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Home My WebLink About8330-zFOIL~ NO. 4 TOWN OF SOUTHOLD BUG,DING DEPARTMENT Town Clerk's Office Southold, BI. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .¥a~tC~..l~Oad ............. Street Map No.~ ~ Pr~lock No ........... Lot No, .P~. ~ .~ .... ~B~9~.. ~.~. confoms subst~tially to the App~cafion for B~ld~g Permit heretofore filed in this office dated ......... Deg. ~ ..... , 19 ~. pursuant to which B~lding Pemit No. ~.. dated ....... Dee.. ~ . , 19 ~., was issued, ~d conforms to all of the req~ ments of the applicable pro~sions of the law. The occup~cy for which this certificate is issued is . .~i~ate. ~e. f~lly .d~ng ................................... The certificate is issued to .... ~o~ .P,. ~ ....... ~er ....................... (o~er, lessee or te~t) of the Moresaid building. S~olk Co~ty Department of He~th Approv~ 5e~ . F...]~ B~ .R,. Y~ ..... UBIDERWRITERS CERTIFICATE No .... ~29~J,~ .... ~...!2.. J.~?~ .............. HOUSE N~BER . ..J~.Q... Street ..~,~. ~ ............................ FOE~ NO. 2 TCYW'N OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~. Y. CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8330 Z Permissio~ is hereby granted to: "&i,s,..z,~....~'~..~.ao~ ................. ~o ~.~..~.:~..~.~ ..................................................................................... p.~m[~es .~ate~ ......... : ........ : ............ :: ...................... --~ ....................... : ............... ~ .................... · ~ ....... :: ..................... On '&~ ~ S ~g--;~- O~r}Qoht-to application dated ............. %...:~¢ ~ ........ : ......... , 19~.~., and approved by the:- ~ ~ '~:'~' Buildiog Iqspector. ' FORM NO. $ TOWN OF SOUTHOLD , Building Deportment Town Clerks Office $outhold, 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, aha unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buddings, 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 Bqilding ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .... [?~..~...~..,~..~...~.. ...... .~......~...?~.g .~......~../.~.. ...... ~.~...~....~. ........................................ Owner Or Owners Of Property ...... ..'~..~.~.~....Z..:.......~....,~./..~...R..~..~...'~....~...~/..-4~.. .............................. Subd,vision ...... ...... Lot No ............. B,ockNo ............. ,ouse No ............ Permit No ...~....~...'~..~?....~.. Date Of Permit/...~....~.,~...-)...Applicant ~.,~..~'.......~..~....~.,..~.:.....~..~....~....; .......... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ FinoJ Certificate .......................................... Fee Submitted $ .................................... Construction on above described building an~p~n,,f~27 ~sr~ll ~,bJe codes and regulations. Sworn to before me this App antlic,~w ..... .?..~-'Z~.....~.. ~~ ~ ~-- -.~.~' -~'sl C~I~~''''c/~' ~ ..~~/~,~2,~.{ .~. day of :~~ ~...../.... (tamp or sea ~ .... ~ No,~ ..b,~ ...... ~~Z~ ...... cou.~ ~/~ ~~NOTARY PUBLIC. State of New NO 52-8125850. Suffolk l~m Expires March ~, SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Heal th Services Reference NumberZ~-~ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant . ~Ec/'-;, ,., ~_,- Address _~', ,,~ -,, ~ 2. Property LoCat~'n ¥': -~ - Village 3. Public Water Company Name 4. Lot size: Width ,, ~t,~- feet 10. 11. Township ,-~, .,.:, ?~ .,. ~ Length ~, ,~.zJ'eet Sewage Disposal System: A.~allon septic tank: Precast ~J Equivalent Block~ 5. Subdiv. 6. Section 7. Lot Number ~ 8. Private Well 9. Public Water Distance to main B. Leaching pools: Number of pools Precast ~/~ Block Speci al__ If private well, fill in the fol- lowing blanks: A. Tank capacity ~ B. Pump G.P.M. ~ Total:well depth , ,. gallons Depth:to ground water ~ Amoun~ of water in well (For Health Services Dept. Use) The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suf~lk County Department of Health Services' current standards thereto." This application will be valid for one year from the date of app~val indicated below and may be renewed if a current local Building Department Permit is in effect. 'f .. Date --, ? ,~ Signed ~'~-~'.. ! '~ ~ ===================================================================================== FOR THE DEPARTMENT OF HEALTH SERVICES~ USE ONLY. Based on ~e 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 ~/ ~,(zx~ SIGNED~ ~ S-15 Rev. 4/1/73 ~02. ~ 72~ ~ ~ ~ew Y~ S~ ~m~ Law. ~pi~ of tb~ su~ map n~ ~ng ~ ~ su~e~s meed ~1 or ~ ~1 ~ll ~ ~ cons~e~ed m ~ a val~ co~y Guarantees or ce~sf~cats~s md~cat~ her~n shalJ mn on~ to ~r~n ~or whom the su~ is pre~. a~ ~ h~s behalf to hde core.ny, governmental agen~ and I~di~ institul~ hsted hereon, and ~ the a~gn~ ~ the ~di~ inshtut~. or c~tfic~s am ~t lmns~mble to ~dffional inst,ufi~ or ~u~t o~ :ed b~ this ~epartment ~d found eneral En~neertn8 0 \ ~ o~. ~z t I ! I LOop COvE ROAo All di~tance~ ~e wells and cesqx~ols are by location from houm o~wer~ and field ebservahons, since mint wells and cess- paols am ~t visible the~e dimensions cannot be certified, SURVEY FOR JOHN P. KATHLEEN W. DOWD AT PECOIVIC TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y, SCALE: I"z30' JUNE S, 1974 JULYg, 1976 FEB 3~ 1976 FEE. 9, 1976 JULY I, 1976 REFERENCE: REVISED SUBDIVI$1~L.~PROPERTY OF ALONSO JOHN P. a ~T~LE~O~ . J ~E FIRSTN~~W YORK RtVERHE~ N.Y. APPROVED AS N??.~ED ¢2._~ ,5' 7~ ~.: ¢9' ~-~Y ~ ,NO~tF7 ,BUILDING DEPARTMENT ~' 765-26~0 ~AM TO 4PM FO~ REQUli,~ . ~d ~NS~¢gT~ONS: :~. b~Fg~ BACKFILLING FOdNDA- . TION O~ START FRAMING , 2. BEFORE COVERING PIPELINE '. ','~ ~ WHEN JOB COMPLETED "".~ ~T~[~H[~L~ [O~ DESlQN OR CON- 'i i.¸