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Home My WebLink About6041-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..2~ ~ ??-.~.9 .... Date F~;BRUAR ~ 2.2 19.8.4 NEW DWELLING ~ THIS CERTIFIES that the building ................................................ Location of Property . .1.6.Q~. MIDDLETON RD.. GREENFORT House No. ' ................. Street Hamlet County Tax Map No. 1000 Section 0.4 1 .... Block 2. .Lot ' 1 3.1 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated · .AU G.U~.~..2 .......... ,19 .7.2. pursuant to which Building Permit No. 6041 Z -dated . .A U G.U.S.T...2 ................. 19 .7 .2., was issued, and conforms to ali of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ..~o~..~ ................... q N~ O~ FAMILY DWELLI.N ............................................ The cartificate is issued to F.~A~J.K A. & MA.RG.A.R..ET A. FIELD (owner, lessee or tenant) of thc aforesaid building. Suffolk County Department of Health Approval S O- 1141 UNDERWRITERS CERTIFICATENO .......................................... N3S.6553 ...... Building Inspector Rev. 1/81 FO~,M 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. 60 1 Z Permission is hereby granted to: · .. i~enk..&..i~e~ret..-F~l~ ....................... .......... ~t~""~'~l:~ii~if ' 1¢~ ...................................... ............. ~'~:~'i'~;~'~ '""i~';'~ '; ............................... ~o .~l..~e~..ene .. ~'~:~f...d~e.~14~ ~. .................................................................................... at premises located at :....j~..F,~J:dde~_~n..iiea~..Ex~;. ............................................................... ................................................ e~et~c~l~....~¥'~ ............................................................................ pursuont to Gpplicotion doted ........................... ~1;2g""'? ............. , 19.~.., Qnd opproYed by the Building Inspector. Fee ~1~,9~. ............ FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY · instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tot 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 installa- tions, 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-exist_i~n.g" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 _/ 2. Certificate of occupancy on pre-existing dwelling ~r land use * 1~/$5.00 3. Copy of certificate of occupancy $I.00 Date .... : New Building Old or Pre-existing Building(Z) House No. Street Ham/et Owner or Owners of Property /'..-?~,-/V'I~', .~,..../(..~._ ~(~._.. . ~E ~ ~./~-~.~ CounW Tax Uap No 1000 Se~ion Block ........... .. . . . , ...... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No... ~.~/~ Date of Permit ~./~ ~plicant .,...C~ ~.~. ....... Hnda~riters ~proval .... ~. * q 9. ~5.~. .Planning Board A~roval - R~ua~ for Tam~ore~ Car~ea~ ..................... Final Ca~ifjeate ........ - ......... ' . ...................... . TOWN OF SOUTHOLD ~'//" ,~ Exam,ned ....... ~ ...... ...~ .......... , 19 ........ / . Appl,c~t~on No ................................. ~p~v~ .., ..................................... , 19 ........ Pemit No..~.~...t ...................... L. ~, ~ ~ ~ ~ ~. Z ..................... · . ~ '~"~:'~:'~ ~ * ~/~o ~~ ~LIC~TION f01 BUILDIN~ ~I~IT a. ' This o~lication must be completely filled in by ~pewriter or in ink and submitted in dupli~te to the Buildir Inspector. b. Plot plan showing I~ation of lot and of buildings ~ premises, relationship to adjoining premises or publ~ stree~ o~ areas, and giving a detailed de~ription of layout ofpr~e~ must be drawn on the diagram which is ~ of this applicati~.' c. The work covered by this application may not be comme~ before issuance of Building Permit. d. Upon approval of this application, ~e Building Inspector will issue a Building Permit ~0 the ~licant. ~h permit shall be kept ~ the premises available for insp~ion thr~ghout the progress of the work.. e. No building shall be ~cupied or u~d Jn Whole or in part for any pu~ose whatever until a Ce~ificate of ~cu~ncy ~- shall have been granted by the Building Insp~tor. 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, S~folk 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 cede, housing code, and regulations. ~-,~ e,,~.,~ ,~Z~ , .~-,-~,n~,, ~,~.,... ~---~...~ ..'~ .~......:,......:.: ................. : ............. ~/~'~-,-..~2, ~"~ -- 6~ ~,~'Z~ ~re of a~c'~ant, or name, ,, a corporat.on, / (AddreSs of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. --.Ng_me of owne~ of pram,sas ..F~.-. ................~- .....~......~.X~.~., .'~. ............ ~.. ...... ..~.....~......,~.. ........................ ~N~ If applicant is a corporate, signature of duly authorized officer. ~ .................. ii;i~;";~;J"~i~'~;"~;F~';~;~';~'~;"~¥ii~;;i ......... ~. I. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ................. .~.. Street and Number ...... .~./.~..~.~.`~g.;Z.~A/..~...~.n~..~...~....~.~..~[c~i.~i~i~¢~ ............ ..~,~' 2. State existing use and occupancy of premises and inte ded use and occ_~_ncy of proposed conShuction: ~1~ , a. Exisiting use and occuPancy .................... ~......~.....~...~...l~... ........................................................................... ..--..-.~V b. Intended use and occupancy ............ ~ ........................................................................................ ~ ............ Nature of work (check which applicable): New Building .................. Addition .................. Alteration ................. ~ Repair ................. .