The URL can be used to link to this page

Home My WebLink About7075-z FOB~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPAI~TMENT TOWN CLERK'S OFFICE $OUTHOLD, N~ Y. BUILDING PEP. MiT (THIS PERMIT MUST BE KEPT ON TH£ PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 7075 Z Permission is hereby granted to: ..... ~......~I~1.~.~...~. r. ...................................... · ................ ~.~mt,~u ~.~..o.a ..~.~ ............................. ~o ~.~l~,.~e.w...q~.. £.eA~...~,~lll,~ ..................................................................................... at premises located at .~../..~........~..o.~.~.....~..~,e.w .AVl .................... 8outhold ~ .~ · pursuant to application dated ..........................F.9.~ ....... J.~ ............. 19.~.~'..., and approved by the Building Inspector. Building Inspector SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant ,; / '.' '~,~ Phone Address i · ,?, ~../' ~' . 2. Property Location ~,,., / ,,~,, i , /~ Village Township 3. Public Water Company Name 4. Lot size: Width d~ feet Length - feet 5. Subdiv. 6. Section 7. Lot Number 8. Private Well g. Public Water Distance to main 10. Sewage Disposal System: (For Health Dept. Use) A. 900-gallon septic tank: Precast /~Equivalent Block__ B. Leaching pools: Number of pools / Precast ~Block ~pecial ll. If private well, fill in the following blanks: A. Tank;capacity ~ gallons B. Pump G.P.M. S C. Total well depth D. Depth to ground water E. A~unt of water in well ~/0' 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. Date : ,. ~9 ,t / ~ S~gned ~ ............. '__ z'_ ............................. '_ ..... ~_ ._.~__ _-_ ...... ~ .................... 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. S-15 Rev. 4/1/73 EXCAVATION INSPECTION REQUIRED Approved ........................................ , FO~,M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19..~..~i/ Permit No.../....~/.......d..~.... ........ Application No...~'.(~...~.:..['. ............ Disapproved o/c ...:~,,~ .................................................................................. .................. Z...Z ...... ................................ (Building Inspac~r) APPLICATION FOR BUILDING PERMIT Date ................... ~'~J~ ......... .1.% ........ 19..~..~ ...... INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in in,k 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 the 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 ir~ buildings for necessary irtsp.ecti~r~. _' / ..... g pp" ' , or' ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................................................... mez' ................................................................................................................................. Name of owner of premises ...... ~t'~.,~&e.]...~8.~,O~l.~.&~.O~. ................................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ..... ~I~.,.~.o.~4L ........................... Electrician's License No. ..~.ft~Clf~ ........................... Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ~ .................................. Lot No...3Q[; ................. Street and Number ...~.~.....~.~.e;~..~l;'~. ......... ~,q~u..~h~'-.d.....~,,~.;e ......................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...~.~;.~.~:!D,~ ............................................................................................................... b. Intended use and occupancy ..~..,t'a,i~]l.~.?;..~L~3,3,$~ ................................................................................ 3. Nature of work (check which applicable): New Building ..... ~ ..... Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) 4. Estimated Cost ......................... ~f~O-'~ ................ Fee ...... i .................. 5. If dwelling, number of dwelling units ..... ~)Tte ............... Number of dwelling units on each floor ............................ If garage, number of cars ................................. t~FO ..................................................................................................... 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 ......... ~ ..................Rear ............ ~6.-8 ....... Depth .kl,~,~..~/~.~... Height .................... Number of Stories .... ~l~.e .......................................................................................................... 9. Size of lot: Front ......... ~Li~ ........................................ Rear ..... .~.~(~ ............................. Depth "~)'"/'""1~-'~" ..... 10. Date of Purchase ............1.C)rJ.,~ ................................... Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ...... ,A.e..~.~ ............................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... ~ ............................................ 13. Will lot be regraded' '"'"~e~' ..............Will excess fill be removed from premises: ( ) Yes ( ~ No 14. Name of Owner of premises ...... ~.~&~3,,..[~ia,(~.~,o~&.. Address ..~!;~;~;.],.1~f~.~,O~ ..... Phone No..,.11~,..~.c)..~2. Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ..... 0~.qle.~ ........................................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b~ck 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. STATE OF NEW YORK, [ ,- ~ COUNTY' OF ...JJ~l~'.¢~TM ............ ~ ~'~ ............................. ]~-:J..Oj~(~'l......~f~-g~&.~o.'h~. ...................... being duly sworn, deposes and says that he is the applicam (Name of individual signing controcf) above named. He is the ............................... ..O...J~.~.~'....-....~..t~J~¢..~.~. ............................................................................................................. (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 conta:ined 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 t,h,ereWith. Sworn to before me this ~ // . ..................... .,,day.of ......... / Notary Public, ...,~.~~_~¢¢~,,~nty ........ ..~../~'/~.~.~..-....?..:/.'~¥/-...~...~;../~... ................................. ~ ~ -- (Si§nature of applicant) JUDITH T. BOKEN ~otary Public, State of New york Suf faD- Court No. 52-0344963 March 30, 19~ Commission Expires I fl , t NOTD¥ BUIL~.ING DEPA,tTIvlENT /,1 · ri :2' NOT 150t 4~ r~rd, t. Jd ~IL DATE: NOFIFY BIJILD~NG DE?ARTM~:NT AT 7.5-2660 9AM TO 4PM FO& REQULR- ~ iNSPECTiONS; I BEFORE BACKFILLING FOUNDA, TI~N OR START FRAMING 2. BEFORE COVERING 3. FINAL WHEN JO~ COMPLETED NOT RESPONSlaLE FOR D~SIGN OR C~ STRUCTION ERRORS ~1.011 ~ Lo~ 1501. laOi