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Home My WebLink About6059-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~)l ~ ...... Date ......... llovember. · .28 .... , 19.72. THIS CERTIFIES that the building located at . ~,th. Df. ire. l~o~,th ....... Street Map No.(loose .Nel~]l; Block No ........... Lot No..~r~v .617..-8out,hOld...N ,Y., .... conforms substantially to the Application for Building Permit heretofore filed, in this office dated ......... Att~ "'10"" 1972' pursuant to which Building Permit No. dated .......... Allgua~ ' '10" 19F2" was issued, and conforms to ail of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .Private. one. fmnily, dnt.l.~r~g ...................................... The certificate is issued to . Leo. Raueh .......... (hrne~ ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. Nov.. ~.. 1~2-. b~ .It...V~,ll&. · · · UNDERWRITERS CERTIFICATE No...N~V. 6~ ' 1~2 .by. J,. l[ubaek~. ................. HOUSE NUMBER...~8~ ...... Street. I~h. D.F .~olt'~0h ............................... Building Inspector ~7 FOF, M NO. 2 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. 6059 Z Date ................ Aq.....1.(~ ...................... , 19..~A. Permission is hereby granted to: ................. 8-~t~t~ ........................................... to ..~milct ..new...eae..J:amtl~.. ~tw$1;l.~z~ .................................... , .............................................. at premises located at ....... ~'~,"t~(~'~'~"~ .............. Ouo~'e"~e~l~"~s't;at;o~' ......................... ........................................ ~$tb..D.z,~,,e,e..~ertk ................ .~eut~l~ ........................................... pursuant to application doted ................... ~,~1.~'~ ......... '~'0 ....... , 19r~..., and approved by the Building Inspector. Fee $.~ .~,~0 ........... SUFFOLK COUNTY DEPARTMENT OF HEALTH APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM Address ~v~ I~15 ~ou-/'lJo~- /) 6[ Section 2. Property location ~_t~lT]4 ~i~, A,/ 7. Lot No. ~'5~ ~gct~ ~}~ ' 8. Private yell ~ Village3o~ ~7~D Township ~ o~/4OA~ 9. Public water 3. Public Water Company ~ame ~ Distance to main 4. Lot size: Width /a.%' feet Length /~ feet (Enter on center plot below) 10. Sewase Dispos~stem: A. /90~sallon septic tank: Precast ~Equiwalent Block B. ~achinE pools: Number ~ Precast~Block Special If private well fill in blanks below: Tank capacity~Gals. Pump G.P.M, ~ Total well depth~ Depth to G.W. ~ Amount of wat§r in well ~ O' Test Hole Data Feet $-, 0 6 8 10 12 14 16 18 The undersigned ERTIFIES: "Construction of autho~ be in accordance with the Suffolk County Departmen~ of Health's current stand- ards ,here,o," {~ 2~~ I ' I 0w~r or Builder installations will FOR HEALTH DEPARTMENT USE ONLY. Based oD the information presented herewith, it is the op'inion of the ~ealth Department, that an adequate and satisfactory Sewage Disposal System can be installed on this plot. Date ~/d/~ ~ Signed S-15 Revised 4/1/72 APPLICATION. FOR APPROVAL TO CONSTRUCT PRIVATE S~AGE DISPOSAL SYSTEMS INSTRUCTIONS: Applications must be submitted in triplicate 1-Means O~ner or Buil.der. Address to which mail should be directed. 2-Means detailed description of property location, together with street name and distance to nearest intersection of main thoroughfare, also Hamlet/Village & Township. 3-Enter name of Public Water Supply District, together with the distance to their main. 4-~ter Length and Width of Lot under appropriate heading, also enter these dimensions on center plot plan shown on the face of this application. 5-Name of subdivision. 6-Section number. 7-Lot number. 8-Private well: Enter "No" if Public water supply is available. Enter 'Wes" otherwise. 9-Public water: Enter "Yes" if Public water supply is available. ~ter '~o', otherwise. P.ROPOSED SYSTEMS: Answer to Item number 10, consult the Suffolk County Health Department's Standards for Sewage And Waste Disposal Systems Design of Residential Subsurface Sewage Disposal Facilities. Part I-Residential Subsurface Disposal Systems covering cesspools. PL~)T PLAN: The following information is required concerning the Applicant's lot: 1. 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. 2. Surface waters-Streams, Lakes, & Bays, etc., located within a distance of 100 feet of Applicant's lot lines, must be shown on the plot plan also. 3. 'Jells and cesspools now on adjacent lots must be shown on the plot plan, together with the distance to the Applicant's proposed Sewage Disposal Systems and well. 4. ~Jhere no buildings exist on adjacent lots, state "~Vacant" .on 'the plot plan. 5. 