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Home My WebLink About5215-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerfificale Of Occupancy No..~490~ ..... Date ............. .ll..¢~ .... 1 ~ ....., 19. ?.2 THIS CERTIFIES that the building located at . I,l,l~a..I, am~ ............... Street Map No]I&SI~U. F&~"ilBlock No ........... Lot No. p.~; .plO.t; .12~ ... ~.t;chogt~e.. conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... Mai'eh..2~.., 19.~1. pursuant to which Building Permit No..~21 ~Z.. dated ......... &px'~,l ..6 .... , 1971.., 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 . Pz'&vat~ .omo..S. Am/.~,y .dwell/rig ....................................... The certificate is issued to ... Rt~l~ex'~;..ii,. F-L1.abe. & .1~;~/'0...ovlml'.a ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .&ll~ .~6..~9~1. · hi/'. P~..~':[l:],a ..... UNDERWRITERS C~RTIFICATE No.. l:~t~dl~n~ ....................................... HOUSk: NUMBER...7.~0 ....... Street..]~,~Li[e. 2.~1o ................................... ·. ....... Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, hi. Y. N? BUILD~IG PERMIT (THIS PERMIT MUST BE KEPT OH THE PREMISES UNTIL FULL COMPLETION OF THE WORK ~UTHORIZED) 5~"J 5 Z Dote ....................... &~31'.~ ...... ~ ........... , 19..~. Permission is hereby granted to: ..... .Ib.Z,~u,'j,Z .. IL~,..~tf~.. :Lue.. A/G.. JehiJ.,.. ILtob Building I n~,j)ector. pursuor~t to application~ ~loted .................. ~.; ....... ;.~jlt,....~i ........., 19.~.t.., and approved 'by the Building Inspector FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. TZ: 5'/P//Certificate Of Occupancy No. Z ~ ~ J/~ Date /9/tu~ , 197/ z/z THIS CERTIFIES that the building located at Street Map No. ~ARD~ Block No. Lot No. '~ conforms substantially to the Application for Building Permit heretofore filed in this office dated .... ~9 & h~/~ ~,' 19 7 ! pursuant to which Building Permit No. ~ L9/.5-~. dated ~ /~ ;'WX, 19 ~// , was issued, and conforms to all of the require- The certificate is issued to of the aforesaid building. ments of the applicable provisions of the law. The occupancy for which this certificate is issued is f £ /'' /4 ( /¢ l' //~ ,~q t l ~ ,~ t, ~- l Z /~t f~ (owner, lessee or tenant) Suffolk County Department of Health Approval Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure (Give deed lo?ation) .Z"o ,.,,..-,/, o ),,,, located have been inspected by this department and found to be satisfactory. AUG :[ 6 1971 Chief of ~enera.1 Engineerim8 Services ',~ ., L:I L AC.. LANE :1 _- , / . ,~ ~ // · '~' ~ /I ' , 11 ~AP OF LAND ~, ~ SUFFOLK COUNTY DEPA~qTMENT OF HEALTH H.D. Reference No EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date/~- ~ f~?/ Approval to construct said systems is requested, pertinent data herewith: ' / 1-Applicant Address 13£ 1~.~ 13,~,, d'~-~'~,,'~ , /J~, 7-Section ' 2-Detailed proper~ty location Hamlet ~/g~F~ ~ ' Town , ,~/~ 9-Private 3-Public water supply name Distance to nearest main 4-Lot Size: Width ~;~ ft. Length /~ft. (also enter on center plot plan below:) 5-Dwelling: Single Family lO-Proposed system: Septic tank Y yPrecast y /Cesspools ~/Shallow pools ~ /Other / / il-Septic tank inside dimensions: Volume Gals. Length ft. Width ft. Liquid depth ft 12-Precast sections: / /Number/ /Square Ft. Cesspools: Block sizeL--~incs.D ~ins. H ?-~ns Total blocks below inlet: PLOT PLAN ~..~! Capacity Gals :ate 'th Data Feet, 0 2 6 8 10 12 16 18 ~ ~o Street ~/~r'C Y-~--' The Undersigned CERTIF~S: "Construction of authorized insta!lation~ will be in accordance with the Suffolk County Health Do~rtments' current Standa~s, Bulletins, and amendments th~eto, covering Private Semge Disposal Systems". Date ~/~/ Signed ~ ~ ~~ ~er 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 satisfacto~Sewage Disposal System can be installed on this Plot. Date /~/~/~ Signed ~~~ ~~.J (10/65 Revis.) // APPLICATION FOR BUILDING PERMIT Date .......................... 19 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of propertymust be drown on the diagram which is part of this application. 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 part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. (Signature of applicant, or name, if a corporation) . ......