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Home My WebLink About6037-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No.Z..~11.~. ..... Date ............. Apt. il... S0..., 19.73. THIS CERTIFIES that the building located at S/S..Lea3.~e. Rood .......... Street Map Nd~&3r. l~(mel... Block No ........... Lot No..7 .... Cttt;el3ogusa..1~3[, ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... J.tl~ .... ~., 19.7~3. pursuant to which Building Permit No... 6037~ dated ........ Agg.. 1 ........ , 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 .-Pr.~-vate. one. tamit~ ~lwet. ,lim~ ...................................... The certificate is issued to ...¢la~,aen. ~o,,it323e~iom .¢ol'p ........ (~me~buil6ez'. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...F.~b..~..1 ~?~ ..b~..R.*..?~...~ ...... UNDERWRITERS CERTIFICATE No...173922.. 2t.. $ ...................... HOUSE NUMBER .... .,lOll~ .... Street .....Lel~l~.e. Pa)all ............................... Building Inspector FOB~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 6037 Z Permission is hereby granted to: .... ~,~.:.~,....:..~:.~,~.t,z~c~:bJ.e~ ..G~I~ ............... ......... ~h,O' ...~r ~..~'tc~z~-.Pa~l~ ...................... ......... a~x~e_~; ....... ~x~' ..................................... ~ ....~.~.~. n.,.~...~,....~.~.~....,...-.~.~.~. ................................................................................. ot premises located at ..~o~j..~ ...... ._~t~-...~io~te~ .................................................................................. ...................................... I~ee~.~..~ee~ .............. ¢~eb~g~® ....... I$~¥.~ ........................................... pursuant to application dated .......................... e,~.~]/ .......... ~....., 19.~..., and approved by the Building Inspector. Fee $~,~.~ ........... PERM;T INCLUDES APPROVAL TO REMOVE EXCESS FILL FKCIP.¢ ABC~VE PREMISES BY Building In~4~eCtor ]-- / SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No~. EASTERN DISTRICT, RIVERHEAD,N.y. APPLICATION FOR APPROFAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYST~.~ Approval t~. construct, said systems is requested,pertinent data herewith: Date i-Applicant ,C./~,,'~a.~'.,/~..w~' W'~F~ Phone 24J-$;~-'Sub div Address ~,~,-~w'~ ~¢ ~z /A~ .~xw~',% ' ~ ~',~/&--//~ 7-Section 2-Detailed property location Hamlet ~C~,Fz &,z ~ n,.~- ' Town _~,~,.~,~/~/ 9-Private 3-Public water suppl,'name Distance to nearest main 4-Lot Size~ Width /*-~'ft. Length ?$~ft. (also,enter on center plot plan below:) 5-Dwelling. Singl.e Family ~Two Family? ~__/Cellar? ~.Slab? 10-Proposed system. Septic tank Lj~Preca~t F.~CesSpools n.SepUc, tank insi. e. ensions. Vol e -- s.Length W dth ft. i uid 12~-Precast sections..~_~. _Number~.~4S~uare E~Cesspools: Block sizeL___incs. D.__ins.~. Tgtal blocks below inlet: ~1 $2 $3 PLOT PLAN Street Ind~ No~ Data Fegt 0 2 6' 8 10 ~ 12 The Undersigned CERTIFIES: "Construction of authorized installations will. be in accordance with the Suffolk County Health Departments' current Standards, Bullet,ns, and amendments thereto, covering Private Sewage Disposal Systems". ' Date ~.~ ~.~, ~. ¢ .. ,~ Signed / ~' ? Owher or Builder FOR' HEALTH DEPART~NT 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 ~,, ,I~ . Signed ~.........__. (~0/65 .evis.) EXaVATION m ml. APPLICATION ~0R APP~0VAL TO 'CONSTh~¢T pRIVATE SEWAGE DI-~POSAL SYSTEMS ~ - ~NST~UCTiORS~ Applications must Be subnitted in triplicate 1-1~eans O~ner or B~lder. ~_~ress to ~hich mil should ~ ~rec~. ~M~ns de~ desc~ption of p~perty lo~tion, ~ge~er ~ st~et ~ a~ ~s~nce ~ n~rest in~r*ee~n of ~ ~fare, also ~et/Vi~ge · To~s~ ~ter ~ of ~blic ~r ~p~ ~st~ct, ~ge~er ~ ~e ~s~nce ~ ~eir min. ~ter ~ and ~d~ of ~t ~der app~p~ate h~, al~ enter ~ese ~ensions on center plot plan sho~ on ~e face of ~s apportion. ~~s~ Che~-~ ~ it~ applique ~ ~e p~pos~ new d~ing. ~N~ of ~sion ?