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Home My WebLink About7884-zTOWN OF $OUTHOLD BUILDING DEPARTI~.NT Town Clerk's Otlice $outhold, N. Y. Certificete Of Occupency No. ~7.~.1 ...... Date ............S.e.l~t .... 12 ..... , lg. ?.7. THIS CERTIFIES that the building located at ...... Br. igar~tine. Zl~ive... Street Map No~arb.o.r. L;[~h~Iock No ...........Lot No.. ~.1... ~.Q%ttb.o.].c~...~. :.Y., ......... conforms substantially to the Application for Building Permit heretofore filed in th~ office dated ........... ~a¥ .... ~..., 19 .?~. pursuant to which Building Permit No..~.88.~5. dated ..........Y,.aY .... ~ ..... , 19.7~., was issued, and conforms to ell of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .Private..one. £amll,¥ .dwe3.11n~ ....................................... The certificate is issued to . .~oba]~t. & .l~ann~r .Alhertsor~ .... D~ners. ............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~.~¥...6....1.9.7. ~...b.~..R....V.~.~I.~ ...... UNDERWRITERS CERTIFICATE No..Ap~rnved..by. J....Kubacki..~.12/.7.~ ....... HOUSE NUMBER ..... 2~30 ....Street .. h~lgantine..Dr$~a .... ~outkal~lo ..... Building Inspector/ FORM NO. 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) N9 788 Z Permission is hereby granted to: ..... .,.~..o..b. ~ Z.q./.~.~ Z .~ ,~.o.n .............................. .................. ~¢.1:.'m:14 ........................................ to ...~.~2L~k.~'m.~z...qne... £a~:L! ;....d.w.e ~-I L~a g ................................................................................. at premises located at ..... Lnl:..~.l ....... ::u~b~....L;:tq'.h~;-~. ............................................................. ............................................................ L~.t.ga~C..~e-Or .i-ye .......... 6ou.~-~3:d ................................. pursuant to application dated ................... l~.~l' ........ .~ ................... , 19.~.~.., ond approved by the Building Inspector. Fee $.IJ.Q. tRQ. ........ FOB, M NO. ~ TOWN OF SOUTHOLI~ BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certdicate 01' Occupancy No. Z67.~.O ...... Date ............ 1[o~....~ ..... , 19.?~. THIS CERTIFIES that the building located at .l~gall~ .i~e Dx'ire ...... Street Map No~[fb~. I~;s .... Block No ......... Lot No, . 61 · · · Sou ~iao~d · · I%.~.~[. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ~Iay.. '3., 197.~' pursuant to which Building Permit No... dated ...... F~a~' .. ~ ..., 19~ , was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . -P~,~.vo:~e · ~no.. fnr~].y. 4~e~ ~..~.1~.~ ................................. The certificate is issued to . Rober~ .& l~.ne¥. ~ber~$on ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval l~r~x~' '({ "~ 97'~' 'by R~'¥~:lla ..... UNDERWRITERS CERTIFICATE No. pandlng .................................... HOUSE NUMBER .... ~j}~(l... Street ..... B~.ig~x~;~. ])~ ..................... Building Inspector r sUFFOLK COUI~TY HEALTH DEPARTRENT c'-5o DATE~ The ~ewa~e ~isposal an~ water suPply th~s location have been ne~En~t~ertn~ ,Z O zE' T ..,~cc~l¢: 40'~ t" SECTION 7209 CF YhE NCW ¥O£K STAF~ EDUCATION LA~' SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicantl%obert T. A]Jbert~o~ Phone 765-3824 Address & N~ ~. .~_ ,~ .~,.~ ~ ~ 2. Property Location ~,.~%~ ~[~m~-~-~ 7. Lot Number ~illag~-C~j~jj~j-- -Town~hf~ '-~,~eh~im ' 9. Public Water 3. Public Wa~F-~o~E~ .......... N~ Distance to main 4. Lot size: Width l~a feet Length~feet 10. Sewage Disposal System: 5. Subdiv?I~b°r T.ights 6. Section (For Health Services Dept. Use) A. 900-gallon septic tank: 11. Precast x Equivalent Block B. Leaching pools: Number of pools Precast ~ Block__~pecial__ If private well, fill in the fol- lowing blanks: A. Tank capacity ,42 gallons B. Pump G.P.M. ~ C. Total well depth 30' -- D. Depth to ground water :L5,4 E. Amount of water in well lB The undersigned CERTIFIES: "Construction of authorized installations 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 Permit is in effect. Date ~pm~! _~0.. 