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Home My WebLink About5115-zFORM ~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No~l+l+31 ....... Date ................ Oat-' '13 .... , 19. ?.~. THIS CERTIFIES that the building located at . ]~'e'rgen' '~:ve ............... Street Map No...~ ........ Block No. ~ ....... Lot No.. ~... ~t~$.tuek...~.Y.. ....... co,ores subst~ti&ly to ~e Application for Build~g Pemit heretofore filed ~ ~s office dated .......... Dee ..... ~2., 19.~. p~su~t to which B~ld~g Permit No...5~ ~. dated ......... j~ .... ~.$ .... , 19..7~, was issued, ~d conforms to ~1 of the requ~ ments of ~e applicable pro,ions of ~e law. The occup~cy for which ~s certificate is ~sued is ..... Private · ~ · f~ly. ~e~l~ng .................................. The ce~ficate is ~sued to ...~cho~as..~eba. ss~...~er .......................... (o~er, lessee or tenant) of ~e Mores~d b~ld~g. S~o~ Co~ty Dep~tment of He~ Approval ~t. ~--~ 9~'$ "b~ .~,. ~$11a..~/. Cond~tion~ Unde~r~ters Cert ~ N892~~/ ~ --~ ..... .......... ............. B~ld~g ~spectbr FOEltI 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) 5115 Z Permission is hereby granted to: to ......... t~1,~. ~.. eae.. ~aa~1,~..~,;t~lj ........................................................................... at premises located at ........... ~J~.---JJ4JJJ~tli~b-~lF ......................................................................... ................................................................ lajtst,-~.--.l~Z.~ ............................................................ pursucu~t to application dated .................... JJJl~j ..... jJjjf...~ljj ........ , 19 ........ , and apprm~ed by the Building Inspector. Fee $ ...~a~t~. ......... Building Inspector $-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date October 6t 1971 Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure at S/S Bergen Avenue, 1~0~ W/O Cox Neck Lane, Mattituck ..... (Give deed location) located have been inspected by this department and found to be satisfactory. Chief of General Engineering Services B 1§71 TO WHOM IT MAY CONCERN: The water supply of the property located at S/S Bergen Avenue, 150 feet W/of Cox Neck Lane, Mattituck, has been approved with the understanding that the water is not to be used for baby's formula since the nitrates are in excess of approved standards. Any future owner or occupant is to be informed of the high nitrate level of the well water and fore warned about i~s prohi- bition in the preparation of baby formula. Very truly yours, Robert A. Villa, P.E. SUFFOLK COUNTY DEPARTF~NT OF HEALTH · . EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date Approval to construct said systems is requested,pertinent data herewith: i-Applicant yl/Id.S,,~,/~ a , ~o~, ~o Phone 6-Sub div Address %=m? ,, ~ .;c /.~o~/~ ~F /~2~ ~ 7-Section /S~ ~ ~ ~ ~ ~ .... /~Lot No. 2-Detail~ property location ~ ' ' ' ' ' Hamlet To~ ~r~r~ k ' ~Private well? 3-~blic ~ter supply name Distance to nearest main 4-Lot Size: Width/~O ft. Lengt~o o ft. (also enter on center plot plan below:) 5-~elling: Single Family ~ T~ Family? ~ Cellar? ~/plab? ~ ] Crawl S~ce? lO-Proposed syst~: Septic tank ~ /Precast ~/Cesspoo~s ~Shallow pools l~-Septic ta~ inside dimensions: Vol~e Gals.Length ,,, ft. Widt~ft. Liquid depth 12-Precast sections: ~Number~Sq~re ~{. Cesspools: Block sizeL incs.D ~s.H Total blocks below inlet: ~1/~ ~2{f~,~ ~OT PLAN ~ ~ ,G 'ade ~ m Street o ~ The Undersigned CERTIF~S: "Const~ction of authorized installations will be in accordance with the Suffolk County Healt~rtments' current Standa~s, ~lletins, and amendments thereto, covering Pvivate~Se~e Disp9sal Systems~ ~er or Builder . / ft ins Data ~eet 0 2 4- 6 8 12 ~6 tI e No~th 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~/-/.~.~f~ (10/65 Revis.) s-15 NO. 1 TOWN OF $ouTHoLD BUlL DIhlG DI~PARTMENT TOWN ~LII~'$ aFFIX! ,, A~r~d ........................................ , 19 ........ Permit No ............................. · ~ Application No.....?../....(.~'.~... ..... Disapproved a/c .......................................... ~ ...... ~ APPLI~*ATION FOR BUILDC~NG PEP, A41'I' ~' Date ................................... ./....,~.........27. ~.C~..,., 19.~.....'