The URL can be used to link to this page

Home My WebLink About5716-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .I.1~..~..5 .... /~..~. ~ .~..~.... ?..O.A~reet Map No ............. Block No ........... Lot No...~..~.... ~....~.E. ~.F?.~.E ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... I ~...~'E.~., 197 F-.-pursuant to which Building Permit No. ,5 ~.l. ~ dated .......... I ~. ·. ~.£.~.., 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 .. ~, .... O Iq E' ..... ~. F~/¥1 .~. I-~.f. .... '~.~/. E. L 1-, ~ lk~.~_~ .................. The certificate is issued to · ! C. ~. ~.K I~...~.. ~..~..~ .~. ~.~..E..'/. .... ~.. ~/..~l C. k/ ........ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval w/Z,~lT~. ..... ./~... ?'...z~...~ .......... UNDERWRITERS CERTIFICATE No ....... .~...q. ~-,. ~...7....~. .......................... HOUSE NUMBER .... I.~..~..~..Street ..... J"~..,~.]g.¥ .~. ..... .'7~'.~. ~ .b ................... ............................................. 1'~..h....-'Yr.. ~ .-.,. ~ .c .K: ............... · Building Inspector FOF,~! NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN C:LERK'$ OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5716 z Permission is hereby granted to: ~)~ ~ ......... Building Inspector. Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. Permit No. 1~7/~ ~ TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure (Give deed location) located have been inspected by this department and found to be satisfactory. O~2T ~ ~ ]97~o FOB, M NO. 6 TOWN OF SOUTHOLD Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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 $5.00 2, Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1~00 pete .... ........ New Building ..... z~ ........... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ...~../...~.....~..~.~/.J'~.~../...~.......~..~..~..?... ........................................................................... Owner Or Owners Of Property ...~..¢.Z~.~...../:~....~...O. ........ /~..~../,.¢..c../.,/ ........................................................... Subdivision ~//.g. ,~. ,~,~.~.,~:.~,./,'(......./.~,~:/,~.CJ.~-~.....Lot No....~..,?,,. Block No ............. House No ............. Permit No....~...~../...~:.... Date Of Permit .~./Z.~../..~.]..Applicant ../.~./2..~..~.~...~..~....../~...../..t~.]...~.:.b'.: ............... Health Dept. Approval L?.~.?...~..,~..'-~../....~'..'~...Z.. .......... Labor Dept. Approval ................................................ Underwriters Approval ...~...~..~?..Z....~.. ..................... Planning Board Approval ................................... .;,.. Request For Temporary Cectificate ........................................ Final Certificate ........~.......~?....~..../..?. ..... Fee Submitted $ ......... ~..~... ............ Construction on above described building and permit meets all applicable codes and regulations. App, con, .................................................... Sworn to before me this ......... Notary (stamp or seal) TERRI LEE ELAK HOTARY pUBLIC, State of New York No. 52-6168295 Qualified in Suffolk County Commission Expires March 30, 19~ SUFFOLK COUNTY DEPARTMENT~._OF~i HEALTH ...... -. ~ ~ . ~ H.D.Reference No~ '~.~ WESTERN DISTRIC~ACK, N. Y. AP~ICATION FOR AP~AL TO ~NSTRUCT PR~ATE S~AGE DIS~SAL SYSTE~ Date ~ Approval to const~ct said systems is r~uested,pertinent data here~th: 1-Applicant~% - ~{ ~ ~ Address ~Q ~ ~ ~, - '~, %~ /r ~ C' ~ -~ ~ ~ ''?-Section 2-Detail~ p~pe~y location ~/~, ,~ ~, ?, J ,,, ~. 8-Lot No. ~ L ~ -" TO~ j ~ ~ ~:, ;~ /~.~ 9-Private well? Hamlet /~'~-~ , ., ~ ~ ~-~blic ~teP supply ~me ,.'f '~ - Distance to nearest ~In ~-~t Slze= Width L.~ ~ ft. Length ,; ~ ft. (also enter on center plot plan below:) 5-~elling: Single Family ]F] T~ Family? ~ /Cellar? ~f/~lab? ; ~Crawl S~ce? lO-Pro~s~ syst~: Septic tank ~ /Precast ~ /Cess~ols ~Shallow ~ols il-Septic ~ inside dimensions: Vol~e Gals.Length ft. Width ft. Liquid dept~ft. 12-Precas% sections: / /Number/ /Square Ft. Cesspools: Block slzeL incs.D ~s.~ins. Total blocks below inlet: ~1/ ~2 ~ ~3 .