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Home My WebLink About5894-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the BuihJb~ Inspector Town Hall Southold, N.Y, Occupancy Date .......... Jp,l.y.. ) ~.,..19i~.1 ........ 19... THIS CERTIFIES that the building ................................................ Location of Property .... 51~.1.5. ~l.o.~.l~b. ~.o.q d., ........... .G?.e.e.n.p.o.~.~. ,..lq.e?.. ~.o.r,.k. ..... House No. * b'tl~t Hamlet County Tax Map No. 1000 Section ...4.~. ....... Block ..... 2. ......... Lot. 1.2. ...... Subdivision ............................... F'ded Map No ......... Lot No .............. conforms substantially to the Application for Buildin~ Permit her~toforo filed in this offic~ d~ted f . ...... l~. ~. ~..9. ......... ,1~ .~.. pursuant to which B~ildin~ Petit No .... 5. .8 .97.. Z. ........... dated ..... .~.a.y...2.2. ............... 19 .7.2., was issued, and conforms to all of the zequiremants of the applicable provisions of the law. The Occupancy for which this certificate is issued is ......... ............ ~ri.v.~ ~..o~. F.a~i. ly. p.w. 9 .~.~.i.n.~ ............................. : ...... The certificate is issued to ..... .O.e.o.l?. 6.~. ?. :..V/.I.1.]: .i .a.m? ................................. fown~., of the aforesaid building. Suffolk County Department of Health Approval ....... ~.Q -: ? 3.7.-~.. {/,2,.1/. 7 ~ ................ UNDERWRITERS CERTIFICATE NO ...... lq ~ §.?.z+ 3 ..................................... Rw. 1/81 Buikl, ing Inspector FORM NO. 2 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? 589~ Z Permission is hereby granted to: ......... ~.~........!~..~..e.~.e.....A....~.. ......................... ~o ....~ ..~.e.~...~.e....~....~.~.?.~.s.~... ................................................................................. at premises located at ...... ~I/~..~[or.~.,P~4~L..(.O~.) ................................................................... pursuant to applicotion dated ............................. ~[~' .......... 9. ....... , 19...~., and approved by the Building Inspector. Fee $..2~0{~ ......... FOBM NO. S TOWN OF SOUTHOLD Building Deportment Town CJerks Office Southold, N. Y, 1197! APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, end 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 disposol--(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 $5.00 3. Copy of certificate of occupancy $1.00 / Date ...~.:;.....~...~,...~..../, ....................... New Building ................. ... O_[d or Pre-existing Building ............................ Vacant Land ............................ Location Of PropeJ~,~././.~.~ ...... ~'~/:~.~.~'.~''.'~'.~.'.~.~''~.~..~.~'.~.~'~.~'~.~'~.'~.~:''~'..~..~..~'... '~' .................................... ,., ...... .... ,.,, G , /.._,.-- / /¢ ............. Owner Or ~w,,~,o ~ .v~.-../, ............................................................................................ Subdivision ................................................................ Lot No...'~....~.... Block No ............. House No..~...~.;~... Permit No..~...~..... Dote Of Permit .?.?..~../..;~..~...~.~pplicant ..,,~,.~?..~...~[~....~.;..~.z/..:..,~..~-.~..~....~..~ ................ _ ,$~ ..-~ ~. '? - (~- ',--/, ~7 ~" Labor ................................................ Health Dept. ~pprova~ .......... ¢. ................................ Dept. Approval Underwriters Approval .. ~..¢.~...~..~...'~:~..?..~J .......Planning Board Approval ............. .-..~ .................. Request For Temporary Certificate ........................................ Final Certificate ............... .~ ........................ Fee Submitted $ ..... ~.-........~72.. ................. Construction on above described building and permit meets all pp~ic~ab~ codes and regulations. ...................... ..... Sworn to before me this ~,~ ,/~ ................ dayof ............................................ (stamp or seal) Notary Public .................................... County FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certi[icate O[ Occupancy No ............. Date ............ c~.., 19~?~ THIS CERTIFIES that the building located at . .A/.~.~.. ~ ). ~ ............ Street Map No....X ........ Block No .... ~, .....Lot No ..... '~ ........................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....~c~].~ ~ ......... , 19 ~..Z:.. pursuant to which Building Permit No.