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Home My WebLink About7550-zTOWN OF $OUTI'~OLD BUILDING DEPARTMENT TOWN CL£RK'S OFFICE SOUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED), % / permission is hereby §ranted to: ~.~.C~:~...(~.:...~.e..~ .o.r..e. ..................................... · .:?&.... ,~-~.~ oZ..~e:.. ~.~ .-:..v e .s... ~9~.~e~o.s .......... · ............. .~, ._'~ ~,~.~. · .~?.~ .~ ......... ~.,3: ......................... t~ U~,~,d...~,~, ..~ ~L~ ,~,~ i.o~L .,~ ..~ ;~is.~i~ g...~w.e~l~ g ..~ · .~e...~l~.~ ~ ~... ~.~ - .~.~ ~-. · et premises located at .~,e.~..-..2-~ .......... ~ee..-~ ....... T~eeen.~e.-~3he~,e-e ............ ; .............................. .......................................... ~oo~.£o.....N.-~ ....................... ~ .............. : ................................................. pursuant to opplicatJon dated .......................... ~'~'l; ....... ~i ........ , 19~br.;.., and approved by the Building Inspector. Fee $.1..~, C)O ............ Buildin~ ,Inspector * SUFFOLK QOUNTY DEPARTMENT O~ MEALTH H.D. Reference No. APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE. SEWAGE D~SPOSAL SYSTEM Public water Village ,Township 9. 3. Public Water Compa~n~name j~ .... - , Distance to main 4. Lot size: Width ~ feet Length, *~J :::feet (Enter on center plot below) 10. Sewage Dispos~ystem: ~r cast '~/E'quival nt Block~ : m. /~900~gallon septic tank:~P k~ ~ ~r~erecast ~-~Bloe~Z n~k~'~Lpecial . B. k-L~'aching pools: Number ~If .private well fill in blanks below: Tank capacity ~Gals. Depth t~G.W. Amount ~ wat~ in Test Hole Data ~x ~et 2 4 6 8 10 12 18 The undersigned ]ER%IFIES: "Constr'uctiofi~f~ authoeiMed installations will be in accordance with the Suffolk County Depart~e,nt of Hearth's curren~ stand- ards thereto." d~~ MY ~ Signed Owner or Bull FOR HEALTH DEPARTMENT USE ONLY. Based on the info'¥mation 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 Signed ~'- ~ 8-15 Revised~4/1/72'~ il FOR~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ~ k · x. ........................................ , Permit No. ~/q--J~O ~ Disapproved ~'(B~lding Inspector) APPLICATION FOR BUILDING PERMIT ................. ..... INSTRUCTIONS a. This application must be completely filled in by typewriter o¢ in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproperty must be drown 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 a 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. 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 other 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 comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises' and in buildings for necessary inspections. ............ : .................................................... (S~gnature of applicant, or name, if a corpO:rd'tion) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... . .~..~..(....~¢n~...~..z...~.'~...~.; .................................................................................................................................................. ................ I Name ofownerofpremses >:~. .~.. ff.:c:.~ :~ ~ ~ ~ ' ~ o ~, ~ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of la~d on which proposed w~r~ will b,e( done./~'tcp No.: ....................~..: .............. Lot No ....................... Street and N mber ...................'~.~..~..,~..~.~..~ ......... (-~,.~/..~-..~'.~..C,~ ................................................................. Municipality State existing use and occupancy of premises and intended use end occupancy of proposed construction: a. Exisiting use and occupancy ........... ..,¢/.~.,../..c,..¢..~.~...~ ................................................................................................ ~ ~//~,~ r ~.'~' ...... : ................................ b ntended use and occupancy /',?/_4,~.......~' ' .~.. ~..,.. ~.-.~ ~. ,~T .4:;-. ...... 3. Nature of work (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 ....................... ......Number of dwelling units on each floor ............................ If garage, number of cars ' ' 6. If business, commercial or mixed' .occupancy, specify natgre~and exten~ of each type 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 I Rear Depth ................................ Height ............................ Number of Stories ....~ ........................... 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ................ s~/.....~...~ ......................................................................................... 9. Size of lot: Front ................~.~.~...~.'....~.. ............. Rear ............. ~.~....~. .................... Depth ........ .~..J-..Z~ ............ 10. Date of Purchase ........................................................ Nome of ~rmer Owner ............ ......................................... 11. Zone or use district in which premises are situated ................./~./..~..~...~..~Z..¢.i...~..// ......... ¢~....~..X.'E....~..~'[ ........................... 12. Does proposed construction violate any zoning law, ordinance 0F regulation: .............. ~....~..~ ................................. 13. Will lot be regraded' . ...... ..~.....~..~ ......... Will excess flit be removed from premises: ( ) Yes (~) No ! 14. Nome of Owner of premises .................................................... Address ........ , ....................... Phone No ....................... ~ame of Architect .............................................................. Address ........ ~. ...................... Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from ,property lines. Give street and btock number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW ~Y4)RK, -, [ COUNTY OF ....~z,~-..~..f.?....~..~-...~ TM .................. ~./...~.4..-~,(~..'~...~.. ........ ~.~ff~.~.~.~ ....... being duly sworn, deposes and says that he is the applicam (Name of individual signing contract) a'bow~ named. He is the ~ ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application filed therewith. 'S' '~Z~: d;; t h°if~~~''''' 19~'~ NOTARy PUBLIC, Sfa~e of New Yor~ Cam m~l on Exp res March 30, .=v,s,o.s YOUNG & yOUNG dULYIg,1974 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG ru.~'~R: ' SURVEY HARRY SEYMOUR ~ ~ ~. LOT NO. 28," M~P N ~ 2 OF ~ECONIC SH~~