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Home My WebLink About8224-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z69~ ....... Date ................l/arch.. 31., 19..~.6 THIS CERTIFIES that the building located at . ~oundv. iew. Ave ........... Street Map No. ~;o:~.thwoods Block No...EX ...... Lot No..12 ....,~outhald.. N,Y, ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...........Oct...3 .... , 19.7%. pursuant to which Building Permit No...822.1+Z dated .............0~.t...3 .... , 19.75., 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 . .. Pr. lva.t.e. 0l~..f~nlly. ~ellSr~g .................................... The certificate is issued to . .B. ~'.i.a.r~..0.~.C.q .r:m.o.:: .... .0W~,~' ............................ of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant) .Mar.,..~1...1975...by. 2,. ¥ill& .... UNDERWRITERS CERTIFICATE No..T..e.mp..a. gp.r.o.v.a..1..b.y...ff.,..K..u.b.a, qk..i. ~./.2. ~/..~.6.. HOUSE NUMBER ...... .1.3720.. Street ... ~oun&v. iew. Ave ....................... FOI~I~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTk~ENT TOWN CLERK'S OFFICE SOUTHOLD, N*. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 8224 Z ~ate ............................ 0~ .......... 3 .......... ~9.?~.. Permission is hereby granted to: ....... $ 2.?.....I],~,.~.. 4~..~f~...L~.~ ......... to lJ~ild...n~w...o~e..,f, ami;~.~.. ~;e.L,~.i~ ..................................................................................... at premises located at .~O,t,...~ ....... };J'4~.t,]3~x~od[.S..~s.t,.,~-~l,t;}to-14~ ......................................... ............................................ · /~..am~.~nd...~.e~. ~.x~o .......... ~;o~.~h~4. ........................................... pursuant to application dated ..................... ~.1~. ......... 3 ............... ,' 19~.~...., and approved by the Building Inspector. Fee $~,-~ ~'~l ............ 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. Applicanl~(r~v,~_~ ~,~_ ¢_ Phone~7<.~l~/ 5. Subdiv~ 2. Property Loca~tOfi' i~l~ - ~,~ u ~ ~,~_ 7~ 7. Lot ~er I ~ ~/,~ ~,~ z J~,~. ~ 8. Private Well ~ Vi)l~~,,~ ~ - T~nship ~,,~,;F~o~ ~ g. Public Water ~ 3. Public Wate~ COmpany Na~ ~ Distance to ~in 4. Lot size: Wid~ jQ~ feet Length ~if feet lO. S~age Disposal System: {For Heal~ Services Dept. Use) A. gOO-gallon septic tank: Precast ~/ ~quivalent Block__ B.Leaching pools: Number of p~ols I ~Precas~ J B1 ock Spect al ll.~.~If ~.rlltte well, fill in the fol- !~ :lowlng'~l anks: A. Ta~ capacity t/J, gallons B. Pump G.P.M. % C. l~al well' depth O. ~th to ground water ~ E. Amount of water in well / / / 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 fQr one year from the date of approval indicated below and may be renewed if a current local Building Depar. tment Permit is in effegt. Da ne ........ -'.-L-.-'- ................................. 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 ins.tailed, on this plot. S-15 Rev. 4/1/73 18.157N TOWN OF SOUT.O~.Df~ BUILDING DEI'ARTMENT TOWN CLERK'S OFFICE ~U~OLD, N. Y~ ~,~ ........ ~..~ ............ , ~._.~ ........................................ , ...................... ......... Disapprovod o/c ....... ~,~ ..................~ ............ ............................................................................. ......................... ~?z~ ......... l/ (Bui~ing InspectorJ APPLICATION FOR BUILDING PERMIT Date ............ INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Buildir Inspector, with 3 sets 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 areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is port 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 ~ 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 part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPL(CAT[ON iS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to theJ 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 aiterations, or for removal or demolition, as herein The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to authorized inspectors on premises ,.buildings admit and for necessary inSpectiorls~ (Signature of applicant, or name, if a corporati,~n) ............ /.~ ~.. .. ~. . Z.e~,. . . . . . . l)~, . . .r. .