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Home My WebLink About5650-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. Z.~.0~) ....... Date ............ Apr'...1.¶ .... , THIS CERTIFIES that the building located at . ~cond, .Ay® ............... Street Map Nopec.. 8hot*eS Block No ........... Lot No. 11 .~. .... P. eoo~l.o... It. ¥, ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ~lov. · ~) .... , 19.]I1. pursuant to which Building Permit No. dated ......... l(oV30. ....... , 1971.., 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 .. Pl't,~at~t .one..£~1~..d~llin[ ..... , ................................. The certificate is issued to .Ad®l~,de. · .8~ho~dol'£ ..... 0~el· .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .I~OV...~0..~.~...bX. R.*..¥~.11~ .... UNDERWRITERS CERTIFICATE No .... R · ~63k.~.. .... ~O~'.. 2~.. 19.~.2 ................. HOUSE NUMBER.. 3.~0 ....... Street...~oeond. &.~e .................................. Building Inspector 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? 5650 Z pursuant to application dated ..................................................... , 19...7.~., and approved by the Building Inspector. }:ee $.../..~..~ ....... Building Inspector / S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH e ~ ,~/z~ Dar Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deed location) have been inspected by this department and found to be satisfactory. SUFFOLK COUNTY DEPARTMENT OF HEALTH H.P. Reference No WESTERN;DISTRICT, COMMACK, N. Y. APPLICATION FOR APPROVAL TQ CQNSTRU~T ,PRIVATE SEWAGE. DISPOSAL SYSTEMS Date Approva'l' "to construct said 's'yst~ms 2-Detailed~operty lpcat~Rn ~ ~ ~O~ ,~$ 8-Lot No. / / ~ .... Hamlet ~'~ O/'//~ ~"'~ T0~ 3-~blic ~ter supply n~me ~/L) ~z~ Distance to nearest main , , 4-Lot Size: Width ~ f~. Leqgb~/.,~,~ ft. (also enter on center plot plan below.) . 5-~elling: Single Family lO-Pro~sed system: Septic tan--k ~Precast y /Cesspools ~ /Shallow pools ~//Other / / il-Septic ta~ inside dimensions Vol~e Gals. Length ft. Width f~. Liquid dept~ft. 12-Precast sections: / /Number /Square Ft, Cesspools~lock size~1 zncs.D ~ ins.~~ ins. Total blocks below inlet: P~T P~N Ta] ~ to Street ~ F C ~ ~ ~'~ Data ~eet [0 2 10 12 14 ~6 to ~ ~ Nc ;h The Undersigned CERTIFIES: "~;omstruction of authorized installations will be in accordance with the Suffolk County H, ealth Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Systems". Owner or Builder FOR HEALTH DEPARTMENT USE ONLY. asked on the i~formation presented herewith, it is the opinion of the Health Department, t~at an adequate and satisfactory Sewage Disposal System can be installed on this P~ot. Date (10/65 Revis.) S-15W ~igned APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS INSTRUCTIONS: Applications must be submitted in triplicate i-MeAns Owner or Builder. Address to which mail should be directed. Z-Means detailed description of property location, together with street name and distance to nearest intersection of main thorofare, also Hamlet/Village & Township 3-En%er 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 7-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, 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 PLOTiPLAN: 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 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 'q~acant" on the plot plan. i 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-lO0 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 Well-SO 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 m~ximum of 2 feet Bottom of Cesspool to ground water must be held to minimum of i foot 113 .J ;.0 Tow, v o,~ ,.Sou~'l.~co , N.Y. FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. Examined ..... '~' '~' ' '" ' '"¢~v,~ ....... 19...~. (. Approved ........................ .,....'.~ ........ , 19..,., .... Pemit No. '""~'~'"~C-)"~ ...... Disapproved a/c ............................................................................................ / , APPLICATION FOR BUILDING PERMIT Application No. . ~.~- .,, 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 ofproperty must 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, housing code, and regulations. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... ..~...........;.._..-.7-..