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Home My WebLink About8207-zFOEM NO. 4 TOWN OF SOUTHO~D BUILDING DEPAHTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupancy No.Z~..~. 2¢). ...... Date ................ I;)..e.~. .... .~.~.., 19..~..~. THIS CERTIFIES that the building located at Pl~b..~.~l.~tA~.....I,..a~.~. ....... Street Map No.. 0It. ien.~..bY l~l~k No ........... Lot No, . .1bt8 ..... .0~.i.~n..~ ................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. ~.e.l~;.. 23 19. ?~. pursuant to which Building Permit No..820.'7Z." dated .......... 8ep/;.. ,2.1+ .... , 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 .. Pa:~vaJ;~. ona .£amily. d.'~e].lJ, ng ..................................... The certificate is issued to .E. 1.i.x.~b~.t.h..M.i.t.e..h.e.X.l...: .... .0A~...e~ .................... ~owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval i .D.e.e....2.6....~ .97.~....bx.R..,..V.i..1.1.a.... UNDERWRITERS CERTIFICATE No.. ~I2/~10~?. .... D.e.~...~.6....~ 9.7.~ .............. HOUSE NUMBER ... ?.0.0. ....... Street . .P.1..u~...%.s..1.a.n.d...L.a. ....................... Building Inspector [ FO]~H NO. 2 TOWN OF SOUTHOLD 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? 8207 Z Permission is hereby granted to: ~ou%hol~ at premises located at ............ ................................... ,~,,,~'...~.*....~. .................................... ~i,~ .................................................. pursuant to application dated ................... ...~..r~..:..~.~. ....... ; .......... , 19.~.~...., and approved-by the Building Inspector. Fee $.3k ~.6.¢t ........... THE, NEW iYORK, BOARD OF,i FIRE: ~UNDERWRITERS ~ ' h ? , iF ~=1 iil i ~ ~ BUREAU OF'ELECTRICITY 85 JOHN STREET NEW YORK NEW YORK 10038 Mrs.,Ellzab~h Mitchell,:;~e/s~P~um:Island [Lane 300 ,,n/o Park ~lew ~¢~,:: .~. OTHER APPARATUS: Motor/s. 1 lhp, 1 1/Shp_ . & l_lhp A.C. Uni~. 1-tt.5kw Hot water heater, l~12.0kw Elec. Fur. W.B. Ruland Electrician Mattituc. k, ~,I. LIC'. 2q2E This certificate must not be altered m any manner; return to the office of the Board if incorrect. Inspectors moy be identified by tl~ Ii! SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference NO.~-'~) -- /R ~ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 1. Applicant--v~ ~'~ob~ 6. Section ~ Address ' ~ --~ 2. Property location ~'3~/~" 7. Lot No. 8. Private well Village ~/~f'- __Township ~Y~ 9. Public water 3. Public Water Company name Distance to main 4. Lot size: Width /~ feet Length. /~ feet (Enter on center plot below) 10. Sewage Dispos~System: A. ~90~ gallon septic tank: Precast WEquivalent Block B. ching poola: Number/ recaat BIoe Special__ The undersigned If private ~ell fill in blanks below: Tank capacity.~Gals. Pump G.P.M. ~ Total well depth Depth to G.W. ~/ Amount of water in well Test Hole Data Feet 0 2 4 :ERTIFIES: be in accordance with the Suffolk County Departmen/~ of Health's current thereto." /~~~L ~--~f~.~ ards Date ~~'~ Signed Owner or Builde~ 6 8 10 12 14 16 18 "Construction of authorized installations will stand- FOR HEALTH DEPARTMENT USE ONLY. Based oD the information presented herewith, it is the opinion of the Mealth Department, that an adequate and satisfactory Sewage Disposal System can be installed on this plot. Date ~/~/ Signed ~ S-15 Revised 4/1/72 BUILDING DEPARTMI~IT TOWN CLERK'S OFFI~ SOUTHOLD, H. Y./::~/?~--- .,'~ amined ..... ....................... , ........ No ................... Approved ......................... ..1. ........... , 19'. ....... Permit No. ~..~=..~...~ ..................... . --ri-- ~.] D~sappraved a/c ................. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets m areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in port for any purpose Whatever until a Certificate of OcCupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with ail applicable laws, ordinances, building,code, housing code, and regulations, and to admit authoriZed inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) ................................ ......... ........... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................... ....................................................................................................................................... Name of owner of premises ....... ...