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Home My WebLink About8149-zFOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, No Y. Certificate Of Occupancy, THIS CERTIFIES that the building located at . E,/~, D.e..lla. a. ~..D.~..i.v~., ....... Street Map No. La..u.,..C.t.y E.S~lock No ........... Lot No. ~.... ]~.l~®l...1~ ~1~... ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. A.~Ig.. ] ~ 19 ,~.~. pursuant to which Building Permit No.. dated ........ A~lg..l~. ...... , 19.7~., was issued, and conforms to all o£ the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . ...................................... The certificate is issUed to . .F. al~..vJ, e~. ~.,ll~.d.lllg..~.Q. ~[lrl~ ..... O~'l~e~'lll .............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~.~'l~,...~.. ~[~.~.~.. ])~..~.,..~illt ..... UNDERWRITERS CERTIFICATE No. ~0~.~... ~.. J~.~ ................. HOUSE NUMBER ..... ~8~ .... Street ... ~.~$~. ~$~ ........................ Building Inspector ]FORM NO. 2 TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OF~:ICE SOUTHOLD, N. Y. BUILDING prE R~v'~ I T (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 8149 Z Permission is hereby grQnted to: .F..~r~$.e.w,..~ld~...C~. .............................. · ...1.~?-....~a-n.. ~e-.~ ......... ?eteheg~e .... to .b~,z~l~.. ~®~.. ~e...£~,~ ~.. ¢1~ ~ .~ng ..................................................................................... at premises located at ........Lo-t..-~....,[~',~F~...C~,t~'~.-F,~ ..................................................... ..................................................... De3~a~..DrSve ......... .t.a~e.1 ...................................................... pursuant to applicatlan dated ...................... AI~......1.~ ................ , 19.~.~.., and approved by the Building Inspector. Fee $'"39'~) ........ SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant~'..9. r. ~J f f Phone Address ~q ~.,..~., ~ ~ ~ ~.,,_~ ~.~ Property Location ~ L ~ ~ ~ ..... V~Ti'~ge ~_~u~m · 3. Public Water'CbBFl~'ny Name 4. Lot size: Width )~ feet 10. Sewage Disposal System: A.~-gallon septic tank: Precast ~quivalent_ Block 7. Lot Number 8. Private Wel~ Length ~m~ feet Leaching pools: Number of pools. Precast_ ~,~ B1 ock _Special. 11. If private well, fill 1 ow~.g blanks: ~ A. ?'~k capacity t~Z gallons ~otal well depth , ~'~m;D ~-~epth to ground water ~ . ~unt of water in well ~ in the fol- (For Health Services Dept. Use) TB~ unde~lgned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health Services' current standards thereto." This application will be valid for one year from the date of approval indicated below and may be renewed if a current local Building Department Permit is in effect. Date ~/!~/~ Signed d~t~ i~.~ ..... ~ ~ FOR THE DEPARTMENT OF HEALTH SERVICES~ USE ONLY. Based on the information presented here- with, it is the opinion of the Department of Health Services that an adequate and satis- factory Sewage Disposal S~tem an/d Water Supply can be installed on this plot. SI NEO<' ...... = ... APPROVAL DATE S-15 Rev. 4/1/73 ' dz' , , 'THE'. NEW YORK, BOARD OF FIRE.UNDERWRITeRS ~ : :.,i'.~', ~ ' ~ :' ,.Oct0ber '16, !97~15 JOHN STREET, NEW YORK NEW YORI< ~OO3B ',, ' ' , ,' -'~'o.,e ,', .... '' ~..,,..,,o,,,~o.:o.~,,., ,, ,,,-,, ,~,,, ~ 200732 B~uce rVllffohell e/s Delmar D~.,.~O0~ s/o O~nA S~,~ ~&~el, ~.Z, .._ '. };L,~ n t ;e ollow ~ ~locatton , ~ Bmsement ' ~ Ist~ ~..nd FI ..... Sect~9~z Block Lot . lelr c r e~Je~tials'. :' t.o! ~.~ (3;) ? l. ot NOTE: · == MONO/~ENT sueo/vls/o/~ /~a/~ F/LEO m ~ OFF/CE OF rile CLERK OF SUFFOLK COUNTY ON 4~E ~, I~70 ~$ FILE NO. ~86. UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY iSA VIOLATION OF SECTION 7209 OF THE NEW YORK STATE ~DUCATION LAW COPIE~ OF TH{S SURVEY MAP NOT 8EARING THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CON~IOERED TO BE A VALID TRUE COP~ GUARANTEES IND{GATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS pREpARED~ AND ON HiS BEHALF ~£vzs~or, s YOUNG & YOUN ,~ 400 SURVEY FOE: FARMVIEW BU LDING COMPANY, INC. LOT 58 "LAUREL ~OUNTRY ESTATES ~ LAUREL ~u~.~.~ ~o: · ow.o~ SOUTHOLD : ~Y SUFFOLK CO., N. Y,, : SCALE: I" =40~ t975 J GiN/ bot disposal and watei' supply e~].!ties for this location have boen insp¢,e~ted bT thlis depaFtmon% and found Chief o~neral Eng2neer 8 Services J Lot NOTF: OF TMff ~LE~K OF SUFFOLK COUNTY ON THE LOZ.