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Home My WebLink About5853-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Zh812 ....... Date ............I~el~t .... 1.3 .... , 19.~. THIS CERTIFIES that the building located at ],ee~aa' D~' .&. l~em¢. DZ, ..... Street Map No..~ ......... Block No...313[ ...... Lot No. - X al · .8Otlt~l~].&l .1I,¥.~ .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .........y~], ..... ~..., 19.~2. pursuant to which Building Permit No. dated ............ l~&lr ..... ~.., 19.~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 .PT~.-I~t;®-Olle. £tm~.].~ .dVl.]:~.~r~g ....................................... The certificate is issued to . .lt~&s~;- l~cllroe4eZ' ......... 0vnez' .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval I~el)t;. 8 '19~2' 'by '~,' T-$I.].& ....... UNDERWRITERS CERTIFICATE No.-Il. 3~t+?· ....................................... HOUSE NUMBER.. ~09~ ...... Street. '~,OO~;~1~ 'D~' ' · '&' ~O' -11101~ 'D~' ................. Building Inspector "! FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5853 Z Permission is hereby granted to: ~o .~..~...~.e....~..,~....~mZ~ .................................................................................... at premises located at .......... W~..~&tr.~)~..~..~..~ll~r-~, ................................................ ..................................................... ~m~L....~io%.. ......................................................................... pursuant to application dated .........................~ ......... .~ ........... , 19~,...., and opproved by the Building Inspector. Fee $.~..~..e..~ .......... Building Inspector lrOB~ NO. 8 TOWN OF ~OUTHOLD Building Depadrment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instmctbns 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 dispcsal--(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 $§.00 2. Certificate of occupancy on pre-existing dwelling Or land use $5,00 3. Copy of certificate of occupancy $1.00 Dote ..~....~...~..:...~,~....l...cL~.~ ........ New Building ...... ..~.... ........ Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property,.~:~..s.~.~......~,...~......:,:..~...d~...~(~,S ..... .~). ............................................... Owner Or Owners Of Property ...~..I.~ .~..~'.~."~.......5..C~/....~....~.....e..~....O..~..~.. ........................................................ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No.,.~.~...5...~.......~.. Date Of. Permit ~/.~..~....5~../.~.~kpplicant .~.~.V./:9.1)~-~....~g.L~L~,,~....II3~.C~ ......... Health ~pt. Approval ....... /..:. .......... ~..~=.w.=....Labor ~pt. Approval ................................................ Unde~rite~ Approval ~.~J.....~/..~.Y.~.~ ...... Planning B~rd ~provol ........................................ R~uest For Tempora~ Ce~ificate ........................................ Final Ce~ificate .......................................... F~ Submitted $ ...... ~ ........................... Construction on obove describedplb:ilding~permit rneets~::~o~ppl~[cob'~..es ..~d~~' Sworn.~t..before me thisAP i antd~l~'~Z~'~['~/'~---'~'~ "J' '~ .... I..~ ....... day of ....~....~..~L-~..~.~...~..~..~..~....~ (stamp or seal) ~- '~/'~ / Notary ublic .................................... County TERRI [i~E ELAK NOTARY PUBLIC, ~tate of New No. 52-6168295 Qualified in Sull~lk Commission Expires I~a~ci~ ~U, J. 9 ~ SUFFOLK COUNTY DEPARTMENT OF HEALTH HoDoRe£erence APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval to construct said systems is requested,pertinent data herewith: Date~*~ S iqq~ 1-Applicant p~r~,~J ~1~. i~ Phone~-'~6-Sub div ~VS ~ Address ,i~,~m~ ~ ~.~ ~ ~ 7-Section 2-Detail~ p~pe~y location~, ~A ~e~ .~ JA 8-Lot No. Hamlet ,~, ~O To~ ~o~T~_~ 9-Private well? ~ 3-~blic ~ter ~pply ~me Distance to nearest ~in 4-Lot Size: Width~ft. Length~ft. (also en~er~n ~enter plot plan below:) 10-Pro~s~ system: Septic tank ~Precast ~Ces~p~o~Shallow ~ols y~Otber / / 11-Septic ~ inside dimensions: Volt.Gals.Length ft. Width ft. Liquid depth ft. 12-Precast sections: ~Number/ /Square Ft. Cesspools: Block size~incs.