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Home My WebLink About7949-zTOW31 OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Ot~ice $outhold, N. Y. Certificate Of Occupancy No. Z6.687 ...... Date ............. Se.p.S...1.9. .... , lg.?5. THIS CERTIFIES that the building located at . ~.e~qe~.o.t.$..D.r.l.v.e ......... Street Map No. Zennenott. PBlock No .......... Lot No, . ~0. .... $.quth.o.]~d....~.,.Y.: ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ~la.~..2% 19.7.~. pursuant to which Building Permit No...7.gbrgZ. dated ........ .I.~.~....2.~...., 19.2.5., 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 . .t?r£v. ate..Qne, family. .dwel~-ng ..................................... The certificate is issued to ~aul. Eatael~.in~. .... .U~tne~ ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Sept 19. · ~97-5. ................ UNDERWRITERS CERTIFICATE No..~ppro.~.~..8./.~/~.~.., I~Y..J. :. ~t~g~ ...... HOUSE NUMBER .. t~O ...... Street .. Y~nn~cntt. D~. ......................... 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) N? 7949 Z Permission is hereby granted to: .................... ~.m: f.ho!~ ...................................... at premises located at ........~.~.~...~.~.....~.?...~..~...e..e...O..~.~...?.~.~.~. ............................................................. ............................................................... Xe.~.~..¢..qC..,t...~'. ......... .s...~...t...~..o,.z..a,. ....................................... pursuant to application doted ........................~J~......~J. ................ , 19....~.~, and approved by the Building Inspector. Fee $..~..~3..~. .......... BUilding m nspector 'I 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. Applicant L Address ! , ~ 2. Property Location Village ~' " 3. Public W~ter Companx Name 4. Lot size: Width feet 10. , Phone ~ % ~ 5. Subdiv. ',,'~, Z.~ 6. Section ~- ~ ~,~', 7. Lot Number 8. Private Well Township i~' -- : 9. Public Water · ' .... ~stance to main Length. feet 11. Sewage Disposal System: A. 900~'~gallon septic tank: Precast .Equivalent Block B. Leaching pools: Number of pools 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 (For Health Services Dept. Use) E. Amount of water in well The undersigned CERTIFIES: "Construction of authorized installations will be in accordanc with the Suffolk County Department of Heal th 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 ~ 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 Disposal System and Water Supply can be installed on this plot. APPROVAL DATE '~,., ~'~!~ ~ ~ SIGNED ~ S-15 Rev. 4/1/73 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ....... Disapproved a~ ..... ~ ...... ~ .................... ................................ AFFLICATION FOR BUILDING PERMIT INSTP, UCTIONS a. This application must be completely f,Jled ~n by typewriter or in ink and subm,tted in triplicate to the Buildi Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buddings on premises, relationship to adjo,ning premmes or public streets areas, and giving a detailed description of layout of property must be drawn on the diagram which is port of th~s opplicati, c. The work covered by th~s apphcation may not be commenced before ~ssuance of Building Permit. d. Upon approval of this application, the Building Inspector will msue a Building Permit to the applicant. Such pert shall be kept 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 whatever until a Certificate of Occupar 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 t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describ: The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. Southold If,~, (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buiJd~ Builder Name of owner of premises ........ ?.a..¥~......~.'~.c-%..e...~..];..J...~.~ ............................................................................................ If opphcont is o corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's L,cense No .... .~..:....~...~..~..~.~..e..~..~..$ .................... Plumber's License No ....... ~.:..~..:.....0..J:..1....~..~ ............... Electrician's License No. ..~..-...,~.9~f}~.~g .................. Other Trade's License No ............................................... 1 Location of land on wh,ch proposed work will be done. Map No ... ~.9.n~:.e..a..°..lg..~...~.~. ..... Lot No...~..0.. ............. Street and Number .......... ~.e~Tklg. f~g. cLl;.~...~).~.C.~..f~ .......... 3~1~£.&~ ................................................................ Municipality 2 State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Exisiting use and occupancy ..................................................................................................................... b. Intended use and occupancy ..... .o..rl...e.....f.~..ra..~.~...~¥~.,~,~,,~-Ilt~ ......................................................................... 3. Nature of work (check which applicable). New Building ..~ .... Addition ................ Alteration ....... ) Repair ................. Removal .................. Demoht~or .............. Other Work ................................................. '27 ~ (Description) 4. Estimated Cost ................... ~..LI:..~..0..O..O....+ ......... Fee .., ............................................................................... (to be pa*d on filing this application) 5 If dwelhng, number of dwelhng umts ... O~e ........... Number of dwelhng units on each floor .......................... If garage, number of cars ...... ~¥'..O. .................................................................................................................... 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use ...................... 7 D~mens~ons of ex~stmg structures, if any. Front .................... Rear ................................ Depth ................... Height ........................ Number of Stones ......................................................................................................... Dimensions of same structure wfth alterations or additions Front ................................... Rear ...... Depth ................................ Height ............. Number of Stones ............................... 8 Dimensions of ent, re new construct,on. Front ..... ~.-..~ .............. Rear ...... .6..~.-..~.. ............ Depth ...~..0..-:-~'. ..... Height ................... Number of Stories ...... .o...~..e. ................................................................................. 9 S~ze of lot Front .................................................. Rear ..................................... Depth ........................... 10 Date of Purchase .................................................... Name of Former Owner ...................................................... I ] Zone or use district in which premrses are situated "A" dist 12 Does proposed construction wolate any zoning law, ordinance or regulation .... .~.o.. ............................................. 13 Will lot be regraded ......... 5r...e...S. .......... Wdl excess fill be removed from premises' (X) Yes ( ) No 14 Name of Owner of premises .~..~l,!~7k..~..~k~.~,~.j,~..g ................. Address ................................ Phone No ..................... Name of Architect ................................................ Address ................................ Phone No ..................... Name of Contractor ?..e...°...~,~..a..s. t3-..e~.~.Jr. ............... Address ................ .~...°.~..J::~..O.~¢hone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~sting or proposed, and red,cate all set-back dfmens~ons fro~ property hnes Gwe street and block number or description according to deed, and show street names and ind~cat whether interior or corner lot /bo,/'/I }/ NM ¢ o-rT STATE OF NEW YORK. ~¢ ¢ COUNTY OF ....... ~LLI~ ~.0.1]~ ........ ~ ~ = .................... J. .............................. (Name of individual signing contract0 above named Sworn to before me this ~"ay ........... , ................... ,.2..1 of ..................... Notary Public, . ................... ~.~;[xQ~_I~ ............... County NOTARY pUBLIC, ~a~e of N~W Y~rK (Signature of applicant) He ,s the .............................. ..B..u...i..]:..~e~ .............................................................................................................. (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and ~s duly authorized to perform or have performed the said work and to make and fi this application; that all statements contained in this apphcation are true to the best of his knowledge and behef; a~ that the work will be performed m the manner set forth in the apphcation filed therewith. being duly sworn, deposes and says that he ~s the apphca~ NOTIFY BUILDING QEPARTMENT AT 765-2660 9AM TO 4PM FOR REQLJIR. ' ED INSPECTIONS: , 1. BEFORE BACKFILLING FOUNDA.-~ rTION OR STAR]' FRAMING [ 2. BEFORE COVERING PIPELINE ,---,,.-3. FINAL WHEN JOB COMPLETED I NOT .ESEONS]BLE FO" DESIGN OR COBLr- STEUCTION ERRORS ./ - 20'- FLooR 22'-0 3-o X 3rio