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HomeMy WebLinkAbout5794-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z.~002 ...... Date .............. Feb....11~ , 19 THIS CERTIFIES that the building located at . Th~'~esa' 'a 'D~Op 'Ho~e · D~*' Street Map ND. Deep. Hole. ~]~lq~t~es ......... Lot No.. 1 ..... Mat. tituck · · E...Y · ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... April .... ~.., 1972. pursuant to which Building Permit No. dated ......... Apt. il ....5..., 19.72., was issued, and conforms to all of the require-  s of the applicable provisions of the law. The occupancy for which this certificate is issued is . .Prt-v. ate. one. £a~il¥. dwe.~.l.i~g ...................................... The certificate is issued to . l~re~l. ~elBon ....... ~n. er ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ' .Dee.. '26' · '1'97P' - 'by' P,'~ '¥:~'3.~'a - UNDERWRITERS CERTIFICATE No ..... N. 697O0 - .Jan .30- -1973 .................... ttOUSE NUMBER.. '2t30 ..... Street. "l~'~o~esa- .DI' .................................... ................. ........... .............................. Building Inspector FOBM NO. ~ 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? 579 Z Date . &pF~m. ~ , 19 *~ Permission is hereby granted to: at premises located at .......... .~.,J....J..l.,~.e...e.J~.....J~J.l....~.JJ'.t~J,..~..l~..~....t~.! ......................................... ........................................................ ~a$,t~L. tueh....1~,~., .................................................................... pursuant to application dated .............................. ..~.I)Z;J,J, ....... ~....i 19...~...., and approved by the Building Inspector. Fee $.....J....~1~....e. ~ ~. ..... pERMiT INCLUDES APPROVAL TO REMOVE EXCESS FiLL FROM ABOVE PREMISES BY P, EGRAC I~4G L,.;T ~ DR"' ,,,/~y CON-TRUCTION ~ C~ ,~P~ L CG:NS ~ RuCTI3N ~ CELLAR CONSTRUCTION ~- OTHER THE NEW YORX BOARD OF FIRE UNDERWRITERS ak BUREAU'OF ELECTRICITY 85 JOH?: STREET· NEW YORK· NEW YORK 10038 CERTIFIES THAT Mr. Fred A×elson· Theresa Dr1¥eE coz', o£ Deep Ho].e & Theresa Dr, Mat tttuck, L,I. .,.n,,,,,~,~ ~ ~,,,.,,,~,,,,: x n,,~,....,,, [ ~ ~, r~. [] ~,,d r~. outs ide ..~,,~,~o,, ~VENS ~ISH WASHERS 2/0 EXHAUST FANS A WG NO. OF NEUTRALS OF NEUTRAL 1 2/0 *Y:~rnaces:Oil 1-1/8hp, 1-1/!2hp Motor/s: 1-1/2hp P~netboard/s: 1-24cir.200am~o.n~ SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference NO~i)~/~m~} APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date Approval to construct said systems is rgquested,pertinent data herewith: 1-Applicant j~w~z~ ~_ ~.~L~/ Phone,~7-$~6-Sub div ~a~m/L e~e'z~ Address~ ~~~ y3_~S-- YY~,~/~t ~ '7-~,,,~. ~Y-~_ 7-Section ' 2-Detail~ p~pe~y locatio~ ~-~ ~~ ~8-Lot No. ~ / Hamlet ~/,~ To~ ~~ 9-Private well? ,/~- 3-~blic ~ter supply name Distance to nearest ~in 4-Lot Size: Width/~ft. Length~o~ft. (also enter on center plot plan below:) 5-~elling: Single Family ~T~ Family? ~/Cellar? ~ /~lab? ; ;Crawl S~ce? / ~ lO-Pro~s~ system: Septic tank ~ /Precast y~Cess~ols /~Shallow ~ols / /Other / il-Septic ~ inside dimensions: Vol~e ~als. Length ft. Width ft. Liquid depth 12-Precast sections: ~Number/ /Sq~re Ft. Cesspools: Block sizeL incs.~s.H Total blocks below inlet: ~1 [%d~2 f;~3 ~T P~N The Undersigned CERTIFIES: . ! ins. Indfi , e Nc Capacity Data Peet '~ 0 ~ ~ 2 10 "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Systems'W FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, opinion of the Health Department, that an adequate and satisfactory Sewage Disposal System can be installed on this Plot. Date (10/65 Revis.) S-15 Signed 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. Z-Means detailed description of property location, together with street ~ame and distance to nearest intersection of main thorofare, also Namlet/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 ?-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, il, & 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 " . ,, , N " 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 WeE-DJ) 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 1 food to maximum of 2 feet Bottom of Cesspool to ground water must be held to minimum of 1 foot FORM NO. 6 TOWN OF SOUTHOLD BuiMMg Department T~m Cledm Offlee Seuthold, N, Y. 119'/! APPLICATION FOR CERTIFICATE OF OCCUPAHCY InitrucHonl A. This application must be filled in typewriter OR ink, and submitted in tripJicate 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 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), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey df 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 ..~..I.~.......~....~..?..~......~.~..~.~.?~......c~..!...~...~.~...~..~.~.c.~.`~.......~.....~.?...~..).~.~.~.~....~.:..~.~ Owner Or Owners Of Proaertv..~. X~.¢-.~.~xcL\<- C~, ~.).~0¥~ ~r~×~O~ Subdvs on .~....<.~'.~:.~......~....~.?.~..Q.%S.?...~......~.'..~.~.c~.~:.~. Lot No .... ~ ....... B.~k No ..... Ho.~ N~.~ ~ Permit No. ~..~..;~.~..... Date Df Permit .~ .........]