The URL can be used to link to this page

Home My WebLink About5282-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Sonthold, N. Y. Certificate Of Occupancy No. ,Z.43a8 .... Date . AugUst ..... THIS CERTIFIES that the building located at N/S. bonqv~w, l~ne... Street Map No. 2901 ....... Block No..x~ .. Lot No. 70 .. · SouthOld,. N..Y, .......... "TerlCy Wat:e~a" conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... blay ....6, ........ , 19.71,. pursuant to which Building Permit No.5282 dated ..... 14ay ....6, ......... , 19 71, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occukdancy ~or which this certificate is i'- issued is ..... private, one. £amily .~lwell;tnq ................................... The certificate is issued to .claar. l~a ROwan ........... ........................... (oWner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Building Inspector House % 640 Longvie~ Lane Fire Und'e~wrteers Cert. % N 896560 FOR,B'I NO. ~ : TOWN OF $OUTHOLD ' BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5282 Z Permission is hereby granted to: .............. C~t:L~..~nsl~......~b~?l~$. ~e~au ................ · ~.~ ....... a~....4.1.~ .............................. .................. ~e~£~'~ ............ ~.I.,~ ...................... to ~i&~,..~e~...~.. ~.~;~..~u~,;~n~ .................................................................................... et premises located at ........~[~t~.~,..~.0 ....... ~.~r.~¢.....~9~....~ .......................................................... ................................................. ~.1~.... :i,o~v.~e~...:t.x~ ~ ......... L...~eu$,h~.~ ......... ~ o~.. .............. pursuc~n¢ to application doted ......................... ~ ......... .~. ........ [ ...... , ]9.,~'.],,, and approved by the Building Inspector. .Fee $...~.0.~.0~ ......... Building Inspector $-9 SCHD SUFFOLK COUNTY DEPARTMENT oF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located J(Give deed location) have been inspected by this department and found to be satisfactory. SUFFOLK COUNTY DEPARTMENT OF HEALTH WESTERN DISTRICT, COMMACK, N. Y. APPLICATION FOR A,PPRO~AL TO CONSTRUCT PRIVATE, SEWAGE DIS~SAL SYSTEMS Date'~Wm ~ /~ /q Approval to const~ct said systems is requested,pertinent data herO.th: / "~ ~ ~ · 1-Applica~,~/.~/~ Phone. ~, 6-Sub div~ ~/~, [ -~ ...... D~staflce to nearest ~in f/~ 3-~blic ~te~ ~pply name,~/~,~ ~ . 4-Lot Size: WidtSp~ ft. ~nEt~[.l .ft. (also enter on center plot plan below.) lO-Pro~sed system. Septic tank ~Precast / /Cesspools ~Shallow pools / /Other ~ M-Septic tank inside dimensions: Vol~e Gals.Lengt~ ~ ft. Width ft. Liquid depth. Total blocks below inlet: ~/~0 ~"[~ ~ .... PLOT PLAN Ca~cit~Gals. G.P.M.~ ~ ,0 Street Indi No Data Feet 0 · 6 ~6 ,h The Undersigned CERTIF~S: "Construction of authorJ: ~ed installati~will be in accordance with the Suffolk County Health Departments' current Standard~lletins, and amendments thereto, covering Private~ Se%Disposal ~ystems". FOR HEA~TH DE~TMENT USE ONLy. Based on the 'informat~ed herewith, it is the opinion of the Health Department, that an adequate and satisfactory Sewage Disposal System can be installed on this Plot. (10/65 Revis.) Examln~cl ........................................ , lg , Permit No ..................... Di..m.~ a/c ........................................................................ ~2 (4/C. O . ...; ....................... ........................ APFLICATION FOR BUILDING PERMIT ......................................... , ,,z./......* INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plat plan sho~...in~ I.oc,ation of lot and of bu_lldings on premises, relationship to adjoining premlee~ or public streets or areas, and giving; a amallea aescriptlon of layout of property must be drawn on the diagram which is part of thle application. c. The work covered by this application may not be commenced before issuance of Building Permit. Upon approval of this application, the Building Impector will Issue a Building Permit to the applicant. Such permit d. shall be kept on the premises available for inspection throughout the progress of the work. e. No building ~all be oocupled 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 H~REBY MADE to the Building Department for the issuance of a Building Permit pureuant to the .Build!ng Zone Orfl. inance of the Town of Southold, Suffolk County, New York, and other applicable I.awl, Ordinances or Kegulations, for the construction o.f buildings, additions or alter~gLLa~s, or for removal or demolition, as herein described. The applicant agrees to comply w,th all applicable laws, prBT~ances,~bu_,~ng code, housing code; and regulations. 'v'""fiiia~-~';;;~¥ '~'~'~i'i'~;~7~;';,'~'~,'~7i~ ';;'~';~';i;,~T '"'"' ' (Address of applleont) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................... ....... .'.'i. ii ;i ii"ii'i'ii157.1'iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii Name of owner of pre I .Zi.~.'