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HomeMy WebLinkAbout4100-zFOItM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.~..$59.~. ..... Date . 5eptemb~r .... 22, ......... , 196.t. THIS CERTIFIES that the building located at N~. ~oun~l~. Av~ ....... Street Map No ............. Block No ........... Lot No. iou~Old,. ~. ~ork .......... conforms subst~tially to the Application for Building Permit heretofore filed in this office dated . .. ~9~.~ · · ~,. .... , 19 .~8. p~suam to which Building Permit No. !~9. ~. dated ... ~.. ~., ..... , 19. ~8., was issued, ~d confoms to all of the req~ ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. pr.~V~..O~..~.~. ~lllag. ..................................... The ce~ificate is issued to ...~4 .~t~1 .......................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of He~th Approval .Se~..5,. ~g,. ~. V~ ........... ~uild~' ........... l House ~ 11645 Soundview Ave. TO~VN 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? 4100 Z Permission is hereby granted to: .... ~.,...~.......~......~..~ ............. ........... ....~...k~.....~ ....... ~...!... ....................... to .~..~....m~.......~.s.~z...~..?..~......~.. .................................................................................. at premises located ..................................... pursuan¢ to application dated ......................... I~l~ ......... ~ ............. , 19..~.., and approved by the Building Inspector. Building Inspector / S-9 SCHD RECE1V~'~, Rt SUFFOLK COUNTY DEPARTHENT OF HEALTH Date Bldg. Permit No. ~/~J TO WHOM IT MAY CONCERN: / ..-The'sewage disposal facilities for a structure located at (Give'deed location) have been inspected by this department and found to be satisfactory. District Engineer SUFFOLK COUNTY DEPARTMENT OF HEALTH EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval t~ construct said systems is requested,pertinent data herewith: Date 1-Applicant Phone 6-Sub div Address 7-Section 2-Detailed property location 8-Lot No. Hamlet Town ~-Private well? 3-P~blic w~ter supply name Distance to nearest main 4-Lot Size: Width . ft. Length ft. (also enter on center plot plan below:) 5-Dwelling: Single 'Family ~ ,~ Two Family? / /Cellar? ~ /~lab? ~ J Crawl Space? ~_~ 10-Proposed system: Septic tank J fPrecast I /Cesspools J /Shallow pools / /Other / il-Septic tank inside dimensions: Volume Gals. Length ft. Width ft. Liquid. depth 12-Precast sections: / /Number/ /sqUare Ft. Cesspools: Block sizeL incs. D ins. H Total blocks below inlet: ~1__~2 ~3____ PLOT PLAN Capacity G.P.M. Street The Undersigned CERTIFIES: Data Feet 0 2 6 8 10 12 lg 18 Indi e No rth "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Systems". Date Signed ~/' ", ~ or Builder FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department, that an adequate and satisfactory Sewage Disposal System can be installed on this Plot. Date (10/65 Revis.) S-!5 Signed ! ins. Gals. APPLICATION FOR APPROVAL TO CONSTP~JCT PRIVATE SEWAGE DISPOSAL SYSTEMS INSTRUCTIONS: Applications must be submitted in triplicate 1-Means Owner or Builder. Address to which mail should be directed. 2-Means detailed description of property location, together with street name and distance to nearest intersection of ~ain thorofare, also Hamlet/Village & Township 3-Enter name of Publid Water Supply District, together with the distance to their main. ~-Enter Length and Width of Lot under appropriate heading, also enter these dimensions ' on center plot plan shown on the face of this application. 5-Dwellings: Check-mark "V" items applicable to the proposed new dwelling. 6-Name of sub-division 7-Section Number 8-Lot Number 9-Private well: Enter "No" if Public water supply is available. Enter '~es" otherwise. PROPOSED SYSTEMS: Answers to Items number 10, il, & 12 please consult the Suffolk County Health Department's Standards, Bulletins and Amendments for Sewage & Waste Disposal Facilities. i.e., Part II-Residential Sub-surface Disposal Systems covering Cesspools Part III " " " " " " Septic Tanks Part IV " " " " " " Unusual soil conditions Part V " " " " " " Shallow Leaching Pools PDOT PLAN: The following information is required concerning the Applicant's Lot: Lot size-Length and Width in feet to be indicated at the Lot lines of the heavy lined square in the center of Plot Plan shown on face of this application. Surface waters-Streams, Lakes, & Hays, etc., located within a distance of 50 feet of Applicant's Lot lines, must be shown on the plot plan also. Wells and Cesspools now on adjacent lots must be shown on the Plot Plan together with the distance to the Applicants proposed Sewage Disposal Systems and Well. Where no Buildings exist on adjacent lots, state "Vacant" on the plot plan. Streets adjoining applicant's lot to the right, left or rear, enter street name. WELL LOCATION: To locate the well & sewage disposal systems on Applicant's lot, the following Standards must be observed: Well-100 feet minimum distance from the nearest cesspools Well-25 feet minimum distance from rear, and rear sides of property lines Well-lO feet minimum distance from front, and front sides of property lines Well-50 feet minimum below grade for well point Well-40 feet minimum into ground water for well point Well-4 feet 6 ins. minimum below grade to well head and lateral water pipe CESSPOOLS LOCATION: Upon determination