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Home My WebLink About5194-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~'.1.27. Date l~a¥ 7 , 1973 THIS CERTIFIES that the building located at Cedar. L~ & 8llmmit Itd Street Map No.Baysld~ Teri~ No. Lot No...8 8ollthold !,: ,Y. conforms substantially to the Application for Building Permit heretofore filed in this office dated .. Feb ... l~ · , 1971 pursuant to which Building Permit No.. lipide dated ...... Ma:~.. · 31 , 19 .71, 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 . .Priv. ate..o~le, family, dwelling ...(Al~pI'o.v.e.d...by...~.d.A. Dp.ea.l.s') ... The certificate is issued to ~ilbu~ Verity of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICAT£ No .... N..91c~17 ttOUSE NUMBER..I~2Q ..... Street Codalz..&ye .... .... 55 ....... (owner, lessee or tenant) · 0c.t..2? 1971 ..... Building Inspector 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? 519~ Z Permission is hereby granted to: /. _ ~ ............ .~.t..~.~.~...~ ..... ..v...e...~;..~.7.; ............ ....U..~..,4. ..... ..P...,!.~.:..~.:. ~.....,~...T..: ..................... .... .8....~.~.~.~.,..~. ........ ~:.y...: ............................ to ..~.~.:..~.P......ff..t~..~.. ...... ~.~..~ ......... ~..~.:..~.¥. .......... P.~..~..~. ................................... .................................................... .~.o...~....r...~.~.~.~. ........ ~.:Z.'. ................................................... pursu=¢ to apphcation d~ ...................... ~Z~.l.~ ..... .~. ............... . 19Zt..., a~ appr~ by the 7 $.~ '54 30"E ·" 16 IT SUFFOLK COS~TY DEPARTMENT OF HEALTH H. D. Reference No -~'D ~// EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT ?RIVATE SEWAGE D/SPOSAL SYSTEMS Date Approval tn construct said systems is requested,pertinent data herewith: Address //3~ p~¢,'~c ~;l~ /~,~/~..~., /.J. /~,~', ?-Section ~V,;/~" 2-Detailed property ~location ~,/~' C~¢~ ~$" ~a~ ~. ~ 8-Lot No. / Hamlet ,~;lla~¢ ~,~' ~&~/~ To~ ~u~/~ , 9-Private well? ~ , 3-~blic ~ter~supply name ~,,~ Distance %o nearest main 4-Lot Size: Width./~ ft. Length/~$ ft. (also enter on center plot plan below:) 5-~elling: Single Family ~ T~ Family? ~ /Cellar? ;~/~!ab? / ~ Crawl S~ce? 10-Pro~sed system: Septic {ahk ~ /Precast F~/Cess~ols / /Shallow pools / /Other / / ii-Septic ta~ inside dimensions: Vol~e Gals. Length ft. Width ft. Liquid depth, ft 12-Precast sections: / ;N~be~/ /Sq~re Ft. Cesspools: Block sizeL incs.D ins. H ins Total blocks below inlet: ~1 ~2 ~T PLAN Ca~.pacityp. M. Gals ~ {o Street P -~o~.~ : ~ o ~m ~ Indi at, No th 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". Owner or uilder ~ata~C ~ 0 ~$ 4 10 12 FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department, that an adequate and satisfactgj~pSe~ge Disposal System can be installed on this Plot. (10/65 Revis.) ~k~i~ ~ ~t~ i%C~,~C~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~ ,,~'~',~ ~/~,~/ C¥/~, ) ..~ SOUTHOLO, N. V...L,, x r. ~,~. ~,~{~ ,=....~.:L~..~.. ........ ~ ~. ~ ~. ~-~,..-v~ ~ . o. ,.,-. ............ ....... ............... ........................... ........... ................................. ......... APPLI~YION FOR BUILDING PE~IY ~t, ........................ .~. ........................ & , ~9..D/ .... a. ~ls a~licatl~ must be c~plately flll~ in ~ ~ewriter or in ink und submitted In ~pl!c~ I~r. - b. PI~ ~17 s~i~ I~ation of I~ a~ of buildings on premiMs, mlatlon~ip t° "djolnl~ ar~s, a~ gwl~ a ~11~ ~Kri~l~ of I~t otp~ must ~ dr~ on c. ~ ~rk cM~ by this ~li~o~ mw not ~ commenc~ b~Mm d. U~ ~r~ol of ~is a~lica~, the Building I~ctor will I~e Q Buildi~ Pe~lt ~all ~ k~t ~ ~e p~mi~s ~llable for ins~cti~ t~g~out tho p~w of t~ ~. e. No building shall be occupied or used In whole or in part for any purpo~ whatever until a C~rtlflc~t~ of Occupancy shall have been granted by the Building Inspector. B ^PPLi.CATION IS HEREBY MADE tothe Building Department for the issuance of o Building Permit pumuant to the uilding Lone Ordinance of the Town of Southold, Suffolk County, New York, and ~her ppplla~ble ~ Ordt~ncet ar Regulations, for the construction of buildings, addltlon~ or al.terations, or for rerr~val or dem~lltl~n, al hewn delcrlbed. