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Home My WebLink About8317-zFOB,M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No.g6.967 ....... Date ......... April .... 8..., 1976. THIS CERTIFIES that the building located at . Bay'~aw. Road ............ Street Map No..xX ......... Block No. xx ...... Lot No, . ~... ~.(~uthg~L4.. ~i~, ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ I.~9.v..2~.., 19.7.~. pursuant to which Building Permit No.. dated ..... kov... 2.~. ....., 19.?~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .P.~i.vat~e...o~o,. f~li~-y..~l~$~g ..................................... The certificate is issued to . .Foun~orn..H~me.s .I~c ................................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval April .6..~.9.7.~...b.y.R....Vi~la ..... UNDERWRITERS CERTIFICATE No...~276~6~ .... ){ar..3~...%9~6 ................ HOUSE NUMBER · 9R'3~' ' · Street . be$.~lew..Roa~l ........................ ....... ....... Building Inspector ~ · '0~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWFl GLERK'S OFFICE SOUTHOLD, FI. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8317 Z Permission is hereby granted to: ~..~..e.~.,.....,.~i~:..~..,. ............... : ..................... ....... : ...... :....:.~'.~.~.~.~ ........................................ ....................................... ~...;:..; ............................................ ~...: ................................................................ at premises Io~a,ed at ..~....~.....~.'.~.......~..~..t~ ........... ~ ........................................................................ ......................... :...: ...... ~.,X, .................................................................. po~ant to ap licatio~ dated ......................................... .~ ~ ~ ~ ,,~ _ _ ., : '< ,.. ,. ~.~.' 1'9... ~,~-'~ and.. approved ~y. t~e ..~,~.+, -¢ FOKM NO. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ~nk, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: 1. 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 disposalm(S-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 compliance 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 Land .............. Locat,on Of Property .... ..... Owner Or Owners Of Property ..... ~..~.~....~..~.~...~....~....~. ..... ~.~....~...~..,~....I....ty....C;..: ............................................. Subdivision ~),~-..~,~..~..t~.~..r~....~.~,~..,,~. ....................... Eot No ............. Block No ............. House No ............ Permit No ~,,,~.J.].~,... Dote Of Permit~.V..~..~.Applicant ~,~,..~,.,~..~,,~,,,~..5,, ..... ~,e.,,~.,.,~,~..../~/..~,,.:. H,,alth Dent Annroval /~.f>/~L, ..~..~ /.~...~.~... Labor De t. Approval ................................................ Underwriters Approval '~.~..P:.~..~...~.~.I.~..9..~...'T.. ............ Planning Board Approval ........................................ Request For Tempo~ry Certificate ........................................ Final Certificate ..... ~ ............................... Fee Submitted $ ..... ;~F,~.~.~....~. ................... Construction on above described building a~d pe.,~it meets all applicable codes and regulations. Sworn .t.?o. b;afCyr~fme ,~ ~ (stamp or seal) 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~ .~ ....~,.,, ~,~,~ ~,~hone')~,~'% 2]~m 5. Subdiv. Address ~ ] ~ ~- ~ ~ ~ ~'..~ ~ ~ ~. "~"~ .... ~ ,. ~g ~ 6. Section 2. Property [oca~on ~? t~ , ~w ~ ,~ ~ 7. Lot Number ~m ~- ~'~ ~.~ ~, j,~ . ~,,~: 8. Private Well Villa-~e~ _, ?~.~. ~ "~ownship ~ ~--~ ,~ 9. Public Water 3. Public Wate~ Compan~ame ~ ,. ~ ..... Distance to main 4. Lot size: Width ~ feet Length ~,s~feet 10. Sewage Disposal System: A.~gallon septic tank: Precast ~' Equivalent Block B. Leac'~n~--ng pool s: Num~e~", of pools .~ (~ Precast]~ Block__Special__ 11. If priva'c~ well, fill in the fol- lowing blanks: A. Tan k ,,~c~apaci ty ~ 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. 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 /'r"//~F't/~/ SIGNED ~ ~ I ~ S-15 Rev. 4/1/73 3 /,,MC. LE