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Home My WebLink About5683-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No..Z~2~.~ ..... Date ............. Jal~ .... 2t~ .... , 19.?.~. THIS CERTIFIES that the building located at . 8'/S 'I~ay '~ve. '(Sku~k. ~,a.) Street Map No. X~ .......... Block No.X~ ....... Lot No. XXx..~ttt~hogue N...Y., ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Dec..-20..., 19.?1~. pursuant to which Building Permit No. dated ....... Dec.. 2.~ ....... , 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 .. P.l, ivate .e~e..~aml.ty. ~lw~l~Lng ...................................... The certificate is issued to 'gug~n 'l~ax'tenm' ~ 'Wife ' · Owners ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Ju~e...6...1,97~. by .~...~illa ..... UNDERWRITERS CERTIFICATE No... I~2~866 .... Jllln. e. ~ ~ · . 1 9F.~ HOUSE NUMBER.. ~00 ...... Street...B~q~..Aye..(~Sk'~ .I~) ......................... FORM NO. 3 TOWN OF $OUTHOLD BUILDING DEPARTMENT; TOWN CLERK'S OFFICE SOUTHOLD,. N. Y. I~UILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: .......... ~...o...~.~...~. ............... .......... ~3~l~e~ ......... .l~.~ .......... ~ ................. to ~3-a :.~e~...ea~.. ~a~;~.. ~.X.~ ............................................................................... .... et premises located at .............. ~..]~q~..~ ......................... ? ................ ~ ....................................... ................................................ (:ateaelme ........... ~t~., ........... , ........................................................ pursuc~¢ to application d~ted ............................... ~.~,.,.,~0,...,.'~....., 19,..~j', and approved by the - Building Inspector. ]:ee $... ~.~/*~{~ ........ :Building Inspe~ FORM NO. 6 TOWN OF SOUTHOLD Building Depafl'ment Town Clerks Office Soathold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposol--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Swam statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 New Building ..... !...~... ........ Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ........... '.~...¥....~./.~.-].~.. ...... ./..~..~.. ................ ~.~....~./. .............. * ............ Owner Or Owners Of Property ....~../~.'....~..~....~.......~.. '~'~...~...~. ................................................... Subd vision ............................................................... Lot No ............. Block No ............. House No ............. Permit No..~.......,~...~.,.. Date Of Permit ~......' .~...~.~p¢lican, ...~-~.~,...,~ ................... Health Dept. Approval ......~....0.....?.....~....~.. ................... Labor Dept. Approval ............ ~....[...%.. ...................... underwriters Approval .~.......~...~...~..~..~. .................. Planning Board Approval ........ ...~...:....~.. .................. Request For Temporary Certificate ........................................ Final Certificate .....~... ................................. Fee Submitted $ .....~.,.~.~.. .................. Construction on above described building and permit meets all applicable codes and regulations. Applicant ~ .~......~: .............. ~...~,,..~~ Sworn to before me mis dayof .......... ...................... Notary Public ......,V. ............ I ............. County (stomp or se~ S-9 SCHD SUFFOLK COUNTY DEPARTMENT Date Bldg. OF HEALTH JI~N 6- 1973 Per.it No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure 3 (Give deed location)' located have been inspected by this department and found to be satisfactory. Chief of General Engineering Services 1973 SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No '~ EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date Approval to construct said systems is requested,pertinent data herewith: 1-Applicant ~e~ ~/¢~$ Phone ~34~ ~'~6-Sub div Address ;~ G~F A~- ~;%/,~ ~ ~ 7-Section 2-Detailed ~ro~er%y location A~/ ~ g~'~,¢~ ~¢/~¢~-Lot No. .Hamlet ¢~c ~j ~¢ Town ~ ~A~ A~; 9-Private well? 3 Public water supply name Distance to nearest main ~-Lot Size.' Width ~ ft. 'Length~'~'ft. (also enter on center plot plan below:) ~-Dwellin~: Single Family ~w~Two Family? ~ /Cellar? ~ /.Slab? ; ~Crawl Space? lO-Proposed system: Septic tank ~ /Precast ~ ;Cesspools /~/Shallow pools /~Other il-Septic tank inside dimensions: Volume Oals.LenEth ft. Width ft. Liquid depth ft. 12-Precast sections: / ;Number/ /Square Ft. Cesspools: Block sizeL/6incs.D ~'ins. H Fins. Indi e No ~th Capa city~k_u~6als. f Total blocks below inlet: ~1 ~e~ ~2 ,~3 PLOT PLAN Data Feet 0 ~ 6 8 - 18 Street The Undersigned CERTIFIES: "Construction of authorized installation.~ will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Systems". ~, ~ Signed '- Owner r Builder Date FOR HEALTH DEPARTMENT USE ONLY. B~sed on the information 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 evis.) EXCAVAllffi INS EC'riON REQUIRE . APPLICATION FOR APPROVAL TO CONSTRUCT PR/VATE 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 Publid Water Supply District, together with the distance to their main. ~-~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. 