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HomeMy WebLinkAbout8311-zNO. & TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z7.277. .... Date .......... 0e~...6 ........ , 19.76. THIS CERTIFIES that the building located at P./S Sou~ .Har.bol'. Road... Street Map No..xx ......... Block No.. Xx ..... Lot No, .. =... 8outfaced. · I~,Y, ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. Nov. . 2.% 19..7~ pursuant to which Building Pen-nit No.. 8.~11Z dated .... NoF.. 24 , 19.7.~., was issued, and conforms to nll of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is P. ri~ate, one. family ~wellin~ ................................. The certificate is issued to Rabe~'~ J. !Cologi .... ~me~- ......................... '~owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .0e~;.. ~..19~6..by..R,..Vlll& ..... UNDERWRITERS CERTIFICATE No.. l~27368~ ... 14a~,..1.~.. ~9~6 .............. HOUSE NUMBER .... 2795[. · Street ..l[cmtl~. tia~r..R~ad. ................. ....... Building Inspector FORH NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8311 Z Permission is hereby granted to: ¥ at premises located at ~_~.~,~J~...~ ,.~t~..:.~. ,~....~_ ~i_.~ .................................................................... .... ~ .... ~ ..... ' dated ..,~,,,~¢ ............. :...Z~; ~ ......... , :1~' b ~ 'p~?~ ~o.~ ap¢l,cgt,o~ and appr~?d by the '~ BuilSino I "-~' '~ ~Bfij~lding In~oector' , ~ FOXZM NO. 6 TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled ~n typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal....(5-9 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 comphance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s~te 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 as 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. Certificate of occupancy on pre-existing dwelling or land use $5 00 3. Copy of certificate of occupancy $1.00 New Building .... ~ ....... Addition ................ Old or Pre-existing Building ................ Vacant/and .............. Locat,on Of Property .~.~..'~....~.O..~..~,./.~....~...'~....~...~.....~....~?.~....~.,;/.....~....~.~.~.~.~.~/.~ ................ Owner Or Owners Of Property ..~.'.~.~..,~.~....~.......~'....~.~..~...~........~..~.....~.....~...~.../.' ................................. Subdivision ................................................................ Lot No ............. Block No ............. House No...~....~...~. Permit No ~...~..../.?.....~.... Date Of Permit ..~.~..7.~...~.~pplicant ....~....~.,..'~....~'.~......~... ........... ..~......~...~..../..i ....... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Find Certificate ...... ~ ............................. Fee Submitted $ ................................... Construction on above descr,b,~d ~u]~itng ~5~.2~~p!licable codes and regulations. pp,c ............. ................... Sworn to before me this ~ 7 77 .... o, ...... Nota~ Public ...........~~/~.. qoun~ [UZA,t,, ~,~ ,tV,tL~ ~TARY PIJDLI~ ~ta}e of New ~tk ~Ydm F~r~ ~rrh 30 SUFF~)L.K 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 ~i ~ ~/ ~ ' ~ Address . , i 6. Section 2. Property Location_/ ~ F 7. Lot Number .~ ~ ,~ , ~ ~ ~ , 8. Private Well Village ~ Towns~i~ ~m 9. Public Water 3. Public Water Company Name - Distance to main 4. Lot size: Width / - feet Length ~ ' ~ feet 10. Sewage Disposal System: A.~-gallon septic tank: Precast ~ Equivalent Block~ B. Leaching pools: Number of pools Precast ~,~;~ Block Special__ 11. If privat~well, fill in the fol- lowing bl~nks: A. Tank capacity ~-~ gallons B. Pump G~.P.M. )~ C. Total well depth D. Depth to ground water E. Amount of water in well (For Health Services Dept. Use) 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 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. APPROVAL DATE. S-15 Rev. 4/1/73 //1' ~ HARBOR RoAD SURVEY FOR ROBERT E~ MARY AT SOUI'HOLD TOWN OF SOU TH OL O SUFFOLK COUNTY, N.Y. SCALE: I"' 30' OCT, 21,1975 NOV. 4,1975 KOLOGI REFERENCE, All &stunces to v,ells and cesspools are by I~.-~-n f~-- i,~. - o'"~'r: ~n.,J cannot b~ cedff,ed I/1' ~ $OUTH HARBOR SURVEY FOR ROBERT 8 MARY KOLOGI ~lit 50UTHOLD TOWN OF SOU TH OL O SUFFOLK COUNTY~ N. Y, SCALE ~ 1"~ 30 ' OC 1". 21,197'5 NOV. 4,/97'5 RoAD REFERENCE~ All distances to wells and cesspaoJs am by [~catmn ~Tom house ~ and field ob~ah~. ~e ~ well* a~ ~ls am not w~ble t~ di~sions can.t ~ ce~. ALTERS 162.7' soUTH Unauthorized a~teratic~ or add,trail to th,s survey ;s a violation of sectlofl 7209 of the New Yc~ State Education Law Copras of thts survey map not bearing the Ior,d ~ur~eyor's raked ~eal or embossed seal shall not be constde.ed o b. c vchd copy Guofanmes or certihcahon$ indicated he*eon hn~l run only to the person for whom the survey is prepared, and on his behalf 1o the htJe coml~an¥, governmental agency and lending mshluhon hsted hereon, and to the assignees of the ~endmg inshtufiofl. Guaranlees or cerhf~co~on$ are not transferable to add~honal mshtut~ons or subsequent owners. HARBOR RoAD SURVEY FOR ROBERT 8~ MARY tit $OUTHOLO TOWN OF SOUTH OLD SUFFOLK COIJNTY~ N. Y. SCALE: I "/" $0' OCT. 21,1975 NOV. 4,1975 JULY ~7, KOLOGI REFERENCE eUARANTEED Ft lVERHE A D, N.Y.