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Home My WebLink About6056-zFORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at . ~B~gBIm$$111 .D~' ........... Street Map No..R~. r~. ~,~11,. l~l~ck No ........... Lot No..'.~. ..... [30.G~ld ~ ~[,Xe .'i.... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... A~lg..¶0 .... , 19. ~ pursuant to which Building Permit No...~1~ dated ............ ~....~.0., 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 . .~R.~T$.~.~...~..~..~...~.1~..d.~..]~].~g. ' . The certificate is issued to ...li~.~..0~... of the aforesaid building. Suffolk County Department of Heaith Approval (owner, lessee or tenant) UNDERWRITERS CERTIFICATE No.. ~..~1~.,~..... ~ '~. la .1~. ..................... HOUSE N UM BER...1.0~ ...... Street... ~'~[1..~. ~ ' Buildin. g Inspector FOIIM 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) N? 6056 Z Permission is hereby granted to: ....... :.. ~-~tch~tme ................................................ to ...~u~;l~..n~.,~..£m~:~..d~l:l~x~ .................................................................................. at premises located at ..... ~t...~ .......Ear. be~..;~Lgi~ts,..E~. ....................................................... .............................................. ~rigan~_~ ~..g~ ........... ~c~tko:L¢ ................................................... pursuant to application dated .......................~i,~.....%0. ............... , 19..'~., and approved by the Building Inspector. Fee $., ~[q~ ~0~ ......... SUFFOLK COUNTY DEPARTMENT OF NEALTN . EASTERN DISTRICT,RIVERitEAD,N.Y. H.D. Reference No.~ APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEFa$ Approval to construct said systems is requeste~,pertinent data herewith: 1-Applicant , ~ ,Pho-e~J~ 6-Sub ~iv~~ Address o ' ~ ~ ~-7-~ ?-Sec%ion 2-Detailed prope~t~ y l~c&tion ~ ~ ¢-~---~ $-~ot No. ~-~ 'j '~ ~ 9-Private well? 3-Public water supply name Distance to nearest main k-Lot size~ Length~;~g ft. ,~idth /~ ft. (Also enter on center plot plan below.') lO-Proposed system. Septic tank/.~./Precas, t/~-/Oesspools~__/$hallow, peols/ /other/ / il-Septic tank inside dimensions:~lame~ Gals.Length Fi.Width_ ft. Liquid depth ft. PLOT PLAN Street Ind :ate No %h Test Hole Data IFeet 0 2 10 16 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 FCR HEALTH DEP~T~NT USE ONLY. Based on the information presented ~'erewith,it is the opinion of~the Health Department,that an adequate and satisfactory Sewage Disposal System can be installed on this Plot. Date ~ ~-~ Signed ~ -- ~ __ 10/65 East AP.PLICATION FOR APPROVAL TO 'CONSTruCT' pRIVATE ~EWAGE DI~POSAL SYSTEMS I~'A'~uCTIONS: Applications must be submitte~ in triplicate 1-Means O~ner or Builder. Address to ~_ich mail should be directed. 2-Means detailed description of Property location, together with street name and distance to nearest intersection of ~ain therofare, also Hamlet/Village & Township 3-Enter name of Public Water Supply District, together with the distance to their main. ~-Enter Lengt~. and Width of Lot under a~propriate heading, also enter these dimensions on center plot plan shown on the face of this application. 5-Dwellings: Check-mark m/. items applicable to the propose~ new dwelling. 6-Name of sub-division ?-Section Number 9-Private well~i Enter ~No~ if Public water supply is available. Enter "Yes" otherwise. P~0POSED SYSTEMS: Answers to Items number 10, ii, & 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 PIOT 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~m on face of this application. Surface waters-Streams, Lakes, & ,,Bays, etc., located within a distance of 50 feet of Applicant's Lot lines, must ~ 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 m/acant" on the plot plan. Streets adjoining applicant's lot to the right, left or rear, enter street namee WELL ~OCATION: 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-2~ feet minimum distance from rear, and rear sides of property lines Well-10 feet mi~_immm distance from front, and front sides of property lines Well.50 feet minimum below grade for well point Well-40' feet ~m~n~ 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 fe~$~.~.~ nearest well Cesspool "Center" must be 12 fe~$~.~!~ce from nearest water line Cesspool "Center~ must be 15 feet Cesspool exterior must be 50 _feet minimum distance from surface Waters, Streams, Lakes & Bays~ ,etc. . ~; f~! ,~,~ Cesspo°is must be 20 feet mi~di~'~a~e ~ ~ge trees Cesspool center to Cesspool center must be at leas~ 16 feet Cesspool cover top to grade mus~l~ ~.eld,~,t~.,minimum of 1 food to maxiamm of 2 feet Bottom of Cesspool to ground wat~r~e~d~d to minimum of 1 foot ~0~,~ ~TO. I ~/~'~ , TOWN o:: SOUTNOLD BUILDING DEPARTMENT S~THOLD, N. Y. .... .............. , ................ ' ' .............. ~ D,t, [ 0 . , ............ ' ' INSTRUCTIONS a. This application must be completely fill~ in by ~pewriter or in ink and submitted in Inspector. ~ ~.~ ~ ' ~ b. Plot plan showing location of lot and of buildings ~ premises, relationship to adjoining premises or public stre~ or areas, and giving a detailed de~ription of layout ofprope~ must be drawn on the diagram which is c. ~e work covered by this application may n~ be comme~ed before issuance of Building Permit. d. Upon approval of this application, ~e Building lnsp~tor will issue a Building Permit shall be kept on the premises available for in~ection thr~ghout the progre~ of the work. e. No building shall be ~cupied or u~d in whole or in pa~ for any pu~ose ~h~t~ver until a Ce~ificate of ~cupancy 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 Lows, Ordinances or Regulations, for the construction of buildings, addltior~s or alterations, or for remowl or demolition, as herein described. The applicant agrees to comply web oil applicable lows, ordinances, building code, housing code, and regulations, ......... (S'gnature o'~fapplicant, or name, if a corporation) (Address of a~plicont) State whether applicant i~ owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..~/.~....~ ................................................................... ' ......................... If applicant is a corporate,~gnature of duly authorized officer. title of corporate o 1. Location of land on wh,c~P~Opased w,ork w be done Map 1~ . ~.~../..~.~.. Lot Nc> Municipality .................. 2. State exisHng use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy .......... .~..~..,~.J..'~... ................................................... b. Intended u% }and occupancy ............. ~.. .......................................................... 2 ............ ............. 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 ~ C6J1~' · 6. if business, commercial or m/xed 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 e.nhre new construchon: Front .. ~..~.. · · Rear ..... ~ J~-~fk ~' Height ....../..~'...: ..... Number of Stories ...... ./.. ....... ' .... ::::::::::::::::::::::: ======================== / 9. Size of lot: Front ......... ./..~g. .......... Rear ............. ~..~2..~ .......... Depth ....... .~...o...~..: .............. 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 11. Zone or use district Jn which premises are situated .................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation.> ................ ,~(~.~. .............. 13. Name of Owner of premises ~-~-...~..~.Address ............................................ Phone No ..................... Name of Architect ...................................................... Address .................................... Phone No ..................... Name of Contractor ..~.~'~.4~...~4~.~(-v'~,Address .~......5~............~.....~(,/~... Phone No.~....~'...~..~..~o PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ~all set-b~ck dimensions from properly lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. Notary Public, State of New York Ne. 52.0344963 Suffolk County Commission Expires March 30, STATE OF NEW,~D~,~o.,~ 1S S ........................... ~, .~...-.,~-:-.~ ~ ~. ,being duly sworn, deposes and soys that he is the applicant (NamcYof indi i~l signing application) ' ' ' above named. He is the ~/ .............. '~'~ (Contractor, ;;~.~t, ;;;~;;;;;;;; ;ffi~';'~/';;~;;i .......... of said owner or owners, and is duly authorized to perform or hove 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; end tha~ the work will be performed in the manner set forth in the application filed therewith. /'~' ,,~ ~ ~_~ _ . Swam to before me this .................. of ...... Notary Pub c,~, jUDiTH T-~'.' 'B~ E~N · ~ Coun ........................... :~ ~ ' ~ Z~/;..'-' '-' '-' L*~' ............................. ............... ........... .... Z. o'g 7'7 .T----- ~' THE NEW YORK BOARD OF FIRE UNDERWRITERS' ak BUREAU OF ELECTRICITY ~-' 85 JOHN STREET, NEW YORK, NEW YORK 1003B D~'. December 12, 1972 .4.,,.,..... ~,,.,,.m. 606~66 N' ~iS C~IFIES THAT onJ~ the ele~t~a~ equipment ~ ~crt~ ~ and intr~uc~ by t~ ~ppllr~ ~m~ on ~ ~ ~ ~a~ld Cochrane, e/side Briggantine Rd., 300' e/o Ancho~ :' Sou~hold, L.I. ~...p~..4,~~ 'Dece~er 7, 1972 FIXTURES EA~ES ~KI~ SWITCHES ffLUOR~CENT --~ -- 27 19 26:. ~ 1~ 11.9, ~Fu~nace: Oil 1-1/8hp. Mo~oz'/s: 1-1/2hp .o. or ~fc~ A w o 1-1/12hp UNIT HIATERS MIJ4,TI-OUTLET SYSTEMS Th(t'~'ertNjC~ ~ust not be altered in any mon~r; return to the office of the ~ard ~ in.rrm. I~ ~y ~ J ~ ~ ~ '-. ~ F~ ~' ~ ~, ~ ¥ ,~:o'