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Home My WebLink About7045-zNO. & TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~3.¶. ...... Date ........... .l~p~;...~ ....... , 19.~.. THIS CERTIFIES that the building located at .Lako.m~.do. ~1'~..~. (i~o~th). Street Map No~Od&r. ~.e&0h B~o~c~ No ........... Lot No..~.3. & .~1~ .... $0tltho3.~.. 11 ,][.,... confoms substantially to the Application for Building Pemit heretofore filed in this office dated ............. J. al~.. 2, 19. ~. pursuant to which Building Permit No. 76~.~Z. · dated .......... Ja~..2 ...... , 19..~t~, was issued, and confoms to all of the require- ments of the applicable provisions of the law. The occupancy for which thi~ certificate is issued is ...PF~.Ya..t~...O~..e..f..ai~..~..~. d.~.~..~.1..~n[[ ...................................... The certificate is issued to .El'~mt. ~Olm~d~ ~. t~.f~ .... .0~-n~ra ............... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval 8ept.. 2~ .. ~ 9.~.~.. b~ .R,..gilla ... UNDERWRITERS CERTIFICATE No. &l~p~Oved .J.. HOUSE NUMBER . .91 .~ ........ Street. Lakeside. D,'ive...~o~.th ............... 'I'OWM OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S O~FICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORI7ED) No. 70~15 Z Permission is hereby granted to: ....~ ........................ ~.. ........ ~ .......... ~ ............ ~ ......... Buil~.lng IreAoector. ·../...'./...~Z~ ........... Building Inspector THE NEW YORK iBOARD OF FIRE. UNDERWRITERS BUREAU OF ELECTRICIT~ ' .' --/~Lb SS .JOHN STREET, NEW YORK, NEW,YORK THIS CE~IFIES THAT ~,=.~i~ao. 5epte=bep 26, 197~ ~fou~tobeln~mpl~e~thther~ui~mentsofth~. RXT~ RXTU~ ~ ~1~ 29 50 27 29 I 11.9 DRY~ ~RNA~ ~TORS mT~ A~A~E ~ ~IAL~'~ T~KS ~ UNITH~A~ M~ ~MME~ ~ ~00 gG x ~ 3/0 ~ ~/0 ~-.7~ 2-.5~ WB R i d I COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTiRID. IN ANY MANNER. SUFFOLK COUNTY DEPARTMENT OF HEALTHReference Health Department Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant ~yiF~$T ~ ,,.To,,I. s Phone ~-76&3 5. Address ~;~ R,,,~ ~;-~. cl~. ~,~ i~-~ 6. Section 2. Property L~cation '4~o ~o,,7~ e~*' ~','~ ~W, ~e~o~ ~,.,.~, d.~i ~,~. ~x~ ~r~u~)i~,~J~c,~,~,~8. Private Well Village So~k~l g ' Township $'o~'~A~-,I/ 3.Public Water Company Na~ .~ Distance to ~in 4.Lot size: Width feet Length feet 10. Sewage Disposal System: (For Health Dept. Use) ~-gallon A. septic tank: Precast ~Equivalen~_mBlOck. Ij B. Leaching pools: J Number of pool s__ ~ Ii P recas t ~?~BI ock____Speci al__ If privatewell, fill in the J 11' f°ll°wingblanks: A. Tank capacity ~.-gallons C. Total well depth D' Depth t° gr°undwater ~ J E. Amount of water in well____ |. _ The undersigned CERTIFIES: "Construction of authorized ~nstallat~ons w~ll be ~n 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 ~s 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 plot. APPROVAL DATE /~//9'~//~/72 SIGNED (- ~ -- ~ S-15 Rev. 4/1/73 BUILDING DEPAICrMENT TOWN CLEItK'J ~Fl~ (Suildin~ In--tot) APPLICATION FOI BUILDING PE~IT .................. L:....Z: .............. , I NSTRU~IONS a. This application m~t be complexly filled in by ~pewriter ge in i~ and s~mitt~ in triplicate to ~e Buildi~ Insp~tor, with 3 se~ of pl~s, aocumte pl~ plan ~ ~ale. F~ acco~i~ to ~h~ule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stree~ areas, and givi~ a ~tail~ de~ription of layout ofpr~e~ must be drown on the diagram which is c. The work covered by this a~licatJon may n~ be commenced before issuance of Building Permit. d. Upon apprbval of this application, ~e Building Insp~tor will issue a Building Permit to the applicant. Such permit shall be kept on the premis~ ~ailable for inspection thm~hout t~ work. e. No building shall be ~cupJed or u~d in whole or in ~n for any