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HomeMy WebLinkAbout5656-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~ Date ............. .&Pr!~...q3... 19~. THIS CERTIFIES that the building located at ...~./!~.. ~o~,lI.se&G ~vo .... Street Map No.. ~ ........ Block No.l~ ........ Lot No.. ~... ~O~hO~.l~ .... l!.][.a ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ ~)~ ...... ~..., 19.~. pursuant to which Building Permit No. ~.. dated ......... ~0~ .... ~ ..... , 19~.., 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 .. 1;~lY~t;ll .O~O..~l~ .~l¥O],lill~ ...................................... The certificate is issued to . .W!l~l,:l,~..a~d. J'.alllc~. Moffat. ~.1' ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...&prt~.. 3..~.9~. .... ~ .Ro. ~lll& UNDERWRITERS CERTIFICATE No ..... ~.01~d~:~ .................................... ItOUSE NUMBER.~I~I,O ....... Street ....~O~SB~&~,I...A~IO .............................. Building Inspector FORM 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? 5656 Z Permission is hereby granted to: ...... ~?.~.~......~......~.~ ........ ....... 2~....~.~..~..~ ..... ~ .... to ......... '.~.~......~.i....~ ....... ~..~ ........ ~~. ....................................... pursuan,t to application dated ....................... ...... ~...., 19~./.., and approved by the Building Inspector, ~ee *.../....~ ............ PERMIT INCLUDES~,.~kPPROVAL TO REMOVE EX~$ FILL FROM ABOVE Pt~}~"iSES By REGR^DING LOT OKIvEwAY CONSTRUCTION CESSPOOL CONS fRUCTION CELLAR CONSTRUCTION OTH E R Building inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT O~ HEALTH D~te AP~ 5 t972 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. Chief o2 Gsn©~'s,l .~h-,~in_e~.cjr,~ Seznr:~ ces SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Re erence EASTERN DISTRICT, RIVERHEA~, N. Y. APFLICATION FOR APPROYAL TO CONSTRUCT PRIVATE sEWA,GE DIsP~:sAL SYSTEMS Approval to 'const'ru~t said systems' is requested,pertinent data herewith: Date Address /)~,,.~ _~,= O~ C ..... ,.~ J ~% ~ 7-Section~ [ ~ 2-Detazled property ~tcatzon~.~,~,~,.,<,z~.~= ,,C~,~ f~ 8-Lot No. ~ Hamlet ~ .... =~..~w~,~, ,~,.~, ~ ~,A, To~r,,~=~ ~,.~ c~,~-Private we%l? 3-~blic ~te~ SU~pl~-~'~6 ,'% ....... Distance to nearest main 4-Lot S~ze: Width7~u;~t. Lengthg/,~t. (also enter:on center plot plan below:) 10-Proposed system: Septic tan~k ~ /Precast / /CesspoSls--/~Shallow pools / /Otb"e// / 11-Septic tank inside dimensions~ Volume Gals. Lengt~ ft. Width ...... ft. Liquid depth ft. 12-Precast sections: / /Number/ /Square Ft. Cesspool~: Block sizeL~ incs.D~' ins. H ~ ins. Total blocks below inlet: ~i 77;~2 PLOT PLAN Ta Capacity ,ado I ate No th Data Feet 0 2 4 6 8 10 12 14 18 The Undersigned CERTIFIES: "Construction of adthor~zed installation~Will be in accordance with the Suffolk County Health Departments' current Standards, Fulletins, and amendments thereto, covering Private Sewage Disposal Systems". Gals. Date ~-~C S ned . FOR ~ALTH DEPART~NT USE ONLY. Based on the info~ation ~resented: herewith, it is the opinion of the Health ~rtment, that an adequate and sat~sfacto~ Se~ge Disposal System can be installed on this Plot. Date / ~/~ Signed ( 10/65 Revis. ) ~~ J EIIDN APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE ~EWAGE DISPOSAL SYSTEMS I~STRUCTIONS: Applications must be submitted in triplicate i-Means Owner or Builder. Address to which mail should be directed. 