lOUSE NUMBER.. 93~ ....... Street...S.O~l.~.h..(~ .1'.O.~.~..R.d .............................. ............... ~.~ ..... ~.0~a.~n..aY·. ............................................ Building Inspector / 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? 5596 Z Permission is hereby granted to: ..ff~!~...~.~:~...~..s. ....... ~...~~...~a ~= ................ ~F~.... ltoae~a3Ja ..i~'~ ...................... to ~1~ n~ ~e ~ ~:~ .... at premises I~ated et .......... ,~.f...g.~.~...~.,.~.. ~..&~ ........................................................ pursuit to application dated ......................... ~.~ ......... ~ ............. , 19..,.~ and appr~ by the Building Inspector. S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH JUL 3 1 1972 Date Bldg. Permit No. TO WHOM IT MAY CONCERN: at $/~ The sewage disposal facilities for a structure located (Give'deed location) have been inspected by this department and found to be satisfactory. Chief of General Engineer'~g ~Zervzces District Engineer JUL 3 1 1972 ~ ~ SUFFOLK COUNTY DEPARTMENT OF HEALTH APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date Approval to construct said systems is requested,pertinent data herewith: 1-Applicant 1~3~ ~. .~f. P~e~_~g'~A--/..6-Sub 2-Detailed '~p~" loc~tion~/~ ~ ~, ~.~ ~ ~ ,,~., ~, ~ ~.. __ __ pp Y ~-Lot Si~e= Width~ft. Length lW~ft. (also entes on oente~ plot plan ~elow:) 5-~elling= SingIW ~a~i!y I ~ T~' Famil~ I ICellav? I ISlab? ~ ~ Crawl a~ce? lO-Pro~sed system: Septic ~k I//Precast ~Cesspools / /Shallow pools / /ot~eF / / ii-Septic ta~ inside dimensions: Vol~e Gals.Length ft. Width ft. Liquid depth ft. 12-Precast sections: /;Number/ /Square Ft. Cesspools: Block size~ incs.D ins.H ~,.ins. Total blocks below inlet: ~1 ~2 ~OT P~N Capacit~Gals. ~ ~ G.P.M. ~ r.~ · ~ fade ~ ~ ,W.L. o ~ o o ~ tes~ Data Fee% 0 2 6 8 i0 12 14 ~6 ~ ~ Street o (D ~o ~ ~ Indi ~te The Undersigned CERTIF~S: "Const~ction of authorized installatio ill be accordance with the Suffolk County Health De~rtments' current Standa~s, ~lletins, and ~mendments thereto, covering Private Se~ge Dis~sal Systems". FO~ ~ALTH DEPAET~NT USE ONLY. Bas~~ on the i~'fo~ation presented herewith, it is the opinion of the H~lth De~rtment, that an adequate and satisfacto~ Se~ge Disposal System can be installed on this Plot. Date r~,)(r (~0/65 Revis.) Signed 0 .60u-r-H~lz. t4 t'4. ~''7°''42'00''~'' ~ /~,4.99 ~ C U T'C/--/O~ UE FORM NO. 1 TOWN OF SOUTHOLD BUILDING' DEPARTMENT ........................................ , 19 ........ Pemit No ..................................... ( ' ding Inspecto7 APPLICATION FOR BUILDING PERMIT t Oct e 19...~..!....~. Da · ............................ ~.~.. ~....,..~)., INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildina~ 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 ofproperty must be drawn on the diagram which is part of this application.3~ ~ 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 appl cent Such permit~,,~ shall be kept on the premises available for inspection throughout the progress of the work. 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 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 appl cable Laws, Ord nantes or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing cede, and regulations. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Contrsetor Name of owner of premises ........ ~,e.~+o~...Sa.~t~...j~, ................................................................................................ i ...... If applicant is a corporate, signature of duly authorized officer. 1. Location of land on which proposed work will be done. Map No.: ............. ~ ....................... ko* Nc~ ....... ~ ............. ,, - Holden & Southern Cross R C Street and ~lumoer ........... ;.~ .................... /j.: ............................. .~. ............ l~.g.j~Q.g~l,e ................................... J Oq,~../' 'C., .~.,.~5 Municipality .... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .......... ~.~...c..~...~..t.....~.,a...~..~. ............................................................................................ b. Intended use and occupancy ......... .QlO,~...~,ll:t~L~...~e~l&13~. ........................................................................ 3. Nature of work (check which applicable): New Building ...~ ....... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ................ ~.~.e...00.O ........................... Fee ....... .1.0 .............................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... .o..~...e. .............. 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 same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .............. ~..D. ................. Rear .....~.0. .................. Depth2,~...~../...~,.~_~ Height .................... Number of Stories .......... .O.~. ..................................................................................................... 9. Size of lot: Front ..1J~...~...~)~.t,~ .... Rear .................................... Depth ...... ].6D....~....~ ..... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ ............... A.....C~.£S ~, .................................................................... 11. Zone or use district in which premises are situated "" 12. Does proposed construction violate any zoning law, ordinance or regulation? ............. D,Q .......................................... B. Saul Jr 13. Nome of Owner of premises ........................................ Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor T'TO.L].~..~4L12,~..~ome,~ .......... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-hock 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 NEW YORK, .. ! COUNTY OF ...... .~....I~T:....Z...O.....~.. ......... ....................................... ~n~S..Gn~Cl.Z'~.S ............................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ....... ~ ................... .0...o..~..~.a..9.~.9.~...~[~,~ ....................................................................................... (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 cantoined 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 in the application filed therewith. Swam to before me this ................. Lay of ......................... __ ....... Notary Public,~..~.~...._.~.~.. Co~nt~.._ ~~c'~nt) ~" JUDITH T. Notary Public, State o~ New York ~;7~'7~-.~' ~ - '' No. 52-0344963 Suffolk County Commission Expires March 30, ~ FU~ ~WN : FU~ DOWN : ,,~,, FU~ DOW~ J I - ~--- ~-- . ,~, ~. = _ = ,i i i ~ ~'. ~ ~. ~ ~&'. _ ~ .... ~,... ~ , ~ .... ~ ~ = ~ ~: ~ . I ~Z~btW6 KITCHEN C~BINET ELEVATIONS -'-~'~-~: /~ ~ ~,,.~,~, ~ _ ~ ~ ~ ~ ~ Ii , ' " ' [ ~1 -.--~-. -,- ' ~ ;,,~ REVISIONS: ' HERMAN H YORK ARCHITECT ( ' --..--~-. · --.~"-~~,~ :~"~"U , , .. ~ ....., . · ................ , ', ~ r ~'~ (N:~.) ~ ,' '~. ; eL. /.zJ/~ ~'w"_ /~'~ ____~ I~'~' /~'-~" ~, ~, ~ · .. 6'N£~C,~Y~7~£~ . ,, ' . ..... ,~., ,- &l..~.¢ e .- .. ..... ......... .... - II .', , :. ~ ,,~.~. ~ / ~'~ , , ,., , ~ .... ~., J ~ ~T~ ,' . ~' . . .....~'~,: . ...... . ...... ~---~ '  ' .,, ,, ~ ~O.~ 4 I&'l ~, ~*MAICA I15B2) NEW ~, ~ Oj ~L " ~"*~' .................