of the Sewage & Waste disposal "type of systems" required, the following Standards must be observed for the location of same: Cesspool-lO feet minimum distance from lot lines to center of cesspool Cesspools exterior must be 100 feet minimum distance from nearest well Septic tank exterior must be 75 feet from nearest well Cesspool "Center" must be 12 feet minimum distance from nearest water line Cesspool "Center" must be 15 feet from house foundation Cesspool exterior must be 50 feet minimum distance from surface Waters, Streams, Lakes & Bays, etc. Cesspools must be 20 feet minimum distance from large trees Cesspool center to Cesspool center must be at least 16 feet Cesspool cover top to grade must be held to minimum of 1 food to maximum of 2 feet Bottom of Cesspool to ground water must be held to minimum of 1 foot TOWN OF SOUTHOLD TOWN CLERK'S orifiCE.,/. / Sm)THOU), H.Y. ~'~/ ............... ~mln~:l ........................................ A~ .. ....................................... , 19 ........ Pemit No ......... .................... ................... ~ ~ ~-~ ._ ~ ~.~ , , .......................................... ~~ .............. ............. ........... o . *~Lm*T~O~ ~0~ .U~L~. . INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plat 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 property must be drawn on the diagram whmh 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 Jn part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLIC-~TION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Z~ne Ordinance of the Town .o.f Southold, Suffolk County, New York, and other applic.a, ble Laws, Ordinances or Regulations, for the construction of buddings, additions or alterations, or for removal or demolihon, as herein described. The applicant agrees to comply with all opplicabl& lows, ordinances, building code, housing code, ~nd regulations. ] corporation) .... (Address of applicant) //~' State whetherapplic~i~/~v~ee,~gineer, 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.: .......... ........~...i..'..~.. ........... Lot No.: ..& ................. treet a umber ...~../~... "~ ~ ~ ~ ~ ~ ~ ~~ ~0 ~ ~ s ~ .............................................................................. ~ .................... ~..~ ................... 2. State exlst~ use and ~cupancy of promises and intended use and ~cu~ of p~ con.ruction: o. ~i~1~ ~ and ~cu~ ..................................................................... ~ .......................................................... J ~ use and ~cu~n~: ................ ~.~..~ ............................................................ b. In~ 3. Nature of work (check which applicable): New Building /""" Addition Alteration Repair .................. Removal .................. Demolition .................. C~r Work (Describe) ........................................ 4. Est,mated Cost ................~.~.~..I~S~....~....=..... ................... Fee ............... ............................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ........... .l ............ Number of dwelling units on each floor ............................ If garage, number of cars .......................... ~ ........................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 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 ......... ~.-~...'~.. ................ Rear ........ .~'.~..'~.. ........... Depth ...~..~ ............ Height .....,~...../. .... Number o~f Stories .................. ~ ............................................................................................ 9. Size of lot: Front ........~.x(~.. ......... Rear ............ ./.../.~ ................. Depth .....,-~..~..~....'~ ........... 10. Date of Purchase ........................................................ Nam~ of Former Owner ........................................... l 1. Zone or use district n wh ch prem ses are s tuated ..~.~.....~.. ................................................................. 12. Does proposed construction violate a~y/~z~.g law, ordinance ~_e, gulat~ '"".~"'~'/~"! ....................................... 13. Name of Owner of p remises~..~ ............. Address4~.~l~.:,¢~..:..~.~'. Phone Name of Architect ............................... , ...................... Address .......... : ................................. Phone No ..................... Name of Contracto~...~--~.v~'~... .............. 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 number or description according to deed, and shaw street names and indicate whether interior or corner lot., ~ STATE OF NEW' .'~.~(., ~ S S COUNTY OF ..... ~~ ...... ~ ' ' ............................. ~..~.....~J~J~..~ ................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named He s the ~.~ .............................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Swam to before me this ............... da of .............. ............... , ...................... Notary Public, ~~ Count~/ 'i~[~'~'~ re ' :f a~l~[ica nt, .... / k o[ RIVERHEAD 'BUILDING ,SUPPLY. CO. 303' OSTRA'-'D£R AVE:NUE RIV£~H:F'AD. N. Y; ' ' RIVEt~HEAD ~o~ ~?~o~ ~w~ur ¸CO. 'CZ F~ o ~ 5 303 IUILDING SUPPLY CO. O~TRANDER AVENUE RIVE~HEAI). N. Y, F='I L L 'd '0 ~ade.; Appl~ asDhdl% 5amp-groot ln~ h~low g~ade end ~" eemeD% ~rge RIVERHEAD BUILDING SUPPLY CO. 303 BSTRANDER AVE'NUE RIVERHFAD. N. Y. tTEl.