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 ¥ " " " " " " Shallow Leaching Pools PIDT PLAN: The following information is required concerning the Applicant's Lot: Lot size-Length and Width in feet to be indicated at the Lot line~ of the heavy lined square in the center of Plot Plan sho~ on face of this application. Surface waters-Streams, Lakes, & Bays, etc., locatel ~ithin 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 sho~u~ 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 '~facant" 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 Well-~O 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. '~I ~O JII~l]~j~ Cesspools must be 20 feet minimum ~$$n~e, ~m 1..a~r~e trees Cesspool center to Cesspool cente~mAs~ ~ a~leA~ 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 wate~m,~ ih~ ~to minimum of 1 foot BAY AVENUE N.,~'o,'~o"~. , ,oo.o¢ I , SURVEY FOR EUGENE B,gR. ~ SALLY MARTENS AT CUTCHOGUE TOWN OF SOUTHOLD ~ARANTEED SUFFOLK COUNTY, N. ~ IN~R.COU~Y T;TLE G~RANTY ~MOR~AGE CO. EUGENE ~ · SALLY MARTENS SCALE: 1"=40' MAY 5, 19 ~0 LAND RIVERHEAB~ N.Y. 3 7../ Examined ........................................ , 19 ....... IPOBJf NO. I TOWN OF soUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, N. Y. Approved ........................................ , 19 ..... Permit No ............................. Disapproved a/c ........................................ ~ Application No. APPLI~,TION FOR BUILDING PERMII Dote ....... .~..~...~.,~. ................................ , 19....~../. ..... ~ 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 premises or public streets or areas, and giving o detailed description of layout of property must be drawn on the diagram whlch Is part of thio 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 I~ue a Building Permit to the applicant. Such permit shall be kept on the pram sas ava labia 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 Bu Iding Perm t pumuant 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, hou.~ing code, and regul~tlons..~ (Signotur~ cf applicant, or name, If a ¢ommtlo~) .... ........... ............... of ................... (NUma and title 'of corporate officer) Location of land on which proposed work will be done. Map No,: .......................................Lot No,: ........................ State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy,. ................................ U)~~~ ...................................................................... b. Intended use and occupan:' .................................................. ..~, ...................................................... 3. Nature of woik (check which applicable): New Building ~ Addition Alteration Repair .................. Remora! .................. Demolition .................. Other Work (Describe) .................................. 4. Estimated Cost .......... .m...-. t ..-r. z..-~.. ................................. Fee · (to be paid on fi:lng this application) 5. If dwelling, number of dwelling umts ........... J .............. 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 st'ructures, 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 .....~.,~ ............. Height ........ J...~.. ..... Nurnber of Stories ................... ./. ................................................................................................ 9. Size of lot: Front ....... ~...~.. ............. Rear ............~.~'.. ................. Depth ...... ,~.~..~.~....../). ~ ~_. , 10. Date of Purchase ....~. ............................................. Name of Former Owner ..~......~...~..~ ........... ! 1. Zone or use district Jn which premises are situated .................................................................................................... ~ 12. Does proposed construction violate any zoning law, ordinance or regulation? .......... ~...~.. ................ ~ r~'~;, c, '~.~..?.....~....~. ..................... ~3. Nome of Owner of premises .,.~.~..,..-..~.(,.~.,,.~. ......... Add,ess ...=...,.,~.~.,-~..~Z ........ Phone Name of Architect ........................................... ,...~.....Address ............................................ Phone No .................... PLOT DIAGRAM Locate clearly and distinctly oll buildings, whether existing or proposed, and indicate oil set-bock dimensions fram property ~ines. Give ~treet and blo~k number or description according to deed, and show street nam~ and indica?e whether ~nterior or c¢rnor bt. STATE OF NEW YORK !.. ................... ...... ........... : ................. e,ng du,y swo n, deposes and soys he is the applicant 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; teat 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 Jn the application filed therewith. Swam to before me this ~ , ........ ............... , Nota~! Pub,c,~~..~.. Coun~,"~'/~' ........ ~;;~;,'g;;;;"g'i"i'(,'~iig;;';f ............................. /~ ELIZABETH ANN (/ NOTARY PUBLIC, State of~'ew York No. 52-8125850, Suflol~ Term Expires March 30 ~ ~'~ N. 87e01' ~O"E. AVENUE ~oo. oo' ¢ L SURVEY FOR EUGENE B.,JR. ~ SALLY MARTENS AT CUTCHOGUE TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. SCALE ~ 1"'=40' MAY 5, 1970 SEPT, 30,1971 dAN. 17, 197'2 REFERENCE 8UARANTEED TO ' INTER'COUNTY TITLE GUARANTY & MORTGAGE CO. EUGENE B..JR.I~ SALLY MARTENS SOUTHOLD SAVINGS BANK LAND SURVEYOR .' , NIVER#EBD~ N,Y. BAY AVENUE o. SURVEY FOR EUGENE B.,JR. E~ SALLY MARTENS AT CUTCHOGUE TOWN OF $OUTHOLD SUFFOLK COUNTY, N.Y. SCALE: 1":40' MAY 5, 19 70 SEPT, 30, 1971 REFERENCE 9UARANTEED TO~ JNTER*rJOUNTY TITLE GUARANTY ~ MORrGAGE EUGENE B.,JR. ~ SALLY MARTENS LAND SURVEYOR N.¥S. LIC. NO,