The URL can be used to link to this page

Home My WebLink About5926-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. 2~90.1 ...... Date ............. 1/or .....f0 .... , 19. THIS CERTIFIES that the building located at . ~h:l.p ~ $. D~'~r~ ............ Street Map No. ]B&yvSeW. ~oo~?c~t'eS ....... Lot No.. ~'2''' Southo~d.. N..Y, ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ la~.~r... 26 .... , 19 .~2. pursuant to which Building Permit No. dated ......... J~xtle-. 6 ..... , 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 ... Pr.:l. vat~ .one..famia,~. dwelilSng ..................................... The certificate is issued to . .Frardc 'Anderson. ....... UWner ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~ov. 8~..1972..l~y. ....... UNDERWRITERS CERTIFICATE No ..... 1~ .1+.~96~ .... Sept' ~% · 197~ ................. HOUSE NUMBER... '~'1'~ ...... Street .... lih.:l.~t 9. Dil,t-V~ ............................... ........................................................ ~OE~[ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N!. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI:IEMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ..... ,l,~m~'~:..~e~...z~ ....... &/C....I~.. .......... .1.~.1.....~.~~... ~l ..................... ............... ~t~h.t, oV~ ....... lt.,~., .......................... ~o ...~..~..z.~...~..,,~..?.....t..~..t.~z..~:..z..z.~ ................................................................................... at premises located at .......~Gt,...~- ......... ~J~.3t¥&r~...~i~i~o~..~J~ ................................................... ............................................. · h~,t~:.,~.~.~.~.~ ............. ~ia~t~o~l~.....l[.Z~ ..................................... pursuant t9 opplication doted ........................... ~......:~. ........... , 19....~, ond epproved by the Building Inspector. Fee $'"'J'~'~'. 3J" ..... pEV,.MIT iNCLUDES AppROVAL TO REMOVE ExcESS FROM ABOVE pp.,EMiSES BY CELLA~, coNSTR. UC'I tON o~H~ I~OBM NO. ~ TOWN OF $OUTHOLD Building Department Town C:led[s Office Southold, H. 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: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approva! of Health Dept. of water supply and sewerage dJspcsal--(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 Cede 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 o~ 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 ~,:o//~ ~ Date ............. r.._r .......................... New Building ...... ~.... Old or Pre-existing Building ............................Vacant Land ............................ ' ' ' ~""'~'f' · · ~ /: c/ Location Of Property .~. ........... ~. ....................................... ...~..... Owner Or Owners Of Property ....... .~..../..~.~// ......... ..~...¥./~.~...~..~...O..~. ..................................................... Subdivision .. /,,/.~:~; .... .~.~....~..~.~.~t No...../....~.... Block No..., ......... House No....~..../.~,.-'~ Permit No~....~..~. Date Of Permit ...~ .~.......~pplicant ...... X/..~....'~....~..~.'../.~'. ....... .~.....~..../-.~.~.~ ........ Health Dept. Approval ......... ...~...~../.~...~...~.i.~....~.. ........ Labor Dept. Approval ................................................ Underwriters Approval .~,.~..: ................ ~.~.~.~......~..P anning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate /'~ Fee Submitted $ ~ ............................... Construction on above described building and permit rr~ets all applicable codes and regulations. p cant ~ ~~'~-~. Ap ........................ ......... i...,z... ........................... Sworn to before me this · ..! .~.. da of ..~..D...V%..~.~ , -~ ~ ......... y_o' . ..................... ......... Notary Public ...~%~.~... County TERRI LEE ELAK NOTARY PUBUC, Sta:e of New York No. Qualified u, .