~emoval ..................Demolition .................. Other Work (Describe) ........................................ Estimated Cost ......~.....~..~.x...~.~..~. ................................. Fee ..................................................................................... '. .... (to be paid on filing this application) If dwelling, number of dwelling units .......... .~'.. .............. Number of dwelling units on each floor ......... Z .............. If garage, number of cars ~ If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 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 ............ ./Z../. .................. Rear ....... ..~../. ................ Depth ......?.. ............... Height .................... Number of Stories ............... ~.. ................................................................................................... Size of lot: Front ...... .~..~.../. ......... Rear ......... ..~..?...~.'~.. .............. Depth ......... ..~..../..~... ............ Date of Purchase ....~.~..~...~.../~......../..~....../...~'..~....Z:.....Name of Former Owner ....~t~.~.....~..,.....~.../...~.....~.. ....................... Zone or use district in which premises are situated .................. ~/~ .............................................................................. Does proposed construction violate any zoning law, ordinance or regulation? ~ gl Name of Owner of premises .~.~.~...~.~'~e-//J~..~....~./A~ss - .~.....~.?.?.£~.~..~..~...~.~..~...~.~.,~Phone No.~.?..?..-..~..~.~....z: Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ........ -,~~ ...................... Address ............................................ Phone No ..................... 3. 4. 5. 6. 7. 10. 11. 12. 13. 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., 11 ..... ....... - I · 2//'; ?¢ STATE OF NEW.,...,vO]~,,/,,. ' S S .COUNTY OF .~ ......... .f ' . .............................. ~.f......~..~.C...~..~..~. ................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the .................................. ~ .......... ~~ ........................................................ ~ ....... (Contractor, agent, corporate officer, etc.) of.said owner or owners, and is duly authorized to perform or have performed the said work and to make a~d 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 application filed therewith. Swam to before me this . -~ .//~/ .................. · ~.... day of .......... ~....,~., 19..~-~- /'~ / /~ Cf' "; ...... . .............. ....................................... Notary Public~~...~.....~ounty (Signature of applicant) (.,/ )UDITH T. ~OKBN ~ Suffolk Coun~,~ V, orch 30, 19.~'~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY [~ 85 JOHN NEW NEW YORK 10038 STREET. YORK, THIS CE~IFIES THAT Frank Fie[d, s/e/ end of M ddletoa Road, in the follmving location; [] Basement [] Ist FI. [] 2nd Fl. Section Block Lot w.sexamlnedon JU~y3L, 1978 andfoundtobelncompliancewiththerequirementsofthi#Board. DRYERS FURNACE MOTORS FUTURE AF~JANC$ I~EDERS A~T. K.W. O1[ H.P. GA~ H.P. AMT. NO. A.W.G. RANGES ' SPECIAL REC'ET SERVla~ DISCONNECT I NO. Of I S METER AMT' ~V~P' WEE EQUIP 1'~2W 1~'$W 3~'3W 3'1~4W NO'OF*~'CCA'COt40' i 200 CB ' x OTHEE APPARATUS: R V I C EXHAUST FANS DIMMERS · - 3 / 0 i GFI 1,4.65kw. hot water Mt.Frank Field Hiddletoa Rd. 11944 Per 11 This certificate must not be altered in any manner;, return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. ~. 75 ',¢8")0."z.:. .~ ioo.o v-",'plo3~e . SUFFOLK COUNTY DEPARTMENT OF HEALTH APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date~ ~ Approval to construct said systems is requested,pertinent data herewith: !j ~ H.D.Reference No~ //?/ 1-Applicant ~D~ ~ ~- ~' ¢C ~3 ~ .Phone72 ~Y~k6-BUb div Address ,Z~' ~0¢~. ~¢~ $$~t~ ~ ~.~(, 7-Section 2-Detailed property locatzon' ~0~ ~¢,&~ (~,~)8-Lot No.~ ~mlet To~ ~ ~ C d 0 9-Private well? ~' 0 3-~blic ~ter supply name ~ ~ $~ Distance to nearest ~in ~ ~ 4-~t Size: Width~ ft. Length2~' ftJ (also enter on center plot plan below:) 5-~elti~: Single Family ~ T~ Family? ~ /Cellar? ~ /~lab? ; ~ Crawl S~ce? ~ 10-Pro~s~ system: Septic {ank ~Precast ~Cess~ols / /Shallow ~ols ~Other~ il-Septic ~ inside dimensions~ol~ef~O Gals.Length ft. Width ft. Liquid depth ft. 12-Precast sections: / /Number~Square Ft. Cesspools: Block sizeL incs.D ins.~ins. Total blocks below inlet: PLOT PLAN The Undersigned CERTIFIES: Ta~ .Grade G ,W.L. Capacity Gals. --~ G.P.M. Data Feet ~ 0 2 ~ 6 ~ 8 12 1¥ No~th "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendm~7 thereto, covering Private Sewag~ Disposal ~ystems"./ ~/ ~) 6Wrier 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 ~Z ~>'U" Signed ~ (10165 Revis.) S-15 APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMB INSTRUCTIONS: Applications must be submitted in triplicate 1-Means Owner or Builder. Address to wfiich mail should be directed. 2-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 Public 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 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 & Was.t, 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 lines of the heavy lined square in the center of Plot Plan shown 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 aIso. 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 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-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 feet Bottom of Cesspool to ground water must be held to minimum of I foot lqo, 1£75870 't /,1.'73 '~8 '.'O ~£. ~ 100.0