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Home My WebLink About5585-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..~1~ .... Date ...... ~.lll~e...20 , 19 THIS CERTIFIES that the building located at I~ye8 tla,'varlew .~e Street Map No. ~e~. H~Block No. . .Lot No...10~,106 . ~ee~po~t ~,~,. conforms substantially to the Application for Building Permit heretofore filed in this office '~ .. 0e~ . ~9 ..., 19 ~ pursuant to which Building Permit No. ~~d ....... Oe, .26. , 10~.,wasissued, andconformstoalloftherequire- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. ~ge. oBe. fa~51y ~llIng ............................ The certificate is issued to .g~wa~ ~oOko~ .... ~o~ ........... (owner, lessee or tenant) of the aforesaid building. Suffolk County Departmen~ of Health Approval ~ .20. ~-9~. · ~. B, u~u~wm,~s c[~F~c~ No . ~ .21855 ....................... }lOUSE NUMBER ~0 Street B~O~ ~O .. Btuldmg Inspector FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..~.. ...... Date ............. ~l~lae.' .2.0 .... , 19. THIS CERTIFIES that the building located at . E/~.. IMiyv.;ew .'m ....... Street Map No. 811mmel'. l/v~ Block No ........... Lot No.. 1.0.~..106... G=eenpor~.. I~.Y... conforms substantially to the Application for Building Permit heretofore filed in this office Oat...19 .... , 19. ~2. pursuant to which Building Permit No.. ~:~ ........... 0o.t..26..., 19~r2_., 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 ...l~i~rate. one. family. ~welltng ..................................... The certificate is issued to .Itdwa~. Beeke~' ....... ~aner ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~an® .~..1.9~2...by-R, .¥~.1~a ...... UNDERWRITERS CERTIFICATE No.. l~' .25855 ....................................... HOUSE NUMBER..1'1 ~(~ ...... Street... ]~&~"g'-~.81~ .&~O. ................................ Building Inspector I~RSI NO. 2 TOWlq OF $OUTHOLD BUILDING DEPARTMEIqT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5585 Z Permission is hereby granted to: ..... ~...~...~......~...........~......~...~m~. z.e~e~ .......... l~39.....'~.,,,..]~'la.~.iit,. ............................... to · .,11~1.4 ..a4,v.. ~__,~e · · .1'~-.,~'~]~,~ ....................... : ......................................................... at premises located et ...... ~l~..~,..Jl.O~l~....~~l,lk,~tttl~ ...................................................... ............................................ ~.....~..~ .............. .as~!~ ........................................ parsuc~t to application dated ................................... 0111~ ......... ~lb-., 19..~., and apprbved by the I],uilding Inspector. SUFFOLK COUNTY DEPARTHENT OF NEALTN H.D.Re£erence No~~0 WESTERN DISTRICT, COMMACK, N. Y. APPLICATION FOR APPRO~&L TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEHS Approval to construct said systems is requested,pertinent data herewith: Date l-Applicant BO A~ ~'r ~ID~$ . , PhoneT~2'/~/~ 6-Sub div~4~: A' Address i1~ ~ ~' ~ ~1~ ~'~ ,,/~1 ~ ~ ~ ~ 7-Section~ 2-Detatl~ p~pe~y location ,~/~ ~t~ ~ 8-Lot No. /~ ' ~ ~ ~mlet~ ~ ~ ~[~ O ~ U~ To~O ~/~ 9-Private well? ~ 3-~blic ~ter supply ~me ~ ~ ~ ~ Dis~nce to nearest ~in 4-~t Size: Width ~ ft. Length{~O ft. (also enter on center plot plan below:) 5-~elling: Single Family ~ T~ F~ly? ~ ~Cellar? ~ Y~lab? ~ ~Crawl S~ce? ~ ~ lO-Pro~s~ syst~: Septic ~nk ~ecast ~ yCess~ols ~YS~llow ~ols Y YOther / / 11-Septic ~ i~ide d~mensions: Vol~e Gals.Length ft. Width ft. Liquid dept~ft. 12-Precast sections: ~Number/ YSq~. Cesspools: Block size~& incs.D~s. HF ins. Total blocks below inlet: ~2~3~ ~T P~N Gi W.L. ~ o Street O i Indi Nc "Construction of authorized installation: Data ~eet 0 2 6 8 10 12 ~6 The Undersigned CERTIFIES: accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Systems". Date/~/i//~/ Signed~ Owner or Builder e will be in can be installed on this Plot. Date~ (~0/65 Revis.) S-15W 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 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 ~ain 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 Number 8-LOt Number 9-Private well: Enter "No" if Public water supply is available. Enter "Yes" otherwise. PROPOSED SYSTEMS: Answers to Items number 10, ll, & 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, & 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 LOCATTON: 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-10 feet minimum distance from lot lines to center of cesspool Cesspools exterior must be 100 feet minimum distance from neares~ 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 Cess_p~ool to ground ~w~_ter must be held to minimum of S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF I{EALTH Date Bldg.