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Home My WebLink About5185-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupnncy No. ;~1~0~. ...... Date .............0et .... ~ ....... , 19. THIS CERTIFIES that the building located at ~.0,~o. ~/-~ .Bo~sseau .A~ Street Map No.. ~ ........ Block No. ~ ....... Lot No .... ~... 3outh~.. ~.Y. ...... confo~ substantially to the Application for B~ding Pemit heretofore filed M ~s office dated ...........~h .... ~ 19.7~. p~su~t to wMch BuildMg Permit No. ~18~" dated ........f~arch..: 26.., 19. ~.$, was issued, ~d conforms to a~ of the r~e- ments of the applicable prov~ions of the law. The occupancy for which this certificate is issu~ ~ . Private..one..f~. d~alZ~g ....................................... ~e cer~icate is issued to .La,once ~. F~rence. ~e ........ ~ ........... (owner, lessee or ten~t) of ~e ~oresaid b~l~g. Suffo~ Co~ty Dep~tment of Health Approv~ .. Sept - - ~ s - 297~ "bY' ~-' -Villa · House ~ 122~ ..... ~*~ :~"' ~ ' ' ' ....... T ........... Bu~d~g Inspect~ 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?- 5185 Z Permission is?ereby §ronted to: ' · ............... '.~%a ....... lh~.. .......................... pursuant to application dated ......................... .~1~2~ .......~ .......... , 19..~t~., and appro~ved by the Building Inspector. Fee $.--~0..0~ ......... Building InspectoI . S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. 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. SEP 2 4 1971 (Jhie~- os' 6eneral Emgineering Services ~.. 'I'UTJA ILL lq. 78' Z7' 30" E. S. VS,' Z&' 00" W. i IA&? O~ LA~D SUI2. V~ Yr~ b rO~ SCA LE. 50'-- 13= lA 0 N U IA r--'lq, T TITLE. r, rLOt BNCF= $ I'T U A'~ ~ AT SOUTUOL3 NE\V Y0~E: Lt$O GUAlZAklTI:;_r-D '1'0 TI-iE SF,=CUBITY -FITLY. AND GUB. I;Zb. klTY C01&PAkI¥ AND '1'0 TI4E MOIZTI4 FOE. E, BANV. AMD COfAP,&N Y VA~ TUYL s S01'4 LICENSED LAND SUEVEYOI~ ~ G~-ENPOIZ1 , iqr=~v YOg. V.. SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference N ~3(~ EASTERN DISTRICT, RIVERHEAD,N.Y. ~ APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS ~ Approval tn construct said systems is requested,pertinent data herewith: Date2~_~ ~' 1-Applicant ~A,~m? I gO PhOne ~-~ 6-Sub div Address ~$~,XFm~ *$w~ . .7-Section 2.Detailed_prq~erty location ,~aw~ 2~.~ ~8-~t No. ~mlet ~ ~TM~ To~ ~ ', 9-Private well?~ ~-~blic ~ter ~pply ~me Dis~nce to nearest ~in ,, ~-~t Size~ Width~ft. Leah ~ ft. (also enter on ~enter plot plan below:) 5-~elli~: Single Family ~ ~ F~ly? ~ /~ellar? ~lab? ~ ~ C~wl S~ce? ~ ~ lO-~o~s~ ~st~: Septic ~ ~Precast ~Cess~ols ~S~llow ~ols ~ XOther ~ il-Septic ~ i~ide dimensions: Vol~e Gals.Length ft. Width ft. Liquid depth ft. 12-~ecast sections: ~Num~r~Sq~ Ft. Cess~ols: Block sizeL incs.D ~s.H ins. Total blocks below i~et. ~1~2 ~ ~T P~N The Underui~n~ CERTIF~S: "Const~etion of au%ho~tz~ i~%alla%i~ ~11 be in acco~ance ~th the Suffolk County H~lth De~rtments' current Standa~s, ~lletins, a~ amendments thereto, coveri~ Privage S~ge Dis~sal Sys[ems".. Da~e~ ~g t99l Sign~~ FOR ~ALTH DEPART~ USE ONLY. ~s~ on the info--riCh ~resen%~ here~th, it is the opinion of the H~lth De~meng, that an ad~uate and ~tmsfac~o~ S~ge ~s~sal S~t~ --N ~om ~ ~ ~ Indi ate ~ '~ ~ 'th ~ 0 2 4 6 8 lO 12 ~4 18 can be installed on this Plot. Date (10~65 Revis.) s-15 Signed~.'~ / TOWN OF $ouTHoLD ~",~4~/-- ~ ~ BUILDIN~ DEPARTMENT ~ · ~ ~ ~_ ~ ~ TOWN CLERK~ OFFICE ~ ~~ ~ ~,N.Y. ~ ~ ~'~ ~ ~' ~ ~,~ ..... ~ .......... , ~ ~ ~ ~ ~i~t~on ~o..~.~.~ .......... - - A~r~d . . 11 " , 19.7 .... .Pe~it ~/~1 ~ ~ ~ ~* Disapproved a/c APPLICATION FOR BUILDING PERMI'T ~c~ ~ .... Date ..~7~. ................... ~.. ............................ . 19..?../.. ~ INSTRUCTIONS a. This application must be completely filled tn by typewriter or in ink und submitted In duplicate to the Building Inspector. i . b. Plat plan showing location of lot and of buildings on premises, relationship to adjoining premlees or public streets or areas, and giving a deeailed description of layout of property must be drawn an the diagram which II part of thle application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this apl~llcatlon, 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 part for any purpose whatever until a Clrtlfleate of Occupanc4~ shall have been granted by the Building Inspector. -~- APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit purduant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lawl, Ordinances or R...egulatlons, for the construction of buildings, additions or alterations or ,for removal or demolition, al bereln clescrlbed.