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Home My WebLink About8404-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.. E7~6~ ... Date ........... Aug...5 ....... , 19.7.6 THIS CERTIFIES that the building located at . Ship.'.$ Drtwe ............ Street Bayview WoQ~ ~ Map No ............. moc~ ~o .......... Lot No.. -1,~.. · S~ld.. N.Y. ......... confor~ substantially to the Application ~ B~lding Permit heretofore filed in this office dated .......... ~tar. ....2, 19.76. p~suant to which Building Pe~t No. $~g. dated ........ ~r.... h., 19.7~, was issued, ~d conforms to ~1 of the req~ ments of the applicable provisions of the law. The occupancy for wMch this ce~ificate issued is . Pr~va2a .one..f~y. ~el~ng ................................ ~e certificate is issued to . .La~enca .~ hello ..... ~er. ................... (owner, lessee or ten~t) of the Moresaid building. S~olk Cowry Department of He~th Approv~ .. ~uly.. UNDERWRITERS CERTIFICATE No..~289~8 ..... ~e.. 23 .. ~ 9.~6 ............. HOUSE ~MBER · · · 9~ .... Street .... Sh~p ~.s .Dr~v~ ........................ , C .... ........ ~FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOW~ C,.£R,.K:S OFFICE , S6UYH~O~.D', ~. ?. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted crt premises located ,-.,' BOARD OF FIRE ,UNDERWRITERS ' ' ' , lit Ill~:lfl~ll[ [~ ~ ,I '~ ,' ~ m REAU OF 'ELEC'~RICITY" m ' ' "/ ' '~ - - ' ~ - .... ~'~ .... llcan~ ~med on' the able applic~tlon number in the premisea ~f ' ' e ' i ent ~ ~sc~bed belo~ aha ~ntr~c~ oy t,~v ~ , · .; Z,,-Z:.~Ll~.tlo~;' ,'~'B~me.~" ~ l~tFf.'tl~ 2nd FI. ,, attiq~ouesl de ,, ,, , , , . . , %,, I, ,, RXTUEES FL~E~ENT , DRYEES iii Ill i FURNACE'MOTORS-IIt::i ~TURE APPLIANCE FEEDERS TIMECL~KS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO OF FEET SERVICE ~ DISCONNECT Iii This certificate ltl hi lfl-:tH h,-~dt ~d S P E R '¢ m, V ~' I¢ I~ ,' , C' ~ E '" " ' ' ' ' " · ' I' r ~ 3/0 Ill, t,I ' , -, t l-4 ,, ~ ., 1, h ull ~'~' [ . l~' dt Ill i~hlijt¢l__' .... ' ~.,,,' ~ ,, ' //Y-[II ~- ' " ~'; I ' ~ ~ ~ '~ ~1 :lit r~~ , ~ It , ~',,', , 't ,~ ' I ' ;~ ~ ", ' ,q ' ~ ' J ,' ' GBERAL MAN be altered in any manner, return to the offic~ 'of t~e ~oard ~f incorrect Inspectors may be ,dent,fled by e~r credenhaJs NOTE-LOT NOD. D. EFED_ lO MAP OF ~-~ F~[[ ]-a~ ~'TRE BUFFOt[~ COuN~'~F.,!I4!S SUFFOLR COUNTY HEALTfl DEPARTt,TERT~,~P NO. 5520. - The sewsge d!spos~l~and waSer supply .fPei!itiea for th'~ lo¢,~tion have been :inspected by fi, is department a,~d found [. Chief of General Eng ng Services F~. NIO. ['/LAP OF PP-OPERTY FC~ FUHI~dELLO SURVEYED L, ,22Y~ VIOLET t 1SS.OD ~ SOUTHOLD T~WN OF ~:OUTHOLD, GUADANTEED TI) FHE CHICAF_~ 'FI A5 SURVEYED 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 Address L,r , , ,,,/~ 2. Property Location ~_~ V~ll~ge 3. Public Water,Com~9~y, Name 4. Lot size: Width- feet 10. Sewage ~sposal ~'tem: A. ~allon septic tank: Precast,_.~Tt__Equivalent B. Leaching pools: Number of pools 11. Block Precast ~OBlock. ~"Special If private well, fill in the fol- lowing blanks: 9allons A. Tank capacity. Phone Township ,~ength feet /'/7 5. Subdiv. 6. Section,, 7. Lot Nu~be~ 8. Private Wel~ 9. Public Distance to main (For Health Services Dept. Use) B. Pump G~.M. C."' lotal-~ell~epth D. Depth.~o ground water E. Amount~f water in well /// The undersigned CERTIFIES: "Construction of a~or~zed ins,;t~l~__t~ons will be in accordance with the Suffolk County Department of Health Services' curffe~t 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 / z ~-~ /- Si~ned ? , ~ ~ / FOR THE DEPARTMENT OF HEALTH SERVICES~ USE ONC~ ~a~on ~he/~_formation~esented here- with, it is the opinion, of the Department of~6~l~ ~e¢~'~. ~'adequ~t~'~d. satis- factory S~age Disposal System and Water Supply can be ~nstalled on th~s plot. APPROVAL DATE ~~ SIGNED ~ ~~ S-15 Rev. 4/1/73 // ~A~oplicatian '"IA_CATION FOR BUILDING PERM~I'-,,~..~~ o. This application must be completely filled Inspector, with 3 sets of plans, accurate plot plan b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public . areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is port of this ppplicat,on. c. The work covered by this application may nat be cemmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in pert for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. 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, .