~'/Permit No. t/"~"n~ ~ TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deed location) have been inspected by this department and found to be satisfactory. 4/ /07' /SO. 0 k 10~5 lOP. +k,~ ,..¢,o~[.,.,lk C~,~.-~I Ct~/4r2r oP-3~.~ 102; ~ h APPLICATION FOR BUILDINg PIIIMII ~', INSTRUCTIONS ~ a. application must be Completely by typewriter or in Ink and submitted in duplicate to the Building filled in Impactor. b. PI? .pi.an showing location of lot and of bu.lldings on premlm, mlatlonlhlp to adjainlng premlell er ~ Itmets or areas, ana g~vmg a deealled de~crlpelon of layout ~f property must be drawn en the diagram whlch il part ~rlN]l el~llcatlon. c. The work covered by this application may not be commenced before i.uarme of Building Permit~ d. Upon approval of this application, the Building Inlpactor will Ilmae o Building Permit to the al~lelflt. Such pem~it~ ~hall be kept on the premises available for in~oection througlhout the prngre~ of the work. · e. No building shall be occupied or used in whole or in part for any purpoee whatever until a Clrtlfleato of Occupancy Ihall have been granted by the Building Inspector. '" .A.P..PLI_CATION !S HEREB. Y.MA_DE to the Building Department for. the issuance of · Building Permit II~mam to the ;u,,alng/.on~. Or.d. ,nanc* at .l~.e ,own of Southold, Suffolk Coun.ty, New York, and other appll6~ble ~ O~dlnanoe~ m egu ations, mr the comtruct,on of buildings, addltlera or alterat,ons, or for ten. vel er demolition, el heroin dsecrlbed. The applicant agrees to ~ornl~ly with aU applicable laws, ordinance~bullding code. housing code, and ~agulatlonl. .... .......... , ............. (Addreu of ,4ppllcant) State whether applicant is owner, Ise~ee, agent, architect, engineer, general contractor, electrician, plumbe~ or builder. Nome of owner of premlse~ .... If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) I. Location of land on which prepoled work wil, I be done. Map No.: ._.././..~. ...........................Let No.: .../.. .................. 2. State existing use a.nd occupancj/Bf premises and intended use and occupancy of prppaeed mtru~tlon: a, ,tlnguseandoccupan ......... ...................... .................................................... ' ................................ 3. Nature of wink (check which applicable): New Building ~ ................. Addition .................. Alteration .............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...................................... 4. Estimated Cost ...... .~..~...~.g...9. ................................. Fee .......................................................................................... (to be paid on fi~ing this application) S. If dwefling, 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. D mens OhS of ex st ng structures, if any: Front ...... .LZ-...L~. ..... Rear ..~ .................... Depth ............. Height ........................ Number of Stories ....................................................................................................... ~' Dimensions of same structure with alterations or additions: Front ....~'.....~...~.~...'./. .............. Rear ......~....~...~..~...~.. ........ Depth ....... .~./..,/~..../.x. ......... Height ...../.~.. ................. Number of Stories .........~. ..................... '&. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ..../...6....6..~ ........... Rear ........ ./....~.....o. ................. Depth ....../.~.?. ................. 10. Date of Purchase ...... //./.-~/..~/. ............................... Nome of Former Owner ...~.~.:.....~.~..~.,,,f.~...(..~...~. .............. 1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Daes proposed construction vi01ote any zoning law, ordinance or regulation> ... z . ............. 13. Name of Owner of premises .~..:..~.~...~....~'...6.../.~..~....~......Address e~...z~......~.x.L....~.Z.; ........... Phone No ..................... Name of Architect .....~,.,~..~.~x../.~../f~. ......................... Address .~..::.~..~.~...~...~.~.4~. .............. Phone No ..................... Name of Contractor/~....a. 419../~x;'~...~.......~.~.~.ff..~.. ...... 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 descri >tion according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW' YORK, COUNTY OF ............. ~.~ ............... .----/ ~3_ __,,~ ........ C~/..&..~..,~........~',~-C,~i...~..~..AZ...~....('...X'/..~..-. .............. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ..... ~..~.x~./..~..~.~..~,..,_,_,_,_,_,_,_,_,~..~.~J~. .................................. : ........... :: ........................................................ · , (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 ............. Notart Public, . . DLA~J