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Home My WebLink About5881-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerli[icate O[ Occupancy No. $. ~..~1~ ..... Date .............. 0Or...1.0 ...... , 19~ THIS CERTIFIES that the building located at ...G~nlt,t~l .I~n~ ........ Street Map No. F~lt,. 8la- ~[Block No ........... Lot No..1.29 .. Gre~l~port · .II,Y., ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... li&~'....16 ..., 197'~.. pursuant to which Building Permit No.. dated ............ F, ay....1.6., 19~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .Pri~te · OhO. family, d~elt.i~g. ...................................... The certificate is issued to . Ri~2. I,&~$tFy ....... OlOl®'la ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ... Oat;...~.. 19.~" b-~o.'/ill.& .... UNDERWRITERS ¢[RTIFICATE No ..... I[ .~.~6~ ......... , ........................... ItOUSE NUMBER...¥~.~ ..... Street... (}FOOl1. ~lil.].-~ .............................. Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5881 Z Permission is hereby granted to: ..... ............ ~-.~Jel~ ....... II';l:~ .......... ~o ..... l~l~l,~t .~..e~e...£~...~e:~lAz~ ................................................................................ at premises located at .......~,$~..'[~....$S~..,~....'~a$'~,~.~..~}11~'S$. ............................................ ...................................... I~.~,Ja' "JtlX' "l,=ml .............. ~,~'e~'J,t, .................................................. pursuant to application dated .................................. J~ll~l'""~'6"'", 19~r~..., and approved by the Building Inspector. Fee $....~e~lJL ........ TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, in triplicate to the Building 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, 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 applicabre. 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 unusuai 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 safet~ inspection of boildings 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 New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property_~ -- -- ,--- ,,~...~...~....~,.~.~.~.].~...~.,.~.....~....~..~...~......~...~.l~..~.z ~..~...~..o..~..r.' ..................... Owner Or Owners Of Prope,y ..~...~.mok~l) Subdivision ~..~.~.~..~...~. .... .~...-./'~..,~. .................. Lot No.)7~............ Block No. ............ House No .......... :.. Perm,, Date Of Permit - Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit/meets all applicable codes and regulations. Sworn ~before men__this ~ ~/~ SUFFOLK COUNTY DEPARTMENT OF HEALTH -.=~J~///{' , H.D.Reference No~f--~ ~ APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval to construct said systems is requested,pertinent data herewith: Date i-Applicant ~ t! ~ A;~T~ V Phone~?~-IO~-Sub div~;mT~L) Address;~.~6 ~D- - ~rk~t)~ . . 7-Section 2-Detatl~ p~pe~y locatio~/~.9~e~;~%~' '~ ~ ~o 8-~t No. ~mlet ~ ~ ~o~'-~V~c~.~ 9-Private well? ~ 3-~blic ~ter ~ppl~ ~m~ng~my ~ar~ Dis~nce to nearest rain ~ 4-Lot Size: Width;~ ft. Length~ft. ~also enter~on center plot plan below:) 5-~elling: Single Family ~ T~ Family? ~ l Cellar? ~ /Slab? ~ ~ Crawl S~ce? lO-Pro~s~ syst~: Septic ~nk ~lPrecast ~lCess~ols ~Shallow ~ols ~ lOther~ il-Septic ~ inside dimensions: Vol~,~ Gals. Length~ ft. Width~ ft. Liquid dept~ft. 12-Precast sections: ///Number~/Sq~re Ft. Cesspools: Block sizeL incs.D ~s.H~ins. Total blocks below inlet: ~l/Tt ~'~ ~3__ PLOT PLAN Street O ~o apacity Gals. ~'th Data ~eet rs ~e~ 0 ~ 2 ~ 6 ! 8 12 ~6 Indi No The Undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private~ewage Disposaj~,System$~4 ~ _ - Owner or Builder 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. (10/6~ 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 which mail should be directed. 