The URL can be used to link to this page

Home My WebLink About8246-zFOruM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building lo,cared at .. ~Sa~],:te. lqa]r ........... Street Map No..~..a.]-.~.a .~.~.e..l~ck No ........... Lot No... J~8 ...... P,a.~.t;:~tue.]g.. ~.,.~.., .... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... .0et ..... ].h.., 19.~. pursuant to which Building Permit No.. dated ......... 0.at.. J.~ ..... , 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. rl.v.~te..ol~o. $.a~$lY ,c~t~.l~[[ The certificate is issued to . .Fl'al~e~. ~I,. 0XlaS~I ...... ~. ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .Ja~..~&...l~g~... b~..B,..V.~],:t&. UNDERWRITERS CERTIFICATE No. 1~([~0~2 .... ~.~(~...~.. t~?~. ............... HOUSE NUMBER .. ,1.~0, ...... Street ,,. ~.s~,~;~.~. IgOr' ........................ Building Inspector TOWN OF SOUTHOLD BUILDING DEPART,~ENT TOWN CLERK'S OFFICE SOUTH~G~.D, N- Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8246 Z Permission is hereby granted to: /..L,..~.~/..~:/L.;. ........ 'i~:.~)~/;: ........ r.:!.~..¥L~.~ ......... at premises located at ...................... I~/~..' ,~-~ .~.LT~ .~..~. ........... ..~.~..~...x.~.. ............ ........................................................................... .F..J. ~...'Zi......z..~...~..~.. .................................. pursuant to application dated ..........................(~.~-..~.- .-~ ....... , 19.~....b..'~.., and approved by the Building Inspector. Fee $.......~.....~.. .......... ~. Building Inspector ~ CE~IF~ THAT Mat~ituc~z L.I. J~b 199 m in t~ ~llo~ t~t~o,t; ~ g~em..t ~ l,t FI. ~ 2~ FL O~$SidO ~tlon Bl~k ,~.mi~ December ~ ~9~5 ~f~to~inrompli*nc,,mith~h~i~ments~hisB~rd. tB ...... 4 _~ ~ ~ -==t~_ --' ...... ~-- ' ~'-~ -~" ' '---t" ~- ~ '1 .......................... ~*Pu~aees: 911 1-1/Shp, 1-1/l~n .. *Future app&l~nce fee3er/s: 1-3~6, 1-2~12 Fom~ Point Elec. Inc., '"' ..... This ~llflc~t~. ~u~t :i~ot I~ alt~ in an manrm'l ~eturn to tb~ offlc~ ~ th~ Beard if in~rrmit. InSl~Ct~s may be identlfiscl by their ~r~cl~mtlal~. ~ SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services - _ Reference Number~-J-O ~/~ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISBOSAL SYSTEM AND A WATER SUPPLY A lican ~'~-~0~l) P ne~ ~..(~.? /~f~ 5. Subd~~ Address ~'~"~ L~9.~ ~ ~.~ ~ 6. Section 2. ~y}~_~ion~f~ ~ ~f~ ~ 7. Lot Numbe~ ~ ~/~~ ~~ ~ _ ,. _ ~ 8. Private Well.~~ Villag( ~~ ~nshi~ - 9. Public Wate) 3. Public Water Com~ Na~ ~__ Distance to ~in ~ 4. Lot size: Width~ feet Length~~ feet 10. Sewage Disposal System: A. 900-gallon septic tank: Precast .Equivalent Block B. Leaching pools: NumberT/~°l s Precast "Block Special 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~~-- 11. (For Health Services Dept. Use) The undersigned CERTIFIES: "Construction of authorized installations will be in accordance wi th the Suffolk County Department of Health Services' current standards thereto." This application will be valid for one year from the dat~f appr?val indicated below and may be renewed if a current local Building Department P~ry~it is_in effect. Date~ ).~' 7~-~/ Signed~~~ ====================================================================== 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 Disp/osa~ Sy~sd;em and Water Supply can be~ms~ta~?~ his plot. APPROVAL DATE /~ ~ ~ SIGNED S-15 Rev. 4/1/73 TOWN OF SOUTHOLD TO~H CLERK'~ OFFICE ~UTHOLD, N.Y. ~, ' ~ ' ' o ~ f..~. Examined ................... ~Z ......... , 19 ........ ~phcat~on N ............... u~sapproved a/c .............. ~ ..................................... ~ .................................... ....................... ~ ................................... ~, ..................... ~ .......... (~- ~ (Building Inspector) ~'~ ~ -~ ~ .~.,,,:.~7....~.~.. .................... ~9.7~... I NSTRUCTION~ a. This application must be completely filled in by typewriter or. in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relatiofiship to adjoining premises or public streets oF areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. ~ c. The work covered by this app!ication may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Pbrmit to the applicant. Such permit~ shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used ia whole ar in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to thew Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regular oas for the construction of build ngs, add t oas or alterations, o.r for removal or demolition, as herein described. ~ The applicant agrees to comply with all applicable laws, ordinan~s, budding code, housing code, and regulations, and to adm t author zed inspectors on premisesr and in buildings for n~ssary inSPections. ~'j (Signature of a~plican~,'l~i:~ame, if a corporation) (Address of applicant) If applicant is o corporate, signature of duly authori~d officer, (Name and titl~ co~orate officer) Builder's kic~se No ..................................................... Plumber's Li~nse No ................................................. Electrician's License No ............................................. State whether app cent is owner lessee agent, architect,.