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Home My WebLink About5844-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. ~,~39~. ..... Date ............ Aug .... 20 ...... , 19.7.3. THIS CERTIFIES that the building located at . .0lc. ,~uYct~..'.-a,~e ........... Street Map No.. xx ........ Block No..xx ....... Lot No~xx.. l~atti.t, uck.. 1~ ,~f.. .......... conforms substantially to the Application for Building Permit heretofore filed in this office ~d ........... l~ay .....2.., 19.72. pursuant to which Building Pemit No. 5~Z.. dated ......... ~.ay .....2 .... , 19.7.2, was issued, and confoms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . PX'ivate 'one' .far~:t-:~y · d~elling ....................................... The certificate is issued to .. J~mes. & -Pat.x~iela..Ki~i~ ...... ~-~.~ ............ of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant) ...,:u:., .J.7...J.97.3. by. B....Vill~.. UNDERWRITERS CERTIFICATE No.. I~..t07889 ....... Au$.. 8...J97.~ ........... HOUSE NUMBER ....3.1+.50 ...... Street ...0lc. ,lu.l®..Lane ........................ Building Inspletor FOlt~ 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 CO~MPLETION OF THE WORK AUTHORIZED) N? 5844 Z Permission is hereby granted tq d /~- r .... ~.~:~:.:::~. ........ :..'.....!:~:.~ ~:~?.:.':..~.~.....~ at premises iocotea at ..... ~ ........ ;...t....2..,~ ............ :..:. ..... ~ ......... t ......................................................... ........................................................... ......... ............................. pursuant to appl'cat'on doted ......................./....:..;...:.:.j ........ ~...~'~...., 19......~..;'~'nd approved by the Building Inspector. APPLICATION FOR BUILDING PERMIT ~ INSTRUCT QNS ~,~ a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with(~ 3 sets of plans, accurate plot plan to scale. Fee according to s~hedule. b. Plot allOWing location of lot and of buildings on premises, relationship to adjoining premises or public streets or eyeas, and~_ giving a detlibd description of Jayout of propert~ must be drawn on diagram which is pert of this application. c. The ~ ~ by this application may not be commenced before issuance of Building Permit. d. UPefl'~[J~ '~ll of this application, the Building Inspector will issue a Building Permit to the 'aPplicant. Such permit shall be kept on the premises ~lable for inspection throughout the work. e. No building shall be odcuPied or used in Whole or in part for any purpo~ Whatever'until a. Certificate of Occupencv shall have been~l~ gsented by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Depertment for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other appl cable Laws, Ord:nancas 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 law~. ordinances, building code, housing code, and regulations, and to admit authorized inspectors on I~emises and in buildings for necassal~/inspections. (Signat~ of applicant, or name, if a corporation) ....... State whether applicant is owner, lessee, agent; architect, engineer, general contractor, electrician, plumber or builder. ...... ...... ............. .............. ;. .............. , ................. Name of owner of premises ...~~.....~.. ...... ~..~.~....~ ......................... .~ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which ro osed work will be done Ma- N Y~- - t" v~ ' ' n pro~ _ . p o.: ........:,.. ........ L.p_~ NO. _..~'...'....~.........,.~ ..................... 2. State existing use and occupancy of prerqjses and intended use and occupancy of proposed construction: a. Existing useandocc~pancy ......... ..~.....~......C.~.~ .......~ _.~ ~~ .................. '. ........................................... : ......... ,' b. ................. ...... 3. ~lature'~of work (check which applicable): New Building .....%....~... ...... Addition ............ ..~...,....~lteration ............... Repair ............. . ............ Removal ....................... ,. Demolition ........................ Other Work ...... ~ ...... ,....; ...... , .......... (Description') , 4. Estimated Cost ....~.~.~..~ ............. Fee, ................................................................................................ (to ~ paid on filing this application) 5. If d~lling; ~um~r of dwelling uni~' ...~... Numar of dwelling anl~ on e~h ~oor~ .......... ,.~ .......................... If ~ra~, numar of cars .....~.....,....L.~.~..: ....... ;,:: ........................ ~: .................................................................. 6. If busine~, commemial or mix~ o~upanw, s~cify nature and extent of each Wpe of u~ ..................................... 7. Dimensions of exi~ing ~ructures, if any: Front ..................... Rear ........... ~ ........... ~.. De~th ................................... Height ........................................................... Numar of Stories .