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Home My WebLink About7728-zFOR~ NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z.6.~2.8 ...... Date .............. ,[.muo ....18..., 19. ?.~ THIS CERTIFIES that the building located at ... 1)Olzmr .Dl'~.ve .......... Street Map No. LAY.,..C. tlr. F~s~loek No ........... Lot No.. ~-[~.. La~a~el...I~,Y., ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... F. eb.. 27...., 19..7~ pursuant to which Building Permit No. 7.7.282.. dated .......... .F.~b.. 22 .... , 19.7~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .I?~'I.v. ate..o.,ue. £amily..dwe.~'~ lng ...................................... The certificate is issued to . It0.1and .Homes. Ina ...... 0wr~eF ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval J~me...1.8...1.97..~. by. R~..Wttl~ .... UNDERWRITERS CERTIFICATE No...N22~99 ..... May., 46. ,].97~ ............... HOUSE NUMBER ..... 2~. .... Street .... De,lmaI,. D~$,i~ ....................... !. ....... TOWN O~ $OUTHOLD BUILDING DEFARTMENT 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? 7728 Z Date ........................ l~.e;J) ....... 2~ ............. 19.~..~... Permission is hereby granted to: T-~13,a~l.. It~e~ .. I.ae ........................................... .......... .~.a..~.~.~.~e.~ ............................................... to B~ ltl ..r~ew...oz~e...f. ami3,y.. ~,well. t~ ....................................................................................... at premises located at .~uo.~..r2~......~?~e.t...(~O~WL-~,..~t&~o-S ................................................... ......................................... Del~a.r...Dr.l. ve .............. ~a~e.1-.....~ ~.~....: .......................................... pursuant to application dated ......................... F~......~-~. ............. , 19~ ..... ond approved by the Building Inspector. Fee ~**** **0. ,0. ............. ~ FOII~ NO. ~ TOWN OF SOUTHOLD , Building Depmtment Town Glerks Office Southold, N. Y. 11971 APPLIGATION FOR GERTIFIGATE OF OCGUPANGY 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-0 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: l. 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: i. 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 16 June 1975 New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property Owner Or Owners Of Property Zn3.and Hozaes~ .3'nc, . . Subdivision ................................................................ Lot No.·...........20 Block No. ............ House No.........2775 .... Permit No. 7728Z Date Of Permit .~..7..F.~..b...7.~pplicant Inland Hot, es, Health Dept. Approval ..6,./...]'..8../.~5..-...4..-...S..O...-..1..5...4......Labor Dept. Approval ......... ~..~..~ ................................ Underwriters Approval .N...2..2...5..1..9..?. ............................. Planning Board Approval yes Request For Temporary Certificate ........... .n...o. ........................ Final Certificate .......................................... Fee Submitted $ ..5.....O...0. .......................... Construction on above described building and permit meets all~atior~ A pp Ii ca n t ~.. ~, ;....~ ~~..~ (stamp or seal) Sworn to before me t~its ......... Notary Public ....~~. Coun~ SUFFOLK COUNTY DEPARTMENT OF HEALTH HealthReferenceDepartmentNumber _ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant ~1~I~,~t~)) ~(J~,1~$~ ]~I~C, Phone;~90-~c~(~O~J 5. SubdivLau~Q~ Address I~,0, ~3o~ ~.9.7~ M~'~t::~.t'.~ck~, ~ ]~t~ 6. Section 2. Property Location I)e~t~a~: t)~£~e~ l,a~el 7. Lot Number ' ' 8. Private Well Village )~tt~:~l Township~lbo~,(l 9. Public Water 3. Public Water Company Name Distance to main__ 4. Lot size: Width )~4~.} feet Length. 1~,0 feet 10. t ll. Sewage Disposal System: A, O~gallon septic tank: Precast ~ Equivalen~ Block__ B. Leaching pools: [~umber of pools Precas~,~, Block .Special__ If private well, fill in the following blanks: A. Tank capacity ~.,~ ~allons B. ~ Pump G.P.M, ~ C. Total well depth (For Health Dept. Use) Do Depth 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'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 G~er el~ 1074 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 pl~ot. APPROVAL DATE S-15 Rev. 4/1/73 C) DELMAR Rorno~o¢sl° S. , ,5-Z~O,gAM T0'4pM',FOg ~EQ ~~', .]~ % iN