~'.~...~.../.~ ,./~...~.~..,....,...~..../.,..'~....~...~....~'...Z::.. ~ .................................................................... If opplicont/~ corporate, signotuj~ of duly outho~zed officer. (Name and title of corpor6te officer) Builder's Liconse No. , ................................................... l:P[umber's License No ........ ~.,.~ ......... Electrician's License No ......... ~.......~..~...r.....~... Other Trade's License No ............................................... (~J4',-1/~F'-'~c~' ~E*~ ~¢~"~' - -/-" 1. Location of land on which r~Loposed work will be done. Map No.: .~. ................... /... ............... Lot No.../..~ ............ Street and Number ....24 ............... ~_.....~..d~..' .................................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................................................ b. Intended use and occupancy . . ~ ................. ~.' ~lature of work (check which applicable): New Building. I/ AdditiOn Alteration Repair .................. Removal .................. Demolition .................... Other Work ..................................................... ~',,'~__ ~,t~ //~ (Description) 4. Estimated Cost ....... ...c~...../X..~..°.. .............................. Fee ...?..?,.:....m.....~. ..................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units.....................~'~ ....... Number of dwelling units on each floor ............................ If garage, number of cars .................... ./.. ...................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................ ~ ........... 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ .Number of Stories ................................ 8. Dimensions of entire new construction: Front ........ ~ .................... Rear ........~...~. ............... Depth ..3../...:. ........... Height ......~'...~.....'..,. Number of Stories ................ .?. .................................................................................................. 9. Size of lot: Front ..... .~...~.....~......~. ................................. Rear ...... ./...~..7......~.. .................. Depth .../...~..,,~T~...~...../..~ ..... 10~ Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ........ ..'~..~-~.ZR.~: .~'./..~-~.~. ................................................. 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ........................................................ 13. Will lot be regraded' . ....... ...~....~. ............ Will excess fill be removed from premises: ( ) Yes 14. Name of Owner of premises ......~..~../~...~'..~..../'..~/..../~...~'~/..~'..Z.../'-Address~..~..~ ............. Phone No ....................... Name of Architect ......~.-..~.~__ .......................... Address ................................ Phone No ....................... Name of Contractor x..;-....~.......r...,~...-.~......-:~.. ........ ~ .............. Address ...~ Phone No.'~...!...~...~ .......... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. / / STATE OF NEW~,~, ,~., (SS ) COUNTY CLc ..~:,~.~1:~.1./~. ..........~ ' ................ .~..C)..~J.~./C'~. ...... ~., ....... ~.lli,~:/. ........ being duly sworn, deposes and says that he is the applicon, (Name of individual signing contll~f)/J~ above named. -' He is the ......................... 4~L.~. ~ .................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this ~plication are true to t.he~ best of his knowledge and belief; and that the work wil be performed in the manner set forth ~n the application filed therewith. Sworn to be~re me this /' / / ,,...~ ~,.,<~ Notary Public,. ................ .._....,...;~,~'~.l.~,~... County ..,~... .................... : .................. .x~....,....~....~.~.~.~. .4"/ · ~ ~,~ .., If (Signature of applicant) ,/ -'. ...... ELIZABETH ANN NEVILLE ! . NOTARY PUBLIC. State o! New York No. ~-8125850, Suff01l~ Cou, n_ty ExBires March 30. 19~,~_.~ · 7 . U APPROVED AS NOTIFy BUILOING DEPAP, TMENT A~ 765-2660 9AM TO 4PM FOR R~QUIR. E~ INSPECTIONS; I. ~EFO~[ BACKFILLING FOUNDA. TION OR STAAT FRA~ING 2, BEFORE COVE~ING PIPELINE 3, FINAL WHEN JOB COMPLETEO ~OT RESPONSIBLE FOR DESIGN OR CON- ¸'i