~s.H ins. Total blocks below inlet: ~1 ~2 ,~3__ Grade Street L o ~ Tho ~ndo~s~gned acco~ance with the Suffolk County Health De~rtments' current Standa~s, a~ amendments thereto, covering Private Semge Dis~sal Systems". Date ~ ~ ~ ~er ~ Bui~er Capacity ~ls. G.P.M. ~ Lte Data ~eet 8 10 12 Indd Nc ~h "Construction of authorized installatio will be in Bulletins, 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 SflALLOW LEfCUIIiG SYSTEM Use one (1) 900 gallon reinforced precast B. Use five (5) 8 ft. diameter, 2 ft. leaching rin§s. concrete.Septic 'rank. high precast concrete C. Use 4 inch diameter, class 2400 pipe throughout. D. Tile wasteline from the Septic Tank should enter as high as possible. the middle ring E. Use four cross-over pipes between the middle ring and the four outside rings, 8 inches above the bot-aom. F. Backft'll material shall be course sand and gravel. G. Slabs shall be a minimum of 6 inches tIlick, 8 ft. in diameter. II. Solid concrete covet- t:o be minimum 1 foot belou {p'ade. 1. Bottom of pool to be Iniriimtn~l of 2 feet above ground water. ,~.'~) J~ TOWN OF SOUTHOLD ~//~/?~ ~-'~f*~//-~/~-~ '~ ~ ~ O BUILDING DEPARTMENT~~ _ TOWN CLERK'S OFFICE ' SOUTHOLD, N.Y. ~ ~ ~- Disapproved ~/c ............................................................................................ ....................................................................... _7"F ...... ............... ...................... ........... ........................ t (Buildin~ In*pecto~l ~ / ~Cc ~ APPLICATION FOR BUILDING PERMIT ...... ........................ , INSTRU~IONS . a. This a~plication must bo completelg filled in bg tg~ewrit~r or in ink and ~uBmitte~ in tri~licato to tho Buildin~ Inspector, with 3 sets of ~lan~, accurate ~lot plan to ~cale. Fee aecordin~ to schedule. b. Plot plan showin~ location of lot and of buildings on premises~ relationship to adloininfl premises or public streets or areas, and~ ~Nin~ a d,tailed descriCtion of lagout of proCerW must be dra~n on diagram which is part of this application. c. Th~ work co~ered bg thi~ ~p~lication mag not be commenced befor~ i~suance of Buildin~ Permit. d. Hpon approval of this a~lication, the ~uildin~ Inspector will issue a Buildin~ Permit to tho a~plicant. Such ~rmit shall be kept on the ~r~misos available for in*p~ction throughout the work. ~. ~o buildin~ ~hall be occupied or used in wholo or in part for an~ purpo~o whatever until a ~ertificat0 of Occu~anc~ ~hall have been) ~rant*d bg the Buildin~ In~ctor. 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 Count,/, New York, and other applicable Laws, Ordinances or Regulations, for the construction e 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) owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder._~ State whether applicant is Name of owner of premises ..~...~ .~.F~.~..~......~...~...)~....~..~.~..O....~....~. ....................................................................................... If appljr~ant is a corporate, signature of duly authorized officer. {Name and-title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: .................... Lot No .............................................. Street and Number ~`:~C~/~~?-~r~.~r~?~i~~. ...... .-....~.~...~...!.'..~...~...~....i~....; ............. -7.. ~, ? ~--.~ ,~o~, MunicipaliW 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: 3. turegf work (check which applicable): New Building ......~..... ........... Addition ..................... Alteration ......... ~ ..... /Repair ......................... Removal ......................... Demolition ................. Other Work '% ~ . ,/ (Description) d_ 4. Estimated Cost ....................... 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 ..... ~Lg.J~.~m .......................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................ i .................... 