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Home My WebLink About5810-zFOR31 ~qO. 4 TOWN OF SOUTHOLD BUILI)ING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate O[ Occupancy THIS CERTIFIES that the building located at . 1{./$. A(luavtev. Ave .~.x% · · Street Map No...XX ........ Block No .... .~. .....Lot No.. ~... ~a~t. ~P~.. ~..%~ ..... conforms substantially to the Application for Buil~ng Permit heretofore filed in t~s office dated .......... ~ ..... ~ ]., 19 ~. p~su~t to which Building Pe~it No...~ ~ dated ......... ~.. ~3. ..... , 19.~2., was issued, ~d confo~s to all of the req~e- ments of the applicable provisions of ~e law. The occupancy for which t~ certificate is issued is ~N~Y~. ~. ~y. ~g. ~9~0~. ~ .~. A~P~ ) ......... The certificate is issued to !~...~! ..... ~.~ .............................. (owner, lessee or ten,t) of the aforesad b~ld~g. Suffolk Co~ty Dep~tment of Health Approval ~...~...l?~...b~. ~ .~!~ .... UNDERWRITERS CERTIFICA~ No. ~ ................................... HOUSE NUMBER ..... ~ 7~.~ .... Street ... ~. XI~Y. A~ ....................... Building Inspecto~ FORM NO. ~ TOWN OF SOUTHOLD 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) N? 5810 Z Permission is hereby granted to: ~dam Ch~tel & W~fe ............... .~.....~..e.~..~...,,.. ............................... .................. .~..l,V..e...rm ............................................. to ..... J~z:~.&. zu~.~., mm..2~d.l~...~,~e3,~.Lt:g ................................................................................ at premises located at ........~.~.....~..¢A~IE/~9..I(.,..A..T.~....e..~.~.~.~.J,g~ ..................................................... ................................................... · a~;..Ba~to~ ........ ~.~. ............................................................... ~T~ 'l~t 19...~....., and approved by the pursuant to application dated ............................ ,.::......,.* ....... ,~ ...... , Building Inspector. Fee $.....~.'J.,O~l ....... S-9 SCHD SUFFOLK COUNTY DEPARTHENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: at The sewage disposal\facilities for a structure located (Give deed location) have been inspected by this department and found to be satisfactory. FEB 2 5 197'4 Chief of General Er~ineering Services SUFFOLK COUNTY DEPARTMENT OF HEALTH APPLICATION FOR APPROVAL TO ~NSTRUCT PR~A~ S~AGE DIS~SAL SYST~ Approval to const~ct said systems is r~uest~,pertinent data here~th: ~te~ 1-Applicant ~-- ~ttl Phone~6-Sub div Address ~ ~ ~ ........ ~ ..... ., ~ ~z~ 7-Section Hamlet To~ ....... ~ ~ 9-~ivate well? ~ ~ ~ ~'" n n r t in ~ 3-~blic ~~,~me ~ta ce to ea es ~ 4-~t Size:. Width~ft. Length /~ft. (also enter on penter plot plan below:) 5-~elling. Singl~ Family ~ T~ Family? ~Cellar? ~.Slab? ~ ~ Crawl S~ce? ~ ~ lO-Pro~s~ syst~. Septic ~nk ~Precast ~yCess~ols ~ /S~llow ~ols Y YOther ~ / il-Septic ~ i~ide dimensions: Vol~e~ Gals.Length ft. Wmdth ft. Liquid depth ft. 12-~ecast sections: ~Num~r~Sq~re Ft. Cess~ols: Block sizeL incs.D ~s.H ins. Total blocks below i~et: ~1 ~2 ~3 ~T P~N H.D.Reference No~ Capacity~Gals. The Undersigned CERTIFIES: No,th Data Feet ~ ~ 0 l~o~ 2 ~' 6 8 10 12 ~w,~ y 16 18 "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sew~sposal Systems". '~er or Builder FOR HEALTH DEPART~NT USE ONLY. Based o~r~he information presented herewith, it is the opinion of the Health Department, that an ad~ satisfactory~age Disposal System can be installed on this Plot. S-15 TOWN OF SOUTHOLD~ BUILDING DEPARTMENT'.,~ YOWN~TH~D,,CLERK'SN. ........................................ , 19 ........ Pemit No .................................... Disapproved a/c ......................................................................................... .~ ~ ~ "~ I ~; APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter 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 ~J' 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.0,f 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 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 Depqrtment for the issuance of a Building Permit pursuant to: the Building Zone Ordinance of the Town of Southold, Suffol'P, County, New York, and other applicable. Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or de .molitJon, aS herein described. The applicant agrees to comply with all applicable laws, ordinances, building c~pusing code, and regulations. (Signature of applicont, 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 ........... Ad.