~engineer, general '~ontractor, electrician plumber or builder. ...... i.b., ............... ............ - ........ ............................. ,.. o, ........................................................................ OtherLocationTrade's LicenSeon No ............................................... of land which pr~osed work will be done. Map N~¢ .... ~~ ............. 1. Street and Number .... Municipali~ 2. State existing use and occupancy of premises and inCeoded use and occupancy of proposed construction: Exisiting use and occupancy ................................................................................................................................ , , .... Intended use and occupancy ............. ~ ..... ~ ................................................ / j :j'x 3. I~lature of work (check which applicable): New Building. ................. Addition .................. Alteration ............... Repair .................. Removal .................. Demolitior. .................... Other Work ..... ~:~ ........................................... J ¢,-'~, 0~" ''f} ~ Y~'~ ! ~) (Description) 4. Estimated Cost ..... ~..~,..~ ........ '...T. ............................... Fee .......................................................................................... (to be paid on filing this applicatja~n) 5. If dwelling, number of dwelling units J Number of dwelling units on each fJ;9or If garage, number of cars J , 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 construction: Front ._.~'.~.../.....j ~'~ ...................... Rear ............................ Depth ........................ Height /.~.~.. ............ --J~.~Number of Stories ..................................... ~1~'~'~"'~: ......................................... ~¢~' ................ 9. Size of lot: Front ..... J...~....~.. ......................................... Rear .ff..~..~... ..........................Depth ................................ 10. Date of Purchase ........................................................Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ................................................... ~2,')' .......................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .................................. ~ .................... 13. Will lot be regraded '"'"~///'/.~ ~ . i~. ~ ~'~[2Will ~cess filb~be removed f~m, pmmises:/~/~..~r,~( l~Y~ ~) No 14. Name of Owner of premis~.,.~..~.~/..~ddress ~..~.~'....'. Phone No ....................... Nome of Architect ..~..~ ........... ~ ........ '.~. ............ j~. ............... A~IJ~'JJ~.,~:., ........... '1~ ........ ~]~JI,~jI~No. ~ .................. Name of L~onrrac[orf...c.: .............................: ...... ~ .................. ~aress ............................/... mane ~to ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner Jot. ................... :.~..~/.~,,i,,t'' ......................... ', ........................... being duly sworn, deposes and says that he is the applicam (Name of individual signirl~/d~ntrac~ ?. above named, i~ ~ ~ I~ .... ~ -~:*'J.-- ~ He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained Jn this application are true fo the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the ap. pl,~ation filed therewith. Sworn to before me this ~ t, ~ ........................ .................. , v ., .. , ..... .......................... NOTARY PLIBLIC. State of New Y~ Nm ~2-4522026 - Suffolk Cou~ o~ THE ! OF THE: COUNTY (~N A~G. N.Y.$,LI C. NO. 12645 NOTE: UNAUTHORIZED .~LTEI~ATtON Ok ADDITION ' TO 'J'l~l~ SU~¥EY IS A VIOLATION OF '-'~"~? 5ECi'ION 7~09 O~ TH~ N~W YORK STATE ~? [~ ~ EDUCATION LAW. TO B~A VALID ~RUE COPY, ~ ~ ' ~~G~ ~''A~B ~ : ; OWN~TO ~D~TIONAL INSTITUTIONS OR SUBSEQUENt I = MONUMENT ~ SUBDIVISION FILED IN THE O~FICE OF THE CLERK OF SUFFOLK COUNTY ON AUG. 3~I968 AS MAP N0.4682. LOY' NO. 2e "SAt~ TA!RE ~STATES" MATTITUCK TOWN iOF sOuTHOEg SUFF. CO., N.'~. SCALE: 1"=4,0 ~ ~.~. ' ; YOUNG ~ YOUNG NOV 20, 1975 ~//~ O~l~, I I~ ~, ~ ~Afl~$UR~OR,N.Y,S. LIC. NO, 12845 RIV~E~Dt N.Y. :',[ .?' Town Clerk Building Southold, N.Y. 765-2660