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Home My WebLink About5146-zFORM TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No.~.~'r.h'?.~. .... Date ............. Dec'labee~ 9., 19.Vt. THIS CERTIFIES that the building located at Nak~i$ Raa~ .... Street Map No. XXX~ .. Block No..~ .... Lot No. J~...~.~hOld..N.,.~., ....... conforms substantially to the Application for Building Permit hereto£ore filed in this office dated ......... 14a~.eI~...~., 19. ~. pursuant to which Building Permit No.. ~.~.~. dated .......... l~t~C]~ .2., 19..~.l, was issued, and conforms to all of the require- ments of the applicable provisions of the taw. The occupancy for which this certificate is issued is . Prlva~e. o~e faintly- ~ell .lng ................................. The certificate is issued to ~.t;~t~.~y ~r~. .. 0..wrl~.I~ .................... (owner, lessee or tenant) of the a£oresaid building. Suffolk County Department of Health Approval Underwriters Cert ~N9103~ 2150 FORM 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? 5146 Z Permission is hereby granted to: at premiss located at ..... ~.: .~..~ .... ~ ........................................ ;....~m~ml,~ ........ ~.~,~ .......... ~ ......... ~ ...~..~............. ................... /' ~ S-9 SCHD Date OEO 3 1971 Bldg. Permit No. TO WHOM IT MAY CONCEKN: The sewage disposal facilities for a structure located at ~/of Nokomis Rd, approxo 400' W/Mfnneh~ba Blvd., Laughing Water (Give deed location) Town of Southo!d have been ~nspected by this department and found to be satisfactory. DEC ~ Chief of General l~mglnoering ~ervi cee District Engineer 197I 'il . THE NEW YORK BOARD OF FIRE UNDERWRITERS ', i i,,,~,,.f,,,,,,,.i,,~,,,..,~,,,,: At ~"~"'""' ~ ~'~'~' ~"~ ~. outside s,.,,. .... ~,,,~ ~,,, October 22, 1971 FIXTURES RANGES OVENS EXHAUST FANS SERVICE or,CONNECT NO. OF R2370 Artist Dr. Middle Island, N.Y. 11953 ~¥RA~/~ A~E~ ........ '_ - ' the .......... c ~uuru n incorrect. Inspectors may be identified by thY~[r credentials SUFEO~ CQ~UN~Y DEPARTMENT OF HEALTH County Center, Riverhead, New Y6rk PA 7-4700 H.D.Ref. No. ~___ APPLICATION FOR APPROVAL OF INSTALLED PRIVATE SEWAGE DISPOSAL AND WATER SUPPLY SYSTEMS Inspection for approval is requested, pertinent installation data herewith, 1-Name of Owner. S~$~e,~ ..(~%T~eg .... ' 3-Subdiv. Deso~ibed Address Pq 0, ~ ~1. ~o~ho~d ~hone~4-SecCion No. 2-N~e of' B~iider Ame~ie~n H~ a ........ Phone,~2~OO 5-Lot Number Address ~ Veterans ~m'L. hi.ay, C~ek 6-Bldg.Pe~it No.~ 7-Sewage System installed by CLIFP~D Phone Address ~9 Hubbamd lve.s Rlve~heads ~ .... 8-(a)Deed location of property M/sid~ of Mo~i~ Rd. b~W/o~ (b)H~let or Village ~u~tn~ Ws~ ~ (c)~own ,S~,,~a _,' 9-Septic ~ank~al L ft.W it,Liquid Depth lO-Cesspools-(a)No.pools (b)B~ock~ b~low inlet-i), . , ' 2) .3) ..... {c)Block size-L in.W . in.H tn.(d)Precast poo1~(~)1..,.2~3 ~ (f)~ 'ft.__in; Di~ ft, ,,,.,,{m.'(g)Fimished grade to cover ft. (h)Backftli Material ~ . Il-Water Supply: Public Syst~ ,, ; Private Well If Private, the following questions are to be answered: 12-Private Wa~er Supply Sysc~ i~talled by ~t~1~ B~om, Phone~, Address Ro~e I~ Hedf~ ~ 13(a)-Total Depth of Well (b)Depth to Static Water Level 14-Diameter of well pip~ 15-Name o~ Laboratory Re~ ~bB ~6-Hethod of Disinfection ~7-~i r~dy for in~pec~ton~ ~ The undersigned CERTIFIES: Above systems have been constructed and are in compliance with the Suff61k County Health Department's current Standards, Bulletins and Amendments thereto. , ~yBuilder 19-Insert