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Home My WebLink About6194-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southolcl, N. Y. Certificate Of Occupancy No. Z..~.0..~.~ ..... Date ............. l~l~,. ....~. ....., 19 ?3. THIS CERTIFIES that the building located at ..Wtgkha~ &. Fl'~e~ ..... Street Map No. Qa:l~ ~ .H~;$. Block No ........... Lot No... 3.~..~.0. ..... l~J;.!$~.l~k..' ~I~.Y. ~.. conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. 5epfc ..'~, 19 ~. pursuant to which Building Permit No. 6] 9!+Z .. dated ........... . .(~.~...2~..., 19 ?.2.., 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 ........ pr.~.v.a.'~e.. 9~e...f.a.~.~..~y..d.w.e.~ $.~.n.g ................................ The certificate is issued to ...Rich.~rd..&..ar~.~..Dl~l~e .... , .~.e.~$ ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval F~b. 20..~973...by. ~,. ¥1lffl,J~ ....... UNDERWRITERS CERTIFICATE No..~.. 7.1.9.e9... ?.~..'9...9....l 9.7.3. ...................... [lOUSE NUMBER ....... 6~ ....Street...P..reeman. ?~ .................................. 1760 Wt~lr~am Ave Building Inspector / FOBM NO. 2 TOWN OF $OUTHOLD 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) 619 Z Permission is hereby granted to: .~...~.,,.~.:...~...m~...~...~..,e.,~.o..n....O..~......A.,,,~,....~.~.elm~l, & Ma,.Se Dz~Me ............. ~ .C.-~.... ,~.e..~. ,, ,~,.... ~; ~, ............................ .................... ~e~la .......................................... to .2~t.t&..new..~e~e .. ~4mAt~..~e~l-~ --~.~ .................................................................................... at premises located at ...~,e~..~&r..,~9,...i~O....Garde,~.Jita ....................................................... ......................................... .~mkhe~..A~e~..~..F'~.e~r...~cad ............. ~.~i.t~k ................. pursuant to application dated ..........................O~t, ......... ~ ........ , 19..~., and approved by the Building Inspector. Fee $..~-~e~ ......... FOlt~ NO. ~ TOWN OF ~OUTHOLD Building Deparlment Town Clerk~ Office Southold, 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: i. 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 end 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 3. Copy of certificate of occupancy $1.00 $5.00 Ma~ch $~ 1973 Date ........... New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property .................. ........ Owner Or Owners Of Property ....... .R..~..c..h...a..:...d....~.....M...a...:..~.e.....~...:.~..e. ............................................................. Subdivision ....~..a:.~.d....e..~....~...e.~F~.~.~..s. ........................... Lot No.3..8..~..3..9...EBI¢l~l~:~..o...~....4...0. House No ............. Permit No...6.:1:.9...4...2. ....... Dote Of Permit ~..O./...2..4./..T..2..Applicant ..M....~....T..?......(~...~..,s..t.z..u...c..t.~..o..~......C?...:..p... .... Health Dept. Approval ....2./..2...0/...7..3. ......................... Labor Dept. Approval ................................................ Underwriters Approval .... .~..9./..T..~. ........................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all appl. icable Applicant ..,M.?.~..%...T..?.........~...~...~.~ ~,~ ~..~...1..°..~.....~...[P.~~ Sworn to before me this ~,,~A~' /~,~ Notary Publlc~-~.~~ County TERRI LEE ELAK PUBLIC, State of Hew Y~l~ No. 52-6168295 Q#~tKied ,~ ~ffc[~ County gemmiss[on [x;~,: ,,~ ~ 30, 19~~/ (Stamp or seal) ; SUFFOLK COUNTY DEPAKTHENT OF HEALTH APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date Approval to construct said systems is requested,pertinent data herewith: 2-Detailed property location ~a ~.~- ~¢~( 8-Lot No.~ 3-~blic ~ter ~pply ~me ~ ~ Distance to nearest ~in ~ $ 4-Lot Size: Width ~ ft. Len~th~ ft. (almo enter on center plot plan below:) 5-~elli~: Single Family ~T~ Family? ~ellar? ~ Slab? ~ Crawl S~ce? ~ ~ 10-Pro~s~ system: Septic ~nk ~ fPrec~t ~Cess~ols ~ YS?llow ~ols Y YOther / / il-Septic ~ insi~e~mensions} Vol~e~Gals,Length. ft, Wmdth ft. Liquid depth ft. 12-~ecast sections. ~Number~Sq~re Ft. Cess~ols. Block sizeL incs.~s.H ins. Total blocks below inlet: ~1~2 ~3~ PLOT PLAN H.D.Reference No ~ </~/~ The Undersigned CERTIF~S: Data ~eet ~ ' 0 ~ 2 6 10 12 "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Dis al S stems". Owne~ ~.~ Builder FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it %s the opinion of the Health Department, that an adequate and satisfactory Sewage Disposal System can be installed on this Plot. ( o/65 Hevis.) S-15 Signed 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 thorofare, 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-Dwellings: Check-mark "V" items applicable to the proposed new dwelling. 6-Name of sub-division ?-Section N~mber 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, & i2 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 Pbols 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, & Bays, etc., located within a d~.stance of 50 feet of Applicant's Lot lines, must be shown on the plot plan aIso. 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 propSrty 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 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-10 feet min~w, zm 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 of 5df f0I1~ L.Ot \ .-'~Lot ~8 6 THE ASSIGNL[$ CF TH~ LENDINg SUFFOLK C0UN2[~EALTH DEFART~ENT FEB 2 0 197 DATE~7. D. REF. ~7~ ~O ,The sewage d~s~'and water supply facilities for thl~ ~cation have been inspected by this de ~nt and found Chief of aneral Engineering Services ttO rE : · --MONUMENT StY~OI~II$ION MAP F/LED/N THE OFFICE OF rk~E" QL~ OF.