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 oI entire new construction: Front ..... ,,o~,~. .............. Rear .,~.~. ..................... Depth ..~./'~.. ....................... Height ..... ~. ....................................... Number of Stories ..... [ ............................................... , .................................. I I O ~ 9. Size of lot: Front ...... ~..O. ......................... Rear ..... .[~,~.0. .............................. Depth .a...5'.. ........................................ Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase ..~J..o.?..:...I...q...~...I. ............ 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: ..... ~L..O. ................................................ 13.. Will lot be regraded ...... .'Z'.IT..~. .................... Will excess fill be r~dr~qyej;I ~ocn.pr. emises: [ ] Yes ~ No 14. Name of Owner of premises ~([l~..~.~......~.....J~...{~....~...~..-J~....3F~,9.~.l,...t~ ................. .~..~.....?..~.~..4 ................ (Address) (Phone No.) Name of Architect ................................................................................................................................................... . . (Address) (Phone No.) Name of Contractor ..~.g...~....~....O..~...A...5......¥)~.~t~...5;. ........ J.~..J:., ...... ~q~!~.~.~.~.~.~-u~.~T~.~?~-~ (Address) (Phone No.) Locate clearly and distinct property lines. Give street and blOc er interior or corner lot. STATE OF NEW YORK, ) COUNTY OF ...................................................... ) all buildings, whether existing or proposed. number or descripJion according to deed, an ~d indicate all set-back dimensions from I show street names and indicate wheth- ........... L~.,I~,...~'.-,~:.~., ,~,.~,...,~,, ~,.,~,.?,,...,~.,,~, ...................................... being duly sworn, deposes and says that he is the applicant above named, (Name of indi~M~al ~ig~in~ contract) He s the ..................................................... , ,C~..?..~.., .~. ~..~. ?..*~.. ~ ........ .0., ,~.-~..~..~.~, .~. ............................................................................................. (Contractor, agent, corporate officer, etc.} of said owner or owners, and is duly authorized to I:~jf~ ~r have Derformed the said work and to make and file this application; that all statements contained in this application are true~t~t~,t ~{~l~%~E~eo~i,~e and belief; and that the work will be performed in the manner set forth in the application filed therewith. No 52-0344963 Suffo',k Coul '~ ~,~ , ~.,~ Commission ~xpires Morch,,~' ~ .............. ....... =.,....day of .............. ...... _ ....: , Notary Public, ~. ,.~.,,....~. ,,~~unty "~T~'~'~'" ........................... (Signature Ol appticantJ {/ ~0" \V. - DF. Ut,iL · NOTE- DATUM = 0.0 H}GI-I \VATERMAIZK L.ONG ISLAND 50UND N · TEST HOLE., SAND WATEIZ. PROPERTY SURVEYED FOR. SCH ROF::DL:R SITUATE AT SOUTHOLD TOWN OF $OUTP. OLD,~.Y. A~I~NO~P J u~.-/18,197Z. SCALE - ¢0': I" iD = II~,ON PiPE E] =- MONUMENT ~ll = WELL 4~: CESSPOOL · SURVEYED - MAYIS, 1972 VAN TUYL ~JC~is~D L~.~) ~u~'~o,~s GREENPOET ,, NEW SUFFOLE COUNTY /~EALTH DEPAI~TMENT SEP 8 m~. ~. ~.~-//~d The se,ua~e disposal and wate~ supplF faci~ties for the structure located at have bee~inspected bF this Department ~d Chief of Oensral ~i~zu~-ln~ ~ervzces U TOh~ LEE DRIVE DRU~L · NOTE. DATUM =O.OHIGH ~VATERMARI~ LONG ISLAND SOUND MAP OF PROPERTY I'"-' L.LJ SURVEYED FOR -> ERNEST SCHROEDER · ~ ~ ~ SITUATE AT g ' SOUTHOLD ~ '~ ilto.,~..(~' TOWN OF 50UTI4OI, D,Id.y, SCA L E - 4-0'= 1" G = IRON PiPE E1 =' MONUMENT CESSPOOL · SURVEYED ' MAY I~, 1972 VAN TUYL & SON ~ ? LEETO~ s¥~S~, so"W- D~,U~iL · NOTE. DATUM = 0.0 HIGH WATERMAEK LONG ISLAND SOUND · TEST HOLE. I ' ~. CLEAR ' ~ SAND J-- - Z' WATEi~ MAP OF PROPERTY SURVEYED FOP-, RNES,T. SC R. OED R -" $OUTI-IOLD ~ ,o'*:~,.~'~ TOWM OF SOUTI4OLD,kI.Y. ,to \ SCALE - 4-0'= I" ~) = IRON PIPE 13 =' MONUMENT ~: WELL 4~: CESSPOOL · SURVEYED ' MAY 3. 1972 VAN TUYL LICENSED LAND