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Home My WebLink About5731-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. ~'1~7~1~ Date ~ 19 1972 THIS CERTIFIES that the building located at .Cl.l~'~,~..&.~ .......... Street Map No.~i~$e~ ~ck No ........... Lot No.. ~ ..... ~..~.~, ......... conforms substanti~ly to ~e Application for B~lding Permit heretofore filed in this office dated .......... N~...~., 19 ~. p~su~t to which B~lding Permit ~o. ~.. dated ........... ~... ~., 19.~., was issue, ~d confo~s to all of ~e require- ments of the applicable provisions of the law. The occupancy for which thh ce~ificate is issu~ is ... ~t~..Qne. ~mi~ .dv~g ..................................... The ce~ficate is ~su~ to .... ~. A.~. . ~ ........................... of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant) · ~...?...lg.~... b~ .~,..~rixxa.. HOUSE N UM BER..~. 030. ...... Street ......C .1.~...a~.. ?.~..A..V.e ............................ PO~ NO. g 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) NV 5731 z Permission is hereby granted to: at premises located at ....Z,o~...&....~l,tJ~.~e~.d..:~il ................................................................... ............................................... ..q.s...,.~..,.?...~ ......... ~...~.~ .................................................... pursuant to application doted .......................... ~..~.~ ....... ~. ............ , 19...~., and approved by the Building Inspector. ~.'Zh- J;,]CLUDES APPROVAL 1'0 ;~c ~OVE EXCESS FILL FROM ABOVE PREMISES BY ,]~V~ ~/'-,Y CON TRUCTION --,~,',,,s CONS*RUCTION "£LLAR CGNSTRUCTION FORM NO. 6 TOWN OF $OUTHOLD Building Depor~ment 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 fines, 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 ~ u,,-,O~l or Pre-existing Building ................ .~... ~/V' ~' ~:: ::: ;.. ]:]]] ] ............ ,. ............... .x..... ............ Owner O r,~s Of~p~~~..~..7 ... ~(~'..~'~ .~....Z}..~ ............................................... Subdivisiol~...~..~..~__.'._Lot No ............. Block No.,.; .......... House No ............. PermtN~.~../z '"-teOfPerml'~.Z~.~...~''' A cant~'t/''~''y~11'/7''~ e/""~'O~¢'~' /~/~" Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ...~...~. .................... Construction on above described building on'permit meets all~'pplicobl~code~ and regulations. AppI eant ~.....~... ~.~.'~...~ ......... Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) FOBM NO. 6 TOWN OF SOUTHOLD Building Department 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 oil 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 ......k~............~OId or Pre-existing Building ................. ./~.....;/Vacant~Land ..~ ....................... ~nerO~~~ ............................................. Su~ivisi~~~....~.L~ No..Q ........ Block No ............. House No ............. Permit N~.~..~/~ ~Date Of Permit~/~.~.Applicant ~ ~.~...~.~...Z~.. Health Dept. Approval~...~../..~.Z.~...Labor ~pt. Approval Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .~...,...~.. ....................... Construction on above described building and/permit meets all~plicable code~s~ and regulations. Applicant ................ Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County S-9 SCHD SUFFOLK COUNTY DEPARTMENT Date Bldg. OF HEALTH Permit No. TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure (Give deed location) located have been inspected by this department and found to be satisfactory. - ' Service.~ Chief of General ~:g~n~e~' SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS D '<~/V~;'~ /- /~ )' -- Approval tn construct said systems is requested,pertinent data herewith: 2-Detailed. p'r6p~'r{y' %oe~tio'n~ ~_~']]]'"..~ ,~,'/~, _ 8-Lot No. ~ -- )-Publi~ '~ra~e-r-~pp~ly Jame~ ./'~/~.~ j ~,~2~,. ~-~' -~)lgt&h~e'to nearest main ~ g-Lot Size~ Width_/D~L£t. '~[n'g/8_~j~_~'i;---(also enter on center plot plan'be%~/:~-- - 5-Dwelling. Single Family ~,; Tw~ t~ily? / /Cellar~,Slab? ! /Crawl Space? / / 10-Proposed system: Septic ~ank I [Preeast ~4~/CesspooIs ~_~S.hallow pools / /Other [ il-Septic tank inside dimensions: Volume O&~s.Length ft. W~dth ft. Liquid depth ft. 12-Precast sections: / ~lNumber/ /Square Ft. Cesspools: Block sizeL incs.D insoH ins. Total blocks below inlet: ~1/~2 ~ ~3 PLOT PLAN Capacity~Gals. Street A The Undersigned CERTIFIES: accordance with the Suffolk County Health Departments' current Standards, and amendments thereto, covering Private Sewage Disposal Systems". ' ' - ~-'I~-_- ~ ' -Builder "Construction of authorized installatiN~t~ll~'-~ be in ; Bulleti ns, Data Feet 0 4 12 ~6 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 7/~/~-- (10/65 Revis.) Signed APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS INSTRUCTIONS: Applications must be submitted in triplicate 1-Means Owner 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 mmin thorofare, also Hamlet/Village & Township 3-Enter name of Publid 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 "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 "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 line~ 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 ~ithin 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-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-~ 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-lO 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 1 foot iiO ~'E' : ,,c[t~011/1510# 1lip Irll. J'O Ill ~'flJ' OFFIC& .EVaSiONS YOUNG & YOUNG ,4t:~1/.. 