~.~ i ne applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (Signature cf applicanT, or name, If a ¢orparatlon; (Address of applicant) State whether applicant is owner, le~see, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant Is a co,rote, signature of duly authorized officer. (Name and title'of co~orate officer) ,. o, on wa,.,, ........ Strm and Numb~ ,ls[~a~ ~' 7'~ onHE~ ~ ........................ ~ ............ ~.~ ........ ~....~ ........................... ~., ........ ~ ..................................... ~A LoT ~/_ /~ Munlcl~ll~ 2. State existing u~ and ~cu~n~ of premiss and intended use and ~cupancy of pmp~ ~isti~ u~ and ~cupan~ ....~ ................................................. b. Intend~ use and ~cupanc', Z ~/Z~ ~..~X~ ......... 3. Nature of wink (check which applicable): New Building ~..~... .......... Addition .................. Alteration ............... Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...................................... 4. Estimated Cost ....~z~/.(~..0...~.. ...................................... Fee .......................................................................................... (to be paid on fi~ing this application) 5. If dwelling, number of dwelling units ......... .~. ............... Number of dwelling units on each floor ....~.. ..................... If garage, number of cars ....... ~2~ .................................................................................................................................. 6. If business, commercial or mixed occupancy, ~pecify 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 · . . ............ 7 .................. 8. D,mens,ons of/ent, re new construction: Front ......~..' ........................... Rear ...~..~.'..'~.. .............. Depth ..~.....~.....~.. ........... Height ...o./.~. ........... Number of Stories ..... ~. ...... ~. ........... ; ................................. ~ ....................................................... 9. Size of lot: Front ....../.~.~...~. ......... :,'Rear ..... /m~., ...................... Depth .../..~....~. ................... 10. Date of Purchase ...d?....~...~. ....... [.~..&.~ ......................... Name of Former Owner .~.~..~..~.....e...~......~..h.l~..:.k.~.~.= ............ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction ¥iolate any zoning law, ordinance or regulation? ....~.~.. ................................................. 13. Name of Owner of premises ~,,~ff~,~.E.~cJ~.~,.~.,,q~.,~,,,C~ddress .6,o.).~...~_~,.,?,..~ ,~,.~,. ............ Phone No. ~,~,,~,,','~..~..~..~... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ...... ,~,~,,,~,,,~.....,~.~.~...~...~, ................. 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. / STATE OF N~ 0 t - (Name of individual signing applicati~) above named. He' is the ............................ ~..~....'~ ............. 'j ......................................... (Contmct~, ag~t, Co~orate officer, etc.) of said owner or owners, and is duly authorized to pe~orm or have pe~ormed the said work and to ~ke and file this application; that all statements contained in this application ara true to the ~st of his knowledge and belief; and that the work will be performed in the manner set fo~h in the applicati~ fil~ ther~ith. Swam ~ ~fom me this .... ,~, .... ..... ... .......................... ~o. 52-8125850, ~uffol~ Term ~es ~rch OTE: L,vv, MOTE.: TI¢o CO~T% LIVING P,,/Y\. q'_ ~X~ ' D4'-5" O OAT E: REVISIONS: ONE FAMILY RESIDENCE HERMAN H. YORK ARCHITECT F-12ST FLOOR PLAM PLAN NO,,,~ DRAWING NO. },.~F ~ UN £XCAVATED FILL · UKIE×C &VATED NOTE' NOTES: I- DETAIL OF OPTIONAL' CELLAR. EWEEY DATE: ONE. FAMILY ~E.$ID E N CE. HERMAN/ ,,H. YORK. ARCHITECT FOUN DA. TIQIq PLh, ki PLAN NO...~,, sc,~,LE: '/¢"' r-o" ~ NO.~,??.,~. ,, ,~zt 3~ ('Z) "z~ 4- ~TTIC- WALL SEcTiON ~ WALL CROSS SECT\0¼ ELEVATI 0 kl t" , [SED TWO ~: ,ID 5- 17'-o' +-4- 5ECTIOM DETA.~L OF FIR. F'PLAQF-- WA, LL F. ITCHEIq SECON~D FLOOR PLAN 1 CLCVA110 N S DATE: ONE FAMILY RE'51 DE- N CE "RMAN H. YORK__ ARCHITECT 1 E~TIO~ LEFT SiDE ELEVATION TYPE .y/- A S P ~ALT .K!OTE: TOp o. ~ ~ F~OMT DATmr" ~ ELEV,~T I 0 ~ I I ,L ONE HERMAN FAMILY RES1 DENCE H. YORK ARCHITECT 5TO ~ E N ~ PLAN 0 .................. D~,W~Ne No..~-. ~::.~... I ] i ~_L F_V/xT I 0 N ILO. _ K FOOTP4 G ("OO"//'A) / t __-/ oPT Il i- t t I'gl i i D 1A,G P-A4A. ' g'-~' .. q':o' FO~ TWO CAR