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Home My WebLink About5925-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy N~I ........ Date ............. NOW...9 ....... , 19..73 THIS CERTIFIES that the building located at . 3/~. Sound..View..Ave ..... Street Map No... x~ ....... Block No.. -xX ...... Lot No.. xxx .... Southold,... N..~Y. ...... conforms substantially to the Application for Building Permit heretofore filed in this office ' ciat~ ......... J.u~®...% .... , 19.72. pursuant to which Building Permit No. dated ............ Jlt~e ....%., 19.72, 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 .. Pre, rate .erie .f.a~.i. ly. d~elltng ...................................... The certificate is issued to .Roi® .&. Jolm. Bel~l,'~all ...... 0~ne~.s .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ... liOV .... 9. · .~.97.3...by. R...Villa. UNDERWRITERS CERTIFICATE No.. N..1212~.... Oct...1.{~...19.73 .............. HOUSE NUMBER ... 1 L~)O ..... Street .... SOtl~d. ¥ia¥. Ave ..................... FO~ NO. ~ 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 COMPLETION OF THE WORK AUTHORIZED) N? 5925 Z Date ........................... ~...%~...e...... ~. ............ , 19..~1~. Permission is hereby granted to: ..~iu~a..& ..,T~ ....~e ~.~.y-,~ .......................... ....... ~.,~.....~Ie~,~G ..~, ...................................... ............ l~t, ho~& ................................................ to ..... J~I~lcL · ~.. ez~e · · ~ t.~ · · ~,~ e.tt..~ng. ................................................................................ at premises located at ...... ~.j~..,.~cru~..~t.:Ee~,v..A~.e.....(...l~.~.6.ot~/t..~,4~) ...................................... ........................................ ~.e~h~16 ......... /~.J., ................................................................................. pursuant to application dated ........................~ll~e....-~ .............. , 19...~:., and approved by the Building Inspector. Fee $.~0...1~. ........... dd~ng Inspec~ FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerics 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: 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, o 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 $1.00 $5.00 New Building ...Z. ......... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ...~..:....~.~..~...~.....?~.~...~./..~...~././..~...~......~..~..~`.~..~...~...f...~...~ ......................... '~' Owner Or Owners Of Property .~...~...~....'~.....~....~.~...~.. ........ ~-.~..~..~..~...~.. -~..-..~.. ...................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No.."~..~...'~.....~..~... Date Of Permit .~..-...~....~.Z~Applicant ..~..~.~..~f..~/.....~.~.../'~...~.!......~.....~./~..~-Z..~...~...~.( Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building a~~et/~~,~,~egulations. Applicant ~ .~...~. ~..~....,,~..%-.,~..~,~.~- - .'~. · .: ..................................... .... ~. day of ..~~../ ¢ 7 ~ (stomp or seal) ~otarv ~ub~ie ~td~e of New 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: 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, N[ultiple 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 $5.00 3. Copy of certificate of occupancy $1.00 Date ................................................ \/ New Building ~ Old or Pre-existin Building ........................ Vacant Land ........ l~ti~_ Of P.~.~rty ................................................................... ~..~ ...................... ; .............................. Owner Or Owners uf Property ...... ./J....//..~'...~........~..~.~....~.......~...~/~,~'r.~...~...~f.~..~..~ ................................ Subdivision ................................................ ~ ............. Lot No ............. Block No ............. House No ............. Permit No .~'...~...~.. .......... Date Of Permit .................. App cant ~.~.~ ............................. .~ .............. Health Dept. Approval ............................................ Lobar Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and p~ m~t~s I a~e .c/odes~a~gulations. Sworn to t'efore mu~4thisApplicant ....~~/%~.-:.~ .... ~day of i~~/~' 7c'7~' (stamp or seal) Notary Pqb~c ....~j4nty v ~o. ~-~:;o~ ~e. az ~ew ¥orlc '~on~,~- ...... ~,f~o:k~:gFC°unt~d-'~ 'o .~o0. o C. I/tr. DATE ~Q~'~ The sewage di~p~al ~d rater facilities fo~' ~bt~ l~eat~ Chief of SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Refsrsnce No.'TgI APPLICATION FOR APPROVAL TO CONSTRUCT PRIV.ATE SEWAGE DISPOSAL SYSTEES D~ Approval to const~ct said systems is requested,pertinent data herewith: a~e i-Applicant ~*~ -~-~ ~~E~~/~ Phone~r~6-Sub div Address ~ ~..~/ ~'~ ~/-~/~. 7-Section 2-Detail~ p~e~y locatzon~/~ ~J~D~ 8-Lot No. ~ Hamlet ~ ~'~ To~ ~~ ' 9-Private well? 3-Public ~.ter supply name Distance to nearest main . 4-Lot Size~ Width %_~_~ft. Length~ ft. (also enter on center plot plan below.) 5-Dwelling. Single Family ~ Two Family? ~ ~Cellar? ~)~S!ab? ~ ~Crawl Space? 10-Proposed system: Septic tank ~ ~Precast~___~Cesspools ~Shallow pools y YOther il-Septic tank inside dimensions: Volume ~Z~Gals.Length ft.' Width ft. Liquid deptb___ft. 12-Precast sections: ~Number/ /Square Ft. Cesspools: Block sizeL incs. D ins. H___ins. Total blocks below inlet: ~l~d ~2__~_~3 , PLOT PLAN ~l'es~xe Data ~eet 0 2 6 8 lO 12 14 ~6 18 ~ ~o Street ~ d~'b~//~/ m ~ . 