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Home My WebLink About5826-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at . ~erf. oot. P~th ........... Street Map No...14.°.°.$ .e..C.°.V. eBlock No ........... Lot No.. J.8......~l.t..c.h.o.g~.e .... N. :.Y.: ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... A.p~'.~.l....~ .~., 19.7.2. pursuant to which Building Permit No. 5~2~Z.. dated ....... .Ap.~.~..1 .... ~..9 .... , 197.2. ., 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.r.iy.a..t.e..qn..e..f.a.m.i.1;(..d..v.e.~.l..~. g ....................................... The certificate is issued to . .R.°.b.e~t...R.e..h~...~..~.~.f.e.....ov~ke...rp. ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health ApprovaPe.c... 5..1.972...by. R, .VSZla ......... UNDERWRITERS CERTIFICATE No..N. ~...8.8.96...J'..1~..O..!3.7.~. . (..F.Og.a.l~..tlr) .............. HOUSE NUMBER.. ~.6.O. ....... Street ...... .1~..e..l*.~.O.o.t.. p.~..~1. ........................... BUILDING P~:RMIT (THIS PERMIT MUST BE KEPT ON THE P~EMISE~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 5826 Z Permission is hereby granted to: : ,, pursuant to application dated .......................... &~.~.~......~,¢~..~..., 19.~.., and approved by the Building Inspector. .,~ i~ Fee $.D.~ ........... SCHD SUFFOLK COUNTY DEPARTMENT OF MEALTH D~te 0[C5 Bldg, Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give dee~ location)/ have been inspected by this department and found to be satisfactory. Chief of Gemer~l Pmgdneering Services FO~M NO. 8 TOWN OF SOUTHOLD · Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF iOG~UPANGY Instructions A. This application must be filled in typewriter OR ink, and submi}ted in triplicate to the Building Inspector with the following; for new buildings or new us~: : , 1. Final survey of property with accurate location of all ~uilqlings, 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 Re~sddnces and similar buildings and installations, a certificate of Code compliance from the! ArChitect br Engineer responsible for the building. ~ ,5. Submit Planning Board approval of completed site plan ireqbirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming ~ses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, s}ree~ts, buitdings and unusual natural or topographic features. 2.Sworn statement of owner or previous owner as to use, o~..Cu~ancy 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 certi, fJcate.' ~.d'.i ...... Old or Pre-existing Building ..................... ; ..... Vacant Land ............................ New Building oca.on of P aperty ..... ~ner Or ~ners Of Property ......................................................... :'"*'*r ....................................................... Su~ivision ....,..~.M~..:~ ........ ~.~L~]..~.z: ............... Lot No .... . Bbck No ............. House No ............. Permit No. ~2 .................. ~ Date Of Permit ~//J~.,~.~Applicant .... h-.? ....................................................... Health Dept. Approval ............................................ Labor ~pt. ~ppr~val ................................................ Underwriters Approval .............................................. Planning Boa~d Approval ........................................ Request For Temporary Certificate ........................................ Final ';Ce~ificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit mee~j~ oll~li~ajple codes and regulations. Sworn to before me this ~'/~.~L¢~/ '7 ? '~' (stamp or seal) ' SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D,Reference No ~,)'"/ APPLICATION FOR APPROVAL TO CONSTRUC,T PRIVATE SEWAGE DIS~SA% SYSTEMS ~ Approval to const~ruct~ai~ sys,%ems is requeste~,pertineht!dat'a herewith: ~ate/[(//u%~,x -~ Address d ~,'~7~'/~ ~ "~ tl-[ ' [ 7-Section ' , 2-Detailed p~perty lo~ation~f.~ ~;~ Ofl~%~j~? ~ 8-Lot No, Hamlet ~/./~ ~-~ ~A~ TO~ ~ D ~'~ '~. / ~ 9-Private well? 3-~blic ~f~r S~pply ~ame ' Dis~ahce to nearest ~in 4-Lot Size~ Width/~ ft, Length ~i--f%, (also enter~on.center plot plan below:) 5-~elling. Single Family ~ Two Family? / ~/Cellar? ~ Slab? ~ ~ Crawl S~ce? lO-Pro~sed system: Septic tank / /Precast ~Cesspodls ~Shallow pools / /Other / / il-Septic tank inside dimensions: Vol~e Gals. Length~ft, Width ..... ft, Liquid depth ft, 12-Precast sections: ~Number/~gSquare Ft, CesspoolS: Block size~incs,~ins,H . .ins, Total blocks below inlet: ~1~2 ~$ PLOT PLAN Capacity___Gals. O. P.M. !Data eet Indi Nc "Construction of authorized installations will be in can be installed on this Plot. Date ~/~-~?/'~ Q~ (10/65 Revis.) S-15 The Undersigned CERTIFIES: accordance with the Suffolk County Health Departments' cu~redt Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal ~ystem~'. Date /~/]~d~/ ~0~7~ Owner OF ~B~ilder) FOR HEALTH DEPARTMENT USE ONLY. Based on the i~formati0n!~en~ herewith, it is the opinion of the Health Department, that an adequate and satisfactory Sewage Disposal System APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS INSTRUCTIONS: Applications must be submitted in triplicate i-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-~ter name of Public Water Supply District, together with the distance to their main. 4-~hter 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-~ectlon Number 8-Iot 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 ~cilities. 