~- Ccu~ (stamp or seal) t LOT- 11.6~' 4-0' ~'0" \¥. - IG8.06 LOT · 13 I / MAP OF PP, OPERT¥ '5U F, VEYED FOR ·FRANK ANDERS SOUTHOLD lOWIq OF $OU'iHOLD,KI.Y. · NOTE: LOT NUMBE~.$ OF BAY¥1EW WOODS ESTATES," FILED iN TIlE SUFFOLK COUNTY CLERK'S OFFICE SCALE ' zFO'= I" El = I¢ONUI~EHT A. = TACKED 5TAKE · su~wv~ OCT. 4 VAN TUYL m SON LICENSED LAWD SURVEYORS ~ENPO~T, NE~ YORK SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No f~a//~/ APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS requested,pertinent data herewith: Date systems is Approval to const?ct said i-Applicant ~/,'~(V~4~ ~/ rtl : /~i ~ Phone ~ ~ '~6-Sub div /'W~ ~-~, ~ ~c~. Address /~, , .%~ ~ , ,~,~. , ~ ~,, .... £,1~ , ~ 7-Section 2-Detailed proper{y DC idb ~./ · , : ':~ .: : ,.,: 8lLot No. Hamlet '' Town 9-Private well? 3-Public water supply name Distance to nearest main 4-Lot Size: Width ,, ft. Length ~ 'ft. (also enter on center plot plan below:) 10-Proposed system. Septic tank F/;Prec3~e~2/~Cesspools/ /S~llow pools / /Other / / il-Septic tank inside ~imenslons~ Volum~als.Len~th ft. W~dth f~. Liquid depth ft. l£-Precast sections: /~;Number~:~Squa~'Ft. Cesspools: Block sizeL ~ncs.D ins. H ins. Total blocks below inlet: ~1 ! ~2 ~3~3 PLOT PLAN Capacity ~ ~Gals. -~ G.P.M. ~ ~oo ~ ~ m o .Grade ' ~ L ~th Data ~eet 0 2 6 8 10 12 ~6 18 ~ ~ Indi ~ ~ ~ No The Undersign~ CERTIF~S: "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standa~s, Bulletins, a~ amendments thereto, covering Private Sewage Disposal Systems". '> -- Signed ~ ,// ~ .~ · Date '~ , Owner or Builde~ 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. (10/65 Revis.) 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 ~hich 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. Enter "Yes" otherwise. PROPOSED SYSTEMS: Answers to Items number 10, ll, & 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, & Bays, 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-lO0 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 I food to maximum of 2 feet Bottom of Cesspool to ground water must be held to minimum of i foot TOWN OF SOUTHOLD 7//~/?z._~y'~'' '-~,t..L '~t'- BUILDING DEPARTMENT ~ '~~~ ~UTH~D, H.Y. 7~7/7~ ~ <~ ~ ........... ................ . .............................................. ,< ............................. ~ _ ~ ~ ..... / ................................................................. ..T.7 ...... ............. ............... ...... ....................... , , , ~, ...... L.~...~.~ ...................... , ~.Z~. ...... ~. lhi~ ~fi~tion mu*t ~ mm¢l~tel~ flll~ in b~ ~writer or in ink ~nd ~ubmi~ad in tri~limte to the ~uildin~ b. ~lot ~ ~in~ Iomtion of lot ~nd of buildings on ~mmi~, r~l~tion*h ~ to ~oin n~ pr~mi~*~ or ~ub ~i~in~ ~ ~d ~ri~tion of M~oat ~f ~ro~rW mu*t ~ dr~n on di~r~m ~hieh i~ pe~ of thi~ ~ppli~tion. ~. ~ ~ ~rad ~ thi~ ~limtion m~ not ~ ~m~n~d ~for~ i~u~n~ of 8uiMM~ ~rmit d. ~n ~m~ o{ thi* ~imtion, the 8uildin~ Im~or ~ill i**~ ~ 8uildin~ ~rmit to the i~ ~nt Such t~ pmmi~ ~8ilab~ for ins~ion throughout the work , e. ~M~k~B'~ ~o~ or ~d in Whole o~in ~ for any pU~p0~ whatever Until a ~rtificate of O~u~nw shall have ~n ~ ~ t~ ~ilding Ins~or. APPLI(~TION IS HEREBY MADE to the Building Department, for the issuance, of a Buitding Permit pursuant to the Building Zone Ordinane~ ~;f'th~. Town of SOuthoid; Suffolk County, New ybrk, and other appliCable~ Laws,'Ordinancas or 'Ragulatl/}n~ 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 ffemises and in buildikgs for necessary inspections. (Signature of applicant, or name, ifa corporation) (Adiiress of applicant) State whether applicant is owner, lesseer ager~, a~itect, eugi~acr, general contractor, electrician, plumber or bu If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate Officer) 1. Loca,tion of land on which proposed work will be done. Map No.: ,5,,~2.0 ........... Lot No ...... .l,;~ .................................. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and o~c_ upancy .................................................................................................................... ; ............... ~'N b. Ifltended.u. se and occupancy "- ,, . i 3.~' N'a~m of work (check which applicable): New Building ...][. ................. Addition ..................... Alteratien...h, ......... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost ...~..~.~.{).0.,.~.0. ..................... Fee .....~..(..~..;...~.~..'~.~. .............................. ~ .................................... (to be 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 uss ..................................... 7. Dimensions of existing structures, if any: Front .~.O~ft .......... Rear ........................... Depth ................................... Height ........................................................... Number of Stori/es ........i .................................................................... / Dimensions of same structure with alterations or additions: F/tont ..... 0 .................... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front .,,~.!,8~ ............ Rear ...5~.!.J~.?. ............. Depth .~[..&..,,~.a. ...... Height ...~ll~a...~.! .................... Number of Stories .........~ ............................................................................. 9. Size of lot: Front ....~.~..8..t*~..2...~ .................... Rear ]-~Ot0l ......................................... Depth .~..6...8. ~.~..~....~i.. ~..b.~.~.~.! ............ Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchass ...a.~,g~'.~l:.e...5/..~'.~. ...... ~'~ Name of Former Owner ................ ~ ..................................................... 11. Zone or uss district in which premisss are situated ....~e, tll.aa.f~.ta~. ............................................... ; ...................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....D,Q ................................................... 13. Will lot be regraded ....._~___o_ ........................... Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises ./.~....~g.~..e.~.~..q~....,~l,..Jl~t~..~ 1 ... PeL'q...,7.ef.'f.e~a eat ,..~[Z ........... (Address) (Phone No.) Name of Architect ...H.~...z~:.....P..e..t.,.e.,~.~.e..~.. ............................................................................................................... (Address) (Phone No.) Lanoer ~eaes, lno. 151 B ~ea h S~tthtmm 88- Name of Contractor ............................................................... !..~'. ....... ~...! ............................... 5. ...... '~q~.~ ........ (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildinga, whether existing or proposed, and indicate all set-beck dimensions fram property lines. Give stregt and block humber or description according to deed, and show street names and indicate wheth? er interior or corner lot. ~,,~Z'8 ~'et~.~ez'~ being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract) He is the .................................. (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 bell,e~; and that the wor,k,,,,will be performed in the ~nner set forth in the application filed therewith .... ; // ~? ............. ................ day of ........................... Notary Public, ..F..X./~.....~;Fcf./~.....~'.J¢~.~ ......... Countl, o. ~:~aaa....~m:~z.c~J~' ..................................................................... ~ta~ ~ ~l~t ~. Z~tur_e of ~t) LOT- H S. 63'2~'50"E. - 36.0 14'a.83 ~610 N. 62' 40' 40" W. - LOT · 13 IG8.06 50UTi-iOLD · NOTE: LOT NUM~E~.$ $;;O',Vhl ~EFE~ TO "MAID OF DAY~:I~W WOODS ESTATES," FILED I~E SUFFOLI{ COUNTY SCA 40 '" ,~:t'-"- 7~ --5- .......... 7 ........ -~-'- ' ' ? ....... ?~ ~ ~ r q