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. ~ell- 25 feet distance from rear and rear sides of property lines when possible. Well- 10 feet distance from front, and front sides of property lines when possible. Well- 50 feet minimum below grade for well point. Well- 40 feet minimum into ground water for well point. ~ell- 4 feet 6 inches mini,mm below grade to Well head and lateral water pipe. CESSPOOL LOCATION: Upon determination of the Sewage & Waste Disposal "t~ of systems" re- quired, the following Standards must be observed for the location of same: 1-Cesspool- 5 feet minimum distance from lot lines to exterior of cesspool. 2-Cesspools exterior must be 1OO feet minimum distance from nearest well. 3-Septic tank exterior must be 75 feet from nearest well. 4-Cesspool exterior must be 7 feet minimum distanc~ from nearest water line. 5-Cesspool exterior must be 10 feet from house foundation4 6-Cesspool exterior must be 1OO feet minimum distance from surface waters, streams, lakes, & Bays, etc. 7-Cesspools must be 20 feet minimum distance from large trees. 8-Cesspool exterior to cesspool exterior, must be at least 8 feet. 2-Cesspool cover top to grade must be held to minimum of 1 foot to maximum of 2 feet. lO-Bottom of cesspool to ground water ,n~st be held to minimum of 2 feet. Disapproved a/c ............... ~ ....... ;.~ .................. -. TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~ ~ ~ ~" 19 ........ APPLICATION FOR BUILDING PERMIT ~.,~. .................... , 19 ............ INSTRUCTION$ a. This application must be completeJy filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, an~ giving a detailed description of layout of property must be drawn on diagram which is part of this application. c. The work covered by this application ma,/ 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 work. e. No building shall be occupied or used in whole or in part for an,/ purpose whatever until a Certificate of Occupancy shall have beer~ granted b,/ 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 Suffo[k Count,/, New York, and other applicable Laws, Ordinances or Regulations, for the construction o~ 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, and to admit authorized inspectors on premis,~a~and in buildings for necesser,/inspections., (Signature of applicant, or name, if a corporation) (Address of applicant) If applicant is a corporate, signature of duly authorized officer. ................ i. ..................... -/ 1 ~:r;;~;;dOfNl~ndmJrn wh~~rk will be done.~Ma~! ~,..,~..~;y~.. Lot N~) Municipality 2. State existing use and occupancy of premises and inte~_.~se and occupancy of proposed construction: a Existin ..... " ........ t fo-'- (- 3. Nature of work (check which applicable): New Building .......... ~ ....... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... ~ I Description) 4. Estimated Cost ..0.......?...*.....°......~ ............ 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, 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 ~ O ' .................................... Depth ........................ Height .......... ~ ..................................... Number of Stories ............... (. ........................................................................ · t 'Z..7... 9. Size of lot: Front ......... ~ ........................... Rear ........................................ ,,gDe~ot,h ..;; ............................................ 10. Date of Purchase ...~:/../..~..1....-~..~ ......... 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. Will lot be regraded ~ .............. Will excess fiil be r~moved from premise.s.~[[ ]AYes 14. Ne me of Owner of premiss '~r'?'" '~""~'"'"'~' '"' '~'"~"~'""~" "'~'i~"?-~'l~''~'''''T''''''~'''!'''~''~,~aare~ oneo.,. '~' Name of Architect ........ s.F.'.~.. ......... ~ ............. ~9. .................................................................................... .. ............... ...' lo ,-,"~ IT'""_ . _ w ~- (A~lress~--~. ~ ,I (P~one~,~ ~N°') ~ 5 ~ Name of Contractor ~ ...... ~.~~ ................. ~ ...................... .z~.~..~..~. ....... (Address) (Phone mo.l PLOT DIAGRAM kocate clearly and di~inctly all buildings, whether exi~ing or propo~d, and indicate all ~t-b~k dimensions from prope~ lines. Give ~met and block number or description ~cording to deed, and show ~reet names and indicate wheth- er interior or corner lot. STATE OF NE~~ ) COUNTY OF '"'?/YT/ .......................... ) ...................... : ................................................................................... being duly sworn, deposes and says that he is the applicant above named. {Name o£ individual signing contract} He is the ................................................................................................................................................................................................................. {Contractor, agent, corporate officer, etc.