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Home My WebLink About5437-zFORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. !l~3 ...... Date ............. llm.~....~.lf. ..... , 19~... THIS CERTIFIES that the building located at}~ .Rg & .8~ ~ .... Street Map No.~. ~k .~lock No ........... Lot No. ~ .... 8~.. ~.~. ......... conforms substantially to the Application for B~lding Permit heretofore filed in this office dated ........... ~.. ~..., 19 .~. pursuit to which Building Permit No...~. dated ............ ~.. R..., 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 ~ ~. ~. f~ll~. ~wel~ ....................................... The certificate is issued to . ~o~r~. ~e~ .I~ ..... ~r ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approv~ ~V" ~" ~97~' ' '~'R¥ 'V~a .... ~ 6he~ ... ~.'... ........... B~lding Inspecto: FORM NO. 9 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEPJ~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5437 Z Permission is hereby granted to: ............ he~...e.r.~...~.*.......~.... ........................ at premises located at ........... ~t....~ ...... .JlJl~.&"~Jlek..~41t. lt41 ............................................. pursuant to application dated ....................... .4iJl~&..-.J .............. , 19.~J..., and approved by the Building Inspector. Fee $... ~O.e. OJJJ ........ S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date TO WHOM IT MAY CONCERN: The/~s~age disposal faci~ies for a structure.located have been inspected by this department and found to be satisfactory. Chief of Genera] ~.l-~ ...... '~ SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROFAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date~ 2 Approval t~ construct said systems is requested,pertinent data herewith: . 1-Applicant )--'~ ~og,A.'~ ~ ~g~ ~mJ(.. Phone~~-Sub div VJ~g~ d2~=. Jg~ Address ~ ~ ~ ~,~ ~ ~ ~ ~,~,~ ~ 7-Section 2-Detail~ p~pe~y location ~ ~S~w.~,~-~a~=~ ~; _~,~w ~-~t No. ~ ~mlet &*~ To~ S~ ~,~ 9-~ivate well? ~ 3-~blic ~ter ~pp~.~me ~stance to nearest ~in 4-~t Size: Widt~ft. Length Y~-~ft. (also enter on center plo~ plan below:) 5-~elli~: Single Family ~ ~ F~ly? ~ ~Cellar? ~l~b? ~Crawl S~ce? ~ ~ lO-~o~s~ ~st~: Septic ta~ ~ f~ecast ~ yCess~ols ~S~llow ~ols ~Other ~ / il-Septic ~ i~ide dimensions: Vol~e Gals.Lengt~ft. Width ft. Liquid depth ft. 12-~ecast sections: ~ yNumber~Sq~ Ft. Cess~ols: Block sizeL~incs.D W ~s.H~ i~. Total blocks below i~et: ~1 /)~$2 ~$3 ~T ~N Capacity ~ ~aals. Street W.L. -£ :ate 'th Data Feet 0 2 6 8 10 12 18 tndi No The Undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards~%~ulletins, and amendments thereto, covering Private Sewage Disposal Systems". ?' Owner o~'~' Bui~Ser FOR HEALTH DEPARTHENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department, that an adequate and satisfactory Sewage Disposal System can be installed on this Plot. Date_~~ Si (10/65 Revis.) FOF,,M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...... ..~.g.cJB.~..~ ....... ..2. ,.~ ...... , 19...7.,1, Approved ........................................ , 19 ........ Pemit No....5..4.3..7....3.. ................... Disapproved a/c ............................................................................................ Application No...,5..~7. .................... ~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by ~pewriter or in ink and submitted in duplicate to the Build Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets~Jr areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this applicatigj]J. c. The work covered by this application may not be commenced before issuance 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 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 S6uthold, 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 applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............................. ..................................... Nome of owner of premises .....~..q..~....~...°...~'./~5....x~.~ ./~/.,l~'~......./.~.~--.,. .............................................................................. .~ If applicant is a corporate, signature of duly authorized officer. (Name and ,itleot corporate officer, / F ~/~t ~ 1. Locotion of land on which proposed work will be done. Mop No.: .~:...~T...c...~.~.~...~.,~7*~J_ot No.....~ ......... ~ Street and Number ..... ...... ......... .~~.. .............................. /.?Z'~._~' ~£ Z-- 4//J' ~ ."~/~ufiicipality---'- - -- 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Exisiting use and occupancy ................................................................................................................................. Intended use and occupancy ....~...~../..Z..?....~...,~..../~...~.......~./g..~../...Z...~.......~......I;~....~..Z..Z..(~.~ ................................ 3. Nature of work (check which applicable): New Building ..... ~ ........Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost. ..... ~.~..................................o oo ............ Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ .~... .............. Number of dwelling units on each floor ~.'. ~ .F...-...~.../?. ?....~...'~ If garage, number of cars ......... /. ................................................................................ : ................................................ 6. If business, commercial or mixed occupancy, specify ngture and extent of ea,c)~ type of use ............................ 7. Dimensions of existing structures, if any: Front ....-:--,~..~..~./.. ....... Rear ..~ ...... i ..... 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 ..... ~.~..f../../.~ ................ Rear..~X~.../.F.' .............. '/ Depth .~..~.../..~. .......... Height . ./~./. ........... Number of Stories ....~. ........~ ............................................. r ...................................................... g. Size of lot: Front ..... ~./~..../. ............ Rear ...... /-~..~. ..................... Depth ]0. Date of Purchase ...... ,~..~...~..~../.~'..?/. .......................... Nome of Former Owner ,~'/~..~...e'~'~...~...~.~.~.~z.d........~../..L.~..~.~.~.? ] ]. Zone or use district in which premises are situated ..................................................................................................... ]2. Does proposed construction violate any zoning law, ordinance or regulation? ........ .~...~. ............................................. ]3. Name of Owner of premises ..~...~...~..~.~../.~..~.~..~...e..~,!~ddress ~[~.~.~.~..~.~...~P.i.~.~..~.~...~. Phone No.~.~..~..'~...~..... ~ome of Architect' ...................................................... Address ............................................ Phone No ..................... ~ome of Cofltroctor .................................................... Address ............................................ Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from lines. Give street and block number or description according to deed, and show street names and indicate or comer lot. STATE OF NEW YORK, I S S COUNTY OF ...... .S~ff~., ........ )' ' .................. t.a~,:eace..~,~r..,Za: ..................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the .................... ~.gD.~'.~g.I;.~X...:t....O~.,.D.~R~ ......................................................................................... (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 end file this application; that all statements contoined in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Swom to before me this Notory Publi ..... Count,/ Or '/JZAI~ETH A' N ' NO:' Y PUBLIC, State ~ No. 52-8125850, Suffolk Cou~ Term EXpires M~h ~0,