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Home My WebLink About5899-zFORM NO. 4 TOWN OF SOUTHOLD BUII,I~ING DEPARTMI~,NT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ... ~pee..~rat3, ........... Street Map N~tllakoma .l~&l;~l~k No ........... Lot No.. 10 ........ Sou.thol~t..li.l~., ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated .........~alr...2-3 ..... , 19..7.1~ pursuant to which Building Permit No. dated .......Ealr .... 2~. ..... , 19.72., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is ...??.i.v.a.t.e.. p.n.q..l'..a~..l.ly..d..w.e.l~i.rlg ..................................... The certificate is issued to . ILtcb-ar4 .ltllal,-j'. & -~.l~e ......... 0~m ............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . D. ec...tbs...1.~.3 .... by. lt.. UNDERWRITERS CERTIFICATE Nol[..$1962.1 ........ 0oi; · · 11. · .197.~ ............ HOUSE NUMBER .... 3?0 ......Street . .~eel~ee. ~.at.]. .......................... 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 PREMISES UNTIL FULL COMPLETION, OF THE WORK AUTHORIZED) N? 5899 Z Permission is hereby granted to: ...~..~..~...~.~..~.~..~1~1~ · ..A~?O ..ll~eve.'~,,,ar~ ........................................ ~.ve.~e~l ............. to -" ~'a~t l~t "~e~r "~'"fa~3:;~'"~t~ I~:~'..'~ .................................................................................. at premises located at ........ ].~...'J.O....]~'l~,12e]f~l~-.M2.~.~,~. ............................................................ ................................................. ~e~1~e..~'~'l. ............... .8~u.~03~ ................................................. pursuant to opplication dated ........................... M~,~. ...... ~ ........ , 19....~, and opproved by the Building Inspector. Fee $..%~'e9~' ....... pE:',f,'.iT INCLUDES AFPLQVAL TO F, EMOVE EXCESS F[L,L F?~OM ABOVE PREMISES BY REG P, ADhNG LOT DRWEWAY CONSTRUCTION ~ CESSPOOL CONSTRUCTION ~ CELLAR CONSTRUCTION ~ OTHER THE NEW YORK BOARD OF FIRE UNDERWRITERS ~;Sb BUREAU OF ELECTRICITY , r 85 JOHN STREET, NEW YORK, NEW yORK 10038 D.t. 0cCober 11, 1973 App,cotio,~o.o./it, 629323 N THIS CE~IFIES THAT Rlena~d CeHlla~9 W/S Teepee '~Ull. UUU* W/U ~ e~o~i~ o" October s 1973 a~fou~tobdincomplia~ewithther~ui~mentsofth~B~' 119621 lO RXTUEE RXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST OUTLETS SWITCNES 68 59 63 68 DRYERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT S E R V I C OTHER APPARATUS: 1 500mom Water Heaters: 1-4.SKW Electrle Heaters: 3-.SKW 4-,75KW 9-1.0KW 1-1.25KW 8-1,SKW Panelboard/s 1-14ekt 1-11okt 125amp Hallock N.Young A-70 Reeves Park Blverhead, L.I.11901 COPY FOR BUILDING DEPARTMENT. THIS COPY _OF~ CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. SUFFOLK COUNTY DEPARTHENT OF HEALTH H.D.Reference N o ,~'d -/'//,3~ APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS ~r~-/9- 7Z Approval to constr~ct said systems is requested,pertinent data herewith: Date 1-Applicant ~' ~'~ u~_ ~&rC . Phone ?~7-g~27 6-Sub div /JVN#~t~ 2-Detail~ p~pe~y location ~/~ r~PEg T~k/~ 8-~t No. Hamlet ~u~&/J To~ ~rM~L~ 9-~ivate well? 3-~blic ~ter ~pply ~me ~ Dis~nce to nearest ~ln 4-Lot Size: Width /~ft. Length /~ft. (also enter on center plot plan below:) 5-~elling: Single Family ;~; T~ Fa~ly? / /Cellar? ~/~lab? ; ~Crawl S~ce? lO-Pro~s~ ~st~: Septic ~ ;//Precast ~/Cess~ols /~/S~llow ~ols / /Other / / Il-Septic ~ inside ~mensions!.~ol~e~Gals.Length ~ ft. Width f ft. Liquid depth y ft. 12-~ecast sections. ~N~ber~Sq~re Ft. Cesspools: Block sizeL incs. D ins. H ins. Total blocks below i~e%: ~I ~2 _~3 -- -- PI~T PLAN ~ ~ o ~ '~ -ade ~m ~ ~ W.L. ~ m Street TEP~ O~ ~ ~ ~ Indi No ~h The Undersi~n~ CERTIF~S: "Const~ction of authorized installations ~11 be in acco~ance with the Suffolk Coungy Heai[h Detriments' current S~anda~s~ Bulletins, a~ amendm,ng, gh~r~go~ eoverSng PrS~ag~ Somgo D~s~sal FOR ~LTH D~PIRT~T ~S~ O~L~. Baa~ on gh~ 5nfo~agSon p~o*~ng~ hor~gh~ ~ ~, gho opSnSon of ghe Hoalgh Do~mon[~ ~hag an ad~ua~o and ~a~5~faego~ Se~g~ can bo 5n~allod on gh~s ( 10/65 R~vt~. ) ~k~apa city ~ ~Gals. Data Feet ~ 10 18 APPLICATION FOR APPROVAL TO CONSTRUCT PRi~ATE 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 and distance to nearest intersection of main 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 7-Section Number 8-Lot Number 9-Private well: Enter "No" if Public water supply is available. Enter '~es" 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 " - - " " " 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 m~nimum 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 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-10 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 I food to maximum of 2 feet Bottom of Cesspeet to ground water must be held to minimum of 1 foot TOWN OF SOUTHOLD BUILDING DEPARTMENT .