2-Means detailed description of property location, together with street name an~ distance to nearest intersection of ~in thorofare, also Hamlet/Village & Township 3-Enter name of Public Water Supply District, together with the distance to their main. 4-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 Nnmber 8-Lot Number 9-Private well: Enter "No' if Public water supply is available. Enter "Yes' otherwise. PROPOSED SYSTEMS: Answers to Items number t0, 11, & i2 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 cktstance of ~0 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 mi~tmum 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 TOWN CLERK'S OFFICE ........ ........ ........................................ ! ZZ f Approved 1( ~/ , 19..~.1... Pemit No~....~...] ......................... ~. Disapproved a/c ............................................................................................ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector! , ~ , . . . . . . b. Plot plan showing location of lot and of bud rigs 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 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 o 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. ,, .A,P,.PLICATION IS HEREBY MADE to the Bu Iding De,,artment fo~"the issu~n~- _z ..... ~ ~' u ~,¢ u/ O DuIlalng ~ermit pursuant to the auiming Zone Ordinance of the Town of Seuth~ld, 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, ordinances, building cede, housing code, and regulations. ...... (Signature of applicant, or name, if.~a~c~o~yporatian) .................. (Address of applicant) State whether applicant is owner, lessee, agent, architec! engineer, general contractor, electrician, plumber or builder. ............... Name of owner of premises ..... ~.~.~...,~..,~.........~.....,~....~.,.~.. ,~...~...~... ................................................. If applic~t is a corporate,,.signature of duly authorized officer" ~ t ,,~,~'~ ~. ~ .,,~ J _ ~ . ' .7-fo - ~=~1 (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No .~....~....3..~ Lot ~-~,- Street and Number ~..~'4~..~t~./.~.(,~...,~...~. , ....... Mun c pa~i~,' '~ ...... "" 2. State existing use and occupancy of premises and intended u.se and occupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................... b. Intended use and occupancy ..../....f~....~..~.~.~.....~..~.~_~.....~..,.~....~... ...................................... 3. Nature of work (check which applicable): New Building ................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolitior .................. Other Work (Describe) ........................................ · .......... 4. Estimated Cost ....... .~.,~.d~gJ~.. ................................. Fee .................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... ../.. ............... Number of dwelling units on each floor ......'-"T .................... If garage, number of cars .........~.. ................................................................... ~ ............ 6. If business, commercial or mixed occupancy, specify nature and extent of each typeof use ............................ 7. Dimensions:l~ existing structures, Jf any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ..................................................................... ; ........................................... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ ,~.,~t ~n# 8. Dimensions of entire new construction: Front .._~'..-~.....-:.~ ............... Rear .,~..~....'..~....~ ..... Depth ~ ......... Height ....... ./~'..~ ..... Number of Stories ....~. ........................................................ 9. Size of Iotl ' " Rear ...~.~...~...~,. .............. Depth .~.~..~,..~....~. ......... 