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Home My WebLink About6039-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. CORBSC~gD Certificate Of Occupancy No. Z~300 ....... Date ........... J. uly.. 30 ....... , 19.7.3. THIS CERTIFIES that the building located at ~xl'®awater. s. Lane ........ Street Map No.0?'~.e.n.t...By. .t.~o~o ........... Lot No. 38 ...... Or:Lent.. ~.¥.. .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... ~,ug....1..., 1972.. pursuant to which Building Permit No.603~Z" dated ........... Aug .... .1 .... , 1972.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. Pr.~,v~.t.e. one..fa~nf~.y.d.~.e~Ll:l~ ..................................... The certificate is issued to .StoLla. l~_alfo~l:as ....... .~ne~ ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval July "2~' '197~' ' 'by' R~' ¥:J."Eh ..... UNDERWRITERS CERTIFICATE NoN ,09.7~1~8 ..... Jun~,. ~,~.. ~ .9.7.3 .............. HOUSE NUMBER ...8.~. ....... Street . .~. ,~..~.W.a.t.$..1'.~.,..L~._ ....................... FOBM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, Hi Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 6039 Z Permission is hereby granted fo: ............ ¢~'~'~i;~ .............................................. to "~"~'~r "6i~e'"f~f ~'j/" ~[~'f ~'~i4'~ ................................................................................... at premises Jocated at ....~;,...~ ....... Fj':d~"'7~'"~'~"~'~,"'~"~' .................................................... ........................................ ~l~'o ~wa~'~ ~"~" 1~ f~'~ .............. OY~ i~f,' .................................................... pursuant to application dated .......................~'?~.'C~' ....... T ........ , 19...~., and approved by the Building Inspector. Fee $~"~; ~0 ............ pE?3~IT iNCLUDES APPROVAL TO ~EMOVE EXCESS FILL FROM ABOVE PREMISES BY REGRADING LOT DRIVEWAY CONSTRUCTION CESSPOOL CONSi RuCTIChN CELLAR CONSTRUCTION OTHER Building I~or TOWN OF SOUTHOLD BulJdlng Department Town Clerks Office SouthoJd, iq. ¥, ~97~ 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 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 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 New Building ..... ..~.... ....... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property .......... .............................. Owner Or Owners Of Property ..I~.:.....~..~..,~.~-.~ .................................................. Subdivision .~~.~.~.~ ...... Lot No. ~..l!~.... Block No ............. House No ............. Permit No...~....~....~...~... Date Of Permit~.~,..4.Z~'~pplican, ~~......~....~.~ .................. Health Dept. Approval ....~.....~....~.././...~....~../. .............. Lobar Dept. Approval ................................................ Underwriters Approval ~......~...~....~.....~....~..~......: .......... Planning Board Approval ...~,,~. ............................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ......~..d.~.~. ............... Construction on above described building and permit meets all applicable codes and regulations. Applicant ~.~.......~....~ ............ .~..~:; ..~ ....... Notary Public .................................... County (stamp or seal) TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE MUT.OLD, ,. Y. Examined ......... ~....~ ......... L., 19.2.~ ,~ ...................... ............... , No. 3 Disapproved a/c ............ ]....~ ............ ~ .................................................................... ............ .... ................... ............................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building\ [ Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or 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 Bqilding 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 Occupancy~ shall have been granted by the Building Inspector. APPLIC^TION IS HEREBY MADE to the Building Department for the issuance of a Building Pe/mit 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 regulati~ (Signatu~ of applicant, or name, if a corporation) J; (Address of applicant) 6/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,' plumber or builder. If applicant is a corporate, signature of duly authorized officer. ;;~d title of leer) Location of land on which pr~gos~d work will be done. Mo~'~,, ................. Lot No..,,~,,,~,, ............... Street and Number .... ~-t,,-t,~,,~'...~-,-~.~S*~--~ ...............................................................................................~ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use ond occupancy ..... /~e~... ....................................................................................... '..[.~ff.. ....... b. Intended 3. Nature of work (check which applicable): New Building L ........ Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ........ ~:'~/.4~.. ................................... Fee ....~..~..:...~ ..................................................................... (to be paid on filing this applicatiOn) 5. If dwelling, number of dwelling units ......... ./.. ............... Number of dwelling un. its on each floo/'. ........................... 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 entJ~ new construction: Front ...... ~::7~.~ ................... Rear ......... ~..~. ......... Depth ..... ~ ........ ~.. Height ......... ../...~..... Number of Stories ... ~.. ............................................................... ............................ Rear ........ .~.....O~... .................. Depth ................................ 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. Name of Owner of premises ,~.~...~r...~~....Address~~ ./.~T~.~ff~. Phone No. ~'~'.....~../'....~...?~'~ Nome of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ~...~. ................. Address ~.~....~~... phone No...,~....'e'(..~/.~) PLOT D'AGP,~J~ Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b~ck dimensions from ~laral~rty lines. Give street and block number or description according to deed, and show street names and indicate -~,~er I~terior or comer lot. t STATE OF NEW,~VOR. I~_ ~. .................... ~...~~~...~ ............. being duly sworn, deposes ond says'tbet he is the opplicont (Nm of' d'vidual s~gning applicoti~ above named. He is the ................ ............ ~~ ..................................... '. ...................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duJf 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 manner set .forth;in the apj~lication filed therewith. Swam to before me this ..................... ........ .o,o .............. ........................ : .... SUFFOLK COL~TY DEPARTMENT OF ~ALTH H.D.Reference EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR API~D~AL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date Approval to construct said systems is requested,pertinent data herewith: Address ~~. ~.~z~-~ 7-Section ~ 2-Detailed property locatzon dP ' 8-Lot No. Hamlet O~ Town 9-Private well? 3-Public water sup@l~y name . Distance to nearest main 4-Lot Size: Width/~ ft. LgD~th ,,.v ft. (also enter o.n,.center plot plan below.') 5.Dwelling: Single Family ~_~ Tw~ Family? ; ;~]ellar? ~ Slab? ~ ~ Crawl Space? lO-Proposed system: Septic tank F~;Precas.t~Cesspools ~ /Shallow pools ~ ~Other /. / ll-~eptic tank-?Si.de .d, im_ensions.~olume %~als.Length.~ft. Width .ft. Liquid depth ft. 12-Precast sections. F~';Number~z~_~SqUare Ft. Cesspools. Block sizeL___incs.D___ins. H . .ins. Total blocks below inlet: ~1 ~2 ~3_.__ PIDT PLAN Street D~ta Feet ~'/~ ~'~' 0 ~ 8 I[ 18 The Undersigned CERTIFIES: "Construction of ,authorized installations will be in accordance with the Suffolk County Heal.t.h, Depar~ments~,%.current Standards, Bulletins, and amendments thereto, covering Pr~ivate Sewage Disposal Systgms". ~O~er ~'%~ - Builder FOR HEALTH DEPARTMENT USE ONLY. Ba on the information presented herewith, it is the opinion of the Health Department, that an adequate ~, satisfactory Sewage Disposal System can be installed on this Plot. .. (10/6~ Revis.) APPLICATION FOR APPROVAL TO CONSTBNCT PRIVATE SEWAGE DT.~POSAL ~YSTE~ INSTP~CTIONS: Applications must be submitted in triplicate 1-Means Owner or Builder. Address to ~hich mail should be directed. Z-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. ~-Dwellings: Check-mark "V" items applicable to the proposed new dwelling. 6-Name of sub-division ?-Section N~mber 8-Lot Number 9-Private well: Enter "No" if Public water supply is available. Enter "les" otherwise. PROPOSED SYSTEMB: 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 sh0~ 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-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-~O 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-l~ feet minimum distance from lot lines to center of cesspool Cesspools exterior must be lO~_f~_~.~.mum distance from nearest well Septic tank exterior must be ~"~est well Cesspool "Center" must be 12 feet mi'~'_~e from nearest water line Cesspool "Center" must be ~ Se.e.t from house foundation Cesspool exterior must be~$ ~t ~ ~iistance from surface Waters, Streams, Lakes & Bays, etc. "~ ~- ~ ~ ~ Cesspools must be 20 feet minimum distance frome~_arge ~rees Cesspool cover top to grade~%~~~minimum of 1 food to maximum of 2 feet Bottom of Cesspool to ground water .~eld to minimum of 1 foot · 3 tW. ,fflb °.¢"( '40" W: - I~.~. 0 q SO' 14 13 13 C)~/~/-/T' ~ NEA~Ttt DEPARTMEN2 fac~.i%ies Fe~ %hi~ !o~*~ have been ~h~9~ e~ ~eneral~nglneerin$ Service5 N *° "'~"h °f o,.i,,..,+ ~,~ +~ ~-...~+,'o, c f;laW ,'~ ¢-/~ Joffol~4 Co. ~1,','/,~,