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HomeMy WebLinkAbout6034-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.~[[~..~1~ Date .......... I~OV ..... 20 ....... , 19. THIS CERTIFIES that the building located at 14ai. n. I~ .&- 8out, hharbor..RdStreet Map No ..... XX ...... Block No..xx ....... Lot No...~t .... 3o~lghold .... lq,l[., ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ,/uly..~ .31., 19.'22. pursuant to which Building Permit No. 6031~Z.. dated .............Jllly... 39 19.72, 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 . Pml. vate..ore..fa:~i-ly .O,w¢.~.}ln~ ....................................... The certificate is issued to ... Re.lela. · i~ite.hel ...... 0~mer ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ... 0e.*o-. 1 S-$972.- .Dy. R o.¥1.tla. - · UNDERWRITERS CERTIFICATE No... ][ .~9~0 .... ~(2'g.. ~.~ .'[ 9~2 ................... [lOUSE NUMBER .... ~O ....... Street .....Sollt~h. tlal'b~l' -Roa~ ....................... FO~,M NO. e~ TOWN OF SOUTHOLD BUILDIN~ I~FARTMENT TOWN CLERK'S OFFICE ~OUI~OLD, N~ Y. BUILDING PERMIT CTHIS PERMIT MUST BE KEPT ON THE I~EMISES UNTIL FULL CON~PLETION OF THE WORK AUTHORIZED) 603 1 Z Permission is hereby granted to: ~ at premises located at ...... ~o~l, th..o,a,~L~a~..~a..~..-t~t .~t..~ol~ ..................................................... ....... , ...................................... .~4R~.tl',G.'Ld.r..~.,,~[.* ................................................................................ pursuant to application dated ..................... Jtl:~r.~' ....... ~.~ ............. , 1~...., and approved by the Building Impector. REGRA[.'4NG LOT DRF,/F.~,'AY cONSTRUCTICN- C~-'iiS POOL ~OF~S, ~uCTI C~.LLAK CONSTRUCTIO~ ~ OTHER Bullaing In~tor TOWN OF SOUTHOU) Tm Cle~.l Office APPLICA'rIOfl FOR CERTIFICATE OF OC:CUPANCY Imtmdtom A. This application must be filled in typewriter OR ink, and submit~od 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 dispasal~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. R. 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 New Building ......~..., ........ Old or Pre-existing Building ............................ Vacant Land ............................ location Of Property ...... .,~././~.:..~.,,~.~.....~.......',,~.'~....~,.,.,.,.,.,.,.,.,.,~.....~.~ ............. Owner Or Owners Of Property ........ Z/Z/.~.....Z..~.....,f~......~..../..~...~....'~'..~T...~.../,,. ..................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No...~J~.~....~.. Dote Of Permit,~..°......~.J......Applicant .................................................................. Health Dept. Approval ...... )...B..~..l,.~.l.~..'~... ............. Labor Dept. Approval ...... J~.i~. ................................ Underwriters Approval .,.~.t.~.~.....~.~...L:.Lr.~..~,I. .............. Planning Board Approval .....~.J..~. ............................. Request For Temporary Certificate ........................................ Final Certificate ....... ..~..... ........................... Fee Submitted $ .................................... Construction on above described building and pe~mit~meets o,~ll~a~p/icable/f~--~' -- ~ ?~L/~,'~,, codes and regulatiom. Applicant ........... ~'....~....~,..........~.....~.....~t.. ....................................................... Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or ~I) SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No ~ .~ -//~ The Undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Systems". / /, Date ' ' Signed Owner or Builder FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department, that an adequate and satisfactory Sewage Disposal System can be installed on this Plot. Date (lo/65 ~evis.) S-15 Signed ~'~'~ , Street Indi Data Feet 2 6 8 l0 ~12 14 18 EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR 'APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date Approval to construct said systems is requested,pertinent data herewith: 1-Applicant · , ~', .'~/~S ~" / '~ ~ ' ' ', Phone ~''' '/.''~ :' ~ ~ 6-Sub div Address ~-6, ~C ~ ,'~',~' ¢~ ,.. ~-r,~,.. ,~ t ( ?-Section 2-Detailed property ,l~cation ~ ' ...... ;'""~" .~-~i ~ 8-Lot No. Hamlet ~' ~'~' ~": "~ v ,,~ ~own ,'~o~ +/c~ c 9-Private well? 3.Public water supply name ~-Lot Size~ Width ft. Ler~gth "- 'Tr. (also enter on center plot plan below:) - elling. Singl.e Pamily gi y? A_/ ellar? L3 Slab? ! Crawl Space? ! ! 