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Home My WebLink About7409-zTOWN OF SOUTHOLD BUrLDINC, DEPAR'I~.NT Town Clerk', Oiiice Southold, N. Y. Certificate Of Occupancy No...~...~..0..~..7. Date ~-' ~- /~: 19..7.? · . ~ ~IS CEBT~IE5 that ~e bml~g l~a~ at. ~ ~ .'~.. ~ .~.~L S~ ~ ~o ..... ~ ...... ~o~k ~o..~. ....... ~, ~o..a...~.~...~ confo~ substanti~ly to ~e AppUcafion for B~d~ P~it here~fore ~ ~ this office dated ... ~.~...,a ~.~ ..... , 19.~ p~su~t ~ wM& B~g Pe~t No. ~f men~ of ~ applicable pro~sio~ of ~e law. ~e occup~cy for wM& ~ ~ca~ h ............ . ....................... ~e certificate is ~sued to. ~. ~.~'~.~ .~~ .... ~. / (o~er, les~ or ~n~t) of ~e ~oresaid building. S~o~ Co~ty Dep~ment of He~ Approv~ ~.~ :.. ~ ~.~ .......... ~WR~TERS CERT~ICA~ No. ~ 3~ ? ~ ~ ~ ~ ~/~V ~ Building Tn.~,c~r FORM* NO. 2 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) N.o 7 109 Z Date ~'~y 12 ~ ~.~. .... Permission is hereby granted to: to ~u;L&d,..~u~..a~t~,t ;~o~...o~ ..e~:L~t, ln~..ac ce s~s or4r...£ ~rage.)...h~ ~..~ ...... ....... c~uv~r.t...~..~n~as ~...c~.t~a ............................................................................................... at premises located ..~o~o,....~£...I~,/~../~e~r...,~t'.f~/,k..~Lye. ................................................. pursuant to appfication dated .............................. ~.b~,l~......i.~. ......... , 19.~.Lt.,, and approved by the Building Inspector. Fee ~.~;,~0 ............. Building Inspector( SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant/~1~¥ ~. g'[[~.,l_.~ Phone 7J' F ~ %FJ~"-5. Subdiv. ~ Address ' (~ ~-¢'.?- r~.~-~ ~ ~ [[~ 6. Section~ 2. Prgperty Location ~.F~ ~ '~ ~ ~,~ ~-~. Lo~ Num'b~ 3, n 4. Lot size: Width+~O feet ' Lengt~ feet~m~ 10. Sewage Disposal System: (For Health Services Dept, Use) 11. A. 900-gallon septic tank: Precast /.Equivalent Block B. Leaching pools: Number of pools J-- Precast V/-Block Special__ If private well, fill in the fol- lowing blanks: A. Tank capacity /l[~ gallons B. Pump G.P.M. C. Total well depth D. Depth to ground water ~' E. Amount of water in well The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Heal th 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 . ======================================================== :::::::::::::::::::::::::::::: 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 an adequate and satis- factory Sewage Disposal System and Water Supply can be installed on this.ploYo~ APPROVAL DATE SI "ED' S-15 Rev. 4/1/73 THE NEW YORK BOARD OF FIRE UNDERWRITERS ls BUREAU OF ELECTRICITY [---- 85 JOHN STREET, NEW YORK, NEW YORK 10038 9175 ,5 N 367358 December 8, 1977 Ap,~,t¢on No. Date THIS CERTIFIES THAT ' below and introduced by the ap~lic, ant named oN the above application number ~n £he prem:ses of H. Williams, New Suffolk Ave., ~Fruf~olk, L.I. i. ,~,e.ro..,~.~ lo.at,on; [] ~.~e,,,~nt [~ ~st rt. [] ~.d r~, outside sect~o,~ December 5~77 ~-Xl'U£E$ 12 16 9 12 aad found to be in co,npiiance with the requirements qf this Board. OVENS FAN MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R V I' C E I 2 1 2 OTHER &PPARATUS: · Multi-outlet systems no. of feet: 12-0~-plug strip, 8 receptacles Electric room heaters: 1-2.0~, 3-1.5~, 2-1.25kw, 1-.5~ Panelboards: 1-10cir. 125 ~ps 1-~.5~ hotwater heater 1G.F.C.I. B.J. Elec. Co. Stil~ater Ave. Cutchogue, L.I. 11935 Lic 505E?e~ 1 fhi~ certificate must not be altered in any m~nner; return to the office o~ the Board if incorrect, lnsoectors may be identified their credentiaJs. ~om,ned ..... .~...1..~...., ,~..~..~ ~pr~ ...... ~ .:~...:......f..~..., 19..;~..{Pe~it No..~ ........................... ......... ~ -~ PPL' G IT ~ ~ ~~'~~ .NSTRU~IONS a. a~lication must he complet.ly filled in by ~writer o~ in ink and s~mi~ in ~riplicate to ~ ~uildi~ Ink,tar, with ~ ~ of plans, aocu~ pl~ plan to ~al~. F~ ~c~i~ ~ ~h~ule. b. Plat ~an showing I~at~ of lat a~ of bui~i~s ~ premiss, rel~i~ip to adjoining pre~i~s or public s~r~ ar~s, and givi~ a detail~ de~ripti~ of I~ ofp~ must he drawn on ~ diagram which ~ ~ of this applicati~. c. ~e wo~ c~ered by ~ a~lication may n~ ~ c~me~ before i~e of Buildi~ Pe~it. d. U~ a~al of this a~l~at~, the ~ui~i~ Ins~or will issue a Duildiag Permit ~o the applicant. Such shall ~ ~t ~ ~e premis~ ~all~le for i~i~ th~g~ ~e work. ~. No buildiag shall ~ ~cupi~ or u~ in whole or in pa ~ for any pu~e whatewr uatil a Ce~ific~ of ~c~y~ shall have ~n gmnt~ by the Duilding Ink,tar. 