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Home My WebLink About5309-zFORM NO. 4 TOWN OF SOU'I~OLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at . ~a~e~ .lea~ .............. Street Map No. IH ....... Block No ...........Lot No.. &~.& conforms subst~fially to the Application for B~IdMg Permit heretofore filed ~ ~s office dated ........~.. l~ ..... , 19 .~. p~su~t to which Building Pemit No. ~... dat~ .........~Y ..... }8..., 19. ~., was issued, ~d confoms to ~1 of ~e requir~ ments of the applicable pro~sions of ~e law. The occup~cy for which ~ ce~fficate is ~su~ ~ .~ .~..f~ .~~ ....................................... ~e ce~icate is issued to . .~. ~ ....... ~. .......................... (owner, lessee or tenant) of ~e ~ores~d buil~ng. S~olk Co~ty Dep~ment of Health Approv~ ~...~. ~...~. R, .~ ...... FOR~ NO, 2 TOW~ 01: SOUTHOIID BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 5309 Z O~e ' ~ ~ ........... ~ ............... L~. .......... ~.~, ....... ,19.2.t. Permission is hereby granted to: .............. .~.%..~x~z~.a .................. .................. ....... ~:I~...~!,~m..i?~ .............................................. pursuan¢ to application dated ................................. ~JI' .......... .J~....., 19...~..~., and approved by the Building Inspector. S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date ~ ~t~ . /~ Bldg. P~rmit No. ~o 5> TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure (Give deed location) located have been inspected by this department and faund to be satisfactory. EASTERN DISTRICT, RIVERHEA~',N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIV.ATE SEWAGE DI.$P~SAL SYSTEMS Date Approval tn construct said systems is requested, pertinent idata herewith: i-Applicant ~ J/l~ ~:~'~ Phone~_F~-~6-Sub div. 2-Detailed property locatmon ~z/c~ ~ . 8-Lo~ No. ~ -- Hamlet ~'~f~L./r ~d To~ O%~,~cg~. i 9-Prkvate well? )-hblic wat~ supply name ...... Distance to nearest main 4-Lot Size: Width/~ ft, Length//O ft. (al~° enter Dn center plot plan ~elow:) 5-~elling: Single 'Fkmily ~ Two Family? ~Cellar? ~/Slab? / ~Cram o~ce? lO-Proposed system: Septic tank / /Precast ~Cesspo~/Shallow pools ii-Septic ta~ inside dimensions: Vol~e Oals. Length~ft. Width ft. Liquid depth ft. 12-Precast ~ections: ONumber~Squ~re Ft. Cesspools: Block size~incs.D ~in~.~ns. Total blocks below inlet: ~2 ~o~3__ PLOT PLAN Capacity ~als. Street Data ~eet 0 2 6 8 10 12 ~6 ~ i In ate , th "Construction o~ authorized installatioq~ will be in The Undersigned CERTIFIES: accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal S~stem~J. Date Signed /~ ~. J~/~ ~Owner or [B~ld~r FOR HEALTH DEPARTMENT USE ON.~Y. Based on the information ~resented 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 ~evis.) Signed TOWN M sOu~OLD BUILDING DEPARTMENT TOWN CLERK'S OFFIC! SOUTHOLD, No ¥o ......... : .......... .,,Z/.., ~*mi~ ......... ~r.:.... ^pp,~ed ........................................ , ~o.~.j....o...Z~.,. Di~n~ved ale ................................................. _ . i ................................................ ,Zii '.iiiiii'i ........................ . (Building Inspaat¢) APPLICATION FOR BUILDING PIR,~rT 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 showing location of lot and of bu.lldinge on premises, relationship to adjoining premises or public Itrelts or areas, and giving a d~alled descril:~lon of layout at proparty mUst be drown on the diagram wh]ch is part of thi~ application. c. The work covered by this application may not be commenCed before issuame of Building Permit. L~ 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 port for any purpose whatever until a Certificate of OccupanCy shall hove been granted by the B.ulldlng Inspector. APPLICATION IS HEREBY MADE to the Building Department for the Issuance of a Bul d ng Permit pumuant to the ~Build!ng Zone. Oral. Inance of the Town of Southold, Suffolk County, New York, ond other appilcoble Lava, Ord nonCes or ~egulatlons, tor the conltmction of bulldJngl, addltior~ or alterations, or for removal or demol tlon, as hera n dolor bed. i ne applicant agrees to comply with all applicable laws, ordinances,____ .-~bullding code, hous. Lgg code, and ragulatlons. (Signature of appllcan ~f'~'or nam~;'ii'~'~"'~'l~'~"~l'~')' ........ .... ............. (Address of applicant) , State whether,.,., j_ -' .~applicant is.owner, lellee,.~Jarchltect, engineer, general contractor, electrician, plumber or builder. 1. Location of land on Which p~ work will be done. Map No.: ..... xf,/~... ,~,, .................... Lot No.: ..~,..'~...,,~...~......,~' Municipality 2. State exllting use a?d occupancy of Premllec ar~J Intsndtd use and occupanCy of prapaeed conetruatlon: a. Existing useand~cupancy ....... ~-~ ~''~~~: ............ L,.,,,~m ............................................................. 3. Nature of work (check which applicable): New Building'~...~ ......... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) 4. Estimated cut ...... ................................. Fse ............ ............................................................................. (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 ....................................................................................................................... i ..................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, Jf 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 ent re new construct on Front · ..~..~.... .............. Rear c.~..~.. Depth ~.~. Height .................... Number of Stories ...... ~..~'..~........r~..~.~...~..~. ................................................... · 9. Size of lot: Front .... ~.. ................... Rear ...... /..~...O.. .................... Depth .... -/..~....~..-.-~t ........... 10. Date of Purchase ........................................................ Name of Former Owner .....~/*~".....~.~ .......... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction vioLgte any zoning law, ordinance or r~'~u~at~or~,..,,~_... .............................. ..... ' · 13. marne or ~vner at pr/~..,,L~.~Address ......... ~ .............. Phone No..~,.~a~..'...~.."~.~...~ Name of Architect ..~.~.~~ ., ..Address .................................... phone No ..................... Name of Contractor ..... ~...~.Address ....~...~...~.~....: ......... Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly oll buildings, whether existing or proposed, and ind cate all set-back dimensions fmm property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or Comer Iotj ,~7',a,~"/~/O~ /6° STATE OF NEW Is.s. .......... ~'~..~'.'~.~ .......................................... being duly ~worn, d~es and says that he is the app cant (Name of individual §ign, ing appli~:ation) · 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 be~ore me this/J ........ .................. Notary Public, ......~/...'~....'~.....'T~.....~...:.~ ........ ! ......... County .......................... ~g~a'l~e';~'(;~ii~';~¥~ ............................. '~' PETER AL COLEMAn, Nefary Public, State of No. 52-5758570 Qualified in Suffolk Counly ~.~C~, mission E,xpim~ ~M~ch 30, 1972