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Home My WebLink About9094-zTOWN 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) No. 9094 Z Permission is hereby granted to: Fr.a r~a e ~ ..i~Q s.a.. ~o~%a s_ .I ~c ............................... ............... 9.92.....Kaiu..t~d.....~.u~ch.o.g~a ......... toB~i~,~...n~.tt ..oi~¢...f. am% l~...~e 11 ll~ g ....................................................................................... at premises located at ..~-O.t..~8 ......... .D4~e~...]-~,o[e,..C~..~s:~ .......................................................... ................................................ ~./.f~...~.gm~ z...,g.~. ........ .t:~.~.~it,~.c..k. .................................................... pursuant to application dated ......................... ~,2C......1..~. ............. , 19..~.~.., and approved by the Building Inspector. Fee $..~.t..:.~..0.. .......... TOWN OF SOUTHOLD , Building Depmtment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposals(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, o certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey.of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 New Building .....~. .......... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property Owner Or Owners Of Property ,,..?.~..~..~..~.c...e.~....~.~..~..e....~.o..~...~.~.t...~.c.... ......................................................... Subdivision ~.~D~e~e~-~];~e.~e~e~D~e~'~t No....~..8..... Block No ............. House No...~.~.~.... PermitNo. 90~34 Z Date Of Permit .~/l~,/,?,7.Applicont Frances Rose }JoineD, Inc. Health Dept. Approval ~,., '~ s:~ .~_..~. ....... Labor Approval ~/R ~ ...... D"-'~' ~ ..... Dept. ..; ............................................. Underwriters Approval .... ~.?..:;,;,:~..,Q.~..L .~... ........Planning Board Approval ....~.../..~. .............................. F' - · Yes Request For Temporary Certificote ................. f~ ................... ,n~ Certlflcote .......................................... Fee Submitted $ ........................... Construction on above described building on, permit' meets all ,op~licable~ ~ codes and regulations. Applicant ~/~, ~ ,~- ;~., ,~,,,~,,,~,.- ~<~ .... ............................................... .. i .W. ~ i~..t.~. ~ eja°;eo fm.~. i~j~ ......................... ../~...... (stamp or seal)///~ Notary Public .................................... County ,,~c._w~ /;D SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number~$---~'d ~/~. APPLICATION FOR APPROV/~L TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Address-' "-~'~ ~-:~ ~ ~?<~.~ 1~-~.~' /.',, 6. Sectioh' 2. Pr~De~,~r~t~n~ ~ ........ ~ ~'~ ~ ~]-~-~,~,_~ ~A.~,~. _~ ~7- Lot Number~, ' "~' ~,~.~~ /~',-~ 8. Private Wel~ V~llage. ~ ~'~ ~'~-~ z To~nshnm~e.~-~~~ ~,, ~ ¥ ~ 9. Public Water~' 3. Public W~ter Compa~y~Name Y~> _ Distance to main 4. Lot size. Width/z~ feet Lengthj~m:~.,.feet 10. Sewage Disposal System: 11. A. 900-gallon septic tank: Precast__Equi val ent Block B. Leaching pools: Number qf pools Precast~__Block ~pecial If priva,-t~ well, fill in the fol- lowing blanks: A. Tank capacity - ~ ,gallons Bo Pump G.P.M. ,S~i.,~'~ ,. C. Total'well depth~ D. Depth to ground water E. Amount of water in wellL/~] (For Health Services Dept. Use) The undersigned CERTIFIES: "Construction of authorized installations will 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 B~a current local Building Department P~rmit is in effect. ................................................................ :___~_~=~:___::::=:=:=: 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 ,,/'~/~//~f SIGNED ~'~ S-15 Rev. 4/1/73 LL Lot ~ Lot G7 NO Th-: I = MONUM£NT SUBDIVISION MA£ FILED (N rHE OFFICE OF THE CLERK OF ~UFFOLK COUNTY ON J~N. 28~ 1~5 ~S FIL~ N~ 4258, T~ ~OCaTION OF WEISS AND C~ss~OOSS S~OWN HEREIN ~RE FRO~ F[~LD~BSERV~T~ONS ~ND/OR F~OM DATA OBTAINED FROM OTHERS YOUNG & YOUNG 400 OSTRANDER AVENUE, ~IVERHEAD, NEW YORK ALDEN W, YOUNG ~'~J RV EY FOR: BEN MENDOZZA ' LOT 68 HOWARD W. YOUNG LAND SURVEYOR "DEEP HOLE CREEK ESTATES'" Ar MATTITUCK UTHOLD SAVINGS BANK ~'OWN OF SOUTHOLD SUFFOLK CO., N. ;tALE I" = 40' DAT[~ OCt. 10~, 1975 No. 75 ./ /o! ~? NOLTE; ~ -' MONUMENt" ~ -' STAKE F TH~ CLERK OF SUFFOLK COUNTY ~N R£VISIONS YQUNG YOUNG 40b OSTRANDE~ AVENU, E RIVERHEAD NEW YORK ALDEN W. ¥OL~NG SuRvEY FOR:i LOT 68 HOWARD W. YOUNG LAND SURYEYOR AT FYLe~¢ES ltOS~ FIOMES, 'INC"' ~.,~ ,,.,,~,r, . * ,, .BRO k D,W;A,¥~ ~,; r ' 'ROC~ POINT, Il.: Y. 11776 . ;}. . ,