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Home My WebLink About6441-z FORUM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. Z6308 ...... Date ...... ....... ~tnua.~'.. 21., 19..~.~ THIS CERTIFIES that the building located at ...~./$..~.~$.e.~..~y~. ........ Street Map No..Xx ......... Block No..~ ....... Lot No.. X:~ .... l~Mt.~J,~;V0k..~.,X; ...... conforms substantially to the Application £or Building Permit heretofore filed in this office dated ............ ~are,h...~2 19.7.~. pursuant to which Building Permit No..(:~.~]g. dated .......... ~ar.. ~27 .... , 197.~.., was issued, and conforms to all o£ the require- ments o£ the applicable provisions of the law. The occupancy for which this certificate is issued is . · PrS.~a~e..one..£~i~. ~l~.~],].ing ...................................... The certificate is issued to .~.o~n..~. (owner, lessee or tenant) o~ the a~oresaid building. Suffolk County Department of Health Approval .................................... UNDERWRITERS CERTIFICATE No..~I.1.9.~.~ 7 ..... I)'~'0'.. ~ 3... ~ 9.7.~. .............. HOUSE NUMBER ..... .~'.6.Q ..... Street ..... ~ .uri. s.!t.. AY.~. ......................... FOI~I NO. ~ 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) Ne 6441 Z ~r 27. 73 Date 19 Permission is hereby granted to: · J. oh~ .. 6¢..t~t~ ry.. i% drcr ..................................... ........ -1'9%-',,'-'0~ ....... 3'Tt~"-~ve .......................... ........... ~'l~s~ft~g ....... ~} ~ ~'~'""11'3~8'"' ............. to[h~J.l~ ..~w...oge ..£~a~A l,.. ~w,tt.~.m~ ....... (. £.~re~.-.~-~z -- ~*tr~7.. ~.--..f-~.m~-s~.mg.-o£... ...se~o~.. ~:lao~...~.~.tt... ~eq .~.e.. ~elet ~.~.~ o n~ '~' · .p ~Jz t;~' ................................................... ot premises located at ..... [~'./.~L..8t~....At/-e ..................................................................................... ................................................ :~a.tt Ltue.k.~...tto.¥, ...................... '- ............. ; ....................................... pursuant to application dated ......................~O~ ....... ¢'2 ....... L, 19.~..., and approved by the Building Inspector. ~]O~J~l check average se%back, Fee $.g.~.~lO ........... : ......... ........................ Building Inspector/ FORM NO. $ TOWH OF $OUTHOLD BuildinB Depoffment Town Clerks Office $outhold, 14. Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building tnspector with the following; for new buildings ar new 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal--($-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple ReJsidences 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), Nomconforming 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, o~cupancy 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 ' / .~....~..~ New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property,~..~..~.~.~/~../~...-~... ,.~T././..~,...ZT.'/.~.:..~-.~.. '~"//'~'...'~'"'~"~"~'~"~Z"~'"~:"~'"~/~4 Owner Or ~ners Of Property ~.~.~..~..~.~.~.~ .......................................... .,....... .. Subdivision ................................................................ Lot No .......... ~.. Block No ............. House No ............. Permit No.~..+/.~J~. Date Of Permit ...~.~.Appllcant ...J~.~6t..~.~..~ ........ Heath Dept. Approval ...Z~.~ ................ Labor Dept. XpprovaJ ................................................ Underwriters ~pprova' .. Z../Z~.~. ............. Planning Board Approval ........................................ Request For Tempora~ Ce~ificate u ...................................... Final Certificate .......~ ........................... Fee Submitted $ ~ ...................... ~.:._~- / ' ~C.'~ ~ ~: ~ ~ Construction on above described bui ding and perm,t meets ~h appl~able c~es and regulations. Apphcant ......... ~ ............... day of Notary P$kblic .....~'.....¥~.... County L\ (stamp or seal)~.,,20 0C~ SUFFOLK COUNTY DEPARTMENT OF HEALTH H,D. Reference No. ~-/t~ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM Address/Q.~ c~Y~/~f-~ /~-~///~/d,,/~/'~ //-~ 6. Section Village~'~f~ .Town~)~ip S~'~f/~ 9. Public water : 3. Public Water Company~name /~ ~ ~, Distance to main.~ 4. Lot size: Width~l~ feet Length/~/~/feet (~nter on center plot below) ~10. Sewage Dispos~ystem: A. /900/gallon septic tank: Precast ~E~uivalent Block /f~ ~ Street~ The undersigned CERTIFIES: be in accordance with ards thereto." FOR HEALTH DEPARTMENT USE 0NLY.'Based oD is the opinion of the ~ealth Department, Disposal Syste~ can be installed on this Date If private well fill in blanks below: Tank capacity~/~Gals · Pump G.P.M. Total well depth Depth to G.W. ~ ~) Amount of water in well ~/~ Test Hole Data Feet 0 2 6 8 10 12 16 18 "Construction of~authorized installations will the Suffolk County Departmeht of Health's current stand- f ~ Owner or Builder the info~mation~resented herewith, it that an ~dequate and satisfactory Sewage plot. 9.//~//~ __ Signed S-15 Revised 4/]/72 I l _J APPROVED AS NOTED DATE:_ "~/~'~- ~7 x?*) FZE: 025' ~ BY o/~7~t [NO11FY BUILDING DEPARTMENT AT 76E-2660 9AM TO 4PM FOR REQUIR. ED INSPECTIONS: ~. BEFORE BACKPILLING POUND,~,- TION OR START FRAMING 2. BEFORE COVERING PIP~LINE 3, FINAL WHEN JOB COMPLETED .T A DIVISION OF ~v~r~5 PRODUCTS COMPANY RESIDENCE FOR. 33~~ HIAWATHA AVE. _J 4721 EAST 14TH ST. DES MOINE~, IOWA 50313 RESIDENCE FOR CK,D DR'N DATE PLAN N~. I ~*-~ ¢¢~~'~'~r] / ~ I~* I', I- ....... %~-% .... ~% ........ 1~ ~ ~ ~ ~'~ SH~B 'q LEFT" DID~ ELgYATIOtd . 1 } E LEV~ION 3355 HtAV~A~HA AVE, MINNEAPOLIS, JVll biN, 55406 472;I EAST 14TH ST. DE~ MOINE$, IOWA DATE o~ ~? --3