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Home My WebLink About8499-zFOruM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at F.~.e..cl. ~i~r..e.e.t. .............. Street Map No.. ~ ........ Block No...x~. ....... Lot No, . .x..~....N.e.w.. ~.u.~9..~..' .N.,.E.: ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. .~p.r.¢~...], ~19.7.6. pursuant to which Building Permit No. dated ............ .Ap.r.J:.~...].~., 19.7.6., 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 ...P.z~.v. '4~;.e..o.~.ke. f.a.m.i.~y.. ~l!~.e.~,$$rlg ...................................... The certificate is issued to ....S.~.e.~a..n..&...0.~ga...0y.e.h.~ .~.o$$ ..... .0~e~,$ .............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ,T.q~.y...20...J.9.?(;...b.y.R.o..¥i~l,a .... UNDERWRITERS CERTIFICATE No..(..tg.mP.)..N..69.7.6.~.0..-...f,.i.n.a.1..p.e.n. di~g. ....... HOUSE NUMBER .... 1~ ....... Street ... F~'.ed. 8.tr.(~et ..... Ne~,~. 31~f.'.f.c~tk. ....... ...... Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8499 Z Permission is hereby granted to: ....... ~o.u~hol4 ..................................................... at premises located at '~//S FZ' d St, z'ee~ ....................................................... .~.e.~...?.~..t.?.o...~,........~ ................................................................ pursuant to application dated .................... .A.~..~..~.].. ........ ~.~.. ........... , 19.~.~..., and approved by the Building Inspector. Fee $..9-~ .e.~. ~. .......... 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~5. Subdiv. Address . ~..~ ~.~.~ .~-_~'#~.~, /~4.~. 6. Section 2. Property Location - .~' ~' - $ 7. Lot Number o 10. Village. Public Water Company Name Lot size: Width/~7 feet Sewage Disposal System: A. 900-gallon septic tank: Precast Equivalent Block B. Leaching pools: Number of pools Precast Block Special ll. If private well, fill in the following blanks: A. Tank capacity B. C. D. E. Pump G.P.M. Total well depth Depth to ground water Amount of water in well gallons Township Length /~"~ feet 8. Private Well_ 9. Public Water Distance to main (For Health Dept. Use) 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. 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 pl~ot. APPROVAL DATE SIGNED TOWN OF SOUTHOLD BUILDING DE,I',.ARTMENT~< TOWN CLERKS ~UTHOLD, N. ........ ~ ........................... · App caton No .~..tL~ ~. .~- ~proved ................... :.~ ......... ~....., 192~.. Permit No.~J(.~..~.~ ......... ~~-- ~ ~ ~ uisapproved a/c ......................... ~ ~ o ....................................... ~,~ ............................................ , C~ ~,~ / APPLICATION ~ BglL~IN~ ~J~MIT ~ %] a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Buildin~ Inspector, with 3 set~ of plans, accurate plot pla~ to ~ale. Fee accordingto schedule. b. Plat plan showing location of Jot and of buildings on prom ses, re ationship to adjoining premises or public streets m ureas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is pa~ 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~l shall be kept on the premises available for inspection throughout the work. shalle' haveN° buildingbeen grantedShall bybe the°CCUpiedBuJlding°r usedlnspector.in whole or in part for any purpose whatever until a Ce~ificate of ~cupancy 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, attar removal or demolitioa, 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. ........... //CSig~C~re of applicant, or name, if a corporation) (Address of applicant) '~/~'/~" State whether applicant Js owner, lessee,, agent, architect, engineer, general contractor, electrician, plumber or builder. 5.~£~/~ o ~.~ 6./~ ' · ................. Name of owner of premises ............................................. ~ ...... ./'J.~.~..~:.F.'. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ....... ~..~......~../..Z.~. ......... Electrician's License No..~.~.~.~,./~.~..~..~. ......... lOOO- f /?- w- // Other Trade's License No ............................................... Location of land on which proposed work ~w, ill be done. Mop No.: ................... Street and Number ..................... ~...