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HomeMy WebLinkAbout5919-zTOWN OF $OUTHOLD BUILDING DEPART~I~,NT Town Clerk's Office $outhold, N. Y. Certificete Of Occupnncy THIS CERTIFIES that the building located at .N.o.r.t..h..L.~% .n.e ................ Street Est Map No. G. Cr~ .B. ey... Block No ........... Lot No. ~t7. .... ~.as.t. ~Mar£Qn ........... conforms substantially to the Application for Building Permit heretofore filed i{{ this office dated ........J.u~.e ..1 ....... , 19.7.2. pursuant to which Building Permit No..~9197-,. dated ......... .J..u~.e. .... 1. .... , 19..7.2., was issued, and confoms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...P.r.$.v.a..t.e..o.n..e..f..a..m~.]..y., .d.w.e.:l:~..~..g ...................................... The certificate is issued to .., .A.ug~.s..t..S~.a..h~. ....... ~..w~. ~r. · of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant) .s.~.~.t...2.~...!97.~....~y. ~:. Y.~.n..~... UNDERWRITERS CERTIFICATE No...N36326 ..... Aug..1.0...1.97.2 ................ HOUSE NUMBER ...... '12~ .... Street ....l~orth..Lane ..... ~.o .Ma.~t.¢n .......... Building Inspector ] FORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at A/tD,~ .~&.. ,~ ~4 k3.~.~ ....... Street map No..gq..mV. ? .... 2", s.r ,:.. co, nforms substantially to the Application for Building Permit heretofore filed in this office .I l'l' J' ~'I~L ~ ~ ' ' [ .......... ' 197..2~. pursuant to which Building Permit N~ .~ 1..~ .~.., " " ~'/ ~ ~ .... I "~ -~' dated ..... ~ ......... , 19.d .~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to ~..~.. ~'.'.0.~ ..... ~ ......... ~ v (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~t.~.-&. 1;.:' '~['>' ~.'' ~' '~3.' ~Z'c.~ga, UNDERWRITERS CE~I'I~.IQ~TE No.~..~~~ ...................... HOUSE NUMBER ............. Street ................................................. Building Inspector FORM NO. ~ TOWN OF $OUTSOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5919 Z Permission is hereby granted to: ........ o ~,t,a~-.,.o.~m. .................................................. to ..... tm~& ..mew..,ime ...feJi3~.-6weLl. -ta~ ................................................................................ at premises located at .......... ~;...~J.~.~....~a.e.+,.,~ijl~,..~,:L~..~&~JjJ~e~.l~..~,J~..Jj~ ............ ......................................... ll-j~...li~.-.:i~'m ............. ~ %...lleJ, l~...~ ~.~ .~ ............................ pursuant to application dated .........................,l'l:l~e.....~ .............. , 19J~1~.., and approved by the Building Inspector. I Fee $.14.:~.~,.~: .......... Building Inspector :,' J SEP 2 2 ~972 ~.~. v~. ~ ,_3r9 T}~e sewage disposal and water supply ~ac~lities for the structure lo~ed at have been inspected ~ this Departmen~ ~d found to be satisfacto~, SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference No EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date Approval to construct said systems is requested,pertinent data herewith: 1-Applicant~ ~'~.1¢~ B*,,,~Jg'~' ~,,~ Phone ~J$~f~/O6-Sub div /_,-~,J,~,~ Address l~e ~o~ A~ C~'~,~,~ o ?-Section ~ 2-Detailed ~ro~erty, location~,~A A~ ~$~" ~ ~O~ O~ ~, J~ 8-Lot No. /~'.~ Hamlet ~a%~ ~¢,,, Town ~h~/~ 9-Private well? 3-Public water supply name Distance to nearest main S-Lot Size: Width;~ ft. LengthA~ ft. (also enter on center plot plan below:) 5-Dwelling: Single Family ~ Two Family? ~_/Cellar? ~.~.Slab? ~_~Crawl Space? 10-Proposed system: Septic tank ~W'/Precast ~ ~Cesspools /~'/Shallow pools / /Other / / il-Septic tank inside dimensions: Volume 2~ Gals.Length ft. Width ft. Liquid depth ft. 12-Precast sections: ~ ~Number/~Square--~. Cesspools: Block sizeL incs.D ins. H ins. Total blocks below inlet: ~1 ~2 PLOT PLAN Data ~eet 0 2 4 6 10 [ 12 ~6 Street O O Indi :ate Nc 'th The Undersigned CERTIFIES: "Construction of authorized installatiom will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, cov~r, in~g Private Sewage Disposal Systems". -,,~/I P '~" "' ' " ~ "-'" ~'// Date ~/2~ °'sighed' ' ".t~'~ ~,Sz~ ~,-~//~ .U~, ' Owner o or Builder FOR HEALTH DEPARTMENT ~ ~Y.~Ba~d ~.t~h~ information presented herewith, it is the opinion of the Health Departmenk, that ~n.a~uate and satisfactory Sewage Disposal System can be installed on this Plot. Date (10/65 Revis.) s-15 APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMB INSTRUCTIONS: Applications must be submitted in triplicate i-Means Owner or Builder. Address to ~0~ich mail should be directed. 