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HomeMy WebLinkAbout5715-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 . t~Ol'e~..(~l'eek. ~ ....... Street Map No. C~II~. ~ll: .~l~ock No ........... Lot No...1.9 ...... 8~*t, il~].l~..li.~.a ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... l~eb ....tl~..., 19.~]~. pursuant to which Building Permit No..~1 ~.. dated ............. .l?e.b... J.8.., 19.7~.., 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$.~..~.e...~..e.. f.~.~y..5.w.e, ll~A~l .................................... The certificate is issued to . .~i&~.~el~. l~obeme~ ...... 0~1~®1' .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval · · -Sept: · ~. 4.9J/2. · 'bit' I~ "6i~&' ' · UNDERWRITERS CERTIFICATE No..~[. I~$~X) .............. .......................... HOUSE NUMBER. ~.. ........ Street ..... (I.~'ey ~eek l,a,~ ......................... FO~ NO. 2 TOWN OF $OUTHO~D i~ BUILDING DEPARTMI~N~ TOwN CLERK'S OFFICE! SOUTHOLD, N. Y. BUILDING PERMIT ITHI5 PERMIT MUST BE KEI~F ON THE PREMI~t~$ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: '.~ ¥ ,~.: ' .............. /~,~. ~. ........ ,~/~ ........... ~...4..~.L~ ...... :... ~..~'~. to ....~.Oz~ ~ ........ ,~ ....... ~.~ ......... .~.¢..z~. ........ ~ ...~.. ,~, ........ ~. ......................... at premises ~ated at ........................ ~.~. ...... ~.~,~..~.....~.~.~... ~ .~ ~ ............................................................................ ~.~.z~.~ ................... ................... ~ ............... ............... ~.~.~....%..~.~.~.~ ......... ~.~....z.~ .......... :.;~....~....~..t... pu~suoni to opplicotion d~'*d ................................ ¢,;~......~.~, 19~a ~nd approv~ by the Building Inspector; Building 'Inspector SUFFOI~ COUNTY DEPARTME~ OF ~H~b~LTH ~P~CATION FOR ~PROVAL TO CO~TRUCT PRIVA~ 3~AGE VI3P~ Approval ~ construc~ said syst~ is r~ueSted~pert~ent ~ata here~th= Date ~ - 1-App~c~t'~4~A~ g~/. ~c . Phone~*2d~e ~Sub ~v ~e~ Address ~ ~'~ ~,,-,,~ ~'~t ~ ~/ ~ ~/~ /~ ~ 7-Section 2-Det~led p~perty ~cation ~'/_~ ~u ~ ~ '~. ~' ~t No. /~ 3-P~b~c ~er sup~ n~e Dis~ce to nearest ~ ~-~t size: Len~h.x*d~O ft. Width 7~ ft. (A~o enter Cn center plot plan below:) 5-~e~g: S~gle.f~?/.~o f~m~?~Ce~ar?~S~b?~Crawl Space?/ / lO-Proposed s~t~.Septic t~Precast~Cesspools~ha~,~other/ / ~-Septic ~ ~side d~ensions:V,l~e G~.Le~th~ Ft.Widt~t.~quid de~th ft. ~-Precast sectio~ :~ /N~ber.~Square f~.Cess~o~ :Block size L/~ i~ .D ~s.H~s. Capacity ~, Gals Test Hole Street The Undersigned C~q: "Construction of authorized ~stal~tio~ will be accor~ce ~th the Suffo~ Co~ty Health Dements' ~rent 8t~dards,Bu~et~, ~en~ents thereto~cover~ Private S~ge Dis~sal Syst~". ~LTH D~ USE O~Y. ~ed on the option of the H~lth Depar~t~thet ~ ad~uate ~d sAtisfacto~ S~ge Disposal System be ~sta~ed on this P~t~ ~te ~ ned 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 and cELstance to nearest intersection of main thorofare, also Hamlet/Village & Township 3-k~%ter 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" items applicable to the proposed new dwelling. 6-Name of sub-division ?-Section Number 8-Ix~ t Number 9-Private well: Enter "No" if Public water supPly is available. Enter "Yes" otherwise. PROPOSED SYSTEMS: Answers to Items number lO, ll, & 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. WELl4 LOCATION: To locate the well & sewage disposal systems on Applicant's lot, the following Standards must be observed: Well-100 feet minimum distance from the nearest cesspools Well-25 feet minimum 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-lO 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 1 food to maximum of 2 feet Bottom of Cesspool to ground water must be held to minimum of 1 foot FOR3'I NO. 6 TOWN OF $OUTHOI:D Building Delmrtmenf Town Clerks Office Southold, N. Y, 11971 APPLICATION FOR CERTIFICATE OF O~CUPANGY Instructions A. This application must be filled in typewriter OR ink, and s~bmitted in triplicate to the Building inspector with the fallowing; 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 sew~?age dispcsal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire U~jderwriters. 