~,~-& ~' dated ~t ' ~ 19 '? L-, was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is...~.~:.~. '~....~-"~r~.....~.~ 0~,~. ~.?. .......... The certificate is issued to... ~1~.~...4 .... ~/,~.l~, t~ c,,~..,~..~A~./,~,,.c~,, ...... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval~ .. ~/./. 7.? .~..- ................. UNDERWRITERS CERTIFICATE No....~-K-~... ~..~. ..... ((..?.. ~ ....................... ttOUSE NUMBE~ ............. Street ................................................. Building Inspector FOBM NO. 6 TOWN OF SOUTHOLD Building Department Town CEerks Office Southold, H. 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 Roard approval of completed site plan requirements where applicable. R. 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 occupancv $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancv $1.00 Date .. ~...~..~..~.....~." ~ .................... New Building .................... Old or Pre-existing Buitding ............................ ¥ocant [and ............................ Location Of Property ~'/"~ ~'¢,7~/~ ~e~-p C/~e~/~F'' Owner Or Owners Of Property ...~..'..~.~.~..4~...~L.~.....~..:..~...~..../-'....~...f...~......r~....-~... ....................................................... Subdivision ................................................................ Lot No.....?-<....~'... Block No ............. House No Permit No..~'.~..,~i.~...~.. Date Of Permit .~...4~..~...~...~.~../.A~plicant .:~..~.~.~.,~..~...~.:...~'.:..~....~..~..~.'?.~:.~. ............. 5'~ )~') -- ~' Z/''7 '~' Lnhnr ................................................ Health Dept. Approval ........ ~ ....................... · ............ Dept. Approval eJ ;3 ~-Ttc~ - ~. ~, ? 7/ Plannin Underwriters Approval ............... ............................... g Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ .........'-?...:...~. · ................ Construction on above described building and~permit meets all applicable codes and regulations. Applicant.~ ..~. :~..~.~......~.... ;....~...~'-') ........................... Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County TOWN I-IF SOUTHOLD OFFICE OFBUILDINr~ INSPECTOR TrlWN OI_E:RK'm OFFICE 5BUTHDLDr N. Y, May 11: 1 972 Mr. ~. l~ar~errer Commissioner of Public Works Suffolk County Yophank Ave., Yaphonk, N. Y. Dear Sir: In accordance with Section 239K of the General Municipal Law of the consolidated Lc~ws of the State of New York, this is to notify the Commis- sioner of Public Works of the County of Suffolk that ...................................... has applied to the Town of Southold for a permit to construct a building on ..K/.~...N~r.$~..~a~....L..C..R...2.2.)...~.r.S..e..n.~.~...r..t......:i:.~.:....~.~.u.st ~.Fest of ~o~mmvzew i~ ~'s'~'"& Levinson) as shown on the attached plot plan, submitted in triplicate, dated ..0..c...~......~.? ~ 1 969 ............................................ andtitled LaD. o~ ?to,arty £or George & .... ......................................................... l~r go.~ et We shall withhold further action on this application for ten days or os otherwise provided Jn the aforementioned Section 239K. IJo_LE: Levi~son house in Very truly yours, high~,.~ay. .~ Building Inspector ' ~:~ Town of Southold, N. Y. 15/'16/72: Approved to 'che Town o£ $ou'cho~d pursuant 'co See. 239~ ~-of the General Municipal Law; as per revised plot plan. A permit requi~ed under See. 1~§ of 'che Highway Law for access to C.R. 27. SUFFOLK COUNTY DEPT. PUBLIC WORKS R. M, ~RER~ .C~I~iI$8ION£R Chief EnEine;;'~''~' ul~~ SUFFOLK COUNTY DEPARTMENT OF HEALTH EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE¢6~/POSAL SYSTEMS Approval to construct said systems is requested,pertinent data here th: Date , i-Applicant ~o/~ ~, /%;~4&i;~1~ Phone~6-Sub div Address ~&J{! $~£~ ~.~.#~'77~---i; ~'a<~-~i~ ~,~ 7-Section 2-Detailed property locatmo~m~s,~s,,~~ ~ 8-Lot No. ~I ~ Hamlet ~6~s~ 'To~ S~c~o& ~ 9-Private well? 3-~blic ~ter su~y ~me~N~r ~ ~F~ Distance to nearest ~in S-Lot S~ze: Width ~ ~ ft. ~engt~ft. (also enter on ~nter p~ot plan below:) / ~-~ell~ng: Single Family ~T~ Family? ~ /Cellar? ; ~1~? ; ~Crawl S~ce? 10-Pro~s~ sys%~: Septic tank ; /Precast ~ ~Cess~o~Shallow ~ols il-Septic ~ inside dimensions: Vol~e Gals. Length ft. Width ft. Liquid depth ft. 12-Precast sections: / /Number/ /Sq~re Ft. Cesspools: Block sizeL incs.D ins.~ins. Total blocks below inlet: ~1/~ ~2~ ~3 ~T PLAN H.D. Reference I e NoPth Data ~eet 0 2 6 8 10 12 ~6 18 Street The Undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Systems". 