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, goneral contractor, electrician, plumber or builder. ................... .................. Name of owner of premises ...................................................................................................... If applicant is a corporate,signature of duly authorized officer. (Name and title of corporate officer) ~. Location of land on which proposed work will be done. Map No: ...................... ~/~! ........ Lot No: .................... Street and N,~mber ..~..'~.~.....,.L.~ ..... ..~..~.,d~....~...~.. ...... '~7~' ~--- --7 ~' (~ >' .................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy /L/0/./E: b. Intended use and occupancy ............................................................................................................... 10. 12. Nature of work (check which applicable): New Building ~ ............. Addition .................. Alteration .................. Repair ................. .A~,Removal .................... Demolition .................... Other Work (Describe) ...................................... Est.mated Cost ...... ~:~./..i~. ...................................... Fee .......................................................................................... / (to be paid on filing this application) If dwelling, number of dwelling units ..... .~..~ ............. Number of dwelling units on each floor ........................ L.. If garage, number of cars ......~.......~....~. ...................................................................................................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use ................................ DJmensio xisting structures, Jf any: Front Rear .......................... Depth ............................ Height ............................ Number of Stories ............................................................................................................... Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height ........................ .....,blumber ~ Stories .................................... ~ / ~'L~,~ ~ ) '" D mensions of entire new construction' Front ~ (i ~4~'~ Rea~ Depth J...'~.. , - , - '- .... ............. :' '" ..... I've ght J~.~..~t...../). ............. Numoer ot ~tories ....J. ...................... Size of lot: Front .~.~.:..~... ............. Rear ....~..J.~.:...f~.. ............ Depth .../...f...~...:...~...., ........ Date of Purchase ....... .,~...v.:.~.j.~.~. ...................... Name of Former Owner .l~...~.......i~...~......C..~...~.. ................ Zone or use district in which premises are situated ................................................................................................. Does proposed construct on v o ate any zon ng law, ordnance or regulation? ,,,,..'~.. ....................... , - /) ~'Z~,'~" ~'~-' ' ..................... Name of Owner of prem ses .~ll.~.~,. ~ ,~.~ ~.~: Address ..... ~~.,...,.ff.~., ..... Phone No 'Z.[ z' .~7..~../.~. /O~Oo..ff.?...l~...~....~....~..,,,~...,..~.....~...:lC~c'" )"/icc~ .............. Name of Architect f/.."..".:.~.:. ..............Address ........ Phone No /~ 6 /~o,~,fv~ PC., ' .................. Name of Contractor ..... ~ ........................................... Address ...... C~C,-~f~.....~L..~'. .......Phone No./...'..~....7...~..~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all Set-bock dimensions from property lines. Give street and block numbers or description according .to deed, and show street names and indicate whether interior or corner lot. STATE OF NL:W~'O~R'~, /Z' ~ ~ ~ ///-"/~ . be n duly deposes and says that he is the applicant ...................... , ................... , ....................... -. ..................... g sworn, (Name of individual signing application) above named. He is the ............... ..C~..~T..°...~... ........ :~ ................................ ._ .................................................................... (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 Jn the application filed therewith. Swo~ ~.~re me this~---~ - ............ .............. Notary Publi~.~ ...... ;Z~.?..'T.~c.~~~''[ ............. ('Signatu'"' '~~'~e of ......... applica ~'~ ............................ - t :T ,I ~t ; ~* OWNER PAVE TO ~U[T LOCAL CQDES, -" - . ' ' . ~, CHECK ALL- D ~ENS OHS AND ~E~BA~; ' ~' ~ , ' . 4. A~CH ~ECT HOT RES~NSlBLE FOR bESIGN & [~AT ON OF S[~rC T~NK ' , ' SEEPAGE PI~ ~ WE~L, ~EFEq Td ORIGINAL ~URVEY FOR INFORMATION, ,~-/ ';- ' PHI~DELPHIA, PENNA.