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Home My WebLink About7155-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Otiice Southold, N. Y. Certificate Of Occupnncy No.Z~..~.~ ....... Date ............. .J..1~.....! ...... , 19. ~ THIS CERTIFIES that the building located at . Tl'~ia~. Path. (P~.T. RDJ... Street Map No. ~ .......... Block No..X~. ........ Lot No~..E&.~.~...M~..$.c~....N. ;.Y.: ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ liar..2~..., 19.7[*. pursuant to which Building Permit No..7.1 ~.. dated ........... April....~.., 19. ~., 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 .. P~.~,'[&.~...o~..f.~a~..1.1f..d..~.]...1.~1.s ...................................... The certificate is issued to .Rg.b.e.r.t. K®~ham ~ 0~ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .J. ll~y...1...19~.....bT..R. :.V.:L.i.I.& ..... UNDERWRITERS CERTIFICATE No... ~..1.(~ .... .J..t~..e.. fi. 3...1.9~.. .......... HOUSE NUMBER . ..t..1 ~ ...... Street ...~I~, .P~.~ .......................... Building Inspector ( ~ORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PJ~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7155 Z Permissio~ is hereby granted to: Hobert Ketcham J~ .... .~;~.....Z~,rl.~ .............................................. Bu~Id new one famil dwe~]ln ~o ...... : ....................................... ~.. .......... '...:.....~ ...................................................................................... pursuant to application dated ................... ...~..~.. .......... ~. .............. , 19~..~...., and approved by the Building Inspector. NO'B! RX~J.~[TtJ~ d~]l~g, ~o b~co~.9~cesso~ bld~ wi~ Fee ~.~ ~.~.~. ............. Building nspector ~ SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Applicant / kPhone , ,, · ~'//~. SUbdiv. Address ' - ~, ~ ,'~ ~ ~' v~ ,~ IR, 6. Section Property Location , ~ ,, ,,, ~ 7. Lot Number -, ~/t~'~ '~ ~ ~/~- ~ ( c¼:~ 8. Private Well - - ~' /ownship ~,-,~l[~_~? 9. Public Water Village,--, A',,' · Public Water Company Name Distance to main Lot size: Width '- feet Length .,, feet 10. Sewage Disposal System: (For Health Dept. Use) A. 900-gallon septic tank: Precast ~Equival ent Block := B. q~aching pools: !:~:T: C~umber of pools ~-:q:~ Pre~t ~qSqock Special li~ If ~ivate well, fill in the ?: folt~ing blanks: A. ~nk capacity ~ 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 Health's 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. FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department that an adequate and satisfactory Sewage Disposal System and Water Supply can be installed on this p~ot. APPROVAL DATE //, .T~-~'- ~ SIGNED S-15 Rev· 4/1/73 Examined .......... ...~..~...Y .......... , Approved '~ ~ FORM NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19.~f.~. Pemit No. 7.(...~'....~',..Z....Z .......... Application No..2./.....~....-~.. ............... Disapproved a/c ............................................................................................ ............... .......................... ................................. APPL,CAT,ON FOR BU,LD,NG PE.M,T INSTRUCTIONS a. This application must be completely filled in By typewriter or 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 or areas, and giving a detailed description of layout of property must be drawn on 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. o~'Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builderl 1. Location of land on whicJl,proposed work will be done. Map No.: .................... Lot No .............................................. Street and Number ........ ~'7.~.~...~..'~'.....~........~..°...~....-~.. ............ ~...~:.....~.~ ............. ~.~...~........~....~.~../..~...,~... ...... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................................................................................................................................... b. Intended use and occupancy .................................... ~...~.. ..................... ..~,...L/..~..~.. ............................................... 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... ~¢ (Description) 4. [stimated Cost ............................................... Fee ................................................................................................. (to be paid on filing this application) .................,~ . ..- , / ~' - 5. If dwelling, numbe~ of dWelling units -- Number of dwelhng umts on each floor ......................................... If garage, number of cars ............................................................................................................................................ If business, commercial or mixed occupancy, specify nature and extent of each type of use ...... ~f~'";'"~'fiY~2'~]'" Dimensions of existing structure, s'fl amy: Front.........,...,,... Rear ...;-,-'~-::~....v..,.....::. ~e~ptl~ ............................. ; ..... ! Height ........................................................... Number of Stories ............................................................................. Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ........................................ .... ,~,," 3,/ 8. D~mens~ons of entire new construction: Front ......................... Rear ....;......_ .............. Depth ................................ ' ei ht--~/z~r ' Number of Stories ! ('C~"g~&~' (~ '~ ~' M g ..................................................... ;; .......................................... ._. .......... ;....m ..................... _ ' .~-o ' _ .~F-o ~ _, ~=J.~ 9. Size of lot: I-font ...................................... ~ear ....... ~ .............................. uepm ......................................... ; ........ Height .................................................... Number of Stories ..................................................................................... 10. Date of Purchase ..................................... Name of Former Owner ...~..~....~...~..~.....n.....~..~.~..~...-./.../~.. ...... ..~....~-_..; ...... 11. Zone or use district in which premiss are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ ~~~ ............. Will~s.~fill be removed from~premi~s:~,~[ ] Y~s~ [~Uo 13. Will lot be regraded 14. Name of Owner of premiss ....................................................................................................................................... / (~dress) Name of ~rcmtect ..................................................................................................................................................... ~ (Address) __ (Phone No.) PLOT DIAGRAM Locate clearly and distinctly ali 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 wheth- er interior or corner lot. ) COUNTY OF ...... ~7~./.Y_~.~r~7~..,,__ ............... > (Contractor, agcn t, corporate of£icer, ere.) 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 forth in the application filed therewith, ...................................... dayof ....... ................................... Notary Public ...................................................................... County ....... ~ ....... /~..~. ............................. /i~. .................... (Signature of applicant) THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU O'F ELEcTRiciTy . ~ ak 85 JOHN STREET. NEW YORK, NEW YORK 10038 THIS CEEIFIES THAT Robert Ketcha~ ~., Bay ~ke ~a~k Rd., w/s~de, s/o ~n inthefollo~i~utlon~ ~ ~.~..~ ~ ~t~. ~ ~ F;. outside s~tio. ~ e,amined on June 10, 1 ~ 7 ~ and found to be in compllo~e with the requlrements of th~ S~rd. 13~ 16 13 13 DRYERS FURNACE MOTORS ~T. K.W. OtL H, P, GAS H.P. FIXTURES RANGES SPECIAL REC'PT. 1. 3O ICOOKING DECKS OVENS DISH WASHERS AMT. K.W. I A~T. K.W. , MT. K, W, TIME CLOCKS BEll IUNITHEATERSUNIT HEATERS MULTbOUTU~T EXHAUST FANS ~MMERS SERVICE DISCONNECT I NO.O~ i S E R i 150 CB METE~. X I 2/0 ' ' OTHER A~ARAT~: ~o~o~/~: V I C 1 2/0 Ronald B. Busch, 925 Long Creek Drive, Southold, L.I. 11971 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. SECTION ?';09 OF THE NEW YORK STATE EDUCATION LAW. /G