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Home My WebLink About5897-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .~.~. ~. ~..5.~. !.~?.....~...~. ..... Street ~,~p~o.&,~.l...~... ,,~o~,,~,o .... ~. ...... ,.o,~o..s. .... ~-~r~-- .~:/' conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... .~%..~. ~ .... , 19'~. pursuant to which Building Permit No. dated ........ ~P~..~...~.~ .... , 197.~, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is ~ ~-'~'-~/ ..... , .................. The certificate is issued to. ~.. ~... ~t .......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . ../~... ~..~.../.~. UNDERWRITERS CERTIFICATE No. /~t ff ~.,~ ,.~ HOUSE NUMBER... ~'~. ~ .... Street ................................................. ~O~m NO. 2 TO~N OF $OUTNOLD BUILDIN~ DEPARTMI:NT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥o BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5897 Z Date ..................... ~ll,y ......... ~ ............ , 19...~. Permission is hereby granted to: ...&l.m~mmar~.. ~ ~am.t~'-a~ t.,l~..ge%~ ................ .......... · .~e · '~' r .et~.e. · .l~et~ ....................... to ...l~a&.~...z~eae · · e~e -. ~.~&~, .~, · .a'~e.3:~.~ .................................................................................. at premises located at ....... ~Q~..~ ......~l~"'~eS ............................................................................ ................................................ ~e~.]:~.e..~ ............. 'l~em~ ........... 'ii'~ ................................. pursuant to application dated ........................... ~ ....... ~ ......... , 19.~.., and approved by the Building Inspector. Fee $.~)¥~ .......... TOWN OF SOUTHOLD Building Depaltmem Tram Cledm Office Soathold, FI. Y. 11971 APPLICATION FOR CERTIFICA'riE OF OCCUPANCY 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 occumte location of all buildings, 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 fram 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 reepomible 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 saf~y inspection of buildings or premises, or other pertinent in- formation required to prepore 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 New Building ........ .~... Old or P/re-existing Building ............................ Vacant Land ............................ L ation of ........ ......... ................................................... ..................................... Owner Or Owners Of Property ....~r~.A~.' ........ ~..; ............. ~ ............ Subdivision .......~'.~./....A~.~.~l~.~....'? ...................... Lot No ......~.:... Block No ............. House No ............. Permit No....~.",~'.,~,,~,,... Date Of Permit ~l~.f~,...Applicant , ,~.~,..~,;~f~¢-:~.,.,,~ ................... Health Dept. Approval ~'~ ~f~ ~ ¢'7 Z~- Labor Dept. Approval ............... ~ ............................. Underwriters Approval O'c~(? 1~"7~. /~..-...~.~..~5'~Plannin Board Approvol /'~' /~ Request For Temporary Certificate ........................................ Final Certificate ~ ~,~ Fee Submitted $ ..~... ............................. and permit meets codes regulations. Construation on above described building, n ............... ...~.~.1.1..~ an.~. Applica? *. ............ Sworn to before me this ~: - - ~ [~ '7 ~ (stamp or seal) TERRI L£~ ELAK I~0TARY PUBLIC, State of New York No. 52-6168295 (~uatified in Suffolk County Commission Expires March 30, ~.~ '7 ~ SUFFOLK COUNTY DEPARTMENT OF HEALT~ EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROFAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval tn construct said systems is requested,pertinent data herewith: Date 2-Detailed?roperty .lo6ation ,' - 8-Lot No. ~- .Hamlet ,~,-~ Town~~__9- Private well? 3 Pablic water supply name .. Distance to nearest main 4-Lot Size: Width/.f~'ft. Le~ngth~.~m~_ft. (a~l. so enter on center plot plan below:) 5-Dwelling: Single Family ]~'] Two.Family? ~/Cellar? ~ /.Slab?~; J Crawl Space? ~ ~ 10-Proposed system: Septic tank ,F';Precast FfJCesspools ~._/Shallow pools ~._/Other ~_/ il-Septic tank inside dimensions: Volume ~Gals.Length ft. Width ft. Liquid depth ft. 12-Precast sections: /~ FNumber~Squ~re Ft. Cesspools: __ Block sizeL incs.D ins. K ins. Total blocks below inlet: ~1 ~2 ~ PLOT PLAN Data ?eet 2 Street ~ I e -The Undersigned CERTIFTES: "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, Sewa Date Signed Owne~ 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. (i0/65 R~'is. ) APPLICATION FOR APPROVAL TO .CONSTRUCT pP~IVATE ~E~AGE DISPOSAL SYSTE~ INSTRUCTIONS: Applications ~aet be su~aitte~ in triplicate i-Means Owner or Builder. ~_&~ress to ~ich mil should be directed. 2-Means detailed description of property location, together with street name and distance to nearest inter~ection of main thorofare, also ~amlet/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" it_~__~ applicable to the proposed new dwelling. 6-Name of sub-division ?-Section Number 8-LOt N,,m~er 9-Private wellz Enter "No" if Public water SUpply is available. Enter "Yes" otherwise. P~OPOS~D SYSTE~..' Answers to Items n,,m~er 10, 11, & t2 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 m " " " " " Septic Tanks Part 1~ " " " " " " Unusual soil conditions Part V " " " " " " Shallow Leaching Pools PLOT PLAN.. The followiD~ 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 aisc. 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. ~ere 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. W~r.T. 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 mi-~-,,m distance from front, and front sides of property lines Well-50 feet minimum below grade for well point Well-40 feet minimum into ground ~ater for well point Well-$ 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~w.,m distance from lot lines to center of cesspool Cesspools exterior must be ~00 feet mintw~,m distance from nearest well Septic tank exterior must be 75 feet from nearest well Cesspool "Center" must be 12 feet mini.