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Home My WebLink About6022-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerlificale C~ Occupancy No.~ ....... Date ........... llo~l'~be~'...8 .... , 19.72 THIS CERTIFIES that the building located at i~X],~, ll~ad ................ Street Map No... ~ ....... Block No...~ ...... Lot No. ~..Pe~Ol~O...N,][., ........... conforms substantially to. the Application for Building Permit heretofore filed in this office dated ......... J.~].y .....12, 19 .?2. pursuant to which Building Permit No. 60a~.. dated ......... .J..~. ......'~..., 19.?~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ....1~..$T.a.t~.....~...l~..~.~..5.w~.],~ ..................................... The certificate is issued to . .ll~Wltt .&. ~ts~ 1~.O~ ....... ~0 .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County DePartment of Health Approval .Il..o~.,..~...?2....bY..R.n. ¥.$..~ ....... UNDERWRITERS CERTIFICATE No...I 50~0~ ..... O~.t.. ~,..1972 ................... HOUSE NUMBER... ~.~10~' ..... Street .....~'1~., 1~ ............................... ...~d..f~.o. or..~..e.~u~.~e4..-..~equ~res. ~tnep.e. ct~on .&. C/.0 .fo~. Building Inspector IN~3E 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) No. 6022 Z Permission is hereby granted to: ....... /.mm~t~..,g, me~...7,M.. ~...~s~,..lr.. ~ to ..~d34-1mv-- m~e ..L~i:l:~T'"dv~2~t~' ................................................................................... at premises located at ...... &r~L..lf433,~.~G~ ................................................................................... ............................................... ~e~o3z~o .......... ~"~ ............................................................................. pursuant to application dated .......................... ~:t~3,~ .......... ~.~,....., 19..~1~., and approved by the Building Inq~ector. Building L Inspector 7;/ 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: I. 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 dispasal---(S-9 form or equal). 3. Approval of electrical installation fram 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: !. 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 New Building ~/ Old or Pre-existing Building Vacant Land Location Of ~r~perty~-~-~j-j~[~b~1[~.~j['~L/L-~..~--~`~r1~4~..~i~=~j~.~ Owner Or Owners Of Property ..w~.L~...JLJ~...~...:k...~.l~...~,91~ed...~...a...¥. .......................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No. ~t~.,~.~.. Dote Of Permit~).V.J,~/..,'~e/.~,~Applicont .~'#.~..~.~.~'..~e.~..~.,,~.../Jl~.~., ............ Health Dept. Approval ...~r.//...~./..~.....,~...~ .............. Labor Dept. Approval ................................................ Underwriters Approval ~I..~..~...~.~.,~..L.~..eJ...~... ............. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building, on, permit meets all applicable codes and regulations~ Applicant ..-.. ..... Swam to before me this Notary PubliL,..~.~'~.~,,,t'~-~. County TERRI LEE ELAK NOTARY PUBLIC, State o! New York No. 52-6].68295 Ouaiifiecl in Suffolk County Commission Expires March 30, (stamp or seal) SUFFOLK COUNTY DBPARTHENT OF HEALTH H.D.Reference APPLICATION FOR APPROFAL TO CONSTRUCT ,PRIVATE SEWAGE DISPOSAL SYSTEMS Date~u4~ ;~ ~ ~pproval to construct said systems is requested,pertinent data herewith: , l~pplicant ~O~e~O~ ~ ~&. Phone~~-Sub div ~ i~ress. ~'~,,i~o~ A~ ~I'~wL~ i~ ~ 7-Section ~.Detailed_ p~operty location~z~ v~¢~ ~ $~?~'~ ~.~.r~.~ 8,Lot No. Hamlet ~ ~,~ ' - Town .~wT~.~' ...... 9-Private well? 3.Public water supply name ~A~w~ Distance to nearest main ~-L0t Size: Width~O ft. Leqgth~.~._ft. (also enter on.center plot plan below:) %-Dwelling: Single Family ]~Two Family? ~ /Cellar? ~/.Slab? ~.~Crawl Space? / ~ 10-Proposed system: Septic tank ~ /Precast ~ /Cesspools / /Shallow pools ~ /Other / / il-Septic tank inside dimensions: Volume~ Gals.Length ft. Width' ft. Liquid depth .ft. 12-Precast Sections: ~./Number~_~Square Ft. Cesspools: Block size~incs.D.