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Home My WebLink About6209-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~z~07 ...... Date ............ $111~0...18 ...... , 1973.. THIS CERTIFIES that the building located at . .S/8..Lesl~.® .Roa4 ........ Street Map No. l~y. Homes. Block No ........... Lot No. 6 ...... C~tehogue...NoY., ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ O~t.. 2~., 1972.. pursuant to which Building Permit No.6209Z.. dated ........... 0~t....~0.., 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~a~e. o~e. £ui1¥. dwellinI ..................................... The certificate is issued to . C .la,lien .¢on~truc.t~,on. C~ ......... O~lel' .......... of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant) June.. ~8.1973 · .by. ~R.. ¥111a ..... UNDERWRITERS CERTIFICATE No ....,Tll~O. 1~, $973..by. J.o..lrub~ak~. .............. HOUSE NUMBER. -~00 ....... Street .....LO~2,,~.O · Pa:JO, d ............................... Building Inspector :l ' ' l~O~,~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT.MUST BE KEPT O1'4 THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6209 Z _ . ......... ~ ....... ~.~../.. ................ pursuant to application dated ................. ~........-~..~. ....... , 19.'~...~ and approved by the Building Inspector. Fee $..~7....~.:....~...~. ....... ! V Buiiding Inspector TOWN OF SOUTHOLD Building Delm~tmeM Tm Cled[I Or, ce SNthold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OC:CUFAN~Y Im~mctJona 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 disposal~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 o; 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 $.~.00 3. Copy of certificate of occupancy $1.130 Date ...... .., ..................... ~,.,~.. ......... New Building ....... · ,~.,,,.,,,,, Old or Pre-existing Building ............................ Vacant land ............................ location Of Property ~.~;;~`~/`~/~/~/~/~/`~7~/~/~ .............................................. Owner Or Owners Of Property ,/~'.~/,,/,/,//..,,~,,~.,~'~.,/.,,,~,..~..,/,.~.~,...~,..'~,,,,~.~/~.~.~ (~,,, .................................. · ' i .... ~ .'~ Subd,v,s on ~..~,,~....~../..~. ............................ Lot No ..... ~,~... Block No ..... , ....... House No Perm,t No...~.~.~.../.... Date Of Perm,t',......~..~...:./a~opI,cant ..,/.,~.~.~'.....~-.,6x,~.~'.x...~.~...~'.. Health Dept. Approval ....... ~... ............................... Labor Dept. Approval ................................................ Underwriters Approval ...... ..~'....' ................................ Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .......~Jr..,:.~: .............. Construction on above described building and permit meets all applicable codes and regulations. Applicant ........................... .~ ............... ,, .................... .~,. ........................ Sworn to before me this // / ................ day of ............................................ (stamp or seal) Notary Public .................................... County SUFFOLK ~OUNTY DEPARTMENT OF HEALTH H.D.Reference EASTERN DISTRICT, RIVE~D,N.Y. APPLICATION FOR APPROFAL TO CONSTRUC~ PRIVATE SEWAGE DISPOSAL SYSTEMS Approval tn construct said systems is requested,pertinent data herewith: Date 2-Detailed property location &. ~'~/,'~' &.',~/ ~ . 8-Lot No. ~-- Hamlet />~¢ ¢,,','¢ Town_~o~, F,; ~! 9-Private well? /~ c 3-Public water supply name DistanCe to nearest main ~-Lot Size: Width~?&'ft. Lengt ;h~_~ft. (also enter on center plot plan below:) -Dwelli : Single Family F-/T ¥ ly? ; ;¢ellar? ! !.Slab? L;¢rawl sate? ! ! lO-Proposed system: Septic tank ~_/Precast ~9'/Cesspools ~_/Shallow pools ~_/Other / il-Septic tank inside dimensions: Volu~.e~_Gals.Length ft. Width ft. Liquid depth 12-Precast sections: //JNumber~_~Square Ft. Cesspools: Block si~L incs.D ins. H Total blocks below inlet: ~1 ~2 ~3 PLOT PLAN .~hte CapaCity~__.__Gals. T.at ~ ~1. Data ?eet z .'~' 0 H" 2 :/~' 6 r' 8 10 (lo/65 ~evis.) s-~5 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. · The Undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal S~stems". Date Signed ~-. Owne~ or Builder APPLICATION FOR APPROYAL ~0 CON$~CT P~ITA~ ~%~AGE DISPOSAL INSTROCTIONSz App]/cations ~at be su~tt~ in tripl~cat~ i-Means Owner or Builder. ~ress to ~hich mail should be directed. 2-H~ans detailed description of property location, together with street name and distance to nearest intersection of rain thorofare, also ~amlet/Village & Township 3-Enter na~e of Public Water Supply Distric~, 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-tuber 8-Lot ~-Private well.' Enter ~No" if Public water supply is available. Enter ~Yes· otherwise. PROPOSED SYSTEM~.' Answers to Items number 10, tl, & 12 please consult the Suffolk County Health Department's Standards, ~,l~etins and Amendments for Sewage & Waste Disposal Facilities. i.e., Part II-Residential Sub-surface Disposal Systems covering Cesspools Part III " " " " · " Septic Tanks Part 1~ · " " " · · Unusual soil conditions Part V " · " · " " Shallow Leaching Pools PICT 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 sho~m on face of this application. Surface waters-Streams, Lakes, & Bays, 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 sho~ on the Plot Plan together with th& distance to the Applicants proposed Sewage Disposal Systems and Well. ~ere 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-lO0 feet mi~tw.,m distance from the nearest cesspools Well-25 feet minimum distance from rear, and' rear sides of property lines Well-10 feet mi-t~,m 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 .~w.,m distance from lot lines to center of cesspool Cesspools exterior must be 100 feet minimum distance from nearest well Septic tank exterior must be 7~ feet from nearest well Cesspool "Center" must be 12 feet minimum distance from nearest water line Cesspool "Center" must be ~5 feet fro~ house foundation Cesspool exterior must be 50 feet mi~,~,m distance from surface Waters, Strea~-, Lakes & Bays, etc. Cesspools must be 20 feet mi~..,~ 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 TOWN OF SOUTHOLD Building DEqmltmeBt Town C:IE~ Office Sou&oM, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCC:UPAN~Y Instmct~xm 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 approvml 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 opplicab~e. B. For existing buildings (prior to April 1957), NomconformJng uses, or buildings and "pre-existing" land uses: 1. ,~ccurate survey o7 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 _ ~ Dat :.../....