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Home My WebLink About5224-zFORi~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~.~'~r~' ..... Date .. THIS CERTIFIES that the building located at . ~ ~ Street MapNo..~ ..... BlockNo.. ~... LotNo. .~ ~ ~ffo~ ... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... A~il ~ .. , 19 ~ . pursuant to which Building Permit No.~ dated ........ ip~. ~.. , 19.~]., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is ~sued is . .~l~. ~e. f~flY..~.~i~g .......................... The certificate is issued to g~ ~, ~a~ki . ~. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval to finishing 972 by R~ 'Villa FORM NO. 2 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°. 5224 Z Permission is hereby granted to: .............. ,~.~..~,ur~k/ ................. ..................... We~..~u~.f-e~r ................................ to !mt/~..~J~..~J~..~J~.ly..4Jtm:~l~ .................. ~ ................................................................. at premises located at ...... Jl~ll~..~J~l. .......................................................................................... ;....:...~ ........................................................... g~u'"J~uft~tk ....... ll'~Z~ .................................. , ...................... pursucu~t to application dated ......................... ..~.J~.....~ ............... , 19..~.~., and approved by the Building Inspector. Fee $..~i)~.~ ......... Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. Permit No. %~.~? ~/-- TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located (Give deed location) have been inspected by this department and found to be satisfactory. SUFFOLK COUNTY DBPARTMENT OF HEALTH H. D. Reference NO EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date Approval to construct said systems is requeste.d,pertinent data herewith: 1-Applicant ~-~,,'~ ~ ~/~f~/~f~z2_f~ Phone 73~Z~-Sub div. Address ~/~4~)~/~ ,~'~/ M)~3 -~Y,~, ~,~ ~-/~,' 7-Section, . ~ 2-Detailed .property location/~'~ ~7' / 8-Lot No. ~)~-- Hamlet ~,~,~ ~z¢~ . ~Town. ~,~/~/~,/ 9-Private ~ell? ~" 3-Public water supply Dame ~f3~J~. - Distance to nearest main 4-Lot Size:. Widt~,Z~6ft. Length~f. t. (also enter on center plot plan below.) 5-Dwelling. Singl? Family ~Two Family? ! /Cellar? ~-/'.Slab? ! ~Crawl Space? lO-Proposed system. Septic tank .~ /Precast y /CesspooYs ~Shallow~ pools ~l-Se~tic ta~ inside .~mensions: Vol~e~ Oals.Len~th~/~. Widt~l~,t. Liqu~ dept~__Zft 12-Precast sections: ~-F~umber~ /Square Ft. Cesspools: Block sizeL_z~incs. D~__ins. H~ins Total blocks below inlet: ~i/~-O ~2 PLOT PLAN ~ Capacity~als 2G' P'M' = ~ ~ ~ Street ~ ~ Indf ~ate ~ ~ ~ N~ ~th The Undersigned CERTIF~S: "Const~ction of authorized installations will be in accordance with the Suffolk County Health De~rtments' current Standa~s, Bulletins, and amendments thereto, coverin~ Pri~ate Se~e Disposal Systems". '/ / ' ~ O~e~ o~ ~er Data F~e~ 0 2 4 6 8 10 12 14 ~6 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 ~/~f (10/65 Revis.) Signed zmmf No. 1 TOWN OF souTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE /~'~ ~: ! ? ,9 ~ I ~mJned ...~.~ .............. ,, ........ ~ ~ ~ ~ ? A~ .............................. ~ ....... , 19..~.~.. Permit ~o ............................. ............................. ..................................... ..... . ................ ;~. ~'~ APPLI~TION FOR BUILDING PE~ .~ ~te .~,...~ INSTRUCTIONS '~ a. This Ppplicotion must be completely filled in by typewriter or in ink and submitted in d~plicate to the Building~'~ Inspector. b. Plot plan showing location of lot and of bu_ildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn an the diagram whlch I~ part of thle 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 rthe 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 pureuQnt to the ,Build!n~.' Zone. Ordinance of the Town of Southold, Suffolk County, New York, Grid other applicable I.awl, Ordinances m Kegulations, tar the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, o~inancer~ building code, housing code, and regu.lat!o~s. ........ ~j ($1gnoture of appll_cont, or. me, If a c~rpamtlon) - (Address of applicant)/~/ ~/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... ........................................................................ ................................. Nome of owner, of premises ....~o.~....~....~..~/..~..~..~....~__~./~),..~ .~.~..~. ............................................................... 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. ,~op No.: .~...~....~....~.. ....................... Lot No.: ..~.'?.~. ........ Street and Number .....~..~........~...~..~...~. ........................................... i ....................... State existing u~ a~d ~cu~ncy of pmmMs and Intended use and ~cu~n~ of p~ c~Ctl~: a. ~isti~ u, a~ ~cupancy ..~ ......................................................................................... '.. ................... ~. ,.t..~.~ ~s.~nd=~,~o.? ...~.~....~..~~ ....................................................................... 3. Nature of work (check which applicable): New Building ...J~ ..... Addition ................. Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) ..................................... · /~ 4~..~~:> .... Fee 4. Estimated Cost ...................................................................................................................................... (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 cars ...... /. ........................................................................................................................ 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 .....J .......................... Height ............................. Number of Stories ............... 8. Dimension.s of entire new construct on Front ~,~.../.. Rear <.~..,./. .......... Depth~.....~-~....~,.~/.. .... Height .................... Number of Stories ~" 9. Size of lot: Front . ./..~....~.~.~..~;' .......... Rear · .~....u'..~-.~.....Z~,~.../.~.--~. ........... Nome of Former Owner Date of Purchase ]1. Zone or use district n which*' prem ses are s tuated ~"~.~.~('~...~...~_..~..?..~:.. ~...~...~.../.. 12. Does proposed construct on va ate any zon ng aw, ordnance or regu at on? ...~...~ .................. 13. Name of Owner of prem ses .~,~...~.....~:....~.~...~..~..~..~...Address~'4~'_~.¢~'~',~...~...~..~one No,,~,...~....~.~.,?...~ Name of Architect ,~.,'~.-~..~..~...~.<..~...~....;_ -- ......... Addres~.'..'~'...~'~.~..~...~'.~..~..~,~......~,,S~hone,/-/~ /~'47~ ~," No. ,-~=....~...4~. ....... Name of Contractor ....-~..~...~...~....~....~....?..~.~ ........... Acldres .~....~.~....~?..~...~..~-~..~..~.....~hone 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 interioror corner lot. STATE OF ~ t S.S. ...... ~ing duly sworn, deposes and says that he is the applicant f (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 Jn 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 applicat~ filed therewith. Swoj;l~r~d;bbefore me this /') · ,~ ..... ora Publ ............ ~'~ ........ ...... cou.f ..... ........... NOTARY PUBLIC, S~ate of New York I1~. 52-8125850, Suffolk :Term Expire~ k#~ch 30, _ _ Z