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Home My WebLink About6221-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certi[icate O[ Occupancy No. Z ~0~) ...... Date ............ THIS CERTIFIES that the building located at .2~er.a$&. Dr.. (~.~..I~.) .... Street Map NoDeep .H~e.. Block ........... Lot No. ~... ~tti~uek.. ~.Y, .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ~ .... ~J .... , 197~.. p~suant to which Building Permit No..6~$%. dated ........... NoW .... .~.., 19~., was issued, ~d conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . ~iv~te. ~a .f~y. d~ll~g ...................................... The certificate is issued to . J~. ~ ....... ~e~ ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~.~ .~6~..1973 ..................... u~u~wg~r~s C~T~CAT~ ~o.. ]~53 .... ~h...12,..~.~ .................. HOUSE N UM BER..~.~8~ ....... Street ..... ~$~a. D~ ............................. FOE~ NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6221 Z Dote .......................... JJ~lr~Jlb.e~.....~..., 19..~.9~. Permission is hereby granted to: ~t 112 ................. ~.e..~..o.~ .............................................. ~o :i~l,t3,ct..no~..one...~mJ-t.l.ir...d~m] ~ ~_n~ ...................................................................................... at premises located at ...... ,to.t,..~....13e,q~..3o,l.e..C~,e]~..~,~t~'~e~l ............................................. ................................... ~. ~ ..~e~.e-~ ..Dz~.~.~ ............. l~f,t t..~t~k ................................................ pursuant to opplicotion dated .......................... .0...0.~ ....... ,~.1. ........... , 19~..~..., and approved by the Building Inspector. Fee $~.0..0.~ .0. ............ Building Inspector/ FOBM NO. 8 TOWN OF $OUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal--(S~9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 pete / New Building /// Old or Pre-existing Building Vacant Land ............................ Location Of Property ..'~.Z~ .~..!~...~..Z~..,~..~.~ .......D./~.. ........................................................ Ow e Or Ow ers Of Property ,,..~ .~....~........~. ....... ~9z¢'.,/~ ................................................................. Subd,v,s,on ....... ...... B,ock,o ............. ,ouse,o ............. Permit No. ~2-*.~:/...'~... Date Of Permit//.'L-.~.Z..*?..~.Applicant. ...~'; ~,¢,<.;~.,./. ..../~..t;~ .... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ,.'~..~..~:.../.i.~.../..~.'~~ Fee Submitted $ .................................... Construction on above described building and permit me, ets all gpplicable codes an~l~'regulations. App I icant~~~-~./...~_~.~..~ .......... D. ................. Sworn to before me this ~/ v /////~I~ ~_¢c ! ..... day, f ...... stamp or Notary Public'.~'~4c~~. County TERR[ LEE FLAK NOTARY PUBLIC, State o~ ~ew York No. 52~d$295 ~l~'~i~i0~ Expires ~l~rch 30, SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APP~Y~AL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval to construct said sy~stems is requested,pertinent data herewith: ~ ~ 2-Detailed property locatxon.T~; ~',% ~x~ .~/~.~~ ¢'/ !-,F'j ' C . ' "" - ' ' ' Hamlet ~ ~ ~ / ~, /~ Town ~ ~/~ ~ ~ 9-Private well? 3-P~blic ~ter s~pply n~me ~istance to nearest m~in ~ ~-Lot Size~. Width ~ ~ ft. Length ~ ft. (also enter on c~nter plot plan below:) ~-Dwellin~. Single Family ~Two Family? ~ /Cellar? ~Slab? ~ ~Crawl Space? ~ ~ lO-Proposed system: Septic tank ~ ~Precast~_~Cesspools ~ /Shallow pools ~ ~O%her / ~-Septic tank inside dimensions: Vol~e~Gals. Length ~t. Width ft. Liquid depth i2-Precast sections: ~umber~Sq~re Ft. Cesspools.' Block sizeL incs.D ins. H Total blocks below inlet: ~l ~ ~2.___~3 ~~/~-~.~/ PLOT PLAN The Undersigned CERTIFIES: "Construction of authorized ! ft. ins. Capacity~j~Gals. G.P.M. %~"~ Data ~eet 0 2 ~ 8 <7" 10 18 will be in Date (10/65 Revis.) Si ned accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Systems". Date ~ .~/ /~) ~__ Signed ~/~/ /7~~ Owner or ~ 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. ~ ~'/-~ ~ APPLICATION FOR BUILDING PERMIT ,, ,o,, .................... . INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wit~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, an giving a detailed description of layout of property must be drawn on diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building,..p, ermit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to~he applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose wh'atever 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 Zon( Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction ot 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, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address'of applicant) State whether applicant is owner, lessee, agent, architect, engineer,~electrician, plumber or builder. Name of owner of prem,ses ...'