~,~ distance from nearest water line Cesspool "Center~ must be 15 feet i~ house foundation Cesspool exterior must be 50 feet m4.4w.,, distance from surface Waters, Streama, Lakes & Bays, etc. Cesspools must be 20 feet mi.~ww,~ distance from large trees Cesspool center to Cesspool center must be at least 16 feet Cesspool cover top to gra~e must be held to minimum of 1 food to maximu~ of 2 feet Bottom of Cesspool to ground water must be held to minimum of 1 foot FOu'Mr NO, I .. BUILDING DEPARTMEN~ ~ / ~~ ~/~ Examined ~pp i~fi~ ~o ............... / ................. a. This a~lication must be completely fill~ in by ~writer or in ink and submitted in ., licme to t~ Building I nsp~tor. b. Plot plan shying I~ation of lat and of ~uildin~ on premises, relationship to adjoining premiss or public strel~ or ar~s, and giving a detailed de~riptim of layout ofpr~e~ must ~e drown on the diagram which is ~ of this o~licotim. c. ~ work covered by this a~lication may n~ be ¢omme~ b~fore issuance of Building P~rmit. d. Upon approval of this application, ~e Building Ins~r will issue a Building Permit t~ t~ ~li~nt. ~ ~rmit shall ~ k~t on the premises available for ink,ion th~ghout the pr~ of ~e wo~ e. No buildi~ shall be ~cupi~ or u~ in ~ole or in pa~ for any pu~ose what,er until ~ ~ifi¢at~ of ~cupancy shall have been granted ~ the Building In~.ctor APPLICATION IS HEREBY MADE to the Building Department for the issuance of ~ Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, 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 code, housing code, and regulations. (Signature or applicant, or name, if a corporation) ...................... ,,...~..~ ................. , ....................... ,'.~.. ' '.(Address of appl!cant) State whether applicant is owner, lessee, agent~ architect, engir~eer, general .contrpctgr, electrician, plumber or builder. . Name of owner of premises ..~....~'....'~..:~,.~.....~'.....~...~..' .?... ...... ' ..... If applicant is a co~mte, signature of duly authoriZ~ officer. / / ..... ........ (Nam..a~ title of comom~ officer) - : ~ · 1. L~i~ of la~ on ~ich p~o"d Work will be~done. Map No~ ..~~..... ~ ~ ..... ~.~ ............ St~ ~d N .................................................................................................................. . ~ ~ Municipali~ 2. Stm~ ~sting use a~ ~ncY ~f pr~s~ ~ int~ ~ and ~cu~ncy of bo Exisiting use and occupancy ........................ ........................................................................................... us, ...... ./.......~...~ /, ~'/,/,: i ............... ntend and ........... ........................... ................................. 3. Nature of work (check which applicable): New Building ........ d~'........ Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. ~timated Cost ........................... ~ ......................... Fee .......................................................................................... (to be paid on filing this application) §. If dwelling, number of dwelling units .......... Z ...... i ....... 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 Stories ................................ 8. Dimensions of entire new construction: FroNt .................................... Rear ............................ Depth ........................ Height ......./..~.-...v. .... Number of Stories ....... ../. ............................................................................................................ 9. Size of lot: Front ..... ../..~...'~....~. ........... Rear ....../...~.~. ...................... Depth ..:'~r~'~ ....... 10. Date of Purchase ....... .~.~.. ~. Na~Lrn ~.'.."~..../../..~.~.....'~...../..~....~...~.~... ....................................... e of Former Owner,/~ ~' ..................... 11. Zone or use district in which 15remises are situated ...../~//~..~'...~...~ ............................................................................... 12. Does proposed constructiort, violate any zoning law, ordinance or regulation? 13. Name of Owner of premises ~'../,,~...~..~;4[..~(...l~e[q~..~ ./...~ddress ~....~'..~.....~..~..A~...~'..~..~'.~'/.s~..~d~ne No...?'....~'.~......~.....~ Name of Archit~t ...................................................... Address ..................... Phone No ..................... Name of ~omroctor .................................................... Address ............................................ Phone No ..................... Locate clearly and property lines. Givesh whether interior or cam PLOT DIAGRAM distinctly all buildings, whether existing or Proposed, and indicate all set-back dimensions from ~et anc~ block number or description according to deed, and show street names and indicate STATE OF NE';; .................. · ./...~...4~.....~...~/,~....~...~..~.~.;....;;; ...... ;:'.~:i .............. being duly sworn; d~Pobes ~na says that he is the applicant (Name of individual signing application) above named. He is the ..... .../~...~.~..~.^~..~..~...~../~....~....~-:..~.~..~....~...~...~.:..~...~..~.~.~.~.~...~..../~. .~.. ..................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and Js duly authorized to perform or" h0ve'pe~formed the said work and to make and file this application; that all statemen~ts contained in this-application are true to the best of his knowledge and belief; and that the work will be performed inthe manner set forth in the application filed therewith. Swam to before me this Notary Public, . ........................................................... CoUnty (Signature of applicant) ~OTE: "= MONUMENT SUBDiViSION MAP FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON JUNE P~Ig?;~ AS FILE NO, 5723. REVISIONS YOUNG & YOUNG 400 OSTRANDER AVENUE, R'IVERHEAD, NEW YORK ALDEN W. YOUNG SURVEY FOR: CLAUSEN CONSTRuct. LOT 5 OF "BAY HOMES" ~::,::!:~-'~ TOWNOr ~:', J~ ~:,,~' '~, SCALE: ~ : ~n~. ~ " ' L .... SUFFOLK COUNTY HEALTH DEPARTMENT ~.'.~'s OCT 2 6 1972 _m~. ~. ~he sewage disposal and water su~oly facilities for the Structure loc~ed at have been inspected by this De~tmen[ found to be satisfactory. r