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Home My WebLink About5641-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..~..6].~ ...... Date .... AI~:P~'I,.. ~9 , 19.~2 THIS CERTIFIES that the building located at ~$11;~_11Wat;er A~ Street Map No. :XX Block No. :i~... Lot No. ~ .C~;¢hoguO N,Y, conforms substantially to the Application for Building Permit heretofore filed in this office dated NOV~ 22 , 19 ~F~ pursuant to which Building Permit No.. ~(~+~Z dated NOV 21~ , 19 ~¢t., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ~Pr£va'te' o lie family' dwe!l't~tg .......................... The certificate is issued to l~!eha~d Maeh~owsk~.. 0~'nel, ....... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No HOUSI:NUMBER '~'~0 Street Building Inspe~.tor [ FOI~.M NO. :~ 'row~ OF Sou'r~OLD BUILDING DEPARTMENT TOWN GLERK'$ OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT .CI~'I~ IS PER~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted ~o: H/~CH r~}O ~O ~ t~ I ~ -.~-.~~..-a~--~.~:~e~~ ..... ~~a ............................ ~ ...................... ..... ~..~.-~e-.-~t~--.-~e~,~ ............................................................................ at premises located at .... ~----~:~.~Ut~.-~V~ .......................................................................... ............................. ~- .................... ~tu~e~e~ ........ -~.,.~, ..................................................................... pursuar~ to application dated ............................. ~DV .......... ~ ......... , Ig.~r~..., and approved by the Building InSpector. S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH BldE. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deed location) have been inspected by this department and found to be satisfactory. SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference WESTERN DISTRICT, COMMACK, N. Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS APproval to "eonstrucb 'said systems is requested.pertinent data herewith: 1-Applicant ~¢ ~,~ ,TV' ~ lC ,t~ PhoneT~/ /F¢& 6-Sub div Address ZlS~ ~: !///t,.~ ,C? ~ /~' ,',.//f;~,~,,~ ~ , ~ ~ 7-Section 2-Detailed rope~y location U/~ $ T~ ~ ~ ~ ~,~ ~ 8-Lot No. ~mlet ~, C ~ 3~ ~ To~ ~ ~F~4 ~ /¢ 9-Private well? 3-~blic ~ter supply name ~ m,' Distance to nearest ~in 4-~t Size: Width ~ ~ ~ ft. Length ~ ~ ~ft. (also enter on center plot plan below:) 5-~elling: Singl~ Family 10-Propos~ system: Septic ta~ F /Precast y /Cesspools /X/Shallow pools / /Other / / il-Septic ~ inside dimensions: Vol~e Gals.Length ft. Width ft. Liquid depth ft. 12-Precast sections: / yNumber~Sq~re Ft. Cesspools: Block sizeL/A incs. D Tins. H~ ins. Total blocks below inlet: ~T P~N Ca~ Tank~ ~cityF ~als Data Fee~ 0 2 4 6 8 10 12 ~6 ~= Street JT~ //~v ~ /~u~' o · ~ ~ lnd~ e The Undersigned CERTIF~S: "Const~ction of authorized installations will be in accordance with the Suffolk County Health De~rtments' current Standa~s. Bulletins, and amendments thereto, coveri~ P~ivate Se~ge Disposal Systems". Date /,u F /~;,~? Signed ~ ~ ~ ~ ' ~er or Builder 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 ~F~ ~/~/ Signed AT CUTOHOGUE TOWN OF ,..,OU] .H ',, :r ~,;. Nrc, SCALF-50'--I ' NOTE-ELEVATION5 A~IE B&-., ~D ON .... ~ 220 __ .. _~,~4~ Itl ~, CMl .CLN~.CZ~ T'~T_LE: !~5U_P~.A, NCL COMPANY '4: 0 2 ~0 I0£. tD 3,0.0 AT' ~E. CORNE'I~ OF PEDPEI;!TY, TEST kC~L E GUAI~Ar, ITE E D ,,"C, C_HIC~GO TITLE IbI..SURANCF._ ODMPAINy _AS SURVEYED DE¢ YAN_.._~YL_.~ ~,,,",;1 %° 20' IO"E. , :, ',.. ;Hrt. 'L(~/ ~ ~ KC_.: CuTCHOGUE TOV,/H OF ~OU/HOLD Cr'~ [ [- [::r',' ,' . El: MONU~4(N/ X ' ~-CE.~..,,-OwL5 ~ ' . GUAF-'4AMTEED TiS)THE HOMF l'trL~- u W_,,.: , &$ 5URVEYED NO'¢ ~,t971 ~ VAN TU,YL~SL)N. .. . "~CENSED ~ND {Bu~ di~ Ins~tor) ~ ~0 Date ~....:.a.~ ................. ,19.~..