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Home My WebLink About5132-zFOI1,M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~ . ~h-260 · Date THIS CERTIFIES that the building located at Map No. Gagen Block No. 1~ Lot No.. ,lane 8 , ~9 71 · N/~ Custer AVO.. Street ~ 8euth~ld N,Y, . conforms substantially to the Application for Building Permit heretofore filed in this office dated ~o1~ ~ , 19 ~,$ pursuant to which Building Permit No. ~3~ dated Fol~ I~ , 19 ?~, 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 zs Priva.t;e ¢~13e family d¥Olling ..................... The certificate is issued to Fotlllde~s He.es..~[Ilc .. - Ol, rlae~ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~touse ~ 170~ Building Inspector l~OE3~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERJ~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5132 Z Permission is hereby granted to: ....... :....~mma~z~,.. ~[mmz ..3,~ ....................... .................... llb~lte~. &~e ......... ., ..................... to ........ ~.~ ~.. sm~..sm~.. ~m~l,~...ebm3~ ~it ........................................................................... at premises located at ............ ~...~S~I~..~-~ .............................................................................. ............................................................ ~N~te~l~ ....... I~.,~-, ................................................................ pursuo~¢ to application dated .......................... ~1~. ...... ~ ................ , 19.~.~.., and approved by the Building Inspector. Building Inspect1 S-9 $CHD SUFFOLK COUNTY DEPARTMENT OF HEALTH TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located ? /~ × (~ve deed locatio~// J haYe been inspected by this department and found to be satisfactory. Chief o£ General Engtneerin~ Services SUFFOLK COUNTY DEPART~NT OF HEALTH EASTERN DISTRICT, RIVERNEAD,N.y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date/~P~IL Approval to construct said systems is requested,pertinent data herewith: 1-Applicant 4D~R~c~ L~o ~}~L PhonegG~A3~O6-Sub div C~P-C-.~.r~ Address J~.,~.~ /~ 7-Section I~a 2-Detailed property location ~D*~,,~ o~ c.~'~ ~E 8-Lot No. Hamlet ~c~?W~uD Town$~r~-~ ~.~ 9-Priyate well? ~$ - 3-Public water supply name ..~+~ ~ · ~ Distance to nearest main 4-Lot Size: Width~OO ft. L..~...Aj_~_.~. %a-so enter on center plot plan below:) 5-Dwelling: Single Family ~V'~ Two Family? ~_./Cellar? ~_~Slab? ~_~Crawl Space? lO-Proposed system: Septic tank ~ /Precast F /Cesspools /~'/Shallow pools ~._/Other il-Septic tank inside dimensions: Volume Gals.Length ft. Width ft. Liquid depth ft. 12-Precast sections: / FNumber! /Squ~re-~. Cesspools: Block size~_~_.incs. D___ins. H ins. Total blocks below inlet: ~1 ~2 PLOT PLAN H.D.Reference No ~0- ~.~/ V I Indi e No 'th Data ~eet 0 2 6 8 10 12 18 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/~PR~& ~, I~O Signed _~.~.~.~_~9.~ · - Owner o~~ Builder FOR HEALTH DEPART~NT 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 (lo/6 evis.) TOWN OF soUTHoLD ,BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOU'THOU), No ¥o . a ed ...~..'. ................................ ,! 9..~..,/.... Approved ........................................ , 19 ........ Permit No. ~ ! c~ ~. ~ Disapproved a/c ....... ~ ..................................... Application No ..... .. ~.. ~....~....~ ..... APPLI~TION FOR BUILDING PERMIT .. Fobur 3 Rte .................................... ............... , ,97! ....... INSTRUCTIONS ~ a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or pub c streets or,~ areas, and giving a detailed description of layout of proper17 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 port for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY/VtADE 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 Lows, 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. awrenee Jr (Signature cf applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ....~.~l[elZ~L.~lllll...~l~ ................................................ ~ ................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title 'of Corporate officer) , "'. 1. Location of land on Which proposed work will be done. J~Aop No.: ....... ~ ........ ~. ................ Lot No..~ ................. Street and Number ....... .~..~........C~...t~..~....~...?~.. .~....~...~..~.....~..e.~.e. ..... /7 O~~/ Municipality .................................................. ., 2. State existing use and occupancy of Premises and intended use and occupancy of proposed'c~nstruction: a. Existing use and occupancy ....~.~IL~t~..~IL~ ................................................................ b. Intended use and occupancy ....llll~..~tll~...~.e,l,~,..{...~..~..~.~J~... ....... 3. Nature of work (check which applicable): New Building ~e~3ee ...... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...... ~....~........~.~.~ ............................. Fee ...~..-'JOeO~ ..................................................................... (to be paid on fJ~ing this application) 5. If dweUing, number of dwelling units ..... ~1~ ................ Number of dwelling units on each floor ............................ If garage, number of cars ..... JlilJ ........................................................ 6. If business, commercial or mixed accupancy~ 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 ............ G~6 .................. Rear ...... ~6. ................ Depth ...~.~. ............. Height .................... Number of Stories ...~...(eJJ~,~l~le~..~.J~J;~ .................................................................... 9. Size of lot: Front ..... :J4;)O ............... Rear ........... ~ ................. Del~th ............ :l,~). ............ 10. Date of Purchase ........................................................ Nome of Former Owner ...~J,t~J'J~Z~ ............................ 11. Zone or use district in which premises are situated ........ .a.~..a....~;j~; .......................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............ JJ~ .......................................... 13. Name of Owner of premises (JgJdl~..fftJ~.!~.:JJJJ.Address ......... ~lJt, J~]dJ~ ............... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ~..J~..~T~ ............................ Address ................... ~.tJ~l,t~J~lR.~,lj~ ..... Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or preposed, and indicate oil set-back dimensions from property lines. Give street and black number or description according to deed, and show street names and indicate whether interior or comer lot. /00 · STATE OF NEW 0 ................................. :..~aaM~J~..~,J~..,~J'. ............... ,.....being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ............................... ~z:L1J~II~ ............................................... '~: ....................................................... (Contractor, agent, corporate officer, etc.) ~hf said .owner or .owner.s., and is duly authorized to perform or have performed the 1said work and to make and file is application; that all 'statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application flied therewith. Sworn to befpre me this MARION A'b REGENI' NOTARY pUBLIO, State of New ¥~, tim 52-3233].20 Suffolk Coum ,Term Expires March 30, 19.~ i