HomeMy WebLinkAbout8979-z FOI~M NO. 2
'TOWN oF SGUTHOL.
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 8979 Z
Permission is hereby granted to:
............ ~....~/~...,4_~.....~..,~
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................................................ ., ........................................... ......... ........ /
~~:'": ................ ~/~'~)~j~.... ....... :,;';); .......... ~ .......... ~.~,~a.~=~j ....... ; ......... t ........ ~ ............... ~z~ ..................
................................... ~-~ ........... ~: ...................................................... ~...~ ........................
pursuant to application da~' ............ ~~~...~.F19~.., and approved by the
Building Inspector.
Fee $..Z...~.,,..~7~ ....
Building Inspector
I~NFORMA~ION ~B~f~fiING DEPARTMENT
WE ARE 1N THE PROCESS OF ISSUING A CERTIFICATE
OF COMPLIANCE FOR THE ELECTRICAL INSTALLATION
AS COVERED IN AN APPLICATION FILED WITH OUR
DISTRICT OFFICE.
OCCUPANCY
ubmitted in DUPLICATE to the Building
buildings, property lines, streets, and
THE NEW YORK BOARD O~/'~FI~E UNDERWRITERS
~:i,/~7 .!~¢y. ~,,~ ,::j . Yeroge disposol--(S-9 form or equoO.
/~'/ ~' ~ //~. C~',.C,:~..~ Jnde~riters.
Residences end similar buildings end
inSt~llotlons, ~ cer~m~m~ u~ ~ ~,,,~..~v ........ ~he Arch~t~t or Engineer res~nsible for
the building.
5. Submit Planning Boerd opprovol of complet~ site plan requirements where epplicoble.
8. For existing bui(d[ngs (prior to April ~57), ~on~conforming uses, or bu~ldlngs ond "pre-ex~st~ng"
lend uses:
1. Accurate su~ey.of property showing ~11 property lines, streets, buildings end unusual natural
or topographic features,
2. Sworn statement of owner or previous owner as to use, ~cupancy and condition of buildings.
3. Date of any housing code or safety inspection of buildings or p~mises, or other pe~lnent in-
formation required to prepare a certificate.
C. Fees: 1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existi~ dwelling or land use $5.00
3. Copy of certificate of ~cu~ncy $1.00
New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land ..............
~0,,~ o~ ~,~e,,, ...... ~..~.~7. ...... .~.~/~.~.~ ........... ~.~.~ ............... ~.~ ...............
~ner Or ~ners Of Prope~y ~. ~ fD
s,b~,~o, ...... /~.~<~.~4~ ....... ~?~;Lo~ No.............~ ~k No. .....,..... ,o,, No .............
Permit No..~ ~ Date Of Permit ~;~.~,;.~,,,Applicant .~~..~.....~.~..~.
H,,,~ ~,,,. ~,,o,,~ ...~.:u.=.....:~...:: ........... ~o, ~. A,,,o,,~ ................. ~..~ ....................
R~quest For T. mpora~ Ce~ifica*e ........................................ Fin~ Certificate .~ ..................................
F~e Submit*ed $ ..,~.: ...........................
Construction on above described building and permit meets all applicable codes end regulations.
:5.7..~/..<~,?.. ~.,...:. .~.~./:.,.. .
App,,cont ........... .., :.:.:>_:::~ ...... >C'">'~T :' : ................
Sworn to before me this //x~{-~"/z~ ~ ' . .
................ day of ............................................ (stamp or seal)
Natal, Pub,c .................................... Co.n~
THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD
OBSERVATIONS AND OR FROM DATA OBTAINED FROM OTHERS
THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE
WiLL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY OEPARTME~
OF .EALrR SERWCES
APPLICANT:
ADDRESS TEL .....
.%
COMNTY.
WATE~ ~E~VICE = P~IVATE W~&
UNAUTHORIZEO ALTERATION OR ADOITION TO
THiS SURVEY IS A VIOLATION OF SECTJON
7209 OF THE NEW yORK STATE EDUCATION
REVI$1ON~
YOUNG & YOI 45~9s
400 OSTRANDER AVENUE, RIVERHE
ALDEN W. YOUNG
PROFESSIONAL ENGINEER AND
I~AP PREPARED FOR:
.-tTEDERICt~ W. K~£LIAI ~ MAt?GAtT£T E. I~AEIIIV
YOUNG
THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD
OBSERVATIONS AND OR FROM DATA OBTAINED FROM OTHERS
ADDRESS
SUFFOLK COUNTY D[P/'~RTi¥'.£NT OF HEALTH SERVICES
FOR APPROV/,L C,' ~ _h:.TF:UCTION ONLY
APPROVED ~ ,, ~
NO I'E ;
LOT NUMBE. I~'$ ~'EP£R ro MAP OF
COUN~V.
NEARES~ WA~E~ MAIN = 5 MI~ES ~
UNAUTHORIZED ALTERATION OR ADDITION TO
THIS SURVEY I$ A VIOLATION OF SECTION
REVISIONS
·
YOUNG & YOUNG
400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK
AL~DEN W. YOUNG
PREPARED FOR:
75 fllGHLAfl ROAD CORP.
HOWARD W. YOUNG
LAND SU RYEYOR
AT
C U TCHOGUE
'tOWN o~' SOUTHOLD
SUFFOLK CO., N.Y.
SCALE: / "=50' DATE' NOKIg/976 NO.
-%
THE LOCATION OF WELLS AND CESSPOOLS .S~O,WN HEREON ARE FROM FIELD
THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE
WILL CONFORM TO THE STANOARDS OF THE SUFFOLK COUNTY DEPARTMEN
OF HEALTH SERVICES
APPLICANT; ..... -,~ __
ADDRESS _ TEL .....
SUFFOLK C'~UI~,~'~' ·
FOR APPRO'.':M. C i' C'J'U:-TRUCTION ONLY
DATE ~ ,
APPROVED
NOrS:
LO7' NUMBERS REFER ~0 MAP OF
"HI~HLAND~SVATES ",WHICH IS
OFF/G~ OFTH~ ~K OF SUFFOLK
COUNTY.
UNAUTHORIZED ALTERATION OR A~D~TION TO
THIS SURVEY IS A VIOLATION OF SECTION
REVISIONS
YOUNG & YOUNG
~ 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK
ALDEN W. YOUNG HOWARD W. YOUNG
MAP PREPARED FOR:
75 HIGHLAN ROAD CORP
AT c U TCHOGUE
TOWN OF
S O U THOL D
SUFFOLK CO., N.Y.
SCALE: DATE:
I "= 50' N0~1~1976