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Home My WebLink About8041-zFOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No..~80~ ...... Date ............. ])ell.. ~. ....... , 19. ?.~. THIS CERTIFIES that the building located at . [t/l~. ~tlth.(ll. Road ..... Street Map No...~ ....... BlOck No.. ~ ...... Lot No, .. ~... ~out~ld.. ~.~, ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... J~ne.. ,~0., 19..~ pursuant to which Building Permit No. ~Z.. dated ........... ~ly.... ~.., 19..~ was issued, and conforms to all of the require- ments of the applicable ~rovisions of the law, The occup~cy for which this certificate is issued is . .Pre, ate, ,o~e, ~ ,d, e~g ...... (. ~r~ .floo~. o~) ......... The certificate is issued to ~lCh~d. ~ele~ ....... ~e~. ........................ (owner, lessee or ten,t) of the aforesaid building. Suffolk County Department of He~th Approval . .~ee:..8. ~.. ~. R.,. ~it~a ..... UNDERWRITERS CERTIFICATE No..pe~di~..ff2~.[O.~ ~. .... ~. ~[..I.f.~ HOUSE NUMBER. ~l ~ ........ Street .~t~. R~ .... $~tho~ ............. Building Insplctor FOI~M NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N: $041 Z Permission is hereby granted to: ........ .a..~,~ .. ~th.e...e. ~..e.~ .................................... ................. ~.~.~...~.~.c~...~.o.~d ............................. 8outhold Bu/ld new one fami.~, dwe~.l~ng (e e~e ~Z=.$~; floO~ o ~ ~o ................................................................................ ca~ ........... u~ .... .......................................................................... 2nd..f.3,~ar..~;_-f~u~2u~, ...................................... et premises located at ....T.~``t`h.~...~..1.....~...~..a..d...~.{;.e~.~x.~;..e.D..t.~.~.~.n.).~..(J~.~..~]`.~.) ............................................. ..................................................... ~.~.~.ko.l~ ....~. ,X., .......................................................................... pursuant to application dated ........................... J.13D. e.....~.0 ......... , 19...:?.~, and approved by the Building Inspector. ~ee *.~.3.'.~. .......... ........ ......... ............. 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. Al)pl icant 2. Propert] Locatipn Vi 11 age 3. Public Water Company Name 4. Lot size: Width~Y feet 10. 11. 5. Subdiv. 6. Section-- 7. Lot Numb-'~- 8. Private Well 9. Public Water Distance to main Lengthen: feet Seway~isposal System: A. ~O~gall~n/~ic tank: Pre~'~st ~E~quivalent Block B. Leaching pools: ~ Number of pools Precast_/~ B1 ock Speci al If private well, fill in the fol- lowing blanks: A. Tank capacity'l~allons B. Pump G.P.M. ~ ~ ! C. Total well ~epth D. Depth 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 :~ ::: ./~?U Signed~%/~/~ ~:~~ ' FOR THE DEPARTMENT OF HEALTH SERVICESm 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. S-15 Rev. z~/1/73 BUILDING DEPARTMEN'I~*~, SOUTHOLD, N. Y. Exam,ned ......... t ........... , ,,..~.~ ,%oproved .......~......!~....!......[ ........... , 19.~.~. Permit No..~.~...~..(...~r~.......~ .......... ;'""~ .............. ¢'~':'¢'~ ............................................... "~ ~. ~ ~ ~~ ............. ~-- ~ ~1-~ ~ ,L., ~ APPLI~TI~ FOR BUILDING PE~IT ~-~ ~ ~~ ~".~.~.~.:~ ....... Ink,tar, with 3 ~ts of plans, accurate pl~ plan ~ ~le. F~ acco~ing to ~h~ule. b. Plot plan showing location of lot and of buildings on premises, relationship to ad oining premiss or public struts o~ ar~s, and givi~ a detail~ de~ription of layout ofpr~e~ must be drown on the diagram which is c. ~e work covered by this a~lication may n~ be commenced before issuance of Building Permit. d. U~n approval of this application, the Building Insp~tor will issue a Building Permit to the applicant. Such permit sha~l be kept on the premis~ ~ailable for inspection thr~gh~t the work. e. No building shall be ~cupJ~ or u~d in whole or in pa~ for any pu~ose whoever until a Ce~ificote of ~cu~ncy shall have ~en granted by the Building Insp~tor. APPLICATION IS HEREBY ~DE to the Building Department for the issuance of a Building Permit pu~uant to the Building Zone Ordinance of the Town of ~uthold, ~ffolk County, New York, and other applicable ~s, O~inances or Regulat ons, for the constru~ on of bu ldings, additions or alterati~s, or for removal or demolition, as herein de~ri~d. The applicant agrees to comply with all applicable laws, ordinances, building c~, housJ~ c~e, and regulati~s, and to admit authoriz~ in~ecto~ on promises and in buildings ~r n~e~a~ i~tions. ~ 2 ~~ .