The URL can be used to link to this page

Home My WebLink About8363-zTOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ~/f.Y. ............ . .~ ~//~/a) /~ .V.~. Street Map No.I]QL~-~ ~A~Blo~No ......... Lot No,~.. ~ .~.~.~V.~.~...~'~' confoms substan%ially %o the Application for B~lding Permit heretofore ffl~ ~ ~is office dated ..... J.~ ~.. 3.~. , 19~&. pursuit to which B~g Per~t ~o~.~. ~" dated .... J ~.~.. 30.., 19~., was issued, ~d conforms to ~ of ~e req~e- ments of the applicable provisions of the law. The oeeup~ey for which t~ ee~ificate is , uoa pp.t ......... (owner, lessee or ten,t) of the ~oresaid building. S~olk Co~t7 Dep~ment of He~th Approv~ ~.~ 9.T'...~. ].~.~.(~.. ~.. ~x: ~.~ ~ un~awa~as c~a~iF~ca~ ~o. ~ l .a.x. o .~ ..... ~b.~. >../.!.~ ~ ..... ~ous~ ~a . 3 oX ..... st~oot .~X ~.t$0./L .¢~ ~ ~...~ ff~ ........... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT O-HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8363 Z Permission is hereby granted to: ,?..~~.~..~,~?.~ : ............ , ...... ...... ::~. ~ .~ ~'~,~,z,~x~,: ....... :~. z ~J. . . . :~ , · ,, .~ ~~:~~ ................. tO .~' , ........... ~ ' ~:~.,~: ~~ ~~.: ........................................................ at ~i~s I~oted'at ~ , _ , ~ . ~~..~ ......... ~~ ....... ~ -~G -' ~ m~ i~ ' 1~.., and opp~ved by the ~,~Uant to apphcatmn dated ..... ~. B~l~mg Inspector. ~ ~ Fe~ ~.~ · ~ ......... FOP~ NO. 6 TOWN OF $OUTHOLD , Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installation fram Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1 00 New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..................................................................................................................................... Owner Or Owners Of Property ....................................................................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............ Permit No ..................... Dote Of Permit .................... Applicant .................................................................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. Applicant Sworn to before me this ....... '~/'~ .............. t~"~"~'"" ................ day of ............................................ (stamp or seal) Notary Public .................................... County fiXTURE SWITCHES ~ ~CAHDE~CENT FIXTURES ~, -'u OVENS DISH WASHERS EXHAUST FANS OUTLETS ~ ~ FUTURE A~IANCE FEEDER~' MULTI-OUT~ET I DIMMERS -il~ SYSTEMS, JNO. oF d- SERVICE DISCONNECT ,Iq ~ -',.~ ~l~ S ,HI ~.~IIE~ h;~'R~;~?~ V ~r' B~--. _ , NO OF CC COND. ~ OF~ HI-~ ~,~ a~ ' A w. O OTHER AP~ARATUS~ ~q-1 Smoke De~e~tor " " "50verton,Pass, , Thi~ cert,flcate must not be altered in any manner; return to the office of the' Board [f incorrect. Inspectors may be identified b'y credentials 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 ARTHUR J. TILLMAN Phone 584-6045 Address 260 Seventh Avenue, St. James, N.Y. 2. Property Location Southside Harborview Avenue, ~prox. 150 feet east of Inlet view East Vil l age Mattituck Township. South~Id 3. Public Water Company Name None 4. Lot size: Width 162 feet Length 270 feet 5. Subdiv. Inlet East F~tes 6. Section none 7. Lot Number 5 8. Private Well Yes 9. Public Water No Distance to main lO. Sewa~/~isposal//! S~yste~: A. ~9~-gallon septic tank: Precast x Equivalent Block B: Lea~lling pools: 3.Q~ cu. ft. Number of pools / Precast~/9,3~° Block Special , 11. If priv~{~ well, fill in the foi- l owing b~nks: A. Tank :c~pacity 82 gallons B. Pump G.P.M. 15 C. Total well depth D. Depth to ground water E. Amount of water in well (For Health Services Dept. Use,) l"ne undersigned CERTIFIES: "Construction of authorized installations will be in accordanc~ with the Suffolk County Department of Health Services' current standards thereto." This application will be valid for one year from the date ~f approval indicated below and may be renewed if a current local Building Department P~r'm/t is in~ect__ ========================================================================== 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 System and Water Supply can be installed on this plot. APPROVAL DATE SIGNED S-15 Rev. 4/1/73 68 formefly no~._oro. Reeve Dor~~ / ~ot 6 IVO TE mt = MOYUMENT ~ SUBDIVISION MAP FILED IN THE OFF/GE OF THE CLERK OF SUFFOLK COUNTY OH MAY t, 197.~ AS FILE IVO 82~t9 '- /¥8.9'24 'IO'W t 112,~0 ' -' ~ ~ Lot -~ REVISIONS YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W, YOUNG HOWARD W. YOUNG SURVEY FOR: LOT NO. 5~, II~.ET £~sr ' .: ~,,~ ~. .. :. ~,~ . APPRI~VED AS NOTED NOTIFY BUILDING DEPARTM2NT 1, BEFORE ~CKFILLING FCUNDA- 3. FINAL WHEN JOB COMPLETED rzi L4,, ; / '0