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Home My WebLink About4875-zFORM NO. 4 TOWBI OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, BI. Y. Certificate Of Occupancy No. Z.~SI~ ...... Date ............ F&b... 3 ....... , 19.75 THIS CERTIFIES that the building located at . F-l~ed. Stl'ee& ............. Street Map No...ar ........ Block No .... ar ..... Lot No ..... ar ....]leV- Suffolk.. ~1o¥,. · · conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. Ju~-y · - %~19-70- pursuant to which Building Pemit No. ~.87.~Z.. dated .............. j~.. I~7 19 '70, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .Private. one..f, amil7 .dvttling ...................................... The certificate is issued to . Fl'Slik .l~tFtko8eh.. · OwlloF ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..Feb.' '3 ~' 't~)Tl''-by' R.o. '¥t~l't& .... House ~ ~00 .... ~' . . ' ..... FOF,,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) 4875 Z Permission is hereby granted to: .... ~'"t[~s~' ....................................... ......... ~.~ ......... I,,I~,..Z,,:~,, ........ to ............ ~.. ~e~..ea~..~e~lA~ .4~e~,~ ........................................................................ at premises located at ............. ~,l/~....~..G.~ ................................................................................. ........................................................... ttme..~.fo.~ ......... II,,.Y., ....................................................... pursua:n¢ to application dated ............................... ~'t=~ ....... J~ ....... , 19....J]~/~ and approved by the Building Inspector. JJJJ~l JI'IJFII~, ~IIIIIJEI~ IJj~, ~ &'J'~J&~ ~ ~J Jl~ J,~, . Building Inspector 'TOWN OF soUTHOLD ~/~/'~O BUILDING DEPARTMENT ?/ · ~- TOWN CLERK'S OFFICE Examl.ed ...................... , ........ ............................. A~r~ed .........., ................................... ....,~ , 19 ........ Pe~it No. :..~..~....../.....~......,~ _ ~ ......................................................................................... ................ .... - ................................. ~.~.;fi,~.~;~Ti~-.~ .............................. 'qg, , 0.' ¥c, o APPLIOTIOH FOR BUILDIHG PE~I~ ~, ............................. ~ .......................... Z~... 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 property must be drawn on the diagram which is part of this application. ~9~ c. The work Covered by this application may not be commenced before issuance of Building Permit. m d. Upon apprOVal of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit "~ shall be kepf 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 p~reuant :to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York and other applicable Laws, Ordinances or Regulat ons, for the construction of bui dings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (Signature cf applicant, or name, if a corporation) r,~genera:~m State whether opplicant is owner, lessee, ogent, architect, eng bet or builder. ................ ..~...~./../-...Z).. ~ ..................................................................................................................................................... Name of owner of premises ............ ../~'...~...~.~.....,~.. ....... .1~/....7-..~.....~....~...~.....~.....~.......~... ............................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ........................ Street and Number Municipality State _eXisting use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... : ........ .~..~....~....~....,~.....~.........~....~....4~...~.. ...... : . .. b. Intended use and occupant', / ..~.z~.~.../.,z: 3. Nature of work (check which applicable): New Building ~ Addition Alteration Repair .............. ~, Removal ............ ~ ....Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost .~..~...~',~.~.Z~.....~...~.~. Fee ........................................................ (to be paid on fi~ing this application) 5. If dwelllng, 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. D mens ons of ent re new construction: Front ....... ~....~. ............. Rear ....... ~...~.. ........... Depth ........... .?.. ......... Height ..../..~- ........... Number of Stories ........... /.. ....................................................................................................... 9. Size of lot: Front ...../..~'..~.. .............. Rear ....... ./...~......