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HomeMy WebLinkAbout2465-zFORM ~0.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN C~ERK'S OFFICE SOUTHOLD, N. ¥. EEI~TiFli~ATE 13F FICEIUPANEY No. Z .2,1k.69 .... Date ................. ~l'lLq. y...~), .....19.66 THIS CERTIFIES that the .building located at .~l~.~;;~..P~,~0.e. .............. Street Pee~nio Shoz'es sec II Map No ............. Block ;No ............. Lot No..106~...Peoon~o~. ~., ......... conforms substantially %o the Applicati, on for Building Permit heretofore filed in this office dated ............. ~y..23 .... 19. ~ pursuant to which Building Permit No.. 2)~6~..~ dated ........... ~.32~... 2b~ .... 19.6.~., was issued, and conforms to all of the require- ments ,of the applicable provisions of the law. The .occupancy f. or which this certificate is issued is . P.3~i~tate..c~. fo, mt3~y, d,%~e;[3,ing .......................................... The certificate is issued %o . .k~ill;]~.~. A~. ~liO ...... 0~e~ .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... ~.~l~-~ .{~..~96(~. ~y. R,. ~.il.~. · FOI~M NO. ~ 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? 2465 Z Permission is hereby granted to: ..~lllim~..k~..~O~3.~ .................................... ............ .~9.A.~ ....... 66t~...Av.e ............................. ............... ][~.T.r~.~..~1~,~.3,~.,...~.,.~.,. ................... to ....... I~,l,d..~ew..one..g~.~..d~,e.~.],~ng ................................................................................ at premises Iocoted at ....~0.~...,'~Q64.....R~P-,I;..~t.....P~tL~.~...~hD~l~E~ .......................................... ......................................... N/~.... ~Arl~l~...Pla~e ~ ~ ......... P.e~3nie s...N..X ...................................... pursuant to application dated ................................. ,,T.1A~. ....... ~,~ ...... 19..~J:., and approved by the Building Inspector Fee $...~..O..t.~ ......... Building Inspector SUFFOLK COUNTY DEPARTMENT OF HEALTH EASTERN DISTRICT County Center, Riverhead, New York PA 7-4700 H.D.Ref. No. SO - 48 APPLICATION FOR APPROVAL OF INSTALLED PRIVATE SEWAGE DISPOSAL AND WATER SUPPLY SYSTEMS Inspection for approval is requested, pertinent installation data herewith. 1-Name of Owner W%lliamA. Mullio Address 99-4~ 66th Ave. ForestHills~N.YPhone DE.g-6OOO 2-Name of BuilderSafew~v Custom Bldrs.Oorn. Phone 281-7280 Address BOx B, Sh%rtey~ N, Y, 7-Sewage System installed by M & T Drainage Address 176 Oak Street~ Deer Park. N. Y. 8-(a)Deed location of property BliP-biS Lane~ Peeor~%c. N. ~ (b)Hamlet or Village (c)Town 9-Septic tank-Gal ~ ft.W ft.Liquid Depth ft. 10-Cesspools-(a)No.pools ~ (b)Blocks below inlet-i)__2) 3)~ (c)Block size-L 8 in.W ~6 in.H 8 in.(d)Precast pool (e)l__2 (f)H ft. in; Diam__ft. in.(g)Finished grade to cover (h)Backfill Material sand ll-Water Supply: Public System ; Private Well _vms If Private, the following questions are to be answered: 12-Private Water Supply System installed by SweMe~& Hoffmar~ AddreseM~ll ROad~ Yaphank~ N, Y, 13(a)-Total Depth of Well .(b)Depth to Static Water Level 14-Diameter of well pipe in. 15-Name of Laboratory ~mmmn ~ab. 17-Date ready for inspection_~~__ 3-Subdiv, Sec. 2 4-Section No.~es 5-Lot Number 10~ 6-Bldg.Permit No.2~6~ Phone ~0.7-~1~2 3 ft. ?hone YA.4-6gOO 16-Method of Disinfectio~ The undersigned CERTIFIES: Above systems have been constructed and are in compliance with the Suffolk County Health Department's current Standards, Bulletins and Amendments thereto. 19-Insert sketch of location of Water & Sewerage Facilities with accurate dimensions. .//.,~OR HE~J~H D~P~'fENT USE ONLY ~ ....-~ . Ba~d upon the information stated above, satisfac~ory functioning of the S-Se Instructions for Submission of Installed Private Sewa2e Disposal and Water System Application Applications are to be submitted in duplicate. Required information should be typed or legibly printed in ink. Inspectors are not permitted to make inspections of installations until applications have been submitted to and accepted by this de- partment. The item ntunber on the application form abd item number listed below are the same: 1. Oumer's na~e and address - if o~ner and builder are same, so indicate. 2. Builder's name and address ~ a~rovals will be mailed to this address. Give name of filad realty subdivision map. 4. Section number o£ realty subdivision map. 5. Lot number of plot on which disposal unit is constructed. 6. Building permit number assigned by the Building Department. 7. Name of person or firm who actually constructed the sewage disposal facilities. 8. (a) For example: s/s Jones St., 100' e/o Smith St. (b) Hamlet, (unincorporated area in to~nship), for example: East Moriches. Village (incorporated area), for example: Horthport. (c) To~mship, for example: Brookhaven, etc. 9. Give inside length and width in feet. Liquid depth is measured in feet from bottom of outlet pipe to bottom of tank. 10. (a) State number of pools. (b) State number of blocks below inlet pipe for each pool. ~ (c) State length, width, and height of cesspool blocks in inches. (d) Indicate by check if pretest sections are used, (e) Give number of leach- ing sections per pool., (i) Give height and diameter of each leaching section. (g) Give depth .in feet f~°~finished'grade to cesspool cover. (h) Describe backfill material used. 11. Indicate by check ifwater supply is public ~r private. 