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Home My WebLink About5642-zFORM NO, 4 TOWN OF SOUTHOLD BUH,I~ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificzte Of Occupancy No. Z..~.~ .~.~. Date .............. 77.., .S..ff.P. ['., 19.7..~. THIS CERTIFIES that the building located at . ~..~..O...~.~ .~. o. ?..5.....A ~ ff.. Street Map No. ,. ~&5 .~- · · · Block No.'~.. ........ Lot No ...... /~./. ~.~ ....................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ ~..~... ~.l.O. ?..., 19-/. I. pursuant to which Building Permit No.~.~..~/.~-. ~-, dated ........ .~..~....N..5. )./..., 1~. [.., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is .... ~... ~..~. ~ ..... .~.~...~7..,..~.Y. ..... Z~.~. L~ .~.~! .~ .................... The certificate is issued to ....... ~..0.F4...I~. .... ~..~..~! f.~ ..~/..~..~.. ~ .ff. ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~ .7.. ~.~ .~. ?... I. ~. 7. ~....~,... *yq~. F.~k t.&~ UNDERWRITERS CERTIFICATE No....~/.....t~..~...~.-.].~. .............................. HOUSF~ NUMBER ...... .-~ f..~'...Street .......... ,.~ ~ .~..~.~.L ~ ...... t~ ff. ~ ............... ................................................. . .-~. ~'.¢P .~. It,,.,. ~..~xc .¥. ....... ~. ~~-1~ .... Building Inspector FOItM 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) N? 5642 Z Permission is hereby granted to: ....... ~l~mm~t ..~.3.~e-~.....A.~..... ~l~m..eel~ez~' ......... ~.~.~.~.....,~..,~..fi~% ................................ ................ · ~,~.~nead. ......................................... to .... ~l&~ ..s~e~..e~-. ~l~.~r-.~r~..~ ............................................................................... at premises located at ...... .~l~...~l.%3.....peeoxple.4~J~l~,e~ .............................................................. ............................................ ~'- f~l~,,t~'"t:ve .............. ~e['Ol~ ..................................................... pursuan~t to application dated ............................ ll~ ....... ,~ ............. , 19..~., and approved by the Building Inspector. Fee $'"~01;00 ......... ui~aing inspector / · ' ' SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference NoL~D ~ ~/ 7 EASTERN DISTRICT .. RIVERHEAD, N · Y. FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS APPLICATIONApproval to construct said systems is requested,pertinent data herewith: Bat Address II~.% ~. ?n~~ ~.T ~F~' ~-'~ i~i ~, 7-Section~;~, 2.Detailed~property locatxon$~ ~&~N~ ~ ~ · 8~-Lot No. ~ !~ . Hamlet ~;&~ ~ ~v~(, . To~n (~ ~T~D( O 9-Private well? 3-Public water supply name ~.? Distance to nearest main S-Lot Size: Width ~ ft. Length;3gft. (also enter on center plot plan below:) 5-Dwelling: Single Family ;¥~ Two Family? ~../Cellar? ~.Slab? ; ICrawl SP?ce? ~_~ 10-Proposed syste~: Septic tank; ;Precast F ;Cesspools ~/Shallow pools ~ /Other ~_/ il-Septic tank inside dimensions: Volu~.e Gals,Length__ft. Width___ft. Liquid depth___ft. 12,Precast sections: / ;Number/ /Square Ft. Cesspools: Block sizeL_F_incs. D~L_ins.}{,~!~_ins. Total blocks below inlet: ~1 ~2 ~3 mOT Capacity~Oals. [ IPU G.P.M. o~ C . .~ W.L. ~= Street ' Nc The ~nde~signed CERTIFIES: "Construction of authorized installations will be in accordance with the S~ffolk County Health Departments' c~rrent Standards, B~lletins, ~d amendments thereto, covering Private se~ge Disposal Systems". uwner or ~il~er 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. I ~eet 0 2 8 10 12 18 Date ~ 7/~ Signed EXCA /ATiON INSPEGTION REQUIRED. $-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date ~?~~ 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. PE C O N / '(~ D ~q~,rovad ale ..................................................... · · ... . . . . ...~:..... a. This applicatiOn must be completely filled in by typewriter or in ink und submitted in dupllcato to the Buildingc~ Inspector. b. Plot .pi.an showing I.oc.ation of lot 9.r~ of buildings an premises, relationship to adjoining premleal or public Itmets or areas, aha gwmg a amallea aescrip~lOn of layout of property must be drawn On the dlagram whlch is I~rt of thle apf)llcatlOn..~. 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 luue a Building Permit to the applicant S~h permit~1 shall be kept on the premises aval able for inspection throughout the progress of the work. APPLIGATION FOR BUILDING PIRMIT 0 ~ ¢ c~te .