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Home My WebLink About7957-zFOEM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . .~1~9~.~ a.. D.~i..sy ..R4. ...... Street Map No. ~s. et. t~o~iL~ck No ........... Lot No .... 27 ..... M. a.l;.~t.u.ck...N.,.Y.: ..... conforms substantially to the Application for Building Permit heretofore filed in this office ~a~928. 7~ 79~.7z dated ........... July.... , 19.?~. pursuant to which Building Permit No...~0~ dated . ~.ay..~8.,7%' a..m.~, y..1, qg. 7%., was issued, and conforms to ~1 of the req~,ire- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . P~.ivat.e. c~..f.~.~.ly...d.~.e.l.~.i~g. :~.i.$~ S.w.l.~.m~.i.n.g..Pqq$ ............... The certificate is issued to . .Hiaharcl. Itous.ton .... 0wne~. ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .Mar... ~ 9..197~...by. ~...Villa ..... UNDERWRITERS CERTIFICATE No..N21+ZQ22. Aug. 2~..~ 9?5..a.p.o.c~!. N2b~l .~5.Q .Aug 20 HOUSE NUMBER ...70.~ ..... Street .. C~muse.t; .Dr ............................. 890 Daisy Road FORM NO. :~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7957 Z Date ...................~,2t7 ....... 28 .............., 19..~.~. Permission is hereby granted to' R,'t,el:m ~1,.. I:t, ou~ ~on ....................................... ............... · N~...3e~..-P.X. aoe ............................... to ...bltilct..~eW...o~e..£amily.. ~wel ~.La~ .................................................................................. ct premises located at .... ~o.t..~.~-...~q~11Se~r-.~l.l-S ..... see.-.t.'~. ................................................ ............................................... ~ats~...&..avn~e~ ............ F~at.t4_ t~aclc ............................................. pursuant to application dated ........................ ~T:..--..2~ .............. , 197.~..., and approved by the Building Inspector. Fee $.~.~.~. ........... SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number 10. APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Address ,)-~d~/~'m~ ~)~ /~Z~, .i~_/I~£~F ~Zy~r~' i~6. Section' ~--' Property Loc~t"ion' ~m ~ ~ ~ ~ ~ ~ ~-' ~'~,' ~ 7. Lot Number ~ ~ 8. Private Well Village l.~. : r':~ ~ Township ~w,,~ ~ 9. Public Water Public Water Company Na~e C~?~- m ',~ Distance to main Lot size: Width feet Length feet Sewage Disposal System: A.~C/~OO~gallon septic tank: Pr~e~'t / Equivalent Block B. Leaching pools: Number of pools / Precast~'~) Block ,Special 11. ~ 1 owin~,bl anks: Tan~ capacity ~ . X. ~B. Pu G.P.M. : C. To~I well ~epth D. De))~i~q to ground water If pp4-vate well, fill in the fol- gal 1 ons "E. Am~mt of water in well (For Health Services Dept.,,Use) The undersigned CERTIFIES: "Construction of authorized installations will be in accordano 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 ~/~ 6'., .' ~ Signed FOR THE DEPARTMENT OF HEALTH SERVICES USE ONLY. Based on the information ~resented here- w--~-~h~ T~T~-~i~-~o-~h~ De~e~alth Services that an adequate and satis- factory Sewage Disposal System and Water Supply can be installed on this plot. APPROVAL DATE ~-~J)~ ~ SIGNED /~ ~ ~ S-15 Rev. 4/1/73 ~t 2.6 /vOTE '~ ' ~ =M.~NUMEN~' ~UBOI~IISION MAP P/L~D IN THE O~CE REVISIONS YOUNG & YOUNG MAR /,,~./976 400 OSTRANDER AVENUE, RIVERHEAD. NEW YORK ALDEN W. YOUNG HOWARD W YOUNG SURVEY FOR: R/CHARD D HOUSTON LOT NO 27, "SUNSET KNOLLS, SECT 2" AT MA TTITUCK GUARANTEED TO TOWN OF SOUTHOLD SUFFOLK CO,, N.Y. BY~~~,~ SCALE, /'~'~'~01 IDATE 0CT:16,1975 1N° U75-731 UNAUTHORIZEC ALTERATION OR ADDITION TO THIS SURVEY (SA VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION % ~ INSTRU~I~S o. This ~licotion mu~ be complexly fill~ jnby ~ewriter or in ink o~ s~ in triplicate to the Bui~i~ m or~s, ~nd giving o detoil~ description of I~o~ Ofpr~ m~st be drown on the diagram which is ~ of this opplicotion~ c. ~e work c~er~ by this o~licoti~ may n~ ~ commenc~ before issuance of Building Permit. d. Upon appeal of this opplicoti~, t~e Buildi~ InSerat will issue o 8~ilding Permit to the applicant. Such pe~it ~ s~oll be kept on the premi~ ~oiloble ~r insp~ti~ thr~gh~t the work. e. No building shoU be ~cupi~ or u~d in whole Or in po~ ~or any pu~e whoever until o Ce~ificote of ~cu~ncy sh~ll ~ve been granted ~ the B~ildi~ In~ector. APPLI~TION 15 HEREBY ~DE to the B~I~ ~ent for the i~ance of o Building Pe~it pu~ont to the Building Zone Ordinance of *~- Tn~,~ ~,*~oe~un~, N~Y~rk, and ~her.opplicable ~, ~i~onc~ or RegUlations, for the constru~ion of b~ ild~ngs, ~dditions or oltero~ons, ~fo~ ~owl ~r ~ti~, os ne~ ~cri~. The applicant ogres to comply with ~ II ~pplicoble I~s, ordinances, bull~in~ c~, h~i~ c~e, o~ ~loti~, o~ ~ admit outhoriz~ in~ton ~ premi~ ~s and in ~i~mgs ~r n~esso~ ,~tions. ' ~ ........................ ~.~ ............................................................. ~ (Signature of ~li~nt, or ~, if o co~mtion) ~ f Stoto whoth~r ~pplic~nt i~ owner, e, ~nt~ ~rchl t, en~ifi~ ~ ener~ [~tmctor, *l~ctrician, plumber or builder. Nom~ o{ owner o{ pr~mi~ ............ ~ ..................... ~ ..................................... I{ *pplic~nt is o co~orot~, ~ion~tur~ of dul~ outhori~d officer..-~ (Name and title of corporate officer) Builder s License No .................................................... Plumbers License No .... Electrician's License No. ~.¢..~:..~......' ~ · , ' *5'yY Other Trade s License No..; ........., .................... :.: ............ ' "~ ~0 -- L~.~J~~. ~ L~ation of ,a~ ~n whickered wor~i~ be dae~ ~~;..~~:.~ .............. Street and Number ..... ~....!~.~...~.~: .......... 7.~..~/~~~i~j~ ........ State existing use and ~cu~ncy of premises and intended use and ~cu~ncy of p~o~d c~st~tion: e. ~isiting use a~ ~cupancy ....... ~ ............................................................. ~ ........... ~ ........................................ b. Intended u~ and ~u~ncy }..~ ......... ~..~....~.....~. ...................... .~ Nature of work (check which applicable): New Building,. ................. Addition Alteration ~: ................ Repair .................. Removal .................. Demolition .................... Other Work ........................................ ,..,~ ....... ~ ~ (Description) 4. Estimated Cost /7~& ~ ~ Fee (to be pa. id on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of ~rs ...... i ........ ~ .................................................. i .................... i ................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dimensions of ex Sting structures, if any: Front ....:.7.......~.....: ....... Rear ................................ Depth ....... ............. Height ........................ Number of Stories ................................................................................................................. .Dimensions of same structure with alterations or additions: Front ..~ ................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................. 8. Dimensions of~e~tire new constructiOn: Front ~.../...~.., .......... ~ ..... Rear ....~../...~ .............. Depth ....~....i.~.....~. ....... · Height ..... ./....~..~. ....... Number~of ~tor~s~l~ .......... /" ................................ /7~'~"~' .............................. De h i ........... "........~.~i ..... . 9. S,ze of lot. Front ...... ./...~'.,.~....~'....~.~ ........... ~ ............... Rear ....................................... pt 10~ Date of Purchase ...... :.:..~../.....~.../../....'./....~.. ................... Name of FOrmer Owner 11. 12. 13. 14. property lines. Give street and block nu~ whether interior or corner lot. Zone or use district in which premises are situated ..................................................................................................... Does proposed construction violate any zoning law, ordinance or regulation: ..... ~...~. ........................................./' :. Will lot be regraded ....... .~'...~'...~.. .......... Will excess fill.~e remoged from p~i~: (~) Y~ ( ~No .... Name of ~ner of prem,~s ..~.~...~...~ ...... ~.~--~ ................ ~ No..~......~ ...... Name of Architect .............................................................. A~re~ ................................ Ph~e No ....................... Name ~f Contractor ............................................................ A~re~ .... Ph~ No ....................... PLOT DIAG~M L~ete clearly and distinctly all buildi whether existing or pro~d, indicate all ~t~k dimensions from or description according to ~d show street ~mes and indicate STATE OF NDCV ~..R.,~,¢',./~'~ . ~S S ~ ~: , .................... :.,~~.~~ ...... 2. ................. being duly sworn, d~oses and says t~t he is ther;applicam (Name of individual signing c~tracu abeve name. ~.~ He is the ........................... ~..~.~. .................................................................................................... (Contractor, ag~t, co~orate officer, ~c.) of ~id owner or owners, and is duly aut~rized to perform or have performed the said work and to ~ke and file this application; t~t aH statements contoin~ in this application are ~e to the best of his knowledge and belief; and tha~ the work will ~ perform~ in the manner set fo~h in the application fil~ ~erewith. Swam to ~fo~e this __ ~ t ~ ...... ..... .......... · .................... ~-~ - JUDI~ T. ~ (SIg at · o app ) Nele~Public, Sm~ ef ~ Y~ ..<-- ......................... /~//0 .......... APPROVE.~ AS NO]ED