The URL can be used to link to this page

Home My WebLink About8235-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPAHTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at Do~ua. Dl,.ive ............... Street Map No.D. eep. Hole. ~l~ock No ........... Lot No.. 2~. ..... ~M.a$.t.i.t.~.Ok...N..,.Y.: ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... 0Ct;~. 9. .... , 19.~.~.. pursuant to which Building Permit No..82.~.. dated .......... 0.e.$...]~ ...., 19 .?.~., 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~..i.v.a.t..e..o.~.e...f..a~..i.ly..d..w.e~ .i~.g ...................................... The certificate is issued to Fr.a~la.e.s. Ilo.ac. I~omas. ~'~ ............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~al~. ~.. ] 9.~.~. b~ .R~..~.illa ..... UNDERWRITERS CERTIFICATE No. I~2(~0~.l .... D. ed...16...~.9~. .............. HOUSE NUMBER ..... ~+60. ..... Street .. Donna. Di~.II.'V~ ........................... Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMEHT TOWN~ CLERK'S OFFICE SOUTHOLD, N~. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 8235 Z Permission is hereby granted to: ..£.~.~.~L~...C~ .......... .~..csJ:.'. ....... kl.~.~/:T~q.. at premises located at ............................. /..1~/../;~-. .......... ~.~..~..,.~..,..~.~. .I..-~,!~. · .................... L¢..T. ...... ~5......~b.~f.~..~........~:l.o~. £.... ~.r~. ~..~: N,...~ ,~.~A..-r~. ~, ......... ~ ............... pursuant to application dated .: ............................... ~;'..,.:~,~:-;..~ 10~.~.~,.; on,d approved by the puilding Inspector. Fee $ '~0.' ~'~'-~ ' ~""~* ~'l~'uilding Inspector '1. SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT __~ ~ A PRIVATE SEWAGE_DISPOSAL SYSTEM AND A WATER SUPPLY ~ Address ,44.¢.~..~.' ,~0,.~._~ ' ~. ~ ~V ,~. Sectio~~ 2.. Pfope~.LoEat~n ~/~ ~ ~~ ~. ~'~ 7. Lot NymphetS. ~/0 '~/~~~ ~ 8. Private well ~illage~-~ Township ~~ - ]~. Public WaterlOo Distance to main~ feet ~. Public Water Company Name ~YO~Y~ 4.~..Lot s~Z~e:~ Width//~ feet Lengthff_~; lO.t Sewag~.~isposal System: ~ A. 9ODd, gallon septic tank: Precas~-~ Equivalent Block 11. B. LeaE~ing pools: (For Health Services Dept. Use) NumDer of pools Precast '/ Block ~pecial__ If private well, fill in the fol- lowing blanks: A. Tank capacity ~'~gallons B. Pump G.P.M. C. Total well depth. D. 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 Services' 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 Pear, it is in effect. Date 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 Dispos? System and Water Supply can be ins,~alled on tb.i~ plot. APPROVAL DATE /,~i / ~/~ ; .... SIGNED S-15 Rev. 4/1/73 ·OWN SOUt OU BUILDINe Dll)M~M~IT TOWN CLZRJC'S OFFICE APfLICATION FOR BUILDING FERMIT ~ . ex ........................... . INSTRUCTIONS , i~ a. This application must be completely filled in by typewriter or. in ink and submitted in triplicate to the Building Inspector, with 3 sete of plato, accurate plot plan to r. ale. Fee according to ~chedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or ..~. Iic streets al areas, and giving a detailed description of layout ofpraperty must be drawn on the diagram which is pa~t of th,s 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 a Building Permit to the applicant. Such permit shall be kapt 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 whatover unti! a CertificQte of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of t. he Town of Southold, Suffolk County, New York, and other applicable Lava, Ordinances or R~egulati,.ons, for the construct:on of. bu!!ding~.., a.clfl, it!ohs or o. lterations, or for removal or demolition, as herein described. ~ne applicant agrees to comply with all applicaom lows, orainances, building code, housing code, and ragulQtiom, Grid to .. admit authorized inspectors on premises and in buildings for necessary inspections. 1 ..... ...................... (~;Ignature of applicant, or hath&, ifa .c.