HomeMy WebLinkAbout3865-zI~ORM 1~O. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
'I"OWN CLERK'S OFFICE
SOUTHOLD, N. ¥.
CE:F~TII:'I~ATE: OF OCCUPANCY
No. ][. '~0~. .... Date ............... ,Ta~ual~. · · 11~.., 19.69
THIS CERTIFIES that the building located at ][~t~. l~ddl~-PO&d[. (4~).. Street
Map No. ~ ...... Block No.. ~ ....... Lot No. ~1[ ..... ~ottt~ho~d .- t~,¥., ........
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ............. '~,pl*J~,' "1" 19'68 pursuant to which Building Permit No. '3~' ~
dated ......... ~pl~l" '1~ ..... 19~1{~., was issued, and conforms to all of the require-
ments .of the .applicable provisions of the law. The .occupancy ~or which this certificate is
issued is . .P~:[Ta~' oll~ '~'~.].F .d~'el-~.~ng .........................................
The certificate is issued t.o . ~hOO .MOI~'4.~ .... 0W~o~i '1~ '~ 't~'~;):~ .........
of the aforesaid building.
.Suffolk County Department of Health Approval .. ~T~II... 1011..1.~.. ~ .R.f .¥~].~ ....
FO~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? 3865 Z
Permission is hereby granted to:
to I~L1A..mm..a~e,~ntL1a'..~Jm~ ~_e .....................................................................................
at premises located at ...~l,.~..IL~d.a~.e..~.ol~ .....................................................................................
..................................... IAe~t~.3A,...~.,~., ..........................................................................................
pursuan( to application dated ........................... A~p]e .t~ ....... '~6 ......... , 19.(1~.., and approved by the
Building Inspector.
Fee $..10.,00 ..........
ouilding ~nspector
S-9
SCHD
SUFFOLK COUNTY BEPARTMENT OF HEALTH
Bldg. Permit No.
TO WHOM IT MAY
at
CONCERN:
The sewage disposal facilities for a structure
~O0 Pt~ ~;. Acke~'~y Pond Rd. on Ni S Middle Rd. (Give deed location)'
located
have been inspected by this department and found to be satisfactory.
District Englnser
~istrict Engineer
SUFFOI~ COUNTY DEPARTMENT OF f~F-~H
EASTERN' DiSTRI¢'T~Ri~4~.Y. H.D.Reference No ~D~ ~/~ ~
~P~CATION FOR ~PROVAL TO CO~TRUCT PRIVA~ S~AGE DIS~ sYsT~ Date ~~
Approval ~ construct said syst~ i~ r~uested,pe~ent data her~th: / /
Address .-Y~/2~' ..~,~ ' - 7-Section
2-Dot.led property ~catien ~ ~ ~ ~m%~.~, 8-~t No.' ~
4-~t size: Len~h~ft. Wi4thj~'~ft. (Also enter on center p~t pl~ ~ .....
5-~e~g: S~gle f~i~?~ fam~?~Ce~ar?~S~b?~Crawl Space?~ ~
lO-Proposed syst~:Septic t~Precast~Cess~o~ha~els~other~
il-Septic ~ inside d~ensions:Vel~e ~.Le~th~t.Width_ fb.~quid depth ft.
PL~ PLAN
Street
T~ Capaclty~_l'Gals
Grade
Ind~ at
Nc th
Test Hole
The Undersigned CERTIFIES: "Construction of authorized installations will be in
accordance with the Suffolk County Health Departments' current Standards,Bulletins,
and amendments thereto,covering Private Sewage Disposa~ Systems,.
~ ~ ~ Bu_ilde~
F(R HFALTH DEPARTMENT USE ONLY. 'Based on the informatiion 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~
( o/65 vis.)
Signed
.APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE S~4AGE DISPOSA.L SYST~24S
I~STRUCTIONS: Applications must be submitted in duplicate.
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 main thorofare, also Hamlet/Village & Township
3-Ehter name of Public Water Supply District, together with the distance to their main.
~-Enter Length and Width of Lot under appropriate heading, also enter these dimensions
on the center plot plan sho~n on the face of this application.
6~D~ellings: Check-mark "V" items applicable to the proposed new dwelling.
~he Sub-division, Section and Lot numbers may be obtained from the Applicants' property
6-~ap, or from the office of the Town Tax Assessor.
9-Private well: Enter "No" if Public water supply is available. Enter "Yes" otherwise.
PROPOSEDSYST~24S: Answers to Items number 10, 11, & 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
PLOT 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, & Bays, etc., located within a distance of 50
feet'ofApplica~t'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 locat%on. To locate the well & sewage disposal systems on Applicant's lot, the
following Standards must be observed:
Well-lO0 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 ~ront, and front sides of property lines
Well-50 feet minimum below grade fo~well point
Well-SO feet minimum into ground water for well point.
Well.~ feet 6 ins. minimum below grade to well head and lateral water pipe.
