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HomeMy WebLinkAbout6208-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. UPDATED CERTIFICATE OF OCCUPANCY No Z-22488 Date JULY 30~ 1993 THIS CERTIFIES that the buildinq Location of Property 1280 LESLIES ROAD House No. County Tax Map No. 1000 Section 98 Subdivision DWELLING CUTCHOGu~: ~ N.Y. Street Hamlet Block 1 Lot 4 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 18~ 1972 pursuant to which 8717-Z & Building Permit No. 6208Z-Z dated OCTOBER 30~ 1971 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ONE FAMILY DW~rJ.INGWITHAT~ACM~O GARAGEr WOOD DECK & PATIO The certificate is issued to of the aforesaid building. DANIEL C. DAVIS & ANO SUFFOLK COUNTYDEPARTMENT OF HEALTH APPROVAL MAY 24r 1973 by R. VILLA UNDERWRITERS CERTIFICATE NO. JUNE 4~ 1973 BY J. KUBACKI PLUMBERS CERTIFICATION DATED N/A *NOTE: THIS CO UPDATES CO Z-5206 DA~ED 6/18/73 FOR NEW D~r~.ING & CO Z-7364 DATED JULY 1976 FOR DECF~-ADDITION & P~. ~ ~lding Inspector Rev. 1/81 FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 6208 Permission is hereby grog/led to: ~o ....... ~~......¥~::: ............... iiii'.~iiiiiill ........................................ pursuant to application dated ............... ~.~.~. ................. , 1~....'~....., and approved by the Building Inspector. t~uilding nspector f FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Sonthold, N. Y. Certificate Of Occupancy No..Z~06 ..... Date ............. .~.~.~...i8 ..... , 1973.. THIS CERTIFIES that the building located at . .15~8...L~sL~O. ROI~ ....... Street Map NoB~/.Hol~a8.. Block No ........... Lot No...9....~.ll~;Ob, Og'll~...!~,~ ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ ~,11~.. 1.8., 197~.. pursuant to which Building Permit No.6208~... dated .............. 0~11.. 30., 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 . .P.l'.l.v&.~.~.. 011~..I'..a~..~.y..~.w.~.l..1.t.llg. ...................................... The certificate is issued to . (}Lallsen .COI~St;rll¢.tg],OII. ~.orll... 01~laOl' ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval · l°lay... ~...i 9~3 ..bY..R,. ¥:Lll& .... UNDERWRITERS CERTIFICATE No~'l]ll~..~..I~...by. ~....][llb&~l ................... ttOUSE NUMBER...~8l~ ..... Street.. l~lll$1to..l~O~td .................................. SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference No. ~O--;~C~'! ! APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM A~lican~ ~5£~/ ~'~[dS~f Phone~Y~ 1. ~ ., , ~ ....... ,, · . Subdiv. ~/ '~/~ Address ~ .., · ~ - Section 2. Property location ~"~o ~ 7. Lot No. 8. Private well Village ~/c~ Township. ~F$~ 9. Public water 3. Public Water Company_name Distance to main 4. Lot size: Width /~$ feet Length MJ~ feet (Enter on center plot below) 10. Sewage Disposal System: A. 900 gallon septic tank: Precast /Equivalent Block B. Leaching pools: Number~Precast ~Block Special -- Street If private well fill in blanks below: Tank capacity ~/~Gals. Pump G.P.M. ~ Total well depth ~ Depth to G.W. ~ Amount of watt. in -well Test Hole Data Feet 0 2 4 6 8 10 12 14 16 18 The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current stand- ards thereto." Date '~/~-~ Signed ~, ¢ ~~-'~,. ~ Owner or Builder FOR HEALTH DEPARTMENT USE ONLY. ~.s~ho:a~P~;si~mO~anth~e~H~:~hal~ee~a:ntm~ ;~.an adj~quate and~-~actory Date /~/~//~ ~-~ Signed Based on the information presented herewith, it Sewage S-15 Revised 4/]/72 APPLICATION 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 street name and distance to nearest intersection of ma~n thoroughfare, also Hamlet/Village & Township. 3-£nter 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 'No" otherwise. PROPOSED SYSTEm. S: 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 infor~mtion is required concerning the Applicant's lot: 1.~ 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 1OO feet of Applicant's lot lines, must be shown on the plot plan also. 3. ~Jells 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. ~Jhere 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-lOC feet minimum distance from the nearest cesspools. ~ell- 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 LOC~TION: Upon determination of the Sewage & Waste Disposal "tjqoe 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 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 10 feet from house foundatie~.. 