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. WEIL 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-~ 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 o'bserved for the location of same: Cesspool-lO feet minimum distance from lot lines to center of cesspool Cesspools exterior must be lO0 feet minimumdistance 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 I foot NO. 1 ~L~ ~)~ ~ TOWN OF SOUTHOLD / BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Yo Examined .....~ ........ ..~....., 19..'?.....? Approved ~'" 19...~ Pemit No. ~'~ ~ Disapproved a/c .................................................... ..... ( u' ding Inspector) APPLICATION'FOR BUILDING PERMIT Date April 19 I~.. .......... INSTRUCTIONS . ~ a. This application must be completely filled in by typewriter or in ink and subm tted ntr p cate to the Bu ding Inspector, ~~ 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, re at onsh p to adjoining premises or public streets or areas, ande g;wng 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 °n~c~e~, 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 beene- 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, Suffotk 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, an~l to admit authorized inspectors on premises and in buildings for necessary inspections· William Beebe (Signature of applicant, or name, if a corporation) ...... C ,,tc~ogue......I/.;/.. ........................................ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......................................................... ............................................................................. Name of owner of premises ...... .Re~e~r.t,..~,e~..&..~.~.£~ ............................................................................................. .~, If applicant is a corporate, signature of duly authorized officer. ~ ..................... ...................../ 1. Location of land on which proposed work will be done. Map No.:~...o..o..s...e....C...o..?~.ot No ...... .1..~ ................................... Street and Number ....[}e~r~.o~t..$~ ......... C,u,f,P-.ho4~tt~ ...... ~..Y. ..................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy vacant land b. Intended use and occupancy ......... ~.~.e....~...e:.~...~.~.y....d..~...e..~...~.~,Tz.g .......................................................................... ~,~ 3. Nature of work {check which applicable): New Building ............ ~.... Addition ............ ; ........ Alteration ............... Repair ............. . ............ Removal ......................... Demolition ........................ Other Work .................................... (Description) (to be paid on filing this application) 5. If dwelling, number of dwelling units ...t:uaa ....... Number of dwelling units o~ each floor ......................................... If garage, number of cars ........., ................................................................................................................................... 6. If business, commercial or mixed occupancy, speci~ 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 ...... ..3~v.3.~ ........... Depth ......2..~ ....................... Height ................................................. Number of Stories ...... 10~3{~ ............................................................................ Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ Zone or use district in which premises are situated ....... .~. t;~,~ .................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: .......... 33~3 ............................................. 13. Will lot be regraded--,,-,,Y..a~ ..................... Will excass fill beremoved from premises: [ ] Yes [3t No 14. Name of Owner of premises ...~...o..b..e..?..t....R..e.~ ........................................................................................................... (Address) (Phone No.) Name of Architect ...................................................................................... (Address) (Phone No.) Wm Beebe Cutc~o e Name of Contractor ...... , .............................................. .~t.j ......................................................................................... {Address) (Phone No.) PLOT DIAG RAM 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, ) COUNTY OF .......... ~U.~£ ~ -~ -~- ........................ ) ...................................................{Name ~i[.~. ..l*A~tl...]~ee~)corttracl~ .................. being duly ofindivi~.~d~$~gnin~ sworn, deposes and says that he is the applicant above named. He is the ................................................................ .(~3~.~Z'~,g~,~ ..................................................................................................................... (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 hest,~! his knowledge and belief; and that the work will he performed in the manner set forth in the application filed therewith, iVo~o~y · ............................. .-,,.,,....d,y of ......................... ...... ~/ ' [b3gnature of applicant) 4 ,;5, ' k!-,: :,