-. ...................................................................................................... If applicant is a corporate,z,I ~ ~'/, ~-,~ ~1' ~er ~3 ~/~' ~ O~1~' sigr~ture oT 'ddl~'a~horize~ oTT . (Name and title of corporate officer) 1. Location of and on which proposed work will be done. Map No.: ...~....~,,;.~ .......................... Lot No ......................... Street and Number ...................................................................... i..~..~..~-. ........................................... .(../...?.. ........... use and occ(p~"n~y of propose~construction: 2. State existing and occupancy of premises and intended use ~"~('~ ~) Exisiting use and occupancy ................................................................................................................................ Intended use and occupancy ....... .../~'....~...~...~..~. ........................................................................................................ / 3. Nature of work (check which applicable): New Building ...... ~ ....... Addition .................. Alteration .................. Repair .................. Removal .................. Demolitior .................. Other Work (Describe) ........................................ 4. Estimated Cost ........ ~/.~..~..~....~ ............................. Fee ~. ~ ~ (to be paid on filing this application) §. 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, spec~ nature and extent of each ~e of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Nu~er 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 ....... .~..~ ........... D~th ....~.~ ............ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........... ~.~ .........Rear .............. ~.~ ............... ~pth .......~.~..~ ........... ~ / 10. Date of Purchase ....... '~'~'~'"~T7 .......................... N~me of Former ~ner ~ 1. Zone or use district in which premises are situated ....................................................................................... 12. Does proposed construction violme an~ zoning law, ordinance or regulation~ ............................................................ 13. Name of ~ner of premises ~,..~..~..~..~.~,.~.~. e,~A~ress ..~.~.~..~.t~ ~ P~ne No. /~ ~ ~ , ........ Name of Architect ...................................................... A~ress ............................................ PNone No ..................... Nome of Contractor ~.~7~.~ ...... .~/~..~....a~ress /X~¢ ~, /~ ~,~ ~ 7~ ~ PLOT DIAG~ Locate clenrly and distinctly ell buildings, whether existing or pr~osed, and indicate ~11 set~ck dimensions from prope~y lines. Give street and block number or description according to d~, and show street nom~ and indicate whether interior or corner lot. STATE OF NEW YORK, [ c c COUNTY OF ................................ ~' ~"~ ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing applicati~) 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 ........................ o, ............................................ Notary Public, . ........................................................... pphca TOWN OIr~ BUILDIHG TOWN SOUTHOLD, 1,4,,' ~mi.~ ......~....~.....~.. ....... , ~.i....~. ~ ^pp~.~ ....................... 5..?.5 ........ , ~*.~..., Permit Na. Dieepproved o/c (Bulh APPLICATION FOR INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und Inq~ector. to the Building ~: b. Plat plan ~ing location of lot and of buildings on premises, relationship to adjoining pmmleee er public ~treets or ,~ areas, and givlmg m detailed de~crlpelon of layout ~f property must be drawn on the diagram whlch ia I~art of ~le al~llcaflon. '. ~. The werk cowered by this application may not be ~,Y, menced before iuuQnce of Building Permit. ~ d. Ul~m al~roval of this application, the Building Inspector will I#ue o Building Permit to the al~llcant. Such "1 permit ~nall be kept on the premises available for inspection throughout the progre~ of the work. e. No building shall be.occupied or ut~d In whole or in part for any purpace whatever until a Certlf~ate of Oocupancy shall have been granted by the Building In~oector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit Imnmant to the Building Zone Ordinance' of the Town of Southold, Suffolk County, New York, and other applk~ble Law~ Oedlnanc# or Regulations, for the construction of buildings, additions or alterations or for removal er demolition, ee heel~ d#cHbed. The applicant ~gmes to comply with all applicablelawl, ordinances,building' code, housing code, and ragulatlam. (Signature of applicon ,t¥or name, If a emtl~mflon) State whether applicant is owner, Imco, agent, architect, engineer, genarol contractor, electrician, plumber or builder. .............. 