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Home My WebLink About5448-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 .][®zmT-RoaS. & .I~kt D~.. · · Street Map No...lt~ ........ Block No. ~ ...... Lot No..~,~...8o~II~IIO.I~[ - · · l~.,][, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... &~..B ...... , 19~.. pursuant to which Building Permit No.. ~. dated &~lg ¶0 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 . .1~1~1. ~1. £11~l]r. I~w®3.11llI ...................................... The certificate is issued to .. ti. al,. l).tl])Oltl;t ...... 0~®~ .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . MI~. 19. 1972. · .blt. ]t .T~lll ....... UNDERWRITERS CERTIFICATE No.. II~l ~[~ ........................................ HOUSE NUMBER. ~11'0~' ....... Street... 1[~1:111~. ~1~. .................................... .................. ................................................. Buildin~ Inspector SUFFOLK COUNTY DEPAR~IENT OF HEALTH EASTERN DISTRICT County Center, Riverhead, New York PA 7-4700 H.D.Ref. No. $o ,5~5~- APPLICATION FOR APPROVAL OF INSTALLED PRIVATE SEWAGE DISPOSAL AND WATER SUPPLY SYSTEHS InsPection for approval is requested, pertinent installation data herewith, 1-Name of O~ner J~L~o~ Z~-/~o~7~ 3-Subdiv. Address j~ ~¢~,, 4~, ~o~ .... (* ..... Phone ~o~.~¥~ i-Section ~o, -- 2-Name of Builder ./,~ ...... ,,~,~ z,, Phone ~.~.~ 5-Lot Number Address /~o/~ ~ /~,,,~.~ ~ ,~ 6-Bldg.Permit No. 7-Sevage System installed by ~, ~,,~ Phone ~ZC- Address ~., ~ ~ ~, ,~.~... 8-(a)Deed location of property ~,,~ ~7 ~,~ C ~,, ~< 9-Septic tank-Gal~L~ft,~ fi,Liquid Depth 10-Cesspools-(a)No,pools ~ .(b)Bloc~ bel~ inlet-1)~2) (c)Block size-L in,~ in,H in.(d)Precast pool ~ .(~)1~ 3._ (f)H ~ fi, 'o in; Di~ ~ ft, ~ in,(E)Finished ~rade to cover ~' ft, (h)Backfill ~terial ll-~ater Supply: Public Syst~ ~ ; Private ~ell If Private~ the foll~imE questions are to be answered: 12-Private ~ater Supply Syst~ installed by c~o~,~ ~4,~ Phone Address ~ ~'--~ ~-'~ l~(a)-Total Depth of ~ell ~l' .(b)Depth to Static ~ater L~vel 14-Di~eter of well pipe ~ 15-Na~e of ~boratory ~ot;~,,~ 16-Hethod of Disinfection ~ ~.~. ....... 17-Dat~ r~ady for ins~ection ,~/,~/,, · ~e undersi~ned C~TIFIES: Able syst~s have been constructed and are in c~pliance with the Suffolk County Health Department's current Standards. Bulletins and ~endments thereto. ~ff~ 4~.,~' 18-Date · ~l/~, Sisned ~ ~e~- Builder 19-Insert sketch of location of ~a~er & Semerase Facilities with accurate dimensions. STREET Based upon the ini'OY~ati~n sta~d above, satisfactory func't~n_i~t of the above sysco, can be expected ,ich proper~ainten~and~ 21 ~.. S-Se SUFFOLK COb~TY DEPARTMENT OF HEALTH EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval tn construct said systems is requested,pertinent data herewith: To~11 Date "/" 8-Lot No. 9-?rivate well? Phone 6-Sub div 7-Section i-Applicant Address 2-Detailed property location~ Hamlet 3-Public water supply name Distance to nearest main 4-Lot Size: Width ' ft. Length' ft. (also enter on center plot plan below:) 5-Dwelling: Single Family ~ '~ Two Family? ~_/Cellar? ~ / Slab? ~_~Crawl Space? ~ / 10-Proposed system: Septic tank ~ /Precast J ~/Cesspools~/Shallow pools / /Other / / 11-Septic tank inside d~mensions: Volume .__Gals.Length ft. Width ft. Liquid depth__ft. 12-Precast sections: ~/Number/ /Square Ft. C~sspools: Block sizeL incs.D ins. H--ins. Total blocks below inlet: ~1[gO~2(~3_~__ NO~E C~ANCE PLOT PLAN ? Ind~ Capacity Gals. G.P.M. £ :ate 'th Data Feet 0 2 4 6 8 10 12 14 ~6 18 Street 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 ~ Owner or Builder 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 instal~n this Plot. Date ~/,~/,~/~ (10/65 Revis.) s-~5 Signed~ TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined 19~ / ............................................ Application ........................................ , 19 ........ Pemit No ..................................... . . APPLICATION FOR BUILDING PE~IT Date &t~l~t J 19...?..Z. ..... INSTRUCTIONS ~ a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildin~ Inspector. qj b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets ~{~ 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 pbrt f~)r 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 iCounty, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or a~terations~ 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 nome, 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 ......... .~...~.......i~....1~...~..1~.. ............................................................................................................. If applicant is a corpo~pte, signature of duly authorized officer. .................. ............... ~'~ar~ and title of corporate officer) ~-~- -- ~ ~x/ 1. Location of land on which proposed work will be donel~ Map No.: ........................................ Lot No ....................... Street and Number ............... JJJJ..g~l~RIr..#~k~.ll~.Jl~.~ll..l~..JJt~l~..;~l~L.......~l~/~..ll~...~.. ................................... ~'~ ..~t /~3 ~J ~.~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ........ ::~ ................... ~ ................... ~..;. ......................................................... b. Intended use and occupancy .............................~l~.Jtml~..i~ ...................... ,.~'.~..:..'~..,...~..~ .............. 3. Nature of work (check which applicable): New Building ....... .il ........ Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ............................................................ Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...(J~t ................... 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 ......... lA-0 ................... Rear ....JA.~0 ................ Depth .....&l)~ ........... Height ...... J.O~(I ...... Number of Stories ..................... ~ .......................................................................................... 9. Size of lot: Front ............ ~,&Jl ......... Rear ....... JlII ....................... Depth ....~&J. ...................... 10. Date of Purchase ......... NJZMI..lt2J. .......................... Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ....... J~II,.A ............................................................................... ..... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............... JJlJ ......................................... 13. Name of Owner of premises ......... Jtl.Llle~lleleJJ~....Address ...J~m~L~ .......... Phone No ...... : Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ......... 3l~llL,J,..IJ~mll~ .......... AddresdJll~ll..JJ4..lJlllll~l/,lll,.JllJ~lL.. Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings/-whether existing or proposed, and indicate all setJoock 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, '~ c c COUNTY OF ....... ~ .......... ,~ '"'"' ............... ~l~ll..~J~..llJ611jlllll~ ............... '~ ................................. being duly swam, deposes and says that he is the applicant (Name of ~'h~ivJduol signing application) above named. He is the ............................................ ~ ......................................................................................... (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 forth in the appIicatio~, filed therewith. Swam to before me this Notary Public, ~[k ii~'~i ............................. ............................................................ County Comn~on Exp~re~ March 3~ I~ ~ .~ o~. .¢ MAP OF PROPERTY AT GUA~XNTEE~ TO FOR NEW YORK STATE LICENSED Date .~rt~ /~ /I)/ PROFESSIONAL LAND SURVEYOR 1~ SEARS ROAD WEST IS~IP L. I N. Y 11795 BOX 291 File No. ~ tel 669-4952 GUARANTEE NOT TRANSFERABLE TITLE No. /Z7 00,~'~ MAP OF PROPERTY AT ~0 ~/v 0 Z..O FOR ' NEW YORK STATE LICENSED Dole .~ /~ ~/ PROFESSIONAL LAND SURVEYOR 189 SEARS ROAD WEST I~LIP. L. I.. N. Y. 11795 BOX 291 File No. GUARANTEE NOT TRANSFERABI~ TITLE No / ~ / 0,'~ ~,~ '%. File No, MAP OF PRdpERTy AT it ' FOR TITLE No. ~O~T_~OZ.~ . , , ,.._~n GUA~NTEEETO:; FOR, , NEW YO~K $~ATE LIC£N$~ PROFESSIONAL LAND SU~V;Ey' R GUARANTEE NOT TRANSFERABLE