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Home My WebLink About7656-zTOWN OF $OUTHOLD BI.m.nING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~Q..~ ...... Date .............. .Al~.r$.l...] ~..., 197~.. THIS CERTIFIES that the building located at..~4L..J&.e.$. . .I~Re.. ............. Street Map No..~..~.~..~.~...E.~loek No ........... Lot No..3 .... .l~..~..~'.~..~,....ll.e.~. ? ......... conforms substantially to the Application for BuilclJng Permit heretofore filed in thl. o/~ice dated ............ .D.e..e...9..., 19~.. pursuant to which Bul]di,g Permit No. ~..~..Z.. dated ............D.e.q.. J.0...., 19..~.., was issued, and conforiz~s to all of the require- ments of the applicable provisions of the law. The occupancy for which thi.~ certificate is issued is...~..Lv.a.~.~., p..ne., .~..~,. ~V.eLz..~.~ ...................................... ~ne eertifieato is issued to .. go..~.~.~..~la~..~...~.t~....o~er~ ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .Ap.r..~.~...1. ~..~.9.?~ ................... UNDERWRITERS CERTIFICATE No.. ~.e.n..d.~. ~ .................................. HOUSE NUMBER ..... 9.8.~ ...... Street ..... .E.i.~J.~..t.a.. ~ ..~. .................... TOWN OF SouTHoLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, Nh Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7656 Z Permission is hereby granted to: .-~eeepJt.. &..Gl~b~ee~-." ~]~p~ .............. - ................. Pee~n.~e .............................................. to ~..~.d....~--~..£~.~ ):~ett'~tg at premises located at .,Z*O~-?.~ ....... ~][,'~';Jl~'~'S-'J~e~f~Ji,'""'~ ................ ~ ....................................... ............................................. li}~..~a~z s ~ · · ~,:a~e ........... t~ ~,-t~:t~tte~. --'-l~'rY', .................................... pursuant to application dated .............. j)i~l~.....;.~) .......... :.;: .......... , 19t~(..~yand approved by the Building Inspector. ~'- Fee $'~'9~'3~ ........... FORM NO. 3 TOWN~ OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. NOTICE OF DISAPPROVAL ............... .~..t.~.l...t.~.k.....z~.:.~.:. ............................ PLEASE TAKE NOTICE that your application dated ................... ~eQ ............9 ........... , 19..~1,.. for permit to construct ...~,,.~.,e,~.~..~.~ .................. ~t the premises located at .................................... ...... ~! .~. ~. J, .~. · .h..I. :~:.., .~, ,;."~ .Zt..~ ................................ Street Map .....E...]:~..~.,a...~.....,~..~, ..... Block ............................................ Lot .~ ............................................ is ~ disapproved on the following grounds ..... ]]lei~del~,l~,~e..l~,~.~,..o~ ......... ...~.o...n..e~....~..o....~... f. ~t.~. ~.l.~_c .e...c~mh.e~. ............................................................................. ..... ..A.~.~.~.e.....Z.'..V....,...e. mt.:t..o..~...~.?.!.~.!....A........o.~.. ~.~.~.~ .l. ~...~.~e ................................................... SUFFOLK~GOUNT~Y DEPARTMENT OF HEALTH SERVICES Health Services Reference Number~S~ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Appl ica~t~,~.~?.OYx O. ~,.~r~o Phone~e~4,-~°~:~t°~ 5. Subdiv. ~ Address~ ~ec~ ~ .~c~.~_u kk~<~ ,~ 6. ~Section-'~ 2. ,Property Lo6ation~kL~'~ ~e, '~e~ ~&'L~ ,OL~ 7. Lot Numbe~ [~.~C~c ~ ~'~ ~ ~k'~L~h~s ~ ] ' '8. Private Wel'l~ Village~i~_ ' ToWnship ~o&~ok~ 9. Public Water~o 3. Public Water Company Name Distance to main 4. Lot size: Width~O feet Length~.~qfeet 10. 11. Sewage Disposal System: A. /~O~-gallon septic tank: Precast r_~quivalent_. .Block B. Leaching pools: Number of pools ~ Precast~, oo Block Special If private well, fill in the fol- lowing blanks: A. Tank capacity ~gallons B. Pump~ G.P.M. ~ C. Total well depth. D. Depth to ground water E. Amount of water in well (For Health Services Dept. Use) The undersigned CERTIFIES: "Construction of authorized installations wi, ll be in ~ccordance with the Suffolk County Department of Health Services' current standards thereto." This application will be valid for one year from the date of approval indicated below and may be renewed if a current local Building Department Permit is in effect. Date Signed~m~ .~ ~ ~ .~.~~~ ~~~~~~~~-.A;-~ FOR THE DEPARTMENT OF HEALTH SERVICES~ USE ONLY. Based on the information presented here- with, it is the opinion of the Department of Health Services that ~n adequate and satis- factory Sewage Disposal System and Water Supply can be installed on this plot. APPROVAL DATE ~/~/~?~ SIGNED S-15 Rev. 4/1/73 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~639~. ...... Date ............. AI)~.~..~......8. .... , 19. THIS CERTIFIES that the building located at .]~42.~a. ~..Lam ............. Street Map No.E. li~a~t, Eg~;Block No ........... Lot No, ...~ ..... l~attl~t~l~lk..I~,~, ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. I~e .... 9" 19~. pursuant to which Building Permit No. dated ......... De~.. ]0 ..... , 19.7~., 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 . .lOl~.~.t~. 0t~. fal~t.~ .~[~.l.~t~lg ...................................... The certificate is issued to . J°Z~gh. 81~,l~la~ .&. lgi~;f®. · 0~t~ol~ .................... (owner, lessee or tenant) of the aforesaid building· Suffolk County Department of Health Approval . .~fJ~..~81111~~. ................... UNDERWRITERS CERTIFICATE No..l~®l~l~ll~ ................................... HOUSE NUMBER ...9i~ ........ Street .. l~ait*.li .Ltltt~ ........................ .......... Building Inspectorf IUII,~IN~ I~ITIi41NT~-' ~.,,..,,~../,a-,, Examined ....................... ~, ........ 