~I.,FFOLK co&wrY' ON REV,S,ONS YOUNG & YOUNG NOV. 28,1972 400 OSTRANDER AVENUE, RIVERHEAO, NEW YORK i FEB. 8,1975 ALDEN W. YOUNG HOWARD W. YOUNG ! FEB. 15, 1973 PROFEgSlONAL ENGINEER AND LAND SURVEYOR SURVEY FOR: RICHARD DRAKE a MARIE DRAKE LOT NOS. 58,39 8, PART OF LOT "GARDEN HEIGHTS" GUAI ~ -~"H~ D ~V~ AT MATTITUCK SOU1 t~ ~EUL~ ~ ~ DIETZGEN 135 11846 \ C;our~ty suffoI1( of bo ~ 4.0 \ bot \ \ \ \ Lot ~6 A .EWS~ONS YOUNG & YOUNG " 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W, YOUNG SURVEY FOR: RIC. HARD DRAKE & MARIE DRAKE ~ LOT NOS. 38,39 & PART OF LOT I~. ;~/~ ~-~.. 'b~. ^T MATTITUCK G' ~a~tN~,, "lei TOWN OF '~ TOWN OF SOUTHOLD BUILDING DEPARTMENT~ ~LD, N. Y. Exomin~ ...... ~ ....... ~.~ ......... , 19....2b - ' ' Application No .............. ~... .............. ~LI:*710N FOi lUlLIlN~ PIR~I7 _ September 7 19....~..~ uote ................................................ IN5TRU~IONS ~. Thi~ application mu*t ~ completol~ filled in b~ t~wri~r or in ink ~nd ~ubmi~d in triplicat~ to th~ Buildinfl In~pector~ 3 ~*t~ of plan~, aceur~t~ ~lot ~lan to ~cal~. Fe~ aecordin~ t° ~eh~dul~. b. ~lot plan ~ho~in~ location of lot and of buildinfl~ on ~remi~*~, r*lation~hip to adioinin~ fli~in~ a d~tail~d d~*cription of la,out of ~ro~rt~ mu~t be drawn on diagram which ~. Th~ work co~ered b~ this application ma~ not ~ commenced b~for* i*~uane~ o~ Buildin~ P*rmit. d. ~on approval of this a~lieation, the ~uildin~ Imp~ctor will i~*ue a Buildin~ Permit to the applicant. Such ~rmit ~hall be th~ pr~mi*~ *~ilabl~ for in~etion throughout th~ work. ~. ~o bu,ldin~ *hall ~ oeeu~i*d or umd in whol* or in ~art ,or ~n~ ~urpo~e w~to~er~until a ~rtifieat~ of ~rant~d b~ th~ Buildin~ In~etor. ~PPklC~TIO~ IS Hfi~fiBY M~Dfi to th* Buildin~ D~a~m~nt for th~ Ordinanc~ of the Town of ~ulhold~ Suffot~ ~unt~, ~ow York, and o~r buildings, addition~ or alt0rations, or for r~mo~al or demolition, a~ h,r,in d~erib*d. ordinanm~, buildin~ code, hou*in~ eodo, and r~ulation*, and to admit authorized in~octor~ on pr~mi~*~ and in building* for n~e**~ar~ in*~ection~. 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~ ........................................................ ~z;~.to~ ................................................................................................................. Name of owner of premises ~;L~.~.~.~.~...~;...~::~fi..~.~.~ .............................................................................................. 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.: ..~.~!~fiI~..~t~$ .......... L~ts..~.~...~.9~....~0 ~ckham ~ve ~ Freem~n Rd ~.~o. tt tuc Street and Number .................................................................................. ;L. ....... ~.. ....................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy vacant land b. Intended use and occupancy ............ ~.~...~.~:;LL3.,'~...C~e~L~g ................................................... ,~..._. ................ ~l..-Ji~l, ture of work (check which applicable): New Building ..~ ............ Addition ..................... Alteration......:....;~. Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) Fee '~ ~ ° (J*~:) . . 4. Estimated Cost ............ ~....--,+ ............ ~ ................................................................................ (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 ..........~.~Q ....................................................................................................... 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 ........ ~ ........ Rear ....4~-~ .............. Depth ..~)~Jll~)~, ............. Height ................................................. Number of Stories .Jc).T~ ........................................... ~ ..................................... 9. Size of lot: Front ...................................... Rear .......................................... Depth .................................................. Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ "k" dist 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ~ ................................................. 13. Will lot be regraded .... ~o ..................... Will excess fill be removed from premises: [ ] Yes iX] No 14. Name of Owner of premises ..... .~.J,.c.~.~.~.~.....~..T.~....~..~.~.J,~'.Q ................................................................................... (Address) (Phone No.) Name of Architect ............. S.~..~,~oEt. ir, o~. ............................ !~[.~.~..e...o..~...a.. ................................................................... (Address) (Phone No.) Name of Contractor ........ ;~6,~.,.~..,..~.t...C~)~'~ .............................. ~..~..e..°..~..e;.......~.~.t.~.'. ..................................... z~ (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildi~ge, 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. STATE OF NE~ ) ~T~'0]_~ COUNTY OF ......................................................) SS ..................................... [~[.,...~.E.oD..~O.~ ......................................... being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract} He is the .................................................. ..C..O~.~.~.~.Q.~.Q~ ................................................................................................................................... {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 b~.~l~fL~iEs~wledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. J~0TARY PUBUC, State of New r~ignature of applicant}