~ ~ .... ~..~.:-:-...:{~,?~ o, op~,,~. ............................ o~ ~ ,,: ................... ~ ~o~,: ............. (Address of applicant) State wh~ther applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~.~..-.~' ... If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) Builders L~cense No ~ Plumbers L~cense No.....~....~. ..................~ ........... Electrician's License No..~...~.......~/-..~ Other Trade's License No ............................................... ,~/// /~,:~ %~ ~( .... /% $~ t 1. Locahon of land on which prc)lkosed work wdl I~e done. ~/~Aap, 1'~o..: >.....'..~,~.~.~.~$......~.....~.... Lo No. '~-~'" '~'~'7'-;"7' Street and Number ........... ..~...O...~....~....~...~.... ....... . .~......~..../.../..././.......~....~.'......~.: .................. .~.~...'~..../..~... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ~......~ b. Intended use and occupancy ................ ~'-' '~'""'~ ........ ~1~" ................................. i ............. Building:...~......... 3. Nature of work (check which applicable): New .... Addition .................. Alteration ................. Repair .................. Removal .................. Demolition, .................... Other Work ..................................................... · 4. Estimated Cost ............. ,~....,~: ..................................... ~ee (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... ~ .......... Number 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, Jf 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 ....... --~ '~...~.....- ................. Rear ....... ~..~....~ ........... Depth ...~....?.. ............. 9. s'iHz;'go~t lot: Front ......... . Number..c~.~...~..'--°' .................................. ~to.~ ........... Z.~..~. ........ Rear ....... ~....~..~.'.~.. ............... ~.v Depth ....~..._.~..~.....~ ........... 10. Date of Purchase ...... ...~.~.d...~. .......... /..~'..~....~... ............ Nome,~ ~'~"~°f E~'mer, Owner ......~.:/~'.~.e.~.~.<.,.....~..,~.... ........ 11. Zone or use d.istrict in which premises are situated ....... Z--'-~......~.~..'.... 12. Does proposeo construction violate any Zoning Iow, ordinance or regulation' 13. Will lot be regraded ...~...~..5.....~.~..., ...... Will excess fi~ be removed from~oremises: ( ), (2<~' Yes No Name of Owner of premises .~. ..... :~ ........................... Add,, ..;. .... ~ ......... ~t'"":' one No ...... , .............. Name of Architect .........../~/~'°'~'" ...... ..~.~. ......................... Address 4.~....~. ...... -/~',~-?,~'~'~ ..... Phone No. ~.~....: ............. Nome of Contractor ....... ~:.;.:. .............. '..~.. .......................... Address ....~. .......... ;~:..:.. ..... Phone No ...................... 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 Y~ORJ(. I ¢ c COUNTY OF ~...[""~ · ~'.~.Z~f,,~.~Zz...,~)...,....~.~?~'..~.~.~ .~.: be ng duly sworn, d~oses and says t~t he is the applicam (Name of individual signing c~trac~ above name. He is the ................................................................................................................................................................................. (Contractor, ag~t, corporate officer, etc.) of said owner or owners, and is duly aut~rized to perform or have performed the said work and to ~ke and file this application; t~t all statements contained in this application are t~e to the best of his knowledge and belief; and that the work will be performed in the manner set foffh in the application filed therewith. Swam to befo~ me this ~ ~ / 4 ~ ~ ~ ~ ~ {$i~noture o{ ~ppllcant) No. 52-~522026 . Sulfa k Cou~ - Commission ~xplres March 30, i.3, MAI::::, OF LAND SL~I~VEYED FOR SOLJTHOLD Tov,,,~ oF ~---~Ot.,JTHOLD, N.Y. $14vve~e_ci ApYi( ~, GYee~pcn-'+, 1'4,e..w W'crrk, J .J SOl IT~OLD TOV,/H OF .,?~O~THOLD, N.Y. N F- 'l