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Home My WebLink About5202-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z.~(~ ..... Date .......... .A..'CJt~...s.t....' 2.?.. , 19 THIS CERTIFIES that the building located at .. Naz, y~ z l~a~ ...... Street Map No. C,a~'~. l~tS. Block No ...... Lot No... 28 .&. 29 · · ~ttitatk.. conforms substantially to the Application for Building Permit heretofore filed ~ this office dated ....... ~¢~ . ~,~ 19~.1 , pursuant to which Building Permit No.. dated ...... tpr~X . ~ , 19 71, was issued, ~d conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ~lVa~ .~ .f~ly. t~l~ ................................... The certificate is ~sued to ...E~r~ ~!V ...... ~ ......................... (owner, lessee or tenant) of the aforesmd building. Suffolk Co~ty Department of Health Approval .. A~ .26. ~971...by. R..Vi~a... FOF,~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT 'TOWN CLERK'S OFFICE SOUTHOLD, hi. Y. BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5202 Z Permission is hereby granted to: pursuant to application doted ........................... $~i~l. ......... ~ ......... , 19...~, and approved by the 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. Chief of General Engineering Servieee AUG ~, 6 1971 District Engineer SUFFOLK COUNTY DEPARTMENT OF HEALTH H.OoRe£erence NO ~0' 7~/ EASTERN DISTRICT, RIVERHEAD,N. Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISFOSAL SYSTEMS Date Approval to construct said systems is requested,pertinent data herewith: 1-Applicant ': ~f ~ I-~ I?~ $ "~" ~ Phonet- '~"~ 6-Sub div Addressh ~" ~¥ ~' ~ ' ~'~ ~ ' 7-Section 2-Detailed pr~op~rt~ location %~t ~ ~,, ~, ~/ ~ ~ ~ 8-Lot No. Hamlet 'x~ z ' ,~ ~ · To~ ~ - ' 9-Private well? ~ 3-~blic ~ter supply ~me Distance to nearest ~in 4-Lot Size: Width ~ ~ ft. Length '~ ~ft. (also enter on center plot plan below:) 5-~elting: Sin~l% f~mily ~ T~ "F~ily? ; /Cellar? ~//~lab? ; ~Crawl S~ce? / / lO-Pro~sed syst~: Septic tank ~ /Precast ~ /Cesspools //'/Shallow pools / /Other / /~ it-Septic ta~ inside dimensions: V~l~e Gals.Length ft. Width ft. Liquid depth f~ 12-Precast sections: / /Number/ /Sq~re Ft. Cesspools: Block sizeL , , incs. D ins. H,, ,ins Total blocks below inlet: ~i ~2 ~3 ~ ~T PLAN Street Capacity ~. P.M. ~Oal~ Data Fee~ 0 2 k 4 12 14 ~6 18 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". Date.. ,~'~'~ Signed ~ ~ · ~ Owuer or Builder 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. Date (10/65 Revis. ) s-15 L.o~ .'30 BUILDING DEPARTMENT TOWN CLIRK'S ~ ,ned ............ ........... ,,*....Z.L ......... : ........ ................~...... ' ' [~1~1~ ~or) / INSTRUCTIONS a. This application must be cOmpletely filled in by typewriter or in ink und submitted in duplicate to the Building Inspector. ab'reas, Plat plan showing location of lat and of buildings on premises, relationship to adjoining premleal ~ public streets and giving a detailed description of layout of property must be drawn on the diagram whlch It gaff of ~hle application. c. The wa~ covered by this application may not be commenced bofore issUQnC0 of Building Fermlt d. Upon approval of this application, the Building Inspector will Issue a Building Permit to ~ applicant. Such permit shall be kept on the premises available for inspection th. rough~Ut the pragre~ of the wark: ~ e. No building shall be occupied or used in whole or in p~rt for any purpose whatever until a Clrtificato of OccUpancy. shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bdllding Permit; pureuant to the Building Zone O~l..inance of the Town of Southold, Suffolk County, New York, and other al~llceble ~ Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, al herein dNcrlbed. The applicant agrees to comply with all applicable laws, ordinances, building c .o~1_~, housing code, and ,egUhtla~. ~' (Signature of al~Cas~t, or name, If /,.~ ~ ~ .~ ~/t - ' (Address of applicant) ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plum~r or builder. ...... ..8....~.Lm...~./.~. .......................................................................................................................................................... ~ If applicant Is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) ~"e4~Tv' //~/~4~ F.J' "~ I. Location of land on which proposed work will be done. Map No.: ....... .~7...Z.~...i ................... Lot No.: ~..~." ~' Street and Number ....~/.~.......~.~.~..~.~....~......~....~. .......................... .~..~..t~.~...Z'..Z~.~..'~'".~../.~.,!.:~i'. ........ i ....... ii...~ ..... 2. State existing use a,nd OccupQncy o premises and in ·ded use and occupanoy of Prapalad comtmctlon: ..... ~,9'~.. ............................... a. Existing uN and occupancy ..~.. ........................................................ ............. b. ;ntended use ond occu;,'o~? ....~..~..~;. ......... ~,~..~.~..U.7 ....... ~...~.~/././?..C,:. .................. ~ .................... 3. Nature of work (check which applicable): New Building .....~.. .......... Addition .................. Alteration .............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...................................... 4. Esti.~.ated Cost .......... ~. .................................... ............ 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 O ~"~ 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. Dimensions of entire new construction: Front ...... ...':~'..~.:..R:..:: ............ Rear ..~'..~..'...~..:'. ........ Depth w~.~...'....~....J'...?..:. Height ..... ./..~.. ......... Number of Stories .............o....~,...??. ............................................................................................... 9. Size of lot: Front ...... /..~. ................ Rear ......... /..c.~....~..: ............... Depth ..../...~...O.. .................. 10. Date of Purchase ...[././..~.../..~.....~.. ............................ Name of Former Owner ....'~....../~.....~.../~...../-...../.~[(....~.. ............. ! 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ..... ~(..~.. .............................................. 13. Name of Owner of premises ~...~...~..,~.O.~.....~.(.,~Y. Address .~..~/.~.'~e..~..:.../..~.A ./~..~/Phone No. ~.~..~.7.~.L:~....O.. Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ~Z)...(~./r.I..I.~./ag..7'......___---~./.~:Z,~.~...Address//.~..~,......~.:..~.~.Z~...~. 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 corner lot. ! e O~ ¸/7 ISTATE YORK, ice OF NEW COUNTY OF ................................ ~'~' ...~.e.~t..~'. ...... ..':~..(~.~...°...-~.-'X'...~..P...~- .-~'-. ................................... being duly sworn, deposes and says that he Js 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 application filed therewith. Swam to before me this ............ ...... of ..... ............ , County y (Signature of a[a~icant) ......... f, em~do.p~l~xplre~ ~4~re~, aa, J9 l/ ROM4RT ~6/ILDER,5 ,r-RON7- I /EF7- J'/Z~£ ELE'Y'/T/O/V PLdMBIN~ , ,q/Gl-~ T 31~£ EL El,",4 T/O/V EL£144 T/OlY ROM,4RT BUILD_FRS ,SECTION ,~ O M,4,R T FOR .~L~ ~PE~IFIC~LI'ID~I~ dF INTgRIOR ,~£~ ~ONI"RA¢~' . B UI L DEBS