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Home My WebLink About5618-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z...~.~/7 Date ...t:~ ~ . .~. , 197'~.... THIS CERTIFIES that the building located at/~ . .V~ZAG~. ~ff Street MapNo. ~ BlockNo .... ~ . LotNo. / ~ conforms substantially to the Application for Building Permit heretofore filed in this office &ted ... ff~V. ,19~/. pursuant to which Building Permit No. ~ &l ~ dated ....... g ~/. , ~9~/., was i~uea, ~nd conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ~. · .PN6-. · · F~ ~ ~ & 'f ..... ~ W~ L ~/.~ ~ ................. The certificate is issued to ~ED ~.~E . ~.. ~ VP~ / ~A.Q.~ ~ N ~ (owner, lessee or tenant) of the aforesaid buildmg. Suffolk County Department of He~th Approval / Z A P~ .............../~7 ~~ ~ UNDERWRITERS CERTIFICATE No . ttOUSk NUMBER } u/t / ~ Street tv~ ~ Braiding h¥,pcctor FOI~M 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) 5618 Z S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH APR 1 ? Date Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located have been inspected by this department and found to be satisfactory. APR 1 7 1972 Cbt'el of General ~h~gIneertng Services SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference - EASTER~ DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISBDSAL SYSTEMS Date Approval to construct said systems is requested,pertinent data herewith: 1-Applicant ~'~/~'T~ AO ,~.. ~ .. ~/.~ D,,~ ~ ~,~ tY/N,,~4/,~' .Phone~6-Sub~-~v Address ~,~-,,&kb_~- c~/~--,~/~. ,,/,~,z.~, , , 7-S~n /M f%~ ~/~ ~ ~ Y.~, g 2-Detailed ~roperty location 8-Lot No./~- Hamlet ,~. ~ '~; ~,; f,~ To~ ,~ ,Y~o ~a , 9-Private welt? ~- 3-~blic ~ter suppl~ ...... Distance to nearest main 4-~t Size: Width ~6~ft~ength~ft. (also enter oqcenter plot plan ~elow:) 5-~ellin~: Sidle Family ;~ T~ly? ; /Cellar? ~lab? ; ~Crawl o~ce? / / 10-Pro~sed system: Septic tank ~ /Precast ~Cesspools ~Shallow ~ols / /Other / il-Septic ta~ inside dimensions:~ol~e Gals.Length. ft. Width ft. Liquid depth 12-Precast sections. /~;Number~Sq~re 'Ft. Cesspools. ~lock size~,.~, incs.D ~s.H ~n~ Total blocks below i~et: ~1~2 FLOT PLAN Street /:) Il/ 0 Q) ~ o · o Data 0 2 6 8 10 12 I e Nobth The Undersigned CERTIFIES: "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". Date ~' Signed ~ ~Z~'~'~'~ ~or ~ 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. Date (10/65 Revis. EMIL $Cd]~: $0'~ l' CO. L~NE ~ ........................................ , 19 ........ Pemit No ..................................... 2_~ TOWN OF SOUTHOLD ~ BUILDING DEPARTMENT ~. ~q ~ TOWN CLERK'S OFFICE ~ SOUTHOLD, N.Y. /~/~/7~ ~ ~ ~'~ ........... DisapProved a/c .... ~..: ................... (Bulling Inspector) APPLICATION FOR BUILDING PERMIT 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 ofproperty 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. 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 applicable Laws, Ordinances 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 code, and regulations. (Address of applicant) U State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......... ....................... Name of owner of premises ...~.{~.~.~,.~...-.~....~...~./~.J- ...... .~1~.~)...~../3~~.,.~..-; ....................................................... .~ If applicant is a corporate, signature of duly authorized officer. ~ .................. ......... 1. Location of land on which pl'oposed work will be done,..._Map No.: ~J./,~.....~...~./)..~.~,..?..~..~..~ Lot No .....~...~. ............ ' £ L Street and Number ....... ~/.~..'.z~.~.: .............. .~....~.'.~ ................................................................................................ t./j 5~'' Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. ExJsiting use and occupancy .............. ~/~~ ....... y~Xt~,..~,q.t;. ..................................... b. Intended use and occupancy ..p~'.~..v~[~...l:)Ztl~...~al~t~.l~..~9~P,,[J-J.13~ ............................................................. 3. Nature of work (check which applicable): New Buildin : ........... Addition .................. Alteration .................. Repair .................. Removal .................. DemOlitior .................. Other Work (Describe) ........................................ 4. Estimated Cost ~.~./~,~Z2./..~ ' (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ~.~./,.~..'T. ~..~.....~../.~..~.~..: ................................................ 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 ..... -'~'~.: ......... Rear .~ ............. Depth .. . - . .......... r ..... ~eight ........~ .......Number of Stories ......... : .................................................. :;.....;..; ............................................... 9. S ze of at 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 ~.X/~.:~..4d'~...~..J~.......Address .~...-.....~'~-.~A~'.~.../~...J'...... Phone No ~....~...-...~..~...~' Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ~Z~/...~...; .,/~..~.~.~.L~.~?../~/..~: .~.......Address .~'.~..T..~4~.~.~ ..G~.~....: ........ Phone No. 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 corner lot. STATE OF NEW YORK. COUNTY OF ...... ~ ~...~.~.o..[.~.. ......... 2~t.b.u~ R. Cadenza ................................................................................................. ~ing duly ~orn, d~es and says t~t he is the applicant (Name of individual signing a~lication) above nome~ He is the .................................. ~.?~.~E .............................................................................................. (~ntmctor, ag~t, co~orate officer, etc.) of said owner 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 tree to the best of his ~owledge and belief; and that the work will be performed in the manner set foah Jn the ~plicati~. filed ther~ith. Sworn to before me this .......... ~.m* ....... ~y or .............. Term Expires March 30, GARAGE *Ce =PS .5-