HomeMy WebLinkAbout5915-zFOKM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificnte Of Occupnncy
N z6~I
o ............. Date ............ 0~t ..... ~1 ......., 19 .~.
THIS CERTIFIES that the building located at .N/8. ]~ddJ. e. fiord. &..g...°~l?.l~re~
Map No.~&..rd.e.n..H.$$. Block No ........... Lot No.P.$. ~ ..... .l~.~.t.~,l;~l~k..l~.,~.q...
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ............. Ap..l'.~.... ,1~972.. pursuant to which Building Permit No.
dated .......... .~. ~...3.1 ....., 19 7.~.., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is p~$?..a.~...0.~.e..f..~..1.~., d.~...~..~..I .... .(.%h..oW..m .ode!.). ~..!1./~...~..e..f.e.~..e.e ....
The certificate is issued to . .~1.~.8. t.~:..C.o..n.z.t~..u.c.%~.o.n.. ¢.O. rl~.....0~..e.1, .................
(owner, lessee or tenant)
of the Moresaid building.
Suffolk County Department of Health Approval SeP. t. 27..197.~...by..R ,. V:i. lla ......
UNDERWRITERS CERTIFICATE No. N. 3~193 ..... Aug. 18...1972 ................
HOUSE NUMBER ... 63.05 ...... Street .... ~iddl®. Road..(.CR27.) .................
3~ Conklln Road
...... ' .................. 5' .~ill .......
Building Inspector [
FO~ 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
CQMPLETION OF THE WORK AUTHORIZED)
5915 Z
Permission is hereby granted to:
lf..~.~t,....q.~t, nt.¢..~ ~.~....c.o~ ......................
....... ~6~....~z~tm..~i~ .................................
......... H,~ze~:l~ ......... Z,,,1. ..................................
to .. ~.~,~A ..~...~.e...~a~...~.~ll~ ...................................................................................
et premises located at ........... ~t~...~...~:..P.~..~ ...... .~l,~ll.,][~l[~t,h~. ..........................................
............................................... .~. ~.~.e....~ ..~.....~...~.em~,..~.~. ........... l~,.~t~k ....................
pursuant to application dated .......................... A]~',~.....~.~ ....... , 19.~.., and approved by the
Building Inspector.
Fee $...~.~.~ ........
pERMIT INCLUDES APPROVAL
TO REMOVE EXCESS FiLL
FROM ABOVE- PREMISES BY
R£GR~,DING LOT
DRIVEWAY C oN~T RUCTION
CESSPOOL C~F,~S'~ RI.)CTION
CELLAR cONS'?RUC~ iON
OTHER
ouilding ~nspecror ~
lrOltM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Clerks 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:
I. 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 dispasal--(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), No~-conforming 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. Swam 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
/ Date ....... ..~....~'..1~..., .. !..r~....?..~. ............
New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................
Location Of Property ....... ..1~../,~. ....... ..~..,...~..?......~...~....~... ......... ~~......._~_~....~..~ ......
Owner Or Owners Of Property .......... ..~.....~...~.. ...... ..~...O....~..~...~..?..I...~....~.. ......... ~ .........................
Subdivision .... .~.....~....¢TT....~....~....~M.........~.~'~.~...~......Lo, No...~..~]... Block No ............. House No .............
Permit No..~....~..~..~.....Z~.. Date Of Permit ..~../.?l~...Applicant .... ~...~....~.~..~...~...9...~.........C...0....~~'
Health Dept. Approval .... ...~....?...~.!...O...~.....~.. .......... Labor Dept. Approval ................................................
Underwriters Approval ....1~........'~...~...!..~....~... .................. Planning Board Approval ........................................
Request For Temporary Certificate ........................................ Final Certificate .......... ~ ....................
Fee Submitted $ ...... ...~.....~...'~... ................
Construction on above described building and permit meets all applicable codes and regulations.
Sworn to before me this
Notary Public~... County
(stamp or seal)
NOTARY PUBLIC. State of New Yor~
Comm;s~o. Ex~z~s March 30,
SUFFOLK COUNTY DEPARTM~.NT OF HEALTH
H. D.Reference
APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date~
Approval to construct said systems is requested,pertinent data herewith:
~-Applicant ~ ~~ ~ Phone~_~6-Sub div~,A~$~.!
2-Detailed property 10cati6n~/~ ~ ) .~,~.~~.6~ 8-Lot No. ~'~ ~--~.
Hamlet ~%~tT~ ' Town ~)~r~A4~A~ .... 9-Private well-~ ~ ~,~
3.Public water supply name ~%~'~_m~ .... Di~-tance to nearest main
S-Lot Size:. Width~_ft. Length~ft. (al~ enter on c~nter plot plan be~q:~'
lO-Pro~s~ system. Septic tank ~ ~/Prec~st ~ /Cess~ols / I/S~llow ~ols
ii-Septic ta~ i~ide dimensions~ ~o1~ Gals.Length ft. Width f~. Liquid depth ft.