} of said owner or owners, and is duly...r,, ~T~o~auth°riz-e~'l~° perform or have performed the said work and to make and file this application; that all statements contained in this app catrFc~T~rd'~l~tRet,/~:~st of his knowledge and belief; and that the work will be performed in the man,er ............. .............. day of ....... 7- / /7 Nota~ ~oblic~. ............... ($igr~t~ra of app'~[eant} ............................... TOWN OF SOUI'HOLD Building Dq,a~lneet Town ¢le~J Office Sou~old, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPAN~Y Instmctiom 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 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 fram Beard of Fire Underwriters. 4. Commercial buildings, Ind,-trial 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. Swam statement of owner or previous owner as to use, occupancy and condition of bullding~ 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 Date ...... t .................................... New Building ........ ~ ........ Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property~/~.)./..~. hL ..........~....~.. ..... .~)... ............ ..~...6..?.~i..'~.. .... .Z..~...~....e-_/..~.. ....................................... ~'..: ~.. ~.~.~. ' Owner Or Owners Of Property ........ .~.~......~......~. .......... ...~.....~...~...~......~.... ........................................................... Subdivision ................................................................ Lot No~. ~.~./~...~'. Block No. ............ House No. ............ ;/Ty · . ............................ Permit Date Of Permit/... ............ App,cont . ................ H~alth Dept. Approval .~.~...~. ............................... Labor Dept. Approval ................................................ Underwriters Approval .~ .~....~.. .................................. Planning Board Appravol ........................................ Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ ....~.........~ ............... Construction on above described building ond~ .~n. ,t me~al, ~a~/cabl, codes and regulations. Applicant ...... ~......~..~...~ .................................................... Swam to before me this ....... ....... Notary Public %,~~~ TERRI CEE ELAK ~)TA~Y pUBLIC, State of Hew York No. 52-6168295 Qualified ~n Suffolk County Commission Expires March 30, FOBM NO. S TOWN OF SOUTHOLD BuiMing DelmK'ment Town Clerks Office SouthoJd, H. Y. 11971 APPLICA%TION FOR CERTIFICATE OF OCCUPANCY Instructions ' _fi_a.__/=- A. This application must be filled in typewriter OR ink, and submitted in ~e 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, ana 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. Commerci&l buildings, Industrial buildings, Multiple Residences and similar buildir~..s and installations, o certificate of Code compliance from the Architect or Engineer respons:ble for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing,buildings (prior to April 19.57), 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. Swor~ staf'ement of owner or previous owner as to us~, occupancy and condition of buildings.. 3. Date of any housing co¢~e~ or safety inspection of bui~lngs or premises, or other pertinent ,n- formation required to prepare.a certificate. C. Fees: \ 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre--ling or land use $5.00 3. Copy of certificate of accupanc~_$1.~ Date ..~.~. ...... Old or Pre-existing Building ............................ Vacant Land ............................ New Building ! Location Of Property ~r~Jm~&M4~¥..&~4~sf.~&~`~D~&v~.R~'~h~E~g~f~et~y~h~y~/~ the R~thea~te~lv. side ef NeJ#Jleyvle~ Reed /~ .... /__ ~..~.~ ~ Or ~ners ~ P~e~ ~ll..~..~.~:.: .................... ~,.-~.~ Su~ivision ...~.~.~ ............................ ~t No..~ ..... Bilk No ............. Hou~ No.~ ...... . Permit~7~l~l Hy J of 5 ~lth Drld b~h cant · ' · ~lth ~t. Appeal ......... ~ .......................... ~bor ~t. Appeal .......... ~ ................................. U~e~rite~ Appravol .......... ; ................................... Planning B~rd ~p~ol ........................................ Request For Tempam~ Ce~iflcate ........................................ Final Ce~ificate ......................................... Fee Submi~ $~ ................................. Constructi~ on above de~ri~d building and permit m~s all o~licable c~es a~ ~ul~i~s. ~plicant ......................................................................................................... Sworn to before me this ............... ~ day of ............................................ Notary Public .................................... County (stamp or seal) C/.O ./ ¸-i