4.. LgX',~ 400 0STRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG . HOWARD W. YOUNG I SURVEY FOR: i ^T $OUF'NOLD s~a~v~re~ rtr~ ~w,t~wo~ ·OWN o~ SOU~HOLO BY ' su~o~ c0., "'~' SCALE: DATE NO '/'OWN OF soUTHOLD BU I LDIN G DEPARTMENT-T:~ TOWN CLERK'S OFFIG~/&/'7~ SOUTHOLD, N. Y. 'Approved .................... !..~ ................. , 19...~..'... Permit NO..~...z...~..../...~.. ~ o/c ................................... ..................... ............................ ............. , r-~m ~.- (Buildinl~/fnspector) .......... ...... ....... a. T ation m be completely filled in by typewriter or in ink und submitted tn duplicate to the Building Inspector. b. Plot,plan showing location of lot and of buildings on premises, relationship to adjoining premiees or public streets or areas, and giving a deCal]ed description of layout of pmper~/must be drawn on the diagram which il part of ~hle application. c. The work covered by this application may 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 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. : APPLICATION IS HEREBY MADE to the Building Department for the issUance of a Building Permit pumuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Law~, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, al heroin d~cribed. The applicant agrees to comply with all applicable I~S, ordinances, building code, hou~ing code,~and ragulatlons. '- (SignOre of applicant, or name, If a corparatlon) (Address of applicant)/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....... ~....~ ................................................................. If appl~, a corpora? slgng~ure o~f duly~authorlzed officer. (Name and title 'of corporate officer) / 1. Location of land on which posed work will,be done. Map I~~~t No.: ...~ ............. / 0 D ~ Munlclpall~ 2. State existing use a.nd occupancy of premiss and intended use and occupency of proposed conJtructlon: b. Intended use and occupon? ....//~.:.?...~C....'~.. ..................................................................................... 3. Nature of wo~k {ch~ck which applicable): New Building .................. Addition .................. Alteration ............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ..................................... 4. Esti.~.ated Cost ...........~..~.....~...~....~..o.~..~ ............ Fee ..~.~.....~. .................................................................... (to be paid on fi!ing 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 .....~....q~..... ............. Depth .~...~... ............. Height ...,./~.... Number of Stories ...... ~ .............. ; ................................................................................. / 9. Size of lot: Front ....~...~....~.. .......... Rear ........ .~....~.....~. ............... Depth .......~.....~'..~ .......... 10. Date of Purchase ...... ~..../..~.~...,~, ................. Name of Former Owner ..~..:.~......~.:.~.~. ...... ...... ] 1. Zone or use district in ~hi'ch premises ore situated ....~.-.~...~.. .................................................................................../ Does proposed construct;on violate a~y zoning law, ordinance or regulation? ....../~...~. ................................................ 12. Name of Owner of premises~.~Address'-' '---~'-- ............................................ Phone No ..................... 13. Name of Architect .............--,~ .......................Address ............................................ Phone No .................... Name of Contractor~.,~..:~~.....,~ddress ............................................ Phone No. 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. STATE OF NEVe'~)P~, ......................... ~.~~~~~__~eing' duly sworn, d~es an~ says t~t he Js the appdcant above named. He is the ..................... ~~~~... ~ : ~-/ ................................ (~ntmctor, ag~t, co~orate officer, ~c.) of said owner or owners, and is duly au~or~ to p~orm or have pe~o~ed the said work and to ~ke and file this application; that all statements contained in this application are tree to the best of his knowledge and belief; amd that the work will ~ perfo~ed in the manner ~t fo~h in the applicatJ~ fil~ ther~ith. Swam to ~fore .................... .................... , Notar/Public, . ........................................................... C~ (Signa~re of applicant) II "¢*