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Home My WebLink About5244-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Z~.h:. 0. 5 ....... Date .......... .0.Ct .... ~ ..... , 19Z1.. THIS CERTIFIES that the building located at g~.t.l<)w- ?eint ~oacl .... Street Map No. W$1io~.~ .P.t. Block No ..... Lot No.. 2.3 .... $o.uthold.. K,Y,.. conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... ~pr. il ...16 , 19 71. pursuant to which Building Permit No. dated ...... ~pr. il. 16.. , 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 issued is .. ~;tva~;~..one. f. am:il,y., ctw.e.lling ................................... The certificate is issued to . 6en~ge. D.ornauer ..... 0,vnet. ..................... (owner, lessee or tenant) of the aforesaid bmlding. Suffolk County Department of Health Approval .-August.. 1-0-I~75 - h,y i4.,..Vii.la .... . ? .... \ ...... Building Inspector ' I~OIL~ NO. ~ 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? 5244 Z Permission is hereby granted to: ......... ,~s.~...G~l-i-... ........... ~C~.... CI.;~,~ i,w..A~ ......................... .................. .~.~ .......................................... to .... i~i.l,i...ne~..~,~.... ~ ~l.~.~...c~ ~.~.~!-~g ................................................................................ at premises located at ...... ~(~t~ -.-.~ ........ W~'"~O~._;r~ ................................................................. ................................................. ~4.~...~!~t-.. ~t-~,~,~,e.-) ............. ~t~.ht3~ ............................... pursucm~' to application dated ................................ ,~:~J.~. ....... ~..., 19..~..~..~ and approved by the Building Inspector. Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTHENT OF HEALTH Date AU8 1 0 1971 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 Services AU~ I 0 1971 SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval tn construct said systems is requested,pertinent data herewith: Date.. 1-Applicant . Phone 6-Sub div Address ~/~ ~;F~ ~ ~'/. ~.~.~i ~ ?/ -- ~ 7~Secti°n ~'~ 2-Detailed p~o39~rt~l~a~p~n~.~ 'j ~.. . .., ~ ~ ~ 8-Lot No. Hamlet . /~/; x.f~o.~. ~ J~ /~.,~rivate 3-Publ~7~_~lD~y n~gs~r.4~,.~ ~/~istance to nearest main 4-Lot Size: Width ft. 'Length ft. (also enter on center plot plan below:) - ellin : Sing f mily I I T lly? ! /Celtar l /.Sla ? /_/Crawl S ce? ! ! lO-Proposed system. Septic ~nk I /Precast ~ /Cesspools / /~allow pools / /Other / Il-Septic tank inside dimensions: Volume .Gals.Length. ft. Width ft. Liquid depth ft. 12-Precast sections: / /Number/ /Squ~e3F{'. Cesspool~ Block sizeL incs.n ins. H..r.I .ins. Total blocks below i~et: ~1 /~ ~3 . ~OT P~N Data Fee~ 0 2 ~0 [2 ~6 ~ ~o Street ~ I e ~ ~ ~ No,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, covering Private Se~ge Disposal Systems". Date . / / Signed FOR ~ALTH ~ART~NT USE ONLY. Based o~g. info~ation p~esented he~e~th~ it ~n~ ~ the ~ ~ng, that a~equate and satisfactou Se~ge Disposal System can be installed on this ~ot. Date ~/~C Signed TOWN OF SOUTHOLD '~,/~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE Approved h ' ~ ' ~ Disapproved a/c ................................... ~ .................. APPLICATION FOR BUIL~ING PE~IT a. This application must b~ completely filled in by ~pewriter or in ink and submitted Inspector. b. Plot plan showing I~ation af lot and of buildings on premises, relationship to adjoining premis~ or public streets or areas, and giving a detailed description of layout ofproper~ must b~ drawn on the diagram which is ~ of this application. c. The work cowred by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inserat will issue a Building Permit to the applicant. ~ch p, rmit shall be kept on th~ premises available for inspection throughout the profess of the work. e. No building shall be ~cupied or u~d in whole or in part ~or any purpose whatever until a Certificate of ~cupancy shall have b~en grantod by the Building Insp,ctor. APPLICATION IS HEI~EBY MADE to the Build ng 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 ~.egu]a~..ns, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. /ne applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (~/(5ig~'ature of applicant, or name, if a corporation) ......... ................ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................... ........ Name of owner of premises .......~...~.~...~.~...E...../.~........~..~..~..~..~.~'.~. ................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work w be done. Map No: ...~...~..O"'~ Lot No Street and Number ...... .~../..~..L..9..~.........J'/..~../..~...~..~...~..~.. ....... .~'..o./~,.~..,~'..~.~"'"i ........................................... / ..... . ..... ~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................................................. b. Intended use and occupancy ..................................................................... . ...................... .. 3. Nature of work (check which applicable): New Building .-.X ........ Addition .................. Alteration .................. Repair .................. Removal .................. Demolitior .................. Other Work (Describe) ........................................ 4. Estimated Cost ............. ~..~....D...D...~. ............................. Fee .......................................................................................... (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 ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........ ~..~,,....,~,. ............. Rear ....,~..,,~', .................. Depth ........................ Height .ff...~..~../...~.;~..., Number of Stories ........... ~ ....................................................................................................... 9. Size of lot: Front ......../.~..O.../ ........... Rear ....... /..~...~.../. ................... Depth .,Z..~.~.;..~...../..Y'..~..,. ....... 10. Date of Purchase '. ....................................................... Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ........ Z~.~./..~...E~....~'./..~...L:.. .................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ......~...o. .................................................. 13. Na me of Owner of premises .(~'.&..e. EE!........~A~R/A~'?.x ...Address aC./....J' .Y'.c..~...'~..(.ff..~...~ .7....~..~.~.~...e~hone N o. ~.~....~..'., .J?. ~? Name of Architect ./Z(.~.~..4..~....~...ZL~.ff. ................. Address~..O...'~..Y.../.~./..(~....~...'3'../../...~'...... Phone No ..................... Name of Contractor ....~...e.~J[~...~. ....... ~..o..~..ff..~.~.. ............. Address ;~...~...~.../'~..~./~..~....~...w....~..a...~...~.~P~one No.~.~.L,~.7...~..~.~.i~' 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 number or description according to deed, and show street names and indicate whether interior corner lot. _ STATE OF NE'V~r~O~.~,, ,~. t S S COUNTY OF ~ ............. ,("~'~) ......................... '....~..~.....~;3~..~ '~ ........... being duly sworn, deposes and says that he is the applicant (Name of inc~dual ~igning ~6plication) 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. Sworn to before me this ~ . . ..... ......... .. ........ . · /o 7/ ; Y ) . ' ' ..... ........................ : ........... NOTARY PUBLIC, State of New No. 52.8125850, Suffolk