__ins. H ins. Total blocks below inlet: ~1 ~2 ~3 PLOT PLAN Data ~eet 0 2 6 8 ~0 12 Street ~ Ind~ ,~at ~ ~ No ~t~ The Undersigned CERTIFIES: "Construction of authorized installations ~4 ~ be in accordance with the Suffolk Cbunty Health Departments' current Standards, ~lle%ins, a~ amendments there%o, coverin~ Private Se~e Dls~sal S~stems". - ~er or ~lde~ FOR ~ALTH DEPART~NT USE ONLY. Bas~ on the info~ation presented he~th, it is the opinion of the H~lth De~men%, that an ad~te and satisfacto~ S~ge ~s~sal S~tem can be install~ on this ~ot. S-15 ~PLICATION FOE APPROVAL TO CONSTI~CT PP~I~ATE SEYAGE DISPOSAL SYSTEMS INSTRUCTIONS: Applications must be su~tted in tripl~cate' X-Neans Owner or Bn~lder. 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 Namlet/Village & Township 3-Enter name of Public Water Supply District, together with the distance to their main. 4-~ter Length and Width of Lot under appropriate heading, also enter these dimensions on center plot plan sho~ on the face of this application. ~-Dwellings: Check.~ark "V# items applicable to the proposed new dwelling. 6-Name of sub-division ?-Section ~,~er 8-Lot Number 9-Private well: Enter "No" if Public water supply is available.~ Enter "Yes" otherwise.. P~0~OSED SYSTEMS.' Answers to Items n-tuber 10, 11, & i2 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 ~eaching Pools PLOT PLAN: The following information is required concerning the Applicant's Lot: Lot size-Length and Width in feet to be ifldicated at the Lot lin~s of the heavy lined square in the center of Plot Pla6 shown on face 9f th~s a~plication. 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 aIso. Wells and Cesspools now on adjacent lots must be shown on the Plot Plan together with the distance t~ the Applicants proposed Sewage Disposal Systems and Well. Where no Buildings exist on adjacen{ lots, state "Vacant" on the plot plan. Streets adjoining applicant's lot to the right, left or rear, enter street name. WE~L 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 IDCATION: Upon determination of the Sewage & Waste disposal "type of systems" required, the following Standards must be observed for the location of same: Cesspool-t0 feet minimum distance from lot lines to center of cesspool Cesspools exterior must be t00 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 miD~-,,~ distance from surface Waters, Stream% 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 TOW. O, ..T.OL. X'h BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~/~' ' ~UTHOLD, N.Y.~ , ' ...... ........ ......... Di~ppr~ a/c ................ . ..... , (Building Ins~q~ctor) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with~' 3 sets of plans, accurate plot plan 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 commencaed before issuance of Building Permit. d. Upon al:ip~r~.oval of this ap~olicetion, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the promises evadable 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 bee granted by the Building Inspector. Building Department for the issuance of a Building Permit pursuant to the Building Zone~ APPLICATION IS HEREBY MADE to the Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations/for the construction 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, amhitact, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~,,~..~f...t~ ~.., ..~. ,~.~..~..~...~.. ~::?...'~., If rate, :z . Lp,, ._signature of duly authorized officer. .....__. ......................... ...................... (Name and'*-'' ' --title of clSrporate officer) -7'-7 ~ [ 7 1. Location of land on which proposed work will be done. Map No.: .................... Lot No .............................................. Street and Number ......... . .'~...~h.~. ...... ..~..P....~..~.. .................................... ~..~.....ee~....~....~...c~.....,..-.....~..:..Y.., .................... ~_~a ~occ Municipality 2. State existing u upancy of premises and intended use and occupancy of proposed construction; a. Existing use and occupancy .............................................................. Nature of work (check which applicable): New Building ...~5. ............. Addition ..................... Alteration,.....,...~;,~' ~r ......................... Removal ......................... Demolition ........................ Other Work...., .............................. ' ~ (Description) 5. :ill dWeliirig,· number of dwelling units ...... ~... ..... Number of dwelling units on each floor ....... , ......................... . ........ If garage, number of cars ..... ~. ................................. = ......................................... ~ .......................... ; .......................... 