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Home My WebLink About5719-zFORM TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No... ~1~)~.... Date ............. ,Y~....15 ..... , lg..~ THIS CERTIFIES that the building located at .l~a~. ll~ .&. ~l~e'/. ~. ~treet Map No. CtI'e~ .~. ]~pek No ........... Lot No. '3 .... BeatifiC. · .]le][~ .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... Jalx~ry .. 2519..F2 pursuant to which Building Permit No.. ~ ~. dated ............ l~®b. · 2~.., 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 .... PZ'-$vate..o~e. ~&,,,:l.l.y..dwo.tl.i~g .................................... The certificate is issued to ~Tolm. &. E~;l~et..l~res.to~ ..... Ow~er~ ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ... July. $ .. 1 ~r~.b,/..Re. ~t~ll& .... UNDERWRITERS CERTIFICATE No.. ~ .2~$1.~ ....................................... HOUSE NUMBER. 1+(~ ....... Street ....'~&lt~'l.~l~' 'P. oa~ .............................. Building inspector FOKM NO. ~ TOWN OF SOUTHOLD BUILDING DEFARTMENT 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? 5719 Z Dote ................. ~l~ll.e... ~Jl, ...................... , 19.J~.. Permission is hereby granted to: .... t,~llmm~"JmBmm"-"~-~'"i',ml~"&'ltlm~ml, m'm'~ltm .... t~,?'"'V ~"~m'i:J~"zm'g ............................. ......... J~m"~'i'"m;x~-'"'~s~ .......... to .... JJ~ ..II~M. J.. ~J~..~lll~. ~J~ ............................................................................... at premises located at ............. ~i~.,j¥..3.~.....~.~/..jj~;~..ji:~.~ ...................................... ........................... · Jei~,l~ ..Jeml..& ¢e~.. e~eel~ .~ ........... ~emi~e~l ............................... pursuan* to application dated ................ 4jllj.....~l~ ........................... , 19..~., and approved by the Building Inspector. Fee $ ~4~l~m~ ........... Building Inspector/ S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH ~ldg. FermiC No. TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located (~ive deed/ location) have been inspected by this department and found to be satisfactory. JUt 6 t972 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office SouthoJd, N. ¥. 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 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 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 3. Copy of certificate of occupancy $1.00 $5.00~'~ f Date ~......L.~ ...... ,~, ..~.. New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ V' Owner Or Owners Of Propert; ...~.....~.,~......~...~...~,.~ .............. · '' J~ ~' L t Sul×l,v,s,an ...~.......~. ................................... a No ............. ac N ............. N ........... Permtt No ..................... Date Of Permit .~..........~L~...... pp ~ .................................................. Health Dept. Approval .... ~...~....[.~.]...~. ....... Labor Dept. Approval ...... .~.....~.~.... ............................... Underwriters Approval ...... .~....~......~..i.?·...~..I...~....'~. .......... Planning Board Approval .... L~.......~.. ......................... Request For Temporary Certificate ........................................ Final Certificate .......... ~ ................. Fee Submitted $ ...~....~ ................ Construction on above described building and,/~~ ~ljpplicable codes and regulations. ............................................................. Sworn to before me this ....... L.L. day of ..... ....... {stomp or seoO Notaiy Public, State of New York No. 52-0344963 Suffolk County Commission Expires March 30, ]97~ t s~tlon 72~ ~ t~ N~ Y~ State Educa~ ~. - Copies of this su~ey map nM bearing t~ la~ su~eyo~s ink~ ~1 or em~s~ s~l shall n~ be ~s~de~ ~ ~ G vali~ copy. SURVEY FOR dOHN 8 ETHEL M. AT BAYVIEW TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. SCALE: I"= 40' MARCH 7, 1972 MAY 19, 1972 ,JUNE 14, 1972 PRESTON REFERENCE, COREY CREEK ESTATES , LOT 3 MAP NO. 49~3, FILED AU$.IS,196T gUARANTEED TO: SECURITY TITLE & GUARANTY COMPANy RIVERHEAD SAVINGS BANK dOHN & ETHEL M. PRESTON LAND SURVEYOR N.Y.S. LIC. NO. RIVERNEADI N. Y. ~ OUFFOLK 60UNTY DEPARTMENT OF Data Feet h':' 0 · 8 10 18 ~ ~ ~ Street · o · The Undersign¢ CERTIF~S: "Construction of authorized installatioE [~11 be in acco~ance with the Suffolk County Health De~rtments' current Standa~s, [lletins, a~ amendments thereto, coverin6 Private S~e/~ .Disp°sal Syst~.~ ~. ~e~ o~ Builde~ FOR ~ALTH DEPART~NT USE ONLY. Bas~ on the info~ation p~esented beneath, opinion of %he Health De~m~nt~ %hat an ad~uate and satisfacto~ Se~e Dis~sal System can be ins%allsd on %his ~o%. Date (10/65 Revts.) ~'~ '" ~" "'~' ~'~ EASTERN DISTRICT, RIVERHEAD,N.Y. ,/ . APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date Approval to construct s&id sy_steme is requested,pertinent data herewith: - l_Ap~licantT~ ~, ¢~ .Pho.~e~/y- '~¢6~-Sub div ~ ~~' Address /? '~ ~,' L~~ - n; 2-Detailed propert~ ~¢ation~/~ d~,, '~Zf~ ;-' - ~-Lot No. Hamlet T~.~ -~¢'~'4~¢'Z 9-Private well?. · q-Public ~ater SuPplY name /~ Dzstance to nearest main 8-Lot Size: Wldt~i ~ ft. Len6%h/?