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Home My WebLink About6523-zFORM NO. 4 TOWN OF SOUTHOLD BUH,rHiNG DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. Z. ~80 ..... Date .............. . .0qt. .... !8. .... ,19.73. THIS CERTIFIES that the building located at . YeoJleCott. I)~. ............ Street Map No.Xennecott. l~lock No ........... Lot No.. 3.~. ....... 5outhold, ... I~.o.Y, .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... &p~.ll .... 30., 19 .~.3. pursuant to which Building Permit No. dated ......... IpZtil .... 30.., 19.73., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .Pri.v. ate..~ne, familY. .dw~lling 'i .................................. The certificate is issued to ...¥1r~c. eILt..&. ,NaJ~. ,'. ~.o.r.l~l$ ...... . .0g~..e.l'. ~ .............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval '..0~t...1.6. .... 1.973....by..R.:..V.L~.i..a.,' UNDERWRITERS CERTIFICATE No. , .1~..~..i.n.g. ' HOUSE NUMBER ..... 2.1~ .... Street ... Xenee.ott. IX~iv® ...................... FO~L~ NO. 2 TO~N 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? 6523 Z Date ..................... A, pr.l,~ .......... .~O ......... 19..~.~.. Permission is hereby granted to: ...~i,~c e,n~..&. ~,m~. ......~lo~.r£$ ...................... ....... .'"~..... 6~e~t"L~ g-'.8"~ .................................... ......... ~z".c~o'~"l.yx,......~...~........1.::122.¢ ................... to ....b..gjj,& ,.~w...~.~ ...f.~m~ ~....d..~.C.1 L~,~ ................................................................................... at premises Iocoted at ....~0.~...~. ....... ~;el~.l:,e~-o.f,.t,..~.)~l.~':k ................................................................ ........................................... ~,/.,s.'....~.~.e..~ ..o..t. ,t....~. r .......... .s..o.~.t...h..o..z..O: ....... ~..,.~ .,. ................................. pursuant to application dated ...................... ~I'~L] ....~ ............ , 19.~.~..., and approved by the Building Inspector. Fee $.$ OO,4~O ......... ~ '" Building Inspe':for J Examined Approved " " 19~... PemitNJ~'~ ~> ~' ..'~'~ ~ ~ ~c~'~4' ~''~' ..................... .................................. ~ a/c ...... ............................................ '7 ..................... ~~ (Buildi~ '~r) ¢~" e. This e~i~tion must ~ ~mplelel9 fill~ in by ~riter or in ink ~nd subm~ t~li~ 3 .U of ~.ns, ~r~m ~ot ~ ~ i~. Fee ,~t~ ~ti~ I ~ ~igtion of I~t ~ ~ ~. ~ ~ ~ ~.thii a~ ~ ~0~ ~_~_~ ~v~ ~T ~ ~i~tl~,, ~ Bu;l~;~ e~ ~ ~ .~ ~ ~pi~ or ~ in ~ or i~ ~ for any ~r~ wha~ ~if~ ~ ~ ~1 h~ ~n~ ~n~UC~T!~_~, ~E~ ~DE m t~ ~u,~i~ ~n~n~ ~or t~ ~nm o* ~ ~u,~i~ ~mi~ ~t to ~ ~ui~i~ Z~ ~lldi~, ~I I1~I1~, or tot ~1 ~ ~lllton, o~n~n~, ~, ~ ~, In] ~Mfiom, ~ lo ~mil ~u~ri~] in~o~ ~mt~ ~ in ~il]i~ ~r ~ in~io~, (Signature of applicant, or name, if a =orporation) State whether applicant is owner, I___~e_, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer '-----------;~'" --"-"" ""-'"'""'"'"'"'"'"" .... ~ 1. Locetion of land on ~h~ work~w, il,~lo~/,. Map~o ........................... .~ ......... ......Lot NO .......~', ..~.... .......... Street and Number ...~.~..'~~......~.,~.-~.../...~::Z~:. ..................... 2. State existing use an(occu ~. / Mun,cipality Existing use and occupancy ...~ .................................................................................................. Intended use and occupancy ..~ ............................... ;~ .................. :.;: ............................................ , INarce and title of corporate officer) Builder's License No .................................. ....... ..... ..... . ...... Plumber's License No ........................... Electrician's License No .............. Other Trade's License No .......... 3. Nature of work (gbeck which apolicable): New Building ........ ...v~.... ........ Addition ..................... Alteration ........ ] ..... Repair ......................... Removal ......................... Demolition ........................ Other Work ................................ ~.. (Description) 4. Estimated Cost ...~..~.,...~J~....