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Home My WebLink About6219-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z..~02~1 ..... Date ............ I~LI~.. 13 ...... , 19.73 THIS CERTIFIES that the building located at . Benne~;t. Pond.Lane ..... Street Map No..Ber~v'c~;..PO~tl~ck No..at!b ...... Lot No... ~ .... .Hatfc~.t;uck., .N ,)[., ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ Eo¥..... 2.., 19.72. pursuant to which Building Permit No. dated ............ N. 0V .... 2..., 19.~2., was issued, and conforms to ali of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. PFf[.¥~te..o~e..f.a~.i.ly..d.w.e.~.~$r~g ...................................... The certificate is issued to ...John .&. gath~Laen.. 1.toore ...... 0'~f~er$ .............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...tier. ch.. ~ ..1973..b7 .~o. UNDERWRITERS CERTIFICATE No..g:'P.r0vgd..by. KBb.~qki..3/8¢{7-'~ ................. IIOUS[ NUMBER.. ~2.~ ....... Street .... B~nncL~..Pon~. hano ......................... Building Inspector ~0~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP. EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6219 Z Permission is hereby granted to: .... Hatt~tuek ................................... at premises located at ....... ~Q.~....~ .......... ~1113~1.~.~..~0~ .................................................................. ........................................... ~.e...t..t...~.~...~.~n.~ ....... ~,t.~l~uak ............................................... pursuant to application doted ........................!1¢~T.....2 .................. 19.7~..., and approved by the Building Inspector. Fee $.~.,~ ~.,~ ........... Building ~n'is~e~tOr' ( TOWN OF SOUTHOLD Building Delm~tment Town Clerks Office Southold, N. Y. 11971 APPLIGATION FOR GERTIFIC:ATE 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 dispcsal--(S-9 form or equal). 3. Approval of electrica~ 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. 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 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 ~ Date .....~., t..~,., .~, ./.~,.~. .................. New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ............ ~..~....'~...../~....%.~,,~ ....... ..~.....~. ............ .~,~'....~ ......................... Owner Or Owners Of Property ...... ~..~.........~..~...O../~...~ ........ . .~....~'.. ............................................................. Subdivision ...~.K-4~,~...~ .~..~..<~ ............ ..~..o...~..~.. ......... Lot No....~... ..... Block No ............. House No ............. Permit No. i~.~./...~....~.. Date Of Permit/.././.~...?.~.~.~..~App~ic~nt/~.~/...~..?..../...~.~.~..~./..~...~...~....6~ .~..~......../...~..~ Health Dept. Approval ...~./...&../..?....~. ....................... Labor Dept. Approval ................................................ Underwriters Approval/~'~>/..~...--./7 ~ Planning Board Approval .. Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ...... ..~....~...O...?.. ................ Construction on above described building and permit meets all applicable codes and regulations. Applicant..,~,,~ ~...,~r.......~ ......................................... Sworn to before me this / ~'//"~'" (Stamp or seal) ................ day of ............................................ Notary Public .................................... County ~ ~ ,,..~,, SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference No APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM o 1. Applicant · /~,, ~-3N~ ~ Phone~9~5. Subdiv. ~¢FT~ Address ' ~ ;~.~ '~! . 6. Section Property location~ ~;"'r . LOt No. 1~ ~W ~ ' ~ 8. Private we Village ~F~. Township~m~ 9. Public water 3. Public Water Company name Distance to main 4. Lot size: Wid~h~6~__feet Length ~? feet (Enter on center plot below) 10. Sewage Disposa~'~SNstem: A. ~O~/gallon septic tank: Precast~ Equivalent__Block~ B. ~ac~ing pools: Number ~"- Precast/~Block Special The If private well fill in blanks below: Tank capacity~Gals. Pump G.P.M. /~ Total well depth~ Depth to G.W._~_/~ Amount o~'water in well ~O Test Hole Data Feet 0 2 4 6 8 10 12 14 16 18 undersigned :ERTIFIES: "Construction of authorized installations wiil Suffolk County Department of Health's current stand- be in accordance with the ards thereto." Owner or, Builder Based on the information presented herewith, FOR HEALTH DEPARTMENT USE ONLY. it is the opinion of the Health Department, that Disposal System can be installed on this plot. D at e Z~///~ ~__ S i g n e d an -a~e, gua te and satisfactory Sewage S-15 ~v~sed 4/]/72 APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE S~AGE DISPOSAL SYSTEMS INSTRUCTIONS: Applications must be submitted in triplicate 1-Means O~ner 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 u~er appropriate heading, also enter these dimensions on center plot plan shc~n 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 '11o" otherwise. ..PROPOSED 8YSTE~: Answer to Item number 10, consult the Suffolk County Health Department's "Standards for Sewage And Waste Disposal Systems Design of Residential 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 sho~n on face of this application. 2. Surface waters-Streams, Lakes, & Bays, etc., located within a distance 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 LOCATI(N: To locate the well & sewage disposal systems on Applicant's lot, the following Standards must be observed: Well-lOC feet minimum distance from the nearest cesspools. Well- 25 feet d~stance 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 mi~mum 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 LOCATI~: Upon determination of the Sewage & Waste Disposal "type of systems" re- ' "quired, the following Standards must be observed for the location of same: 1-Cessponl- S feet minimum distance from lot lines to exterior of cesspool. 2-Cesspools exterior must be 1OO 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-Cessponl exterior must be 10 feet from house foundatie~ 6-Cesspool exterior must be 100 feet minimum distance from surface waters, streams, lakes, & Bays, etc. ?-Cesspools must be 20 feet minimum distance from large trees. 