2-Means detailed description of property location, together with street name and ¢~istance to nearest intersection of ~ain thorofare, also Hamlet/Village & Township 3-I'~ter name of Public Water Supply District, together with the distance to their main. 4-I~ter 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. P~)POSED 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 P._~)T 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 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 '~acant" on the plot plan. Streets adjoining applicant's lot to the right, left or rear, enter street name. WE~ 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 Well-40 feet minimum into ground water for well point Well-$ feet 6 ins. minimum below grade to well head and lateral water pipe C_.E$SPOOLS 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 i6 feet Cesspool cover top to grade must be held to minimum of i food to maximum of 2 feet Bottom of Cesspool to ground water must be held to minimum of 1 foot Examined ........................................ , 19 ........ ........ Approved ................................ , 19 ........ IX)WN OF ~UTH~D BUILDING DEPARTMENT TOWN GLERK~ OFFIGE ~, ~. Y. ~ Permit No .... Disapproved a/c .............................................................................................. (Building Inspector) APPLICATION FOR BUILDING PERMrT oate ....~.,.~....c... ......... ~ ............................... , 19..q..! ...... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building Inspector. .,~ b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining pmmleal or public streets or ~,~ areas, and giving a detailed description of layout at property must be drawn an the diagram whlch Is part of fhie application. c. The work covered by this application may not be commenced before issuance of Building Permit· d. Upon c~proval 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 r~l 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 eppllcable Laws, Ordinances or .. Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, al herein described. ~1 The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. ......... i'~i~;~i~7; of applicant, or name, If"~ corparatlon) '" ·. l~..:.~..~.~...~.v..~. .... .~.~ (Address a~ applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, ele¢trlclan, plumber or bullde ......................................... .G.....e.~.e.. a~. ~..... ~.~. ~.T~.~. ~.~ .................................................................. i. .................... premises ...'~...~.LL.,.a~..a~.p....Ja a~.~ U.~.F...F~...T.. J.~ .......................... Name of ~ner of ........... If agplic~t Is a co~omte, 31gn~ure of duly aut~rized officer. (Name a~ title'of co~or~ officer) I. ~ati~ of land on which p~d wo~ will ~done. Ma~o.: ............... ~ ........................ Lot No.: ........................ _ . . ...... ~'"~.~..~...~ .~(..~.'~'- ~ ) 2.S~te existing u~ and ~¢u~ncy of pmmis, and intended use and ~=upancy of a. ~isting use and ~cupan~ ................................................................................................................................... ~. ,,t,nde ~se =nd ~c~==~:-....~.H.~...~.~.~.~.~.....~.~.~.G.....~e~..~.~ .......... 3. Nature of work (check which applicable): New Building ..... ~ ...... Addition .................. Alteration .............. Repair ............ '~"~A ARem°val .................. Demolition .................. Other Work (Describe) ...................................... 4. Estimated Cost'/~'...~....~.~.~.O...O....~. ....................................... Fee .................... .~ ................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... ~ .................. Number of dwelling units on each floor ..~'...~.~.(~.~:'~R:~ 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 sarne structure with alterations or additions: Front ....................................Rear ....................... ~ Depth ................................ Height ............................ Number of Stories ................................ 8. D mens ons of ent re new construction' Front ~'.~. ~... . Rear ~e ** D th ~. · Height /~...e.~l~ Number ~of Stories ...... ~.~ ........ .~ ........................................ .;.. .................................................... 9. Size of lot: Front ..J.~.~.J..~..~ .......Rear .../..G~,..~.~..'. ............. Depth ..~...