. Appl cant =~C ~ e ~ ................................................................. Health ~pt. Approval ...... ~.~.i.L~.~. ................. Labor ~pt. ~proval .............. ~ ................................. Uode~rite~ Approval ..... '~[~.~.,~.~.[ ....................... Planning ~rd ~proval .....~:: ................................ Request For Tempara~ Ce~ifioate ........................................ ~Jnal Ce~ificat~ ...~ ................................... Fee Submitted $ .,~.:.c.?.?.. ....................... Construction on above described building and permit meets all appl!cable cod/q~/bnd regulations. App cant ~ ~ cz~- · / - ......... ............................................ Sworn to before me this ~'-~'~~--~~ ..... (.~..~.... day ~ ........................ ..~ ............ (stomp or seal) Public TERRI LEE ELM( ~O~ARY PU8U¢, State of New Yo~L No. ~2-61682~5 i~utl~fie~ in Suffolk County It$ion Expires ~a~c~ 30, Lg Examined FOuM NO. 1 TOWN OF 'SOUTHOLD BUILDING DEPARTMENT TOWN 'CLERK'S OFFICE SOUTHOLD, N. Y. · ~-7~.y.. .......... Applicotion No ............. ~.. ., ..... APPLICATION FOR BUILDING PERMIT 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, an_~d giving a detIilad description of layout of property must be drawn on diagram which is pert 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 o'~ the ~amiseI available for inspection throughout the work. e. No building shall be occupied or used in whole or in pert for any purpose whatever until a Certificate of Occupancy shall have been~ grlntad by the Building Inspector. . ~ APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordlnanca of the Town of Southold, Suffotk County, New York, and other applicable Laws, Ordinances or Regulations, for the oOnstruction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinancei, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building~ for necessary inspections. .... ./~.'.~..~~....~.~....~r~/..'~ (Address of applicant) State whether applicant~, agent, architect, engineer, general contractor, electrician, plumber or builder. INfaa~:, ~cf. n~.~s :rc:;p:rr:~i. SaiSgn atC~l~'~;(~ I y au~ ......................................................................... ' ..................... i~';~'~'~'~'~i~'l~'~i'~'~;;~'~i~f ..................... ~ ~_~, ~ ....... ........... .......... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Ex[sting use and occupancy ...... ..~...! ................................. .._ .......... x ........................................................................ b. Inta. d use a,d u ncy ............. ............................................................ 3. Nature of work (check which applicable): New Building .....'~=......7~.. ........ Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description 4. Estimated ................ t~ ............................... Fee ............................................................................... .................. (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 Stones ................. ,....y ................ 8. Dimensions of entire new ~t~ll:ruction. Front ........ ..e.......-..~... Rear ............................ Depth ........ '..t-..; ................ Height .......................... .~.[~ .......... Number of Stories .....~ .......... ; .......................................................... Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase ........ ./..~..~..( ................ 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 excass fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises .z...~. ............... .-c.;;..~ ................................ ,...~ ....................................................... (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor .....~..'.~.~:: .-~.. ................................................................................................................................ (Address) (Phone No.) PLOT DIAG RAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set~oack dimensions from pro~rty lines. Give street and block number or description according to deed, and sho,2.~__street names and indicate wheth- er interior or corner lot. STATE OF NEW2gORI~./~. ~/' ) ~ ,r~' .......................... V--: ...~..~.~L.....~ ........... being duly sworn, deposes and says that he is the applicant above named. (Name Of individual signin£ contract) He is the ............................... ~-" .......... ~~ ................................................................................................................. {Contractor. agent, corporate officer, etc.) of said owner or owners, and is duly authorized to parf96m_or have performed the said work and to make and file this application; that all statements ..... contained in this epplication ere true tO/ehe/13q~tO.~ol~el ~edgeof and behef, and that the work will be parformed in the me set forth ,n the apphcat,on filed ,berew,th. ............................ .dayo, ............. ....... ,, ............. ................................................ · _ ......... $. ,83 ° Z0'40"£. - /.CZ. 85' l F'~ED ~X£L,SOIV M,,q "r T I T U C /K.