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Home My WebLink About7469-zTO~N OF SOUTHOLD Bu~.nING DEP~ Town Clerk'~ Offiee Southold, N. Y. Certificate Of Occupency No. ~.3~ ...... Date ............E.a.~.q.h .... !.0 .... ,197.~.. Roa4 THIS CERTIFIES that the building located at . l~rt. Raai./!.%br. Oo~ey. Ilk. Street Map No.K.o..k.e..0.D..A... Block No ........... Lot No...S.o.u..t.h.o.l.d....N....g: ............... conforms substantially to the Application for Building Permit heretofore ~ed in this office dated ......... /L4[...12 ...., 19.77.. pursuant to which Building Permit No..7~..~.Z... dated ........AuE..12 ......, 19:7.1+., 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 .pti.rate..one. family..dvelling ....................................... The certificate is issued to .~.~hll .l~dd.e.~ ..... .O~e.~ ............................... (owner, lessee or tenant ) o! the aforesaid building. Suffolk County Department of Health Approval ... ~[~. 10... ~9~.~.. bY. .t{,..~.lll&.. UNDERWRITERS CERTIFICATE No..N..19.~20 .................................. HOUSE NUMBER ...1.27~. ...... Street .. p.v.t~..B..o~.d../~..1.1~....C.o..r.ey..C..r.e.e.k...t{.o.a.d... .... ...... FO~ NO. 2 TOWN OF Sou'rHOLD BUILDING DEPARTMENT T'"uWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP. EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7469 Z Permission is hereby granted to: ...................... .......... §re~.~.r~ ................................................ to Imild ne~ one family_ d~ell/nl ' at ,~.0.~. ~ X0Z:E 0.D. , at premises located ..................... ~.~....~.~...~..~t~lf....~.~.~. ....... .( ........................ ;~:..). ............. ............................................................ ~...~.~tip~ ....... ~..,.~., ................................................................. pursuant to application dated AU.~..st 12 19 ~ and approved by the Building In.~:tor. ( r Building Inspector I ( 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 Address 2. Property Location Village 3. Public Water Company Name 4. Lot size: Width feet 10. Sewage Disposal System: A. 900~gallon septic tank: Phone Township Length. feet 5. Subdiv. 6. Section 7. Lot Number 8. Private Well 9. Public Water Distance to main (For Health Services Dept. Use) 11. Precast Equivalent Block B. Leaching pools: Number of pools Precast__Block Special__ If private well, lowing blanks: A. Tank capacity. ~allons B. Pump G.P.M. fill in the fol- 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· ~S~stem~ and Water Supply can be installed on this plot. APPROVAL DATE ~ SIGNED S-15 Rev. 4/1/73 TOWN OF SOUTHOLD BUILDING DIPARTMINT SOUTHOLD, N. Y. Exa,,ined , ....... , ....... !,. ............ .......... . ........................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This application must be completely filled in by typewriter or. in ink and submitted in triplicate to the Building Inspector, with 3 sete 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 oF areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is port 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. ^PPLICATION 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. (Signature of applicant, or name, if a corporation) C- ee o ~' .¥,. ........... ~'.S.....P.P...'~..~. ............................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................................... Z~ufl,Tbd. e ~' ....................................................................................................................................... Name of owner of premises ..~'.QhZL..~...F[Q~cle~ ..................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ...... ~.e,~ ............................ Electrician's License No ....... ~,~.~,~.~.~ ..................... Other Trode's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ~0~ 0 eD aA. Lot No. ~D~ Street and Number .... ~,~.~,.....~/.~...~av~E~t'~et~r...~C~,?i..~.~.~.~..~...#. ........................ ~COJ,:~hD.~L~ .................. Munlcipolity 2. State existing use and occupancy of premises end intended use and occupancy of proposed constructiOn: a. Exisiting use and occupancy ...... .Y. ...................................... b. Intended use and occupancy ...... ~e...;~,aJ~,~,l.~..~r~?,.],~,~ ............................................................................ 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ................................................ . .... (Description) 4. Estimated Cost ................... ..~...8.l.~..~,~ .................... Fee ....9.1..~. ......................................................................... (to be paid on filing this aoplicotJon) §. if dwelling, number of dwelling units .-.se .................. Number of dwelling units on each floor ............................ If garage, number of cars ....t,~) .................................................................................................................................. 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 ........ ~e .................. Rear ...... .~.~/,,~ ............ Depth .~.~/...¥~ ........ Height .................... Number of Stories ...... '1'~ .......................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10~ Date of Purchase ........................................................ Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated ...ll&th..g.~.lg~. .............................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: .... l~ ............................................... 13. Will lot be regruded ...... Z~O ................. Will excess fill be removed from premises: ( ~ Yes ( ) No 14. Name of Owner of premises .~T.e~...i;te¢~et~ ........................ Address ...,T.~..~°,~13]g3Z~OIIl~hone No. ...................... Name of Architect .............................................................. Address ................................ Phone No. ...................... Name of Contractor .'~"v--~a~ ................................... ~ ..... Address ....G~.c~el. tl~z~~. ..... Phone No. ...................... PLOT DIAGRAM Locate clearly and distinctly all 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 whether interior or corner lot. See filed pla~ STATE OF NEW_ YOI~I~. ~ S S COUNTY OF ..~1~;~'.g.,1~ ............. .................... ~D~a~..~ .................................................. being duly sworn, d~oses and says t~t he is the applicanl (Name of i~ividual signing c~tmc~ above name. He is the . bu~.~er (Contractor, ag~t, co~orote officer, etc.) of said owner or ~ners, and is duly aut~rized to perform or h~e performed the said work and to ~ke and file this application; t~t all statements contained in this application are tree to the best of his kn~ledge and belief; and that the work will ~ perform~ in the manner set fo~h in the application fil~ ther~ith. Swam to ~fom ~ this Nota~ Pubhc, ..X.~.~~~ ...... ~ ...~ ........................... JUDITH T. BO~ C X