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and ~gulatl~ns.. (Signature of aPPlicant, or n~, If a a~l~on) ..../.~,z..e ..~,:/.'.r.~,.,...,,l'~,....~ . ;,. ,z. ~.. .. ........... ~.~, ......... ~..,,~..., .~. (Address of applicant) State whether applicant is owner, levee, agent, architect, engineer, general contractor, electrician, plum~er or buil~ .................. O...~..,.~c...-......~.,~,:(d~.e. ................................................................................................................................... ~. Name of owner of premlsel ......... ....... ~..g~.~t.~. ................................................... ............................................... 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 dane. Map No.: ......... ~'~.~......~.. ................ L~t I~o. ef> Street and Number .......................................... .~.,.MS.~I'~,../. ......... ~ ........... .~...~./~'(~./..~..,~ .......... , ............... 2. State existing use and occupancy of premises and Intended use and occupancy of prapaeed ¢omtmctlon: Existing use and occupancy ........... Intended and Nature Repair .................. Removal .................. Demolition .................. Other Work (Describe) ..................................... 4. Estimated Cost ....... ~...~.~.~ .................................... Fee ......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... ,~. ............... Number of dwelling units on each floor ...~.,../.....~../.'. ...... If garage, number of cam .......... ~ ...... ~.~. .................................................................................................................. 6. If business, commercial or mixed ~cupancy, speci~ nature and extent of each ~pe of use ............. ~ .............. 7. Dimensions of existing structure, if any: Front. ........................... Rear ................................ Depth ............ Height ........................ Number of Stori~ ...................................................................................................... Dimensions of same structure with alterations or additions: Front .................................... R~r ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........ ~.~..~ ................. Rear ........ ~..~. .........D~th .....~..~ ......... Height ....Zg.~.~[;.. Number of Stories ...... ...Z: ........................................................................................................ 9. Size of lot: Front ..... /~ ................ Rear .......... [.~.~..~ ............. Depth ......... [~.~.~ .......... 10. Date of Purchase ........ ~W.~ ....../~ ...................... Nome of Former ~ner ...~.~WZ~ ...... ~.~.~.~ ............ 11. Zone or use district in which premises are situated ........... ~.¢~ ................................................................................ J2. D~s pr~osed const~ctlon violate any zoning law, ordinance or regulation? ....~ ................................................ Na~e of ~rchit~t ...................................................... ~ress ............................................ Phone ~o ..................... Name of C~tractor .................................................... A~ress............,...............................~ 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. STATE OF NE'~ cOUNTY OF --., ......................... /~l~[,4Jg././4/J~......(,,~..,~{~.l.,~ .................... being duly sworn, deposes and says that he is the applicant (Name of individual signing opplicat/on) above named. He is the .................................... ~ ....................................... ~ ....... ' ................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Swam to before me this .... ...... . . ............................ No. 52.8125850, Suffolk Cou~a~ Term Expiles March 30, 19,.~_.~{