~-... ................. Depth ...../.....~.....~'.. ............... 10. Date of Purchase ....................................................... Name of Former Owner 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zon ng aw, ordinance or ragu at on? ., .../~.....~. .................................. 13. Name of Owner of pram sas ...~...~.~'..~...~. Address .~.~...~..~..~'.?...~....~..~.......,~7,~., Phone No ./~..~../'.~....~'./~ Name of Architect ...................................................... Address ............................................ phone No ..................... Name of Contractor ..... ~.~..T...~....~..~..~. .............. Address/ff~.~.,C.~.~../~....~.. ~? ~-- No ~'~J~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b~ck dimens ons from properh/, lines. G,ve street and block number or description according to deed, and show street names and nd cate whether interior or corner lot. STATE OF NEW YORK, ! e e , COUNT~' OF ................................ ...... ............................ be ng duly sworn, deposes and says that he is the applicant above (Name of individual signing application) named· He is the ....................... ~.....~..../.~...~..~F;....~.... ........................................... .~ ..................................... , ................. (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 tha? ~'- t,,e work will be performed in the manner set forth in the application filed therewith. Swam to before me this ~ do, Of ........ ..................... , ANN M. BELLOWS NOTARY PU~LI(~, State of New Yei'Jl Suffelk C~ount¥ No. $~-02:142S0 .... Gommission ExPires Mnrch 30, 19~ S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH / - Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located -- (Give deed location) ' have been inspected by thi~ department and found to be sa~isfac~ory. Chief of General En~in~Aw~ =~. - ~=~ .... --"~c SUFFOLK COUNTY DEPARTMENT OF HEALTH EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date -~ ~y ~/7~ ~.Approval to construct said systems is requested,pertinent data herewith: i-Applicant ~' ~,~O~;/~ ~,'~/~ Phone~)°~) 6-Sub div Address ~gl~;~' #,~,/ ~.~,~/~F~ _L~_./~_ '?-Section 2-Detaile~ property l_oqa~ti0n~/~ ,/ FF~3 ~. ~'//~,~ S-Lot No. Hamlet/~£~d ~,;~//~ Town ,)~7~;~ 9-Private well? ~/~' .~ 3.Public water supply name Distance to nearest main S-Lot Size: Width ~; ft. Length~//~-ft. (also 'enter on c~eoter plot plan below:) ~-Dwelling: Single Family ~,~T~-~ily? ! /Cellar? ~'/.Slab? ; ~Crawl Space? 10-Proposed system: Septic tank F /Precast'~Cesspools ~ /Shallow pools / /Other il-Septic tank inside dimensions: Volume Gals.Length ft. Width 12-Precast sections: ~;Number~sCUare Ft. Cesspools: Block sizeL Total blocks below inlet: ~l~'~ ~ ~'~3 PLOT PLAN W.L. ! ft. Liquid depth ft. incs. D ins. H ins. Capacity#~Gals. G.P.M. Street ~o~.the "Construction of authorized installations will be in The Undersigned CERTIF~S: Data ?eet 0 2 4 6 8 10 12 14 ~6 18 accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments_, t~hefto, covering Private ~i~po~~. · f,- :~ Builder FOR HEALTH DEPARTMENT USE ONLY. Based o~n the mnformation 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 ~ ~/~0 (10/65 Revis.) S-15 APPLICATION FOR APPROVAL TO CONSTRUCT PRi-~ATE 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 main thorofare, also Hamlet/Village & Township 3-Enter 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 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 ?-Section N,,mber 8-Lot Number 9-Private well: Enter "No" if Public water supply is available. Enter '~Yes" otherwise. PROPOSED SYSTEMS: 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: L~t 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 wate~rs-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-10 feet minimum distance from front, and front sides of property lines Well-50 feet minimum below grade for well point WeE-DJ) 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-10 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, Stream~ 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 I foot 1/ ~. 8~ F.. P/ETI~oD,4NGELO F,41VNiNG ROAD SURVEY FOR FRANK STRA KOSCH AT NEW SUFFOLK TOWN OF SOUTHOLD SUFFOLK COUNTY~ N.Y. SCALE: 1"=40' dUNE 9~ 1970 ,JULY 21,1970 AUG. ~'6, 1970 NOV. 18, 1970 REFERENCE~ GUARANTEED TO: SOUTHOLD SAVINGS BANK HOME TITLE DIVISION- CHICAGO TITLE INSURANCE CO. (.AND SURVEYOR N,Y..G, LIC. NO. aeT~ RIYERHEAD~N y , .. /I ~:ASTWC~G~ CORP. 17-¢ ..... /8' t