The URL can be used to link to this page

Home My WebLink About5389-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certific8te Occupnncy No. ~h616 ...... Date ............ AIrbill,.. 20 .... , 19 .~2. THIS CERTIFIES that the building located at -~[5,e~. D~.v~ .......... Street Map No. ~ ......... Block No... ~ ..... Lot No...~ .... ~O~t~Ol~. · ~.,~. ...... conforms substantially to the Application for B~lding Permit heretofore filed in this office dated ........... g~ .... 6', 19. ~. pursuant to which Building Permit No.. ~. dated ........... ~.. [..., 19~1.., was issued, and conforms to all of the require- ments of the applicable pro~sions of the law. The occupancy for which this certificate is issued is ...p~x~t~. ~z. f~l~ 'd~oX'~$ ...................... ................ The certificate is issued to .. ~1~*~' · 8'~oOt~fg ...... ~ .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~.. 2~, '~9~' ' '~' ~*-~$.~1~ .... ,. UNDERWRITERS CERTIFICATE No...]. ~'9~ ......... ~ ............................ HOUSE NUMBER...~ ...... Street....~g~8. ~ ............................. Building Inspector ~ FOR~ NO, 2 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) 5389 Z Permission is hereby granted to: to pursuar~t to application dated ................................. ~'.~.~,3~. ....... ~..~....., 19...'~.'~., and approved by the Building Inspector. $t0.00 . .. Fee ...; ................. Building Inspector~ SUFFOLK COUNTY DEPARTMENT OF HEALTH ~ - H.D. Reference No EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval to construct said systems is requested,pertinent data herewith: Date~ 1-Applicant~ ~%~..~//~;,.~,~, ~,.;~/J Phone2;~-3'zz~ 6-Sub div Address ~_~'D ~*~; ,~ ~, 3~T~,~.< 2'~,'~ .~J,~', ?-Section 2-Detailed property location &',~.~ ,~ ~)~'~-F . 8-Lot No. Hamlet Town ~.~,.?Z_..Z ~/. ~ ~/, 9-Private well? 3-Public water supply ,name Dt~tan6e to nearest maino~/F~, ~'~ ~ ,~ ~- S-Lot Size: Width~._ft. Length~_ ft. (also enter on center plot plan below:) ~-Dwelling: Single-Family ~ Two Family? ~FCellar? /~"/Slab? / ~Crawl Space? 10-Proposed system: Septic tank ~ /Precast ~'--'/Cesspools ~_/Shallow pools ~/ /Other il-Septic tank inside dimensions: Volume Gals. Length ~t. Width ft. Liquid depth ft. 12-Precast sections: / /Number/ /Square Ft. Cesspools: Block sizeL incs.D ins. H ins. Total blocks below inlet: ~1;~2_~3 ,~ PLOT PLAN ipacity~_~ls · , Street Data ~eet 0 2 4 6 8 lO 12 14 18 ~ ~ ~ ~ Indi ~ate ~ ~ ~ No ~th The Undersigned CERTIFIES: "Construction of authori~d installations will be in accordance with the Suffolk County Health Depar.~nts., current Standards, Bulletins, · and amendments thereto, covering Private S~ ~Di~a~ystems". / " ~ ~er ' or Builder FOR ~ALTH DEPART~NT USE ONLY. Bas~ on the info~ation presented here~th, it is the opinion of the Health De~ment, that an adequate and satisfa~ Dis~sal System can be installed on this ~ot. Date ~/~ Sign FOB~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT ~TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .... '"~'..'.-~v ......... , 19.Z./.. Approved " ~'~,~ ~ ~,~ ........................................ , 19 ........ Pemit No ..................................... Disapproved a/c ....................................... ~.~ ................ ( ui lng Insp~;;7-'~T~ .......... APPLICATION FOR BUILDING PERMIT Date J'~L'L.~. 6 ,19 71 INSTRUCTIONS a. This application must be 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, re ationship 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 Bud 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 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. (Signature of applican~ or name, if a corporati~;;) ..... ............ R[a:Ln .. ~Rt .....S auJFJ3 .a~Dt ~n.....L~.i ..................... (Address of app icant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................................... ~e~t...~..h.u~ld~. .............. ~ .............................. Name of owner of premises ....A..3,g.~.~.t.~.....~.t~.e.l~lxe~E~. .................... If applicant is a corporate, signature of duly authorized officer. Location of land on which proposed work will be done. Map No.: ........................................ Lot No. Street and Number .-~.~...VJ,{L$~eI',I,~..~.Z' .......... /~'/ -- c~ '7.~' ~ Municipali~' .... ' ............... State existing use and occupancy of premises and intended use and occuponcy of proposed construction: a. Exisiting use and occupancy ¥&c~a~t b. Intended use and occupancy ene famil~ dwelling 3. Nature of work (check which applicable): New Building ....~ ....... A4Jdition .................. Alteration ............. ~ .... Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ..........~.c~t~00...~,, ............................. Fee ........ ~0.~.O. ...................................................................... .~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... .e...J~... .............. Number of dwelling units on each floor ............................ If garage, number of cars ..........e~e ............................................................................................................................ 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 .............. }+..8 ................. Rear ............ ~8. .......... Depth ....... ,R.0. ............ Height .................... Number of Stories ...~e ............................................................................................................ 9. Size of lot: Front ..... t,.1+~ ................ Rear ~,.1.~. + 10. Date of Purchase ........................................................ Name of Former Owner ....... ..~........~...:J...8.~.~ ............................. 11. Zone or use district in which premises are situated ......... .~.~..A.."... ~..1~. .................................................................. 12. Does proposed construction violate any zoning Iow, ordinance or regulation.;> ........... ~ ........................................... 13. Name of Owner of premises ......... Address ...... ................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Davis SheW A/C Seutham ten Nome of Cont~ctor .................................................... Address ......................... ~ ................ Phone No ..................... East Island Dev. Ce 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 NEW ~Y,0~(,.,~, COUNTY OF ..... ¥...u~....z. ?.....~.. ........... ............................................. ~..gtg.9.~.....~.g~.. ............................ being duly swam, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ....................~exL~G..~...g.~D,~.r...~.9..~.9.1R. ....................... ~ ..................................................... (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 'fo~rth in the application, filed therewith. Swam to before me this ................ .e. ...... ....................... · ....... 1 ................. Notary Public,~ ./-d~/A2a~~ County~ (Signature of(d~(pplicaent) ............... NOTAR9 ~LIC, State o~ He~ Yot~ No. 52-8125~0~ Suffolk Coap,~ Term EXPOS M~mh 30, 19~_.,~ E ~ 'S epuc~.oH ~w. CC)fIBS OF THIS suRw¥ ~ HOT I~iWt~ S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date ~A~ 22 ~97~ 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. Chief of General Englneerin~ Services District Engineer ¢: I L -d ARBOR HOMES WATERBURY, CONN. ~""'~'-" ~-~'"' ~:~'~-'-°