~.~'..~:/~.........~C.~...~..~.~Z ...... · -- ~ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: Exisiting use and occupancy ...............~..~.~...~.~¢~./~.~ ....... use ...... ¢.2 ./~..~..~.: ~ ~¢. / J~ ,~...~.~..LL/.~?.~. b. Intended and occupancy ~ .......................................................... 3. Nature of work (check which applicable): New Building.. ...... Addition .................. Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work ................................................ ..., ~ (Description) 4.Estimated Cost ....~...~.~.~ ..................................... Fee ....fL3. ..................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............ ~ ............. Numbcr of dwelling units on each floor ............................ If garage, number of cars .................... ~. ................................................................................................................... 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 ........... .7...~.. .................. Rear ....... ~...~.. ............. Depth ...,~,~ .............. Height ...... ~..~.. ....... Number of Stories ....... ./.. .......................................................................................................... 9. Size of lot: Front ............. -- --/~.~..~ ................................. Rear ..... /~,~ .......................... Depth ../..~..i .~..'" .................. ]0. Date of Purchase ........................................................ Name of Former Owner ........................................................ ] ]. Zone or use district in which premises are situated ........... ]2, Does proposed construction violate any zoning law, ordinance or re§ulation: ...... ;~...,~.. ................ .._.j ................ 13. Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes (I/) No ]4. Name of Owner of premises ...~ ....... ~.,~...~../.~,~,~,'.,~., ...... Address ................................ Phone [~/~. ~'~..¢~..~..~'4~' Name of Architect ................................................... . .......... Address ................................ Phone No ....................... ~om~ of Contractor ...... ~' .~. ~/~. ' ^ddres~ ~UZZ~,~,.~ ......... Phone ~o ~.~/~.~'~/ ............... ..a...n...~.~_~&. ....................... PLOT DIAGRAM Locate clearly and distinctly ali 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, (c ¢ COUNTY OF.....~:....].:..:...;..--..:;. · ~.i.~ ........................ '."~/.¢..¢...~'.~..~,~'"".'~.',.".~,4]..~,*'~" ~ ......................... being duly sworn, deposes and says that he is the applicon, (Nome of individual signing contract) above named. H~ ~s the ............................................. G.~.~..~4'Z...C..~..~,¢. .................................................................................................. (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 oll statements contained in this application are true to the best of his knowledge and belief; and tl.ar the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ,~ ,,, ,,~ ~ ~'~// ...... of ........... /4.p.r.,'./ ............... . f/_ _ Notary Public .................. ..~...~.~./~. ........ County .~~ ....... .=.....:.~~.. ................ C~, ~ - (Signature of applicant) ~UZABETH ANN N[VIL[[ ! NO~[ARY PLIBtlC, Stale of New Yor~ No. 52.S]25850, Suffolk CountY, Term Ezmres M~tah 30, 1~'~p' CHANL^y ' / / ro THIS SU~¥~¥ IS A VIOLATION OF , LENdiNG INSTJTUi'ION LJS'~ED H~[~N, AND TUTiON. GuA~ANT~ES A~E NOT T"ANS~EEABL~ The sewsge disoose/ and water supply faci!Jties for th~ location have bes~ inspected by this departmen% and found L~_~i. -~"'~._~' '~hi~o£ ~enera~En~ineerin~ C3qAN~.AX,' ~. ! - 'ST"f, [ .40' J UCAnO. U~w. 70 ---o APPROVED AS NOTED gATE: ,~/~'-- NOTIFY BUILDING DEPARTMENT A F 765-2660 9AM TO 4PM FO& BEQUIF,. ED INSPECTIONS: 1 BEFORE BACKFILLING FOUNDA- TION OR START, FRAMING 2, BEFORE COVERING PIPELINE 3, FINA'L WHEN JOB COMPLETED NOT RESPONSIBLE FOR DESIGN OR CON- S rRUCTION ERRORS DOE)&.. /.2 L ~'} A S TE.~, L~F.I)RO0~,I