-~etion ~,~r ~-P~vate ~: ~ter ~o~ if ~blic ~r ~p~ is a~able. ~r ~es' o~e~se. 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 AA~ " u . - u e Septic Tanks Part IV " " " ' " " Unusual soil conditions Part V " . . . . n 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 sho~ on face of this application. ~urface waters-Streams, Lakes, & Bays, etc., located within a distance of ~0 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. l~era 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 observe~: 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 mi.~w.,m distance from front, and front sides of property lines Well-~O feet minimma below grade for well point Well-~O feet minimum into ground water for well point Well-$ feet 6 ins. mi,~--m below grade to well head and lateral water pipe CESSPOOLS L0~ATION.. 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 mast be 100 feet minimum distance from nearest well Septic tank exterior mast be 75 feet fro~ nearest well Cesspool "Center" mast be 12 feet minim,,,a distance from nearest water line Cesspool "Center" must be 15 feet fro~ house foundation Cesspool exterior must be ~0 feet mini~u~ distance from surface Waters, Strea~s, Lakes & Bays, etc. Cesspools must be 20 feet mi~w~,, 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 msximem of 2 feet Bottom of Cesspool to ground weter must be held to mi~..,n of 1 foot TOWN O.F SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ^pp,co.o. No, .............. Disapproved o/c ............................................................................................ (Building Inspector) a. This Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises dr public streets or areas, and giving a detailed description of layout ofpraperty 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 tl~ 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 C~rtificate of Occupancy shall have been granted by the Building Inspector. ' iNSTRUCTiONS application must be completely filled Jn by typewriter or ~n ink and submitted in duplicate fo the Building 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. "' ................. -'7'"' State whether applicant is owner, les;see, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .....~.~.~.! ........................................ ~.... ........................................................................... If applicant is a co~)orate, signature of duly authorized officer. /(Name and title of corporate officer) land on which praposed work will be cjon;. Map No.: .~..~ ...~.....~....~....,. Lot No ..... ..?.... .............. 1.StreetLocati°nand°f Number ..~.~...~'.~..~/',~...~....~..~.../0/7/~) ...................................... "~'"'~'/~"'?~l~[e('L"';"; ...... ~ ............... 2. State existing use and gccupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..~....~J~....~.. / .................... 3. Nature of work (check which applicable): New Building ...... ..,/... ..... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition ................. J Other Work (Describe) ........................................ 4. Estimated Cost ............................................................ Fee .......................................................................................... (to be paid on tiling this application) 5. If dwelling, number of dwelling units .......... '/.i...'......' ....... 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 ~/~ ''/ Height ...../..~. .......... Number of Stories ........ ./. ............................................................. 9. Size of lot: Front ..... ./.~...~..~. ............ Rear ..../..~.. ....................... Depth ...~..~...~. ................... 10. Date of Purchase ..... ~ ....... ~..~ ......... : ................ Name of Former Owner ~',',~....~.,...~Z~..~./~.../~'....~.~'...~.~.. ! 1. Zone or use distriet ~n which premises are situated ........... ...~...~...'~. ............................................. 