Cesspools location- Upon determination of the Sewage & Waste disposal "type cf
systems" required, the following Standards must be observed for the location
of same~
Ce~spoel-lO feet minimum distance from lot lines to center of cesspool
Cesspools exterior ~ust be 100 feet minimum distance from nearest well
Septic tank exterior must be 75 feet from nearest well
Cesspool "Center" must be 1~ feet minimu9 distance from nearest water line.
Cesspool "Center" must be 15 feet from hous~ foundat~9n.
Cesspool exterior must be 50 feet minimum~$D~e~ f~m surface Waters, Streams,
Lakes & Bays, etc. ~.\4~\'..~:1/1 ~.~ .... .
Cesspools must be 20 feet minimum"~ista~ ~Ao~~ trees
Cesspool center to Cesspool center~%~%~ ~%~ least 16 feet
Cesspool cover top to grade must b~ held ,~q ~m~%%ku, of 1 foot to maximum of 2 feet.
Bottom of Cesspool to gr,und~watermust ~t~ to minimum of 1 foot.
TOWN OF SOUTHI-ILD
OF`F`IO~' OF' BUILDING INSP~-OTOR
TOWN OLERK'S OFFIOE
SQUTHOLO, N. Y.
Mrl'~, if~lll~rrer
Commissioner of Public Works
Suffolk County
Yaphank Ave., Yaphank, N. Y.
Dear Sir:
c: ~
In accordance with Section 239K of the General Municipal Low of the
consolidated Lows of the State of New York, this is to notify the Commis-
sioner of Public Works of the County of Suffolk that ......................................
l~o:i~tm~t~. ~tu.t:L~l~.. f,.. g.¢;~'~ .t~.v~ .~ ~,m:.. ~'.0...[~....... ~ ./..C. ...............
has applied to the Town of Southold for a permit to construct a building
as shown on the attached plot plan, submitted in triplicate, doted ................
Oet, .30 1967 --~ '
............................................ ~nd titled .............
~O,Vris, ~thoid
We shell wifB~old fu~her ~cfion on t~is opplicoHon for ten d~ys or os
otherwise provided in the aforementioned Section 239K.
Very truly yours,
Building Inmector
Town of Southold, N.Y. '
d
9
· ..4,8 4v 30 ~. - I$0.0
d
MAP OF,
5d~v~Y£D;
Tk-lO MA,5
Biv~head, L.'I[,, l~ew York ;olepho~e: P/h~ 7-2124
FOR. M NO. I
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
Examined ...~.../....~. .............. 19. ~f~......... SOUTNOLD, N. Y.
Approved ......... .......... .........
Application No.
Disapproved a/c ..........................
APPLICATION FOR BUILDING PERMIT
Date ..... I~P.~I.L....I ..................................... ,19~,.~.. ....
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 Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code and regulations.
(Signature of applicant, or name, if a corporation)
.............................. i~;;~ of applicant0
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
..... ....~...N.I~ e_...~lR.. ........................................................................................................................................................
Name of owner of premises ...... ....~.. ~....V~.. I~S ....... ..~.~.~.~ ......................................................................................
If applicant is a corporate, signature of duly authorized officer.
......
........~-'"ii~]me and title Ot corporate officer~ '/
1. Location of land on which proposed work will be done. Map No: .......... ~::~..~.."~... ............... Lot No: .,~/'~('....~?.~....
...... ............. ........... ...................
Street
and
Number
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ...Z~/..~..(4/....../C~.-..--(--'~....-./..'.~/.../"-.~..~l~..(m-."..'~..... ..............................................................................
b. Intended use and occupancy .................................................................................................................................
3. Nature of work (check which applicable): New Building ...~ ........... Addition .................. Alteratioo ..................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ......................................
4, Estimated Cost ............................................................ Fee .~..~.f...~L~ ............................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units .......... ..~.. .............. 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 ...~6'.4x... ...........
Height ....... .~...~..[ ........... Number of Stories ...... ~. .................... :
9. Size of lot: Front ....... Z~.fD~..~.,... Rear ......Z~.~..~..~. ......... Depth ....,Z.~I. .............
10. Date of Purchase ../~'.44~/'Z~q~U~. ........................... Name of Former Owner ..~',.X~:~X~..~.~.A/~C. ......................
11. Zone or use district Jn which premises are situated ........ 4~..~.~(.~.~V./~:,~.(. .......................................................
12. Does proposed construction violat? any zoning law, ordinance or regulation? ....... ,~(~.~ ......................................
13. Name of Owner of premises ...~.g4~.~....Z~Ox~'~ddress .~'~r//2'~ ..................... Phone No .....................
Name of Architect ...................................................... Address ............................................ Phone No .....................
Name of Contractor .~,~.SA~/~.....~.¢/-.'~....~../.,Address ...~,~f'-'-~[~.~/,,~ .................. 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 incl. icate
whether interior or corner lot.
STATE OF NEW YORK, ~ S.S.
COUNTY OF ................................
.....~..~. ~..~.~'~........~.,.....~.~.(~.~,~.,~.~.~/"~. ................. ........ being duly sworn, deposes and says that he is the applicant
(Name of individual signing applicc~tion)
above named. He is 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.
Sworn to before me this
.......................... ............................................
Notary Public, . ........................................................... ' '