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Home My WebLink About7689-zPOElVl NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy No. Z.65.Q6 ...... Date ........ .J..u~.e. ..... ~ , 19. ?~. THIS CERTIFIES that the building located at . ~,r~ndy..D.t.~.V.a..(.P..v.'c.R.~. ). .... Street Map No..Ro].L~n~m.o;mlock No. ' .Lot No....L.a.u..r.e.1...1.~.o.Y.t ................ conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... Js~-...~.0..., 19..7.5 pursuant to which Building Pemit No. ?.6.8.~.Z.. dated ......... ~7an ....J.O. ...., 19.7.5., 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.~'~..vato..o~.e.f.~.~.~.~r..d.~..~el].~.ng ....................................... The certificate is issued to ...R. Sy. fl.:..K.a.r.e.n.. ~'(i.1.1..i.a.m.s. ...... ~..,'.n.e.r.q ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ?..uzg..e...3....~.9.7..~...b..y..R/..V..i.l.l.a. .... UNDERWRITERS CERTIFICATE No..I~22 ~J .~.~....~.~.a.y....J.6....~ ~.7. ~ ................. HOUSE NUMBER .... 2..~.0 .......Street ~.~.e.n.d..y..D.~:l..v.e .......................... l~Ol~,~I NO, ~ TOWN OF SOUTI'~OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N; Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 7689 Z De~e Permission is hereby granted to: .-.~ . . .~,~:.~..~4,...,..:.~:~.~.~..,.:?,.:c.~....,, I ~ o ~ *t premises located ot ...~>..~i .......... ~.~=~.l~.l~..~ ....... ~l.~.t.~.~ .......................................... ................. ~ ................ ~,.. .............. J.~.~.~z~..=...~....~t,...: ........................................... ~uilding Inspector. Fee $~..Z~...~ //~l l~OH~l NO. $ TOWN OF $OUTHOLD ~ Building Department 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 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 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. 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 $1.00 June ur- Date New Building ......~.. ........ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...~.....~....~..~..y..~...[;.Y...~. ......... L*..UZ~.I " at ................. : ...................................... Owner Or Owners Of Pro ert R/6f.~.. a~' .v.e.~ ~i11,~,$ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No.'/..~.~....~.,... Date Of Permit !..-.J..S...-..ZE^pp,,cont .......... Health Dept. Approva=~F .~....-....~..~.0....-...~.. ................... Labor Dept. Approval .............. ./~/...1~,.~. .................... Underwriters Approval ~.....~..~...~...!...~...L/. ................... Planning Board Approval ........ ~..:.1..~ .................. Request For Temporary Certificate ........................................ Final Certificate ......Y ............................... Fee Submitted $ Construction on above described building and permit meets all applicable cc:~les end regulations. · ' .... Sworn to before me th//~ ...... day of ......... // (stamp or seaD '~'~ ~ §UFFOLK COUNTY DEPARTMENT OF HEALTH ~e~lth Department Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant ~R,r~' .¢'A¢/~ ~.9¢/~¢~.,~; Phone ~&~ ~'~5. Subd!v.~/~ Address ~ ~/~;,~ /~,:~ 7~/~ ~.~'~ ~.~ R~ 6. Section 2. Property Location ';¢~'~,.,,~, ~ ~.." ~' 7. Lot Num~ ~¢~m~ ~.~ ~. . 8. Private Well Village ~ Township 9. Public Water 3. Public Water Company Name Distance to ~in 4. Lot size: Width feet Length. feet 10. Sewage Disposal System: A. 9~i~gallon septic tank: Precast ,~ Equivalent Block__ B. Leaching pools: Number of pools °;~t' ~_ Precasi/ ~ Block Special (For Bealth Dept.¢~e) ll. If private well, fill in the following blanks: A. Tank capacity d~ gallons B. Pump G.P.M. ~ C. Total well depth D. Depth to ground water E. Amount of water in well The undersigne~ CERTIFIES: "Construction of authorized ~nstallations will be in accordance with the Suffolk County Department of Health's 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 HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department that an adequate and satisfactory Sewage Disposal System and Water Supply can be installed on this plot. APPROVAL DATE ~' SIGNED ~' ~ S-15 Rev, 4/1/73 .......... NOTE: ~= MONUM£NT · S~OWN ~REIN A~E F~OM FIELD OBSERVATION~ AND/OR F~OM DATA OBTAINED F~OM OTHERS iOUNG & YOUNG 400 OSTRANDER AVENUE RIVERHEAD, NEW YORK FOR: ' SURVEY TOW. o~ SOUTHO~ 4~TE : ~ -' MONUM~NF UNAUTHORIZ~ ,ALTERA~TION OR ADDI3: ON TO 7~5'2660 '9~M TION