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Home My WebLink About6264-z FOB,M NO. J~ TOWN OF SOUTHOLD 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) N?'626~, Z Permission is hereby granted to: .......... .c...o.~..t~...~...z.r.e..,...e......~.e...t.~.~.$~.e...s. ....... 36- 1'7 30th St .., .............. l,,~.~J,~. ....... 1f.,.~, ........................... ~o ....... ~,.4...n~....o.~....f.~,~......~.~.~..~.!~.~ ............................................................................ at premises located at ....~t~..g~ .........JJllil~t..Klliall~ .................................................................. .................................... i~.t~7:....,2.~ .............. ~,~..t..~.;t..~.v, ck ........................................................... pursuant to application dated ...........................JJO~. ......... ~...;..., 19.~,.., and approved by the Building Inspector. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN °CLERK'S OFFIC, E SOUTHOLD, N. Y. VoID November 27,. 72 Date ................................................ , I y ............ INSTRUCTIONS :' "~ a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wi~J 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, relationship to adjoining premises or pubJic streets or areas, a~ 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 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, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or a[terations, 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. M.S.T. Construction Co~p (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. ............................................ A&e~.~...~f...~z~e~. .................................................................................................................. Name of owner of premises .E, oataa..Pate3_~es...&..l~if.e..Izene ........................................................................ If applicant is a corporate, signature of duly authorized officer. I Name and title of corporate officer) Builder's, License No ...................... ~. ........................ Plumber s ,License No ...................................................... _./., ~., Electrician s License No ................. '--~.'~..? ........................ Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No......~..~....s..e..~.....Z~...o.,.];[.s.........~..Lot No..$. ..................... Street and Number ................ S.ta~Le.~...[~x~l ............ ~t.tituC]c .......................................................................... tt~ oCT) ~)_'~ 6) Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............ .~&ca,l:EI;.._la.~c1. .............................................................................................. Intended use and occupancy .......... one..£amil.y...d.~zell:lng ........................................................................... 3. Nature of work (check which applicable): New Building ....~ ....... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost ....~...0.~.0..,0..0......._+.. ...................... Fee ....... ..8~......~. .............................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ..~Qe ........ Number of dwelling units on each floor ......................................... If garage, number of cars .....¢l~e ................................................................................................................................. 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 ............................ Depth ................................. Height ............................... Number of Stories ......................................................................................... 9. Size of lot: Front ............ 1.2.0. ................... Rear ......... .120 .......................... Depth ....... ~J.~.../....l.cJ~t ..................... 10. Date of Purchase ........1.~).~..~ ..................... Name of Former Owner ........ ~.lP~:t~.ft.~...~,~Q[~,8 ..................................... 11. Zone or use district in which premises are situated ....... !!~!~....~.~.~.1~. ........................................................................... 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 ....C..o.~..~¢).8...~l)~J,~.S..~..l/C,l,:[f) ............................................................................ (Address) (Phone No.) Name of Architect ...... ~.;...~,.Q~t;;.g.,~ ........................................................................................................................ (Address) (Phone No.) Name of Contractor ...... ...~.....e..~.. ................................................................................................................................. (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. See filed plans STATE OF NEW YORK, ~uffolk COUNTY OF ...................................................... ................................ .~g.~...~...~...8:i....?..~..O..~...~..~..~. ................................ being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract) (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 best of his knowledqe anEdL&l~elief; and that the work will be performed in the manner TERRF LEE E set forth in the application filed therew;th. NOTARY PUBLIC, State of N*.v York (Signature of applicant) SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference. No.~_~_~__ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 1. Applicant C~X~ ~'~,t ~ Phone~g~-~. Subdiv. Address ~-~ '~ ~. ~.~. ~! ~. 6. Section 2. Property location ~- --~, 7. Lot No. ~_t 8. Private well ~q Village~Township~9. Public water ~ 3. Public Water Company name ~t~'. ~? ~ Distance to main 4. Lot size: Width ~ feet Length. feet (Enter on center plot 10. Sewage Disposal System: A. 900 gallon septic tank: Precast ~quivalent Block B. Leaching pools: Number_~__Precast Block Special below) If private well fill in blanks below: i~/1t~' Tank capacity Gals. Pump G.P.M. Total well depth Depth to G.W. Amount of water in well Test Hole Data Feet ~*~ £~ ~_ 0 ~_~ ~t, %~ 10 14 16 18 be zn accordance with aras thereto." Date ~ [1~ I ~ ~'" installations will the Suffolk Count~ Department th's current stand- 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. Date __ Signed ~,-~'~j, r¥'~,,,''~, ;i !~,~: . ~ ";~ S-15 Revised ~/]/72 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 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: Enter "No" if Public water supply is available. Enter "Yes" otherwise. 9-Public water: Enter "Yes" if Public water supply is available. Enter '~o" otherwise. PROPOSED SYSTENS: 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 1-Residential Subsurface Disposal Systems covering cesspools. PLOT PLAN: 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 100 feet of Applicant's lot lines, must be shown on the plot plan also. 3. 