4. Commercial buildings, Industrial buildings, Multiple. R~sidences 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, ,6Ccupancy 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: I. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land us~ $5.00 3. Copy of certificate of occupancy $I.00 Date .... .A.., .~,~. ~.,~.¢_ .~ .~ ~.., .~ ?.~/..~. ........ New Building X Old or Pre-existing Building ............... ~ ........... Vacant Land 375 Core3r C:t'eek Rea~, Location Of Property ...........................................................;.......... ................ ; ............................................ Owner Or ~ners Of PropeH7 ........................................................ ~ .............................................................. Subdivision ~..~.~...~.~.~...~.~)~...~.~.~... Lot No..~.~...~:.. Block NO ............. House No.~. ..... 2-18-7~ .... T~k C~$~ruotton, Ine, Permit ~o ~ . Dote Of Permit .................... ~ppllcon~ ...~ .............................................................. SOIO I ' ' ~pproval ...: ............................................ Health Dept. Approval ............................................ Louor Dept. Underwriters Approval .............................................. Planning Boo,rd Approval ..................... ; .................. Request For Temporo~ Ce~ifJcote ........................................ Fina Certificate . ......................................... , Fee Submitted $ .................................... Construction on above described building and permit meets oH O~plicoble c~es and regulations. Sworn to before me this TO~V~ OF $OUTHOLD Building Department Town Clerks Office Soulhold, H. Y. 11971 APPLICATION FOR CERTIFICATE OF !OCCUPANCY Instructionl A. This application must be filled in typewriter OR ink, and s~bmitted in triplicate to the Building Inspector with the following; for new buildings or new 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 sewn, LaDe dispcsal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire U~¢erwriters. 4. Commercial buildings, Industrial buildings, Multiple R~sidences rind 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 aT property showing all property lines, ~,treets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, d~ccupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildtr~gs 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~. 3. Copy of certificate of occupancy $I.00 $5.00 Dote ......&..~. ~ .~..S..~....~.~ .,....Ir..c).7..2.. ....... New Building ........ ..X. ......... Old or Pre-existing Building ................ ............ Vacant Land ............................ Location Of Property ~.~.,~, Core~ Creek Road~ Sot~tho~d~ New :York Warren & Josep. hlne Wobeser Owner Or Owners Of Property ....................................................... ~ .............................................................. Subdivision ~.~q....O.~'...~.Q~.~.~....(~.~.~..~.~.~...t;~.~..Lot No...]~,..i~.. Block NO ............. House No.]~.-~ ..... .................... 2-18-72 · Tbmark COnstruction, Inc. Permit No. 5?ISZ Date Of Permit .................... Apphcant ...~ .............................................................. Health Dept. Approval .~..0..]:.0...2.~ ............................. Labor Dept. ~pproval ................................................ Underwriters Approval .............................................. Planning Boa~d Approval ........................................ Request For Temporary Certificate ........................................ Finall Certificate .......................................... Fee Submitted $ .................................... Construction on above descnbed braiding and permit meets all apphcable c~;~es and regulahons. Sworn to before me this ~.~.~ .~...., day of ........... /~ ,~, (stamp or seal) Notary Public ounty 10yc~ ~, LINK $-9 SCHD SUFFOLK COUNTY DEPARTMENT Date Bldg. OF HEALTH P rm t TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located ' (Give deed location) . have been inspected by this department and found to be satisfactory. Chief of' G:ouc.:,al 13:gincez. inS ServiGes FORM NO. I ~ 7'OWN OF soUTHOLD i' BUILDING DEPARTMEN~ TOWN CLERK'S OFFICE SOUTHOLD, N, Y. /~"~~ ~ E×amin~d ............................. ,4..':T......., 19 ........ Approved /~"-'~- 19.1Z..P.~rmit No. ~7/~ ~ Di~pproved a/c '- ................................................. .......................... (~uildln~ Inspector) Application No....~....ZZ...-~.. ........ APPLIGATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building Inspector. b. Plot plan showing Iocatmn of lot and of buildings on premises, relahonsNp t? Cldjoimng premises or public streets or areas, and giving a detailed description of layout of property must be drawn'~on the d~agram which is part of this application. c. The work covered by this application may not be commenced befo~ issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issu~ 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 port for any p~rpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. i APPLICATION IS HEREBY MADE tothe 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 ilar removal or demolition, as herein described. The applicant agrees to comply with oil applicable laws, ordinances, building code, housing code, and regular ans. ...', ..~.e.~.~.~......&o.~.&..: .Z;.~. ~ ............ i ........................ (SignatUre cf applicant, or name, if a corporation) ~ ~. ~:.,.~,'~ ,/~.~..... dT..~.q..,.,:Z/e. .~ Y..: ............. ..... i'~da'ress aF;~p~,~;,~;) '~ '/,~'~'" State whether applicant is owner, lessee, agent, architect, engineer, general contractor, eloctrlcian, plumber or builder. ......... O~.~c~.~./.~.~ ..................................................................... .....~ ........................................................................... Name of owner of premises ...... ~.a~...~./T;..~-4'~ ................................................ ~ ......................................................... If applicant 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.: / str. a.d i : ........................... Municipality 2. State existing use and occupancy of premises and intended use a~d occupancy of proposed construction: a. Existing use and occupancy b. intended use and occupan:', / ..~,'~6~4'/ .'~-¢~/.i&,~,('.~ .......... 3. Nature of wo~k (check which applicable): New Building ..... ~ ...... Addition .................. Alteration ............. Repair ................... Remova~ .................. Demolition ......... ~.~L,.. Other Work (Describe) ...................................... ,. Est,Mated Cost ........... Fee Zm (to be paid on fi!ing 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. Dimensians 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 / ...... ~ ...............D~th ....................... Height ...... /~.~ ....... Number o~ Stories ....... / ............................................................................................................ 9. Size of lot: Front ....... ~ ........... Rear ....... ~..~.~.~ ........... Depth ........ ~..(. ......... ]0. Date of Purchase ........ ~/~..~/. ........................ 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? ............................................ ~omo of Architect ...~.:..~Q.~. ......................... Address ...~.~.~.~.~ ...... Phone Mo .................... Nome of Contractor .............. PLOT DIAG~M Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-~ck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEWel'ODIn, ................. .~.~..~4~.~.......~.~....'~/~..~ .................... being duly sworn, d~poses end says that he is the applicant (l~lame of individual signing app~ica.t.i~n) 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 alt 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. Sworn to b~fere me this ................................................................ ~ RY PUBLIC, S~a~e of New York No. 5~,1654750, Suffolk Co~I~' Term Expi~e~ ~,ar, 30, lg7.,~ ~ 0'~ txvf A//AP oF /~)ROP£RTY' AT j i r I OM,~,RK CONSTRUCTION 'INC..-' , 5250 SUNFNs~- HIGHWAY JCT~ ¢ IG"°~ 8532 LIVI t%© ~EEZ,: ! =¸1 BED & . 'M I I0:- ~:' 8592 To~.~