~ TOWN CLERK'S OFFICE '~/~-,/', '~---- ~rav~ ........................................ , 19 ........ ~it No...~.....~ ....Q..C ................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Inspector. b. Plot plan showing location of lot and of buildings 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 a 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. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building I'~ 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 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 cede, and regulations. (Signature of applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........... ................................................................................................................................................................. Name of owner of premises ...,~...Z.C,..4(.tl~.,~.~. ~ ...~..E~..~...~../~'.. ..... ~.../..g'....~.~.. ......................................... If a~p~ant)s a ~ate~ig~ture of duly authorized officer. ~ (Name an~e ~ c~ officer) 1. L~ation of land on which pr~osed work will be done. Map No.: ....~.~..~ .................... Lot No...L~ ............... Street and Number .~/~.....~.~....~.~.~...~.....~ ......................................... ~.~.~.~.~.~.~ ..................... Municipoli~ 2. State existing u~ ~ ~cu~ncy of premises and intended use and ~cupa~y of pried, c~tmct~n: Exisiting use and occupancy ................................................................................................................................ Intended use and occupancy ....~../...~..~...~..~. ...... .~...~...~'..../.~.~.~......~.~...~../...~..~....~...~..~. ........................................... 3. N ture of work (check which applicable): New Building .................. Addition .................. Alteration ....~...~......e.... Repair ............. ~/.. Removal .................. Demolition .................. Other Work (Describe) ........................................ 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 ....... ~ ................................................................................................................................. 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 ...... ~....~....x. ............~ a - Depth ........................ Height ~ / / ~ .................... Number of Stories ..../......2~ ...................................................................................................... 9. Size of lot: Front ...... ./...'~...~...~ .......... Rear ..... ../...~.~.......: .............. Depth ../..~...~...~.../~..~.~....~.~.~' 10. Date of Purchase ~'~.~:...~...~..~,.../..~..~...~. .................... Name of Former Owner ..~.~.~...~...:....5'....~.../...~..~. ........... 1 !. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ...... ..~...~. ............................................... o~,~ .~..~./~ I~' 13. Name of Owner of premises ~.'..../~../~/].~.r. ................... Address .....,,~.~..~ .,T....~.~.~.~. ................. Phone N ................... Nome of~4f~/~.....~...~...~......~..~....~...W'..~./....'~.....A(...C.'....Acldress Phone No ..................... · Name of Contractor .~....~..~......~..~...~...A{....~...~....~..../~..~:.....Address ..... .~.l.~..~--~.t~..~.~.12v.~.,~. Phone No..~.~l..7..~.~..~...Z.~' PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicatj whether Interior or comer lot. STATE OF NEW~YOR, K, . /,, tS.S COUNTY OF ...~.~'....~. . x' ........................... '....~.../.......~/...~.C~....~..~.~. .......... being duly sworn, deposes and says that he is the applicant (Name of individual signing appli~ation~ ~ ,/~_/ above named. He is the ......................................................................................................................................................... (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 best of his knowledge and belief; and that the work will be performed in the manner set forth in the application~ filed therewith. Swam to before me this ~, ................. of ..... ...... ....... ............. Notary Public, ~~.0~..~.,.,~:~unty Notary Public, State of Ne~v York No. 52-0344963 SuffsIk Count Commission Expires March 30, =/" ~F THIS SURVEY MAP NOT BEARING q ~,'~ ~por f, ;,Ww C x,,~,~ Zw-L~v /-/,'Z_Af~¥" X , j 4-4- 72. · -t / / \ ' ' \\x \ \ ? Z'L. Iz~ P','q T" I O /V ~' 'i X- X $£E S~I££ T ,,to, 2 L Ft, E££VA7 0A/ Z $~,,¢. ¢- ¢ /, 11 V SOUTI/~LD ~ Az', X I ~EPE£ rk~',. · i ..*¢t)'r/-/O/..D ¢