~ ........................................................................... Dimensions of ,me structure with migrations or additionS: ~ront ~.....~ .................. Rear / Depth ............................................. Height ......................................... Numar of Stories ............... 8. Dimensions of entire new con,ruction: Front ....~.~..~....-- Rear ..... -- --~...~..~...~..... Depth'..~~'''''"''''" '"'"':"-~'"'"'"'"'"" , Height .................... ~.~.~,. .................... Numar of Stories ........ ~ ................................................ ~ ......................... 9. Szeo or: F ~t ............ ~ ................ Rear ........ l ................................ Depth ................ ~. .........~...~. ...... Height .................................................... Numar of Stories .................................................................................... .. 10. Date of Purcha~ ..................................... Name of Former Owner ....... ~ ............................. 11. Zone or u~ di~rict in which premiss am situated ........ ~ .................. , ..................................................................... ~ " 12. D~s propo~d con,ruction violam any zoning law, ~dinance or re~lation: ...I.z... .................................................. 13. Will lot ~ m~aded ...... ;_~ ~_ .., ~~,Wil~ fill ~ mmo~/~fmm .mmi~: ~ ]' Yes [~No ~ ~ ~ ;~ ~ (Address) ~ (PhoneNo.) of Arch~t~t' ~.~ ~~ ~~f Name __.......... .................................................................................................................... (Address) (Phone No.) n ~am~ of ~ tre~or ................................................................................................................................................... PLOT DIAGRAM Locate clearly and distinctly all building~ 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 whetfl- er interior or corner lot. ( ~ntracmr, a~nt, coyote office, e~. ] of aaid owner or o~nar~, and ia duly authorizad to ~fform or.ha~ ~rfor~d t)a laid statemen~ contained in this application ar~ true to set forth in the application filed therew~h. THE NEW YORK BOARD OF FIRE UNDERWRITERS ak BUREAU OF ELECTRICITY '--' 85 JOHN STREET. NEW YORK. NEW YORK 10038 ~,,Augus~: 8, ].973 ,~,~,,,.,~,,,~o.o.,,,. 6~o:].5N 107889 THIS CERTIFIES THAT on/y t~ e/~etr~e/equ/pm~t in the fol~ing I~ation; RXTURI / I ~ RXTURES ~ RA~ES ~ING ~K$ O~NS ~ WASHERS EXHAUST FANS ~ I DRYERS SER~ m~N~T ~.~ I ........ S B R "V I C E 1 200' CB I ~1 I I ~ I ~/o I' ~ , .~o OTHER AI~ARATUS: Water heater: 1-4.Skw Motor/s: 1-3/4hp Else ~room heaters: ~ 2-2.0kw, W.B. Ruland, Mattituck, L.I. Ji-l.Skw, ~-1,0kW, ~l-. ?Skw, This ce~ttficote must nor be altered in any manHr; return to the office of the Board if incorrect. Inspectors may be identified their credentials. S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date AUG 17 19)3 Bldg. Permit NO. TO WHOM IT MAY CONCERN: ..T,,he sewage~diepoeal facilittts' for a v ~ (Oive de~d' location) ~ structure located have been inspected by this department and found to be satisfactory. /^AP OF P~OPBI2T¥. · T~ST HOLD- ~ ~N~ ~AV~L /~ /UNAUTHORIZED ALTERATION O1~ ADDJ~J~ TO THIS SURVEy IS A VIOLATION OF GUARANTEED TO TI.II:: AIAER. ICAN TITLE INSURANCE CO/APANY AND TO SUFFOLll, COUNTY FEDEX. AL SAVINGS AND LOAId ASSOCIATION I~Og[-~l~:i~ V.~AN TUYL SUFFOLK COUNTY DEPARTMENT OF HEALTH APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval to construct said systems is requested,pertinent data herewith: z ~ ' Phon~/>:-*z:~2,5 6-Sub div 1-Applicant L ~z' -,,- ¢? ~> ........ '~' Address .? (:' ~--?,-.<' ,5-f'c? ~,~.'Y;'/,~:,~ ,4¥~' .c.'-~:, .?-Section 2-Detailed p~perty location ~:~'~, ~'..+- ~.~= ~,--~-~ 8-Lot No. Hamlet ~ ~ .... ~, ~ ~<. ~' To~ ~%~.,.~-~/~,~ 9-Private well? ~-~blic ~ter supply ~me Distance to nearest ~-Lot Size* Width/K~, ft. Length~ ft. (also enter on center plot plan below:x 5-~elling: Single Family ~ T~ Family? / /Cellar? g /Slab? I fCrawl S~ce? lO-Pro~sed ~ys~em: Septic bank I /Precas~ /~/Cesspools ~ /Shallow ~o1~ il-Septic ta~ ~ns~de dimensions: Volvo Gait. Length lB. Width , .ft. Liquid dceth___ft. 12-Preca~ sections: /~lNumber~rgSquare F%. Cesspools: Block ~izeL incs. D Total blocks below inlet: ~1__~2 ~OT PLAN Capacityf J 3ais. O. P. M. ~ ~ ~ Street ~A~: '~ z ~ .z~,,-?.-~ The Undersigned CERTIF~S: "Constmction of authorized installations will be in accordance with the 3uffolk County Health De~tments' current Standa~s, Bulletins, and amendments ~horeto~ eovorSng PrSvag~ Date~:~ ~J,. %' "' , , rZ~ Signed '~er I e Nokth Data 'eet *~_., ::: ._;0 C' ~0 FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it ooinion of the Health De~uartment, that an adequate and satisfactor~..~ewage Disposal System Date L- o Signed ~' _ (10/65 Revis.) $-15 /. 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