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Home My WebLink About8110-zFOILM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ..... 89~¥1~.W..J~y.e ........ Street Map No...3~. ......... Block No .... ~ ..... Lot No. ~... ~P~.. ~.*~ ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... J~y.. 2~. ,, 19 .~. pursuant to which Building Permit No~.1.~... dated ........... ~.. 29.., 1~.., was issued, ~d conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .P~t~e. ~e. $~Y..~e~.].l~g .... ~ ................................... The certificate is issued to (owner, lessee or ten,t) of the aforesaid building. S~olk County Department of Health Approval .~$...~.. ]~.~.. b~ .R~. ~!$~ ...... UN~E~W~¢~S C~F~C~E ~o.~... ~.. ~2.. ~?~ ................ HOUSE NUMBER ..... 1~0... Street .... 5~¢~ew. Ave ...................... Building Inspector FOR~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT. ON[ THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8110 Z Permission is hereby granted to: ...... Zos..D~.e~....AJ'O....~*t~.o...Oa~%~®as ...... .................. .~.e~.~ ........................................ ~o ...... ~aSl~. ~w...cme.. f~m~ ~...ctwe3.~ll ................................................................................ at premises located at ...Lo:t,...l~. ...... ~t~l:~o~tll..~..~c;~a~,~ ................................................... ................................................... ~w..A~ .............. .8~mt~h, o3.4 ............................................ pursuant to application dated .................... ~I'1~.~. ....... 2.~l .............. 19..~..~.., and approved by the Building Inspector. Fee $..~..I~.~ 3.1~ .......... SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Hea~th Services Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant "~ .'" ~? ~':~ ~ Phone Address u ~ ~,~ ~i,, · ~ ' 2. Property Location .... ,~ ~,,~, ~ Village rm Township 3. Public Water Company Name 4. Lot size: Width ~feet Length 5. Subdiv. ~ 6. Section 7. Lot Number 8. Private Well 9. Public Water Distance to main 10. Sewage Disposal System: (For Health Services Dept. Use) A. 900-gallon septic tank: Precast Equivalent Block B. Leaching pools: Number of pools Precast ~ Block . pr'i~te ll,?If well, fil'l ~lowin~,blanks: De ~pecial__ in the fol- A. Tan~,, capacity ~x~ gallons B. Pump~ G.P.M. C. TQt~I well depth D~qp~th to ground water Amount of water in well 0 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 fQr one year from the date of approval indicated below and may be renewed if a current local Building DepQ, rtment Permit is in effect. Date ~ ~ J~ / 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~adequate and satis- factory Sewage Disposal System and Water S~pply can be installed~B~his plot. DATE SIGNED 18.157N SU-F~FOLK coUNTY HEALT~I DEPARTi~ENT DATE~ " The sewage dizpoS~ location have been - %o b~ s~tlsiac~u~' · ' ~neertn~ /Z,3 ~ ~e~ chief ~rviCeS J~tAUtHORIZED ALTE~Ai'ION OR ADDITI~ ~ CLERK'S OI~FICE ' ~-~ ~ Application No~:..!...~.. ............... ,.,m,, ..... Di~ ~~ ~.~ _ ............................................... ......................... ;;;.; INSTRUCTIONS or in ink and submitted in triplicate to the Building in by typewriter to ~cale. Fee according to schedule. a. This application must be completely filled Inspector, with 3 set~ of plans, accurate plot plan b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises pr public streets of areas, and giving a detailed description of layout ofpraperty must be drown on the diagram which is part'of this application. c. The work covered by this application may nat 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.ocle, and regulatlam, and to admit authorized inspectors on premises and in I:~lldlngs for necessary inspections. Jose h Diaz .................. (Signature of applicant, or name, if a corporatlon) Greenport (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................... ~ui~r. ............................................................................................................................... Name of owner of premises ..../]h~s..&..~e~.tr.~c~..~ae.t~ens .......................... ~ ........................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's Liconse No ..................................................... Plumber's License No ...... ~a.~.fiD~ ............................ Electrician's License No ..... .~..t....S..~.]r..a...~..~..s. ................ Other Trade's License No ............................................... No~hwoods 1. Location of land on which proposed work will be done. Map No.: .................................... Lot No....~7~ ............. Street and Number Soundview Ave Southold 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ......... .v...Rt.~.~l,.~...~ ....................................................... . .................................................. b. Intended use and occupancy ....................... J~zii...fnm:L~..&].w~.:;Lo.g ........................................................... 3. Nature of work (check which applicable): New Building...~ ......... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) 4. Estimated Cost ................. .LJ'.~.~,~.I~J.....~ ..................... Fee .~.Q,~0 ............................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ....O..~..e. .................. 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, 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 .......... 6.9-J~ ................ Rear ........ ~.c,J.~. .......... Depth ..~.1+~.2,~ ......... Height Number of Stories ,.O..~..e... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ....... A....~i,~J; ......................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded ....... ~..e...~. ............. Will excess fill be removed from premises: (Z) Yes ( ) No 14. Name of Owner of premises .ah_~_s...G~et~ez~s .................... Address ..1..lt.....J~A~AitZ'J:~Fglhe Name of Architect .............................................................. Address ................................ .Phone No ....................... Name of Contractor ....~...~...~,~,~. ....................................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate 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, ahd show street names and indicate whether interior or corner lot. See filed plans STATE OF NEW Y. OR,,~ .. ~ ¢ c COU N~"Y OF ..... ~'L'LT,..-.'T. 9.4'A:.......;.... f~'''' Jos · Di.a.~... be n ............................................. . ................................ g duly sworn, deposes and says that he is the applicon! (Name of individual signing contract0 above named. Builder He is the ................................................................................................................................................................................. (Contractor, agent, corl~orate 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. before me this /q o, ............... ................. , .,!UDITH T. BOKEI'4 ~o10~/ F~bJic, Stole of New Yo~ 52-0344963 SuffoJk County March 30, 19~.~