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Home My WebLink About6098-zFORM NO. 4 TOV~N OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z. ~0~ ..... Date .......... ~ .... ~ ....... , 19 ~. THIS CERTIFIES that the building located at . .01e. ~Ll.e. ~ ............. Street Map No. ~ ......... Block ~To... x,~ ..... Lot No~13~... }ll~tt;~l~k...il e~.t ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ Sept .... 7 ...., 19.72 pursuant to which Building Permit No.60~Z... dated .......... 8el~.~... ~ .... , 197~., 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 .. l~A~v&t.e. ~ .fnm~]~y. d~ell~]~ ..................................... The certificate is issued to .. a,A.. iiO.e~i* ........ 0~ne~, ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .Mai*.... ~...197~..by. ~. ¥:L~la .... UNDERWRITERS CERTIFICATE No.. ]1..6~'7.9-3..J~n.. 10t .1973 ..................... HOUSE NUMBER.. 3~0~' ...... Street....0.]:.~...~'.~..~...~..~ZA~.. .............................. Building Inspector FORM NO. a 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 WORKAUTHORIZED) N? 6098 Z Permission is hereby granted to: .......... ~r~elm..~ ........................................... ............ I~:tamale ................................................... to B~t~ld..aa~..~.. t~tt~,.. ~:~t.~a~ ..................................................................................... at premises located at ...,~..~I~..L~M~ ........................................................................................ .................................................. ~&.~t£tl~k....~,~.,, .......................................................................... pursuant to application doted ................... a~t,....~. ................... , 19~l~..., and approved by the Building Inspector. a~T~(~T Fee $,8d~,..~0 ........... SUFFOLK COUNTY DEPARTMENT OF HEALTH Date ql3~~'~ 1-Applicant ~'%~'%' ~'~W~v,$~ C(~F Phone ~ ~_~-Sub div ~[ Address % 4 ~ ~ ~~ ~. 7-Section 2.Oetail~~~~~-Lot No. ~mlet ~WV~,, To~ · 9-Private well? 3-~blic ~ter supR1~ ~me ~ Distance to nearest ~in . 4-Lot S~ze: Wtdth~ ft. Lenst~ft. (al~ enter on center plot plan below.) 5-~ell~ng: Singl~ Family ~T~ily~ellar? ~lab? ~ f Crawl S~ce? lO-Pro~s~ system. Septic tank ~Pre~t ~Cesspools ~S~llow ~ols /~ther 11-Septic ta~ inside d~ensions: Volt, als. Length ft. W~dth f~. Liquid dept~ft. 12-Precast sections: ~Number/f/Sq~. Cesspools: Block sizeL mncs. D ins.~ins. Total blocks below inlet: ~1__~2__~3 ~ ~T P~N Ca.city. Gals. G.P.M. I0 APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval to construct said systems is requested,pertinent data herewith: ~ o Street The Undersigned CERTIFIES: Indi ate No bh "Construction of authorized installations will be in Data Feet ~'~f~ 0 ~ 6 8 l0 12 accordance with the Suffolk County Health De~rtments' current Standards, Bulletins, and amendments thereto, covering Private~__~e Disposal Systems". - Owner or I 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 Plot. Date .?/~X -- ( 10/65 Revis.) S-15 Signed APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS INSTRUCTIONS: Applications must be submitted in triplicate i-Means Owner or Builder. Address to ~ich mail should be directed. 2-Means detailed description of property location, together with street name and distance to nearest intersection of ~ain thorofare, also Hamlet/Village & Township 3-Enter 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 '~es" 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 PLOT 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, & Hays, etc., located within a distance of 50 feet of Applicant's Lot lines, must be shown on the plot plan aisc. 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 "Vacant" 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-40 feet minimum into ground water for well point Well-4 feet 6 ins,, minimum below grade to well head and lateral wat. er 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-10 feet mi~t,-~a 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 maximum of 2 feet Bottom of Cesspool to ground water must be held to minimum of 1 foot FOBM NO. 6 TOWN OF SOUTHOLD Building Deportment Town Clerks Office Southold, N. ¥. 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 dispcsal--(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. 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 dwelfing or land use 3. Copy of certificate of occupancy $I.00 $5.00 Date ...,~LqJ: F,,~t.. ~, ...~,.9.Z ~ ............. New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property .... .~.~.q...~1..u...~..e....[~a:.~..~.~....~.e~...t..t..~..t..~...c.~'....~..e....~.~ ...................................................... Owner Or Owners Of Property ....... ~.~...A..~......~-~....~..~...e..1........~a~.~...~..*.....A..?.....~..~.~..~..e.~. ....................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No...6...O~....8..2.. ....... Date Of Permit ....~..e.~..~..?..~..l.~h'~cant ....~..*...~..'...~.?...,.C~..l~..s..t..[.u...c..t..~..°.~......(~..~..? .... Health Dept. Approval ...~..-~..~.~. ........................... Labor Dept. Approval ................................................ Underwriters Approval ..... .1../...]...O./...7...3. ......................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Apphcant M.S.T. Oonst~,.u. ctz.o.n Sworn to before me this ............ d ~ o'. ............. :....-C~.~....~. ..... (stamp or seal) Notary Public ..."