The URL can be used to link to this page

Home My WebLink About8044-zNO. & TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . l~, ..(k[1].et;~ .D~. ......... Street conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ~...~0..., 19 .:~. pursuant to which Building Permit No.. dated ............. ~ .... 1., 19. ~, was issued, ~d conforms to ~1 of the require- ments of the applicable provisions of the law. The occup~cy for which this certificate is (owner, lessee or ten,t) of the aforesaid building. Suffolk County Department of He,th Approval .Dee..:~. ].~ .... b~. ~ .~ .~ ..... UNDERWRITERS CERTIFICATE No... ~, ~83~ a~.~t.. ~.. ]~ ............ ...... .~.( .............. Building InspectOr ~OP~I NO. ~ TO~N ON $OUT~OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8044 Z Permission is hereby granted to: %..i:~.~..~.Q~ a...~a~....~..~l~..~ & Lo~e~ta C~pbell ~o.~.&~...~.~.~...9~...~.z..~.~.~.~ .................................................................................... at premises located at .~.~...~.....~.~9~..~ ........................................................................... ............................................ ~.~..~lZ..~...~z~e .......... ~.t.~ar. io~ ....................................... pursuant to application dated .......................~.q .......~Q ........... , 1~.~...., and approved by the Building Inspector. Fee ~.t.].~. ............ Building Inspector FORM NO. S TOWN OF $OUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 AFPLICAT[ON FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, in duplicate to the Building 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 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 os 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. $5.00 Certificate of occupancy on pre-existing dwelling or land use Date ..... .'f../. ................... New Building .................... Old or Pre-existing Buildir,~m. ........... : .............. Vacant Land ..................... Locat,on Of Propert,~:...],~.~~,¢~.~'.../...~',,~.~./..~..~.....~B,~r~..4'~./~c ./~.<../..~..'..:~/~.-' Owner Or Owners ~O~f ~Pr~pert~....~..~/.~./...~..~/~../4~../~G.~"~./.~../..~..~..~.~....~~..'~...~... .......................... Permit No.~.~.T... Date Of Permit ,,~.....~.d.QZ~'~pplicant Health De t A royal '/~' bar De t A r a' p. pp ...................................... ~.:....~a p. pp ov I .................. . .............................. Underwriters Approval ..................................... .~..,..Planning Board Approval .~f~....~ ...................... Request For Temporary Certificate ........................................ Final Certificate,~ ............ .,¢.~%~.:>t.. Fee Submitted $ ..................................../ // Construction on above described building and permit meets all applicable codes and r, dgulations. ................................ . ............ .~.. day of ..... .~-....~....~.~.,. ............... (stomp/seal) DISHWASHERS EXHAUST CLEAVES PO!~iT '~' ' N,6B'23.BO E. SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number APPL)CATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Address ~~ ~ ~m~ ' 6. Section. 2. Property L~catio~' ~,~ :?~ ~~}0~. 7. Lot Number _~FL~. ~7~-~/~ . ~ . , 8. Private Well Village_ ~~,~,~3 Townshlp~y~o/~ 9. Public Wate~ 3. Public Water Company Name ' Distance to ~n 4. Lot size: Width / ~feet L~ngth .~jO feet Sewage Disposal System: A. 900-gallon septic tank: lO. Precast/~l~quivalent.~ Block B. Leaching pools: Number of pools ~ Precast/~B~ock ~pecial 11. If pri~y=~te well, fill in the =:foll ow~'g blanks: ~] Tan~capacity_ ~c~L gallons ~:'~:: To~I depth ~::~C~W ,~j wel 1 ~*:~ De~ to ground wate~ ~ ~E. Am~t of water in well (For Health Dept. Use) The undersigned CERTIFIES: "Construction of authorized installations will be in accordance wi~h the Suffolk County Department of Health's current standards thereto. This application will be valid for one year from the date of approval indicated below and maj~q)~ renewed if a current local Building Department Permit is in effect. ~ ~ ' FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Heal'th Department that an adequate and satisfactory Sewage Disposal System and Water Supply ca~ be installed on this plot. ~~~ APPROVAL DATE . o SIGNED ....... S-15 Rev, 4/1/73 l j: APPROYED* AS N°TED .?/L/ )~, ,, p~E~_~ .... ~~ ..... NOTIFY BUILDING DEPARTMENT ~" 76S.~60 9AM TO 4PM FOR REQ' ~IK- ED INSPBCTIONS: , t. BEFORE BACKFILLING FOUNDA,, TtON OR START FRAMING ~, BEFORE COVERING pIPELINE