~....(~.~...../.~.. ......... ~ .................. .~....~...~....~....~...~..~....~.. ...... ~...~..~....~_~~._.. If applicant is a corporate, signature of duly authorized officer. ................... "i~'~'~'~.~ ~[~J~'~'~'~V~;~ ..................... Loca~io, o~ ~a,~ on ~hich pr~p~,~ work wi, be ~o,~. ~p No.:. ........ ~4~.~..~... Lo~,o. ~..~... ~,~,, ~ ~......,..:,.....g...:~a...~.~.....~a,~ ........ - ~,.~....~.~...~...,, ............................... , ........... / ~ ~ Munici~liW 2. State exi~ing u~ and occupancv of p~mi~s and intended u~ and ~cupancy of propo~ con.ruction: ........... ,...... ...... , ...................................................... ......................... .. b. I.te~dedu. a~doeeu.*~e~ ..... ~...~ ...................................... ~..-~..~. ~" 3. Nature of work (check which applicable): New Building ....... Addition ..................... Alteration ......... Repair ......................... Removal .............. ,.., ....... Demolition ........................ Other Work .................................... 4. Estimated ~ ...~~ .......... ~ .... rFee (Description) (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 car~ .,,.~.. .................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of usa ..................................... 7. Dimensions of existing structures, if any: Front .....................Rear ........................... Depth ................................... Height ........................................................... Number of Stories ............................................................................. Dimensions of same sU'ucture with alterations or additions: Front .......................... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ........................................ S. Dimensions of entire new construction: Front .~,~.~.....t'. ....... Rear ....r.,~.J~... ............ Depth ~.~'...~..~i~.../. ......... Height ............................................. ,... Number of Stories ......................................................................................... 9. Size of lot: Front ...~.~...~. ....................... Rear ..... ~..,~rS~......:.: ................. Depth ....~....O....~.../. ................................. 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction ~olate any zoning law, ordinance or regulation: . .~...~. .................................................. 13. Will lot be regraded ~ ............... Will excess fill be removed from premisas: [~'es [ ] No Na e of owner of~7- .'7,remisee ~,,~t-~ 14. m p ........................... .=..;........~...~....... ................................................................................ -{Address) {Phone No.) Name of Architect .................................................................................................................................................... ~ ~,g~ Z j,~, ,~,-/~ ,,~,o..~l;~ )~1~ ~ ,,JJP~r~e,~l~/ ~ ~.z. ' (Add ess) ne N ) Name of Contractor ..... ~e~//~4~z"~g~4~z~"~-`~-~"~g~/~z~E~/~~~ ..... ' {Address) ~ {Phone No.) PLOT DIAG RAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat~oack dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. STATE OF NEW YORK, ) SS COUNTY OF .......... ............................................ ) .......................................................................................................... being duly sworn, deposes and says that he is the applicant above named. . , (Name o[individual signing contract) ' ' He is the ................................................................................................................................................................................................................. ~ ~ !, , : ~ {Contractor, agent, corporate of J~cer, 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 applicstion are true to the best of his knowledge and belief; and that the work will he performed in the manner set forth in the applica, tion ~iled therewith. ...................................... ,.o, .................................................. ,, ............. -/: / , Notary Public .............. ; ..................... ; ................................. County .... '~"~"~' '~"~'~"~'":' '~""~'"~ ~'~ '"'"'~ ~'"': r (~ of applicant) /~-0.0 / SUFFOLK COUNTY HEALTH DEPART~ ~T~ ~ ~ ~97~ ~. ~- ~. The sewage d!sp~sal and water sup~ f~]'*~es for this lecat~on have ~n?~<? Id ?,y ~his depar~,c~]t an~ Chief of General Engineering Services I I rI - l, I I I I Ill It tll TI-IO~,~S E, TULLY Li~i,i~E NO. 22~14 ~ 1[~ ST,~'[E I ,j 11 _Lr I II I THO~AS E. TULEY '~:' :S II pR:}FEXF~ONAL £NDINEER & LAND SURVgYO~ _'.:_u:E i~O. 22914 N, Y. STAT~, ~'~.~.~o~. WALL T-_LEV. .L /v/3 3'~' //: W~ 0 0 ~k t 1 i"q,:AS E, IULI.Y L[G..E rio 22,3i4 ii. Y. SFAI[ : Irt o. ~o~. F L --] 8"l" '] B' 'J" 5,~L O" __U E ]ULL¥ ,:0 ?Z'Ji~ N Y, STATE ~, N, ~,