~ ....... If applicant is a corporate, signature of duly authorized officer. ~ (Name and title 'of corporate officer) State existing use a.nd occupancy of premises and Intended use and occup?ncy of praposed construction: a. Existing use and occupancy ............... , ......................... ; ............. ,a.q ....................................................................... b. lat~nded use and occupant,. ........................................ ; ........... : ............... 3. Nature of work (check which applicable): New Building ....... Addition .................. Al t .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ........./.x .............................................. Fee .......................................................................................... (to be paid on fi!ing this application) 5. If dwelllng, number of dwelling units ........... ../. .............. Number of dwelling units on each floor ............................ If garage, number of cars ..... ,~.. ............................................ 6. If business, commercial or mixed occupancy, spectre and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ......./~...:A,/~q~-."' ................. Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of, ~}ntire new construction: Front .....'~..~... ..................... Rear .~..~.. ................. Depth ........ ..?....~...~....~.. Height ...J...~.. ........ Number of Stories ........ /.. ......................................................................................................... Size of lot: Front ....~..~..~.. ............. Rear ......... ./.~...~. ................ Depth ................................ 10. Date of Purchase ..... ~.../....q...?.../. ........... Nome of Former Owner ........................................................ 11, Zone or use district in which premises are situated ...................................................................................... 12. Does proposed construction violate any zoning law ordinance or regulation? ........... ~., .....~.., .,,a ,., .......... ·/~J ~, ~.- _' . ,~ ,,-, ,, ,x 4=~,~-~,~J , Z/,~'~ ....... 13. Name of Owner of prem.ses~.~..AddressOK~...7..~..~'...~...?..4~.~No ..................... Name of Architect ...................................................... Address ................................ ,..., ....... Phone No ..................... Name of Controctor~..~F,4',~/.~.L..~...~...,e,Z~...~..~.~. Addres~.~'-~..~...././...e~... ........... hone No..~..~..~...Z'.~..~.O PLOT DIAGRAM Locate clearly and distinctly oll buildings, whether ex~shng 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 indico1'e whether interior or comer lot. STATE OF NEW YORK, ! ~ ...-.;,f..~.,.;.Z.~..~..'~...;.:...::../r,~..; ....... .. .......... ., ............................. be,ng duly sworn, deposes and says that he is the applicant [r~ame ot ,na~waua~ s~gmng application) oboYe named. He is the ................................................... ~ ....................................................... ~{Contmctor,~ag~nt, corporate officer, ~tc.) o~ said owner or owners, ond is duly outhorized to perforr~:r~.-~ the~' said work and to rtmke ond file this applicotion; that oil statements contoined in this application are true to the best of his knowledge ond belief; and rne work will be performed in the manner set forth in the applj,c.~Jqn file~VtJ~erew th. Swam to beforeme this / , / / / ....................... ............ .................... Notary Pubhc, . ............................ ~ ............... u a pi~iicant)" /__~¥ 71 ~L ,,q. $1J~OLK COUNTY DEPARTHEHT OF HEALTH EASTERN DISTRICT County Center, Hiverhead, Ne~ York PA 7-4700 H.D.Ref. No.~- ~ API~J_¢~?IOH FOR APPROVAL OF INSTALLED PRIVATE S~AGE DISPOSAL AHD gATER SUPPLY InSPection for approval is requested, pertinent installation data herewith. 9-Septic tank-Gal L ft.l~ lC.Liquid Depth ft. _ lOoCnSepools-(a)H0.poo[e_g'~.,_(b)Blocke belo~ inle_t-1)/-~-~ 2)/~) 3)~ (c)Block sine-L /~ ln.~_~___in.H ~ in.(d)Precast pool (a)l__2 (f)H ft. in; Diem ft. in.(g)Finished grade to cover / (h)BackfillHatexial_~d~_~. ll-~atex Supply: Public System ~/~a~-~ ; l~rivate ~ell If Private, the following questionS are to be anewered'~ 12-Private ~a.~r Supply Syete~L i. nsCRlled by ~ Phone Addr~8 13(a)-Total ~pth of ~el~(b)Dep~h ~o S~a~ic ~a~er L~el 14-D~etmr of w~l p~pe~., ~ ~ 15-N~e of hbora~ow~16-Hech~ of DisinfeC~ion~ 17-DaCe r~dy for inapoc~inn~, The undersigned CERTIFIES: Above 8ystens have been conStructed'and are 3 ft. in coupliance with the Suffolk County Health Department's current Standards, Bulletins and Ameminents'theratq~-~. ~ X"~../.-/'~'~' ~ 18-Dat~Sisned~ 19-Insert sketch of location of .~ater & Sewerage Facilities with accurate, dinensions. STREET Based upon t[~e/information stated above, satisfactory functioning of t e above systems can be expected with proper maintenance and care. S-Se I I I I // ii__ TULLY ~ 5I- O" ~iO~tLl_ CO¼5~RUcT\o~l TIO*:i'G E ]'JLLY : :3 2Zg~4 N. ¥, STAf~ --- -F_-- ......... ~G'< 8," F-II-I1 4LO" ~L '% o" L - J ~,L¢' L ' "1 ~UIL ~ W'ooTa :Mbo. ~Z~- o"