10. Date of Purchase ........................................................ Name of Former Ovmer~l,~.: ....... : 11, Zone or use district in which premises are situated .................................................................................. 12. Does proposed construct on v o ate any zen na aw, oral nance ~r maulationP .. 13. Name of Owner of premises ...~...~.....'.~.....~..&.~..~.~ ...... Address .....~..~...~..~...~.~..~....U..~.. .......... Phone No.~.'J~.~.l~...~...~-. Name of Architect ..~:~.I~....~./~.R~2'I,~..~.. .......... Address .~'..A.~..~.J~...~..~.~....:.~.,.... Phorm No~ ....... ~ ...... : .... Name of ContractoC'.'t..e~t,e..~.~..f~.~.ttC.~,....^ddress .~...~....'g./~t../?..l~...~..... Phone No.~...~.~.~.7~j~ PLOT DIAGRAM 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 ,~her Interior'or comer'lot. STATE OF NEW~ YORK, J S S COUNTY OF* ~:~'../~---~..~,~. ....... $ ' . . .., ...... ,,~...'~..,~..~.~.:..~...i.~.~....~.....~'.~.~ .............................. ~i~ duly s~m, d~s and says t~ he is the ~licant (Name of individual signing a~lication) above n~'ed. ~He is the ....~~.~~ ............................. ~ ............. .... . ~. ~(~tmc~r, ag~t, co~orate officer, ~c.) of ~id owner or ~ners, ~d is duly aqthoFiz~ to perform or h~e pe~o~ed the ~ d work and to ~ke ~d file this ~.pplica?0n~.jt~at al~ state~ent~ cont~n~ in ~his '~pli~ am ~ .~ the ~ of his ~owledge and belief; and that me WOrK Wm ~ pertorm~ ~n the manner ~t tach in the ~pllc~J~ fil~ t~r~Jth. Sworn to ~fom~e this ..: ........ o, ....... .. co.. s · No~o~ Publ}c, Sta~ o~ N~ Y~ N~, 52.0344963 Suffolk Coun~ (o~i~i~ bpims March 30, 19~ LOT NO. LOT NO. 129 T --t k. 60' CoHo.- bl.~t ~. LOT NO, IZt~. RAYMOND L. $ HiLDA LAN6TRY Scdte: 40'~1 ~; Lot numb~m VA N TUYL ~, ~ INLET POND ROAD :- MAP OF PROPERTy RAYMOND L. ¢ HILD~ L~N6TRy s~so~ co~ ~s~ n~ OC~ 5 197~ ~.~. ~. ~_///~ The sewage disposa! and water suppl~ fa~l~lt~3 for th~ Structure located at, have been inspected b~ this Department amd found ta be satisfactory. Chief off Genera~ ~ineerin~ Service~ .... ~ .~ ,.. N ~ ~ ' ' ~ ' L VING ' I L" I~' IO'. . - ~-' ' 5 O. 0 .......................... ,,~ v,~,,. S. BURROWS, JR., A. LA: FrFTH AVl.- N.Y, 19, N,Y. P L A 1,1 S JOB SCALE I/~'- I'.o" 'SHEET DATE II/~,/~.9 'CELLAR_W~AkL_ BOX 5iLL LOW SILL FOUkt DATiOL! D IF FI~ P-.F-1,4 T TYPES OF FOL~KI DAT[O~ .FLOOP~ JOIST JOIST 'FP. AMING -OVER. GIP. DEP~ INTO GIP~DEP~ DIFF ~1',4 T TY P6S OF WOOD ~.CTIOIM~ o l/?-" SCALE. SEE I/4/ SCALE PLANS AND CoP~hO E P~ POST CANTI LE VFP~ OVEP. HANO5 MOlq DEARING FI:LAMII'qG 5ECTIOMS - I/~." SCALE DETAILS _P_.._O __P_c ~. PLANTiWG 5F_CTiO~J ~ETT~P.~ FOR. PA ATITIC~N CORNER. SEE 1/4" S CAL6 PLANS G.I. A 14_ F_ ~ APPLICASL:i DETAIL G ,, ~TAI AND SECTIOn4 LETTEP-,S _w. oO D ~.~ T CT, U -r T , . E. F4., 5 FO~ APPLICAP~LE DETAIL~. ,j POP. CH CoL~t¢~[',,[ [50X TO LETT&P-. ANP NL),'v16EP.., I M CIP~CLE. AI~OY5 EAVES. AND P. 8. pE&TEP ON PLANE AMD ELE-vATIONS, SECTION9 ' , SYM Bec L5 N!_~,_T ~R._~ A _L S. . ELECTRICAL P L U N1151N G JOHN S. BURROWS, JR., A.I.A 562 FIFTH AVENUE - ~ ~, N. Y. T YP-I cA. b o DETAILS, JOB [SCALE ]/Z"--l'--C:'" SH~ET F ~ 0 N T~ E L E V A T O NJ JOHN S. BURROWS, JR., A.I.A ~ F(FTH ~VB, - N. Y. 19, N. Y. SCALE [/&"-t 0".I PLUM BtNCr 5K--CT I O / CELt ,I IZ" o' p E N ' c ~. L. L4 A J.GLT.." , . . 60'. AVA'TED A~ AND F 0 U N A T I 0 N P L A J DIM, JOHN S. BURROWS/JR,, A.i.A 5~,~ FIFT~ AVE- N.Y. 19, N.Y, JOB SCAI~E SHEET DATE II D_. 1 G H T 5 I D E E JOHN S. BURROWS, JR., A.I.A ELL -¸1 L E F T ..9 [ D ~ E_L E V A -F O N 'd . E. 0 F--LE V' A T I 0 N JOB J SCALE AO HOTr pJ SHEET JOHN S. BURROWS, JR., A.I.A · -~'~,~ FIFT,~, AVF.. N.Y, 19, N.Y. J'l [VAT 0 N JOHN S. BURROWS, JR., A.I.A ~,'z PlrT~ ~VE. N.Y. 19;N.Y. E L b V ~.TI oM JOB/SCALE J/4"-t'-O" SHEET ~ ~TIoNl ~: JO~N 5. BURROW.b, )wjsIoN ~T, pLA'TT.~UR-G,N.Y, ~Er-TIO