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Home My WebLink About5438-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at 8htlya~. Bl~i~ ............. Street Map No?.e.S$. 0R .~StBlock No ........... Lot No..1~[ ...... 80~th.o.!d...N.~]~ ~ ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... A~I~ ..... 2...., 19 ?~.. pursuant to which Building Permit No. ~'~... dated ........... A..u~... 2 ..... , 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 . l~r:[T~,te, one. family..dwll~in[ ...................................... The certificate is issued to Folmdel~s .Itomes. Inc .................................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval }louse I~ 1~0 Nov--- 22.. ~971...by. R....¥tl. la... " Building Inspector / FORI~! NO. 2 TOWN OF $OUTSOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT fi'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5438 Z Permission is hereby granted to: ........... ~m~r~..l~J~..~ ......................... at premises located at ...........jlt..ll~....ttlt.~lt.t~..Eit, itJll ................................................... ....................................... ~J~..az~..~,r~v~ ........... :~¢~J~.~..-...-~.~-~ ............................................ pursuon.t to application dated ............................. ~.....~ ........ , 19.~1..., and approved by the Building Inspector. Fee $..~(~,01~ .......... ! 1 ' Dui:aing inspectO~ ~ S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH TO WHOM IT MAY CONCERN: (Give dee~ l'oeation) (~ have been inspected by this department D~ VF and found to be satisfactory. SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date ~'~ Approval tn construct said systems is requested,pertinent data herewith: ' 1-Applicant i~ ~ ,~, ,;6 ~ i-~ ~'i,: ~ ~ Phone ]~ ~ t3~0 6-Sub div ~; Address ~,~,, ~ ~ ~ ~ ~ ~. ,_~ ~ ~ r~ ~-,~ ~w "! 7-Section 2-Detailed prqperty location ~/W ~ ~; ~,~,.,,~ ~,~,~ ~'~ 8-Lot No. Hamlet -~ ~ ~ ~ ~' = ~ z Town ~ ~ ~r ~ =o ~"""~-Private well? 3-Public w~ter supply name Distance to nearest main 4-Lot Size: Width AYO ft. Lesgth ~,~ ft. (also enter on center plot plan below.) ~X~ Two Famil ? Cellar? Sl~b? Crawl Space? 5-Dwelling: Single Family, ~ y ~ / /.Si~ ~_~ 10-Proposed system: Septic tank ~ /Precast /__/Cesspools ~_~/Shallow pools / /Other / / 11-Septic tank inside dimensions: Volume Gals. Length__ft. Width ft. Liquid depth ft. 12-Precast sections: / /Number~Square Ft. Cesspools: Block sizeL/~incs.D ~ ins. H ~ ins. Total blocks below inlet: ~1 / ~$-~2 /~'~3 PLOT PLAN Capacity G. P.M. Grade Data ~eet 0 2 4 6 8 10 12 ~6 18 The Un~ersign~ CERTIF~S: "Construction of authorized installatio~ll be in accordance wzth the Suffolk County Health De~rtments' current Standa~s, Bulletins, a~ amendments thereto, covering Private Se~ge Disposal Systems". DateJL~. ~ ~')/ Signed ~ ~<.~t~ ~ ~ ~" ~er or Buildgr FOR HEALTH DEPARTMENT 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 ~ (10/65 Revis.) s-15 Signed TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..........~l,l.gU,~.~.....2., ...... , 19..:~3.. Approved ................. :'. ............. ': ....... , 19....'.'... Pemit No ...... §4.3~..~. ................ Disapproved a/c ........................... ,. ......... ,~,,.. Application No....,~.~,~1~. ................... ~ APPLICATION FOR BUILDING PERMIT Date ..,/,~...~...G. ....... ~(. ....................... , 19.2/. ...... INSTRUCTIONS This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building~J~ 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 Jn 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, ordi nances, 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. ........................................................ ...................................................................................................................... Name of owner of premises ..... ~..~.ff....~....q..~...~..~....../.-/..~...t~....~...~....../.../~...C:..: .............................................................................. ~ If applicant is a corporate, signature of duly authorized officer. ~ ~ ~ ~) ~\ (Name and tit o co po OT 'ce l /.~ .~ ~"~'~" ~ 1 Location of land on which proposed work will be done. Map No.: .W..~.S.T....C'...R...~..~..~....~.X!~.?,SLot No ..... ..~..~.... "~ Street and Number ..... ...~...?...~...P...~.~.~?.. ....... .~...F'?.L.~...~.~.. ................................................................................................. / ~ ~ 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 ....... ~.u..x.L...~....m......O..~.~......9'..e..~..:..%'/.......g...~..~.kh.t~..~ ...................................... 3. Nature of work (check which applicable): New Building..................v Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...~././..~...o...O. ....................................... Fee (to be paid on filing this application) 5. Il~ dwelling, number of dwelling units ......... .~. ............... Number of dwelling units on each floor .~-~ ........ .T....-~.. ........ 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 ...~....~..../..e. ............. Depth Height ....... /.~ ......... Number of Stories ........ ~ ......................................................................................................... 9. Size of lot: Front ..... ~.c~...e..~ ............ Rear ........ /.~.~ ................... Depth ...... /..~.~..~ .............. 10. Date of Purchase ...~.~...G.....:..../..~..~../ ......................... Name of Former Owner 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ........ ~.~. .............................................. 13. N~ame of Owner of premises .~.~..~..~.~..~ .~.~..,L~'Address ~RI~,~4T~.v....,~.V.~....S'~.Y.~..~'...U~hone No.~.~..~....~.~.,..~.. Name of Architect ................... .~..~. ............................... Address ~ t' Phone No. ~ · Name of Contractor .................. :.~. ............................... Address ......... ~..~. ................................ Phone No...~.~ ............... 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 YORK, COUNTY OF ....S=f/;o3~1~ ........... ~'~ ........................... .~a.~z:~'n.D,~..~,~q.Q,,...vT.,~., ........................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the .......... C,O='c.~'=~.~O~'...~....O'~e.~: ................................................................................................... (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 tl*,a~ the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this .......... 2,nr~ ...... day of ...... A%gLus.t ..,u~ ................ , 19..7.]... ELIZABETH ANN NEVILLE NOTARY PUBLIC, State of New York No. ~2-81258~0. Suffolk Courtly Term Expires March 30, 1~,~ ¸.7