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Home My WebLink About8047-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerfi~icnte O[ Occupnncy No.~'?.~.85 ....... ]Date ................ .1~..~.,,, THIS CERTIFIES that the building located at . .L.~.~.~,~.h.o..u,$,e...1~o..a.d. ........ Street Map No..X~. .......... Block No. ~ ....... Lot No, . .~.. ~.O.U..~.h.0.~.d....N.:Y.: .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ J.~..e....P,~:, 19.7.~. pursuant to which Building Permit No..8..0~. ~.Z.. dated ....... J~Y.. ~. 197~.., 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 .. P~'.~V~.e..o..ll.e. ,f.~tlg..~.~.y...d.w.e.~..~.:~. g ...................................... The certificate is issued to (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Healih Approval .~..~r....~.. )..9?5...~..C.t..S.m.$.th. ~.~' Villa UNDERWRITERS CERTIFICATE No..p.~.~.d..i~.~ ............ ................. HOUSE NUMBER ..... .~.0 ..... Street . ~;Lgl~;~c~Bge. ~O2d ..... ~.o.~lth.o.],c~ ........ Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8947 Z Permission is hereby granted to: ~;c. ga~.e.~..L..~...t:~.~.~. .................................... ....... /,:Lg]z t,h~u,s.e ** t~o~.c~ .......... ~h~l,~, ....... at premises located at ,,lil~'A,q.,.l-&~...I.t~tl$.~...B.O&rl ......................................................................... .......................................................... ~ou.thold. ........ ~,X., ................................................................ pursuant to application doted ........................J_.U~:...~.. ......... ~. ........... , 19.~.~.., and approved by the Building Inspector. Building Inspector SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number~'~O APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant 4~, /~H~/~M~ Phone 7L. 5--~S-/Lm Address /-t ~ ~A/o~m~ ~, ~o~ ~ ~ 2. Property Location .6~ ~I&H~ 7~ ~ i~ Village 3. Public Water Company Name 4. Lot size: Width~feet 10. Sewage Disposal System: 5. Subdiv. 7<~ 6. Section ~ × 7. Lot Number .y~ ~ 8. Private Well ownship R~z/~ '9. Public Water Distance to main Length ~ feet (For Health Services Dept. Use) A. 900-gallon septic tank: Precast ~( ,Equivalent. Block B. Leaching pools: Number of pools /~- ~//~ ~ Precast ~ Block _Special__ ll. If~.rivat~well., fill in the fol- 1 o~ ng blanks. A~nk.~[,~ capacity ~Z) gallons B ~_~mp G.P.M. C.~'~otal~ell.~ ,. ,~ depth ~o / D~' Depth-t~o ground water ~ o E. Amount-of water in well_. ,cLxo/_ z_/G/~--/~Y~ The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Heal th 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. S-15 Rev. 4/1/73 EXUVATIOH INS E TI6N P IiUIRED TOWN CLERK'S OFFICE APPLIG~I~TION FOR ~UILDING PERMIT INSTRUCTIONS ~' a. This application must be completely filled in by typewriter oe in ink and submitted Jn triplicate to the BuJldJflg.~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets oB areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this ap~)lication. C. The work covered by this application may not be Commenced before issuance of Building Permit. d. Upon approval of this application, the Building ~nspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available far inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPL;CATION 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, Ordlnanc..es or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descnbed. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Address of applicant) State whether applicant is,owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~'.. 'T--'""-"'"--"- If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on wh'c~.p .?p~ed work will be done. Map No,,; ...... : ....... ~ .................... Lot No ....... ~. ............. Street and Number ~/-~,....~, ....... .'......~ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed consti~ction: o. Exisiting use ond occupancy ....... ~,~Z~....'~'.~....: ................................................................................... b. Intended use and occupancy ..~...~...~.....~ 3. Nature of w~rk (check which applicable): New Building,. ................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ~-~.~.~~, (to be paid on filing this _application) 5. If dwelling, number of dwelling units .......... .~ ................ Number of dwelling units on each floor ........................ If garage, number af c~rs ............................................................................................................................................. 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 qf Stories ...... L:~...~,,r-~,,r-~,,~]~ .................................................................... Dimensions of some structure with olterotions or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions Of entire new construction: Front ..... ~ ............................. Reor ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 10. Date of Purchase ....................................................... ,.Name of Former Owner ........ ..~...~...~..~.. ................................. 11. Zone or use district in which premises ore situated .................. .: ...................................................... 12. Does proposed construction violate any zoniru:j Iow, ordinance or regulation: ........................................................ 13. Will lot be regraded . ........ .~....:....,,Will excess fill be removed fro~ promises: (/~ Yes ( ) No Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ............................................................ Address ................................ Phone No ....................... ~ PLOT DIAGRAM Locate Clemly and distinctly all buildings, whether existing or proposed, and indicate all set-back dime~]~-'~0-'~m '~ ~ property lines. G~e street and block number or description according to deed, and show street names whether' interi~r corner lot. ~ e ~, ~o :3'77 ~ , i STATE OF NL~V Y~RK,,~ .., ~ I c ¢ COUNTY ~ ..~......~"'"' ................ ~(Nam~ {~oi~O~.S~. ... .................... ibeing, duly sworn, deposes and says tl"mt he is the applicon! above named. --~-Ie is the ...... ~ .............................................. ' ............................................... i .............................................. i ........... (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 thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this · ~' (St f . . ~,/ tlOTA~ I~M.',C, Stat, o-erT~ew ¥or~ , . ~ . , . . ' J! ' No. 5,2,.~_J25850, Suffolk County/ ' ~ ]'mm ,Expi[es ~s~Gh aO~ 19~,