The URL can be used to link to this page

Home My WebLink About7443-zFOBS! NO. & TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupancy No. Z.6750 ...... Date ............~eP.~.... 2.6. ...... , 19. THIS CERTIFIES that the building located at Cle&r~rl~w. & .Gar4tner. La Strut Map No. P~$~..~lock No ........... Lot No. 20. ...... 8~q~...~t~.' ........ conforms subst~ti~ly to the Application for Building Pemit heretofore ffl~ ~ this office dated .........J.~Y .... 26.., 19.~. p~su~t to which Budding Pemit No. ~.. dated .........J~y ....~6..., 19.7~., was issued, ~d confoms to ~1 of ~e r~ ments of the applicable pro~sions of ~e law. The occup~cy for w~ch th~ ce~ificate issued is ... P~I~.. 9~..~e~.~Y. ~q ~g ..................................... The certificate is issued ~ ...J~ .~. ~0$ep~e. ~s~,~h ..... ~ .......... (owner, lessee or ten~t) of ~e Mores~d b~d~g. S~olk Co~ty Department of He~ Approv~ &~. ~...~.97~.. ~Y. ~*..Vil~ ..... UNDERWRITERS CERTIFICATE No. (pend~g).. Appr~d. b~. J... ~ack~ ..... HOUSE NUMBER ...80 ......... S~eet ... Clea~lew. A~e ....................... 89~ Gardner ~. s~irs ove~ 8" B~l~g I~pector ~ work other th~ oorreotio~ ~ notioe attae~4 ~ require another building permit, FOB~ NO. ~ TOWN OF ~OU~IOLD ~UILDING DEPARTMENT TOWN CLERK'S OFFI~ ~T~LD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7443 Z Permission is hereby granted to: .z,m~..~...,~../.e~m..;l~M .em~....~..~....vU'. ................................................................. ~ ......... ~....z..... .......................................................... pursuant to application dated ....................... ~ ......................... , ........ and approved by the Building Inspector. uuilding mspectoI r b. Plo. t plan ~no~, i.r~,. Io~. a. tion of lOt a?l. Of buildings on premises, ~e'~tion~'~'~joining premises or Public street~9 a eas, aha giving a (:letallea c~lscription ot la~ ofproperty must be drawn on the diagram which is port ~f c. The work covered by this application may not be commenced before ssuonce of Building ~, d.. U.pon approval of this application, the B~ildina Imn~-tor will ssue a Buildi'-- c~i,_,, .A ~._ __. ...... snau De kept on the premises available for inspactio~ th"~hout the work. ,~ ......,..u ,n. ~p~,canT. 3ucn permst e. No building shall be occupiecl or usecl in whole or in part for any purpase whatever until a Certificate of Or. cul:xa]~¥ shall have been granted by the Building Inspector. .,,eg at~..ons, .for the construction of buildings, additions or alterations, or for removal' or dm,na/lflnn ,m k&.,~.,. /ne app,cam agrees to comply with all applicable laws, ordln~me~s bulldt.,,~ -~,~ I~,,i,,~-~'-i/~'i-_'---~.~? admit authorized inspectors on premises and In buildings for nocessan/,Inspoctions. ....................................................................... ¢$1gnature of ~ppli¢ont, or rmrt~, If a co~oratio~ . (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................................................... .................. Name of owner of premises. ~.hn ~ ~.~,~,~,~...~. ~G ~ Oh. 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. OW'Gel' Other Trade's License No ..................... 1. Location of land on which proposed work will be done. Map No.: ..F.&~,~I~,.~K ..;...j:;,: Lot No.....2~. .................. Street and Number ..~Lleaz,.V.;l~t,W..A~,~,..&..~8,Z,/[~L]3.~e~E~..L.a.13~ ..... ~g.~,.~],l[ .. ............ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of propaeed construction: a. Exisiting use and occupancy .....F~g4t,D,~& ................. . ............. b. Intended use and occupancy o~e famil~ ~welling 3. Nature of work (check which applicable): New Building..~ ........ Addition .................. Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work ................................................ (Description) 4. Estimated Cost ............. -~0.t.Q~....~ ......................... Fee ..... .bc~.~,~ ........................................................................ (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 ...................................................................... 6. if business, commercial or mixed occupancy, specify n6ture ancl 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 ~ories ................................ 8. Dimensions .of entire new construction: Front .....~'~ ........................... Rear ....... ~.~. ................ Depth ...... ~,~ ............. Height ...:.,~ ............. Number of Stories ..g~g ............................................................................................................ 9. Size of lot: Front ......... .1~.~ ....................................... Rear ........ 1_2.~' ........................... Depth ....... .1RO .................. 10. -Da~e of Purchase ... ..................................................... Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated njk~t c1.'~.s~; '12. ,Does proposed construction violate any zoning law, ordinance or regulation: ...... ,1~ ............................................ 13. Will lot be regraded ....~1~. ................... Will excess fill be removed from premises: ( ) Yes (3) No of remi ~TeJazt & ,Tose h:LEte 14. Name of Owner p ses .......................... ~: ................... ~j.i~l~ss ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ .Phone No ....................... Name of Contractor ..... ~..~....~..~.& ...................................... Address &~[13.e. bg&l~. .......... Phone No ....................... PLOT DIAGRANI Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions fram 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 YORK, COUNTY OF ..~1~'£.o~1~ ............. ....................... ~g]~..~.,1,~.~. ................................. ~ ............... being duly sworn, deposes and says that he is the aPplicam (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 hove 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 perfoymed n the manner set forth in the applicati°n filed therewith. Swam to before me this ................. .26.~ay .of ..~, ............ ~ ...... , 19..~.~.. ~ ~4~ ~,~ T. BOKEN f~ JUDITH (Signature of applicant) ~ ~Notary Public, Slate of New York No. 52'0~44963 SUf[olk Co Comrni~ion .,;~. ,, . vnt~l~ ~ Ex~,,~ march 30, SUFFOLK..COUNTY DEPARTMENT OF HEALTH SERVICES ReferenceHealth ServiceSNumbe~L7/~_ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant / ~ ~ Phone /~ ~' ~ 3. Public Water Compf~me ~ 4. Lot size: Width ~feet Length /&~'feet 10. ll. 5. Subdiv. 6. Section ' 7. Lot Number 8. Private Well 9. Public Water Distance to main Sewage.Disposal System: \ A. 900~gallon septic tank: Precast .~' Equivalent Block B. Leaching pools: Number of pools Precast~ Block If private well, fill lowing blanks: A. Tank capacity ga~lqons B. Pump G.P.M. Special in the fol- Ce Total well depth Depth to ground water Amount of water in well (For Health Services Dept. Use) The undersigned CERTIFIES: "Construction of authorized installations will be in accordance 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 '/ /~ ................................................ 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 plot. APPROVAL DATE -~/~ r~¥~/7~ SIGNED ( ~ ~~ S-15 Rev. 4/1/73 <( _ ,~.?~-~'~o'~.. '= ','~°'°, . . I ~ 0/ "%: ,, j . ~- ~ ~:~. ~ ~ ~ ~oT.~ .... I ~ ' ~ ~ ' ,o ~,~~-,~,~------~ LOT ~U/A~ ~l IOW~ ~ ~ "~F O~ z~ tamp SU ~V~o~,s :N,,~. ~ s~°t~ A~ O.~A~l~ ~ ......................... . r t I~U~ ~ COZ 'rI '; ,/