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Home My WebLink About6204-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z...~'.0..O .~'. Date f.a~ ! ~ ") .~ THIS CERTIFIES that the building located at ~ ~ ~ ~ ~ o o ~ ~ ~ Street Map No.~?.~.~lock No ........... Lot No. ~ ~ ~ ~ '~ ~o ~ r conforms substanti~ly to the Application for Build~g Permit heretofore filed in t~s office dated ~ C ~ / 7 ~ ~ ...................... , 19 .... p~suant to which Building Pemit No. ~.~ .q~. ~ ~e~ ..... '.' ....... ~.7 ...... , ~9~, ~ ~s~, .~ ~o.fo=~ to ~n of the ~.e- ments of the applicable provisions of the law. The occupancy for which this-certificate is issuedis ~.~1~~- O~/[~'A~lc.~[ ,~/~/-~l/JG The certificate is issued to 6~ 5 ~ ~ ~ z~ ~ ~ '~ (owner, lessee or tenant) of the afores&d b~ld~g. ~ ~ /~ ~3 .~Z ~ fit Suffolk Co~ty Department of Health Approv~ ·. · . .~/~ UNDERWRITERS CERTIFICATE No ................................................. ~OUS~ NUMBER.~.O.~ ...... Street...~.~.~ ~. ~.~...~.~.' ......................... ... ~.[... Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 620~ Z Permission is hereby granted to: ...... ..C..~.~.~.~...~....CC...?'.~.~..~.~.~.. FAIr, IL'( ~...~I.;LI. at premises located at ............................................................................................................................ ....................................... ~ ......... ~ ................................................................................ ~ .......................... pu~uant to application dated ................................................................ , and approv~ by t~e Building Inspector. Fee $...?.....~..... ~. ~~... -~/'/~/~/ Building Inspector TOWN OF SOUTHOLD~ IUILDING DEPARTMENT TO~N CLERK'S OFFICE ~f~ ~UTHOLD, N. Y. Examined ....................................... . ........ ~proved ................. ~.2...~ 19~.~Pemit No ..... ~.~..~..~..~.~ ~ Di~pproved a/c ............. '~ .......... ~- ~..........~..,...~ ................................. ~ ....................................................................................................................... ................... (Building Insp~tor) APPLICATIO~ 'FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, witt~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Pict plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, an~[l~ 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 on the premises available for inspection throughout the~work. . I-/ e. No building shall be occupied 6P [J~e~d iff'Wh61'~ of in part'fbr any ~url3d'se f" ' ' ' Whatev~r unt a Cart f cate of Occupancy shall have bee 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~ Ordinance of the Town of Southold, Suffolk County, New York, and other applicable LAwS, Ordinances or Regulations, for the construction df 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· (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; Name of owner of premises ...{JJj~.J~j..~..aJllj..J~..J~.il~..~la~jll~ .............................................................. 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 ............ ~ ............................. Strut and Numar ............. ~..~ ........................................................ ~ ' ~ .............. : .............. ~- ~unicipaliW 2. Sta~ exi~ing u~ and occupancy of premiss and intended u~ and ~cupancy of pro,md con~mction: a. Existing u~ and ~cupancy ...; ......... ~ ........................................................................................................ b. Intended u~ and o~upancy ........... ~ ................................................................................................. · 3. Natureofwork(checkwhichapplicable): NewBuilding ....... ...~... .......... Addition..... ................ 4Iteration ............... Repair ......................... R6moval., ....................... Demolition ........................ Other Work ......~,[,..., ....................... · ~.D)scription ) O 4. Estima~d Co~ ........... ~E~ ............ F, YV' (to be paid on filing this application) 5. If d~lling, numar of d~lling uni~ ........ ~. ...... Numar of ~elling uni~ on e~h floor ......................................... If ~ra~, numar of cars ............................................................................................................................................ 6. If busine~, commercial or mixed ~cupanw, s~cify na~m and extent of e~h Wpe of u~ ..................................... Fr~ ................ [~ ..........................Depth ................................... 7. Dimensions of exi~ing ~mc~r~, if any: ~ ...... , ~ ~ Height ........................................................... Numar of Stories ..................... ~ ..................................................... Dimensions of ~me ~ructure with alterations or additions: Front .......................... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front ..... ...4~...e....~...~... Rear ....... .~...8..~. .............. Depth ..... .~...~..I. ..................... Height ................................................. Number of Stories ...................................................................................... I 9. Size of or' Front. /4?: ...;~le'... Rear ............... ~..,/,,,,--~'~ ...... Depth ...