~....~..~..~.... ........ New Building ........ ..~......... Old or Pre-existing BHilding ............................ Vacant Land ............................ Location Of Property .~...~..~.../.~.~.....~.....~..,.....~.....~.../~....~...~...?.....~..~. ........................................... " Own.r Or Own~rs,~ , ,,Of P~o,,y ..~'.Z~.~..~.~.. ........ ~ ......................., d.~.~./~ .................................. .... ~..~.....~.~.~.~ .................... .ot .o ...... ~... B,eck.o ............. .o.se .o ............. Subdivision Permit No...~..~..~...~... Date//Of Perm t~?Z~..',~R~kpplicant .../.,.'~./~'.~.......~./J/.~....~...~....~....~... .................. Health Dept. Approval · .... ~.~...~. .............................. Labor Dept. Approval ................................................ Underwr'ters rova ~'~ n 'n App ............................................. P a m g Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate / Fee Submitted $ .....~.~...4~.....~... .............. Construction on above described building and permit meets all applicabte codes and regulations. Applicont . ....~../.-...~.~....'P.~....~.....~....~...~.../.~, ~ ~..~..~..~... ... Sworn to before me this -'~'~ ~' ~~~/~'"/~'~ '~ .............. day of ...~ .......................... (stamp or seal) Notary Public ~.....~9~..~ County TERLql ~E ELAK NOTARY PUBUC, ~tlto ot Flew York No. 52.616~295 (~ualihed ~n Sulf01k County Commission Exp~re~ March 30, TOWN OF SOUTHOLD ~ BUILDING DEPARTMENT' ~a/~r,~ TOWN CLERK'S OFFICE $OUTHOLD, N.Y.~'7:~ ....................................... o " t' - Examined .~............ , 19 ........ Application No ................................. Approved ............. ~......~..(. ................ , ]9...q. .... Pemit No...~.......'.~.....(~.....~....~. Disapproved o/c ........................... ~ . .................. ...................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT ,b Dote ..................... , 19.~.xa~ .... INSTRUCTIONS ~ a. This application must be completely filled in by typewriter or in ink and submitted in triplice~e to the Building Inspector, 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, relat onsh p to adjoining premises or public streets or areas, and 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 Perm t. ~' d. Upon approval of this application, the Building Inspector will issue a Building Perm t to the applicant. Such permit shall be kept or~ the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any ~urpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. 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, Suffoik 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 all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorize.d inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Addlress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder~ ..~., ,v / ~ Name of owner of premises .... .~.~..~.~...~.....~.~:......~. ........ ~. ....... [~. ...................................................................... If applican~pora~~d, uly auth~d officer. ~ (N~e and title of corporate officer) ~. Location of land on which propo~d work will be done. ~ap~.: .................... Lot No....,~, .................................... ................ ............ ~unicipali~ 2, S~ate exi~ing u~ and o~upanc~ of premiss and intended use and occupanc~ of propo~d con~ction: ~. ~,~i.,.~ ~ o~.~ ......... ~~ .......................................................................................... 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair ........................ Removal ......................... Demolition ........................ Other Work .................................... · (Description) ..... 4. Estimated Cost ............ ~ .~..'...¢~.. ~...~... ....Fee ..../... ................ i ............................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... /.. .. Number of dwelling units on each floor ......................................... If garage, number of cars ................. .'~ .................................................................................................................... 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 ...... ~p..~.. ............. Depth .....~.A~. .................... Height ............. .~..~....~. ...... : ................... ' ..... / .............. Rlumoer OT bmrles ......................................................................... 9. Size of lot: Front .. ....... /..~·~..':.. ................ Rear ...... ~..~.~..--.. ..................... Depth ......~....,~...~. ................................ Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase ..~'~../....~.~. Name of Former Owner ~ ,~'..~..~...~../~...,~...~,_..~.,~.../.v~.. ............... 11. Zone or use districZ which premises are situated ...... g~..~.. .................................................................................... 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 ~...~'.~....~..~...~:..../~.....~...~....~....'?...~.~'..~:~..~-. -~.- .................................... .~-.~.~....~..~-.~..~.~..= ...... ...... '_"~ ....... : ...... o -- (~(fdress) . (Phone No.) Name vf A,~h t~t ............................... ~r...~..~... .......... i~,TcJ;~';;i ..... ........................................... (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 indicate wheth- er interior or corner lot. STATE OF NEW YORK, S~ COUNTY OF ......................................................) .................... .~.~...~.~......~.~....~.....~..~...~'... ...................... i ....... being duly sworn, deposes and says that he is the applicant above named. t~Name of individual signing contract) .e,,the .............. .......... '/ .................................................................... of said owner or own,ers, 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 of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. (Signature of applicant) n£v,s,oas YOUNG & YOUNG SURVEY FOR: CLAUSEN CONSTRUCTION C~ , ,4¸ , I