~a~a~-~L- County TERRI LEE ELAK PUBLIC, State of New York No. 52-6t 69295 Ti{ie N0'07- 63501 POO/ lOCATIONS OLE uOL NOTE I~MONUMENT S OnK COUN ~he sewage disposal and water supply facilities for %his location have been inspected by this depar%men~ ~d fo~d to be sati~i'actor~~~. Chief of General Engiaeeri~ Services .EV,S,ONS YOUNG & YOUNG AUG.3i,1972 400 OSTRANDER AVENUE, RIVERHE~r~, NEW NOV. ,4,1972 ALDEN W. YOUNG G PROFESSIONAl. ENGINEER AND AT M AT T I T U C K TOWN OF GUARA~EED ~IVI~ION OF SOUTHOLD aMEmC~N TITLE INSURANCE CO. SUFFOLK CO., N.Y. SCALE: 1111401 IDATE:oCT. 22.1971 W0~1_64~ TOWN OF $OUTHOLD ~/,~/~ ~ BUILDING DEPARTMENT~ 7ow CL.K'S SOU~OLD, N. Y. ~ ........ - 19.~.... ~ ~ /. ~ppli~ation No ................................. Examined ~pr~ed ...................... ~ ................ , 19 ........ Pemit No....~..~..~..~....~....~q,~ Di~pproved a/c .~ ....... ~ .... ~. ~,~ ................................................................................ .................................... ~ 0 , I' ' ~ Date ...................... .~ ........ INSTRUCTIONS a. This application must ~ completely filled in by ty~writer or in ink and submitted in triplicate to the Building Inspector, 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 ~o adjoining premises or pub c streets or areas, an~ giving a detailed description of layout of pro~rW must be drawn on diagram which is part of this application. c. The work ~vered by this application may not be commen~d ~fore issuan~ of Building Permit. d. U~n approval of this application, the Building Ins~ctor will issue a Building Permit to the applicant. Such ~mit shall be kept the premises available for ins~ction throughout the work. e. No building shall ~ occupied or used in whole or in pa~ for any purpo~ whatever until a Ce~ificete of Occupan~ shall have ~e~ gran~ by the Building Ins~ctor. 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, Suffotk Count,/, 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 adm!t authorized inspectors on premises and in buildings for necessary inspections. M.S.T. Construction Corp (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder; ........................................................ .c...o. ko..r. ................................................................... ............... Name of owner of premises ....... .~.,A .~O~f~. ..... .~ 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.: ,....,,~[~,, ........... Lot No ....... ~ .................................. Street and Number ...... ,0,~,.?...~.,~,~.e....~,~,,e, .......... ~;~.~.:~,~,~,~....~[.~T.^~... ............... ~ .............. i ........................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a, Existing use and occupancy ...... ,¥~,~.~;~1;.,~,~.d, ................................................................................................... b. Intended use and occupancy ......... ~_~..~m,LZ. Sr,,~.t,~:p., ............................................................................. 3. Nature of work (check which applicable): New Building ~ Addition Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost ........ ~.Q,.Q(~).. + ................... Fee ...~.Q,RO ................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... .o...~..e. ..... Number of dwelling units on each floor ......................................... If garage, number of cars ..... ~;~.e ................................................................................................................................ 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: Front ..... [/.l~,.br. .......... Rear ..~._.~ ................. Depth .....].,~.../...~.~ ............ Height ................................................. Number of Stories ...~f~ ............................................................................... 9. Size of lot: Front ....1..?.,~. ........................... Rear ........ .~.?.8 ........................... Depth ...J,2_~ ......................................... Height .................................................... Number of Stories ................................................................................., .... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated ...... t.~.~.~.~...~,~.A.~. ............................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ................. Z3.o. ...................................... 13. Will lot be regraded ~r.~.~ ......................Will excess fill be removed from premises: [ ] Yes [ ~ No 14. Name of Owner of premises ....~.,~,.o...?T-~3.e,~' ......................................................................................................... (Address) (Phone No.) Name of ar~h;t~t . ~sOntOS }.~;zneQ~a ....... (Address} (Phone No.) Name of Contractor .....],;.,.9.~,~...~.O~.~...P~c~.p .......................... ~,.zz~e.o,~, .................... (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proPosed, and indicate all set-back dimensions from properW 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 plan STATE OF NEW YORK, ) SS COUNTY OF ................ ~.IL~D]...I~ .................. ). ........................................... .~;[.'.~....~.S..~)~.~.~ ................................... being duly sworn, deposes and says that he is the applicant above named. (Name of in[tividual signing contract) , He is the ........................................................ .C.Q~.+o~'.~.¢.~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 statements contained in this application are true to the best ofi~j~[t~e and belief; and that the work will be performed in the manner set forth in the application filed therewith. NOTARY PUBLIC, State of New York ~ , No. ~Z,~-6~t 68295 "~ . ~ Quallfi~[ i~'l'l'l'l'l'l'l'l'~ County,, ~ .................................. /..day o, .......... .--._..J~ ................... ~em~si~r~ U-Wa..~, ~,,,~j~A ~ Notar Public ~ ~~ounty ~,~/ (Signature of applicant} .9¸ q"TPe.~P