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Home My WebLink About7351-zFO~V~ NO. · TOWN OF SOUTHOLD BU~.BI~G DEPART~3k~T Town Clerk'g Office $outhold, N. Y. Certificate Of Occup;,ncy No. Z6383 ...... Date ............ ~farch .... 27 ...., 19. ~.~ THIS CERTIFIES that the building located at .. t%tthill' t,~e..~ ........ Street xxxx Road conforms substantially to the Application for Builrllng Permit heretofore filed in thi.~ office dated .......... r .Feb...il.., 19.~. pursuant to which Building Permit No..7.3~1Z · dated .......... L 'Jm~e'' '2~' ', 1~.., was issued, and conforms to an of the require- ments of the applicable provisions of the law. The occupancy for which thJ.~ certificate is The certificate is ' ~ued to . .La~i-mlee..Bre,~l, ....... 0~11~1, ....................... / . ,. (owner, lessee or tenant) of the ~resatd blffidins. Suffolk/~ounty//Dep ~a~nent of Health Approval 1~1'-..~1~.. '1-97~' · .by. R~ .Vi.l.$a ..... UND~i{i{WRITERS ¢ ,ERTIFICATE No..N. 19'~31 ..... D~a. ~;..1.971~ .... : ............ THE NEW YORK BOARD OF FIRE *UNDERWRITERS BUREAU OF ELB~"rRICfTY!r :'' , , 85 JOHN STREET, NEW YORK. NEW ~0RK T0038 THIS CE~IFIES THAT L.A. B~er~ w/slde Tu~111 Rd.. Yenneeott Pa~k~ Yenneoott D~, & ~ C~eek D~ve, Southold. ~0 SER~CE ~NN~T I ~. ~ ~ S R ,V ' I C "8~olal ~eoeptaele~z 1-50ampa.. 1-30amp,. 3020 Botsseau Ave., SOuthold, L.I. 11972 COpy FOR. BUILDING DEPARTMENT. THIS COPY OF CERTIFI~I' ~T BE ~TERED IN ANY~MANNER. FOEM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH*OLD, N:. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7351 Z Permission is hereby granted to: ~be ~ ...~wa stye s,t~...~/4~...L~wremee .- ~,e~e.~.. ........ 8~atho'l'd ..................................................... to ,bl~il~ --t~e1~ ..o~e-..~am~-].~'. · etwe-:~.~.~g ..................................................................................... at premises located at ..... ,'J~t~...3 ............ ~or~.~e~,o~.t,,,~'~ ............................................................. .............................................. ~t~h.i'Z~: ..'~a~xe .............. ~cr~t,t~o'~,~[ .................................................... pursuant to application dated ........................... ~e.~.....].]; ........... , 19.~.., and approved by the Building Inspector. SUFFOLK COUNTY DEPARTMENT OF'~ HEALTH ~,,~h Department ~'~e 'N~mber ~ L~./ - ,, A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY ,'~ Address 2. _PropQrl~y L. oc, ation~l lY-F~tli~ ~'~~d , . ', _ _ 8.~' Private We~ Villag~ A ~'~ ~ ~ Towns~ip~o~'~ ~ 3. Pub]j~c,,-W~t~r Comp~Name ~.~ )~0~ ~ ~/,D~stance to ~in 4. Lot size: Width~ feet ' ~10.~ Sewage Disposal System: ,, . allon septic tank: Precast ~quivale~t ' Block__ B. Leaching pools: Nbmber of pools! / · Precast~O~)Block Special If private well, fill in the fol 1 owing blanks: ,~ A. Tank capacity~__~gallons B. Piomp G.P.M./V~L~ '· ~C. T tal welloep~n D. Depth ~o ground water ,E. Amount o~ater~,!n well. ~ ll. The undersqgned.CERTIFIES. Construction of author~zed~nstal~lat~ons w~ll be in accord~ce with the Suffolk County Depart~eht of Health's cur~ht'standards, thereto,. Thi~s~]appt~i'¢~(ioD~ will be Valid for one year from the date of app6oval indicated below and may ~e renewed if a current local Building~Department Permit is in e¢~ect. Date " Signed~ FOR HEALTH DEPARTMENTUSE ONLY. Based'on the ~n'~ormation presented herewith, it is,the 'opinion-of the Health Department that an adequate and satisfacto~ Sewage Disposal System and Water Supply can be ~nstalled on this plot. ~PPROVALDATE~7/~ SIGNED S-15 Rev, ? . ' TOWN OF SOUTHOLD ~ /~ ' / ' BUILDING DEPARTMENT ~),~/~ ~/ ~ ~"-. ~ ~ - TO~N CLERK'S OFFICE ~ ~ ~ ~ ~K ~ ~ ... ~puCOtlon ~o ................................. ..... ...................................... ~e~t,o ............................. ~ ~ ~ ,~ ~e ~ Disapproved o/c ...... ~ ........................ ~.:.~..,.~. ~ ~ ~ ~/~ ............................................. ; ................................................ ~ ....... ~: ~ ~ ........................................................................ L---1' '~ -~" :~- --'-~=~ ~ D~te ...................... ~ .......... ~.~....., 19..