12-Precast sections: ~Number~quare Ft. Cesspools: Block sizeL mncs. D ~s.~ns.
Total blocks below inlet: ~1 ~2 ~3
~T PLAN
Street
Capacity__Gals.
G.P.M.
Indi
"Construction of authorized installations will be in
:ate~
· th ~
Data ~et
~B?~O,L 0
~ 6
% l0
The Undersigned CERTIFIES:
accordance with the Suffolk County Health Departments' current Standards, Bulletins,
and amendments thereto, covering Private Sewage Disposal Systems".
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.
Dat ~ ~ ,0_ Signed ~ ~
R.vis. EXCAVA110H REQUI
S-15
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 ~ain thorofare, also Hamlet/Village & Township
3-Enter name of Public Water Supply District, together with the distance to their main.
~-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 "Va items applicable to the proposed new dwelling.
6-Name of sub-division
?-Section Number
8-Lot Number
9-Private well: Enter #No" if Public water supply is available. Enter '~es" otherwise.
PROPOSED SYSTEMS: Answers to Items number 10, 11, & 12 please consult the Suffolk County
Health Department's Standards, Bulletins and Amendments for Sewage & Waste Disposal
Facilities. i.e.,
Part II-Residential Sub-surface Disposal Systems covering Cesspools
Part III " " " " " " Septic Tanks
Part IV " " " " " " Unusual soil conditions
Part V " " " " " " Shallow Leaching Pools
PLOT 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 shown on face of this application.
Surface waters-Streams, Lakes, & Hays, etc., located within a distance of 50
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 Applicants 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 rear, enter street name.
WELL LOCATION: To locate the well & sewage disposal systems on Applicant's lot, the
following Standards must be observed:
Well-J00 feet minimum distance from the nearest cesspools
Well-25 feet minimum distance from rear, and rear sides of property lines
Well-10 feet minimum 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
~ESSPOOLS 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 minimum distance from lot lines to center of cesspool
Cesspools exterior must be 100 feet minimum distance from nearest well
Septic tank exterior must be 75 feet from nearest well
Cesspool "Center" must be 12 feet minimum distance from nearest water line
Cesspool "Center" must be 15 feet from house foundation
Cesspool exterior must be 50 feet minimum distance from surface Waters, Streams,
Lakes & Bays, etc.
Cesspools must be 20 feet minimum 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' SOUTHOLtIj ,.
OF'FlOE OF BUILDING INSPE~T'Ci'F~.
Mr. R. Kammerer
Commissioner of Public Works
Suffolk County
Yophonk Ave., Yophonk, N. Y.
Dear Sir:
In accordance with Section 239K of the General Municipal L~w of the
consolidated Lows of the State of New York, this is to notify the Commis-
sioner of Public Works of the County of Suffolk that ......................................
M.$ .T.Constr.u. ction Corp 260 Jericho T~k
a ' ¥
..... .....................................................................
has applied to the Town of Southold for a permit to construct a building
on N/S Middle Road (0R27) At Conklin St (Grand Ave Ext)~ Mattituck
as shown on the attached plot plan, submitted in triplicate, ck~ed ................
....~. ~.?..~..]:.....~.~ ~...?..~..2...... and titled ... ~.~D.~... ~,§~..~..~.~...~..~...G..~.~..~ p ~ ~ei[~hs
We shall withhold further action on this application for ten days or os
otherwise provided Jn the aforementioned Section 2391(.
u.-/26/72: Approved to the ~own o£ Southold Very truly yours,
pursuant to See. 239K off the General N~ni-
eipal Law; if used as a model home, add~.tiona~/ . ~.
installations will be required. A permit /~,, .~
under See. 136 of the HiEhway Law w. ill be /~y~t~j~
required if any work proposed within R.O.W. g~ding Inspector
of C.R. 27. Recommend that drive have
access to Grand Ave. since C.R. 27 is
throuEh road.
SUFFOLK COUNTY DEPT. PUBLIC WORKS
William S. Matsunaye, dr. /~ I - '
Chief Engineer ~j/'
Town of Southold, N. Y.
LOT.
/7
LA. 5. T.
&
LOT~,6
dF PROPERTY
SUR'VEYED FO~
COHSTRUCTiON
-NOTES.
:_ELEVATION5 SI-IO%VN,ARE i[ELATIVE
:TO ASSUMED ELEV. IS.0 AT NOR'~HEAST
..CORNEl[. OF PRENISE$
:~OT NUMBErs $~o\¥N ~EF;;~ TO
"I~A~ OF GARDEN UEI&NTS;' FILED
IN T~IE SUFFOLK COUNTY CLERK'S
~:OFFI~,E' AS MAP N? 5"/?
SITUATE AT
MATTITUCK
TO\VN OF 5OUTI-IOLD, N.Y.
