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Home My WebLink About6217-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..g. 5.2.2.~; ..... Date ..............g.un..e...22 ..... , 1973. THIS CERTIFIES that the building located at l~enry'.s..Lane ............. Street Map No. l'.a¢on:Lc .~o~i~ck No ........... Lot No .... 38 ........ PeconJ.¢.. ll.,.~, ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...........l'lov.. 1 .... , 1972.. pursuant to which Building Permit No.621?Z... dated ............ I~.o~ .... 1..., 1972., 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. rLvate, cme. £arally. d,wei.q &nj ..................................... The certificate is issued to . 14..~ .T ,..Cons.tx-ut t~on. Co~'p ..... I~me~ ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .~'una.. 2.1,.. 1973.. by. .~t...~.:tl~t... UNDERWRITERS CERTIFICATE No. Il..837.kl ...... Jtpr~l..1 ~/...1.973 ................. HOUSE NUMBER...19..5.~ .... Street ...... tleillL'~ .LalI~ ............................... Bttilding Inspector ]FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6217 Z Permission is hereby granted to: ...... ~..9...~.e..~$.....~.......t~... ...................................... ~o ...... .~.~.d....~... ~..e...~.~y....d...~.. ~.~.$~ ................................................................................ at premises located at .......... ~,g.~..~. ....... ~..~I~.O.~...~.~;~-e.~. ............................................................ ............................................ .~u~...~. ........... ~.e.c.~L~ ....... ~.~.~ ............................................ pursuant to application dated .....................~ ...........1 ................ , 19..~.;~.., and approved by the Building inspector. Fee .~....?..8...~. ............ FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hell $outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted mm to the Building Inspec- tor 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 disposel-(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 installa- tions, 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 pZOperty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn 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 informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelHng 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 $15.00 pete .... New Building ............. Old or Pre-existing Buildin~ ............ Vacant Land, ............. Location of Property..[..~.~.-.~....~.. ~ ..... ~~ ............. House No. . ~ .......... ~ ' ' I~ Street , Ham/er Owner or Owners of Property ..~.l...~J~.....~.,....~.......~.~ .......... County TaxMapNo ,000Secton ~ ..~.....~,ock ...?...J ....... Lot ...... J..~.. ...... Subdivision...(~j~..~"Y~......~ ....... Filed Map No..~.0..O.j..LotNo...~.~ ....... ,ermitNo..~.'..¢~.. DateofPermi,. J..°J.'7~..App[ican, Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate . ..-~. ................... Fee Subm,,ted ....... Construction on above described building and permit meets all applicable codes and regulations. C~. C~.0,~oO.,...Q.~ Applicant /~,' .~0,~1~,.-~ .~ ~n..,~ , .................. Rev. 10-10 78 SUFFOLK COUNTY DEPARTMENT APPLICATION F0R APPROVAL TO OF HEALTH H.D. Reference CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 1. Applicant ~%~'r- (~,,..',TR..~.~:,~...A Phone Address 7_.(~ Jw.~ ~~ 2. Property location ~]~ ~ ~ Village Township ~~ 3. Public Water Company. name ~--~ 4. Lot size: Width %%~ feet Length feet 10. Sewage Disposal System: A. B. 5. Subdiv. ~¢~'~ W~K~ 6. Section 7. Lot No. %~ ~ 8. Private well ~ 9. Public water Distance to main --- (Enter on center plot below) 900 gallon septic tank: Precast Equivalent Block Leaching pools: Number ~ Precast Block Special -- Street 4 If private well fill in blanks below: The undersigned be in accordance with the ards thereto." Tank capacity Gals. Pump G.P.M. Total well depth Amo~oew~r in Test No 1~'~ '~ Data "';' ~i~eet C~ ~ 8 ~.~t ~ ~ ~"~ 12 14 16 18 CERTIFIES: "Construction of authorized installations will Suffolk County Department of Health's current stand- Owner or Builder 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 can be installed on this pl~,.~~!Date ,- ~, Signed S-15 Revised 4/]/7~ APPLICATION. FOR APPROVAL TO CONSTRUCT PRIVATE 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 thoroughfare, also Hamlet/Village & Township. 3-Enter name of Public Water Supply District, together with the distance to their main. 4-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-Name of subdivision. 6-Section number. 7-Lot number. 8-Private well: Enter "No" if Public water supply is available. Enter "Yes" otherwise. 9-Public water: Enter "Yes" if Public water supply is available. Enter '~o" otherwise. PROPOSED SYSTEMS: Answer to Item number 10, consult the Suffolk County Health Department's Standards for Sewage And Waste Disposal Systems Design of P~sidential Subsurface Sewage Disposal Facilities. Part I-Residential Subsurface Disposal Systems covering cesspools. PLOT PLAN: The following information is required concerning the Applicant's 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. 2. Surface waters-Streams, Lakes, & Bays, etc., located within a distence of 100 feet of Applicant's lot lines, must be shown on the plot plan also. 3. Wells and cesspools now on adjacent lots must be shown on the plot plan, together with the distance to the Applicant's proposed Sewage Disposal Systems and well. 4. Where no buildings exist on adjacent lots, state "Vacant" on the plot plan. 5. 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-lOO feet minimum distance from the nearest cesspools. 