12. DOes proposed construction violate any zoning law, ordinance or regulation? ......~..~.. ...... '.;';.; ...................... 13. Name of OwnEr of premise~'"~"~"'~"~""~'"~'~'"~'~'"/' '~"~"'~ddres~"~."/~'""' ..,~_.'~~'~'''~'''''..5.... ./..~...~.. ~ Phone No. ~.~...~.~..~'....~. Name of Arch tact ...................................... Address ....................................... Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate al set-back d mens ons from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner 10t. STATE OF NEW YORK, t c,S X~'~/[~''~ ~ .............--~,~me~.,~ ..................................... being duly sw0'rn, deposes and says that he is the applicant (l~im of ' d'v'dual signing,~.~ - --., .,/J.~-- __ .~ _~ap~-Iicati°n) .... above named: He is .the ....... ,,~~,~-d~. ,4~,,,,~",~,,.~, ,,~,,,,~,,,~,~,,,,'~,,,,,,~,,,,~,,,,,~,,,,~,,,,~,,, ,,,~,,,,~,,,,~, ,~,,, ............................ ;,,. /' (Contractor, agent, corparafe officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will, be performed in the'manher set forth in the applicdHon filed therewith. Swam to before/me this , .............. of ........... ,, JUDITH T. BOGEN Notae/ Public, State of New York No. 52-0344963 Suffolk County ommission Expires March 30, 19~ I~OB~ NO. s TOWN OF SOUTHOLD Building Depedmom Tm Cle~s Office SMMioM, H. Y. ~97~ APPLICATION FOR CERTIFICATE OF OCCUPANCY Ind~tiMIS 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 oil 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 o 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 ~ .00 Date ~ ............................. New Building ....... ~ ..... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ~ Owner Or Owners Of ........................................... F ....................................... Subdivision ..... ~.~../...~..'~...~..~. ...................... Lot No......~..... Block No ............. House No ............. Permit ~o..~C~ Dote Of Pe~Jt (.~ ............ Applioant H~alth Dapt. Approval ............................................ Lobar Dapt. Appreval ................................................ ~nderwriters A~proval ....... ~ ................................ Planning Board A~pro~ol ........................................ ~equest For Temporo~ Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ...,.~,~.,c~...~ ................. Construction on above described building and per/p~/t meets//ell,,,gpplicable codes and regulations. Applicant '*"~'~'~~~~":'"-~"~ / "~ ........................... Sworn to before me t~is //.~' ~ (stamp or seal) ................ day of ............................................ Notary Public .................................... County ~o..~ 7 7_ ~'~'-'---~' "'~IF:FOI.'K COUNTY [.-]EALT[-] DEPARTNENT '" DATE FEB 7 1973 .. ~. ~EZ. #_'~-//-~"~ The sewage disposal and water supply facilities for this location have been inspected by this de~~ ~and found to be satisfactory. Chief of General Engineerin~ Services ~1.(~)~v -% NOTE: B= MONUMENT SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON JUNE E, 1972 AS FILE N0.5723. REVISIONS YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W, YOUNG HOWARD W. YOUNG .SURVEY FOR: CLAUSEN CONSTRUCT~ SUFFOLK CO., N.Y. ~ . aCALE: '" ''0' I DATE:0CT. 24, 19~~ ~2~25 /2 ,I RIGHT SIDE ELEVATION 7 LEFT SI. DE ELEVAT~N REAR ELEVATION I I FRONT ELEVATION SINK I~ REF'G. KITCHEN WALL CABINET ROOF PLOT PLAN RANGE WALL ELEVATIONS GENERAL NOTES SECTION C-G, EAM ,DETAIL. PATti ~C~ ~',~' ~_~ ....... ; ~ ~ ,~ STORAGE ~._~...~..~.~ , ~, ,, ,, , ,~. ~ ~ ' , ' ' /t FAMILY~M.~LIVlNG ~M. o BED R . . ' ~ x , ' ,., - _, ~,l -.. x .> / __. · ~- - ~ I ' ~, I~ ~ -~ ~ ~ , I , / ~ . . . .. ':. ~ ,, t .~ ! ' ~' , .~ ~ DINE ' ~....,,..~..x ~,~ .~.~ x ...... ~ ., - II ¢ !1J ~ ~BED RM. 0 BED RM. t 0 PLAN FLOOR DESIGN - 554 SHEET-2 PLAN - I TOTAL-:~ SECTION "A" WALL SECTION STAIR SECTION II BASEMENT PL A'N ~,L'' DESIGN - 554 SH£ET-~ PLAN - I TOTAL-S