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Home My WebLink About8364-zI~F.M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, BI. Y. Certificate Of Occupancy No. Z~22~ ...... Date .......... Sept;..8 ......... , 19. THIS CERTIFIES that the building located at .... l~.awa~;ha 'Path ....... Street Map No. xx ......... Block No...X~: ..... Lot No, XX~' 8o~ti~o14. · I~.,.~., .......... conforms substantially to the Application for Buriding Permit heretofore fried in this office dated ............. Jat~ · 26 19.7/~. pursuant to which Building Permit ]No.. dated ....... Ja~a' · 30 ., 19 ~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 .IEri.vate. ane f~ily..dwel,~n$ ..................................... The certificate is issued to . Dona.}d. C, .A,ldx'}eh .. -0w~ev ..................... (owner, lessee or tenant) of the a/oresaid building. Suffolk County Department of Health Approval Sept. · ~ · ~ 976" by-R-,..¥~t~. ~ .... UNDERWRITERS CERTIFICATE No. -]~00~[ ..... A~k~'' '~" 49?6 ............... HOUSE NUMBER ...... .~620. · Street .Hi&~atha..l~atl~ ......................... ............. ' ........................... . . - . . ,. .:. . . - -' " ' ":: : :: : " " "." FOR~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, Iq. y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLI-~r'ION OF THE WORK AUTHORIZED) N? 836 Z Permission is hereby granted to: Date ......................... · 'aa: ......... 3e .......... :9.76.. to.-b~/..aec., eae...~.a~..~t., awe .~.Z.~i ed ot Ti~ //a ................ ; ................. · .... ~r~-~l~;.~,4~ .................................... ........................... : ................................. ~ e,~tho-2~--.-.i~,.~.~, ..............................................................:. .... ~..., ...... :% ...... :.........:...... ...... .~, ............................ pursuant to application dated ............................. Building InsPector APPLICATION FOR CERTIFICATE OF OCCUPANCY lustructluns A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the fallowing; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, 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 from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, o 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 $l.00 New Bt~ilding ....~.. .......... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Prope.y ....~.~..~...~~ ............................................................ Subdivision ...~[~;~,~.,~.¢)~n~Lot No ............. Block No ............. House No Permit No ..................... Date Of Permit .................... Applicant .... ...~...~..-'"J~".~.C~,~m...~......~.~T~. Health Dept. Approval ..?~/...~./..'./...~. .......................... Labor Dept. Approval ........... ~....¢..(..~....~. ..................... Underwriters ~prova~ ......................... ,.~ .................. ~,a..,ng Bo~rd Approval ...... :.:.::.'.~ ...................... Tempo f cote ........................................ Certificate ...... ...................... Reques~ For Fee Submitted $ ...... '~.~......~ ............ Construction on above described building and permit meets all applicable codes and regulations. Sworn to be, Jure me this /,/// . ~., 0.~/._/o .. .......... ..... Nota~ Pub.c ............ ~a..ty 6~r" 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,~mX/~X~ ~'. ~/~9/~/~/ .,Phone 7~~.._~.. 5. Subdiv. ~a~ Address ~/~~ ~X~ ~o~o~. ~ V. //% ~I 6. Section ~ 2. Property Location ~/A~~ /~', ~,~ ~t' 7. Lot Number ~ t~ ~o~/~ ~o~, Z~}~ ~.~.8. Private Well Village ~~X~ Township ~o~o~. ~,~/ 9. Public Water 3. Public Water Company Name ~ z Distance to main 4. Lot size: Width //~2/feet Length//~,e feet 10. Sewage Disposal System: A.~..~gallon septic tank: Precast v/Equivalent Block B. Leaching pools: Number of pools -- ~( Precast ~'Block ,,~pecial__ 11. If private well, fill in the fol- lowing blanks: A. Tan~capacity ~)'~ gallons B. Pump G.P.M. /-~ ~ ~ C. Tqtal well depth ~_~2~ ' D. D~p~h to ground water ~ E. /~?~nt of water in well ~/ (For Health Services Dept. Use) //0 o ~ The unders'igned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk Coun~ Department of Health Services' current standards thereto." This application will be valid for one year from the date of app~val indicated below and may be renewed if a current local Building Department Permit is in effect. Date Signed ~~C~- ~2.~ FOR THE DEPARTMENT OF HEALTH SERVICES~ USE ONLY. Based on the information presented here- w~th, 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 ~/~/~..~/r SIGNED ~. ...... ~ S-15 Rev. 4/1/73 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY { dl B5 JOHN STREET, NEW YORK, NEW YORK 10038 ..,e August 25, 197~; .¥,.,c.,io.~o.o./.~ 85?448 N 300375 THiS CE~IFI~ THAT o~y t~ e~tr~ equ~n~ ~ ~scri~ ~w and in$r~c~ by t~ appl~ant ~m~ on the a~ oppl~atlon n~m~r in t~ p~m~ez of Donald C. Aldrich, w/s Hiawatha's Path, Southold, L.I. inthe/oilowing~atlon~ ~ B~oment ~ lstFI. ~ 2nd Fl. outside s~.t~o. ~..,~.=i~d.. ANgst 23, 1976 andfoundtobeincompllancewlththerequiremant*ofth~sBoard. ~TOEE ~ I ' ' ) "- FIXTURES I RANGES IC~KING DECKSr OVENS I DISH WASHERS EXHAUST FANS OTHER A~A~TUS, ~o~o~/s: ~-~/~ 1 GFI Donald C. Aldrich Minnehaha Blvd. or~L ~NA ~ Southold, L.I. 11971 ~;'~-~ ~ Pe~ , O ~ ~ This cerhfJcate must not be altered in any manner; return to the office of the Board ~f incorrect, Ins~f,ed by t~ credentials. I~1 ""-- 4 9 4e -- *~ ~A~'HORIZED ALTE~AHON OR ADDITIOI~ TO THIS SURVEY IS A VIO.~ATION OF SECTION 7209 C~F THE NEW YOR/~ &TAT~ ~ ~r 07~-03 - o qy.oa~g_ EDUCATION LAW,