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Home My WebLink About8331-zNO. & TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . ?.o .n.n.a..? .r.f.v.e. ............. Street Ck Est Map No..D.e.e.D..Hp.l.e.. Block No ......... Lot No, . .7.1. Mattituck conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... .D,e. ,c,, ,~ .... , 19.7~. pursuant to which Building Perrait No. , dated ..... D..e.c. ~ .8 ..... , 19.7~. , 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.r.i.v.a.t.e. 9.n.e...f.a.m.i.1..y..d.w.e..1.1.i~..g. .................................... The certificate is issued to . .G.e.o.r.g...P.e.r.n..y.I.I..I .... o.¥~.~e.r .......................... (owner, lessee or tenant) of the aforesaid b-ilding. Suffolk County Department of Health Approval . Sel0.t 2..1..9.76...b.y..R.....Vi.l.l.a. ...... UNDERWRITERS CERTIFICATE No...N.2.?k2..Ii.6 ..... .M.a.r....1.~.,..1 ~i6. .............. HOUSE NUMBER .... ,2,~,~. ...... Street...D.q.n.n.a, ,D..r.~.v.e, ......................... · . .~.o.t..e.;..c.~. ~., .s.t.a.~. ~?..t.o., .k~..~..~.~?.a. ....................................... Building Inspee~or TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8331 Z Date ............................ ]1~11t11, ......... .~. , 19.~.~.. Permission is hereby granted' to: ............ ~.e~.. ]~t .............. a,,~o, XA ............ at premises located at ..~..~....:]~t~p~O~i ...]J~..t~l'tt ........... : ....................... '...., ......................... pursuant to .application Building. Inspec, tar. Fee $...~.~ ........ dd~ nsp FOl~M NO. $ TOWN OF SOUTHOLD , Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink,, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate Iocat.on of all buildings, property lines, streets, and 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 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. '~. 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 $§.00 3. Copy of certificate of occupancy $1.00 New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ......... ./..L....,~.:...o.....,..~. ...... v'l, ~., ~r~l.i.:.~?/Z.,..~......~.. ..................................................................... Owner Or Owners Of Propert,~ ..~).-IL~XkJ.~.L~.,...~JJ'-r,~..~..~,~~''- ......................................................................... Subdivision/x., , ,~ ~,,~ ~.~..j~[.~.../k.,~...~...t~......~..,.~..~...~...~.. ....... Lot No.' ....~...J...--' Block No ............. House No ............ Permit No..4~3~..I.....~..... Date Of Permit ..... Health Dept. Approval ...... .~....'?~...~...~..../..?....] ........... Labor Dept. Approval ................................................ Underwriters Approval ....... .J~....' ................................. Planning Board Approval ........................................ Request For Temporary ,(~ertificate ........................................ Fincd Certificate ........~ ................... Fee Submitted $ .~.~...~. ..................... Construction on above described building and permit meets all applica,bJe codes ar~, regulations. Applicant ........... ~..~. ~,,/~'... · · .~. · · .J..~... · · .~'..?J~'/~...~.....~'./.?'~. :~. .................... Sworn to before me this ~~/// ~ ~'~'~' .......... ~. day of .... ~~'"L'L"~' .......... (stamp or seal) Notaw Public ...... ~... Coun~ ~ // ~lb SUFFOLK COUNty HEAL~H~MEN~ 1976 ~9 87° /~F. o0' cP /.or 7,/0. 70 ._~ETAUKET Al. Y. N Y STATE' Lit A~o 3Z4O3 ///AP o ~ lot 4/0. 71 "DEEP HOLE C£EEI? EST/~tTE~ " ~1 ~A~ TO~ O~ ~OUTHOLD ~ SUFFOLK COUMTY ~ O~ V~ 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~/)~/~_~ ~J Address i~ Ot_~.~,~'~ Z~c~A~;~~. ~ 2. Property Lochtion ~ c,'~ ~,~ ~ Vi 11 age -~ ~,~ .... Town s'h i P- C~,, .~ o L ~ 3. Public Wat6r Co~pa~ Name - ' 4. Lot size: Width //~ feet Length /~feet 10. 11. Sewa~isposal System: A. ~,O~-gallon septic tank: Precast ~Equivalent Block~ B. Leaching pools: Number of pools Precast ~Block__ Special__ in the fol- If private~well, fill lo~ing bl~-~ks: A. Tank c~acity. B. Pump G~.M. ~-1 C. Total well depth D. Depth ~co ground water E. Amount of water in well 5. Subdiv. 6. Section 7. Lot Number 8. Private Well 9. Public Water Distance to main (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. S-15 Rev. 4/1/73 ~ERTICIqL 0 2660 9AM l'O 4PM FOg. Rk,. ,, ~ 4 .fL ~..." O,a, C E LLA~, ',,-t: FLOO~ :ot FOUkIDAT F. I7 (~i4 L I \1 I 1,1 (% k', 0 0 iv; ,q I / F k 0 0 F, P LA _.Si