~ ..... II~ISTRUCTIONS a. This application must be complete'iy 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. 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, ordi nances, building code, housing code, and regulations. - y (Signature of applicant, or name, ilf)l corporation) (Address of applicant) * State whether applicant is owner, lessee, agent, arch tect, engineer, genera contractor, electrician, plumber or builder If applicant is o co~orate, signature of duly authorized officer. : ~X ~1¢ .................. ......... - h L~ation of land on w~i~h pr~ed wo~k will be done.~Map No.: .................. u .................... ~t ~ .................. ~ ................................... .............................. ............ 2. Stat~ existin~ u~ ~nd occupanc~ of premise~ ond intended use ond ~cu~ncy o{ pr~d construction: Exisiting use and occupancy ................................................................................................................................. Intended use and occupancy . ~....~....~ ....... ..~...~ ~'~: ......... ..? ............. .......................... Ct ................... 3. Nature of work (check which applicable): New Building................../~ Addition .................. Alteration .................. Repair .................. Removal ..................DemolitJor .................. Other Work (Describe) ........................................ 4. Estimated Cost ~'/ ~., o o O ~ C~ O I:~ (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 / . 6. If business, commercial or mixed occupancy, specify nature and extent of each b/pe 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 ........ ..~.~..?..i ......... r~ntl~ ---~ z~ Height .....-~...J~....~. ..... Number of Stories ........ /. ............................... 9. Size of lot: Front ...... /...°.....O. ............ Rear ........ .~../.. ...................... Depth ..... ..~.....o....~.. .............. 10. Date of Purchase .................................................... r~ome of Former Owner ........................................................ 11. Zone or use district in which premises ore situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation.;> *~ .~. .................................. 13. Nome of Owner of premJses~.:./~.~../l....~...N.....a~.....~../.~../~......Address ...:~..~.~..~..~..~.../'~....~.......~'T:~... Phone No ..................... Name of Architect .~.../I [~/~..~.~ .............................................. ^c ss ............. Phone No ..................... Name of Contractor ~......~.....~.:~.'~.......~../..~...~...5'. .......... Address .../.~...~./ ........ ~........,~'...v'~' ' Phone No?...~.~).Z'../...~..~....(f' PLOT DIAGP. AM /'lT;/~'~4~c~9'D'/v~/~' Locate clearly and distinctly oil buildings, whether existing or profiled, and indicate all set-back d mens ohs 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, ~ ~ ~ cgu ' ' OF ........................ P'"' ...~...~..~..~.........~J..~./~.....4~.6¥. ........... ~ ................................ be,ng duly swam, d~s and says t~t he is the applicant (Name of individual signing application) above named. He is the ..~.~[..:~.~.~..~.~ ......................................................................................................... (Contractor, ag~t, co~orate officer, etc.) of said owner or ownem, and is duly authorized to perform or h~e peffo~ed the said work and to ~ke ~d file this application; that all state~nts contained in this applic~i~ am t~ to ~e best of his knowledge and belief; and tha~ the work will be performed Jn the manner ~t fo~h in the ~pIIc~i~ filed therewJ~. Swam to before me this ..... ....... / x . Nota~ Public, . ....... ~~~.~ Coun~ ~ (Sig~e of ~plicant) ~ ..... 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