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Home My WebLink About5603-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Z.l~6~ .... Date .... ,Yune 20. , 19.~ THIS CERTIFIES that the building located at l~/q~ l~aml~Ier Road Street Map No. ~e~ Wt~s Block No .... Lot No.. 23 5¢nlthold N,Y~ conforms substantially to the Application for Building PermR heretofore filed in this office dated .NOir · % ., 19. ?2. pursuant to which Building Permit No.. ~60~ dated ....... 1~1~..4 .. , 19.~Y2., 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 Pmivate ,me..fami.~F .~weltin§ ........................... The certificate is issued to .g~l~i.~.u~. & Edith .Do~S · · · ~er~ .... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No 1~' ~209.~ ...... tIOUSE NUMBER -~8~ Street lta~ble~- Read Braiding Inspector FORM NO. 2 TOWN O~ $O~TBOLD $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5603 Z Date ............................... JJlJz.....~ 19...~.~ Permission is hereby granted to: ..~.131~....1~ o..~l~.~t, ....................................... .............. l~.waa~inaa~ ........... .1~...¥.. ....................... to .... ~al;I,Zd,. ~te31..sll~ ..£~n,t3~: ..cL~zeL3.tnJ ................................................................................ at premises located et ...... ~JJt ~ J~$...~.....~..&.,.~...~.l~ .............................................. · aJb].e]'...~ .............. ~ ....... ]I.'~o .................................. pursuan,t to application dated .............................. JJlJ~l' .......... ~ ........... , 19..~.~.., and approved by the Building Inspector. Fee $..l~Ja.t3~ .......... r ~ Building Inspector ..... ................... l JULIU,5 ¢ ~ED/TI-~ 1Do w/./$ ~ YVI£M/ TOWN OF .~OOT~OI-O , N.Y. \ HOLE ,., ~etl o ~ ,4 Y'I// ~i4/ TOWN Or ,500'T'~-IOI..O , N. Y, SUFFOLK GOUNT~ DEPART~NT OF HEALTH H. DoReference No ~d-77Y EASTERN DISTRICT ,. RIVERHEAD, N. Y. APPLICATION FOR APPROFAL TO ~ONSTRUCT PP,/VATE SEWAGE DISPOSAL SYSTEMS Approval to oonst~uct said s~st~ms is ~N~gUested,Pertinent data herewith: Date 1-Applica - :.' ' - =: - -. - , Pho .~.~6-Sub dfC. -- _ - - ~-~blic~%~ ~p~ ~me ~,.~ ~r . ' ' ' ~s~nce to n~st ~in ~-~t Size~ Wid~,~ ft. L~ft. (also en~r on center plot plan ~) l~-Se~ic ~ i~ide dime~ions. Vol~e Oals.Le~th.T%. Width ft. L~ dept~ft. 12-~st section: / F~r~ Ft. Ceas~ols~ Block To~l blocks ~low i~et: ~e ~ ' PLOT PLAN Capacitg'~._Gals. · .P. ~H~ The Undersigned CERTIFIES: Ind~ Nc "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Systems". FOR HEALTH DEPARTmeNT USE ONLY. Based on the, information presented herewith, it is the opinion of the Health Department, that an adequate and satisfactory Sewage Disposal System can be installed on this Plot. (lo/65 S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date ~.6~,w~ / TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located (Give deed loc~tion) have been inspected by this department and found to be satisfactory. JUN ~ ~ Ig72 Chief of Cenoral ~_~_jir~,o_~i , ~, ~ - ~ Approved ........................................ , 19....~.... Permit No ....... . ~//?~,._ BUILDING D~ARTMmT ~ Diwpproveda/c ............................... ~ . I ,~,,,~,~-.~,,~,,,z~ ~ / ~. ..... ~.~.d ......................................... . ~.~ ..... RUCTIO S a. ~ls applicotl~ must be c~letely flfi~ in by ~ewriter or in ink und submitted In ~pllc~ ~ ~e Building In~r. b. Plat plan showing location of lOt and of bu.ildings on premises, relationship to adjoining pmmJem er areas, and giving a detailed description of layout of property must be drawn on the diagram whlch c. The wink covered by this application may not be commenced befora i~uance of Building Permit. d. Upon approval of this application, the Building Inspector will I~ue a Building Permit to the applicant. Such permit ~ shall be kept on the premises available for inspection throughout the pragre~ of the work. Certlfieofe o-f Occupancy\'j- e. No building shall be occupied or used in whole or in part for any purpo~ whatever until a, shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit _pu~luant to the Building Zone Ordinance of the Town of Southold, Suffolk C. ounty, New Y, ork, e, nd other applicable Law~ OMinerme~ or Regulations, for the construction of buildings, additions or alterations, or Tar rernavm or demolition, e~ herein dmcrlbed. The applicant agrees to comply with oil applicable law~ ordinances,~ulldlng code, housing code, qn~l mgulatlonl. - ~ CSIonature of appllcantl/~ name, If a coq)oration) ....... (Addre. of ~l~ll¢ont) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, elKtrlclan, plumber or builder. Nu,,.v, ...... .......... ..................................... ....... ·~ /~' ~. .... ~..P...,:..T..