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Home My WebLink About5728-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certific~le O[ Occupnncy THIS CERTIFIES that the building located at 3.~..'~ .... .~.~.~.. ~! .A?.E..A/... ~,~ .N ~'treet Map no.. ~ ~ !.0.... Block No....--r. ...... Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... .~.....~..~..~.-, 197..~. pursuant to which Building Permit No.~..7.~.~...~ dated ...........~....~...~..~..., 197..~, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to .......... .~)..~.~. !?...~.....W. ~.-.~..L..~. ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...~../. ?. ?..~-....'7.~....~....~. i .~...~.~..Q UND£RWRITER$ CERTIFICATE No... ~ Z 76 7 .ou$~ ~v~ .... .3~.~ .... Street ..... .~.P.~.. ~ ?.?..~.~ .... ~ ~.C .............. Building Inspector ~0~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: to .... ~12A..~e~..mm · ~m~l~lr..4tm~.~ ............................................................................... at premises located at ........... ~il~'~l .........~,~..][l~t~l~ ................................................................... Pursuan¢ to application dated ........................... ~ ...... ~1 ............... , 19~..., and approved by the Building Inspector. Fee $ .; .llll~e(l~l ......... Building Inspector FO~ NO. 6 TOWN OF SOUTHOLD Building Depmtment Town Clerks Office Southold, N. Y. 11971 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 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 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. New Building ..... '/; ............ Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ....... ~t,..~0~..,~'..~al~..~..J~...%t3~]~.~..~.~..~.t .......................................................... Owner Or Owners Of Property ......... ~'.~.~;~'~....~..:~. ................................................................................... Subdivision .... ..t~.~..~,Cl~..[~r~..~;~...~..~..~..~ ............... Lot No ....... ~.0... Block No ............. House No ............. Permit No....~--~.~; ....... Date Of Permit ..... ]./.91..:~...Applicant ~'il] ¢a~' ~fs]3~ Health Dept. Approvol ....... v.~] ............................... Lobor Dept. Approvol ................................................ Underwriters Approval ......... tT;~...~..~...{~....~.~.. ........ Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. ........ ..................................................... Sworn to before me t~j~s ...... /~4..... day of ..~.-f~ ..................... ...... (stamp or seal) FORM NO. 6 TOWN OF SOUTHOLD Building Deportment Town Clerk. Office Southold, N. Y. 11971 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 disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Ntultiple 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 19§7), 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. New Building ....3[, ............. Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ..... ~l~e.~)..~.~m~y.~.~.~.~.~.~.~.~.~.~e:~;[~,.~...~;. ........................................................... Owner Or Owners Of Property ....... h;~jZ, A~.ar~;.~ ..................................................................................... Subdivision ..3~..]Io,..2~ZI~.Be~r..~v~I~ ................ Lot No .....bO.... Block No ............. House No....~.....~....~. Permit No...~2~ ........ Dote Of Permit ....~/~.~2....,Applicant .... .~;i.3.].;La~..i~e~,.]~ ................................... Health Dept. Approval ..... ~ ................................ Labor Dept. Approval ................................................ Underwriters Approval ....... ~,~...~....7.~...~...~ ......... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ .......... .~...~ ....... Construction on above described building and permit meets all appli, cc~le codes and regulations. , Sworn to before me this ...... /~....~-day of ~~ ................ (stamp or seal) Notary Public ...,~...