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Home My WebLink About8267-zFORM NO. · TOWN OF $OUTHOLD BUILIHNG DEPARTM~,NT Town Clerk's Office Southold, N. Y. Certificete Of Occupancy No.Z.6.9.3~ ....... Date ........~a..~o.h... 22. ........ ,19. ~ THIS CERTIFIES that the building located at....BA~., g.~.l.o.¥..L.a.n..e .......... Street Map No.~X .......... Block No...X:I~ ...... Lot No.. IX... ~A¥~l.t.t~¢k...N. ,]~.. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ...........Qet...28..., 19.?~. pursuant to which Building Permit No...826FZ dated ............~c.t .... 2~.., 19.7~., was issued, and conforms to aU of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. Pri~ate..one..£e.~l~.. ~w.e. lliz~g ...................................... The certificate is issued to . .D~.vl4.6. Leslie. T~hill....0~er .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .Mar...19...1976...by. P~,. YLil& .... UNDERWRITERS CERTIFICATE No..~272.o5t~.....~r. ~. 1926. ................... HOUSE NUMBER .... ~10. ......Street.. l~mgeLo~. Lane ........................ FOF,~M[ ~0. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT 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? 8267 Z Permission is hereby granted to: ot premises 'oco~ed ot ...................... ~{.~,~..t:..~..~ ......... ~.~..~.~i ........................................... pursuant to opplic*tion dated ~('~ ~ ]9~.~.., and approved by the Building Inspector. Fee $.,.~..2....~ ...... Building Inspector HE. NEWi:,YORK BOARD OF FIRE,,UNDERWRITER$ i ' . BUREAU OF ELECTRICITY ~85~6HN STREET NEW YORK. NEW YORK 10038,1:.-li ~Ts=l~ ,,? .,,,,,,~.,,o,,~,o.,.,,~,,~ s3~o,2,, ~, ,~-i,-,,l_-,,~.~?,. ~,,,,i-272 m,,.~ ~/s Buncalow Lane ~03' e/o MarraTooka,,Road, ,~L.I.~ ', garage, out sld~.,,,,, March' I 19 7 OUTLETS SWITCHES [' FIXTL 26 16 17 ;H WASHERS 1-Fr .hp ~Ll-15amp GFI -' i'102' Oak Ave. - - : , ~ SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number APPLICATION FOR APPROVAL TO OONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant' ~/~U~F~ ~L~ ~'r, Phone ~- ~ 5. Subdiv. Address ~:~ ~-) ~ h~ ('~C~(~e~. N~. 6. Section 2. PrppertY Location ~ ~e~?~ ~F~t~ 303~ ~/0 7. Lot Number Private Well Village f~TF'~?VCK Township SOcmHo~O~ 9. Public Water 3. Public Water Company Name ~ Distance to main 4. Lot size: Width lb~ feet Length ~ feet 10. Sewage Disposal System: A. gallon septic tank: Precast ~ZEquivalent Block Bt' Leaching pools: .... Number of pools Precast~(~ B1 ock__~pecial 11. If private well, fill in the fol- lowing blanks: ~ gallons Total well depth A. Tank capacity B. Pump G.P.M. C. D. Depth to ground water E. Amount of water in well (For Health Services Dept. Use) The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk Coun~ 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 Permit is in effect. ~ ~ ~/~ 'Signed Date ' ........................ 2~2'_ _ ' 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 Disposal System and Water Supply can be installed on this plot. APPROVAL DATE S-15 Rev. 4/1/73 18-157N Examined " ........................ , ...... ? ........ , 19 ........ Approved ........................................ , 19 ........ Permit No ...... i ............. i .............. ~-.Y~/~//~'~ -- ~/~ Disapproved a/c (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS 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, relationship to adjoining premises or public streets o~ 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 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 kept on the premises available for inspection throughout the world. e. No building shall be occupied or used in whole or 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 the Building Zone Ord nonce of the Town of Southold, Suffolk County, New 'York, and other applicable Laws, Ordinances or Regulations for the construction of buildings, additions or alterations, or for removal or demolition, as herein describetd(~ The applicant agrees to comply with al app icable aws, ordinances, bu Iding code, housing code, and regulations, and admit authorized inspectors on premises' and in buildings for necessary nsp,e~tions. .............. L ................. ,:.~,...-.; ....... ~,,.1 ............................................ (Signature of app icqnt,/or' nome, if o corporation) / !: , , -', ,, "' (Address of applicant) [ ~'~'1"'/~/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ................... ~ ....................................................... ; ........................................................................ If Opp~licant is a corporate, s gnoture/of dul~ authorized officer. (Name and title of corporate officer) L Builder's License No. ' Plumber's License No ............. ; .................... ~.: ............ Electrician's License No ........................................... ;. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ............ , ............................ Lot No ......................... Street and Number : Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. E×isiting use and occupancy ....................................................... , ........................................................................ b. Intended use and occupancy ............................... / 3. Nature of work (check which applicable): New Building* .L.~...... ........ Addition .................. Alterotior~, ................ Repair .................. Removal .................. Demolition .................... Other Work ............................ "~ (Description) 4. £stimoted Cast ..... ' ....................................................... Fee ................. '.../~ ..................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ tf garage, number of .... ' 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, Jf 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 ...4...., ........................... Rear ....L....::: ............... Depth ....:..,: ............... Height ...;..t ............. Number of Stories .... 1 ................................................................................................................. 9. Size of lot: Front ...).! ......~. ........................................... Rear ...',....: ................................. Depth 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11, Zone or use district in which 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: ( ) Yes (,'~:~ No 14. Name of Owner of premises .................................................... Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Cantractor'~..?.,.,'...'.'.~:it!i~,M ....... !..." ...... !: ................... Address ,. ........ I..[.~'../....*.~.:.,..., Phone No. 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 lot. STATE OF NEW YO~I~. ~ ~ ¢ ~"'" CO NT OF ~-L.~ U Y ............ ......................... \~ ....... ;'~ ................. .~.~x~....,t,./',/..,,,t..~z.L.'.'~...:'~z;....cbeing"tduly sworn, deposes and says that he is the applicanl (Nam'e of individual si~jm~ng contracf) above named. He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file this application; that oli statements contained in this opplicetion are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ....... ;~,..' ............. day of .......... .......... Notary Pubhc, . ................................................... ~,ounty ................V.. ................................... ./ .......................................... (Signature of (~pplicant) E/JZA.~ETH '~NN NEY No 52-812585[3, Sulfolk,>?eu~l~ Term £;~pires March 3(}, I{.~_.~ '0 /CZ ~he se~ge disposal and wate~ facilities for this locatio~have beem /' inspected b~ thi~ departm~{ and ~A~d ,~ ~. ~~ ~. '~~ D,4V/D C. ¢ L£JLi£ R TUTt-IILL D,~ V/D C. 43 L~,sl. ig t:?. 72173//1..L