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Home My WebLink About8329-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at .E/~..N.a. ~s.a.u..P.o.~ .~..R. qa.$., Street Map No.HaSs.. P.t.. PB~x~k No .......... Lot No. 28 .... Cu.t.¢hog~e... ]~...Y.: ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... D. ee...~., 19.7.~. pursuant to which Building Permit No..8~?.~.Z... dated ....... p.e.c~ .... ~...., 19.7.~ , was issued, and confoms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is P.x, ixra, te. one. £a~ily. :10/e~ ~.~.ng .................................. The certificate is issued to D.r.~ ..&..N.~. ~.,..Ao. ~..~/}.~.a.n. .....0..~.e.F.s .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .t~.y. ~.8....~ ~?.~...by .R.,..V..i.i.ta.... UNDERWRITERS CERTIFICATE No..DOl~Cll~g ................................... HOUSE NUMBER .... ~+(~ .... Street .. N~-~sau. P.o!nE..Iload. ................... ~0 Carpenter Road B,,ilding Inspector[ I~RI~ NO. 2 T~V~ O~ $OUT80£D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 8329 Z Permission is hereby granted tO: ~'~%~.~ pursbanf b ~plication dated ........................ ~: ...... i. ............ [ .i .... and a rove b the FOlt~ NO. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions ^. 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 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 compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site 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 ................ ¥ocant Land .............. Location Of Property .... 7 ....................................................................................................... " ................... Owner Or Owners Of Property ...~....~..~../...~..... "/~/'~-'n'~4/A~ Subd,vision ................................................................ LOt No ............ Block No ............. House No.~.,~',.~- Heelth D~pt. Approva~ ......... ; ....................... Labor I~pt. Approva~ ................................................ Underwriters Approval .............................................. fflannlng Board Approval ........................................ Request For Temporary Certificate ........................................ Fined Certificate .......................................... Fee Submitted $ .... ..,~...,..o...~ .................... Construction on above described building and permit meets all a~Dp!ica_ble codes and regulations. ................................................ Applicant . '~""~'~'" .... Sworn to before me this ........ ~.~i.. day of ....~.~....(..~..~..?.~/'~///~/ ....... (stamp or sea,~ Nota~ Public ....... ~~. C~n~ SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number~[''~q~-/~ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant Address 2. Property ,^~T~¢~ol~, Village 3. Public Water Comp6ny Name 4. Lot size: Width ~00 feet 10. Sewage _Disposal System: A./~O~allon septic tank: Pre'6~st l~ Equivalent Block Township ,qouthol & Length~feet 5. Subdiv. 6. Section 7. Lot Number ~ 8. Private Well' 9. Public Water Distance to main 11. B. Leaching pools: Number of pools {~ Precast X~0 B1 ock Speci al__ ~f priva-t-e well, fill in the fol- lowing ~anks: A. Tank~apacity 8~ gallons (For Health Services Dept. Use) B. Pum~G.P.M. 10 C. Total well depth 60~ D. Dep~th to ground water E. AmJunt of water in well The undersigned CERTIFIES: "Construction of authorized inst~JTlb/~ions will be in accordance with the Suffolk County Department of Health Services' current st' ' andards 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 ~nd Water Supply can be installed on this plot. APPROVAL DATE ~./~/x~//~_ SIGNED ~ -- S-15 Rev. 4/1/73 T-?]" / I! P~L_A