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.