Loading...
HomeMy WebLinkAbout5407-zFORM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No...Z.~5'9 .... Date ........... &plt.~,~ .... ~ ...... , 19.7~[ THIS CERTIFIES that the building located at .. ]1~..!~1'1.~.. ~ ........ Street Map No. l;outhold..~ltij~eNo ........... Lot No. 22 .... ~reenpox'~.. l~,Y.o..(So~thol~o RAP,D) conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... July... 6., 19. ?~. pursuant to which Building Permit No. ~[1~)~.. dated ............. July .... 16 19.7.~., 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 .. P~iva.te. one .fmmtly. ~e~lli~ ..................................... The certificate is issued to .. Na~ti~ Bl'~e~. & .Wife ...... 0mxa~l ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. ~ .ge..1.97~ .... 1~2..B.,...V.i..1,_~.& .... UNDERWRITERS CERTIFICATE No ..... ~*11~1~...(..n.un.b.e.r., .to. .b..e..~..ut~.p.]..l.e.d .9.n., .~.oe~pt) HOUSE NUMBER .... ~.~ ..... Street ....~l~. l~l*i~ .Dl'i.V~ ........................ Building Inspector[ FOR!~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL N? 5407 Z Permission is hereby granted to: .......... ............. ~O-l--.--~¢.'~..~,ve ................... : .................. ................. ~¢': ,;[~,~,e .. ~k,,-, ,~..,~ ~ ................. to ........ ~EL~..~ew..~e"'~e~;bt:7"~'~:~ng:, at premises located at ....'~G.t,,.~ ....... ~4D~t-~G[~..~,~:~,;'~ ....................................................... ...................................... .L~e~. ~a~.;L~,r~, · ~ =&t~e ............... ~'4ee~e~% ........................... pursuan¢ to application dated ............................... ~T~ ....... 6--I ...... , 19...~'.~., and approved by the Building Inspector. Fee $.'].g.,a~ ........... BUILDING DEPA~T~NT TOWN C~ERK'S OFFICE ~UTHOLD, N.Y. ~/ Ex, ned 192/... ~praved 19.~t. .... Pemit No...~..~..~..~....~ Disapproved a/c ............................ APPLICATION FOR BUILDING PERMIT 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, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofpraperty must be drawn on the diagram which is part of this application. '~i 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 Deportment for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other dpplicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or dqmolition, as herein described, The applicant agrees to comply with all applicable lows, ordinances, building code, housing i:ode, and regulations. · t:>~gnatui' of app icant, o[ name, if a ......... .......................... (Address of al~lic,e'nt) Name of owner of premises~..~...: ....... ...~....~.J~..T..~...~... ...... ..~.....,.~-,..~.../~,..~....,~'.z'~ ................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which prop'&sed work will be done. Map ,No.: ...... .~...Z..~...~ .................... Lot No.......~......'~... ......... Street and Number ............. /.~...,m//..~..~....../...~....'..~..~.../.J.~..~.......~.'...~..:...,....~...~...~.....~...~../~..~:..~.~.~. .......... · ~',~, 5 -~ ' MunJcipolity ' 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Exisiting use and occupancy ......................................................................................................................... Intended Use and occupancy .......................... '7' ................................. '7 ............................ '~ ........ ~'"/~' '"'~' 3. Nature of work (check which applicable): ................. Addition .................. Alteration .................. Repair .......... ~. Removal .................. eD~'~blitio~ .................. Other Work (Describe) ........................................ 4. Estimated Cos~t~/...~.~...~:~.~.....~ ........ ~ ................. 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 ...~..x.../../..~:.;.... Depth ....~...?...~...3..:.~ Height .~-.~...~ ........ Number of Stories ......... ~.. ......................................................................................................... 9. Size of lot: Front ...../.~.~....f .......Rear ..../..?'......~.. ..................... Depth / ~t',~ - 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 1 I. Zone or use district in which premises are situated ~....~....~'..W.~...~...~...~..~.([~...~./.--.E)....~...W.....e...~...~'~.[~Z~ .......... 12. Does proposed construction violate any zoning law, ordinance or regu at on? ~.~. ..................................... 13. Name of Owner of premises ...... ...... ~....&/,./#....~-~,~l.~l~cl~ressl~....~.~..¢~,~.~...<0.~fit~//~. ..... Phone No;/q. aL~... ........... Nome of Architect ~.../',~/~./...~..~d~.~/-/~.~D.~.,.~.....^ddress ...~.,~..~..~.~'-'-'-~..~.........~.?hon. No. .................... Name of ContractorC'~...~.<,C {~ ~L¢~. Address .,.~,~ ..~....j~ ~...~.J~.~/~.~:~'~.r~.~J~hone No..~..Z...~.....Tw/~.~;~ 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 comer lot. STATE OF NI_~OP~, .,,.,l' t S S ......................... .......................... ' g y , deposes and says that he is the applicant (Name of individual signing application)._//~,,._~_.~ above named. He is the ............................. . .~e~..........-~...~...-;.....-~.......,~....~ .............................................................. (~n~tZ)r, agent, corporate ;flick'r;, *tct) of said owner or owners, and is duly authorized to perform or have pe-~'rlrormed the said work and to rn~ke and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the application filed therewith, Sworn_to _before me this ........................ ~.~:LIZABETH ANN NEVILLE / NOf'ARY PUBL_I_C_,_Sta_te..o!. Hew '~k No. 52-81~5850, e~Pffolk $CHD SUFFOLK COUNTY DEPARTMENT Bldg. OF HEALTH TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Oive~deed loca ton) this department and found to be satisfactory.- ~have been inspected by Ca!el of General ~4gineering Services 1973 SUFFOLK COUNTY DEP~TMEgr OF HEALTH Date' EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APP~/~FAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval to construct said systems is requested,pertinent data herewith: 1-ApplicantC-~./. ~ Cm ~JJ.~ ~] Phone~6-Sub div Address 7-Section~A $ #/m ~ ~ ,~ ~ ~' 2-Detaile~ p~y lo~tion ~RL,,'~% ~ , 8-~t No. ~ ~et~ ~ ~, ~o 9~ T~ S ~ D r~ ~/~ 9-Private well? 3-~blic ~teF ~pply ~e Dis~nce to nearest ~in 4-~t Size: Widt~ ft. Length/~ ft. (also enter on center plot plan below:) 5-~elli~: Single Family ~ T~ F~ly? ~llar? ~lab? ~ ;C~wl S~ce? lO-~o~s~ ~st~: Septic ~nk / /~cast /~Cess~ols ~S~llow ~ols il-Septic ~ inside d~ensions: Vol~e ~als.Lengt~ft. Widt~ft. Liquid depth ft. 12-~ecast sections: ~/N~r~Sq~ Ft. Cesspools: Block size~incs.~s.H i~. Total blocks below inlet: ~1.___~2 ~3 PLOT PLAN G ade :~ G W.L. Capacity &m 0 2 6 8 10 12 18 Indt e No 'th 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 Signed~ Builder ~ FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department, that an adequate and Disposal System can be installed on this Plot. (10/65 Revis. ) s-15 Gals. 90.0 ,I i/ ~ "" ~ ~'~ ?~'" -- ~"~" "' ,, LINDAL CEDAR HOMES LTD. LINDAL CEDAR HOMES LTD. ,I L!NDAL CEDAR HOMES LTD. LINDAL CEDAR HOMES LTD. f "THIS DRAWIN6 IS CONSIDERED 'PROPRIETARY', IT IS NOT TO BE REPRODUCED, NOR IS THE IN. LINDAL CEDAR HOMES LTD.