12. Name of person or firm who actually installed the water supply facilities. 13. (a) Give depth in feet from top of well pipe or casing to well point. (b) Depth in feet from top of well pipe or casing to water level in well. 14. Inside diameter of well casing. 15. Name of laboratory performing the examinations. 16. Describe method of disinfection, for example: quart of laundry bleach in ten gallons of water poured into well and allowed to stand six hours. 17. State date on which installation will be ready for inspection. 18. Application must be signed by builder or owner. Signatures of subcontractor, superintendent, etc., will not be accepted. 19. Indicate location of Water & Sewerage Facilities with accurate dimensions on sketch. FO~M NO. I Examined ............... , 19 ....... Approved ........................................ , TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y~' Disapproved a/c .............................................................................................. (Budding I nsp'e/~o r) ! APPLICATION FOR BUILDING PERMIT July 23 19 64 Date ............................................................ , ............ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of propertymust 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 progress of the work. 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 Deportment for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of South01d, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal o[/d~molition, os herein described. The applicant agrees to comply with oil applicable laws, ordina~e~cod~/~nc~~ :.. ?. 22. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. , If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ..R.z.P.e.~°.n..i..c....S..h.~.r..e..s. ........... Lot No: 106 Burt±s Place Street and Number ....................................................................................................................................................... Municipality 2. State existing use and occupancy of premises and intended use ond occupancy of proposed constr~ction: None a. Existing use and occupancy ~,~ .c.~z ~~--e~'-' n-' '~ y ~" b. Intended use and occupancy ............................................................................................... 3. Nature of work (check which applicable): New Building ..... ~ ........... Addition .................. Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ...................................... 4. Estimated Cost ....... .~..0..0..0. ......................................... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ ..0~...e. .............. Number of dwelling units on each floor ....T ....................... If garage, number of cars .......................... Z ................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ........ z ....................... 7. Dimensions of existing structures, if any: Front ........ z ................. Rear ......... .": ................ Depth ....Z ....................... Height ............. z .............. Number of Stories ............... -. ............................................................................................... Dimensions of same structure with alterations or additions: Front ............... .': ............... Rear ........ z ....................... Depth - Height .......... '. ................... Number of Stories ........Z ............................... 8. Dimensions of entire new construction: Front ..~.,k...~.e..e,.¢. ............ Rear ..... ~..~.e.,e.,+¢. ......... Depth ,..~..8.~.e..e..¢. .............. Height ...1..6...,~.,e.?. ........... Number of Stories .0.9.?..~../.?.?..Z..a.?..~..7...8' × 24' 9. Size of lot: Front ..... .k.~. ................... Rear ......... ,~., .............. Depth .....,1.~.2. ..................... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ................................................................................................. 12,, Does proposed constru~ction violate any zoning law, ordinance c~r reg, uJation? ....... ~.o. ........................................... 99-45 ~b Avenue 13. Name of Owner of premises~.~.~..~..l,..~At...~.~...~..~..1.~.:J-.9. ...... Address ~..~¢.~..~,,1,/~,('~.,.~.. ........ Phone No. [~.,q..-~.~.~k~... Name, of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ 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 numbers or description according to deed, and show street names and indicate whether interior or corner lot. (Name of individual signing application', above nam'ed. Aais the ............................. of said owner or owners, and is du'ly authorized t< this applidation; that all statements contained in and that the work will be performed in the mann, Swam to Before me this /'~ / / ........... ~.'.3..r.8. ....... da~.~.~....~., ............... being duly sworn, deposes~and says tho~he is the applicant (Contractor, agent, corporate officer, etc.) ~ perform or have perfbrmed the said work and to make and file this application are true to the best of his knowledge and belief; !r set forth in the op, i~l, icotion filed therewi~, · r''!'9 . .'~'.~.:. ~ .......................... (~ualified in New York Cf ty ..... ,~. ~nires March 30, [965 · xO~' MAC or LANO WILLIAM /~. ~V~ULLIO A~ '~c~le : .,,40 '= I"