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 fi/t//c2 (10/65 Revis.) s-t5 EXCAVATiOH Signed~ apa21tY----Gal s · APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS INSTRUCTIONS: Applications must be submitted in triplicate 1-Means Owner or Builder. Address to which ,mil should be directed. 2-Means detailed description of property location, together with street name and distance to nearest ihterSection of main thorofare, also Nam_let/Village & Township 3-Enter name of Public Water Supply District, together with the distance to their main. ~-Enter Length and Width of Lot under appropriate heading, also enter these dimensions on center plot plan shown on the face of this application. 5-Dwellings: Check-mark "V" items applicable to the proposed new dwelling. 6-Name of sub-division 7-Section Nnmber 8-Lot Number 9-Private well: Enter "No" if Public water supply is available. Enter '~es" otherwise. PROPOSED SYSTEMS: Answers to Items number i0, ii, & i2 please consult the Suffolk County Health Department's 'Standards, Bulletins and Amendments for Sewage & Waste Disposal Facilities. i.e., Part II-Residential Sub-surface Disposal Systems covering Cesspools Part III " " " " " " Septic Tanks Part IV " " " " " " Unusual soil conditions Part V " " " " " " Shallow Leaching Pools PLOT PLAN: The following information is required concerning the Applicant's Lot: Lot size-Length and Width in feet to be indicated at the Lot lines of the heavy lined square in the center of Plot Plan shown on face of this application. Surface waters-Streams, Lakes, & Bays, etc., located within a distance of 50 feet of Applicant's Lot lines, must be shown on the plot plan also. Wells and Cesspools now on adjacent lots must be shown on the Plot Plan together with the distance to the Applicants proposed Sewage Disposal Systems and Well. Where no Buildings exist on adjacent lots, state. "Vacant" on the plot plan. Streets adjoining applicant's lot to the right, left or rear, enter street name. WELL LOCATION: To locate the well & sewage disposal systems on Applicant's lot, the following Standards must be observed: Well-100 feet minimum distance from the nearest cesspools Well-25 feet minimum distance from rear, and rear sides of property lines Well-10 feet minimum distance from front, and front sides of property lines Well-50 feet minimum below grade for well point Well-~O feet minimum into ground water for well point Well-4 feet 6 ins. minimum below grade to well head and lateral water pipe CESSPOOLS LOCATION: Upon determination of the Sewage & Waste disposal "type of systems" required, the following Standards must be observed for the location of same: Cesspool-10 feet minimum distance from lot lines to center of cesspool Cesspools exterior must be 100 feet minimum distance from nearest well Septic tank exterior must be 75 feet from nearest well j~'!-, . .'~C~sspool "Center" must be 12 feet minimum distance from nearest water line "' ~Cesspool "Center" must be 15 feet from house foundation S/ :~l !~! Cesspool exterior must be 50 feet minimum distance from surface Waters, Streams, .... ~ ~t~S~&~ays, etc. Cesspool's must be 20 feet minimum distance from large trees Cesspool center to Cesspool center must be at least 16 feet Cesspool cover top to grade must be held to minimum of I food to maximum of 2 feet Bottom of Cesspool to ground water must be held to minimum of 1 foot FORM NO. 6 TOWN OF SOUTHOLD Bnilding Deportment 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 Date ......?.../....~.....O...:..?...~.. ............... New Building ~ Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property Owner Or Owners Of ..~..; ........................... r ..................................................................................... Subdivision ................................................................ Lot No, ..,,~,...,x~,. Block No ............. House No ............. Permit No. ~..~.~.~?./...... Dote Of Permit Z~..~../.....,.~.l.t'Apphcont '&'.~?..~..~...'/?.;...?...~.*h.~/..~.*..'~....~. .................... Health Dept. Approval d ~nJ~ ~-/ /~ Z ~' Labor Dept. Approval Underwriters Approval ....~...~.?.....~..;..(.~...?...~ ........... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit meets oil apj~Licable~ codes and regulations. ............................................ Sworn to before me this ......~'...(}....