2-Means detailed description of property location, together ~*lth street name and distance to nearest intersection of main thorofare, also Hamlet/Village & Township 3-Enter name of Publi~ Water Supply District, together with the distance to .their m~in. 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 7-Section Number 8-Lot Number 9-Private well: Enter "No" if Public water supply is available. Enter "Yes" 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 line8 of the heavy lined square in the center of Plot Plan sho~ on face of this application. Surface waters-Streams, Lakes, & Bays, etc., located ~,ithin 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-lO0 feet minimum distance from the nearest cesspools Well-25 feet minimum distance from rear, and rear sides of property lines Well-lO 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 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-l~ 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 minimumd~t~s~ea_r~st water line Cesspool "Center" must be 15 feet from h~~~ Cesspool exterior must be 50 feet minimu~d~N6e from surface Waters, Streams, Lakes & Bays, etc. dista~ ~Ol~st~ f~ee~ ~ Cesspools must be 20 feet minimum +~ Cesspool center to Cesspool center mus : 6 Cesspool cover top to grade must be held to minimum of 1 food to maximum of 2 feet of Cesspool to ground water must be of 1 foot FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. ¥. 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 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 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 $I.00 New Building ....... .Z ..... Old or Pre-existing Building ............................ Vacant Land ............................ / / Location Of Property ~ZT- ~;~,~,~/2/,~,/, ~'~ ~, Owner Or Owners Of Property ................... ~...~..~...~....~.....'~... ................................................... Subdivision ~l~/x~/.~...~l(...~..~...Lot No../.8~... Block No~ ............. House No ............. Permit No...C.~,~./..~..~. Date Of Permit ............. ~.....~pphcant .................... ,-~ ......................................... ?/.,,~,Z,/..~..Z.. ........ Labor ....... ,~/~. ................................. Health Dept. Approval ..~,7/7/~-,~ .............. Dept. Approval Underwriters Approval .............................................. Planning Board Approval ... ...................................... Request For Temporar,z..CertLficate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all applicable ~d regulations. Applicant .................................. ~ ...................................................... Sworn to before me this Notary Publi~.~-~ C~ty TERRI LEE ELAK /~OYARy PUBLIC. State ol *~ew York No. 52.61b~J295 Examined .~ Approved ........................................ , 19 ........ Pemit No ..................................... Disapproved o/c ~..~ ..................................... (Building TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE. SO T D ~ U HOL , N.Y. /_~_~ APPLICATION FOR BUILDING PERMIT Dote ... 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, 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. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee~ aaent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...................... ,,;'. ........................... ~ ......................................................................................... if applicant is a corporate, signature of duly authorized officer. ~ (Nameand title of corporate officer) ~ // , , ; 1. Location of land on v~ .l~p~x:).~osed vy.e~k wj~ b.~.done~ Map No.: .................... Lot ~-.;.*~ .......... Street and Number ........................................ ~.~,~.. ........................................................................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ao Existing use and occupancy ..................... {~ ....... ..%,~"~ ......... aa ............................................................................ ,v~ .z-' ~,,' ~'///~., ~' ...... Intended u~ and o~upancv ................................. - 3. 