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Home My WebLink About7026-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .C~.e.2FV;~.w...~y.e...~e.s.t. ..... Street Map No....xX. ........ Block No.....x~. ..... Lot No...x~x....$.ml..t. ho..ld...~ :.~.,. .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ ~.e.C .... 7.., 19..7.~. pursuant to which Building Permit No. ?0?.~.Z... dated ..... D?.c... ?. .......... , 19.7.3., 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. ri?~.~e. 9.n.~..f.~.~.~.l. ¥..d.w..e.l.l.~.n.g ...................................... The certificate is issued to ...L.e..o...Ral~h .... . .0~..e..r ................................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval April 2S 1971~ byR. Villa UNDERWRITERS CERTIFICATE No..N..~. ~.~. ?.~.~. ..... A.p.?~.~....~ .... ? .9..~. ........... HOUSE NUMBER ...... 3?5 ..... Street .... .C.]..e.~..~.v~.e.w...~.v.e.. ~g.e.s.t. ................ Building Inspector IeOF, M NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP. EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 7026 Z Permission is hereby granted to: ............... ~-14 .............................................. to ..~..~e~...m~e..,~d~.. 4we~.~,~ ............................ i ...................................................... at premises located at ..~.~....~,~l~&~'~$e~..&~'e ........ W~ii~. ............................................................. .................................................. ~m~t~m~ ....... li..¥.. .......................................................................... pursuant to application dated ......................Dee ................. ~ ....... , 19~..., and approved by the Building Inspector. Fee $.~[-e~O ........... // ! v BuTtding Thspector ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~' * :~ ~.k EE JOHN STREET. NEW YORK, NEW YORK 10038 THiS CEEIFIES THAT o~y t~ e~t~ ~u~nt ~ ~sc~ ~ ~ ~t~ ~ t~ ~l~nt ~ on t~ a~ ~ numar in t~ p~m~s o~ RANGES COOKING DECKS OVENS DISH WASHERS TIM~ CLOCIC% BEU. UNIT HEATEI~ MULTI'OUTI-gT EXHAUST FANS DIMMERS AMT, WATTS SERVICE DISCONNECT I NO. Oe[ S E R V I i1~0 CB METER X H I 2/0 . OTHER ~A~T~: ~o~O~/~ ~ ~-~/~p ~e~.~oom bea~e~8: 2-2.~ 8-~.5~ 2-~.0~, ~,-.~w A.W, G+ OF NEUTRAL 2/o I'~ .,r, Aeau~'ate'Eleotz'le Co., ~ 827 Mlddle Coun~l'y Rd.. Selden~ LoI. 1~78, ii ,kV COPY FOR BUILDING DEPARTMENT. THIS COPY OF C__ERT__~ICATE MUST. NOT BE__ALTERED IN ,ANY MANNER, APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 1. Applicant ~o ~A ~ ~ Phone~/3~ 5. Address ~o ~ I~ ~ ~ ~ o ~ ~ , c ~ 6. 2. Property location CL~vi~ A~ ~ 7. Village$,~ ~ Township ~, ~ ~1oc~ 9. 3. Public Water Company name .~z~ ~ Distance to main 4. Lot size: Width~.~_~eet Length /f~' feet (Enter on center plot 10. Sewage Disposa~ S~stem. A. /~00//gallon septic tank: Precast ~ Equivalent Block B. kl~aching pools: Number ~ Precast.~lock Special Subdiv. Section Lot No. Private well Public water below) If private well fill in blanks below: Tank capacity ~Gals. Total well depth ~Depth to G.W. Amount of water in well Test Hole Data Feet 0 4 /- d ~- n~' 6 14 16 18 The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Departmer~ of Health's current stand- ards thereto." Ownotr or Builder 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 /%-?/~/7 /~ Signed ~ j'--------- ...... ~ .................. S-15 Revised ~/]/7M (Building Inspector) FOR PERMIT APPLICATION BUILDINGDate ..~-.. ......................................... INSTRUCTIONS a. This application must be completely filled in by typewriter De in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule, premises or pubicl b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining streets OI areas, and giving a detailed description of layout ofpraperb/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 of Building Permit. d. Upon approval of this application, the Building Inspector will issue o Building Permit to the applicant. Such permit shall be kept on 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 Occupancy shall have been granted by the Building Inspector. ~ .A.P..PLIC, ATION !S HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the ~u,lalr~... :on.e O~mance of the Town of Southol,d., Suffolk County, New York, and other applicable Laws, Ordinances or .~.l~U atlons, ?or the construction of buildings, add,tions or alterations, or for removal or demolition, as hem n described. e applicant agrees to comply with all applicable laws, ordinances, building carla, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for nacessory/inpq:~tion~.,~ · ................................. 'g pp '._...^ nar~e, if a corporation) .... (Address of applicant) State whether applicant is owner, lessee, agent, amhiteqt~, engineer, general contractor, electrician, plumber or builder Name of owner of rem ses If applicant is a corporate~ signature of duly authorized officer. (Name and title of corporate officer) Builder's Liconse No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Location of land on whi.ch,oraposed w~ork will be done. Map No.: ........................................ Lot No ................ .~ ...... S~r~et and I~umh~r State exlshng use and ~ntended use and occupancy of proposed cons a. Exisiting use and occupancy ............................................................................................................................ ..~/~..... y. b. Intended use and occupancy .:~......~' ........................................................................................... 3. Nature of work (check which applicable): New Buildin~ ..:~ .............. A~lclition .................. Alteration ................ Repair .................. Removal .................. ~Demolition,~i..' ....... ~..~. Other Work ...................................................... 4. Estimated Cost ~ ../...*..~.. i .......... ~ ....... Fee ~.~. ~ (Description) t (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 .............. ~. .................................................................. i ......................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each t,/pe 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 ................................ 8. D~mensions of ent re new construction: Front ........ ~'.~. ...................... Rear ............................ Depth Height .......~....]. ....... Number of Stories ................/. .................................................................................................... / R r e 0~' ;.3 9. Size of lot: Front ....... ./....7... ...................................... ea ...../ ................................... Depth .../..~..'. ......... , ........... 10. Date of Purchase ...... ~i..'7'~.. .............................. Name of Former Owner .....~...~.......~...~.?...~.....'~......e~....T..~..-~° 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 fr°m premises: ( ) Yes (/~ No 14. Name of Owner of premises ................................................... Address ................................ Phone No ....................... Name of Architect ...... ...~. ,.._...........~.... ........ ~2 .............Address ................................ phOne No ...........~ ........... Name of COntractor ..~.....:f~...~.....~.....u~T... ............ Address ..~.~.~ ................ Phone PLOT DIAGRAM Locate cleor!.y and distinctly all buildings, whether existing or proposed, and indicate ail set-back dimensions from p.raperty lines. Give street and block number ~r description according to deed, and show street names and indicate whether Interior or corner lot. i b ~ //'7 STATE OF NEW,,.Y,~I~'~ ~ I.$$ ...................... ~...~ ............................. being duly sworn, d~es and says t~t he Js the (Na~ividual signing controcD above name. (Contractor, agent, co~orate officer, etc.) of said owner ~ ~ners, and is duly authorized to perform or have perfor~d the said work and to ~ke and file this application; .that all statements contained in this application are tree to ~e best of his knowledge and belief; and that the work will ~ performed in the manner ~t ~h in the application filed ther~th. Swam to before me this // Nota~ Public, . ................................................... Coun~ .................. L ........................ ~ ~..~...~ ...................... . (Signa~e of applicant) W Atl,~p Oy P~oOPERTY r4