~... day of .............. :L ........................... (stamp or seal) Notary Public~~~ County T[RRI LEE ELAK pUBLIC, State al New york NOTARY N~ 52.616~295 ~uah~ed ~*ires Nlarc~ 30, Z~ 1~ FORM NO. 6 TOWN OF SOUTHOLD Building Delmr~ment Town Clerks Office Southold, H. ¥. 11971 APPLIGATION 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. ,~ccurote survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Swam 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 $5.00 3. Copy of certificate of occupancy $1.00 Date ~7-20 -7-~ New Building ..~... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property /k), D p £~ ~ 0.~ ,~ ~ ,~' J. '-/ /) ~'~-~t/ ~, ,~c ,, ~c~¢ /v ~ Owner Or Owners Of Property ....................... ~ ............................ ~ .................................................................. Subdivision ................................................................ Lot No......~.....~.. Block No ............. House No ............. · /~,~y ~-~--, 7 · Permit No...~.~..~..~...~;..... Date Of Permtt ................. ~..~pphcont ..~...~.~..~...~....~:.....~...:.~.~./....~..~.;. ............. H~alth Dept. Approval ...... ~ ........... ~...~ .................... Labor Dept. Approval Underwriters Approval ..~....~..~'...~,.../.5.;?..~ .............. Planning Board ,~oproval ........................................ Request For Temporary Certificate ......... ~ ........................... Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building a~e~r~it mee~:~a,l~~~ regulations. Applicant ~~....../..'.: ............................. ~ .............................. Sworn to before me this ...~..~...~.. da~cof ...~..~..~...~ ...... ~..~...~....~.. .... (stamp or seal) TERRI LEE ELAK NOTARy PUBLIC, State ot ,'~ew Y~k No. 52 6~68295 FOUM NO. S TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, H. Y. 1197! 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 19.57), 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 $5.00 3. Copy of certificate of occupancy $1.00 Date ....'7....:....~....C7....:.~.~ ..................... New Building ..... ~. .............. Old or Pre-existing Building ............................ Vaca_Tn~t ~L~o=d/......;/., .;.._.~.;.~,..,~; .... Location Of Property ....- .................. Owner Or Owners Of Property ......... ; ................ ; ...................................................................................... Subdivision ................................................................ Lot No...?....-~,,. Block No ............. House No ............. Permit No. · ~"oc. (/- ¢-/.. Date Of Perm,t ..../ r~ ~?' ' ) I'cant .................................................................. Health Dept. Approval .~..~...~...z......~....f..~./..~.'.~.7.....~...-..Labor Dept. Approval ................................................ Underwriters Approval ..Z~..?.i..~.~'.:....~:,..../..~..~7.....z~.......Planning Board Approval ........................................ Request For Temporary Certificate ............. .../... .................... Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all applic, abJe cod_es and regulations. Applicant ....................................... Sworn to before me this ..~..~.. day of ......':'~...%~.~....~...'.~...~...~..~. ...... (stamp or seal) ~ , Notary Public '~...~~ County TERR[ LEE ELAK NOTARY PUSLIC, State of New York No. 52 61682S§ · ' ~.,~,'~'" '-- -- . TOWN OF sou'r, ou)"/ ~_ ]~ ~ a~ BUILDING DEPARTME~'~ ~ .'~ '~ TOWN CMRK'S OFFICE , ~ ~' ~UT.~D, ,. v. ~/~/~ ~i,~,: ........ ZB.~ ...... ~..~ ....... , ],.~.~ ' ~ ..... ~/. .................................... ~o¢~/~ ...~.~ ........ ~ ....... ~ ...... ~.~.~Z~ .......... .. ................ , ........ r ..... ........................... ~,,,~ ~ ~1/7/~ ~ *PPUCATt~ FOR ~ /-' ' ~ Dote , .............. a. This application must be completely filled in by typewriter or in ink and ,~UIJIIllLL~,~ In triplicate to the Building Inspector, with ~,~ 3 sets of plans, accurate plot plan to scala. 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, and ~. giving a detailed description of layout of property must be drawn on diagram which is part of this application. c. The won~ covered by this application may not be commenced before issuance of Building Permit. I! d. UPOn approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the promises available for inspection throughout the work. e. No building shell 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 Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolb 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, and to admit authorized inspectors on premises and in buildings for necessary inspections. 