The URL can be used to link to this page

Home My WebLink About6255-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No .... Z,~26:[... Date ........... Ju_~y....1.? ...... , 19. ?~ THIS CERTIFIES that the building located at ...S~tr,~r. Lane ............ Street Map No..B~y.$ J,~.e..Te~l~No ........... Lot No.¶ 9. .... S.01~$h.o. lcl.. ~.,.~.', .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ Kozy.... 2~, 19.72 pursuant to which Building Permit No. $2~7~. dated ........ .Nov... ~22 ..... , 19. ~R, was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is i~sued i~ ?r.~.¥~.~.~.e..o..~.e..t.a..~.~.~, .a.~.e.~.~..~.n~ ........................ ~ ............... The certificate is issued to .Joan. Graho~k~L .... ?.~ar~er. ............................ of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant) ·. June...tS. 1923.. l~Ir..R...V:Llla... UNDERWRITERS CERTIFICATE No. ]~..6~80.~.... ,}'rill.. ~ {3... ~ 9~,,X ..................... HOUSE NUMBER...~00 ....... Street... fJ~mm~I'..La.IlO ................................. ..... Building Inspector / TOWN O~ SOUTHOLDi BUILDING DEPARTMEN~r TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BiZ KEPT ON THE P'REMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6255 Z Permission is hereby granted to: .: ........... ~..o.~n..~,....~..o~k~ ....... .', .................... .................. ~tt.thc~3.d ....................... ~ .................... to :bulld..ne~..on~..£s,~l.~:..d~l.l~g...(...~b.£t...~i~me..&..a~.) ................................ at premises located at .......... ~..~.~ ...... .~r~,~.~,.~..~,.~a¢~ ........................................................ .................................. E/.~...~u~n~..3~aae.. ............ ~he~...N..~.~ ............................................ pursuant to application dated ......................... }~.V.....~.~ .............. , 1~,...., and epproved by the Building Inspector. Fee $.2~'e,0~ .......... Building In~l~ec~ror I ' FORM NO. 6 TOWN OF SOUTHOLD B-ilding Del~ment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF: OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and s~.bmitted in triplicate to the Building Inspector with the following; for new buildings or new u~e: 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 Ur~derwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from th~ Architect or Fngineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Nomconforming 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 owne:r as to.use, c~ccupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildirigs 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 Dote ....... ~.. ,¢. ',~,..~,, .7..~Z, · .................... New Building ......... ...t::~....-i... Old or Pre-existing Building ................ ............Vacant Land ............................ Loeation of Property ................ Owner Or Owners Of Property ......... ,~,,~.~.~, ...... ~t ....... .,~,-~..~,,~:~: ....... ,,/, ........... ~.., ................. Subdivision ................................................................ Lot No ..... L.~.i.. Block No ............. House No.~t., PermitNo ~.~. Date Of Permit ll/.Q.t .7~Applicant i.~..~v~ ~, Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Boai'd Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ..~.'.: .~... ......................... Construction on above described building and ~r~mlt meets ~ a~ica.,b[e c~?s and reguiati~s. , Sworn to before me this~ ............. . .;;~-..~.~ ................... ~ ,. [o~.~vt,st~p or seol) r ~oto~ ~um,c ~.....~.k ......... ~ounty ~o 52-?"8"~q' /~.f e FO~M NO. 6 TOW~ OF $OUTHOLD Building Department Town Clerks Office Southold, H. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and s~bmitted in triplicate to the Building Inspector with the following; for new buildings or new u~e: I. Final su~/ey 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 sewdrage dispcsal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Ur~derwriters. 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 ~ses, or buildings and "pre-exist'ng ' land uses: ]. Accurate su~ey o~ property showing ~11 property Jines, ~treets, buildings end unusual natural or topogrQphic features. 2. Sworn statement of owner or previous owner as to use, ~cupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildidgs or premises, or other pe~inent 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 .... ................. New Building ~ Old or Pre-existing Building ............... ~ ............ Vacant Land Loc~ton Of Property ..~ .......... ~.~..~ .......... ~.~,b...~.~y..~,~ ................. Owner Or ~ners Of Property ....~.~..~ ........ ....... ~.~[~[ ....................................... Subdivision ................................................................ Lot No, .,[,~,.... Block No ............. House No.~... Permit No, ..~.~.~,.. Date Of Permit ..~.~(/.~.Applicant ..~.~ ....... Health Dept. Approval ............................................ Labor Dept. ~pproval Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Tempora~ Ce~ificate ........................................ Final Certificate .......................................... Fee Submitted $ ~' ~ Construction on above described building and ~t meets ali ~plica~le~esgnd regulations. · ............................... Applicont ........... ~.,~.~..~ Sworn to before me this ~ ......... Noto~ Public~e~¢~-.~. .... County SUFFOLK COUNTY DEPARTMENT OF HEALTH H:.D. Reference No~ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE S~EWAGE DISPOSAL SYSTEM Address L~)~t~i~,k)~e~ ~£~cc~5 , ~J~¥,, i6. Section ' 2. Prope~y 'l'0cation ~0;~%~ ~ / 17. Lot No. iq ,k~/'.O~C~%~0~~ 18. Private well ~illage ~.'~-~(~"~ Township~-~A~% ~9. Public water 3. Public Water Company name ~ ~Distance to main 4. Lot size: Width~O0 feet Length ~ ~feet (Enter on center plot 10. Sewage Disposal System: A. 900 gallon septic tank: Preca~t'~Equivalent Block, B. Leaching pools: Number Precast] Block .. Special below) The undersigned be in accordance with ards thereto." Date FOR HEALTH DEPARTMENT is the opinion of the Disposal Systsm can be installed Date /~_~/~ Z~ If private well fill in blanks below: Tank capacity Gals. Pump G.P.M. Total wel~ depth Depth to G.W. Amount of water in well Test Hole Data Feet 0 2 4 6 8 10 12 14 16 18 CERTIFIES: "Construction of authorized installations will the Suffolk County Departme~int of Heal(th's~%current stand- -- -- ~ /07ne~ °r ~Builder ased on rte inf rmJt on presented ew tn, tt Health Department, that an :-~equate and satisfactory Sewage on this plot. ~ ~ ~ ~ Signed ~ vised 4/1/72 APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SgWAGE DISPOSAL SYSTh.nIS INSTRUCTIONS: Applications must be submitted in triplicate 1-Means Owner or Builder. Address to which mail should be directed. 