8-Cessponl exterior to cesspool exterior, must be at least 8 feet. 9-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 must be held to minimum of 2 feet. TOWN OF SOUTHOLD BUILDING DE,P,A. RTMENT TOWI:4 CLERKS OFFICE~'~/ d~,~--~ ,~7'/~,.,/~,~ . ~ ,,~ SOUTHOLD, N. Y. ........................................ , 19 ........ Pemif No ................ Disapproved o/c ............................................................................................ (Building Inspector) Applicotion No..~.. ......... ~. ................. APPLICATION FOR BUILDING PERMIT Date November 2 19...?..2. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Build ng nspector, wi~ 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 adjo n ng premises or public streets or areas, ar~ g~wng 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 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 beeR~U granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zon~f~ Ordinance of the Town of Southold, SuffoU~ County, New York, and other applicable Laws Ordinance~ or Regulations, for the construct on buildings, additions or alterations, or for removal or demolition as herein described. The app cant agrees to comply with all applicable lawl, ordnances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections~ A. Reilly & Sons Inc (Signature of applicant, or name, if a corporation) Mattituck (Address of applicant} State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder~ Contractor Name of owner of premises John L & Kathleen Moore 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.: .~..~.e.~..~....~o~No ........... ..~.. ............................... Street and Number ........ BeD_n_e .~....~..o...~.d....~...e:~_....e. ................ ..~..a...~.~.~.c...~. ..................................... -~_~ Municipali~' 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... .v..a....q~ ............................................................................................................... b. Intended use and occupancy .......... Q~...~'~I~ILI~3,~'...~I~3,,:L~ ........................................................................... 3. Nature of w~rk (check which applicable): New Building z3r.3c[ Addition Alteration .............. Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 83 4. Estimated Cost ............ . .~..1..t ..0..0.. ,0...._+.. ............... Fee (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 .............. .~...W..O. ....................................................................................................................... 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 ........................................ 62-6 - _,22 / 26 8. Dimensions of entire new construction: Front ........ .6..2...-..6. ........ Rear ............................ uep~n ..... .................. ; ......... Height ................................................. Number of Stories ...........~..o. ....................................................................... 9. Size of lot: Front ...... .1.2,~ ......................... Rear .......................................... Depth ......... ..2..0.?.. ................................. Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ "A" dist 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............. 11~ .......................................... es 13. Will lot be regraded -.,~lr~ ............................. Will excess fill be removed from premises: [ ] Yes [~No 14. Name of Owner of premises Job_ri. Moore Jr & WiRe (Address) (Phone No.) Name of Architect ..................................................................................................................................................... l~ddress) (Phone No.) Name of Contractor A. Reilly & Sons Inc ~attituck (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 YORK. Suffolk ) COUNTY OF ...................................................... ) Norman Reilly .......................................................................................................... being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract} He is the ................................................... .CQI~,,~,~C..~.Q,I~ .................................................................................................................................. (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 best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewi~l LEI( 9 NOTARY PUBL~te of New York .............................. .~.... day of ............. ~.~6~.~ ...... 19~ ~ ~ Qualified in Suff0t~ ~oun~y ~'~ ............. ...................................... (S~mre of appliclnt} DEPARTMENT OF HEALTH RIVERHEAD, N.Y. '73 MAR 6 PM 2: q O Unauthorized alteration or addition to this survey Is a violation section 7209 of the New York Slate Education Law, Copies of this survey map not bearing the land surveyor*s ink~ seal or embo.~.~ed seal shall not be considered to be a valid cop) person for whom the ~urvey is prepared, end on his behalf to lh~ hereon, and to the assignees of the Fending institution. Guarante~ or certifications are not transferable to additional Jp~tilufion~ ELEVATIONS ARE REF~ItENCED 1'0 AN A~SI, IMEi~ DATUM JOHN L.,~ ~ KATHLEEN MOORE ~ NO. aeeZ,FI~EO JUNE AT MATTIT~K T~N ~ ~OUTH~D ~B ~, ~ H. D. REF. ~~ the sewsge ~spos~l ~ud wster supply faci!i~es for this location have been inspected by this dcpart~ent and found %o be satisfactory. ~~ ~' Chief of General Engineering Services ° Unauthorized alteration or addition to this survey is a violation of section 7209 of the New York State Education Law. Copies of this survey map not bearing the land surveyor's inked seal or embossed secJ ~hall not be considc'ed Io be a vol~d copy. person ~or ,*,~om t!',e survey is prepared, and on his behalf to the title company, 9o~ernment~l agency ond lending institution [isled hereon, and to the assignees of the lending institution. Guaranlees or certifications are not transferable to additlonaJ institutions or ELEVATIONS ARE REFERENCED TO AN ASSUMED DATUM SURVEY FOR JOHN L.,JR. E~ KATHLEEN AT MATTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY~ N.Y. SCALE: 1";40' OCT. 8, 1972 MOORE R,~.FERENCE ' , MAP OF BENNETT S POND" FILE NO. 5483 , FILED dUNE t~lOIf ELEVATIONS ARE REFERENCED TO AN ASSUMED-DATUM,. SURVEY FOR JOHN L.;~IR. E~ KATH AT MATTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY~ N.Y. SCALE ~ 1"=40' OCT. 8, ~972 TO~ )?0 ' ,