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. 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. 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- lO 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 "type 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 lO feet from house foundatien~ 6-Cesspool exterior must be 1OO feet minimum distance from surface waters, streams, lakes, &Bays, etc. 7-Cesspools 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 ~st be held to minimum of 2 feet. subdivisi°n - CaP fain Kidd 12~ Estates O · -- MONUI~ENT ~USOl VISION MAP FIL ~O IN ~'NE OFFICE OF THE CL~K OF SUFFOLK C~N~ ON SURVEY FOR COSTA$ PETALLIDES 8 IRENE PETALLIOES LOT $ "SUNSET KNOLLS, SECT/ON TWO ' A4A TTI TUCK TOWN OF SOUTHOLD SUFF. CO., N. Y SCALE: I, SEPT. 25, 1970 FO~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ...... ....... Approved " '~ '~ --- ........................................ , I9 ........ Pemit No. Disapproved o/c ............................................................................................ Application No..~...k..~...~. ................. APPLICATION FOR BUILDING PERMIT November 2?._ ?~ Date ................................................ , ~¥ ............ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 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, relationship 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 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 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, Suffotk 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 authorized inspectors on premises and in buildings for necessary inspections. ,.~. Construction Coz'p (Signature of applicant, or name, if a corporation) 260 Jericho Tpk ~'ineola,. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................. :::g,,~-.~.~...?.~...9.%~;L.r. ................................................................................................................. Name of owner of premises ...QQ,%IA~...~':~.~P,~,~,$....~....~'.~.~.e...~.~.q.n...e. ....................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ................. f:~<_...../~... Plumber's ,License No ............... !..._~. ............................ Electrician s, License No .............. /....~ ........................ Other Trade s License No ......................... ~ ......................... I 1. Location of land on which proposed work will be done· Map No ....... '.L.~.s..e...t....~..~'..°...l..l..?........~L. ot No....~.. ................... Street and Number ................. ~;.~,,~(~,u..~£Q. tA~ ........... ~.~.~.t,.'t~,.t,.~ ......................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: · · v cent lu~ud a. Ex~sttng use and occupancy ............... ~ .................................................................................................................. b. Intended use and occupancy one a~ !I [~;- 5'~e ~ 2 ~..n.~ ...................................................... 3. Nature of work (check which applicable): New Building ..... ~ ...... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost ....;~..O.a..C...C~...... ~+ ..................... Fee ....... .~J~'.~,~. ............................................................................. (to be paid on filing this application) 5. If dw~l, li~g_?~mber~ of dwelling units ...ea't~ ......Number of dwelling uni,ts on each fl__o(F, .......v...~x.~.t,I/~ ...................... If gara~ge, number of cars .....~ ......................................................... ..-~.....~. ............. ~.....~ ........ .V..3...~..~ ..................... 6. If business, commercial or mixed occuoaa~ s~ci~/~t~e and extent of,each type of use ....~, ............................... 7. Dimensions of existing structures, if any: Front .....................Rear ........................... Depth ................................... Height .......................... _ Number n~~ ........... .~.....~:~ ........................... Dimensions of same structure with al~~ s: E~on~t ~.....~ ........... Rear ......................................... Depth ............................................. Height .......... .~.~.... Number of Stories ........................................ 8. Dimensions of entire new constructio~?._~_.~ ....... ~a~ ............................ Depth ................................. Height ................................................ ! Number of Stories ......................................................................................... 9. Size of lot: Front ............ .1.~.{~ .................. Rear .......... ~,~O ......................... Depth ........ ~1~1-../.-.1.0-,~ .................... 10. Date of Purchase ....... .1.c~. .................... Name of Former Owner ......... ~f~.,[~t%o[~l~ .................................... 11. Zone or use district in which premises are situated ........ ![~,~.t..[~J,s~ .......................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ......... p.e .............................................. 13. Will lot be regraded -..,y,,ea ......................... Will excess fill be removed from premises: [ ] Yes [ ~r No 14. Name of Owner of premises ...~o~t~&..Y.'e, lll~l~e,~..~..,t,['~ ...................................................................... (Address) (Phone No.) Name of Architect ...... ~a..~S~J~c,s ....................................................................................................................... (Address) (Phone No.) Name of Contractor ....... ..C3N1~.~.~ ............. ~ .......... ~ ........................................................................................................ (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. See file~ plans STATEOF NEWYORK, ,, ) COUNTYOF ............. ~.~ ...................... ) ................................ .~. ~!.~.~...~.......~'.~..O.E~.'..O..$. ................................ being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract} He is the ................................................... ~,~¢,,D..~....O,[....O.~['I~. ........ ~.l~O~..l~ ............................................................................................ (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 best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. 2~ TERRI Lr.~ r_, a~ . .~....~. ....... ,/ ~-~ .............................. L · .,.,d a IIg~{R¥ ·. ~.~,~. ~t!~,.,~,~.~ ............ 19 No. 52-6166295 Qualified in Suffolk Notary Public ...... ~ ........... C~mlesle~.6xP~es. Ue~s~.~¢~.~... County ............................... z. ......................................................................... (Signature of applicant)