19...?,,,:/ ,4~oplJcotion No .......... ................... , ...................... ,,,. Oisopproved ale ..................... , ............. · / ............................................................ .............................................................. .............. ...................... AFPLICATION FOR BUILDING~E[~;~ Oot .......... '.. a. This a~fication must ~ complexly fill~ in by ~ter oe in Insp~tor, with 3 ~ of pl~s, a~mte pl~ plan ~ ~le. F~ acco~ing to ~h~ule. b. Plot plan showing location of lot and of bu dings on premises, relationship to adjoining premises or pu~. lic streets or areas, and giving a detailed description of layout ofpraperty must be drawn on the diagram which is part of th~s 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~wiU issue a'Building Perrfl/t 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 Build ng Department for the issuance of a Building Permit pursu,.ant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construchon of buddings, additions or alterations, or for removal or demolition, as hereih described. The applicant agrees to comply with all applicable laws, ordinanCes, building code, housing code, and regulatior% and to admit authorized inspectors on premises croci in buildings for necessary inspections. (Signature of applicant, or frame, if a corporation) (Address of applicant) State whether applicant Js owner, lessee, ogent~ architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ............... ,~~...,~/dp~d~,~l¢~ ........................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. ~ ............ Plumber's License Electrician's License Other Trade's License No ............................................... Location of land on which proposed work will be done. AAop No.: ........................................ Lot NO: ..... :~. ............ Street and Number ~//..~ l...I....,'..L.C.~ .................................. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy b. Intended use and occupancy .~.;/.~.~ ...................................................................... ; ................ 3. Nature of work (check whic,h applicable): New Building'. ................. V' Addition .................. Alteration ................ Repair .................. Removal .................. Demolition ................... Other Work ..................................................... '~c>~ ~ ~ F _~.~ (Description) 4. ~timoted Cost ............... ~. .......................................... ee ....................................... (to be paid on filing this application) S. If dwelling, number of dwelling units I~, Number of dwelling units on each floor If garage, number of cars ............. ~ ................................................................................ ~ ..................... 6. If business, commercial or mixed occupancy, specify nature and extent 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 ....................................Rea~, ............................ Depth ................................ Height .......................... ..N,u,,mber of Stories ....... ' ........... ~ ............ 8. Dimensions of entire new construction: Front ...... ..~....~... ................... .. Rear ..... ..~...~... ............. Depth .....~.....~...~. ....... Height .................... Number of Stories .................. ~ ................................................................................................ 9, Si~e of lot: Front ........................................................ Rear .......................................... Depth .................. : ............. 10. Dote of Purchase ........................................................ blame~of Former Owner ........................................................ 1 I.' Zone or use district in which premises are situatecJ ........... ~..~..../...~...~'s~...~'~'...~..~....~ .......................................... 12. Does proposed construction violate any zoning law, ordinance or regulahon: ........................................................ 13. Will lot be regrdded ....... ~,,;;j~, .......Will,..eT/ess fill be removed from premises: ( ) Yes (v/J No ~' · ~'J~,,3e~, '~.'v/' A r ,~c~o~-44~z,o Ph ~.,~..,~',.~.~' 14: Name of Owner of premises ...... .~.~.....~..~......~/~ ............ddess ................................ oneNo ................~. Name of Architect ..... ../~....:.~..~....'~-.. .............................. Address ................................ Phone No. ~....6...~?....,'~....~...~'. Name of Contractor ...... ress ................................ 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 block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW ¥C~RJ~,/, ..... COUNTY OF ' ................................................................................................. being duly sworn, deposes and says that he is the applicanl (Name of individual signing contracf) above 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 tha~ the work will be performed in the manner set forth in the application filed therewith. Sworn to beJore me this Notary Publi~31C~,~:~P-,~...~.~Cou ty .... -~ ..... ,~.. ~ ....................... ~ - " (Signature of opplicant]~ JUDITH T. BOKEN N~tary Public, Stare of New York No §2-0344?63 Suffolk Count[ The se~a~e ~,~-, ...... to be Chief' of Genopal E:~fsir2eer L / · = MON~MEN~ REVISIONS M~rz7Tuck · SOU THOL 0 SUFFOLK CO., N~Y. G: ARANTEED TO: ~'~' rlr~e o/v/s/oN OF ;7Z£ CO. ~RH~AD SAVINGS BANK 1975 ,/: APPROVED AS NO, TEDL DATE: FEE: NOTiFy BUILDING OEPARTMENT ~, 765-2660 9AM TO 4PM FOR REQUIk, ED INSPECTIONS; ,,,, NOTED,