~ INSTRUCTIONS r~ a. This application must be completely filled in by typewriter or in ink und submitted in d~plicate to the Building~ Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premiees or public streets or areasw and giving a detailed description of layout of property must be drawn on the diagram wl'~ch Is part of thl~ 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 rathe 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 hove been granted by the Building Inspector. APPLICATION IS HEREBY 6/~DE to the Building Department for the 'issuance of a Building Permit punmant to the Building Zone Ordinance of t.h~l~?.' of Southold, Suffolk County, New York, and other applicable Law~, Ordlnar~ces or Regulations, for the construction of buildings, additions or cll.teratj~i~s or for removal or~d~emolition, as herein cl~cribed. The applicant agrees to comply with oil applicable laws, ordma~'ce~, bui~ regulations. (Signature cf applicant, or name, if a corporation) ........... ......... ...... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder, ........................................................... .................. ............................................................... Name of owner of premises ......... ~ ........ .H.. ........ ..A....~. ............................................................................................................ applicant is a corporate, signature of duly authorized of Hcer. If (Name and title 'of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ........................ Street and Number ~....~..5~ e~-/~'6'E-A/ ~F"..,. /(~A -77' / .............. ........... : ..... 2. State existing use and occupancy of premises and Intended use and occupancy of proposed comtmctlon: a. Existing use and occupancy ............................... ..V'...A.....~....~.....~.....-~.. ............ ./::....O...T.. .............................. ~ .................... b. Intended use and occupan:', . ......................~....~..~-.. ............... ../~...~...../~..../....L..~: ............ ..~.....~.../7~...Z;..L.../.../~'......~... ............ 3. Nature of work (che(~k which applicable): New Building .................. Addition .................. Alteration Repair .................. Removal .................. Demolition .................. ,C~er Work (Describe) ...................................... 4. Estimated Cost ............. : .......... /...5...,~.....~...~..,.O.. ............. Fee ...~....~...~ ................ ~..., ................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ ..~....~..~.-. ........ Number of dwelling units on each floor ............................ . ~.,.~.,.~.., ~.,A ~ ~- Z-~ If garage, number of cars ....................... ..~ ............ ~ ........................................................................................ 6. If busine~, 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 .................. .~....O. ........... Rear ....... .~....~.. ............. Depth ...~...~.. .............. Height ...... /..~. ........ Number of Stories ............... .~.....A~..../~.. .......................................................................................... 9. Size of lot: Front .......... ..'~.....-~'.....~...... Rear .................................... Depth ............ ...~'..~.~.. ......... 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated ................... .'~.....~/..~........--........'~....~.~...~...!...~. ........................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............. ..7/.....0.. ....................................... Name of Owner of remJses iV' Z.O;~A~$~) ,.. v-'~'"' ' ]3. p ........................................ ~aaress ............................................ Phone N .o~.. .................. Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ 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 comer lot. STAT~ OF N ~E~Y~ ~ ~, ,t~¢c COUN OF ..... .~ .................. ~ .................................................................. being duly sworn, d~es and says t~ he is the applicant (Name of individual signing a~lication) . . a~ve named. He is the ............................ ~. ............................................... '~ ........................................................ (~ntmctor, ag~t, co~orate officer, ~c.) of said owner or owners, and is duly authorized to perform or have perfo~ed the ~id work a~ to ~ke ~d file this application; that all statements contained in this applicati~ are tree to the ~ of his ~wl~ge a~ ~lief; and tha~ the work will ~ pedormed in the manner set fo~h in the appl~ti~ filed t~r~i~. ~ Nota~ ~blic, ...... .......... C~n~ (Signa~re of applicant)