2-N~aus detailed description of property location, together with street name and distance to nearest intersection of main thoroughfare, also HAmlet/Village & Township. 3-Enter name of Public Water Supply District, together with the distance to their main. 4-Enter Length and Width o£ 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: hinter "No" if Public water supply is available. Enter "Yes" otherwise. 9-Public water: Enter "Yes" if Public water supply is available. ~luter '~o" 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. PIA~T PIAN: The following information is required concerning the Applicant's 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 sh~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. Where 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. ~LL 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- 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 LOCATION: Upon determination of the Sewage & Waste Disposal "t~pe 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 foundation. 6-Cesspool exterior must be 1OO feet minimum distance from surface waters, streams, lakes, & Bays, etc. 7-Cesspoo!s must 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 waist be held to minimum of 2 feet. ~" ~/ 4' TOWN OF SOUTHOLD . ~ ~. s BUILDING DEPARTMENT :~ ~,,~'~ TOWN CLERK'S OFFICE ~ SOUTHOLD, N. Y. Examined ............. ./, .......... ~ ...... , 19.~.....y~./ ,~ 2 ././.~.. Applicotion No..~.~.....~,~....,~... .............. Approved ........................................ , 19 ........ Pernit No ..................................... Disapproved a/c ......... ~ ..... ~(Building Inspector) a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, witl~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. ~ b. Plot plan showing location of tot and of buildings on premises, relationship to adjoining premises or public streets or areas, an~ 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. ( e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shah have beer granted bv the Building inspector. ~ APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zoll Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction~e buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with ail applicable laws ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. APPLICATION FOR BUILDING PERMIT ~ Dote ................. ........... INSTRUCTIONS ~ (Sig~atu~re of applica~ or name, if a corporation) .................. ) ........ tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................... ............. .... applicant is a corporate, signaturt~o~Uuly authorized officer. ' (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No. ot No ..... J. ~_~...CL... ................................ Street and Number .....~J.~,.~...~, ....... ,~.¢'~./~).1~ ........................................................... .~'~,.~C.~.~......~ ........... Municipality ~ D 0 '2. State existing use and occupancy of pre m ises and intend__e//~u_~and occupancy of proposed construction: a. Existing use and occupancy ........... ..'~..~~ .................................................................................... Bo 10. 11. 12. 13. 14. Nature of work (check which applicable): New Building ....................... Addition ..................... Repair ......................... Removal ......................... Demolition ........................ Other Work ' Estimated Cost ............................ Fee ................................................................. (to be paid on filing this application) Alterationl .............. ( Descrill,ti ~n ) If dwelling, number of dwelling units ....... ! ......... Number of dwelling units on each floor ....................................... If garage, number of cars .......................................................................................................... ~'1"'" ......................... If business, commercial or mixed occupancy, specify nature and extent of each type of use ...... , .............................. Dimensions of existing structures, if any: Front ......~7...~.~ ......... Rear ........................... Depth .................................. Height ........................................................... Number of Stories .............................................. t .............................. Dimensions of same structure with alterations or additions: Front .......................... Rear Depth ............................................. Height ......................................... Number of Stories Dimensions of entire new construction: Front ....~..~2.~ ............ Rear ......... ..~....~.; .......... Depth .~.~. ....... Height ............. I..O..~. .............................. Number of Stories I S~ze of Iot~ Front ......... l~'"' .................... Rear .......... .q:/.:...Z.L.~ ................. Depth Height .................................................... Number of Stories Date of Purchase ...I. t2..%.~.~n~.~ .............. Name of Former Owner ......[~...~...~ Zone or use district in which premises are situated .....~Q..O...'3;~..~.~..21:) Does proposed construction violate any zoning law, ordinance or regulation: ......~...0. Will lot be regraded Name of Owner of premises Name of Name of Contractor Will excess fill be removed from pr~emises: [ ] (Address) (Address) (Address) Phone No.) Phone No Phone No PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-L property lines. Give street and block number or description according to deed, and show street name er interior or corner lot. STATE OF NEW YORK~ ) COUNTY OF ,.~.,~...~.'..~/,.~ ..o..X.~.~, ........................... ) SS ~ck dime~ ions from and indic; te wheth- ( ~' 'ndi idua , ign' g ) I He is the ......................................... ~.~.~x..~....~n... ......................................................................................................................../~ ................... (£'otttractor, agertt, corporate officer, etc. ] of smd owner or owners, and is duly authorized to perform or have performed the said work and to make and lille this applic t on; that all .;tatements contained in this application are true to the best of his knowledge and belief; and that the work will beI performed ¢ the manner ~et forth in the application filed therewith TERRI LEE [~K I ......................... ~. ..... . ............... ~ ~ ~_ ~g~*~o ~'~ ,~ -, , ',,,~()~ Notary Public, .~..~...~ ...... County ................... ~..~ ......................................... ... ................. ~ (Signature of applicant)