~.,&..~..t. ...................................... Height .................. ~. ............................... Number of Stories ................................................................................... 10. Date of Purchase .......................... Name of Former Owner ..... ~..~......~..~ ..................... ...... Iai ... 11. Zone or use district in which premises are s~tuated ...................................................... a~liltt,,~Jl~ ...................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............ ..~?.. .......................................... 13. Will lot be regraded ..... .~...~.. ....................... Will excess fill be removed from premises: [ ] Yes [~No 14. Name of Owner of premises (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor (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 indicat ~heth- er interior or c~ STATE OF NEW Y COUNTY OF .............. ~l..l~'~l k, I ................................................ ~,.,~ ..................................................... oe~ng ou~y sworn, deposes and says that he is the applicant above named. (Name of individual signing contract) He is tha ................................................................................................................................................................................................................. ~ {Contractor, agent, corporate officer, etc.} of said owner or owners, and is duly authorized to perform or have Jae~ormee~the said work and to make and file this application; that all statements contained in this application are true to the best O~ I~,~'l~.'qwl~l~a~d .belief; and that the work will be performed in the manner set forth in the application filed therew,th. .~ ,~G,5~o ~ --: ................... SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference No. ~0 - 12 I/ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE 1. ApplicantGhaX'le' ~1 Phone Address ~ 2. Property location SEWAGE DISPOSAL SYSTEM 5. Subdiv. ~m~tSl'~ S~O~I 6. Section ~&~ 7. Lot No. ~ 8. Private well :_ Village ~reempe~$ Township ~4;~l~Al .~,. Public water -?,~-,%r%: 3. Public Wate~r CompaD~_name D!sta~c~ ~0.~n ~ ~- ' Lot size: Width A~ feet ' A~ f~et~(Enter on center p-Iot ~f~)~. -~ - 4. Length -- " ~" '"~ ~ ,~' ' 10. Sewage Dispos~ystem: ~ A. ~p0~gallon septic tank: Precast- Equivalent Block' ~, B. ~ching pools: Number ~reca~Block Special .. The undersigned be in accordance with ards thereto." Amount of ter in well Test Hole/' ~'~ ' Data , ,Feet 0 2 4 6 8 10 12 14 16 18 If private well fill in blanks b~low: Tank ca~y . Gals. ~//ta~'(w:ll de~thf ~ Depth :ERTIFIES: "Construction of authorized installations will the Suffolk County Department of Health's current stand- Date 00~ ~4, l~8 Signed Own[r. or Builder FOR HEALTH'DEPARTMENT USE ONLY, Ba~e~ on the informatio~resented herewith, it is the opinion of the ~ealth Department, that an adequate ~hd satisfactory Sewage Disposal Date System can be inst%lled on thim~-plot ~ ~.,~ / · ~, --- Signed[ S-15 Revised 4/]/7~ APPLTCATION FOR APPROVAL TO CONSTRUCT PRIVATE S~WAGE 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 .s-treet name and distance to nearest intersection of main thoroughfare, also Hamlet/V~ittage-& ~e~nship. 3-£nter name of Public Water Supply District, together with the distance to their min. h-Enter Length and Width of Lot under appropriate heading, also enter these dimensions on center plot plan shown on the face of this applicati°n. 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 'No', otherwise. PROPOSED SYSTEN£: 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: 1. 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 shm*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. 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. Where no buildings exist on adjacent lots, state "Vacant" on the plot plan. Streets adjoining applicant's lot to the right, left or~e~r~ 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. Well- 25 feet distance from rear and rear sides of property lines when possible. Well- l0 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. C~SSPOOL LOCATION: Upon determination of the Sewage & Waste Disposal "t~pe of systems" re- quired, the following Standards must be observed for the location of sams: 1-Cesspool- 5 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-Cesspool exterior must be lO feet from house foundation.. 6-Cesspool exterior must b~ 100 feet minimum distance from surface waters, streams, lakes, & Bays, etc. 7-Cesspoo!s ~st be 20 feet minimum distance from large trees. 8-Cesspool 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 ~xst be held to minimum of 2 feet. ~ = ~o~ p,p~ '73 F£~ 8 ~8 //:Z7 ,~T ~REEN,~OR 7~ /~. ~. SUFFOLK COUI~TY HEALTH DEPARTNFENT ~ATE F£8 8 ~973 .. ~. ~. ~_/~/~ f~ ties for ~his location have been inspected b~ t!:~n department and found to be satisfactory. Chief of General Engineering J/ l DO NOI' SCALE ,,'71-', NOTE DO NOT SC.-%E DWG. ~ DI~ffN,.iOr . ~ FAIBFIELD .... ~//zv pTz NOTE ',~' ,NOr FAIRFIELD 14OME5 ,0,', P,. =, , ',.,..T FAIRFIELD, COhiN I'-O