13..~.J..l..~.~ ...................................................................................................................................................... Nome of owner of premises ..... L~f.P...~../..~./.~...~..........~...~..~..,,..~.....~,.,~,,,~.,gL.4~., .~. ............................................................ If applicant Is a corporate, signature of duly authorized officer. ................................................................................................ p3,~ ~ (Name and title 'of corporate officer) " ,. ~at,on of ,and on w~,,h p-~--a work w,, be don.. ~ap,a.: :4~ .......................... ~"~.: ..iL(~.~. ....... ....~' st,~ .nd .umber ....................................... ~. ................................. ..Z?..~.~..O ........... ~ ................................. ~ 2. State existing u. a,nd occupancy of premi.s and intended use and occupancy of prch~aeed ~lan: ~ a. Existing use and occupancy ........ 4~.~.,~,d~..~.., ....................................................................................................... .~. 3. Nature of work (check which applicable): New' Building ..... ~ ........Addition ................. Alteration ............. Repair .................. Removal ................ : JD~molitiOn ........... ....... Other Work (Describe) " .................... 4. Estimated Cost ........................................................ tee ............................................................................... L :, . (to be paid on fi!lng this application) 5. If dwelllng, number of dwelling un.ts ........ ~' --".~......".'.'....Number of dwelling units on each floor .~......~.....i?..i ...... · - If garage, ntlmbe~~ of.'car~' ................................................................................................................ ~..~[.,..:.. 6. If business, commercial or mixed occul~ancy, 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 ....... .2~......~.. ............ Depth ...,,,I....~. ............ Height .................... Nurnber of Stories ...................................................................................................................... 9. Size al: lot: Front .......... ..~....~.. ......... Rear ............. .~...6.. .............. Depth ...... ../...~......~....~ ....... ./.~' 10. Date uf Purchase ....... · /...~/~../..,"7.'~,~ ....... ~.,;..~'. ........... Nome of Former Owner .+/~.4..~./d'../.~.. ............................... 11. Zone or use district in ~hich premises are situated .................................................................................................. 1'2. ~Joespropasedcoristr(~ction v o ~te any zon ng aw, ord nence or r~cjulat on~ .............. .... .................... ........ 13. Nome of Owner of premises/17..:.n~.~.~.~....~./~..~.~..~..Address Name of Architect ...................................................... Address Name of Contrqctor ~,,O,.~,~/~..~..?.......~/~./~C.... Address "~;}:~'~'"j~;;'~'~;;)~;'-~4~-- Phone No...~.£.~. ........... ~"jD),,,~.~.~.;~;~i:.~ ....... Phone No. /.~!"~,; ..... ..... PLOT DIAGRAM ~'~,~=~'.~e· ~;~early 'c~nd, di=tinctly'atlbuildings, whether existing or proposed, and indicate all set-back dimensions lrOm preperty lines. Giv~:,.~met,'ane 'black,: number or description according to deed, and show street names and indicate ~,.,~,~he~ ~ter or or corner at STATE O'F NI~W YORK, I S S. COUNTY OF .-,.~..;,~'- ................... .f , (Name of indiY~dg~l ~ing application) a~ve named. He is the ................................ ~...~..~.~[./~.~.~..~L~ .................... '~ ................................................. ....... ~ ~: ':~: ~ ' ':~ (Contmctor~ agar, co~r~e ~ficer, ~c.) of said ow~r or owners, and is duly authorized to perform or have pedaled the ~id work a~ ,to ~ke ~d file this appliCati6n; tHat& siate~ents contain~ in this application are tree t° the ~st of his knOWledge and belief; and that the work wi,I be perfo~ed in the manner ~t fo~h in the application filed ~r~i~. Swam 'to ~fore ~ ~is ....... ' Noto~ Public . ~o~ ~- ' · ' ............. y .... C~ (Signa~re of apphcant)