6-Cesspool exterior must be 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 ~st be held to minimum of 2 feet. Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FORCERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and '.'pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2.. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees i. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. ' 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $I0.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 .. NewConstruction ........... Old Or Pge-existing Buil~ing......~.. ........ ; . House No. Street 'H~mlet x County Tax Map No I000, Section .......... Block .............. Lot..~ ........... Subdivision Filed Map Lot Health Dept. Approval ......... guderwriters Approval Planning Board. Approval ........... . . Request for: Temporary Certificate ........... Final Certicate .... Fee Submitted: $ .... ~,..~.. ................ APPLICANT' ' · TO~I~ OF SOUTHOLD Building Depmtment Town Cledr~ 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: 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 dlspcsal--(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 "pm-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 New Building .................... Old or Pre-existing Building ...... ~...-~. ............ Vacant Land ............................ Locaton Of Property ...~...~...~...././.~.~....~....~... .............. ...~.......~.../.....~.~...~...~.~. ......................................... Owner Or Owners Of Pro ert (~ 4 .~.../~.. ~ .~.....~.. ~_~/I/~' ~ C'~O~:) ...... Subdivision ............-~....~..~....~.../~.....~....~.. ..................... Lot No.....~....... Block No ............ House No ............. Permit No....~,.,,C~...~,... Date Pe Of rmit .................. ~pphcant ......................................... ~. ................ ~... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval ....... ~ ............................ Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......~ ...................... Fee Submitted $ ....... .~2~./~.. .............. Construction on above described building and per~-~ meets~d~,~q~licable codes and regulations. Applicant ........ Sworn to before me .......... ~.~da of ...~ ....................... (stamp or seal) N~a~ Public ~~... Coun~ T~..RR1 LEE ~ PUBLIC. State o! New York RCV BY:Xerox Tele¢0Dier 7020 ; 7-2!-93 ; ~£RTIF~£D TO: TITLE No, RN-93-1192 8RIDG[HAMPTON NATIONAL ~NK TODO ~LONO ~AND~ D~LONG /. SURVEY OF T,OT 9 ' MAP OF BAY HOMES ~'ILL No, 5723 F~L£D JUN~ 2, ~972 .~ITUA I'ED A T PECONIC TOWN OF SOUTHOLD UFFOLK COUNTY, NEW YORK 5.C. TAX No. 1000-98-01-04 SCAL~ I"-= 30' JULY 15, 199~ CCITT LESLIE'S ROAD N 52'5,5'30" E 155,00' $ 53'29'00" W 141.23' Joseph A. Ingegno Land Surveyor 93 -2~ TOWN OF SOUTHOLD /,J,~.--- V'..~,,(- ~ .~ "~.._~ BUILDING DEPARTMENT /, ,~. ~ TOWN CLERK'S oFFICE ~/I7~ ~-?' SOUTHOLD, N. Y. ..... ~...~..~ ................... ~ I ........ ~p~ ................ ....................................................... , ......................... ~ ........... ~ -~~ .............................. ............................ BUILDING ,E~IT / Date~ Z ~ ..... ~ ................... , .............. . INSTRU~IONS a. This applicoti~ must be completely fill~ in by ~pewriter or in ink and submi~ed in dupl~ote to the Building Inspector. b. Plot plan showing I~ation of lot and of buildi~s on praises, relationship to adjoining premises or public stree~ or areas, ~ giving a detailed de~ription of !ayo~ ofpr~e~ must be drawn on the diagram which is ~ of this applJcati~. c. The work covered by ~is a~licati~ may not be commenced before issuance of Bu ding Permit. d. Upan appraval of this applicoti~n, the Building Ins~tor will issue a Building Permit to the appl~t. ~h ~rmit shall be kept ~ the premises available for insp~tion th~ghout the pr~mss of the work. e. No building shall be ~cupied or used in whole or in part for ony pumose whatever until a Ce~ificate of ~cupan~ shall have been granted by the Building Ins~tor. APPLICATION IS HEREBY MAOE 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 al{.applicable laws, ordinances, building code, housing cede, and regulations. (S,gnature of apphcant, or name, if a corp6ration) ............................ ~'x~'~;';'~"~ii~'6~' ............... ~-~"' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premiSes ....................................................................... p. ............................................ a~a corpo~e,~ignature of du, l~authorized officer. ~,~ If ....... ~ .-,~..~ ~,~......,~.~..... (~ame and title of corporate officer) p 1. locat~on of land on which proposed, work wdLbe don ....... .~. ....... Lat No. ................ s~reet and Number ...X.~...~,~./.~.~ ~ .~..~.. ~ ~ Municipali~~''~ ........................... State existing use and ~cupancy of prem~s and intended use ~d ~cup~cy of pr~d c~ti~: a ~s tng use a~ ~cupancy~~~ . ......... ': "~ ':'"~'~' ': ....... 7 .......... ]~ ...................... ~ ................................. l. ~//,' ........ .............. .................................................. 4. 5. 6. 10. 11. 12. 13. property lines. Give ~reet ond whether interioir or ~ lot, Nature of work-(check which applicable): New 'Building ...... Addition .................. Alterotign ................. ....... Repair .................. Removal .................. Demolition ....... 'iL ......... Other Work (Describe) ................ .~,. J Estimated Cost .. ~..~_~..~.C.....'Z:.. ....................Fee ...~...~.:.../...~.. ...................................................................... (to be paid on filing this application) If dwelling, number of dwelling units ...... /.. .................. Number of dwelling units on each floor ............................ If garage, number of cars .................. /. ........................................................................................................................ If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 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 ................................ Dimensions of entire new construction: Front ........ ..~..,...':. ................ Rear ..../.~..'... ............. Depth ...'.~.425 .............. Height ...../..~,..-. ...... Number of Stories ........ /. ........................................................................................................... Size of lot: Front ...... /...~;~...~.. ......... Rear .....~..Z.i,.T. .................... Depth ....~..~_~ ................. Date of Purchase ...... .~--e~,~..../.. ...... .-~2...~, ................. Name of Former Owner ..~......~..~..~...~.,~,~ Zone Or u ~ strict i whidh rem ses are s tuated ..... ~' ..... .s~ !~which p .............. .//1~ ~.~ ..~ ...................................................... Does proposed construction violate any zoning law, ordinance or regulation? ......... ,xi./~ ........................................ Name of Owner of premises~'.//~/~4...~_.-.,/~...~.~:./a/.~d~re~ ~.g~.p ................................ Phone No...~ .................. N~me of Architect ..~..S~..~..~..../......~..<[.c/~../..~_.../~e~.~/..,~,..~;/~/~.,,~./:~ Phone Name of Contractor .................................................... Address .......................................... Phor~jh~a.~.~.~..~.~.~:a- PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck dime~ions from block number or description according to deed, and shew street names ~nd indicate t I-- STATE, OF NEW YORK, . t COUNTY OF ........................ :. ...... ~'~'~ ...................... ~'~.~....~a~at~.~.~...~..~ ....... ', ........ L....being duly sworn, deposes and says that he is the applicant (Name 6~ individual signing application) above named.' He i~ the/a~..~..,~ ........ ---- -- ~'~ ~__a~/~..e~.....~..~...~......~Lra~.~'...~...~........~..~',~ ................................... ~ · (Contractor, agent, corl~or6te 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 contoined 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 therewith. Sworn to before me this .......... of ............... , Notary Public, . .................... '?~l(l~l'L~t'tT~l~ .................... County //' (Signature of applicanf) HOTARY PUBLIC, State of New No. 52-6].68295 (~ua[ified in Su[tolk County Commission Expires March 30, ].9 NO TE' REVI~IO'~ YOUNG & YOUNG MAYI7~J973 400 OSYRANDER AVENUE, RIVEEHEAD~ NEW YORK ALDEN W. YOUNG HOWAREI W YOUNG CNA ~L ES LOT NO 9, "BAY HO~ PECONI C .ow. o~ SOUTHOLD r~r~~ -- ,I '