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 R~aulations, 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, bud ng code, hous ng code, and regulations and to admit authorized inspectors on premises and in buildings for necessary Inspecti°ns?7/ ' ~,~,~,~/',..~_.~ ~.~_ ~ I,,~ /, ,/_~.~.....~...~I:...L~.~ ............................................. ~.4~ - C~/./(-- ~--~,.---'"~ (Signatur~ of applicant, or name, if a corporation) ,~7~ -/~~ ~ .....' .......... ' .... '~F~'~ii:~i ....... : ....................... :~telte wrmmer applicant is o~ner~le's~ee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........... &~/L- .......................................... ,~t...A., ........................... *..~, ................ ./...~ ........................................................... .............................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........... ---. ......................................... Electrician'sPlUmber's LicenseLicenseNo.NN:: O~her Trade's License .... 1. Location of land on whi~l~ ~d '~;~ ~[[[ ~ ~: ........................................ Lot o ...................... t.Map No.: 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. ,,s,ting u, and occupancy .............................. .... .................. b. Intended u.~ ond occupancy .............................................................................................. property lines. Give street and block whether interio~ or corner lot. "~. Nature of work (check which applicable): New Building .................. A~Jdition ........... Alteration .~LL..:2 .... Repair .................. Removal...~...... ................. Demolition .............. : ..... Other Work .................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwell!ng 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 .4.~..i ............. Height ./~....~.. ........... Number of Stories ...~.?... ................................................................................. ~ ................. Dimensions of same structure with alterations or additions: Front ....... ~..q~le~ ................ Rear .2~,.~ ............... Depth ......?.~ ................ Height .....~.0~c..i .......... Number of Stories ..~. ...................... 8. Dimensions of entire new construction: Front ...~..~ ............................. Rear ...... /.b/ .................. Depth ........................ Height .L..~...'....'~.. ...... Number of Stories ...~<t~/. ........................................................................................... ................. 9. Size of lot: Front 10. Date of Purchase .'.~.'~.~../Z! .................................. Name of Former owner ...~,'~ ~..:.....~.~(.¢.~/~J~i: ................ 11. Zone or use district in which premises are situated ................................................................................... ~ ................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... /~/~..,. ........................ i ................. 13. Will lot be regraded ...fZ&,~.,~. ...... Will ex~ess fill I~e.removed from premises: ( ) Yes ('~) No 14. Name of Owner of rem~ses Name of Architect ............. ~ ................................................ Address ................................ Phone No. I Name of Contractor .....~ ................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dime~ions from or description according to deed, and show street names and indicate ~e~ ~o w ................................................................................................. being duly sworn, deposes and says that he is the applicanl (Name of individual signing contract0 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 andhelief; and -that the work will be performed in the manner set forth in the application filed therewith. Sworn to befa~Crne this ...... Notary Publi~ .~.~'..,.C~ .............. ' ~'~ ' '~i~~l~l~'i'~ ~ ~ ~)' ............ ........... i ..... __1