10-Proposed system. Septic tank ~reca~'---~Cesspools il-Septic tank inside dimensions. Volume ~'~s. Length ft. Width ft. Liquid. depth__ft. 12-Precast sections: /3~/Number~u~re Ft. Cesspools: Block sizeL incs. D ins. H ,ins. Total blocks below inlet: PLOT PLAN APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS INSTRUCTIONS: Appi-lcations must be submitted in tripli~cate 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 ~ain 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 ¥ " " " " " " 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 ~O 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 surfa~t~t~, Streams, Lakes & Bays, etc. Cesspools must be 20 feet minimum distance from large Cesspool center to Cesspool center must be at least~16~ Cesspool cover top to grade must be held to minimum ~t food t~a~um of 2 feet Bottom of Cesspool to ground water must be held to mi'nimum o~1 , ~ ~ /~.~' '~ C , ~'OUNG & YOUNG HOWARD W. YOUNG _ , ~ - i nined ...... ~-. ......... ~proved ........................................ , FO~tM NO. 1 TOWN OF SOUTHO'I.D BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. 19,.].1.... Pemit No...~,~.~..,~,....'.~.,,m;~,,. ........... Application No....Z~...~..,~.. ............. Disapproved a/c ......... ~ ............................................ . .......... ........ ............................... ........ 'To ~ ' APPLICATION FOR BUILDING PERMIT ,~ ~,~ Date ............ ..~.....~... ........ , 19) ............ ~- INSTRUCTIONS g~ 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 orx areas, and giving a detailed description of layout ofproperty must be drawn on the 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 progress of the work. ~k, e. No building shall be occupied or used in whole or in part fo.r 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, Suffolk 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. (Signature 6~ appli¢ontl '~r nome, if o corporation) ....... (Address of applicant) ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ................ ./.~...~ ......................................................................................... h If applicant is a cg, rg, orate, signature of duly authorized officer. ~ d:~Nome and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ...................... Street and Number ........ ........ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ....~..../~f~....~..~.. ............................ .... b. Intended use and occupa.ncy ....~.....~....~.(.~.,~..~ ................................................................................................. ' 3, Nature of work (check which appliCable): New Building ..... · ..~.... ..... Addition .................. 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, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, Jf 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 ....... ..~....7..~. ........... : ......... Rear ........~,...~...~ .......... ~'"<' ' Depth ........................ Height ........ Number of Stories .......... ../...~....z~.. ................................................................................................. 0. 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? ..... ~....~. ................................................ 13. Name of Owner of premises /~2.~'/~l~.~Address .~..~,~...~r.~..~o..~'~..-~,~...~' Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ~,z~...~. ..................... Address ~.~....~..~- ........... Phone No..~.~....~.~../..o.. 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 NEW-YORK,_ ~ ~SS .................................. ............................. ~.( ...................... ~ ........ ~in0 duly ~worn, d~oses ond says th~/ he i~ tho opplicom (Name of individual signing appli~tion) ~,,, vv~D~ above named. He is the .......................................................... ~m[ ........................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file 6wledge an~ belief; and this application; that all statements contained in this application are true to the best of his ~,~ '~ , . ,,: . -.. that the work will be performed Jn the manner set fo~h in the application filed therewith. Swam to before me this ~ _ ~ '~ ............... o, ....... ........ , Nato* ,~-- ' .....]'~C?H~ ~nature of applicant) TITLE NO. 07-67159 REVISIONS YOUNG & YOUNG OCTII,197;' 400 ©STRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR: HELEN MITCHELL /'.'" b-" ",,. //,~. .,' .~..,~.-." /U ~ R,]B, ~ T E E.~. T 04 ' ~ '~' AT SOUTHOLD ii~l~N MiT~.iEzLL' :..,, .,..: ' ~'owr~ o~ SOUTHOLD I~I~RI¢,~N~TrI¥[I~IiI~ e~'. ~x.. - ..,/.. ..1 I" 40' I D^'rE: ~...~"~"".,;"~ / = MAY 23,1972 ~"2'- 388 SUFFOLK COUNTY HEALTH DEPAR NENT (~ ~ T'_:s am,';a3o d~ sposal and water supply ~ ~ fac,:!it!es fnl' ti? struct~ro !et%ted at , hsvo been found to bo ,,,~. glfred H. GoldSmith