'th The Undersign~ CERTIFES: "Const~ction of authorized installation, will be in acco~ance with the Suffolk County Health De~rtments' current Standa~s, Bulletins, and amendments thereto, covering Private S~g~is~yst~s%~ ~/~er or / ~ilder FOR ~ALTH DEPART~NT USE ONLY. Bas~ on the info~ation presented herewith, it is the opinion of the H~lth De~rtment, that an ad~uate and satisfacto~ Se~ge Dis~sal System can be installed on this ~ot. APPLICATION FOR APPROVAL TO CONSTRUCT PRl~ATE 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 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 "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. En'ter "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 lines of the heavy lined square in the center of Plot Plan shown on face o.f this application.~--~ Surface waters-Streams, Lakes, & Bays, etc., located withmn a distance of 5(~ 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-lO 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 i food to maximum of 2 feet Bottom of Cesspool to ground water must be held to minimum of I foot FO~.M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ~ '~" ................ , 19 ........ Application proved ........................................ , ........ Pem,, No. ........ Disapproved a/c .... ~ ..................... ~ ................... ~ ................ APPLICATION FOR BUILDING PERMIT Date ....... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink ond submitted in duplicate to the Building Inspector. 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 ofproperty must be drawn on the diagram which is part of this applicotion. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upan 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 progress of 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, ordinanc~e~ulations. /(~i~nature of applicant, j~ name, if a corporatioo) ...... (Address of applicat~t) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. CO- If applicant is a corporate, signature of duly authorized officer. (Name and title' of corporate officer) 1. Location of land on which propo,~ed work will be done. Map KJ, o.: ........................................ Lot No ....................... Street and Number ..'~..;..~......~.~.~,~'.~.....~/...~....~....~...~....~..' .......... ~ ...~....,~...~...~....~... ...................... /~Z y~ /gO ~' ~/~ ~'/~'0/77~/ /~'~' Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................................................ b. Intended use anc~ occupancy ..... ~ ..~....~...~....~7~.....~ .~..../..~./.....~..'~.../..~....~...~....~....~... ............................ 3. Nature of work (check which applicable): New Building ..~...~.... ........ Addition .................. Alteration .................. Repair .................. Removal .................. Demolition ................. ;_Other Work (Describe) ........................................ 4. Estimated Cost ................~ ......... : .............................. Fee ............. ._..~La~.,.. ....... ..~..(.....,~J ......................................... · (to b~ paid on filing this application) 5. If dwelling, number of dwelling units ..... L. ................... 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 ...... ~..."~.Q.~.~..../. ................ Rear c'".~_ / '~ / · ...~...~. ................ Depth .q~.... ;~..~. ............... Height ....../....-~...../. ..... Number of Stories ......... ./.. ................................................. :...~ ................................................ 9. Size of lot: Front .../..~....(? .............. Rear ..... ~.....~....~... .................. Depth . .~.....~....~...i.. '~... .......... 10. Date of Purchase .... .~.&/..~./...~.~....~....~...~....?....,~... ...... Name of Former Owner ...~....'....~.../.'...,~...~'n~/i 11. Zone or use district in which premises are situated ..... ~...Z......~...-~m.~.Q/...~..d.~..~..// ...................................... 12. Does proposed construction v olate any~zg_n ng aw, ordinance or regu at on:~ z~../.f.~ ............................................ 13. Name of Owner of prem.ses ./~..v..-¢..~.-....Q~..C~..~.-.~.~.~..?.iL. Address .'~.'.~...-~..~:..~..~.~...~../.Z.N'... Phone No~..~..-~......'~..L./.?.. Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate cleady and distinctly all buildings, whether existing or proposed, and indicate oil set-bock dimensions from property lines. (~ive street and block number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF ND~ COU N~.~__OF .. ........... (Nan' above named. of said owner this application; that the work wil Swam to before Notary Public, ..~ ^/ No, ~2-13~6200 -- Suffolk Co~ ~mmJ~iOtl F, xpires Mar. 30, 187 ~ 3 jl e is the applicant ./er, etc.) make and file and belief; and THE NEW YORK BOARD OF FIRE UNDERWRITERS SUREAU OF ELECTRICiTy 85 JOHN STREET, NEW YORK, NEW YORK 10038 ~.t~OctobeP l~, 1973 THIS CERTIFIES THAT /lpplication ~o. o. f'~ O ~1717 N ' · · 121 4 JOhn Ber~y~ar~, ~/side byt~apph~nt~m~onthea~e~plwat~numberint~p~m~esof inthefoll~i.gl~.,io.; ~ B~eme.t ~ l~tFt. ~ ~ FI. OUSS!de Sec,ion Block ~ .~ami.~ o. 0 C t 0 b er 15 ~ 19 ? ] .~ fou,d to be i. compliance wi~h ~he requireme, t~ of ~his TER S R V OTHER A~ARATUS: receptacles: z-JO~mps ~'~ Water heater: 1-~$.~kw ~ ~ ~"~"~' Pa~elboard/s:l-.~clr.~ 1-22cir., 1-4cir. 100ar:ps. each ~lec.room heatePs: ]]-2.Skw, l$-2.0kw, 2-1.5~kw~ 1-1.0kw, I P~ost !l~ht John Ber'Pyman ~~1~ -~,., ]~OPton Lane Southold, L.I. 119'/1 G~NERAJ.~N&~ Per_ l 1 COPY FOE B~I[DING DEPARtmENT. YNI$ COPY OF CE~YIFICAYE ~$y NOT BE AlTErED IN ANY ~ANNER. J i