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Home My WebLink About6631-zFO~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificale Of Occupancy No. Z~0.~6 ...... Date ................ A~ .... ~0..., 19. THIS CERTIFIES that the building located at .. E/S. ~.p.*~ .DI'~ ...... Street Map No.~a~e~. ~o~ck No ........... Lot No.. ~.~ ...... ~ou. th~ld...~,~., ...... confoms subst~tially to the Application for B~ld~g Permit heretofore filed ~ t~s office dated ............ j~e .. 3.., 19 '73' p~suant to which B~lding Pemit No...~.%~ dated ......... J.~s.. ~ ..... , 19.7~', was issued, ~d conforms to ~ of the req~e- ments of the applicable pro~sions of the law. The occup~cy for which t~ certificate issued is .. Pr.~vat~ .o~e..~. d~ll~g ...... .(appr~d. hy.~ .App~.a~)... The certificate is issued to . .~r~lX .~ ..... ~. ......................... (owner, lessee or ten,t) of the aforesEd buildEg. Suffolk Cowry Department of He~ Approv~ .... April .~. ~ 9.7~.. b~. R,..M~i~. UNDERWRITERS CERTIFICATE No..pe~ng ................................... HOUSE NUMBER .... 8~.~ ...... S~eet ..... Ship's. D~ive ....................... B~ding Inspector FOR3~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER~IT fi.HIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPL~ION OF THE WORK AUTHORIZED) N? 6631 Z Date ....................... ,T~lae ....... .~ ............. , 19..~[~. Permission is hereby granted to: .......... S~thol& ......... I~.,.Y.,, ............................... to ..~tlO,..a~...o~e..~e~t/t~..dwetll~g .................................................................................. at premises located at ..;t,,.g~....'t3....~a3~;Lew...l~pod~..~a.'ts~,eL.£Y~.~.~2O.) ................................. .................................... ..s~....~.!..s....~ ~.$..~.,. ......... ..s..o..u.t~,],~,.....~.,.~..,. .................................................... pursuant to application dated ...........................~m~t ....... ~ ......... , 19.~.3..., and approved ~by the Building Inspector. 'Fee ,. .6. 2. ... ............ ~J~MtT INCLUDES IkPFROVAL ?~O R£,~tQVE EXCESS FiLL :,gROM ABOVE PREMISES BY REGRACIS~tG LC~T / DRIVEVV^¥ CON' TRUC¥10N ~ CESSPOOL CC, NS', RLICTION / CELLAR CGNSTRUC'ilON / OTHER ~ 'g'~"" BJil'~i'~,'9 Inspector SUFFOLK COUNTY DEPARTMENT OF HEALTH '~ H.D. Reference No. -- APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM/~~ ~Z~ 1. Applicant ~-3~(~ c~f~~dm'~' Phone 5. Subdiv. Address ~ ~ ~t~ ~z~ ,MJ,,~---'---6. Section ~ 2. Property location 7. Lot No. ~ ~ 8. Private well ~ ~ Village , ~T~ Township C~IP 9. Public water z~ 3. Public Water Companj name _ Distance to main 4. Lot size: Wid~ /[~ feet Length ~/~ .feet (Enter on center plot below) i0. Sewage Dispo~ystem: / A. f~0Q; gallon septic tank: ~recast Equivalent Block B. ~ching pools: Number Precast~lock ~cial N If private well fill in blanks below: Tank capa¢ity~Gals Total well depth~ Depth to G.W.~ Amount of water in well Test Hole Data ii Feet ~=1 0 ~o I 2 8 I l0 I 16 I 18 The unde~tgned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Depart~ t of ea 's~~nt ~and- ards thereto." Date / ~ Signed .,~...-'"--- - or Builde~.~ Owner ~..~. ,, FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, i~ is the opinion of the ,Health Department, that an adequate and satisfactory Sewz Disposal System can be installed on this plot. Date .~/~? Signed C ~ ~ _ S- 15/ Rew~smd 4/~/72 The sewage disposal and water s~t~ply facilities for .thi~ loca%ion l~a~e been .. -Chle~ of genera~ E~i~' Se~Ice~ fORM NO. I /~,, TOWN OF SOUTHOLD ~-;~'- 73 .~.~-- ~,, ,/ BUILDING DEPARTMENT~z~ TOWN CLERK'S OFFICE~./~.7-5 .,~.~,, /:./~, ,/~,,,,. ,,~/~(,--,,~/'p~ ~omined ....................... , ~,...~.... /, _ /~.~~,,~,~ No.~..:..~.....~. ............ :. ~,~., ............... . ,,..cz ,.,,,,o...~.~....~z...~ .... 1 ........................... ~ ............. ~ ......... ~-~..~~~~ .. ...................... ........ ...... ...... . ......... .......................... ~, .................. .~g~.~ .......... , ~.~....~ a. Thi~ a~limtion ,mu~t ~ ~mpl*tal~ fiHod in ~ t~riter or in ink and ~ubmitt~d in td~licate to tbe Buildin~ Inspector, 3 ~t~ of ~lan~, a~urat~ plot ~lan to ~cal~. ~ a~ordin~ to scbedul~. b. ~lot ~lan ~howin~ location of lot and of buildings on pmmi~, r~lation*hi~ to adjoinin~ pr*mi~ or ~ublic ~tm~t~ or ~r~a~, and ~i~in~ ~ d~t~il*d d~scription of I~out of ~ro~rt~ mu~t ~ dr~n on di~r*m which i~ ~ of thi~ application. e. Tbe wo~ m~r~d b~ thi* application ma~ not ~ comm~nmd ~for~ i~*uan~ of Buildin~ ~*rmit. d. ~n a~ro~l Of thi~ ~lication, the 8uildin~ In~or will i~u~ th~ pr~mim~ ~*il~bl~ for in~etion throughout th~ ~ork. ,~. ~o buildin~ ~hall ~ oeeu~i~d or u*~d in whol~ or in ~rt for an~ ~mn~ b~ th~ Buildin~ In~or. APPLICATION 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 otber 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 com~oly with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors On ~lll~ry inspections. State whether applicant is owner, lessee, agent, architect, engin~r, general contractor, electrician, plumber or builder;, ............................................... .