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Home My WebLink About5699-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.. ,~'....90.? ..... Date I'O~el11)*l' ~0 THIS CERTIFIES that the building located at ~.~Xl~l~g. Ro. a4 ............. Street Map No .... ~ ....... Block No ...... .~....Lot No .... .~....l~.e¥..Sf~.f0.1~ ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... J..~....~!... ?I~9 .... pursuant to which Building Permit No. ~6~Z... dated ............ ~.al~.. 25.., 19..~.~, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .P~.~V.a?...o~e., .£.~. !.l?...d,v,e.1..1.i,ng ........................................ The certificate is issued to ¥~em~ P, 14a~ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .~O.v....~:..~.9.?.~...~..~. ~:.W~.~. ..... UNDERWRITERS CERTIFICATE No...P.!~..'~.~. ....................................... HOUSE N UMBER .... 86~ ..... Street... ~ .~...~1...S . .~.O~.~. ............................... Building Inspector TOWN OF 5OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5699 Z 19....?...2 Permission is hereby granted to: ............ · ¥~c~r~ ..~.~...~a~b ~!~ .......................... to ...~.i.~...~e~..e~e...f~,~,~.~...~e~ne, ................................................................................ at premises located at ............ ~.*.[*'e~:~..~ ......................................................................... .......................................................... ~*e~.. ~1~$e Mr, ....Ite~ · ............................................................. pursua~ to application dated ................................ .3'..~...~........~.. ............ , 19....~ and approved by the Building Inspector. Fee $.~,~.~ .......... Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: at The sewage disposal facilities (Give ~eed locat~l~n) for a structure located have been inspected by this department and found to be satisfactory. ~ '° FANNING N 84005,50,,W ~OAD M.D. KELLY NOTE: ELEVATIONSAREONANASSUMEDD'A_,..!UM'I ...... ................................................ ......... £; ~ ],,~ ~,' £ '~' ,:'OR VINCENT ~ ROglN MARTIN ~,~' NEW S~FFOLK ~U::.'~:::~T~D TOWN OF SOUTHOLD 5ZC~;~:;Ty TITLE ~ t;~FFOL;~ COut'~T'Y~ N.v vt:;cz;;7 O RODIN :~CAL. E: I" = 50~ NOV. SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference No fl EASTERN DISTRICT, RIVERHEAD,N.y. : ~] ~ 1-Applicant~//~,¢.~ ij~ /~/~R~/~ Phone~? ~ -^" - aa~ress /-~/~, ~ 7 ~'~. . ' ?-Section 3-~blic ~ter sup~ly/~ame ~ ~., o.~..?~,. ~-rrzva~e ~e~ ...... ozstance to nearest ~in 4-~t Size: Width ft. -Len th ~ ~g ~ t. (also enter on center plot plan below:) 5-~elling: Single ~amily ~M~ T~ FamilY? ~Cellar? ~l~ab? Crawl S ce? lO-~o~s~ system: ~eptic ~nk p n Se uc Vol~e Gals.Length ft. Width f~. Liquid depth ft. 12-Precast sections. ~Num~r/ YSq~re Ft. Cesspools: Block sizeL~zncs. D ~ ~s.H,~. To~l blocks ~low i~et: Ca Pa city.als. Data ~eet 0 ~0 12 ~8 , The Undersigned CERTIFIES: "Construction of authorized installatio~ will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, coverin~ Private Sewage Disposal Systems"· Date~//,~/~ ~ Signed / ~,~/.0~.~;~.. ~ or Builder · Based on the information presented herewith, it is theopinion of the Health Department, that an adequate and satisfactory Sewage Disposal System can be installed on this Plot. Date Sigged evis.) s- 5 BUILDING DEPARTMENT TOWN CLERK'S OFFICE Examined . .~.~ ~- I .......... , Approved ........................................ , SOUTHOLD, N. Y. Ic) ........ Pemit No ..................................... Application No. ~--~ ~'/' ~ a. This a~lication must be completely fill~ in by ~writer or in ink and submitted in d~l cote to the Buildin~ ~ Inspector. ~ ~ b. Plot plan shying I~ation of lot and of buildings ~ premiss, relationship to adjoining premises or public struts o~ ~ areas, and giving a detailed description of layout ofproperty must be drown on the 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 permit ~hall 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 {~lhy purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. A PLICATION 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, Suffolk 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 oil applicable laws, ordinances, building code, housing code, and regulations. (Signature of applicant, 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 ........ .~..~'../.~..C=.,~.....~....~.....~... ....... ~....~...,~.~.~..~..'.~.. ............................... ~r~ ~f~pp~contis~c~rp~r~te~sign~ture~fdu~y~uth~rized~ffice~6~v~/ ~ '~7 ,~ , .......... 7-15- - -- I. Location of land on which proposed work will be done. Map No.: ................................ Lot No .......... ~ Street and Number ....... ..~.....~....z..v..Z...~..x'....Z~...~ ...... ~.z~.., ........................ ~..~...~.....~....~...~...~.,./~.. ...... :.::i ......... ' Municipality ......... 2. State existing use end occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..~..Z~....~...~. ~ '~ ...... b. Intended use and occupancy .... ../:~.. ...................... ..~../C~......~..j,,~. ................. 3. Nature of work (check which applicable): New Building ......... ;,~. .... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ........................ ~ .......................... Fee L./ (to be paid on filing this application) 5. If dwelling, number of dwelling units ........... Z ............. 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 ................................ .................................... Rear ............................ Depth ......... 8. Dimensions of entire new construction: Front ~'-/ ~ -/ -J~ .~'.. ........... Height ...../..~..../. ..... Number of Stories .............~. ....................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ...... /.,~..,~, ............................................. 13. Name of Owner of premises ........................................ Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... I 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~ whether interior or corner lot. STATE OF NEW YORK, ~ ~ c COUNTY OF ................................ ~'~ ....... ~.;.z~..*.,.~./~..~.....~..~.~J...'~.~.~'~'. ...................................... being duly sworn, deposes and says that he is the applicant (Nome of individual signing application) above named. He is the .......... .~.....:.~C....:.~...~..:.~. .................................................................................................................... (Contractor, agent, corporate officer, 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 conta:ined in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ~ ..... .~/..~.. ...... ~doy at ..~Jx~l~.l~/~., ................., 192~.. // Z .-~, ELIZABETH ANN N No. 52-8125850, Suffolk Co