sketch of location of Water & Sewerage Facilities with accurate dimensions. STREET FOR HEA~H.,,D~A~4ENT USE ONLY ~ Inspected by , Date Based upon the i~f~o~ation stated above, satisfactory functioning of the above systems can be expected with proper maintenance ~d care. Chief of General~gineertng Se~tc~ S-Se ~ ~ . H.D.Reference APPLXCATION mR ,APPRO~A~ TO ~NST~,,P~,ATE S~AGS ',~SAL App~val t~ Co~t~ct said 'syst~s i~ ~equest~d~,pert~nent data h~re~h: ~te~ 1-Applicant ~ r~M~' ~~ ' ~one~'~g/ 6-~ div Addressed. ~ 2~ ~~ ~,~,. ~ 7-Section 2-Deta~~ "pr°p~Y location~/~ ~'~ .~'~*~a~ 8-~t No., ~$~d g~,~t~, ~a~-~. .TO~r~o~ 9-Private well? ~-~blic ~ter supply name~ . -- ~'~7~L ? Distance to nearest ~in $-~t Size:. Width3,~, ft. ~engthS~qLft~;~ ~(aiSq enter on center plot plan belowS) 5-~elli~. Single Family ~ ~ T~ F~ly? ~ ~Cellar? ~l~lab? ~ /Crawl S~ce? lO-~o~s~ ~st~: Septic ta~ ~ lPrecast 2 lCess~o~ ~Shallow ~ols ii-Septic ~ inside dimensionsLVol~e ~ats. Length ft. Width ft. Liquid depth ft 12-~e~st sections: /~lNumbev~Sq~re Ft. Cesspools: "Block size~14 incs.D ~ ~s.H ~_ ins Total blocks below i~e~: ~1 ~ ~2~ // ~ '' Ca~cit~ Gals DaSa ~eet O , 2 6 8 ~e lis The Undersign~ CERT~S: "Constmctio~ 6f.authorized ~nstalla%ions ~11 be in acco~ance ~th the Suffolk County Health ~e~ments ~rrent Standa~s, ~lletins, a~ ame~ments thereto, coveri~ Private Sense qi~sal Systems". , ,, info~tion presented here~th, it is the opinion of the H~lth De~ment, that an adequate ~nd satisfacto~ Se~ge Dis~sal 5~t~ can be i~tall~ o~ this~ ~ot. aCAVATION i SPECIiON Disapproveda/c .............................. APPLICA'~'ION FOR BUILDING FERMIT Date ...'...I~..q.H..~.~ .; ................. 19. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and ,submitted in duplicate to the Building, Inspector. b. Piotplan showing location of [~t and ~f buildings o n premises, relationship to adjoining premises or public/~. ~ streets ~r areas, .and giving a detailed description of layout of property must be drawn o,n the diagram whic ~hA~ part of this application. / e. The work covered by this application may noi be commenced before issuance of Building Permft. d. Upon approval of this application, the Building~ In spector will issue a Building Permit to/thee applicant. Such permit/shall be kept~on the premises available for inspection throughout the progress 0f the work. e. No' building shaH, be occupied or used in whole oN in part for any purpose whatever until a Certificate .of Occupancy shall have been granted by the Building Iuspect~. APPLICATION IS I-IJ~-~Y MADE to. the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of S~athold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of build ings, additions or alterations, or for removal or demo- lition, as herein described. The a~plicant agrees to corn ply with all applicable laws, ordinances, building code, housing code, arid regulations. .~. ~...~ (S~g~t~e of a~pli~'ar~', or name ff a corporation) e/~ AI~ICAN/H~qE OON~THUCTIOI ~0o INC, ('Address of applicant)1[; y. 117Z~ State whether applicant is owner, lessee, agent, architectfengin~er, general contractor, electrician, plumber or builder ................... OW~l$1' .......................................................................... Name ,of owner of premises ..... .~.T.~,...Ny.~.., . .G~.. .................................................... If applicant is a corporate, signatu're O~ duly authorize d <rfficer. (Name and title of corporate officer) Location of land on which pro~ed w, ork will be done. Map No ................. Lot No .............. Street and Number ]/]g0K~ ~D., ~. A~I~0X,. J~00.