%'~CL ~ND/O~ F~O~I DATA O~]~INED F~OM OTHE~$ TO 8[ A VALID TRUE COPY OU$~ANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FO~ WHOM THE REVISIONS YOUNG & YOUNG SEPT. 17=I975 400 O~TRANDER AVENUE, RIVERHEAD, NEW YORK OC~,/E,/~5 ALDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR: LOT 58 "LAUREL COUNT~/~ ~%'"~ APPLICATION IS HEREBY/~DE to the Building I~rt_ment' f~ the issuerce of a Buikl_ing Pe'rdt pur~.~nt to the Kegu aTJoflS, TOr the constructiofl of ..b~Ji~ . .~. qr OIt~ol~, Or TOg remo,/gl' or demolition, as herein described. The applicont agrees to comply with oil opplicob~ ~ or~nonc~,'l:mtld~-oode, housing cade, and regulatlanl, and to/" admit outhodzed inspectors on premises and in buJMIng8 for neces0ary Jmpectlon~ !. ..... .V..~L,~ ....... l.~~ ........ ~.....__..l:~J ...... ....... Builder's License No ....................... Plumber's License No ................................................. Electrician's License No ............................................. ~ State existing use and occupancy of premises and intended use and occupancy of prapa~ camtruction: b. ,~.~.~ use ,nd ~ ......... ~,g..,X/..~~.... .................................................... '....; ........................ 3. Nature of work (check which applicable): New Building-. ....... Addition ................. Alteration ................ Repair ................. Removal .................. Demolitior. .................... Other Work .................................................... 4. Estimated Cost ~/'~ Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... ./. ................... Number of dwelling units on e~ch floor ............................ If garage, number of cars ..........J ................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature end extent of each type of use ............................ 7. DJmansJons 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 ot entire new construction: Front ....~, .. ............................ Rear ...~'~. ................. D~th ....~..~.. .............. Height ...Ltl:'.. ........... Number of Stories ...J. ................................... , ................................................. .~ ........................ 9.. Size of lot: Front i~...~.. ............................................... Rear .I.~.....~'.. .............................. Depth ...LI~/.. ..................... 10. Date of Purchase ....................................................... Name of Former Owner ....................................................... 11. Zone or use district in which premises are situated .................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... ..~.~ ........................................... 13. Will lot be regraded ....~. ............. .Wjll_e~_ fill be removed from premise)s: ( ) 14. Nome of Owner of premises .~~....._...~... .............. Addres~ ~?~.~.~..~./~,~ J~...~..~... Name of Architect .............................................................. Addre~ ................................ Phone No ...................... Name of Contractor ............................................................ Address ................................ Phone No. ...................... PLOT DIAGRAM Locote 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, and show street names and indicate whether interior or corner lot. COUNTY q ... ' ...........~'-'-- "'~'' '~ -.......~.~.{:)'...~.~9~'~.;~ .......... i ............ ~: ............ being duly sworn; deposes and soys that he is the opplicam (Name of individual signing controct0 above named. 'He is the ....... ,..C0A~J~'-~..../~m... ........................................ , ............................. : .......................................................... :... (Cqntractor, agent, corporate officer, etc.) of. said owner or owners, and is duly authorized to perform ot hove p~?rmed the said work and to make and file thru aPPlication; that all statements contained in thi$.?~.li~oti6i~iar_e tru~ to the best of his knowledge ond belief; and that the work will be performed in the manner set forth m the aPPlic~ion filed therewith. Sworn to before, me this . ....................... : of ....... Not°* ....... ......................... ~// (Signature of al~licarit) · ' JUDITH T. BOKEN / Notery Public, Sfa~e of New York No. 52-O344963 Suffolk~ Courd~ CommJss~n Expires , . 1 NOTIFY BUILDING DEPARTMENI Af 765-2660 9AM ~O 4PM FOK ~EQUIK, ED iNSPECTIONS~ 1. BEFORE BACKFILLING FOUNDA~ TION OK ~TAET FRAMING 2. BEfOEE COVERING ~IP~LINE 3, FINAL WHEN lOB COMPLETED NOT RESPONSIBLE ~OB D~SlGN OR CO~~ ETRUCJlON ERRORE .4-1