197-~ Signed_ ~~ ~7~~_ 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 o)~%this_plg,ty) S-15 Rev. 4/1/73 c ~ INSTRUCTIONS a. This application must be completely filled in bY typewriter or in ink and submitted in triplicate to the Building Inspecto.r, with 3 sets of plans, accurate pl0t plan to scale. Fee acc0rding to sched.ule. b. · Plot plan showing ocat~on of tot and of bu~ dmgseor~ premises; re at~onsH~p to adjoining premises or public streets oF areas, and giving a detailed description ~f la~/out ofpropart~ must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before i~suance.of Building Permit. d. d~p°n approval of this applicC/tion, .the Building Inspector will issae a Building Per'it to the applicant. Such permit shall b~ kept on the premises available: for ~rnspection throughout the work. e. No building shall be occupied or used in whole or Jn 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 Ordinance 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 described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. {Signature of applicant, or frame, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....... .~..~...1~..'z`..~..~.....~...~......~..~.~.~.e....~.~.....~-.....1:~..?.t~..~..~. .......................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ......... ~.*.....~.~,]:a. .......................... Plumber's License No .......... .~.tl~.~'. .......................... Electrician's License No ........ ,jll(.~.J~. ........................ Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ,..~'...z'...1Rq...z'..,..Tu..~E~,..~.,,,,~,e.o.*...;q~o;c 'No...,..~,.~ ................. Street and Number ........... ~.~..~.~.~.~....~'...]...v..e. .............................................. ~... .............. :.....:..~:....i .......................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy Taea~t b. Intended use and occupancy ..... .0..n..e....~..~..m.~.]:.~'...~..e.~..~ ..................................................................................... 3. Nature of work (check which applicable): New Building......~ ........ Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) 4. Estimated Cost .........~..2.~.t.~..0..0.:..0..0. ............................... Fee .....~.l.Q.e.9.~. ....................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... ,Ol~..e. ........... Number of dwelling units on each floor ............................ If garage, number of oars .........~.[9. .............................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..... a/.& ................. 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. ....... 68e. ....... ...,..... ...... ..... Rear ......6~...~ ................... Depth .......~.. ............... Height ......~c).~ ......... Number of Stories~ .......... ~. ............................................................................................ 9. Size of lot: Front .................................................................. 100' Rear ~,~1~)* Depth ....~Z0.0.: .................... 10. Date of Purchase ........ ~./..2/.?~.. ................................... Name of Former Owner F~e~,e~,..&.~:e~A..~ee~e ....... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ~ ............................................... 13. Wil lot be regraded ......... Y. el~ ............ Wil excess fill be removed from premises: (x) Yes ( ) No 14 Name of Owner of premises .R..o...l~...r..f,....?.:..~....~,....n.c.~.e......k]-....l~...~.~.Sg~dclress ..~:~..~ .............. Phone No..~.f;t~..~?~ ..... Seuthold~ N.Y. Name of Architect .............................................................. Address ................................ ,I-Ilone No ....................... Nome of Contractor ................ ^ ress .............. Southold, l~.Y. PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all setJoock dimensions from property ~ines. ~ive street and block number or descriptio~ according to deed, and show street names and indicate whether interior or corner lot. .! STATE OF NEW YORK, ~ c c COUNTY (DF .... ~i,~,-~k, .., ........... ~' "'"' ....................... JJ~i];~'.t,..T~..k.l_..l~__~.t,~,oJa. .................................. being duly sworn; deposes and soys that he is the applicant (Name of individual signing contraciO above named. He is the ................. ~(311f,~e,C~,o~ ............................................................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly aut~rized to perform or have performed the said work and to ~ke and file this application; that all statements contained in this application are tree to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application filed therewith. Sworn to be. fora me this ~ ~. ......... ~ ......... day of ......... ~.,...~ .......~ ........... , 19--75 NOTARY PUBLIC. Sfafe ~w York No ~2.~B22026 - SuffoJE Ceu~ / ' Com~Jssion E~irei March 30. I~,,~,~~ APFROVED AS NOTED ~E:/to,*-~° BY ~ NOTIFY SUILLING DEt~AET~ENT AT I d J-T A I '%[ ¸%,