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Home My WebLink About7710-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Of[ice Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ...... ....1~1~. ~9.~4 ....... Street Map No. CSp.t..g~.d,~..l~ock No ........... Lot No,l.~.~. .... .I~.~.~.~;.~..~k...~ ~ ...... conforms substantially to the Application ~or Building Permit heretofore filed in this office dated .............. ~b.. ~, 19.7~: pursuant to which B~lding Permit No. dated ......... ~b. · · .~ ...... , 197~., was issued, and conforms to all o~~ the req~e- merits of the applicable provisions o~ the law. The oecUP~ey ~or which this certificate is issued is . ~a~..q~..~. a~g...(. ~:~. ~99r. '.O~} ............. The certificate is issued to .~a~ ~~$$~ :¢0~ ........ ~$~. .............. (owner, lessee or ten,t) of the aforesaid building. Suffolk County Dep~tment of He~th Approval .~.. ~.. ~.~. '. ~.~Y ........... HOUSE NUMBER .... ] ~ ...... Street . ~a. ~: .... ~~ ............. Building Inspector FORaM NO. ~ TOWN OF $OUTHOLD BUILDING DBPAI~T/v~ENT TOWN GLERK'$ OFFIGE SOUTHOLD, N~. Y. BUILDING PIERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL JFULL COMPLETION OF THE WORK AUTHORIZe:D) No. 7710 Z Permission is hereby granted to: ~i.~. ~....~o~s~u~t~o~..CO~p ...................... Ma~ti tu~k to ....... ~ ........ ~E., ~$...~...~a~l~g .......................................... : ......................................... pursuant to application doted .....................F~tb ....... lt~ ................. , 19~ .... and approved by the Building Inspector. Fee $~..~.. 6.C) ............ ........ '~'-"~ .... ~1 .................. ~ Building Inspector / THE NEW ~tORK BOARD OF FIRE.~UhDERWRITERS,'r BUREAU OF ELECTRICITY , " ;' 85 JOHN STREET. NEW YORK, NEW YORK 10038 ,'Jul~ '~0 1975 ~"P'~"""" ~'0' ""Ia~9~ 8~ ' N238108 CERTIFIE T A~ ~lec~r~ceJ equipment ~ descriSed 6.1o~ and introduced by the appl~a~t ~amed o~ the above appJica~io~t number i~ the premises of MS~,~ ~oda Rd., Ruth Rd. & Captain Kid Dr., Mattituck, L.I. ~ Block Lot ,,~.,~.,.~,iodo.~ , , , , ~ July 28, 1975 a'~df°~ndt°beittc°'nPl~at~ce~ithtltere~lulre"~ettts°ftl~isB°ard'~,~ ~, SWITCHER RANGES OVENS ~'HER APPArAtUS !~-~ PUzllaces; Oil:' 1-1/8, 2 '1 4' l-1/12hp. ,viii ~ ,,~ , RR # '1,227E B~eakwat er Rd. . Om~A[ ~A~AG~a" ", ~ ~ 'This ceriificate must not be altered in any manner; return to the office of the Board i{ incorr6~t, Inspectors may be identified by their c~edentiols. ~ I FORM NO. 6 TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Insfructlons 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 - Date New Bc~ilding ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ~JJ~ J~HOT)/~ IZ.O~ /~J--~':~ ~r'~C~l~ I~,~'1, Owner Or Owners Of Property ................................................ .~)..~.~ ................................... Subdivision .~.~...~.?..~.:...~.?.?....g....~'.~.?.~. ............. Lot No...!..~....~... Block No ............. House No ............. Permit No. [..~..'2.1....1~...... Date Of Permit....l....! ~ ~ ! ~(~?.~.'£ ' ~ ~ T, ~ ~'-~ Z ~/ ?..J.....Applicant ........... '.~.~. ............ Z ....... i.:..i..:...~. ............. Health Dept. Approval ..... ~. ..................................... Laoor Dept. Approval ................ .~...]...~. ..................... Underwriters Approval .... .~.-.~..J.t../~l~!.....~.~...~../....7..~..~PJannJng Board Approval ....... .~....:..C~-~ .................. Request For Temporary Certificate Fin~ Certificate / Fee Submitted $ .....~....~. .................. Construction on above described building and P~.~~l~ic_able codes and regulations. Sworn to before me this (stamp or seal) ~LK,COUNTY DEPARTMENT OF HEALTH Heal th Department Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant ~ co~i~t~C~r,)~ ~Y~Phone l?t]'- ~4S'q q Address ~ ~ ~~ ~;~1. ~ 2. Property Location~)~ ~)~ ~ ~ Village ~~' ~ ~Owns~P ~m 3. Public Water CompanY Name ~ ~ ~-- ~, 4. Lot size: Width ~eet Length ~ feet Sewage Disposal System: A. ~'9~(~O-~gallon septic tank: Precast ivalent Block B. Leaching pools: Number of pools Precast ~Block Special 10. If private well, fill in the following blanks~ ~1~5~/ A. Tank capacity~lons B. Pump G.P.M.~ C. Total weJ~epth~ D. Depth.y~,gro~nd w. ater~ E. Amount of water in well 11. 5. Subdiv. 6. Section 7. Lot Number 8. Private We'll 9. Public Water Distance to main (For Health Depto Use) The undersigned CERTIFIES: "Construction of authorized installations will be ~n accordance with the Suffolk Coun~ Depar~ent 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 ...... z ........ ~ ................. ~ ............ s_~__- ....................... ~ .......... FOR HEALTH DEPARTMENT USE~ ONLY. Based on the information presented herewith, it is the opinion of the Health Department ~hat an adequate and satisfactory Sewage Disposal System and Water Supply can be installed on this plot. A PrOvAL DATE _ SI NEO S-15 Rev, 4/1/73 SUFFOLK facill~ie~ for '~inspected by this -~'~ ~htef ~£ General ~erviee$ / / po~D I APPRgVED AS F~OiED BY /~-/' ' '7