& ft. (also enter on center plot plan below ) ~-Dwellins: Sin8le Family ~ Two Family? ~ /Cellar7 ~.Slab? ~JC~awl space? lO-Proposed system: Septic tank ~ /Precast F~'FCesspools / /Shallow pools / /Other / / ll-Septlc tank inside dimensions: Votu~e Oals.Len6th ft. Width ft. Liquid depth___ft. t2-Precast sections: / ;Numbe~/ /Square Ft. Cesspools: Block sizeL incs. D ins. H ins. Total blocks below inlet: ¢1]~/ FLOT PLAN ! I Capaeit . ~als o ; G.P.M. o~ ~ ~ ,W.L. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS INSTRUCTIONS: Applications must be submitted in triplicate i-Means Owner or Builder. Address to which mail should be directed. Z-Means detailed description of property location, together with street name and distance to nearest intersection of main thorofare, also I~mlet/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" 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 lO, 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 " . . . u " 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 let, 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 1 foot FORM BO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE , 19 ......... Application No......~...~.../..Z .............. Apprc~ved ..................... ~.. .................. , 19 ........ Pemit No .............................. +~...._~e~, ~ ,2~7~ Disapproved a/c ~...~ APPLICATION FOR BUILDING PERMIT ~ .......................... a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildin~ Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout ofproperty muSt be drawn on the diagram which is p~rt of this epplicotion~ 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 Occupanc~ shall have been granted by the Building Inspector. 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 Regulatiqns, 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 cede, and regulations. (Signatt~n~ of applicant, or name, if a corporation) /~-~ ~. ~_~ ~. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer~ co~ electrician, plumber or builder.~ Name of owner of premiSe~.~....~...'~.......'~.....~....~..r....~..~.......~...J..~. ................... I f ~orp~i~n~t_u. re o,~/~y authorized of f icer. i (Nardex6nd title of corporate officer) ~. ,oca. on of ~and on wh~ch.r~osed work w~U be done. ~op ~o.: .~{3~, ............. h.. Cot ~....~......~ 2. ~~ o¢~oancy of premiss and ,ntended use and occupancyM~?oP~S~C~ const~cti~one'-9: f o. Exisiting use and ' occupancy .......................... ~ .......................................................................................... ~. . b. Intended use and occupancy ..................................................................................... · $. Nature of work (check which oppli~): New'Building .................. itio ...............Alteration~ 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, '~pecify nature and e~ent of,each type of use ............................ 7. Dimensions of ex st ng structures, f any. Front ............................ Rear .............................. .. uel:nh~ 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 ........ ~ O . ~> ~' ................... Depth ........................ Height ....../....~.. ....... Number of Stories .......... ..(. ......................................................................................................... 9. Size of lot: Front .....~...~'~....~.'--'-'~ ....... ~.... Rear ....../....~....~.. .................... Depth ...../...?....~.....~...~...3'. ....... 10. Date of Purchase .....~.'.../.../..J.~'Z...~......~... ..................... ~_~,of Former Owner .~..~.~.. 11. Zone or use district in which premises are situated ..... ;t ....... ; ................................ ~,....~ ......................................... 12. Does proposed construction~r- /) ;'3~vi°late any zoning law, ordinance or regulation?~ ............ ~ .......................... 13. Name of Owner of premise~..~.~.~ ........ Address / J~~ '~" I~1,~.~ lu~J"r/-l'- ~ ~' Name of Architect .................................................... Address ~,..._.Z~; ............ .~ .............. Phone No. ' ................... Name of Contractor ... ddress~.-~ ......... Phone No. 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 whether interior or comer lot. STATE OF NEV~YQR~, COUNTY OF ................................................................................................. being duly sworn, deposes and says that he is the applicent (Nome of individual signing application) above n~ed. He is the ......................................................................................................................................................... (Contractor, ag~t, co.orate officer, etc.) of said owner or owners, and is duly authorized to peHorm or have performed the seid work and to ~ke and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and t~J 'J~oW°rk~9;il~:rf°rme, ~ ,nJh, manner set fo~h in the opplico,i~ filed ,h~with~ ...... .~..~.~.. ~ ............................. FROM: PARLIAMENT H0M . 147 W. Mont~uk H~.~hway H~mp%on B&¥s, N.][. 11946 ~0k ETHEL M. PRESTON ~UlIT¥~ N. Y. 40' re72 TIll ,tOT ~ 4e~'/tfLLfV 4Me. fl, le4,1r, UOHN · ~¥1fEL ~L WItEITON CMN)' 'l Z :L 't