~.. .................. 10. Date of Purchase .~...~.~.~....~..L~.~..I- -~ ' ............................ Nome of Former Owner ..~;.,....~.~..~...~...~....1~.. .......................... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ...~.~. .................................................. 13. Name of Owner of premises'~'..I.~..[.l~.~..J~.~.i:'a[..~JL~Address ~!J~.a~...~,g..~e.~//~/~ehone No. ~..~...~.~..~...O..~..~ Name of Architect ..............~ .................................... Address .......... '-T. ................................. Phone No ..................... Name of Contractor .~...~....N..~.~..[~h..~C....l~.~,......Address ..~R.I.~..~../~ .~....~..a..~.('--.../~... 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 show street names and indicate whether interior or comer lot. STATE OF NEW, OF ...... ~ .being duly sworn, deposes and says that he is the applicant (Name of individual Jcation) above named. He is the .~ke~l~......~.~.~...~~:~,. .............. (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 per~T~d in the manner set forth in the application filed therewith. Swam tobefore me this I , I . ..... ...... .......... , i EL~ABETH ANN NEVILLE NOTARY/PUBLIC, State of New York No. 52-8125850, Suffolk Cou~ntv.. Term Expires March 30, J.9~.¢~ T certain they are made in exact duplicate on oll copies, your builder; 2) your morlgage lender. Where il is neces- home Together they form the basis o' how much of a the working drawings and the plot p~ans are the only instructions to your builder. . ALTHOUGH, when sepa =re and folded, the Description who get he umbe and M Away keep n you o Mae as ae any 4 page, ~ey ae to eacnng n v,~ueofa sentence near /helo of Page l~heS ec,- Maera, Po Pan and e o Wok g ~cations include ,*is Description of Mater*als, the appli- Drawings. Check C~anges Made cable *mi*urn Construction Requirements. part of your contractual ageemen w h you bu de These Re u emen ncu~e s ecfica on on va ous be ,nltaaled by you and th, builder, any c~ange, . . lng instTtutions and builders have mortgaged or built under If any changes, subtractions or additions are made after signing of contract have such modifications put on all sets Jn existence and have them initialed. Have all price changes ~n agreements in wr~Eng. Following these simple rules, there is little chance for any future disagreements between you and your builder, similar (F.H.A., etc.) requirements and are thoroughly familiar with the commitments they are signing. The instructions on the NEXT PAGE are important to read; they enable you to complete the DescrlpEon of Materials, north arrow BELOW is a diagramatic plot plan. Fill Tn the spaces to shaw the dimensions underlined, the north arrow, the street name, the distance from the corner of your property to the nearest street intersection (and the name of that street). If a corner plat, also show the side street name. rear of lot distance to corner ('~'feet if corner lot) distanceto corner { o"feetifcornerlot)_ street name, FL. T ~ '2{ . ~FA ~ F~ I~L A~-FO~A I I,%"Wo"v:; "%..- J A1 MATERN A1 I. A. I~EGIEiTE RED AFICHITECT JERICHO TPKE.~ MINEOLA* N, Y, 11501 ;heet no. number ~ b,A ~- k,J T / DRAWN BY APPROVED BY RUDOLPH A. MATERN A. I. A. RE~IISTERED ARCHITECT sheet no design number ~ 0 0 'f // ....... t whole or I~l ot t~Js s]lYee~g~s prob:~il~d~e Pu'ch .... build from these d ......... H ......... y Eor~ of primed or DRAWN ftY APPROVED RUDOLPH A. MATERN A. i. A. sheet no. design number ~ _9 'F F2. ol,a T F_. L E. VAT I O ~-.J EL E VAT ~,O t.,j, DRAWN BY APPROVED RUDOLPH A. MATERN A. i. A, REGISTERED ARCHITECT 8g E, dERICHO TPKE,~ MINEOLA~ N, Y. 11501 ~heet no. design number I 1%, -- , I ~-2.1GHT ~lf;~F-~ E:LKV6,'f'lc~t*J :~ RAWN BY ~2 sheet no. RUDOLPH A, MATERN A, I.A. /~ ..~--~¢-~---~. r'~ RE61STERED ARCHITECT /~ number T~e~ worktng drawin&~ were prcp~re~ ............. SL4' ,RAWN ,PPF RUDOLPH A. MATERN A. I. A. design number no.