HomeMy WebLinkAbout5200-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. ZZh-382~ Date
THIS CERTIFIES that the building located at Granl[e
Map No.l~o Hbr Haas Block No. Lot No. 19
sept 13 ,19 71
Roa~ Street
Southold
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ApI'll 1 , 19 ~tl pursuant to which Building Permit No.
dated Apl~i~ 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 .Prl.~,ate. olde family dwelling ........
The certificate is issued to ltarolcl Later ..... 0W~eI'- ''
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval Sept 3~ .t971 .by. R, Villa
Undwerwriters Cert # N900~68 ~
~ouse ~ 2o~ .... .~?, t
Building Inspector{
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, FI. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREM. ISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Ne 5200 Z
Permission is hereby granted to:
.................... ~i"~ .................................
......................... $Z89 ....... ~'et.e~m~"~ ........
to ...... b.~%,%~.. ~.~.. _~m~... f.~_% ~,~...~elllml~ ..............................................................................
at premises located at ....... ~"-~9 ....... ~..]~i~...Heellu~ ...................................................
........................................... .~r~...~a~ ............. ~m~ ....... ~,~ .......................................
pursuant to application dated ............................. A~;I~..-.-~ ........... , 19....~l, and approved by the
Building Inspector.
S-9
SCHD
SUFFOLK COUNTY DEPART.~NT OF HEALTH
Date6/2/71
Bldg. Permit No.
TO WHOM IT MAY CONCERN:
S0-751
The sewage disposal facilities for a structure located
at S//S ~ran~e Road, 134' g/O Bayview Rood, Oouthold (Give deed location)
have been inspected by this department and found to be satisfactory.
Chief of General Engineering Servicee
District Engineer
SUFFOLK COUNTY DEPARTMENT OF HEALTH
H.D. Reference N~--~
EASTERN DISTRICT, RIVERHEAD, N. Y.
APPLICATION FOR APPR~AL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS
Date ~(~.27,19'~0
Approval to construct said systems is requested,pertinent data herewith:
1-Applicant ~e Se~d~.~ .. Phone 6-Sub div~O~ ~bor
Address ~olden Ls~e. ~amesnort.N.Y. 7-Section
2-Detai!ed prooerty, toca~tionS/~-~a~e ~.,~'~O 8-Lot No.
Hamlet B~W ~d,;~thOla Tow~ S~u%h~la - 9-Private well?
3-Public ~.ter supply nameVillase of ~eenn~rt~istance to nearest main
4-Lot Size. Width l~ft. LengtR180 ft. (aiso enter on center plot plan below:)
5-Dwelling: Single Family ~ Two Family? ~ /Cellar? ~.Slab? ~ ;Crawl Space?
10-Proposed system: Septic tank F /Precast y /Cesspools ~/Shallow pools · /Other / /
11-Septic tank inside dimensions: Volume Gals.Length ft. Width ft. Liquid depth ft.
12-Precast sections: / /Number/ /Square Ft. Cesspools:' Block sizeLl--~ incs.DS ins. H .~.ins.
Total blocks below inlet: ~50
PLOT PLAN
,feet flr..nge Road
~ %'P'M'Capacity .Gals.
~ l~lbl ic wa
~rade~
The Undersigned CERTIFIES: "Construction
I ~ate
of authorized install~k~l
Data Feet
0
, 2
\
~ 6
be in
accordance with the Suffolk County Health Departments' current Standards, Bulletins,
and amendments thereto, covering Private Sew~Dia~Qsal Systems".
3289
Date~ Signed ...... .~/¢a~,Z~ ~ '.~
FOR ~ALTH DEPART~NT USE ONLY. Based on the info~ation presented here~th, it is the
opinion of the Health De~rtment, that an adequate and satisfacto~ Se~ge Disposal System
can be installed on this ~ot.
Date g~'~/~/~ 0 Signed
(10/65 Revis.)
s-~
18
,~J 8.5' °0 ~ '5'0 "~'.
154,/0
AJ~ o~ IOT 19
,Su~'o- ~ Coup-fY,
Building · Construction
3289 VETERAN'S HIGHWAY
~/C)NKONKOMA, NEW YORK 11779
!
Building ° Construction
:3289 VETERAN'S HIGHWAY
RONKONKOMA, NEW YOF~K 11779
Approved ........................................ , '19 ........ Permit No ..................
Disapproved a/c ..............................................................................................