~...,~ INSTRU~IONS o. lhis application mu~t be compl~t*ly fill~ in by ~pawriter o~ in i~k ~nd ~mi~d in tripllc~l~ to ~* Inspector, wilh ~ ~*t* o{ pl~n~, ~ocumt~ pl~ plan to ~1~. F~ ~oco~in~ to ~h~ule. b. P~ot plon *howino Iocofion of lot ond o{ buildings on premises, r~lotion~hlp to od~oinin~ pr~mi~o~ or public ore,s, ~nd ~ivin~ ~ detoil~ d~cription o~ layout ofprop~ must b~ drawn on th~ dio~rom which i~ ~ o{ thi~ ~pplicotion. c. Tho work cowr~d by thi~ ~licotion moy not b~ commemed b~{ore i~su~nce o{ Buildin~ ~rmit. d. ~pon ~ppmval o{ this ~pplication, ~ Buildin0 Inspector will issue * Buildin~ ~ermit to th~ ~pplic~nt. Such sh~ll bo kept on th* pr~mis~ owil~bl~ {or in~paction throughout th~ work. e. ~o buildino ~h~ll b~ ~cupi~d or u~d in whole or in part {or ony pu~o*~ whatever until ~ Cedi{ic~t~ o{ ~h~ll hove been ~mnt~d ~ th~ Bu~ldin~ Inspector. A~[I~TIO~ IS HER[BY ~D[ to th~ Buildin~ D~pa~ment {or the issuance o{ ~ Buildin0 ~rmit pumu~nt Buildino Zeno Ordin~nc~ of th~ lown of ~utho~d, Suffolk County, ~ew York, ~nd other applic~bl~ ~w*, R~oulotions, for th~ con~tru~ion o{ building,, ~dd~tion~ or ~It*rations, or {or r~mowl or d~molifion, ~ h~min The opplicont ~r~es to comply with all opplicable I~, ordinance*, bulldino c~, hou~inO c~, ~nd odmit outhorizod in~pecto~ ~ premis~ ~nd i~ buildln~, ~r n~ i~fion~. ....... ................................................. . . ..... .......................... .............. (Addre~ o{ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Builder Flame of owner of premises ........ ~a. lJ~A~...$,~.¢t~. ....................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No .............. ..~..~..v....~....]. ................ Electrician's 'icense Flo Other Trade's License Flo ............................................... Location of land on which proposed work will be done. Map No.: ...... ~..e...l~....e.~.~.t..~..~ ..... Lot No...~ ................... Street and Number ...... ~L'~l.~]:l.~l.]...~alqel...~.~,¢l.~ .......... ~l:tu.thD~.~....~T.~'.,. ........................................................ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy vacant b. Intended use and occupancy ...... oz~e..famtd~...~ell:Lu$ ............................................................................ ai ~ if 3. N ute, work (cl~ed~-,~which applicable): New Building ....1[:~,~ ....... Addition .................. Alteration ......... ; ....... Repair;,: ................. Removal .................. Demolition .................... Other Work ............................................. ~ ..... ~ ,~-- (Description) 4. Estimated Cost .................. ~3.~.q.O~....-+. ................... Fee ..... . ......................................................... .~..~ ; ....... (to be paid on filing this application) 5. If dwelling, number of dwelling units ,....o...~..e. ................. Number of dwelling units on each floor ........................... If garage, number of cars ............ .o.~..e. .......................................................................................................................... 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 ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .......6.2 ........................ Rear .......... 4.2 ............. Depth ....... 2.~. ............ Height .................... Number of Stories .1[~. ............................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of, Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises ore situated ..!!~!]...¢L;:],.8..1;;. ............................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............. ~.g ....................................... 13. Will lot be regraded ....... ~.~ ............. Will excess fill be removed from premises: ( ) Yes (~) No 14. Name of Owner of premises ]4~.~..~,g.e.,.~.~.e.~..~.:¢. ............... Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ..~...e..o,....~.~.8:..S..~..e...s.~..$. ........................... Address .......~...o..~..~..~...o.~.~.. ...... Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly oil 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, STA-FE OF NEW Y~RK ~, I S S COUNTY OF ....... ~?...~..o..J....~. ........ f . ............................... ~,(~.~..~t.~(~,~;],. .................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contrac¢) ebove 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 ali statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Swam to before me this ......... ........ ...... , A/,,, , Notary Public .~~~ O~'~ty .... ~)"~:~"i ...................................... (S gnature of opp cant) JUDITH T. BOKEN jsJ0J~iW Public, Sfafo of New York No, 52-0344963 Suffolk County~/~j~'~ Commi~sion Expi~'e~/~,~r¢~ 30,' 19.,.~/ i~' I TC Ft EN /0 'O t,