'lqat?dre of work (check which applicable): New Building ......... ~ ~ ........ Addition ...../... ............. Alteration.....~ ......... Repair ............. ............ Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost ........ .~...i!~,..~.?~/.¥~;.[~(,~;. ......... F e e..~...f"~..~.'.....~..,-~... ........................................................................... (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 ....... ~.;.('.(. ............. Depth ......,..~ .................... Height ......................... ,;'J;:. .................. Number of Stories ............. :', .......................................................................... 9. Size of lot: Front ................ ;;;.;.; ............... Rear .................... ~'...q;-..:.; ........... Depth .....; .............................. ;.,: .......... Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase .............. '.L,.~.,../~C,; .......... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated ............................... ;;;~ ................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: 13. Will lot be regraded ........... ;..;~; ................... Will excess fill be removed from premises: [ ] Yes [~1, No 14. Name of Owner of premises - ' ~- '- - - -- - (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor .........~' ~.~.~,,,.~' ........ ~' ,,...~'~ ....... · '~ ~ .......... ,.....~" ........ ' "¢ ............. ~ ' ~'-, ........... - (Phone No.) (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 descri Orion according to deed, and show street names and indicate wheth- er interior or corner lot. ~'I'ATE 0 F NEW ~o..,/r~~ "' ) ~S' ....................... COUNTY OF .............................................. ) ................................................................... being duly sworn, dapo~s end says thet h~ i* th* ~limnt ~bo~* n~m~d. ~ame of individual si~ing con~act } ~ ~ ~ ~ He is the .......................................................................................... ~.~ ............................................................................................ {Cont~ctor, a~nt, corporate officer, etc.} of said owner or owners, and is duly authorized to ~rform 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 knowled~ and belief; and that the work will be ~rformed in the ~nner ~t forth in the application filed therewith. .................................. d~ of ....................... 10 ............. ~otar~ ~ublic ...................................................................... CounW ................................................................. ~m~ of appllc~tJ THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ ak BUREAU OF ELECTRICITY I 8.5 JOHN STREET. NEW YORK. NEW YORK 10038 ~ateAugust [0. ~972 A..,~.,i,,,,~'o.o,,,.,,~8897~ N 36326 ~HIS CERTIFIES THAT August Spahr, n/s North Drive, 200' e/o Old Orchard Rd. East Mari~J~, L.I. in thefotlowlng location; ~ a~.t x [] :~t rt. [] ~.d Ft. outside . S~tion WaS exatnirted on AUgU s t 7, 197 2 arid found to be in cotnidiance with the requirements of this Board. FIXTURES ~,;,.~.~ ~'ECE'TACLESI SW.TC.ES l,,,c,.,,,,,~,~,,,.I~,o,~sc~,.,, ¥,,,.o, DRYERS T FURNACE MOTORS [ FUTURE APPUANCE FEEDERS SERVICE DISCONNRCT AN[T 1 'T~ER APPARATUS: RANGES iCOOKING DECKS OVENS DISH WASHERS EXHAUST FANS S E NO OF CC COND pER ~' 1 TIMECLOCKS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET R V I C 'I DIMMERS 5 Mattituck, L.I. This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors moy be identified by thei( credentials lrOlUf BO, 1 BUILDING DEPARTMENT TOWN C~RK'S OFFICE~ ~UTH~D, N. Y. ~amin~ ..... ( ~ ~ ~ .................... , 19 ........ ~pr~ed ~ ................................... .......................... ~ ............. , ]9 ........ PemitNo.~ [ ~ ~ ................. ...................................