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Home My WebLink About8366-zFOF,~ NO. · TOWN OF SOUTHOLD BIBT,DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Z7069 ..... Date ........... ,T~e. · 4 ...... , lg. 76 THIS CERTIFIES that the building located at . L:L~'le ~ck' Road ...... Street Map No. ~ ...... Block No ........... Lot No, 7' .... C~It;oho'g~' ' ~;][; ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated '- Feb .1~..., 19.76, pursuant to which Building Permit No.. '8366Z' dated .... Feb-' 4+.. , lg. ~6', was issued, and conforms to ,ll of the reqnh'e- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .Pr.i.wal;e. cna i'ars~ty -dwe.l.~ing ................................. The certificate is issued to -Pra~ .&. If_~.ren- · '¢o~1;elto' · · Ownel-'5 ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval J~e ~ · 19~6 'by R.' Villa ..... UNDERWRITERS CERTIFICATE No.1~.28616 ~ .... ~%me' · T · ~ 9?6 ................ HOUSE NUMBER ....... 970' Street. 'l~itl~l~' N~cli' R'6~id .................... FOE]~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMi::~.ETION OF THE WORK AUTHORIZED) N? 83~§ Z Permission is hereby granted to: TOWN OF SOUTHOLD , Building Depa~tment 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 from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a cerhhcate of Code comphance fram the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s~te plan requirements where applicable. B. For existing buildings (prior to April ]957), Non-conforming uses, or buildings and "pre-exmting" land uses: ]. 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 cerhficate. C. Fees: ]. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3 Copy of certificate of occupancy $].00 Dote ..~...~....~.....~..~.....~..?..~,..~. ................. New Building ..... ~ ........Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..... ~r~.~,~..~{~.C~;..,~O~d.,...g.~t.~.C.]n.~ee..~.w,..YOZ'~ ..................................... Owner Or Owners Of Property .....~..~..~....~...~.~....~.~..~..e...~.....C..o...s.~.e...~..~..o.. ......................................................... Subdivision ................................................................ Lot No....~. ....... Block No ............. House I%1o ............ Permit No .~..~..~...~. ........... Date Of Permit ...~./.~/..~.~....Applicant ..~.e..o...~.~.e......J~...~...e..~..~...~.~.~.~.~..~.~...~.~..g. Health Dept. Approval .~.=~.Q.wlO .......................... Lobar Dept. Approval ............................................... to follow Plannin~ Board Approval Underwriters Approval .............................................. u ......... ~ ................. Request For Temporaw Certificate ....................................... FinoJ Cert,ficate ......................................... Fee Submitted $ .................................... Construction on above described building and ~r~ ~mi~eets all/~a/~te codes and regulations. Applicant ...... .~..~ ............ ~~ ............................................. .... George ~lers, Builder, Inc. I~ ~/~/~ 5worn ~o. betore ~this _George ~lers~ President ~ ~ .......... ~.. day of .:~.....~.~. (stamp or seal) ~ ~ ~ Notaw Public ........... ~~. Coun~ '~ SOFFOL~ COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number ~50 -/~ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant Address j, 2. Property Location Village~ ,~ ,, 3. Public Water Company Name 4. Lot size: Width ' feet 10. Phone - ll. ___,-Townshin , , ) Length feet 5. Subdiv. 6. Section 7. Lot Number 8. Private Well 9. Public Water Distance to main Sewage Disposal System: A.//~-gallon septic tank: Precast / Equivalent Block B. Leaching pools: Number of pools Precast ~4~ Block ~pecial__ If private well, fill in the fol- lowing blanks: A. T~nk capacity B. P_u~p G.P.M. gallons C. Total well depth D. ~epth to ground water E. Amount of water in well (For Health Services Dept. Use) The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health 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 System and Water Supply can be installed on this plot. SI NED -_ _ APPROVAL DATE S-15 Rev. 4/1/73 II Xt L