~.. ¥~~ .Br.~/])o.~ :LA~HING .WA,~ ~ / ..... ,~//5' 0 ~ ........ Mu_ni~cip_al.i. ty .. . . State existing use and occupancy ,of premises an d intended use and occupancy of proposed construction. a. Existing use and occupancy .................................................................... b. Intended use an~ occupancy .. ~)..g~..~..~f~. ~..:L.~..]~. ............ ................... ~ ......... 3. Nature of work (check which applicable): New Building ...X. .... Addition ........ Alteration .. :,. .... Repair ......... Removal ...... Demolition ........ Other Work (Describe) ...................... 4. Estimated Cost ~.~.,.~.~..0... ..................... Fee ................................................. (to be paid o%9 filing this appli .cation) 5. If ,dwelling, number of dwelling units .... .1. .... Number of dwelling units on each floor . .~, ........... If ~arage, number of cars ..ll~ ..................................................................... 6. If business, commercial or mixed occupancy, specify nature and exteot of each type of usa .............. 7. Dimensions of existing structures, if any: Front .............. Rear ............. Depth ............. Height ................ Number of Stories ........................................................ Dimensions of same structure with alterations or additions: F~ont .............. Rear ............... Depth ................ Height ................ Number of Sf~)ries ...................... 8. Dimensions of entire new construction: Front .... .~.6.! .......... Rear ...~.~.~. ....... Depth . ' Height ........ Number of S~ories ...................................... 9. Size of lot: Frgnt 362.~ .......... Rear ....2.(?..1.~. ...... Depth . .~.1~ ! ........ 10. Date of Purchasa .... ~./.~{~/?.Q ............... '. Name o/ Former Ov~ner . .~.~..d?.~.9..H.....~..~.o.i~.h...~. .... 11. Zone ar use district in which premises are situated.. A 1~®~. 12. Does proposed construction viola$e any zoning law, ordinance or regularly? .]~. ....................... ~3. Name of Owner,of premises .~..*..~...~...~.. ........ ~ddress ?.0...~.~.X...2.~..]...~..~.~.~...h.~ne No. 7.~.~(~ . Name of Architect . .H..e.~.d..~.. ~l~)~J~ ........... A~ldress].~.0.~. ~1~1..?pkPhone No.~,~lb.. Name of Contractor ~]~'..]~.~..~.~ll~. ~.~,.. Address ~ .~.~;~..H~J~. ....... Phone No.~J~.9~)~.. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give s .treet and block number or desc~ption according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, )S.S. COUNTY OF ~%%%~.fol. JlC .... ) .......... ~;~1%~.~..(~1~.1'~ ....................... being duly swo~, ~e~s~ and ~ys ~at he is ~e appli- (Name of ~divid~l signing applicat~n) ~t a~ve n~ed. He is ~e .... ~ .................................................................. (~n~a~r, a~t, ~ate ~icer, etc.) ~ ~ own~ ~ ow~, and ~ du~ aut~ ~W p~rm er hava pe~ ~e ~d ~k ~d ~ m~e ~d file th~ applicat~n; ~at ~ stateme~ ~nt~n~ in ~is applicon ~ ~e W ~e be~ of h~ ~owl~ge ~d belief; .and ~.at ~e ~k will ~ p~ in ~e mann er set fo~ in the application filed ~e~wi~. Swo~ W befo~ me ~is ...... ~ ...... da~ of...~oh .......... 10.7[ ........ ~ ..... VIVIANstatY&RD~ ~f ~plicaoolic -' '" N~ ~bH~v[A~O~.; ...... ~nty NOTARY PUBLIC, NOTARY PUBLIC, State ot Now York No. 52-9764324, Su~~/f No. 52'9764324,Sulfo'~, ~''~ty " Term Expires M~'~'1 '"L 1972 '~ 224.1o IAMAICA AVE. . ./',ILEY t J : SIO~. E. L E v,6.'T 1 Oh4 TNe