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Home My WebLink About5997-zFORM N'O. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~gT~ ....... Date ........... Jan .... .1.2 ......, lg. 73 THIS CERTIFII~.S that the building located at ~k. Drlve ................. Street Map No. ~O~ ...... Block No .... ~ .... Lot No. ~..O~eho~e... ~,Y, ......... confo~ subst~tially to the Application for B~ld~g Permit heretofore fil~ in ~ office dated ........ J~y .... 7 ...., 19.72. p~su~t to which B~ding Pemit No..~99~.. dated ........... J~ ... ~..., 197Z., was issue, ~d confoms to all of the r~ ments of the applicable pro~sions of ~e law. The occupancy for which this ce~ificate is ~su~ is .. ~r~y~.~e. o~..~.~y. ~vg ..................................... The cer~ica~ ~ issu~ to .R~ .~n~ ...... ~er .............................. (owner, lessee or tenant). of the afores&d buil~g. Suffolk Cowry Depa~ment of He~th Approv~ .~..] ~ ,..!973...by. ~ .Y$.~e .... UNDERWRITERS CERTIFICATE No... ~ .6~2~ .... ~ec...~9. J9.~2 ................... HOUSE NUMBER..~ ........ Street... 9~ .~r~e ................................... Building Inspector ~ FO~ 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) 5997 Z Permission is hereby granted to: G®oJ'ge Ah&,~.~.~ .. ~,u.~A- rJ~ ~...;~ ~,~. · A/~ · .B..~ · .L~,~m~T .......... CUt, Che~,~ ................................................ ~o ~u~3~l ..~w..~e.. £aa~¥.. &well~n~ ..................................................................................... at premises located at ..&,-~...(~lJ..~)~4.9'e .......... (~e.-sOl~-) ................................................................ ...................................... .~.l~.~k~lme .......... ~.~., ................................................................................. pursuant to application dated ........................... ~.B~. ....... 7. ......... , 19.~.~L.., and approved by the Building Inspector. Fee $.70~,~0 ........... p£~:.,i,'4T iNcLUDES APPROVAL FROt-A ABOVE , , LoT Building Inspect SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No 1-Applicant Address , . ~ , 2-Detailed .property, location Hamlet 3-Public water supply name Phone 6-Sub div ?-Section , ,-~ .... ~, . .-~, ~ ~8-Lot No. .... TO~ "'-~"' - ~9-Private well?, Distance to nearest main ' 4-Lot Size: Width ft. Length ft. (al~o ent'eP on center plot plan below:) ~-Dwelling: Sin~l~Family ~_~ Two Family? ~' /Cellar? ! /.Slab? ~__~Crawl Sp?oe? I / lO-Proposed system. Septic~c~nk .~ /Precast ~_/Cesspoo~ / /Sh~ll~ pools Y ZOther~/ / tank inside dimension~.~olume Gals.Length. ft. Width .ft. Liquid. de~h~ft. il-Septic i2-Precast sections: ~ yNumber/ /SqUa~Ft. Cesspool.s. Block size~ incs.D___ins. H,__ins. Total blocks below imlet: ~1 .-~ ~2___~3 ' ~ PLOT PLAN Capacity Gals. G.P.M. Data ~eet 0 2 ~ 4 ,: 6 ,~ 8 10 12 ~4 ~6 18 Street The Undersign~ CERTIF~S: "Const~ction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standa~s, ~lletins, a~ amendments thereto, covering Private Sewage Disposal Systems". Date Sign~ Own~o r Builder FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the that adequate and satisfacto/S~$e~T~posalSystem/~/.~ opinion of the Health Department, an can beDateinStalled~/~on ~--this Plot. Sign ed~//~-~~/~~~ I AVATIO# DISPECTIOll It[QUIP, ED S-~ Date EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval to construct said systems is requested,pertinent data herewith: APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS INSTRUCTIONS: Applications must be submitted in triplicate i-Means Owner or Builder. Address to ~hich 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 Publid 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-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 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 line~ of the heavy lined square in the center of Plot Plan shewn 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-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 .C. ESSPOOLS 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 fee~ Bottom of Cesspool to ground water must be held to minimum of 1 foot FORM NO. 6 TOWN OF SOUTHOLD Building Department 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 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 Date ......~ ~.....t.~...y.L.~...~&~... New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Owner Or Owners Of Property ....... ......................................... Permit No....'~,.~).~.~/..... Date Of Permit ..~/.~../Zg....Applicant r I ~ ij~t~ Labor ~ t Approva ~ ~ .... Health ~pt. App ova ........................ ~ ...... 't ....... P ........... ~ .......................... Unde~riters Approval ................ .~...[~.)..~.j.~.~Planning Board Approval ...~l.