~ ~T P~N ,C 'adq~ 6W.L. ~o~ o z ~ :ate 'th Data Feet 0 2 6 8 10 12 ~ Street /,? ,/ ? : ~,/~ O ~ ~ ~ ~ Indi The Undersign~ CERTIF~S: "Const~ction of authorized installations will be accordance with the Suffolk County Health De~rtments~ current Standa~s~ Bulletins~ a~ amendments thereto, covering Private Se~ge Dis~sal Systems". FOR ~LTH D~P~RT~ ~S~ O~L~. Bas~ on gh~ 5nfomagSon p~o*~ng~d h~o~h~ op~nSon of ~ho H~lgh Do~m~ng~ ghag an ad~uag, and ~agS~ae~o~ can be installed on this Plot. Date (~o~65 ~evis.) S-15W Signed~ 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 distance to nearest intersection of ~ain thorofare, also Hamlet/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 "Va 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, 11, & 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 ¥ " " " " " " 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 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 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 I foot J · ' b 6cals .. ~0'=1~ i / Gcl]I,?o/~ Co, Cl~rk'~ b]If:,~ 4~: m,~l~ n,~, ~ ,',. ~ '- " TOWN OF SOUTHOLD , . /: ~ ~ -' ': . ' BUILDING DEPARTMENT//~_ ~~~ '~ -~ TOWN CLERK'S OFFICE .~.~ . ~,~,~'. ~:~ SOUTHOLD, N.Y. ~ ."~'~ ....... ~ Examined ......................... ~ ...... ~. ...... , 19 ........ Application~q. ~ ....... Approved ........................................ , 19..,..[~emit No ..................................... ~-' -'~ ...... , , ........... ~ ................................................. , ......... I ........................ ~-~ ~ (Building Insp~6tor} ~ ~n ~ ~ ~ APPLICATION FOR BUILDING PE~IT ~- ~ ~ ~ , ..... Date ...... ~.~ .......L.~ .................... , 1~2.~.r ..... e. This application must be 6empletely fill~d i~ by typewriter er in ink and s~bmitted in d~pli~t~ t¢ the Inspector. ~ ~ ~ ~'1 ~' b. ~lot plan showing location of lot and of buildings on premises, relationship to adj¢inin~ premises or pubti¢ streets areas, and gwmg a detailed description of layout ofproper~ must be drawn on the diagram which is pa~ of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d Upon approva of th s application, the Building Inspector will issue a ~ilding Permit to the applicant. Such permit~ shall be kept on the pr~mis~s available for inspection throughout the progress bf the work. e No bu Iding shall be 8Coup ed or used in whole or in part for any pu~ose whaJever until o Certificate of Occupancy shall have been granted by the Bumldmng Inspector. APPLICATION IS HEREBY ~DE to the Building Department for the mssuance of ~ Building Permit pursuant to t~e Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulotions, for the construction of buildings, additions or a~teration~, or for removal or demoliti~, ~ herein described. The applicont agrees to comply with all applicable laws, ordinances, building c~e, housing c~e, andZ~t¢ons. ~ .... {~i~'~mu~ of applic~nt,~r nome, i{ ~ ZL.,....t ....... .......... Store whether opplic~nt i* ownor, less*o, oflent, ~rchitect, on,meet, ~enerol con~roctor, electrician, plumber or builder~ .............................................................. .............................................................................................. officer ~ ~ ~ If applicant is o corporate, signature of duly authorized ~9~ 76 D ~ ~W ~ (~ ' (Name and title of comorate officer) 1 Location of land on which proposed work wilt be d~ne. Map No.: ..... ''~--/~.~.~.....¢ ............. Lot No .....~ ............. Street and Number ..~/........~.~. ~.....[~.~. ............... ~.~......~ ........ ¢ .................................. Munici~li~ 2. State existing use and occupancy of premises and intended use and ~cu~ncy of pr~osed construction: a. Exisiting use and ~cupancy ...~.¢~g~. ............................................................................................................ ,,ended ,se,nd oc ,,anc, ................................................. Was e~amined on and found to be in compliance with the requirements of this Board, SepTember 11, 1972 - RXTUR$ L~ ' RXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS ~ DRYE~ ~RNA~ ~T~S ~TURE ~ANC$ FEEDERS SPECIAL REC'PT. TqME CLOCKS I BELL I UNIT HEATERS MULTI-OUT~T ~ DIMMERS ''' ~ 3 8 SER~E ~T ~ NO. ~ I S E R V - . I C E ~ ~00 ~~ ~ x ~ ~/~ ~ ~/0 OTHER A~ARATUS: Water hea~e~: ~1-~.5~ Motor/s: 1-1/2bp Elec.room heat~rs:l-2.Skw, 1-2.0kw, ~-l. Skw, 1-1.25kw, 2-.75kw, 1-.5~ Be~nie ! Zimlinghaus, . R2370 ~t~st. Drive, : Middle!Island, L;I. !1953 - ' - . ' D ;'Z / ' ," :', ~ ~f~ ~t ~ ~ j~ ~ ~n~r~ r~n to ~e office of tk kard If incor~. Insp~tors may be identified by thei~ credentials. ?' IoN '0