~.~,mr~.~....~F'.,~,~.~,z-.~..,~......... .................................................................... Name of owner of premises ............. Z~,,.~'~.~/~/,,....~/..~,~...~....~.... .................................................................... If appljllant~is a corpo~te~signature~f duly authori~:ltd offi,ce.r. ....... (Name an~,~ of corp~ate officer) 1. Location of land on which proposed work will be done. Map No.: Lot No .......... ./.....'~... ........................... Street and Number, ........ ..~....~..ff.~...~...~..~....l~..~.......,,...,.,, ........ .~.~.,~..~.~.../::..~. .......... , ......................................... Municipality 2. State existing use and occupancy of premises and intended use a~d OCcupancy of proposed construction: a. Existing use and occupancy .................................................................................................................................... b. Intended use and occupancy ....... ..~..~../.~..~..~..~.....:~.v4ff, Jf/..tr.~.......~..~.../.~2...&~...~..~___~ ........................................... ' 3. Nature of ~vork (check which applicable): New Building .................. Addition ..................... Alteration..'. ......... .-.. Repair ........................ . Removal ... ...... ................ Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost ............... ~ .......................Fee ....... :.......--~.. .......................................................................... (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 ................. , .......................................................................................................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use ........ , ............................ 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. Dimensions of entire new construction: Front ....... .,~2..~...~ ........ Rear ....... .~..~.. ............. Depth ......~.~....~. ................. Height ................................................. Number of Stories ...........~.. ........................................................................... 9.' Size of lot: 'Front ......;...~..~/~..~.. ....... Rear ............ ../...~......~.. .................. Depth /~ /~ '~ Height Number of Stories ................................................................ 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ Zone or usa district in which premises are situated ..................................................................................................... 11. 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................................................ · 13. Will lot be regraded ...... Y~'~-~ ...................... Will excess fjll be removed from premise~: [ ] Yes 14. Name of Owner of prem.'sas ....... ~/~[l~.~'..~.,a~ ....... ~.,,~.. ....... ~-~.~......~....' .~....~ (AddresH (Phone No.) Name of Architect ..................................................................................................................................................... ~ (Address) (Phone No.) Name of Contractor ............ ~.~r.~.....~,a,~.~.~::::~ .~.t~,J....~.., ........ ~'~.~?/"~.~.0. ....... .~....~.~../~..~.. .......... (Address) (Phone No.) PLOT DIAGRAM ,' Locate c early and distinctly all buildings, whether existing or proposed, and indicate all sat-beck dimensions from pr~' linesl Give street and block ~umbe~ or description according to deed, and show street names and indicate wheth- er interior or.corner lot. STATE OF NEW YOR~ .~_. ~ j ) COUNTY OF ............ ~//~C¥~.~..~__ ~' ............. ). _~- ........ .~....~.....~&~...~.~ ~. ,~L.....~.. '"'....~...~.....~-~. z. ............. being duly sworn, deposes and says that he is the applicant above named. (Name~ in~ c, n'f ' d' 'd~ si~ing o ~act) ~ .~ ,~be ........................ ~.~......~......~r~.,x~,....~ ................. ,. ........... : ........ : ................................... (~n~ctor, agent, cor~te officer, etc.} of said owner or owners, and is duly authoriz*d to ~rform or have ~rform~d tbe said work and to maka and fil~ this ap~limtion; that all statements contained in this application are trua to t~ ~st of his knowlad~ and ~lief; and that the work Will ~ ~orm~ in tbe ~t forth in tbe application filad t~rew~h. ................................. ........... ...................... ..... ................................... ............................... ...... ..................................... ' (S~m~ of ap~t} .' . zL4Z APPROVED AS NOTED DATE: ~'-'-'.~- NOTIFY IUILDING DEPARTMENT Al' 765-266D 9AM TO 'CPM FQP, REQUIB. ED INSPECTIONS: 1. BEFORE BACKFILLING FOUNDA- TION OR START FRAMING ~. BEFORE COVERING PIPELINE 3. FINAL WHEN JOl COMPLETED