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Home My WebLink About5385-zFOBM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at f~,A,/r-0- pi A C ~- d'pu%) Street Map No. )(' Block No. Y~ ...Lot No. ~( ~'O ~ '~/~ 0 ut,~ conforms substantially to the Application for Building Permit heretofore filed in this office dated...~. ?..c..~....~. ........ , 19'?!.. pursuant to which Building Permit No. 2~ .~..~ dated h ~ 1971 ....................... , .... , was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is The certificate is issued to..?~. ?.e..~... ~/../.H..4. %/e.~..~..}~ ~.-/... ?./?.t..~./../! ?. I. ~../'{.......~ff~-~. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ''/~{ M ~ t I ~ ? 2- t2 y p [//~.t f~ ........ B~ii~i'ng I~1;~);~ ..... l~Ol~! 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? 5385 Z Permission is hereby granted to: ..... ~...~e~'.'~r ....~'~'-~ ~e.~'"&'i~et apimur~ to ~,14 ..~e~ ..e~e~...~e~r..~bm~.l.~ ................................................................................... at premises located at .........]llll~e~...P~.l~l~ ........................................................................................ .................................................. &el~t~e~ ......... ~.,1~ ....................................................................... pursuar~t to application dated ............................ ~1~....4[t .............. , 19~11~..., and approved by the Building Inspector. Building Inspector - / SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference Ne3(3 - ~ ~ EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROFAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval tn construct said systems is requested,pertinent data herewith: 1-Applicant ~-~o~, ~' ~m,-~a¢,~-~- Phone ~3'-/~f~-Sub div~ '- Address ~ ~,~¢~o~ .~,? ~o~/~, #~/ 7-Sectio~ 2-Detailed p~pe~y locgt~on ~,~ ~ , ~, ~ ~,~ ,~-Lot No. ~ ~ ~ ~ M~,~r /~,~ To~ ~o~/~ 9-Private well? 3-~blic ~ter supply ~meU/~mc~o$~ ~. Q~. Distance to nearest ~in ]f'~. 4-Lot Size: Width ~mmft. LeHgth~ft. (~lso enter on center plot plan below.) 5-~elling: Single Family I~T~ Family? ~Cellar7 ~Slab? / lCrawl S~ce? 10-Pro~s~ system: Septic tank ~ /Precast l~Cess~ols ~Shallow ~ols il-Septic ta~ inside dimensions: Vol~e Gals.Length ft. Width ft. Liquid depth 12-Precast sections: /~lNumber/ /Sq~re Ft. Cesspools: Block sizeL incs. D ins. H Total blocks below inlet: ~1 ~2 ~t3 PLOT PLAN Street . / ins. Data Feet ~D 0 ~-~ / 2 I e Nobth Capacity Gals. --1 G.P.M. The Undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Systems". /-~ Date ~'1/'7/. . Signed ~~B l~de¥~Q~ FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department, that an adequate and satisfacto~wage Disposal System can be installed on this Plot. Date /~/~/~ Signed (10/65 Revis.) s-15 S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. JAN P. 1 197P.. TO WHOM IT MAY CONCERN: / The sewage disposal facilttt~ for a structure located /~/~/~-/P ?~ /~ t ~z~ . ~o ~'t (Cive~deed loca~ion) have been inspected by this department and found to be satisfactory. JAN 2 ! lg72 District Engineer TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE Examined 19'~ ( Approved 19...¢..... Pemit No. Disapproved a/c ............................................................ (Building ~ector) APPLICATION FOR BUILDING PERMIT Date .~...~. /~/ ~' 19....?Z.. INSTRUCTIONS a. This application must bo 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 ofproperty must be drawn 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, housing code, and regulations. (Signatu~/of applicant, or nar~,, if a'~poration) ....... ...... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............. .......................... pp' ' rp ' 'g Y ' ' ' (Name and title Of corporate officer) 1. Location of land on which Rroposed ~ will be done Map No ........................... Lot No .........' Street and Number .... ..~.~,!.~.C.....[~t~.~,.....~..:...~.....~...~.,~'....~...~i~ ....... ,~/- ~ ,~ .~ ,~ / Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .~..~ ~.,e~./~.'-~ //~ 7/- b. Intended use and occupancy ................................... r' ............ '~' ................................. .~.........~.....~w~ ...... 3. Nature of work (check which applicable): New Building................../ Addition Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ......'~.....~,~...~.~..~.A...~....~. .................... Fee ...... ..~....~.~x.~.'~' ................................................................. (to be paid on filing this application) ......... ~. ................ Number of dwelling units on each floor ...~..~.~...~-.. .............. 5. If dwelling, number of dwelling units ~ If garage, number of cars ..: ........... ~...O.~c. ..................................................................................................................... 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 ......-:T. ............ Height ........... '~. ............ Number of Stories Dimensions of same structure with alterations or additions: Front .......... ~ ....................... Rear .......'---. .................... Depth ............... ..-TT.; ............ Height ........... ~ ............. Number of Stories 8. Dimensions of entire new construction: Front ....... ~'....~.. ................... Rear ....~...~.. .............. Depth ....~.~. ............ ................... Height ........ .-: ...... Number of Stories ............................................................................. 9. Size of lot: Front ...... ./. .6. .~.. /. ............. Rear ....../...d..6'..~ ..................... Depth ........ ./.~...~.../. ............. 10. Date of Purchase .................../...~..~....~. ........................ Name of Former Owner .~.~./~........~'../.~/~./...~..~. ............ 11. Zone or use district in which premises are situated ................ ~f...~.....~.~,~..'..c~.L~.~..~../.'.....~.~'.r~'.~.~.~.~'.. .................. Does proposed construction violate any zoning law, ordinance or reaulation; fo .......................... N .~Z,~..-J~...-~ .~.~ ~z 13. Name of Owner of prem,ses ...... ~./~,¢/~?...,......Address ............ ............ Name of Architect ~.e...~. ........................................... / Address .......... ~ .............................. Phone No. -- ,,~/T..~. '~;~. A re ~'.~..~...~e~ Name of Contractor .q~..~e./..ll..r/.~ ..... .~ ............... dd ss ................. ~' ................... Phone No..~.....~.....-~..6'..~...o~.. 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 interior or corner lot. /~ STATE OF Nb-'W ~ORK, .,/ tSS COUNTY OF .....'~.~..J~'~../...~-.....$ ' ........ ~.~.~..r~.~,.......~..~..~...~...~..~ .s~...~...~; ........................ being duly swam, d~oses and says t~ he is the applicant (~ame of individual signing application) above named. He is the (~ntmctor, ag~t, co,rate officer, etc.) of said owner or owners, and is duly authorized.to perform or have performed the ~id work and to ~ke and file this application; that all statements c~toined in this applic~ion am tree to the best of his knowledge and belief; and that the work will be performed in the manner ~t fo~h in the ~plic~im filed ther~ith. Swo~efore me this ~,j .~... '/1 ..... ~..~.~ ...... ~y of ............... ~; ............... :...., 19 V ~- . . Nota~ Public, ~~~. ~oun,"'~'~'',.. ,gna~r ~~"' ................... ~OTAR? PUBIC, St~te No, ~-01388~0 . Su~o~ Co~