pu~ose what,er until a Ce~ificate of ~¢upa~ shall have been granted by the Building Inspector. . ~ ~PLI~ATI~N,IS HERE~Y ~DE to the Buil~ng Depa~ment for the issuance of a Building Permit pu~?t to t~ ouhaing :one ~rainance at the Town of ~uthold, Suffolk Count, New York, and other applicable ~ws, O~nc~ or Regulations, for the constm~ion of buildings, a~itions or alterations, or for removal or demoliti~, as heroin d~ri~d. The applicant agrees to comply with all a~licable la~, o~inanc~, building c~e, housi~ c~e, admit authoriz~ in~ecto~ ~ promises a~ in buildi~s ~r n~e~ i~tio~. ........................... : ............. (Signature of a~cant, or ~me, if a co~mt~on) ................................ ............................. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..,~.~,..~....~...~,.~..:...~'....~.~.~4'..Z'....~'...c...~'~'.¢.L .~...~.... ................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No..~J'..d~...'~..~..~.....~....w..~..,:..~...4......~..~/'~ Electrician's License No...~.~.L.~..?.....~ ................. Other Traders License No ............................................... Location of land on which proposed work will be done. Map No.: ....... .?..~. .......................... Lot No....~..~ ................ Street and Number ...Z...4-../~:....?.....5../.'..?.....~. ...... 'I:)...,T.,.'....~...~....._...CP.z.!..~....~.....~.....~,..~..:~' .................................................... Municipality 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 ...... /....-T....t~...~.;.;.,;,..~..../.~.......~.~.~.(.(.,:....~. ...................................................... 3.' ~Na~re of work (check which applicable): New Building ...~.... Addition .................. Alteration ..... Repair .................. Removal .................. Demolition .................... Other Work .................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... /. ................. Number of dwelling units on each floor ............................ garage, number of ........................ ......... ......................... ....................................................... 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 -- Dimensions of same structure with alterations or additions: Front .................................... Rear .......'--~.~ ................... Depth ~"----"~ Height .................. ;~ ........ Number of Stories ................................ 8. Dimensions of entire new construction: Front .....~....~..~ ....................... Rear ....... .9..~. ............... Depth .~...~.. .............. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ~../~...~.. ...................................... 13. Will lot be regraded~..~../~...<~.. ................ Will excess fill be removed from premises: ( ) Yes (/'~No PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW YORK, . COUNTY OF .................../.."...; .;.; .;. f '"'"" I'"/* ' / ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing controct~ 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 that the work will be performed in the manner set forth in the application filed therewith. Swam to before me this ............... ~; day of .y ............. ~ ........................... , Notary ' Publi~ ............................................... CoUn}y ~(/Dm.I 1'. BOI~N kJe'/S~y Public, Sfafe o¢ New Yod~ No,52-0344963 Suffolk Cou~fy Commission ~pires March 30~ C~¢ ~' SOUTtJOLb tot¢~ ~F SoOTUOL~. ~.Y. ~'LALL-. 40 off ?ROPt-R,T¥ '~~ ~'OUTIJOLb ~L/XLL-. 4o IKoN /t¢~4 UlAkNT /~U&I(/,.NT~-ED To TN~ u,¢, Lipa TiTLe. tM.4. ,.: ~. rkNF/ .T~,It,' ¢OUT~4OLg ¢/~vlH,h5 l~GPb[),IL~, VI~N TuY L, IL 6, }1 £ NOTIFY BUILDING DEPARTMENT AT, 3~ FINAL WHEN lOB COMPLET.~D ~L N 4/ ..2 _.-_L-_"-_ ]"- 'fl / ,9 J