(Building Inspector) (
APPLICATION FOR BUILDING PERMrT ~
pete ............................. ............ , ......
INSTRUCTIONS ~
the Building~
a. This application must be completely filled in by typewriter or ih ink und submitted in duplicate to
Insi~:tor.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining pmmlies or public streets m
areas, and giving a detailed descril~lon of layout of properS/must be drawn on the diagram whlch Is part of thio application.
c. The work covered by this application may not be commenced before issuance of Building Permit;
d..., Upon. approval of this app. I¢.a. tio.n., the Building Inspector will Issue a Building Permit to the applicant. Such permit
sna me Kept on the premises available tar 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 Certificate of Occupancy ~(~
shall have been granted by the Building Inspector.
8 .A.P..PLI_CATIO~N,!S HEREB~Y.MA_DE to the Building Department for. the issuance of a Building Permit purduant to the
.,ui,a?~.. &one. urn. mance of the/own of .Southold, Suffolk Coun.~., New York, and other apflll~Gble ~ Ordlnan~ec m
~egu~ati..ons, tar the construction of buildings, additions or al.rotations, or for removal or demolition, al herein described.
ina apphcant agrees to comply with all applicable laws, ordinances, building code, housing cede, and reguleflofl$.
(Signature cf applicant, or name, If a coq)oration)
~289 Vets.Hwy. ,Ronkonkoma,N.0
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
O~ner
Name of owner of premises Harold .~aay
If applicant is a corporate, signature of duly authorized officer.
(Name and title 'of corporate officer) ~'- ~'
Homes
South Harbor
I. Locafio~ of land on which proposed work will be done. ~ap No.: ........................................ Lot
~/- ~O.~ ~range Road 8outhold
Street and Number ................................................................................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of prppoeed ¢oflctru~t|on:
a. Existing use and occupancy Vaoant land
b. Intended use and occupant, I .~..~...~.~.1I .d..w...e..1..1...i..~.~
3. Nature of work (check which applicable): New Building X Addition Alteration
Repair .................. Removal .................. Demolition .................. Other Work (Describe) .....................................
$15!000.00 ~
~. Estimated Cost .............................................. ,.....,....rea ..........................................................................................
(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 ................................. .l. .............................................................................. i ...........................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................
7. Dimensions of existing s~ructures, if any: Front ...D.I~IIII ............... Rear ................................ Depth .............
Height ........................ Number of Stories ....................................................................................................
Dimensions of same structure with alterations or additions: Front ....................................Rear ............................
Depth ................................ Height ................. _- ~ 4~Ol~l~lunal~ of S~ries ................................ ~,~'~ ~ ~
8. Dimensions of entire new construction: Front,:~ll~.tl~,Q..,k~........L... Rear .~,,~ ................... Depth
Height ...2..~..~..+....-..... Number of Stories .... ~!'. ..................................... : ......................................................................
9. Size of lot: Front ..... .1.0..0. ................ Rear ...... .1....~. ....................... Depth ..... 1...8..0......1...~. .............
10. Date of Purchase ...............2../..8. Z.?.1. ............................. Nome of Former Owner .....R..e...zl:.e.....G.?.ll:.d...~..o..n.. .......................
11. Zone or use district in which premises are situated .....................................................................................................
12. Does proposed construct[on viol~.te any zoning law, ordinance or regulation? ...~.o. .....................................................
13. Name of Owner of premises Harold Lacy. A,~,~,~.S289 ,.V.e~s .Hwy. Phone No 588-1864
........................................... l~ii~ i~ hli.(~ii~ ;~1~. ~r ._. ..............................
Name of Architect ...............'T.~ .................................... Address ............................................ Phone No .....................
Name of Contractor ~.]:.~.~..A.i.l.?..e.....~...n.~.*....~l...?..*. ......... Address .~.8...9.~..¥..e..~..e..'...~...~.:,~ ........ Phone No. 5...8..~...~.1.!.8...6...4.
' z~OllKOnKO ~ ~ ri .l.
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 01[: NEW YORK, I e e
COU NTY'OF ................................ I ~'~'
................................................................................................. being duly sworn, deposes and says that he is the applicant
(Name of individual signing application)
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
that the work will be performed in the manner set forth in the applicatiop filed therewit_h.
Swam to before me this ~!I l)
........................ .,o, ............................................ .,, ........
........................................................... Countr ....... .............................