~,....~..~. ............................... , ~9.7.Z......° / .i INSTRUCTIONS 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. ~Ttege. A..P. PLI_CATIO~N,!S HEREBY.MA_DE to the Building Department for the issuance of a Building I~rmlt punmant to the u.a!n~.. ~.one, u.m, mance of t.he Town of Southold, Suffolk County, New York, and other applicable I. awl, Ordinances or umts..ons, mr me construction of buildings, additions or alterations, or for removal or demo t on, al heroin descr bed apphcont agrees to comply wl~h all applicable laws, ordinances, building code, housing code, and regulatlom. · . .... 6~ddress of ~l~llca~) State whether al~). licant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. V If applicant Is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) ~"7- .-~ 1. Location of land on which proposed work will be done. Map No.: ....... .~...~....~.. .................. Lot No.:/.~'.~. ................ ,~..,,~,, ~/..~. .~.~.o..~,e ~¢..~' /,/~" J¢l~ ,4//11/../;~v~: /o~-~ Street and ......... -~0~7 ~ .............................. r..,..~ ................................. MunlclpallfyP ............ ,,,.,.~...~. ........... 2. State existing use a.nd occupancy of premises and intended use and occupancy of prapmad comtmctlOn: a. Existing use and occupancy ............ /~.~.~.~..~.. .................................................. ~.~.~..,.'/..¢.. ~. ~...¢./.Zz.¢2. b. Intended use and occupanc',. ....... /. ....... ~...;. ........................... 3. Nature of walk (check which applicable' New Building ../~.~ .......... Addition ................. Alteration ............. Repair .................. Remora ............... i": ~molitiOn~. .................. Other Work (Describe) ..................................... , ; _ . ~ . (to ~ paid on fi~ing ~is application) 5. If dwelling, number of dwelling units ......... ~ ......~"...Number of dwelling units on each flor ..Z..~.~ ............... 6. If business, comme~ial or mixed ~ncy, ~eci~ nature a~ e~ent of ea~ ~e of u~ .................... ~ ....... 7. Dimensions of existing s~ructur~, if any: Front ............................ R~r ................................ ~pth ,..: ........ ~t;..: Height ........................ Numar of Stori~ ................................................................................................................. D~mensions of same structure with almm~ions or additions: Fret ................................. ,. R~r ............................ Depth ................................ Height .......................... Number of Stories ................................ Height ..J..~ ..........Number of Stories ........ ~. ......................................................................................................... 10. Date of Purchase ..................... , ;,,.,..~.~, ................. Na~ of Fo~r ~er ....................................................... 11. Zone or use district in which premis~ are situated ..................................................................................................... '12.' ~s pr~os~ construction Vior~fe any zoning law, o~inance or regulation? .......................................................... Name of Archit~t .................................................. ,..A~ress ............................................ Phone No ..................... STATE OF NEW YORK, ! SS ' ,. COUNTY OF ..;~;.:.,-,; ........... )3 ...... ~ ........................ .~...~..~.~.......',J.:~...~..~.~7.~..~.~..~...~..~ ........ ;:...being duly sworn/ deposes and saya t~ be ~s t~ applicant (Name of'indl:y~[ S~ing appli'cation) above named. Ue is the ....................................................... ~.~.~.~.~..~.~ ....................... ., .......................... of. sai~ pwn~r qr 9w~ers,. and is du~y..authorized .to perform or have perfo~ed t~ said::~k ~:4o~.:~ke~d file '"fh,S application; that all statements contained in this application are tree to ~e ~t of his knowl~e a~ ~lief; and that the work will be performed in the manner set fo~h i~ the a~licati~ fil~ ~ith.. ~ -: :r t , ............ : ......... ......... .................... Notort ~ublic, ...y,:..; ...... ~...~,~i .......... ~ak ~ (Slgno~ o~ oppllcont)~ ' ~Y PUBLIC, St~te ? 4