~. .... ~..o...~.~..a ........................................... .~ I f~applicant Is a corporate, signature of duly authorized officer. -~.~- ~:~, (Name and title 'of corporate officer) '~'~:'~/~,J/ ~'/~f-~"~ 1. Location of land on which proposed work will be done. Map No.: .~..../. ......... ~ .......... Lot No.: ......~...~1. .......... and ...... ...... ...... / ~..~ Municipality 2.State existing use a.nd occupancy of premises and intended use and occupancy of propmed comtmctlon: a. Existing use and occupancy ......... ..~.....~...~...¢~'.. ....................................................................................................... b. Intended use and occupon? ..~..~2~.~.......~...e.(~q...Z/...~ ...... ;x~......A~...~../.x~.~..~,! ................... , ................. 3. Nature of work (check which applicable): New Building ?.. ,~.... ...... Addition .................. Alteration .............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...................................... 4. Estimated Cost ............. :,...,s-..~.',~ .............................. Fee / (to be paid on filing this application) 5. If dwelllng, number of dwelling units ....... ..~... .............. Number of dwelling units on each floor ............................ If garage, number of c. ors ........................... ~. ............................................................................................................... 6. If busine~, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if om/: Front ............................ Rear ................................ Depth ............. Height ........................ Number of Stories ..................................................................................................... Dimensions of same structure with olterations 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 ........ /....6..?. ................. Depth ............. '"7"[ ..... 10. Date of Purchase .'J.'~..P/ ././.j..~..~.~..~. ............Name of Former ~... ........................ Owner ...................................... ] 1. Zone or use district in which premises are situated ..................................................................................................... 12~ Does proposed construction viol~.te any zoning law, ordinance or regulation.;) ....... ~.~. .............................................. 13. Name of Owner of premises .-7....:..~.....~.....1~..../~....~. ........... Address ...~..~A~..~)~../.~..,....~..Z.~. Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Nome of Contractor 0.0.~.~.~'..~...'..~.......~../~.J~...Address ..~..t.~...~:..~...~..~..~.. ...... Phone No. ~.~,,-~...~.~..1~ 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 whether interior or comer lot. /O8 STATE OF NEW YORK, t ce COUNTY OF ................................ ~'~' ' ...... · .~..:~...~.A~.,......~.~:~..~..~'..~.~-.~,c~,.,.~......~....~......'~... .............. being d'uly sworn, deposes and says thor he is the applicant · (Name of individual signing application) ~ ' above named. He is the ....... ~...~...~(.../.~......~..~..~.../.~..~...~. .............................. :.....':~ ....................................................... (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 applicotion; that oil statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed jn the;manner set forth in. the application filed therewith. Sworn to before me this~a,~....~..~)~.~.,, · ......... ~..~ ~.-~- o ..... ................ F 4'I '- O~ _ ROM,4~ /' BUILDERS / I I .I I I I .... O--R P AN _ ~+. U' / ? ROM4~T 14uo~ 4 "Co,we, / / / ./ / / 4 "co~'¢.FL. / i~'-0w I I NOTE- FOR ALI. JPEC!F!CAT/O/V..g OF INTER)OR TIHISt4ES - NEATINS APAR4TUs -ETC,- ~EE CONTRACT FLOOR PLAN ,SeIi LK ~ V4"-' I'-O'"