10. 11. 12. i3. 14. If business, commercial or mixed occupancy, specify nature and extent of each type of usa ..................................... 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 ........................................ Dimensions of entire new construction: Front ...... (4.~1~.~./~..!~.. Rear ......~...~.....~.. .......... Depth ....~....; ......................... Height .......... ~ .................................. Number of Stories ...... 4'.~1 ......................... , ............... .~..; ............................. Size of lot. Frbnt ....~O,i~i~/..'...;. ............... Rear ....,~.~ ............................ ,' Depth ..../..~..~...., ................................. He,ght ............................... ,....~.~.?~ ......... Number of Stories ...................................................................................... Date of Pumhasa ....a~alk,.~7..,i.~gat~.. Name of For'mcr Owner ...., ............................................... ; ...................... ~ Zone or usa district in which premises are situated ..................................................................................................... Does proposed construction violate any zoning law, ordinance Or regulation: .......~. ............................................... Will lot be regraded ..................................... Will excess fill be removed from premises: [ ] Yes ~ No Name of Owner of prem,sas .aax~./.lIL..z;....~.,...~..~.e.~L.~....x.w...,. ........................................... ,.r..~r...'.m.w.~...., ....... (Address) {Phone No.) Name of Architect ..................................................................................................................................................... {Address) {Phone No,) ~Add~res$) (rno~e No./ property er interior oy corner lot. PLOT DIAGRAM or proposed, and indicate all sat-beck dim~nsions from to deed, and show street names and indicate whath- .t. STATE OF NE, YORK, )) COUNTY OF .; ....... .: ............................ .................................................... ;~ ................................................ being duly sworn. ~s ~d ~YS ~ be is the appl~nt abo~ na~d. of said ow~r or o~nara, and sta~men~ ~n~lhed in this applica~°~J~& ~~s knowle~ and ~lief; and that the ~ will~ ~ffOr~ In *e ~r ~t fo~h in the appli~tion filed t~'u3a4~3 Su?o~ C0~nty .,- ~ ' ' No~w ...... = ............................ *,5' WELL5 ROAD ~,~c~MONO MAP OF PROPERTY SURVEYED FOR, SCALE- 40'= I" · E P \V I H E ~ $ U S A ,",4 'F 0 Y -' i~!!~!~:~;~;,"'' '~'"°' SITUATE AT ~'"~:~:~E*L~H~ .o~c COMPANY AND T~ AREA = 4~,300~ SQ.FT. o~,.. ~ ' , DESIGN ~1766 ~ HOME PLANNERS, INC., DETROIT MASTER BED RM, 12Oxl56 LIVING RM. 194 x rl36 64'-I0" 42'- 0" TERRACE LINEN P ENTRY EATING KITCHEN 124 X 176 SNACKS DINING RM. 124 x II6 22'-0" {AISED HEARTH FIRST FLOOR 1638 SO, FT, FAMILY RM, 214 x 13e GARAGE BED RM, BED RM, 13° x 12° 14° x 120 N EM, Cl, CL, BED RM, 164 x lO4 140 x 104 SECOND FLOOR 1006 SQ. FT, ROOF me anners, inc. 16310 GRAND RIVER AVENUE DETROIT 27, MICHIGAN Z PRELIMINARY CHECKED APPROVED E A 4~. -0 ISSUED FOR DATE i 2~ '- 0# -I /J£D~OOA4 F / R £'~ 7 F /_ 0 0 R P L ,4 /q .s'c4 /_~: : /¢/t=,,,. 22- 10 ~ ome, h Inc. 176 5 C L]_ LL © ® ® ~) ® AW d- /4 T El EVA T/OM ~'-o' PRELIMINARy__ CHECKED APPROVED omo ners inc. ,,..,,o. PRELIMINARY __ CHECKED APPROVED LINE ITEM QUANTITY & MATERIAL UNIT TOTAL LINE ITEM QUANTITY & MATERIAL UNIT TOTAL MnLINE ITEM QUANTITY & NO, I COLUMN NO, 1 UNIT MEAS, I (TYPE and/er SIZE) I COST I COST NO, COLUMN NO.' UNIT ~A~. (~¥~'~ and/er SIZE) COST COST ~ ~ ~ UN,~IT MEAS, MATERIAL 2 -. 1, [ I} - -~ --- __ .___ , _ 34 , 1~ P~. [~". &".1~".4" '_ - _ 33 ] z a,~t I_~' ~ _~q,'r ..... ] I ~ L ,~ { ~ ~... l _~.,m m,~ , ~ ,4? -- s4 ? ~', 13t,,z ~,z 3/1~,z 3,.4,,' st,No. L~utd. i~qZ~ ,~ i -- se I I ? o~.td.., I ~o1~o i ~ ~ -- -- T ~ ~.x m~ ~ ~~~ -- DATE NOTE: UNIT TOTAL COST COST I~. ome ptanners, inc. 1766 OF 2 LINE ITEM QUANTITY & MATERIAL UNIT TOTAL LINE ITEM QUANTITY & MATERIAL UNIT TOTAL NO. COLUMN NO. II, UNIT MEAS, (TYPE ond/or SIZE) COST COST NO' COLUMN NO, ~ UNIT MEAS. (TYPE and/or SIZE) COST COST 23 ~ ~ a . 23 43 ~ ~~ ~ ~ I I 43 ~ ~_ · . 4~ 57 ~ ~mm s7 71 ~ ~e m . m · - ~ 71 "-- ~~ ~ome pmnners, Inc. APPROVED ~ ERECTION ' ~ 16310 GRAND RIVER AVENUE D~TROIT 27, MICHIGAN