150.33
--. O
Z
0
TEST
HOLE
/X\ / I -_-- ~
. r:72
/ SCALE. 30'= I"
'~ = CESSPO6L
CORR
GUARANTEED TO TWE SECUIZ'ITY
TITLE 6NO GUAEANT¥ CO, ,~ND TO Tile
I?.IVEIZ. WE/~D 5AVfNGG GAIqK
· SURVEYED SEPT. 9,19'74.
I;~oorRl cl~ VAN Tu'Yt.., P.C .'
LICENSED LAND SURVEYORS
GI~EEN'POI~T, NEW YoP. K
TOWN OF SOUTHOLD/O/a°//7~'' ~'~ ~{r~ ,~,,~'
TOWN CLERK'S OFFICE~ ~' ~v~ -- ~
SOU~OLD, N. Y. ~d ~Y ~ ~~ ~
Exominad ....5.~....k........ ................. , 19 .......... Application No ...........: .....................
~roved ........... ~k.~.......~ ...... , 19...f.... Pemit No ...... 5..L...g..~ ......... ~ ~]o]~, ~' ~ _
......................
...................... . ., p ........................
~l~Tl~ ~OR 8~l~l~ ~R~IT
INSTRUCTIONS
a. This application must ~ ~ompleteiy filled in by ty~writer or in ink and submitted in triplicate to the Building Inspe~or,
3 sets of plans, accurate plot plan to scale. Fee a~cording 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 d~scription of layout of pro~rty must be drawn on diagram which is part of this application.
~. The work covered by this application may not ~ aommen~d before issuance of Building PermiL
d. U~n approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such ~rmit shall be
the premises available for inspection throughout the work.
e. No building shall be occupied or used in whole or in part for any purpose w~te*er until a Ce~ifieate of Occupancy shall ha~e been
granted by the Building Ins~tor,
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 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.
M.S .T.
Constructuon Corp
(Signature of applicant, or name, if a corporation)
2 6g -- J-~.iehe .--T-1~k......M.i.r~e e.la ..........................
(Ad'dress of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Owner - builder
Name of owner of premises ....... ~,,~...T,~o~a~;r. uc.tic~..l;.o=~ ..................................................................................
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.:CT~,~cte, Ta.~$.ot NO....~..t..&..~ ............................
Street and Number ....... };~,~.~-~..~P.~,0,...~;.(.Qo~kl~ rk]...oa.V.&zq-~..~.v.a.; ....... _~&~_-k~,g,c~ ......................................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ....Y..~,t;.~. ..................................................................................................................
b. Intended use and occupancy ............. G~e...$a~.'i.~..dt. we.]:E.i.~g. .......................................................................
Nature of work (check which~applicable): New Building ....................... Addition ..................... Alteration..'..r....?~.~_
Repair ............. ........... Removal Demolition ........................ Other Work ....................................
.......................... (Description)
4. Estimated Cost ...........1.;cj.,.~.QQ.._.+ ................. Fee ...~7..'..2...0. ...................................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ...QT~ ........ Number of dwelling units on each floor .........................................
If garage, number of cars ..~)Re ...................................................................................................................................
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 ..... 6.9 ............... Rear ......... ~9 ............... Depth ..... .2.~,~.......2.~ ............
Height ................................................. Number of Stories ........ one ..........................................................................
.............. Depth .....~ ...........................................
9. Size of lot: Front 1 .~Q+ ..................... Rearl.~.0..+. ..................................
Height .................................................... Number of Stories ......................................................................................
10. Date of Purchase ...........1..?.~!. .................. Name of Former Owner ..................... ..~.~Tke.~. ............ ~ ...........................
· - "k" ~S+
11. Zone or use d~strict in which premises are mtuated ...................... .¥.~,...~ .......................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ............ 3[o ...........................................
13. Will lot be regraded -~r~-~ ........................... Will excess fill be removed from premises: [ ] Yes [:~ No
14. Name of Owner of premises ....M~.,.~,...(;c~p ................. ~,60..~.~'.:icho...~pk ......_HS~emla, ............................
(Address) (Phone No.)
Name of Architect (Address) (Phone No.)
Name of Contractor ....... ~.~,~e. ................................................................................................... il~l~g.;.~l~,i ...............
(Address) ·
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, ) SS
COUNTY OF .....~U.~Q~ ............................. )
.................................................... r~,S. Ctt~t~ .................................. being duly sworn, deposes and says that he is the applicant above named.
(Name of individual signing contract)
He is 'the ......................................................... ~'.~6F~.~. ....................................................................................................................................
(Contractor, agent, corporate officer, etc.}
of said owner or owners, and is duly authorized to~'~r~ ~)~..~l~e performed the said work and to make and file this application; that all
statements conta ned n th s application are true to thff bes~ ~ s~k~o~Nl~dge and belief; and that the work will be performed in the manner
set forth in the application filed therewith. ~'~'; ~rqi~3~'~''~
~ ~ ~' ~')0~'~
........................... of ................
, pta ry public, ~.~......~..~..~ou nty ~ ~,~- ~
~- (Signature of applicant}
,/
,.2!