8~te whether applicant is owner, I~e, a~nt, a~hit~t, engin~r, ~neral contrite, electrician, plum~r or builder. If appli~n~ is a corporate, signore of duly authorized offi~r. ' ' MunicipaliW 2. State eXi~ing um and o~upancy of premiss and inmnd~ u~ ~d ~cupancy of pro~d con~mction: b. Inte~d u~ and ~upancy ........................................................................ ~.~ .......................... ~.~ .................. ,. Natdre of ~ork (check which applicable): New Building ~' Addition ~ ' ............................................ Alteration'. .............. Repair ......................... Removal Demolition ......... ; .............. O~her Work (Description) Estimated Cost ....~/..d.~...~. ....................... - ~-ee ,..~ ........... . ................................................................................. (to be paid on filing '~hll application) ../.......~.... Number of dwelling units on each floor ..... .4,.....~...o..C..~.,,~ ............... If dwelling, nUmber of dwelling units ,~ "~ If garage, number of cars ...,~ ...................................................................................................................................... If bueineN, commemlal or mixed occupancy, ~oeclfy nature end extent of each type of uN ...r. ................................ Dlmenllone of existing structuree, If any: Front ....~. ............... Rear ........................... Depth ................................... Height ........................................................... Number of Storl# ............................................................................. · Dlmenelone of nme gcructure with elteretlone or eddltlone: Front .......................... Relr ......................................... Depth ............................................. Height ......................................... Number of Storlel ........................................ 8. Olmenalone of entire new construction: Front '~ g / Rear ....... ,3,.,.,4,,,.', .......... Depth .......... J~. ................... Height .............. ,./,.(.,/. .......................... Number of Storlu ............... ,/,. ................................ , ...................................... g, Size of lot: Front ........... ~f; ....................... Rear ~-~ / n.,,,~ / a-~ , Height .................................................... Number of Sterlu ................. ,, ...... .,,.,.,,.,.,,.,,,,,,,.., .......... .,, ............... 10. Date of PurohlN .~.~.c;a,.,,,/,~,&.,,~,, ......... Name of Former Owner ,,~,,,,,,,,,,,.,,,,,,,,,,,,,,,,.,,,,,,,,,,,.,,,,,,,,.,,,,.,..,,,,., 11, Zone or un dlltrlet In whleh primlNI are ~ltuated ......... ~ ............. ..,,,,.,,,,,,,,,..,,,,,.,,,.,,,,,,,,,,,,,,,,,,..,.., ............ , 12, DOll propo#d oonltruotlon vlollte iny zoning law, ordinance or re~ulatlom ,,,,~,,~,,,,,,,,,,,,,,,,,,,,,,,,,,.,..,,.,.,,,,,,.,,. 1S. WIll lot be reFIded .--.-..~/,,,f:,,~,,.,,,,,.,,.,,. WIll axeD# fill be removed from I~mmlw~ [ Name ~f Centraat~r ,.,.,., .......... ,, .......................................... PLOT OIA(3FIAM Lem~te olearly and di,tlnotly ,11 bulldln~, who~h~ o~i~i~ o~ pmpo~ o~d i~di~a~ all ~k f~m pm~ IIn~, Olw ~et and bilk numar or d~riptlon ~o~in~ ~ d~, ~nd ~ow ~mot n~ ~nd ind~ ~, er Interior or cornet lot, UNTY ........ ,.,.,,,.,,,,.,,,,,,,,,t ~ ~id owner or ~r~, ~d i~ d~N a~horiwed ~o m~orm or h,w ~er~d ~ ~id ~rk nnd ~o m~ ,Rd fil~ thi~ et~m~ ~n~ i~ ~hi~ ~li~ ~re'~r~ ~ ~ ~M ef hi~ knowledW ~nd ~liefi ~nd ~h~ ~he ~k will ~ ~ fo~h in ~ ~l~io~ filed .................... . .......... ................................. COUNTY OF SUFFOLK DEPARTMENT OF PUBLIC WORKS R.M. KAMMERER, COMMISSIONER YAPHANK, N.Y. TYPICAL SECTION FOR RESIDENTIAL ADJACENT TO: .~/.'~ . ,. PERMIT NO C.R. // DRIVEWAY (FLEXPBLE TYPE PAVING ) ~: "/ -:, / -., /' ~. -L J>.,. ,,~'~ ~' '~ ~: ,'.~,~" / ~ ~.~,,,.' ,;..:~-:?.;~?,[////////////////////// ?~:~ .F:~.;;-~:. :':L:A :;:~ ~ ~::}:~ PAVE ROAD LINE EXlSTING~ THEORETICAL CURB LINE :l~ ~ PROPERTY LINE~ PAVEMENT TYPES OF PAVEMENT BITUMINOUS 'MACADAM BASE WITH ASPHALT CONCRETE TOP. 2. CINDER or STONE SCREENINGS BASE WITH ASPHALT CONCRETE TOP. CINOER OR STONE SCREENINGS BASE WITH BITUMINOUS SURFACE TREATMENT AND STONE CHIPS. PORTLAND CEMENT CONCRETE WILL NOT BE PERMITTED II I mI iV o Y~ -T'H /_---L E' L,' ,'~ L~2sT