~ ..... Coun~ SUFFOLK COUNTY DEPARTHENT OF HEALTH .D. e erenoe No ¥ IHISAFPROVAL B FIRES APPLICATION ~R AP~AL TO ~NSTRUCT PR~ATE S~AGE DIS~SAL SYSTE~ Date ~ ~- /~/~ App~val to const~ct said systems is requested,pertinent data here~th: 1-Applicant /~/%D/D~ /~F~A~ ~hone~&~-27g~6-Sub div /~-~ Address ;~ ~ ~/F~ ~. F~ ~/4F~ .f~ ~ r~ ~ ~ c-~ ~-Section 2-Detailed pr6pe~y location ~V ~W~F ~r ~ 8-Lot No. ~o ~mlet C//~zp ~-, - ~ To~' .9-Private well? ~ 3-~blic ~ter supply ~me Distance to nearest ~in 4-Lot Size: Width/,~-ft. Length /R~--ft. (also enter on center plot plan below:) 5-~elli~: Single Family ~ r~ Family? ~Cellar? / /Slab? ~ ~ Crawl S~ce? /~ 10-Pro~s~ system: Septic tank ~ /Precast; /Cess~ols ~Shallow ~ols / /Other ~ 11-Septic ta~ inside dimensions: Vol~e Gals.Length ft. Width ft. Liquid depth ft. 12-Precast sections: / /Number/ /Sq~re Ft. Cesspools: Block sizeL/$incs.D ~ ~s.H~ns. Total blocks below inlet: ~1 ~2 ~3 ~-- /go ~3 ~c~ ~ ~T P~N Capacity~__~als. ~'ade i Data ~eet 0 2 4 6 8 10 12 16 1¥ ~,~ Street ~z~y ~/A ~/-~/~ 2'-~ /~k' ~ ~ ~ Ind~ :ate ~ ~ ~ No ,th The Undersigned CERT~S: "Const~ction of authorized installations will be in accordance with the Suffolk County Health De~rtments' current Standa~s, Bulletins, a~ amendments thereto, coverinE Private Se~ge Dis~sal Systems". FOR ~ALTH DEPART~NT USE ONLY. Bas~ on th~ infomation pregented herewith, it is the opinion of the Health De~ment, that an adeq~te and satisfacto~ S~ge Dis~sal System can be installed on this ~ot. Date Sign~ . ~ ( ~o/6~ ~evis. ) /~ s-15 APPLICATION FOR APPROVAL TO CONSTRUCT PRi~ATE SEWAGE DISPOSAL SYSTEMS INSTRUCTIONS: Applications must be submitted in triplicate i-Means Owner or Builder. 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 thorofare, also Hamlet/Village & Township 3-Enter name of Public Water Supply District, together with the distance to their main. 4-Enter Length and Width of Lot under appropriate heading, also enter these dimensions on center plot plan shown on the face of this application. 5-Dwellings: Check-mark "Va items applicable to the proposed new dwelling. 6-Name of sub-division 7-Section Number 8-Lot Number 9-Private well: Enter "No" if Public water supply is available. Enter "Yes" otherwise. 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 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 lines of the heavy lined square in the center of Plot Plan shown on face of this application. Surface wabers-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-100 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-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 1 food to maximum of 2 feet Bottom of Cesspool to ground water must be held to minimum of 1 foot L.o~- ~bO WIL L If~ttVI WELLS- AT' ,~ o e,' Tz-,' o z_ z:,. Al. ~ = ces~poo l 0 =~ll S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: at The .ge disposal facilities for a structure located (Give c~eed location)/ have been inspected by this department and found to be satisfactory. ~::~./~ ~/~,~ o* ~' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~~ ~ ~UTHOLD, N.Y. ......... , Ex, mined roved ....................... .............. , Disapproved ~/c ..~ ............................... ~ ............ APPLICATION FOR BUILDING PERMIT Date F/az'eh 6, 19..7..2. ....... INSTRUCTIONS o. 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 Building Permit. d. Upon ~appraval of this application, the Building inspector will issue a Building Permit to,the ~oplicant. Such perm t shall be kept on the premises available for inspection throughout the progress of the work. e. Ne:building shall be occupied or used in Whole or in part for any purpose whatever until a Certificate of Occupancy shag hove 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 Z,~me O~e of the Town of Southold, Suffolk COunty, New York, and other applicable Laws, Ordinances or P,~ula ~t~ for the ~tion 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 cede, and regulations. (Signature of applicanl~, or name, if a corporation) O~.n 1eater $ou'oholds N. [. *,~ (Address of applicant) State whether aPPlicant is owner, lessee, agent, arChitect, engineer, general contractor, electrician, plumber or builder. (ha er-Bo:Litter Name of owner of premises ....~.~..l~..~..a~.....~..e...l~...s. ...................................................................................................................... .~ If applicant is a corporate, signature of duly authorized officer. -'75---7'~ '~ (Name and titif~ of corp~'~at~' ~i~'r~ ......... ') 1. Location of land on which proposed work will be done. Map No.: ....... .2.~..1..Q ......................... Lot No.....Jf..O.. ................ Street and Number. ........... ~.e~....H.~,y.f~..~...B.g~....H./~y..e.[q~...~.~.u..~..~.~.d.j...~..~ ~.t ................................... ~ 0~' / Municipality 2. State existing use .ond occupancy of premises and intended use rind occupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................................................ b. Intended use and occupancy ]~.eB~Lcl. eut,~.al ha~e 3. 4. 5. 6. o 10. 11.. 12. 13. Nature of work (check which applicable): New Building ....... ..~ ........ AJ~dition .................. Alter_z.o,,ll .................. Repair .................. Removal Demolition .................. Other Work (Describe) .............--~.... ..................... Estimated Cost ..... .~..~.~ ~..0...0~......0..0. ................................... Fee ..... . .~....~.......~....O. .................................................................... (to be paid on filing this application) If dwelling, number of dwelling units .f..:....6...~....Number of dwelling units on each floor ............................ 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 ........... .~'~ ..................... Rear ........ ~.1~ .............. Depth ...2b,..&..20 ....... Height ....... .::],~! ....... Number af Stories ............... 1 ....... ~ ............................................................................................. Size of lot: Front ...... ..]~..~.1. .............. Rear ............. :~.~.~. ............... Depth ............. ~.1. .......... Date of Purchase ...... .].~,~7. ......................................... Name of Former Owner ....~,~..,1~&~,,OG.,~B%Gt, e ............... Zone or use district in which premises are situated ....... ..~..~;~.q~2.~,,~.~. ....................................................................... Does proposed constru~:tion violate any zoning law, ordinance or regulation.;> .......... ~.0. ............................................./~i i Name of Owner of premises ..~,].~.~.e~lt....9[.e,~],~t. ............. Address ..0'J~.~s..~ ...... Phone No....?.6~.-.22b~./F' Name of Architect ...................................................... Address Phone No. ....... .' Name of Contractor .....~.,~,~e~..~.e,,l~,~. .................... ,Address ............................................ Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions property lines. Give street and block number or description according to deed, and show street names and indi whether interior or comer lot. STATE OF NEW~YO~I~ ! S S COUNTY OF .....~..~z...~...o...~c.. .............. j- · ............................................................ ~....e ........ ~.~ ........ ,.....,..being duly sworn, deposes and says that he is the applicant (Name of individual signing applJcation) above named. He is the ........................... ~.e.~...-~...o..~.~.e:..o.~.o.?.. ............................................................................................. (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 and file this application; that all statements contained in this application are true ~'o the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth m the appl cat on f led therewith. Swam to before me this /~,,,/Z~.~` ~~ .......... .6.~. ....... day of ...... ~..~,-~ ........................... , 19...~.. Notary Public, .....~u....~...~ ..................... County .............................. i~i~l'~'~'~ '~'C~l~l~li~'~"~ ............................. THE NEW YORK BOARD OF FIRE UNDERWRITERS E~UREAU OF ELECTRICITY ak 85 JOHN STREET. NEW YORK. NEW YORK 10038 n.~. June 21 1972 ~pp.~..tlo.~'o.o. fUe 568094 N THIS CERTIFIE, L~ THAT only the elect r;c-~ ~qulpment as described below arid ~n~roduced by the appllcan~ named on the above applica£ion number William ~ells, e/side Bayhaven Lane, 247' s/o Main Bayview Rd. Sou thold,~. I. i~ theyollo~clng lo,'~iO~; ~e~e~t ~ ~t r~, ~ ~,~ r~. outs ide w~examinedon June j19, 1972 andfoundtobelncompliancewlththerequi ....... tsofthisBoard. FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS R I C AWG I~I I _, !05 ii- M~)tor/s: CB i 4 1-1/2hp Ford Electric Co., ~o Rowland Ave., n?_e Point, L.I. 11715 T',is c.,,,f ..... " o~ oe a!tsred - ~nv manper: ,eturn to the office of the Board if incorrect. Inspectors may be identified bv their creden;}als. ~ ,tJJ '0 7:-? 'i