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Home My WebLink About5184-zFO~ NO. & TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . (tardtr~r~. Large .......... Street Map No. ~ .. . Block No. :X~ .Lot No..XX S~ttthold. N.,M, ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ~.~ ..... ~ 19.74 pursuant to which Building Permit No. ~.~...8~... dated ......... Hal, eh .2~.., 19 7~[ , 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 $~J~t.vate. ell~. ffal~ily .dvellix~g .................................... The certificate is issued to . FO~.~.u-.~I~ ~G~,~. ~.~¢ . . 0~'l~r .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .~lg,..9. $9F.1.. by .R,. Y. il~ ..... Building Inspector · FORI~I NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~ 5184 Z Permission is hereby granted to: at premises Iocoted at ............. ~"~.....-'.~'.T-~?-.---..?--".~--:-='~-~-~.' ......................................................... ............. .~/ ~ ........ : ........ , ,,,,,.~ , . . ~ ......... ~,,,,.~,~ ...... ~. - ~. ~,~. . . ~.,: ,. .r~. ~j. . . . : pursuo~¢ to ~pplic~ion doted ............................... ~ ...... .~...., 19.~.~.., ond ~pproved by tho Building Inspector. Buildin~ Inspecto1 S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH TO WHOM IT MAY CONCERN: at have been inspected by this department and found to be satisfactory. AUG g 1~?~ ~h~ he of General ~ngineering Servlee~ SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No~-~ EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval tn construct said systems is requested,pertinent data herewith: Date~~.~ 1-ApplicantF~l;,~'~ /4~'1,~.~ ~l~,A~,, Phone'~6-Sub divF~l~vt~ Address 3~,~.~ ~6 ~T~ 7-Section ?,~~ 2-Detailed p~_perty locatzon .~ ~.~:~..~ ~.,,,,,,.~ ~'~c,,,.-, ...... ~. ~, 8-Lot No. Hamlet O'~ i ~ Town ~.~ui'~. ~ 9-Private well? 3-Public water supply name -- Distance to nearest main S-Lot Size: Width~,' ft. Len~th~ ft. (also enter on center plot plan below:) 5-Dwelling: Single Family ;~/~Two Family? ; ~ Cellar? ~F~ Slab? ~_~ Crawl Space? 10-Proposed system: Septic tank ~_~Precast; /Cesspools ~//Shallow pools il-Septic tank inside dimensions: Volume Gals.Length ft. Width f.t. Liquid depth__.ft. 12-Precast sections: / ;Number/ /Square Ft. Cesspools: Block sizeL/~, mncs.D ~ ins. H~ ins. Total blocks below inlet: ~l/j~ ~2~'~3 PLOT PLAN ~ ~ o/ I , I I Grade I Street Q~il~,,et~$ k~.~ ~ ~o Ind~ No 5h ,N ~te Data ~eet 0 2 6 8 10 12 18 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. (10/65 Revis.) Signed DateA~__~/9 2~ Signed~ The Undersigned CERTIFIES: "Construction of authorized installatio~ will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Systems". Disapproved ale .............................................................................................. APPLI~.ATION FOR BUILDING PERMrI' ~ 0 oote ..#.~....,,?~ ................................ , ~9..'7~ ....... INSTRUCTIONS ~ o. This application must be completely filled in by typewriter or in ink und submitted tn duplicate to the Building.~ Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premiees or public streets or areas, and giving a detaUed description of layout of property must be drawn an the diagram which Is I~rt of ~hl~ appllcation.~ 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 · Certificate of Occup~ncy~;:: : shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of a Bu Iding Perm t pureuant to the BRUildlng Zone. O~inance of the Town of Southold, Suffolk'County, New York, and other applicable I.~wl, O~llrmnces or ~egu atlons, tar the construction of buildings, additions or alterations, or .for removal or demo t an, as heroin described. ne applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and ragulatlons. .... ...... i ........................ (Signature of applicant, or name, if a corporation) ..... ~.,.!.sseav u~_ ~0uT L ...................... .~ ........................... .~...,D. .................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. I~..~: ..L ~, & ......................................................................................... If aPRlica~ Is a corporate, sl~na,~tu,re of duly authorized officer. (Name and title'of corporate'officer) ~'~ 1. Location of land on which propo~ed work will be done, Map No.:~../' ',~..~; ...... '...~..(~...~. ....... Lot No.'~lll~: ............... Street and Number .& ......... ?..~. ...... L.~ ..................................................... ~n.~.. ........................................... T~ / - ..~ o 0 -J' Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .V'....~...c. ~ ~,,~- LG~ b. Intended use and occupan:., OU~, E,'q./'~(h."/. ~....b~..~.LLI../..~.~ . 3. Nature of work {check which applicable): New Building ..... ~ ........Addition .................. Alteration .............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...................................... 4. Estimated Cost ..... ~;~.o...O...O.. ..................................... Fee ..~...~. .................................................................................. (to be paid on filing this application) 5. If dwelllng, number o1: 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 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. D'mesonsn ' of, entire new construct,on.' Front ....... ~.~../.0 ................... Rear ..~r-~. .................... /6 Depth .~..-~....~.~..~. ...... Height ..../.~.: ......... Number of Stories ......... ./.....:..; ........................................... 7 ...................................................... 9. Size of lot: Front ....... ./..~...0..~ .......... Rear ........ /.~..o. .................... Depth ...~...O...~. ................... of Purchase ........................ [...~....~...!i ................. Name of Former 10. Date ! 1. Zone or use district in which premises are situated ~r¢ ~ 12. Does proposed construction violate any zoning Iow, ordinance or regulation? ....... ~/.~. ............................................... 13. Name of Owner of premises .~..?.?..~.o...E.l~.~...~..~tF.,~.~..c...Address ~R:..g...S..tr.=..a.~....~..k~...~.:.¥..T'.~,gPhone No.~7~.~.T~L~...~..... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ..~...~...~...c:.~........~.~.p.~.~. .................... Address ............................................ Phone No .................... PLOT DIAGRAM Locate clearly and distinctly oll 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 ~hether interior or corner lot. i~I STATE Of NEW~OP~I~,/~ ~-ee COUN Y F _ ......... c~~...~r.,~3~....~/~?~., ................... being duly sworn, deposes and soys ,~' he is the applicant (Name of individual signing ap~oti~) above named. He is the .................................. ~....~.~ .................................................. (~ntmctor, ag~t, co~orate officer, etc.) of said owner or owners, and is duly authorized to pe~orm or have perfo~ed the said work and to ~ke and file this application; that all statements contained Jn this application are tree to the best of his knowledge and belief; and that the work will be performed in the manner ~t fo~h in the opplicati~ filed t~ith. Swam to ~fo~ me this ~ .... ....... :....., / - .. ................... ............................. N~ARY PUBUC, S~ o(~ York No. 52-8125850, Suffolk Co~ Term ~ U=ch ~, 1~ Ir, HLo" - -4- HOl'~G: ' (, , -- ' , ~' HERBERT C. STRUPPMANN MEMBER--AMERICAN INSTITUTE OF ARCHITECTS--CHURCH ARCH}~'~CTURC~L GU,~ OF AMERICA' CERTIFICATE, NATIONAL COUNCIL O¥ ARCHITECTURAL REGISTRATION BOARDS Z N, Y,'#stt4 N+ :I,t #C2575 CONN. #3.3.85 · MASS, HERBERT C. STRUPPMANN