The URL can be used to link to this page

Home My WebLink About6434-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPAHTMEI~iT Town Clerk's Office Southold, N. Y. Cerfi icnte Occupnncy No. Z6989 Date April 26 76 .... · .. .... · ..... i.... ............. ,... 19. THIS CERTIFIES that the building located at Jaek~ LapdOg Roa~l .... .... : ... .... -..., ........ Street Map No. JaOkson.% .~ck Ko ........... Lot No, ~ .... ~ttituek conforms substantially to the Application for Building Permit here[ofore filed in this office dated ............. ~a~eh...~a9.7~. pursuant to which Building Permit No. dated ............ ~a~h.. 2~, 19. ~, was issued, ~d conforms to all of the require- ments of the applicable provisions of the law. The occUPancy for which this certificate issued is . Pr. iraqi .~..!~$~. ~$1~S ......... .............................. The certificate is issued to .. ~.~b~ .R9~9 ..... (o~ner, lessee or ten,t) of the aforesaid building, Suffolk County Department of Health Approval . AP~...~9~..~ .~?~,~ ...... UNDERWRITERS C~TIFICATE No. ~$J~J ~a~ 21 1 HOUSE NUMBER . .. ~.~.7.5 ...... Street .... ;~.ek~9!a..I~.~..i.n.~..R.o.a.d .............. · ' ' Building Inspecto-~ FOR,~ NO. 2 TOWIq OP SOUTHOLD BUILDING DEPARTMEIqT 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? 6434 Z Permission is hereby granted to: pursuont to opplicotlon doted ....................................................... ',, ] ., ond oppreved by the Building Inspector. Fee $ ........................ Building Inspector. 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / ~-~r~'i~L REMARKS: FOP. M NO. 6 TOWN OF SOUTHOLD , Building 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 DUPLICATE 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 seW~erage dlsposol--(S-9 form or equal)· 3, Approval of electrical installation from Board of Fire U~derwriters 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from thle 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 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 Dote ...~.P. P,,i.~...~....~.1..~ ~..(~ ..... New BHilding ......~... ..... Addition ................ Old or Pre-existing Building ................ Vocont Lend .............. Location Of Property ~47.,~.. ~.,~.~...~,~-~o.~'..~ ~,~nJ~, ~.~,., Owner Or Owners Of Property ...~,.c.M~-,~.....~.:..~.~R~,t~.~,~.~-,.....jJ..~,..,~.~*~-~,¢:~ .................................... Subdivision ...~.A~/~-~.l~t....~,~t~.~.t~.~.~SO. Lot No.....~.~,.. Block No ............. House No...~ Permit No. ,~.~.~.. Date Of Permit :~:~.~:.'~.,Applicant ..;~.J......~.~.~.~ .......................... Health ~pt. Approval ............................................ Labor ~t. Approval ................................................ Underwriters Approval .............................................. Planning B~rd Approval ........................................ Request For Tempora~ Ce~ificate ........................................ Fin~ Ce~ificate .......................................... Fee Submitted $ .~ ............................. Construction on above described building and permit meets all !pplicab e codes and regulations. _-O Ap p I, c ant ~. ~.~.~.~;~ .~.....~£ ~/v~,~. ~. :. ~.V~L~,O ........... Sworn to before me this Notary Public ...... .~/~./C. County // FORM NO. 5 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD~ N. Y. ORDER TO REMEDY VIOLATION · o .... (owner or a~thorized qgent of ewner)~ (address of owner o;'~thorized a~;;;'bf PLEASE TAKE NOTICE there exisfs o violation o(: Zoning Ordinance Other ~pplic~ble L~w~, Ordinances or Regulations ~t premises hereinoffer described in thor .. ~ (Store chorocter o~ violotion) ...... . ....................... ................. ............................................................ ,n v~o~tio, of .~..~.~.~.::...~.tf~...~.~..... ~':.....'~....CC~-:~.::.~.~.~.~L.:. ........... (State section or paragraph of applicable law, ordinance or regulation) YOU ARE THEREFORE DIRECTED AND ORDERED to comPly.,with the law and to remedy the conditions above mentioned forthwith on or before the .......... ~""~t~ .............................. d~y of ........................ ,...... ........................ The/premises to which this gRDER T? REMEDY VIOLATION refers are situated at /,.-/~_5"/~ ~ ~.~ .~f. ~ .~ ~/~ ~ .'~ Failure to remedy the conditions aforesaid and to comp y w th the epplicable provisions of law may constitute an offense punishable by fine or imprisonment or both. SUFFOLK COUNTY DEPARTMENT OF HEALTH H~D. Reference APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM Applicant. ~,~ ~q ~ ~ ~ ~o;~A~o Ph ~- Z ~6-~ ~.~S ub d iv · Address ~1 ~ F~'? ~. ~A~; [~, --6' Section 2. Property location ~ ~l~/~o~i~ ~ ~l~l~=_~. Lot No. / ~ ~UFFOl ,c C~o~Tf /~AP ~, ~Z~o___8. Private well__~_~ Village ~l'F~Township ~TMO~O 9. Public water ~O Distance to main ~ 3. Public W~ter Comp~name.~-~ 4. Lot size. Width,~eet, Len~t~.~ feet ~Enter on center plot below) ~10. Sewage Dispos~yste~~z~-~z~v~ ~-z~-,~m'--lgo, eo: A. /900/ gallon sep[ic tank: Precast ~Equtvalent Block poo . Street The undersigned CERTIFIES: "Construction ofl authorized be in accordance with ards thereto." Date the If private well flll in blanks below: Tank capacity ~_C~Gals. Pump G.P.M. ~ Total well depth Depth to G.W. Amount of water in well Test Hole Data Feet 0 2 4 6 8 10 12 14 16 18 installations will Suffolk County Department of Health's current stand- ~ Owner or Builder / FOR HEALTH DEPARTMENT USE ONLY. Based is the op'inion of the ~Health Department, Disposal System can be installed Date~/ ~ .~ the info~rmation presented herewith, it that an adequate and satisfactory Sewage on this plot. S-15 Revised 4/]/72