~ ............................. Request For Tempora~ Ce~ificate ........................................ Final Ce~ificate Fee Submitted $ ........ ~..~. ................. Construction on above described building and permit ~e~l app~es and regulations. Sworn to before me ~s ~.~ day of .~ ...... ~.~.~.~ ...... (stamp or sea3:~ Nota~ Public .................................... Coun~ THE NEW YORK BOARD OF FIRE UNDERWRITERS bk ;' BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK. NEW YORK 10038 ~1~ CERTIFIES THAT SERVICE DISCONN~T V I E i ["~urnaces: 2-1/8, & 1-1/4 bps Motors: 1-I bps W. B. Rul andv r~-~~~c~- Mattit uck, N~. This certificate must not be altered hi any manner; retur~ to the office of the Board if incorred. Inspectors may be ident~Sed by their crede?~a~. ,// // / TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application .................. Disapproved o/c .......................................................................... APPLICATION FOR BUILDING PERMIT /~ Date ............... ~ .......... , 19 ............ INSTRUCTIONS e. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of pleas, accurate plot plea to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, an giving a detailed description of layout of property must be drawn on 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 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. 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, Suffo|k 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, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) .......... ................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................................................. . ........... t[wZd _, ............................................................................................... Name of owner of premises .... ,Z~.~......,~.~...~,~l~..~n~..~.y~ If applicant is a corporate, signature of duly authorized officer, t~ (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........... .~..,... Lot No ......... ...~.... ............................. Street and Num~r4.O.....~..~....,~J...~.~ ....... ..~...~...~'./..-~.....~z~..OCz~.~...+...~..-..~.~ ............................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........................... J~...~...d..~..'~... .................................................................................... b, Intended use and occupancy ...... ~.~.~L~,~.' . .......................................................................................... ~ :' :~. --~Natur~ of work (check which applicable): New Building ....~. ........ Addition ..................... Alteration..,.~.~ Repair ............. ............ Removal ......................... Demolition ........................ Other Work .................... : ............... (Description) 4. Estimated Cost ........,,-~,../.t../',~?n. ,~...~.. .......... 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 ..... ~:;).~..~.,.?. ...... Depth ......,,~.,. ,~..~...5~.,.~ ........... Height ......... ~.~..~. ................................. Number of Stories ............/.. .......................................................................... 9. 'Size of lot: Front ........ .././..Z........,~..~.. .............. Rear ........ /../~..~.~..~. .................. Depth ....... ./.~....~.~....-~'..~. ......................... Height .................................................... Number of Stories ...................................................................................... 10. 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: ....... ~.(~ .............................................. 13. Willlot be regraded-.J[~L(~. ......................... Will excess fill be removed from premises: [ ] Yes ~ No · 14. Name of Owner of premises .~0.~...~...~.. J~.¥,l~ .............. (Address,O'S' ,T~3~.. * ' '~'"' ................ 'P (Phone'~'~"" ~' ""~"~"No.) ........ Name of Architect ............ _ ~ (Address) (Phone No.) Name of Contractor '¢~-~'~'~'"~"~'"'~"~/'~'"'~"X""C':"i "~'-~'"~"~" "~";'"~/2"~'~('~'?~";~';'~'~'~'~'/ Address) (Ph neNo) 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 wheth- er interior or corner lot. z STATE OF NEW Y~~ - ) ~ //2; ?~ ~ cOU.TY OF ......... .............. ) (Name ~f i~ividual si~ing con~act} ~ ~Contractor, agent, co~orateof~cer, etc.} of said o~nar or o~nars, and is duly authorized to ~rform or hays ~rfo~mad tha said work and to maka and fils this a~liaation; that all statamants containad in this a~lication ara trua to the bast of his kno~ladga and baliaf; and that tha ~ork ~ill ba ~rform~d in tha ~nn~r .t forth in the application filed therewith~ ~ ~ ~0 ~ ~ . .............................................................................. "* .................................... /, ?' 37 / ? TZ-' _L