~.. ...................... Fee /- (to be paid on filing this application) 5. If dwalling, n~ T0f dwelling units ................. Number of dwelling units on each floor ......................................... If garage, nun~lllr of cars .......... ~ ........................................................................................................................... 6. If business, commercial or mixed occuoancv, specify nature end extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front .....................Rear ........................... Depth ................................... Height ........................................................... Number of Stories ............................................................................. Dimensions of ~ne structure with alterations or additions: Front .......................... Rear ..... .-. .................................. Depth ............................................. Height ......................................... Number of Stories ........................................ 8. Dimep~ions of entire new construction: Front ......................... Rear ............................ Depth ................................. Height ................................................. Number of Stories ......................................................................................... 9. Size of lot: Front ..... tx-._. .......................... Rear ........................... ~ ..... Depth ....,v ...... .~ ....... v .......................... 10. Date of Purchaes -/.~~'./~m-~ame of Former Owner~..~.:.... .................. 12. Does propo~M~~~ae~ ~'mt~m vi~iat~v'mla,te eny zoning law, ordinanoe or regulation 13. Wdl Iotberelemebel---,,/-~f~:-.~.~.'?.~.~""' ............. Wilbe~fill be removel/ from premises:[ ] Yes [gl No · / --y .~ .~. ...... ~7'"r~i; .~ '"~7'~ ~.hone No.~ ,'ma of Co,~~~.....~..~'X~-~ ............. .~.~..~~ ............ .............. IAddre~f [f / PLOT DIAGRAM Locate cleee~ end dimtinctty all buildings, whether existing or proposed, and indicate all set,back dimensions from property line~ Give ~met and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. STATE OF NEW.~ORIC COUNTY OF .....'~..,~z..~, .;...~.~..~.~.~. ................... ) SS ......... {.l~me o.f*i~ti~uel si,~ning contrec'~'Ji' '~i .............. being dly ~Wern, deposes and says that he is the applicant above named. He is the ......... /Contractor, agvnt, corporate officer, etc. ) of said owner or owners, wnd is .duly authorized to perform or have performed the said work and to mal~e and file this application; that all statements contained in this epldication are true to the best of his knowledge and belial; and that the work will be performed in the manner set forth in the applicatiort ~ therewith. ........ ................ r..,.,, ..... "-"~'""~;~'"~:t~'J~2~5 ........ ' ............. .o,e, ,ub,.c, ,--~--~,~ ~:[~..~t ;,;, .................... (Signature of applicant) ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~-- ss Jo.. S*.EE...EW YORK..EW YORK ,OO3. O ctob 19 670~)6~57 ' Date Application No, on file N THIS CERTIFIES THAT 121321 ,~outao ld L,:_* ' ' and found to be in compliance ~ith the requirements of this Board. ,, ..., ~ ,u,....o,o,, ,.,.,,,u,..._, .,,,~~ ;P~IALREC'PT MECLOCKS B UNIT HEATERS MULTI-OUT~T SERVI~ DI~ONNECT NO. Of S R V I C E METER OTHER APPARATUS: COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM Address~.~;~.~[~,~e~Q~zt(L%tqT( 6. Section 2. Pr~pperty location~%~~ ~6~[~, 7. Lot No. ~ ~-~o~J~ %~q~ ' 8. Private well Village~ Township~-~¢ ~_ 9. Public water 3. Public Water Company name ~' Distance to main 4. Lot size: Width feet Length ,feet (E~ter on center plot below) 10. Sewage Disposa~-~ystem: A. ~0~ gallon septic tank:~-"precast~~'6~Bl°ck cial ~recast ~_~_~uivalents_~Block B. ~ching pools: Number Street If private well fill in blanks below: Tank capacity Gals. Tot~l ~depth__ Depth to G.W. Amount of water in well Test Hole Data Feet 0 2 4 6 8 10 12 14 16 18 The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current stand- ar ds thereto." ~w/~ner~or~~ Date Signed 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 ~?~'//----L/7 -3 Signed EXCkVA110N S-15 Revised 4/1/72