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Home My WebLink About7707-z FORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CI~ERK'S oFFICE SOUTH*OLD, N~. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7707 Z ................. Permission is hereby granted to; tL....S.te.v.e ~ t;. ...... .3o.u~lxo]A..Homea..Imc ..... .......... ~.~thold ................................................... to ...~i~,..r~ew...~ne...£ex~il~..dwa!~-~r~ ................................................................................... et premises Iocoted at ..~/.~o~-o~,a~...~oa~ ................................................................................... .......................................................... ~oStho~d ......... ~.-~:.~ ........................... ................. i ................... pursuant to application dated ................. ~Y~I~ ......... ..~0. ................ , 19.~..~..., ~nd approved by the Building Inspector. Fe~ $.fi.O...1D ........... Building Inspecto~ ~ FORI~ 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 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 ar 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 D te ................... New B~ilding ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .~ .......................................................................................................................... Owner Or Owners Of Property ~'d7¥/~o~ Subdivision ................................................................ Lot No ............. Block No. House No.~l..6. ..... Permit No. 'l.~.d..?..;R ........ Date Of Permit/.£.:~.~;..?...f...,Applicant .~.L.r~.f/.d.~.~....~/.~.....~....../.,~ ,c ;/~ ......................... Health Dept. Approval ~J,?,.~¥.~..~...~.~:./..~.'~;}~ .............. Labor Dept. Approval ................................................ Underwriters Approval ..~?.~.:~'~.~,:.:?...~?..~.~.. ............. Planning Board Approval ........................................ Request For Temporary Certificate Fined ' ' ........................................ Cert~hcate .......................................... Fee Subm:tted $ ...~. ............................... Construction on above described building(~d,,.p~i~it~codes and regulations. Applicant ~,~.~.... ~ ............................................... Sworn to before me t~--'~ ~.~ o,o . (stamp SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference No. .r,~ .~.~ ~.,r' ~" ,',,~'t~ ~ ~/y' APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DI'S~O'B'&L?$~TEM 1. Applicant~~ ~T~O ~ Phon~&~-~455. Subdiv. ~r~,~ Address~, ~u,~ ~0 =~o~. ~,~. '6. ~t~ ~ .... location ~%~%~u~,: ~ ~,~."7. Lot No. 2. Property ~u~o~.~'~l L ~ ~' %k~C%, ~o~[ 8. Private welling% Village ~ouw~o Township ~ou~,~O 9. Public water ~ 3. Public Water Company name ~ Distance to main 4. Lot size: Width I~-- feet Lensth %%%~ feet (Enter on center plot below) 10. Sewage Dispos~ystem: A, ~0~ gallon septic tank: Precast~ Equivalent Block B. ~achins pools: Number ~,, Precast~Block Special be ards If private well fill in blanks below: Tank capacit~ Gals. Total well depth__ Depth to G.W. Amount of water in well A~ ~ Test Hole Data Feet O~'~' 12 14 16 18 The unde signed CERTIFIES: "Construction of authl,r ,zed installations will in accordance with the Suffolk County Department of Health's current stand- Dat Signea Owner or Builder FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department, that an adequate and satisfactory Sewage Disposal System can be installed on this ploto S-15 Re¥~$ed 4/]/7Z ~UARAI ~NGINEE~S--SURVEYOR5 SCALE 1 IN. TITLE NUmBer BUILDER'S No. The sewage d~;ooca] a~d ~?at, er Suppl~ fnci[~ities, for t~ ~ ~oeat!on have been ~nspected by %Lis department and found to be sat~or~ D ~ -- '~_ Chief of General EngineerinE Services ALL UCTU L LU,.~BER SPANS TO COMPLY 1F1TH STC~,.ATE ..4ND I,OCAL CODE. APPR(I~E~ AS I~gTED , NOT/Fy BUILDING DEPARTMENT 76S-2660 ~AM TO 4PM FOR 8tiC, ~D INSPECTIONS, I BEFORE BACKFILLING FCLIF, D/ JlON O~ START F~AMING L ~f II i I