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Home My WebLink About5449-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at ..../.~. ~. ~....~.~.~ .~..L.E..~.,., .F'~re~et Map No. ''~ 9/~ / Block No. ~'-- .Lot No. J~. conforms substantially to the Application for Building Permit heretofore filed in this office dated .........~..~... ~ ?...~'., 19 .~./. pursuant to which Building Pemit No..~..~. .~..,~.,~ dated ........../..~. .... ~...~.~.., 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 ...... .0 .At. ff ..... .~-..~..~..I.~..~. .... .~..~'..~.-./-../:/..~...~m. ...................... The certificate is issued to ....~.~ .~.?f...~ ....~..~.~. ! .O..~. ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... /..~..~..~..~.../??'/...--T'...~...?.'.-~...~-.. ~r~.~ "~ ] .~ .2~ .... Buiiding Inspector FORM NO, S ~TOWN OF SOUTHOLD EUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5449 Z Permission is hereby granted to: ...... ,t--./.~.~.~. :.~ ~;. ~. ~ ........ ,~l.,,,..,,m.. ~.-..~ ........ z.~..c,,.. ............ .~'.~,. ....... t~.a../,....?~....~'~ ......... ,,,J~.,u./..~, ~ · ~ ; ...... ~ - · ...... ~ ~ ~. ~_ ' ~) £ k~./,:. ~,/~./..r~t.& ...... to .~.i..,.~-.~...~.... ,~ .~.-. ,c. ....... .,~ .................. at premises located at ..................................... ~:..~q .~l.~..~.~..~...~.~ ..... .~ ~ ~. ~ ............... ..... · *~..E.~.~..:r'. ....... le(..A..':'r~'..ff'~ .................... ~.O.4J..~.~l.a..L.. r-...~ ....... /~..:,,:.: ......................... ............................. /,,..~.T.........~. ............................................................................................................... pursuar/c to application dated ..................................... ..~....../(/.~/.:.~{~'., 19.'2'...~., and approved by the Building Inspector. ~:ee ~....../.. ............... Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ......... ~~ ............ "~"i ........ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by I~/pewriter 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 o 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 o 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 port 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, 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. ......................... . Name of owner of premises~J~.~..~..l~.~.(~ ....... .~M./~I..(.~.J~ ........................................................................................ If applicant is a corporate, signature of duly authorized officer. land on which ro osed work wdl be done p '~'- ~-- ~'~ 1. Location of ' p p il~l . Ma No.: Street and Number .................... /.....-~......--?..-~.. ......... ...~....~....~'../...~....~....~...~. .......... ..~...~..~....'~... ...................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ~ C b. Intended use and occupancy ......... ~./~,J.~......~l(.~.....~.,~.,~j/~..~.....~.....l~.....~.../e.~,./..~.{~, .............................. 3. Nature of work (check which applicable): New Building ............ .~.... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ..................................................... tee .......................................................................................... (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 ..........J. ................................................................................................................................ 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 .....~.. ................ Depth ..~.O..~ ............ Height Number of Stories ...... ~......~ ........................................... -_.~.? .................................................... 9. Size of lot: Front ..... ~.g.~ ............... Rear ....m~/.~. ....................... Depth ....../~.~'.. ................. 10. Date af Purchase ...~ff.R~;/..J.C~.~t ........................... Name of Former Owner 1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ..... ~.~. ................................................ 13. Name of Owner of premiseSJ~//l~..L4/'/Ik,'J~..~.t/4J~AddressL/~..J%~/.-.~-/,....~'~,~.~. Phone No~7...~..~.~...~ Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor,~.~ff.~.12J=~.,t',Jgl:J.l~.S...//)l.C..Address .~.(,f$~e~..,.~..l~...~sr~l~he N°.~.-.~2,~..~..~. ~ PLOT DIAGRAM Locate clearly and distinctly a~L~s, whether ~ and indicate all set-back dimensions from property lines. Give street and block~ ,~, d~¢Tiption and show street names and indicate whether interior or corner lot. (~0 ~'xO tx STATE OF NEW YORK, 1 S S COUNTY OF ................................ · ................................... ............................................ .~ ................ ~emg duly sworn, deposes and says that he is the applicant (Name of individual 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 application, filed therewith. Swam to before me this .................., .... ........................... ~' _I~..IZ_~_.ET.H_ ANN NEVILLE / NOTAII~ PUBLIC,'~te of New No. 52.812585G, Suffolk Term [xpites March 30, I~ $-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date ~[~ t 4 1~71 Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deed location) ' ] have been inspected by this department and found to be satisfactory. Er:g~n,~r~ng Ohiaf of General "~ ~ ~ Services SUFFOLK COUNTY DEPARTMENT OF HEALTH EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROFAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date Approval to construct said systems is requested,pertinent data herewith: 1-Applicant F~o~(A% %4~,~ % II%/C. PnoneP~'..~34~6_Sub air ~='~ Address ~, $$ ~* ~v'= ,~. ~ ~ O ~ ~' 7_Section$~a c~.~~,~#~__eqOI 2-Detailed ~operty location~ ~'4-&~ ~ ~'A~,~ 8-Lot No. ~ - Hamlet~'m$g4564G~ ~,~¥- $~l~4w-~Town ~-~-r~,~O 9-Private well? 3-Public water suRRly name Distance to nearest main 4-Lot Size: WidthV~/~ ft. Le~th/~,/~ ft. (also enter on center plot plan below:)/ 5-Dwelling: Single Family ~F~ Two Family? ~ /Cellar? ~_~.Sl~b? ~ ~Crawl Space? 10-Proposed system: Septic tank ~'~Precast ~u-~Cesspools ~Shallow pools / /Other / / il-Septic tank inside dimensions: Volume~_~Gals.Length ft. Width f.t. Liquid depth ft. lZ- recast sections: ! . umhe. JS. re Cesspools: s ze -TZ ncs. OF ins. Total blocks below inlet. ~1~2/~w~3 L "/-~ ~c~.-~ * Capacity~Z Gals. Street ;ate ~th Data ~eet 0 2 6 8 l0 12 Indi No The Undersigned CERTIFIES: "Construction of authorized installati~ will be in accordance with the Suffolk County Health Departments' current Standards,' Bulletins, and amendments thereto, covering Private Sewage Disposal Systems". - Owner or -- Build%r ~ 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.) I; I LEFT $ DE ELEW~T/O~-I F ~.. C) I'.1 T E LEX,/~T~ O~',l r ' I R, IE R P,, ELE\I flTt Oki ¥ 0 _t FLOC]~ PLaN -5 ~ c_-r. A-A U y. d rI