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Home My WebLink About8332-z FORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8332 Z Permission ~s hereby granted to[ ' ~11~. *~' "' - ] , and approved by the Building ~lnspector. FOKM NO. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office $outhold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This applicahon must be filled in 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--(S-9 form or equal). 3. Approval of electrical installahon from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code complmnce from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where apphcable. 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 ,.re .... ........ I 1- New B~ilding t/ Addition Old or Pre-existing Building Vacant Land '" ' Location Of Property ....... .~'..~..) ....... ...... ~.......~.~. ...... /....v~'.....U.~..]~...../:¢~.,~..,~...:...t2. ................... Owner Or Owners Of Property ....... ~...:.,,.:.~..n.~......./.:,,. ............... .~... ............................................................ Subdivision .:/~..~,.,.....~..../~J. '.~..<~ ........................... Lot No ...../..~.... Block No ............. House No ............ Perm,t Date of Perm,t .................... Health Dept. Approval ...~.../...~./..../'.....~. ................ Labor Dept. Approval ........... I.~.....!.?'...; ..................... Underwriters Approval .....~.....~.....~..!.~.~....,.~././.~/(..~..~...Planning Board Approval ....... ...~....(...4~.... ................... Request For Temporary Certificate ........................................ Find Certificate ..~.. ............................... Fee Submitted $ ~.....? ................. Construction on above described building and permit me~ll applij~.le cede~ and regulations. Sworn to before me this Notory Public .... ~~L,4: .... County SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number ~ -?~ -~ ^PP,TCAT ON FOR APPROVAL TO CONSTRUCT ^ PRIV^tE SEWA B SPOS^L 1. Applican~ ~i~r~i~ ~in~ich , Phnn~ 864-847~ 5. Subdiv.Terry Address ~i C~i~wouu ~ ~i~'~1~, ~;.~. 6. Section 2. Property Lo'cation R~uier Ru~ Suu~ioi~, ,q.~, 7. Lot Number ~ 8. Private Well Village5o~hold Township ~ou~u~u 9. Public Water 3. Public Water Company Name Distance to main 4. Lot size: Width ll3 feet Length ~50 feet 10. ll. Sewa~Disposal System: A. 9~-gallon septic tank: Precast X Equivalent Block B. Leaching pools: Number of pools Precast ~ Block__ Special__ If private well, fill in the fol- lowing blanks: A. T~k capacity~2 gallons B. Pum~ G.P.M. i2 C. T~al well depth ~0 D. De~th to ground water ~{~ E. Amount of water in well t~ (For Health Services Dept. Use) The unders.i~ned CERTIFIES: "Construction of authorized installations will be in accordance with the S~f. folk 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/~ff~~ Date Si gned ~'~[~n ¥~i~ich FOR THE DEPARTMENT OF HEALTH SERVICES' USE ONLY. Based on the information presented here- with, it is the opinion of the Department 6f 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 BU~LD.E ~,S NO. 4 TITLE NO. ZoZ- /~ LoT go.~ T NELSON & POPE 572 WALT MELVILLE, ~ OF SITUATED AT CERTIFIED ONLY TO CIVIL ENGINEERS & SURVEYORS WHITMAN RD. 516 ~ HAMILTON 7-5665 N .Y. 11746 ~ WALNUT 2-5220 DATES "X~/',2.~ S.O LOC U S STANDARD Or A~EA$