~ll..aZllL~ttl~...~t,~l. .................................................................................... If applicant is a corporate, signature of duly authorized officer. 1. Location of land on which proposed work will be done. Map No.: ............. ~ ........................ Lot No .....3[, ............... Street and Number ............... JI~J.~W...q~T. qI~L1ML~..~.~.]~.CM~. ........ ]~.I~..~.....lJ~IL~..~.Ip..~ .............................. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Exisiting use and occupancy --- Intended use and occupancy Z ............. · hle~re of work (check which applicable): New Building ...... ~ ........ Addition .................. Alferatic~ .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ................................... ~... ~ 4. Estimated Cost .............................................. .............. Fee ..... .~..~..t..6**0. .................................................................... :... (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 ...................................................................................................... . ....................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ...... m~m .............. 7. Dimensions of existing structures, if any: Front ....... ~ ................ Rear ...... ~ ..................... Depth .....~ ........... Height ........ ~.'** ........... Number of Stories ......... ~ ...................................................................................... Dimensions of same structure with alterations or additions: Front e,m o.. · .. .................................. Rear ............................ Depth ....... ~ ..................... Height ...... ~ ................. Number of Stories ...... ,m~ ..................... 8. Dimensions of entire new construction: Front ....... .~.~... ................. '. Rear .......... ~ .~...~ ......... Depth .......... ~.'~ ......... ' ~ rtorie ' P~ // Height ...... /......~... .... Number of ~ s ............................................................................................................... 9. Size of lot: Front ....a6,.7.B ........... Rear ........ 8~.~1~1 ................ Depth ...... ~,~. .................. 10. Date of Purchase ..~-~./.~......../.~...Z....~... ..........Nome of Former Owner ..... ~l~e...~tll:~l...8~l~JI ............ 1 i. Zone or use district in which premises are situated ...................~AE..~IB~I*,~e~.....~.....~II~..ilIL~DI~ .............. 12. Does proposed construction violate any zon,ng law, ordinance or ............ jj~ ......... Z~"9~ ........ regu at on> ,1~ . 13. Name of Owner of premises ...~I[..~Lti~Ibl. .......... Address ..~.J~...~JIII~L..,~J~.ll, .......... ~o~e No....~ ........ Name of Architect ...... ~..~.......~.~...~:~.~..~...Address ........................ ~. ................... Phone No .................. Name of Controctor~..~~/...~.;.~ ..................... Address ..~ .~...~.~~l'J~hone No??..~..:.?...?....'~..~' PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-beck dimensions fram property lines. Give street and block number or description according to deed, and show street names and indicate whether Interior ar comer lot. STATE OF NEW YORK, ! e e COUNTY OF ..... ~i.U~'£O/L~ .......... )-o.o .......................... ~l~l..~i~t;e.1 ............................................ being duly sworn, d~es and says t~t he is t~ applicant (Name of individual signing ~plication) a~ve named. He is the .......................... ~e~. .................................................................................................................. (Contractor, ag~t, co~orate officer, etc.) of said owner or ~ners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contoined in this application are true to the best of his knowledge and belief; and tha~ tho ~rk will be performed in the manner set fo~h in the applicati~ filed therewith.~ Swam ,o bela, me this ~ ~ ,~;~ IZABETH ANN NEVILLE I ~ ' NOTARY PUBLI~. State of New York No. 52-8125850 Suffolk Countv Term Expires M~rch 30, Z9 ~ ,~L),~,vl A. CPIETEL AT r..' AS T MA 12,.I oN TO~,~,'N OF $3UTIqO%D, l,,J. "( ,- _,-.,..E - 50'-, I VAN TUYL t SON '"" / ~o ~ 0 MAP OF LAr,.ID ~""~ SUIZV~¥£1D lrO I~. ADAM A. CH-ETEL AT EAST MAglON TO~'~N OF SOUTHOLD , N, Y. VAN TUYL e ~ON Greenpo~, New York / '1' SB '- O' '-o'x 7;0'