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This epplication 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. Pier plan showing location of lot and of buildings pn premises, relationsh p to adjo n ng premises or public streets or areas, and'~ giving a detailed description of layout of property must be drawn on diagram which is part of th s appl cation. . . c. The wad( 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 hove be'~l~_~ granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance Of a Building Permit pursuant to th~ 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 regu at ons, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, Jf e corporation) (Address of applicant) State whether applicant is oM~ner, ~ age~nt, architect, engineer, general contractor, electrician, plumber or builder. ., ............................................. ; ............. ...... ..................................................................... Name of owner of premises ...................... ~--'~ - ~--~....., ..................... ~ ~ ~~ ....... ~ ................................................................................. If applicant is a corporate, signature of duly ~eu~orized officer. %~ ................ ~,¢~.~.-:.~:...~L ...... ~%,9:....~ ......... ~,....~ .-t~ ~. ................. ~ (NameJand title of corporate officer) ~, 1. Location of landron ~o~.~k~o~Ma~No.: .................... Lot ,.,-,----- .... St~t and Numar ........................................... ~ .......... ~ ............................................................ ~...~.~;~.....; .... ~ ~ Munici~liW 2. S~m exi~ing u~ and o~upancy of premi~ and in~nded u~ and ~cupancy of propo~d con,ruction: a. Exi~ing u~ and ~uPancy .................... ~ ....... ~ .........~ ............................................................................ b, In~n~d u~ and occupancy .................................. '4. 10. 11. 12. 13. _~,-~14. ~at~re of work (check which applicable): New Building ' ....... ~ ........... Addition ..................... Alteration.....~ ......... Repair ........ . ......... Removal ....... Demolition ........................ Other Work (Description) Estimated Cost ..........~./.¢..~..~:. ~.. ......... F es · .~...t~ ~.~.....'~...-~.... .......................................................................... (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, commemial or mixed occupancy, specify nature and extent of each type of usa ..................................... Dimensions of existing structures, ~f a~¥: Fron{ ................ ;~.:,~' Rear ........................... Depth ................................... Height N~mber'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 ....~,~9...~ .................... Height ........................ ~...~. .................. Number of Stones ......................................................................................... Size of lot: Front ............ .~ ~....~. ............... Rear ................... ../....~'....~.., .......... Depth .................................................. Height .......................................... ; ......... Number of Stories... .............................................................................. . . ... Date of Purchase ............. .~...~.~..~. .......... Name of Former Owner ............................................................................ Zone or use district in which premises are situated .............................. .~ ................................................................ Does proposed construction violate any zoning law, ordinance or regulation: Wdl lot be regraded ........ ,¢~..~.~.,~ ~ -- ,~..~ ~.J ~. -~Will excess fill be removed from premises: [ ] Ye~s ..~ Dn[ No of Owner of premises ~ard~`f~"~~A~fr~i~x~~~N~~ Name Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor ...... / (Phone No.) (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. E OF NEW YO_~K, ~. ~-, COUNTY OF ......~ ...................... oo ..... , ........ ..'~...~ ........ ~ ............................................. being duly sworn, deposes and says that he is the applicant above named. · ~a~ oftndlvl~ ,i~ing con,ct} ~ ~,~,~ He is the .......................................................................................... ~.~.: ................................................ ~ ........................................... ' {Con~ctor, ~t, coyote o~, etc.] of said owner or owners, and il duly authorized to ~rform or have ~or~d the ~ld work and to make and file this appli~tion; ~ all s~temen~ contained in this application are true to t~ ~st of his knowled~ and ~lief; and that the work will ~ ~or~ in t~ ~n~r. ~t forth in the application filed therewith. ............................ L..de ................ .....