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HomeMy WebLinkAbout6304-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupahcy THIS CERTIFIES that the building located at .... fJouadv~.o~t. Ava..&. H0~t°~ttrLeeat · Map No.. X,X ........ Block No..:1~ ....... Lot No. ;r~ . ~.o.~4.t&old.. N.,.!(, .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ D~.e.. 21.., 19.7.3. pursuant to which Building Permit No. 630tI. Z . dated ........ .D.~¢...~] ...... , 1973.., was issued, and conforms t6 all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .... The certificate is issued to .l~ea .klau~h ..... Cmo~ .... ; ............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval gune...~ ~;.. 49~3...by. t~o,Vt.lla .... UNDERWRITERS CERTIFICATE No. ,J'tllte. ~..1973...b.y. .................. ttOUSE NUMBER..t~990 ...... Street.. ~.O..1~.4. ~'.:},.O.W.. &y.~. .............................. ................. Building Inspector TOWN OF SOUTHOL~D TOWN CLERK'S OFFiCEi SOUTHOLD, N~ Y, N? 630~1 BUILDING' 'PERMIT (THIS PERMIT MUST BE' KEPT ON THE PI~,EMIS~S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Z ,' Dote ........... i~....; ......... ~./.,...~..~.., 19~'....~.. Perm ssion is hereby granted to: ~o ...... ~.~.t./..~. ......... ./9. .............. 4.~./.E. ........... .kT~.~.~.~d,..~ ........ Z~.~../=. J-/~. ~..~..~,~- ............ at premises located at ..... ~.(,2..~.' .A..(.~:~. ...... .Jd(..L/ff.g~....~,...~..~....E'...,....~.. ............ ~...O./.~.T...0./~/....d, jJ ............................................................................................... ~.,~..u..-z:..~r~.o.z.,~ .............................. pursuant to application dated .................................. .~.../.....~).~-~., 19..7..~ qnd approved by the Building Inspector. Building'~ Inspector SUFFOLK COUNTY HEALTH DEPA~i~IENT Chief o~ Oe~opal Enginoerin~ 0o 0 SUFFOLK COUNTY DEPARTMENT OF HEALTH HiD. Reference No. ~O-/~ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE S~WAGE DISPOSAL SYSTEM 1. Applicant ~ ~o ,o 6~ PhoneJ/~ 5. Address ~ ~m ~ ~ o%~gO 6. 2. Property 1ocation~ /~ ~ 7. Village 5~ ~ ~/~ ~O Township 3. Public Water Company name ~ 4. Lot size: Width/~o~¢ feet Length /m~ z feet 10. Sewage Disposal A. B. Subdiv. Section Lot No. .~. Private well_j/~ ~ 9. Public water Distance to main (Enter on center plot below) System: 900 gallon septic tank: Precast ~,iEquivalent Block Leaching pools: Number 2/Precas~ Block__Special__ The undersigned be in accordance with ards thereto." Date /~hr~ '~'~ Street ~o O7~D~ If private well fill in blanks below: Tank capacity~Gals. Pump G.P.M. J~ Total well depth ~f~z Depth to G.W. ~~ Amount o~ water in well _~5'0 Test Hole Data Feet 8 10 12 ~/f~ ~ 14 16 18 ERTIFIES: "Construction of authorized installations will County Departme~t~of Health's current stand- the Suffolk ~ ~r~B~ ~ Signed ~ Owner- or Builder FOR HEALTH DEPARTMENT USE ONLY. Based o~n the information presented herewith, it is the opinion of the ~Health Department, that an adequate and sa~t/isfactory~ Sew,age Disposal System can be installed on this plot.~__~2~ /.~/ S-15 Revised ~ LE~4DING ~'N~'~iTUI'ION LiSttD H_Rf. Or~, SOUND ',/~L'vv' AVENUE SOUT'.-t©LD VAN -F'dYu TOWN OF ~UTHOLD ~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~ ~UTHOLD, N.Y. &/7/7 Examined ........................................ , 19 ........ Approved / /' ' / ....................... '......:......-...., 19.'...7... Pemit No ..................................... Disapproved a/c ......... .~...(.....;:./..Cf ........... ./..~.. ........................ 4....~...(....../. / .. ,... ....................... .,/~' ......... .~..,.~';.._:~./..,..,, ................................ /l APPLICATION FOR BUILDING PERMIT , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector i 3 sets of plaos, accurate plot plan to scale. Fee ac¢ordiri'g to schedule, b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, amt,- 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 Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permi:r shall be ke~p~ol~, the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupen~'y 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 Zo Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction bf buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with ali applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises nd in buildings for necessary inspections. (Signature of ap~llicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder; ..... :: If applicant is a corporate, signature of duly authorized officer. ..................... ..................... , 1. Location of land on which proposed w~k will b~done. Map No.: .................... Lot,~lo .............................................. Street and Number .S~ed~r'xlk~..~ ................ ~. ~___~,,. .................................. /,.~/ ~2 d -Zf c7'3 c3 Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. r:xisting use and occupency ............................................................................................................................. . .. ... . b. Intended use and occupancy .~....~ ..................... ; ............................. ...~.~.....~,, 3. t~Nat;Fe of work (check which applicable): New Building ........ ~. ......... Addition ..................... Alterat on ............... Repair Removal ................... Demolition ........................ Other Work .................... (Description) 4. Estimated uos~ .......................................................................................................................................... (to be paid on filing this application) 5. If dwelling, number of dw~ling units .. ~...... 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 ........................................ ~,~., ,-2- e th ~ ~ .. 8. Dimensions of entire new construction: Front ..... ~.,.~.. -. .. ;... .. . Rear ............................ D p ............................... Height ......................................... .. . .. ... Number of Stories. .................................................................. .... . ...... · ........o. 9. Size of lot: Front ../..~.....~..:....~..-....o. .............. Rear ...~..Z..~.. ........................... Depth ....... ../.. ..~.. ?.. ............................... Height .............................. ~...~. ................ Number of Stories ....... L ............................................................................ 10. Date of Purchase ./~Ced~../~..~..~.... 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. Will lot be regraded ~ .................. Will excess fill be removed from premises: [ ] Yes ~ No 14. Name of Owner of premises ................................................. /~ /~ (Address) (Phone No.) ....... ...................... i="" ................. ........ Name of Contractor .....~4.=..~......~ ...~...-..~.. -~.. ....................... ~s~-~?~.~..-i.....-.~.~'~'~'~i .......... er interior or corner lot. 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 wbeth- STATE OF NEW YORK, ) COUNTY OF ...................................................... ) ........................................ ..~..k:...~. ............ . ~.....~....q....~....~ ........ being duly sworn, deposes and says that he is the applicant above named. (Name of individual signin~,~c~ntr~ He is the .......................................................................... (-'~t~'~/~L~ ~ ~ ....................................................................................................................... (Contractor, agent, corporate officer, etc.} of said owner or owners, and is duly authorized to ~rf~T~m or have performed the said work and to make and file this application; that all statements contained in this application are true. to tl~O~.~f I~,~(~ow.l~dge and beliefs, and that the work will be performed in the manner set forth m the application filed therewith. No. 52-0344763 Suffolk CounhaA ........... .~...~.......~... ........ day of~i ............ 1~/~./ Notary Public,,~ ................. ,(~E...... g~...~;~,~e~a~a n W ..... ~ ........ .T......4......'. ........................................................................ b" - . ~'~,z~'~-~. oT~r~ ~' ~~. FOR REVFRSAL of the ho~se des,gn, these ~ ~. ~'~ plans are reprinted (in everse) on he bach of ~o~oc~o~ ~o ~o~ co~ ~ L. a'~ ~/1" /3:~" , b 'U~ ~co~c, ~oo~ ~,:~ ~ --