'Jell- 25 feet distance from rear and rear sides of property lines when possible. Well- 10 feet distance from front, and front sides of property lines when possible. Well- 50 feet minimum below grade for well point. Well- 40 feet minimum into ground water for well point. Well- 4 feet 6 inches minimum below grade to well head and lateral water pipe. CESSPOOL LOCATION: Upon determination of the Sewage & Waste Disposal "type of systems" re- quired, the following Standards must be observed for the location of same: 1-Cesspool- 5 feet minimum distance from lot lines to exterior of cesspool. 2-Cesspools exterior must be 100 feet minimum distance from nearest well. 3-Septic tank exterior must be 75 feet from nearest well. 4-Cesspool exterior must be 7 feet minimum distance from nearest water line. 5-Cesspool exterior must be 10 feet from house foundation~ 6-Cesspool exterior must be 100 feet minimum distance from surface waters, streams, lakes, & Bays, etc. 7-Cesspoo!s must be 20 feet minimum distance from large trees. 8-Cesspool exterior to cesspool exterior, must be at least 8 feet. P-Cesspool cover top to grade must be held to minimum of 1 foot to maximum of 2 feet. lO-Bottom of cesspool to ground water ~st be held to minimum of 2 feet. TOWN OF SOUTHOLD / BUILDING DE PA RTMENT,~,~ ~, TOWN CLERK'S OFFICE sOUTHOLD, N. Y. ........................................ , lc~ ........ Pemit No ..................................... Application No...~...,,~,.../,.Z ............... ~ Disapproved o/c ..................................... 'z~'""~ (Building Insp~tor) ~ APPLICATION FOR BUILDING PERMIT Date November 1 22 ~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, witl~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, ar~,, giving a detailed description of layout of property must be drawn on 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 o the premises available for inspection throughout 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, and to admit authorized inspectors on premises and in buildings for necessary inspections. M.S.T. Construction Corp (Signature of applicant, or name, if a corporation) 260 Jericho Tpk Mineola (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder: Contractor Name of owner of premises ....~.:..~.a:..r..~..e..~ ..................................................................................................................... If applicant is a corporate, signature of duly authorized officer. ~ (Name and title of corporate officer) ,~ 1. Location of land on which proposed work will be done. Map No.: .P,,.e,,c..',...,H,,°,.,m,,el~ot No ......... ..~...~..8. ........................... Street and Number ................. .~.e.~f......~....~..e.. ........... ..~..e..c...o..n.~..c. ....... ~.:.~.: .................................................................. / ~ ~"' Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: vacant lot a. Existing use and occupancy .................................................................................................................................... b. Intended use and occupancy ......... ..o..n..e....~...a~..~..Z.~.....d:..w...e..Z.~.~ ........................................................................... 3. Nature of work (check which applicable): New Building ..... ~ .......... Addition ..................... Alterat~/Sn ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost .............. ~.1..L0....09.......+~ ........... Fee .....6..6.?..8.~. ................................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ..o...D...e. ......... Number of dwelling units on each floor ......................................... If garage, number of cars one 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. Dimensions of entire new construction: Front7...2. ..................... Rear ..... ~..2.. .................. Depth .......2..6..../.....2..2.. .......... Height ................................................. Number of Stories one 9. Size of lot: Front ........... .1...1;.0.. ................... Rear .......................................... Depth ........ ~1~.8....~.. ................................. Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district In which premises are situated ......... ~i.A..~.'....?..i..s...~. ......................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............... .D:..O. ........................................ 13. Will lot be regraded __~_~..e...s. ....................... Will excess fill be removed from premises: [ ] Yes [ ~ No 14. Name of Owner of premises Jo Ha.r~ett (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) c ......... M.S.T. Construvtion Coro Name of wv,,L,avtv, .......................................................... ~ ....................................................................................... (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 description according to deed, and show street names and indicate wheth- er interior or corner lot, See filed plans STATE OF NEW Y°~'K:~folkou~ ) SS COUNTY OF ...................................................... ) M. Tsontos .......................................................................................................... being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract) He is the ................................................. ..~.O..D:...~...~.~.C...t..o.,.~. .................................................................................................................................... (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 :;tatements contained in this application are true to the be~zU~llI~iJ'k3r~t~dge and belief; and that the work will be performed in the manner Notary Public, ~ia~e ot iqew York set forth in the application filed therewith, No, 52-0344963 Suffolk Cou.n~_~-~ 'J Nov Commission ExpiresT~rch 30, 19 ~' ~ /'1 ,~-- .................................... dayof .............................................. .~...~::~;19 ............. ~~../~ IV' ~ (t// ' /~ %-'~ ~/t~ Notary Publ' ..( ..................... (Signature of appltcant) SUFFOL;~ ¢Ob.~/~ ~XALTH DEPARTMEN~ · ,~5~z.va~ and. ~*ater supply for ;'~ ~:: locution have bee~