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Home My WebLink About8069-zTOWN OF $0UTHOLD Btm.DING DEPARTM'~:NT Town Cl~k's Office Southola, N. ¥. Certificate Of Occupancy No. Z672.0. ...... Date ...........0.o.t/ .... .~ ......... , 19..7..~ THIS CERTIFIES that the bugaing leeated at ...I/e~az:y. Lave ............. Street Map No..P.e~:..~..~.:. Block No ........... Lot No. ~)....P.e.q.op~q.. ~:~? ........... conforms substantially to the Applicat/on for Building Permit he~o~mfore filed in ~ office dated ............J~l&r... 3, 19.?~. pursuant to which Building Permit No. 8069Z.. dated ............~ul~r... [1.~, 19. ~.~{, was i~sued, and conforms to all of the require- ment~ of the appUcable provLsions of the law. The occupancy for which th~, certificate is issued is . PrAvata .one..£a~/2.~. dwalling ....................................... The certificate is issued to .F.4.cha. e..1...1~..r~.c.l~q .~la. ...... . .O~qT ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .t/Op.~ .~0...197~...~y..~,..VAlle .... UNDERWRITERS CERTIFICATE No...i~3~0 ..... 3~pt. ~.. 15~5 ............. HOUSE NUMBER ...206.~ ...... Street ...... .H.e.n.r.y..L.~n.~ ........................ BuiJd,ng Inm~ FOR~I NO. ~ TOWN 'OF SOUTHOLD BUILDIt4G DEPART/V~ENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PER/v~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 8069 Z Permission is hereby granted to: ................ g.vA;~.a~.gu.c ........................................... tO ...... .V.~,~L,,.. ~.,; ,.~ ....O~ ....... ~&.,,l~,~..,O.~.,J.~,.~ .................................................................................. ]or ~9 Peconic at premises located at .......... ; ....... :; ........................................................................................................ ................................................. ~.,,D~.....[;.~ .............. ~.Q~.~ ............................................................. pursuant to application dated .......................... ~.~,15~....~ ............. , lg..~..!J]., and approved by the Building Inspector. Fee Sf;Z ,:..'.(,I ............ SUFK~,~,COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. appl lcan~ Address 3. Publ i c Wa~T'~ny Name 4. Lot size: Width feet Length. feet Sewage Disposal System: A. allon septic tank: . Precast ~ Equivalent Block__ B. Leaching pools: Number of pools '~ Precast ~0 Block__~pecial If private well, fill in the fol- lowing blanks: A. Tank capacity gallons B. Pump G.P.M. C. Total well depth. D. Depth to ground water E. Amount of water in well 5. Subdiv.~ 6. Section~m 7. LOt Number 8~ Private Well 9. Public Water ~tance to main 10. 11. (For Health Services 1 ~ ;o 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 approvaT indicated below and may be renewed if a current local Building Department Permit is in effect. 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-l§ Rev. 4/1/73 Ihe sewage disposal and water suppl~ facilities for this location have been inspected by this deo~ent~d~o,m~ MtC~-"AEL' ' d. '" THE NEW YORKI BOARD OF FIRE UNDERWRITERS September 24, 1975, ~,,,,¢.,,o.,~*',,.o.yi,e 813L~87 . N"247350 Michael Marschean, Henry's Lane, dead end & New Hw. ag, .'. :.. ,~,~,,~i,,~,~o~ September 22, 1975:/. 13 Oustav Bartra- : . . .. RR #1, 227 .East Breakwater'RD.', Mattituck, L.I. 11952 : .).' . This cert,f,cate must not be altered in any manner; return to the office of the Board if ,ncorrect. Inspectors may be i~entified ~y'X~eir/ BUILDING DEPARTMENTally.~* ,- ~ ' '~' -- vow. Examined 19...~..?__ ~ ~ ~ ~ ~,,' ~ppl~catio~ No...~..~..,.../~. ....... ~ 19...~..[ Permit No..~...~..~-.(......~~-- - ~-~' ~ ~ Disapproved a/c ~ ............... ~ .~ INSTRUCTIONS ~ a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the BuiJding~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee acc)re'ding to schedule b. Plot plan showing location of Jot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is port of this application. c. The work covered by this application may not be commenced 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 part 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, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing c~pde, and regulations, and to admit authorized inspectors on premises and i~ buildings for necessary inspections. (Signature of applicant, or name, if a corporation) 250 Cox Road .......... .......................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........... ~[.~P..~..~.9.!....~.~.~.9.~.e.~.~. ................................................................................................ If applicant(-~/is~a corporate,~,_._signat',ure.> ~, of duty,?authorized officer. ............... ........ ........ (Name ~'.~c~ title of corporate officer) Builder's License No. 170 H~ Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ....~,ec.o.~.$.C....~.~...~.8..... Lot No......~..9. ................ Street and Number ................ ~..e. fl.~2....~..~...~..e..,.....~.?....e.9.~.$.g ..................................................................................... Municipality State existing use and occupancy of premises and intended use and'occupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................................................ b. Intended use and occupancy ............................ .g...w..e.~..~.~.~...~. ................................................................................. 3. Nature of work (check which applicable): New Building' ...~ ............ Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................ · .... (Description) 4. Estimated Cost ...... $~.~.~.(}.0. o.0.0. .............................. Fee ....'~..../...~...~..~..... ........................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... .1. ................. 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 ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........ ..A..O. ....................... Rear ......... .~.O. .............. Depth ....~.f~ ................ Height~ ....,1,6.~. ......... Number of Stories ................... 1 ................................................................................................. 9. Size of lot: Front ........... 1.QO ...................................... Rear ..... 1.0.Q4.1;3. ...................... Depth ..21.~o~.1 ................ 10. Date p~: Purchase ........... J.g,n.e...1.9..Z.5. ....................... Name of Former Owner ....]ZUp~elr, J. ................................... 11. Zone or use district in which premises are situated ...................A. ................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: .... .~..,o. ............................................... 13. Will lot be regraded ....~.~.s ................. Will excess fill be removed from premises: ( ) Yes (x) No 14. Name of Owner of premises .~$.e. lA~.e.~...~.~.[~.~t.~,~. ............ Address ~.~l:k:l,...~.Z.~c.~l:~l~l~ne No ....................... Name of Architect .............................................................. Address ......... ~ ...................... Phone No ....................... Name of Contractor .G..e...o.~.E.e.._.A..h...1..e..~.,.L.~..u.~..1..d..e..~ ....... Address ................................ Phone No ....................... PLOT DIAGRAM LocQte clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines· Give street and block number or description according to deed, end show street names and indicate whether interior or corner lot. /00 5TA-I'E OF NEW Y,(:~. I(,~, ~ '~ IS S COUNTY OF ~~,~~ _ ,,~.~ ,~.' , .............................. /.'~.../ff.~(..<g-Z.~..uf..~./,//Z.~..~.../~...Z~../Z.Z~,.~. .......... being duly sworn, deposes and says that he is the appliconl (Name of individual signing confracfl , above named. Builder [ ~- ~ 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 tha~ the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this (~x /~ ,x ~ ...... do¥ of .......... ................ , -- Nora. Pub,c,. ......... ..... Co-n .......... ...... ................................. ~ ~ /~ .~ , ~l(Signoture of applicant) f r I // I "<X; I/VL.~ L, ,57',4'