~. .~' (Address of applicaot) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber c~ Name of owner of premises., .~,~.>.J,~.,~,,,,~ ....... .............. ~ ........................................................................ If opplicqnt,is._~_corpo/'~te, signature of duly autJ~rized officer. ................. &am."~; ....... ~Ti~'~'~) ...... Builder's License No ..................................................... k'~/,~ ~~ .,, Plumber's License No ..... ~~.<..~-,~... ...... Electrician's License No. ., .,~:~..~-,.,~r;w.,,/.;~ ........ Other Trode's License No ............................................... n,~r~-.~.,.~ ~ ,, ~:~l ~ _ - Location of land on which proposed wor~ will be done. Map No.:l..v~..~..~./~-.~.~./~.~L.ot i:,lo. ~.....-~... ............... 1. Street and Number ...... ~...'....'~.~.~,,.~1.....~......6~.~ ......... ~ ....... ~"~-~....~... ............................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. ........ Y.4.c ........................ ......... :i:]':Z ii iii iii Zi ii :::::::::::::::::::::::: b. Intended useandoceupancy ......... .....~.~/~.~ 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ........... ' ' Repair .................. Removal .................. Demolition .................... Other Work ................................................. ... 4. Estimated Cast .(~.~.- ~)O ........................................ / (Description) (...~2! tee .......................................................................................... (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 s:tructure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ........................... ~Number of Stories .............. I ................. 8. Dimensions of ~n~,~e new construction: Front ..,~.. ......................... ReQr ....~.~ ................... Depth .~..~.. ............. Height .......... J..~... Number of Stories , ~,~ 9. S,ze of lot: Front ................~..~,,:~.. .............................. Rear ............................ ,~ ......... Depth ..x..~.~ ...................... 10. Date of Purchase ...................... ~ ................................ Name of Former Owner ~;~.~..~..[......../~..~.1.~.. ~...J~-~.~...C'T... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... ..~..../g. ......................................... 13. Will lot be regraded ...... ~.~..~. ........... Will excess fill be removed from premises: ( ) Yes ~ No 14. Name of Owner of premise~.J~,l/~b/......0..~../~.J~,(.(, .............Address ........ u ...................... Phone No..; .................... Name of Architect .............................................................. Address .~ .....~:~'q'"~i/C~ o~ne No .................................. Address Phone ~ameofcontrector~U.l:~..~L~- .G ~ ' ' ~ ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frorn 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 YORK, ~ ¢ ¢ COUNTY OF ........ St~f~.ol~ .......f"'" ........................ ..V.~.'J;;..o.....~..~.a..~;~.9. ......................................... being duly sworn, deposes and says that he is the applicam (Name of individual signing contrac0 above named. He is the ............ f~P.~,C;,.~.~O..~P.:K'....~P,T:....O.1tfzO, f~2. .................................................................................................................... (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 ell statements contained in this application ore true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed,therewith. Sworn to before me this ~ J \ ...... .~ .......... do~ of ..... 0~o~. ...................... . ,~...~ ~,,</,' ,/.J ~oto~ Pub,,e,. ............... ~ ............. S~OZ~.. coun~ ..~....Y..~ ......... ~.~ ............................... ,,~/. ,~,~,.~t /'.,~ ..... ~// .... ~/, , '(Signaller applicant) ELIZABETH ANN N£VJLLE S.5 ~OUND VIEW A'v'E N[ !E ON FILE iN THE ,.,U ~-O~ r--OUNTY' _LF'~.., OFF'bCE ~,L ~AP HO.F:~75, HAP 'OF PROPEP2'""r' SUD..VE'Y'E D 12..OB :.P.T TOWN ,OF cZ)UT HOLD~ N.Y, t75.C0 TO TNE ~ TI,"LE I NSUD..ANC[:" nCO, LAND sc.¢[..~," D MONUME~x ~ ~,o2 05 lO W. %75.C0 Ot; f; II.£ !iN THE .SUF ~. 0..~4. ECUNT ( _LE I~ _ OFf .... AppP. oVED AS NOTED DATE' ,,"~F~.~ 3 / ~ 7 ~'-