~:~ora~tlan) .... State whether applicant is owner, lessee, agent, amhitect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...4.~.~.~.i.~'~t.,~ ...... ~... ......................................................................... If al~icant is a corporate, signature or'duly author~ed officer. ...... (Name and tltl~orpoi~te offic6?) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. 1. Location of land on which p?p ~o,~1 work will be done. Mo.p ....~... .. '~'~ Street and Number ~'/~/~'"~~"-.-.~'~'~"~'-"~'.'~'..~/~1t~~~::::[:: 2. State ~isti~ use ~d ~cu~n~ of pmmis~ and inte~ed use and ~u~ of p~ Exisiting use and occupancy ................................................................................................................................. Intended use and occulxlncy J" ~/'~ ~ / 3. Nature of work (check which applicable): New Building,. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ..................................................... ~ (Description) 4. Estimated Cost ......................... ./....~..~...~...O....U.. ............ Fee .......................................................................................... (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 structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construct on' Front ,~-..~ , Rear ~ D th~ ~"~ '~ ..... /1' ...................... ~ .................. ep ................. Height ...t..~... ......... Number of Stories ...........~.,~,, ............................................................................... . ...... ;...~ ....... 9. Size of lot: Front. m -,J"l'"~' ........................................ Rear ....... ~.~. ......................... ,Depth .....~t.~..~. ............... Date of Purchas~"..~.~.......~..~... ...................... Name of Former Owner .~,a~,~.,t~m~.~x',,~'~..,_ ----- ~--~-~,- ......... 10. 11. Zone or use distr~:;~n ~vh ch premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ~..~.. ......................................... 13. Will lot be regraded ...~ ............... Will excess fill be removed from premises: ( ) Ye~ ~) No 14. Name of Owner of prem~es~.%~/a'J~.'~,~.m.,,:.~ ......... Address~-.J~d~r~r~.;~.~.~P~e No.~;~..,..~.~.;,,( Name of Architect .............................................................. Address ................................ Phone No ...................... [ Name of Contractor ............................................................ Address ................................ Phone No. ...................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existir~g or proposed, and indicate all set-back dimensions from property lines. Give street and block number or desc~'iption according to deed, and show Street names and indicate whether interior or corner lot. STATE OF NEW YJ;~K,/J ,.1.~ ! ¢ c COUNT)~ OF ..... ~,~..~/,e~.... ~' '''''~ ........... ~Jl~--.~:~;~:..~...~.,~.~,!~ .......... : .................. being duly sworn, d~oses and soys t~t he is the appliconl (Name of ~divid~al ~g contract) -- above nam~. ~~_~~- ~ l ~ ~_ ' He is the ........................ ~:~....~~...~.~ .......................... j ......... ' ' .... (C~tm~ag~nt, co~orot~officer, etc.)~ ' of said owner or owners, and is duly authoriz~ to perform or ~ve performed the said work and to ~ke and fil& this application; that all statements contained in this applicat~n qre tree to the best of his knowledge and belief; and that the work will beperformed, in the manner set fo~h in t Swom~m me this he ~pli~tion fil~ ther~ith. ......... ~.~. day of~ ..... , 19~. Nota~ Public,. SuFFOSK OO~Y BEAS~ D~?~ ~ Lot ~3 Lot ~4 182.00 '. ' ~ot Lo/ ~1 ~EVi~iON$ 400 OS*RAND~E AVENUE~ SURVEY ~OR~~. ~, LOT NO. ~5, ' HOL~ CREEK ESTATES" SOU / ~ ~ ~/~N ~IFLE INSUraNCE ~. U/aAUTHOS~Z~O ALT£RATION OR AOI)ITION TO TNIS SLIF~¥£y I$ a VIOLATION OF $£CTION 7209 OF ~H~ NEW YORI( STAT~ EOU:ATION NOT TR~$FERAeL~: TO AOOITIONAL ' / 4 ¸ 4,, 7T -i · 0~ O~ $0~0~ Building Inspector's Office Town Clerk Building Southold, N.Y. 765-2660 i~f~ ~