(~cllnance~ or Regulations, for the construction of buildings, additions or alterations, or for removal or. demolition, as here,n described. The applicant agrees to comply with all applicable laws, ordinances, building code, hous, ng code, and rngulatlom, and to odmit authorized inspectors on premises and in buildings for nocessary/inspections. ~ (~l~dress of applicant) ~ State whether a~essee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner o p emises ........... ..................~.. ........................................ ! ...................................................................... If applicant '~corporate, si~gs~ture p~:?cluly authorized officer. (Name and title of corporate/officer) Builder'Spl , LiconseL:cen No ............. ..~ .................. ' /_.~----F./-~c~'"~ ....... ~- ~ umbers ' se Nol .... ..~....~ ....... : ............ , Other Trade's License No ............'H ................... ~J ..... ~.~ ~c-'~. .~ /" ' Location of land on which p~ill ~F~Map No,: ........................................ Lot No.... ,~,. ................. Street and Number ........... ...~...,..'.?../,Z,.~,,.,,,,,....,..,,,.,.,' f- -; ................................................................ ............................. State existing use and occ//upency of Premises and intended use and occupancy of propased constMrucU~iiclanrlity a. Exisiting use and occupancy ........................ .~..~.._......~...~, .............................................................................................. b. Intended use and occupancy ............. ~..~ ....................................................................... 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................ Repair ................ ~d~,ernj3val .................. Demolition .................... Other Work ..................................................... · '~zT~'// ~ ,~//'~'~ ' ~) ~7'-- ~'~' (Description)' ' 4. Eshmoted Cost ............... :/.. ............................... ~ ........ Fee ./. ....................................................................... ~, ............ ~/ (to be Paid on filing this application~,~' 5. If dwelling, number of dwelling uc~'.~.. ......................... Number of dwelling units on each floor ..... , ...................... If garage, number of cars ......................................................................... ~.~. ............. x....~ ...................................... 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 ......................... ,~hl~n~er of Stories .........;~.~.../. ........... 8. Dimensions ~,~,~,,ef~tire new construction: Front ......... '3'" ................... Rear ...... .'... .................. Depth ........................ Height .... ,~n~er~ (~ Stories ................ ,~....~.~. ...................................... ,~..~. .... ................ · · ................... //, ............. 9. Size of lot: Front ........................................................ Rear/~ ..................................... Depth ................................ 10. Date of Purchase ....... ................ L,.~ ............................ Na~ ................................................... 1 1. Zone or use district in which premises are situated ........ ~. .................................... ~ ...... ~ ...................................... 12. Does proposed constru~i01ate any zoning law, ordinance or regulation: ....................................................... Will lot be regraded ' ill excess fill be removed fr is.e ( ' ( ~ No ,3. , · ........ 14. F, ame of Owner of premises~.~ ....................... Add,, ........ ~.. Phone No./....'. ................. Name of Architect ......... .- .......... ~..../. ............. : .................... Address .....~ ........~:.v......~,~ Phone No ..... .,..~.~.j~. Name of Contractor , Address, ..~ '~ PLOT DIAGRAM Locate clearly and distinctly oil buildingS, whether existing or proposed, and indicate all set-back 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,,.~OJ~, /// ~ S S cou w - ................ ;.~~; ..................... being duly sworn, deposes and says that he is the opplican~ (Nam~ ~f individual signing cont~,~ obeve named. He is the ................................... .(,..~....~~ .......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Swam to before me this ~. 19 --~ .Z.~.. ............... day ofc)...z Nota~ Pul~lic, . .......... .~¢1'~... ...... · ............................................................................ ~ ................... (Signature of applicant) ,0