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Home My WebLink About5740-zFORM NO. I TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificete Of Occupancy THIS CERTIFIES that the building located at9'1 ?" 0 NP~'rO D~YV~i~/ R~treet ;~.~.~...~,.. ~/-~--. Map No... 5.~.~... Block No ........... Lot Ho.. ~. ~.~.~ ........... confo~ substantially to the Application for B~ld~g Permit heretofore filed in t~ office dat~ ............. ~ ...... , 19 .... p~su~t to which Bulldog Pe~it No. dat~ ........... / ~.. ~ 19~, was ~su~, ~d conforms to all of the r~u~ men~ of the applicable pro~io~ of the law. ~e occup~cy for which th~ ce~ificate is ~su~ is. ~ ..... ~[ .... C~ ~l.r.~Y. ..... 5~f~L~.~.~ .......................... The eegificate is ~sued to...~.~'~ ~.~ ~.O .... ~ ............................ (own?~, lessee or tenant) of the Mores~d buil~g. Suffolk County Department of He~th Approv~ . ~o~,wm~,s c~,~,r,c,~ ~o ........ ~/...~ P~ ............................ ao~s: ~v~:a.. 7/~ F...st~t.. N~.n:I~ ..... ~.:!i~.C!.(... ~ ~ ........... Building Inspector FOI~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) 5740 Z Dote l(arCh 10 19....~.... Permission is hereby granted to: ............. .......................... ............... .~ .tT......~.~r~L..&~. ....................... .................. ,a.~.e~h~ ........................................ to .......~,, .~,~.~, ..d. ,, ~..,.,~_ .?....~. ~ .~.~.....~....~. ~.,~.....~. .............................................................................. at premises located ....................................................... .~ ...... .~.~......~.1[~1~. .................... Ne ~.a.~ev Roadt a~thold pursuon¢ to application dated ............................. ?...e~........~.. ................ , 19...~....., and approved by the Building Inspector. i -- PERMIT INCLUDES APPROVAL TO REMOVE EXCESS FILL FROM ABOVE PREMISES BY ,.G,, ~ , .~ L""T '. ......... RU~T~,-~ ~ _ CELLAR C.~I,;STRUC'II~N _ ~- ~THER Building Inspector S-9 SCHD SUFFOLK COUNTY DEPAETHENT OF HEALTH FEB Date Bldg, Permit No. TO WHOM IT MAY CONCERN: at The sewage disposal facilities (Give deed location) for a structure located by this department and found to be satisfactory. fO~M NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office SouthoJd, 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 fram Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Cede compllonce 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. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date . .~.~.....~...~.....~.. L.~...~..,~ ....... New Building ..~.~..~, ......... Old or Pre-existing Building ............................ Vacant Land / -- .. ... Location Of Property ........ ~. ....... ['~1'. ...... G .......... ,~ ............. (~ ......... Owner Or Owners Of Property ~.~...'.~../~....,~C~E,.~..= ........................................................................ .......... ............. Permit No..~..'~...~'..l~!....~.. Date Of Permit ~/./.~../.'J~...Zd..Applicant ~-.k4Z/o~..~......'e/~'.R-/E'>~ ........................ Health Dept. Approval ~:~.....f.~q ..................... ~z'~' abor Dept. Approval ................................................ Underwriters Approval ~..~..~.~.~.... .............................. Planning Board ,~oproval ........................................ 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 this ................ day of ............................................ (stamp or seal) Notary Public .................................... County H.D.Referenoe EASTERN DISTRI~, R~R~AD,N.Y. AP~ICATION FOR APPR~AL TO CONSTRUCT PR~ATE S~AGE DIS~SAL SYSTE~ Date ~-3 Approval to const~ct said systems is r~uested,pertinent data here~%h: 1-Applicant ~a~ ~A Address ~ ~%o~ 2-Detailed p~pe~y location Hamlet ~Q'%e ~ To~ 3-~bllc ~ter shpply ~me Distance to nearest ~in 4-Lot Size: Width %Q5 ft. Le?gth~g ft. (also enter on center plot plan below:) 5-~elling: Single Family 10-Pro~s~ system: Septic tank ~ /Precast ~Cess~ols ~S~llow ~ols / /Other / / il-Septic ta~ inside dimensions: Vol~e Gals.Length ft. Width ft. Liquid depth ft. 12-Precast sections: /~/Number~"~Sq~re Ft. Cesspools: BlocksizeL incs.D ins.~ins. Total blocks below inlet: ~T P~N Capacity~Gals. i :~. P,M. ~ f. WoL. :: Street The Undersigned CERTIFIES: Indi ~te No th "Construction of authorized installations will be in can be installed on this Plot. Oats (10/65 Revis.) S-l~ Signed ancordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Systems". Date Signed ,f~,~._~Q~ h' ~-~-x_ A3~x-v- o ilder FOR ~ALTH DEPART~NT USE ONLY. Bas~ on the info~ation presented here~th, it ts the opinion of the Health De~ment, that an adequate and satisfacto~ Se~ge Dis~sal S~tem APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS INSTRUCTIONS.' Applications must be submitted in triplicate 1-Means Owner or Builder. Address to ~mich mail should be directed. 2-Means detailed description of property location, together with street name and distance to nearest interSection cf 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 "V" items applicable to the proposed new dwelling. 6-Name of sub-division ?-Section N,,mber S-Let Number 9-Private well: Enter "Nom 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 & Waste Disposal Facilities. i.e., Part II-Residential Sub-surface Disposal Systems covering Cesspools Part III " , . , m # 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 waters-Streams, Lakes, & Bays, etc., located within a distance of 50 feet of Applicant's Let 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-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, Stream% 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 ~.~' ~ ~. ~ o TOWN OF SOUTHOLD /~,/,.~ ..~.~/~,~.~.~ BUILDING DEPARTMENT TOWN CLERK'S oFFIcE ~/~ ~"~ S~.OLD, ~. ~. ~/~.~ ~ ~ Examined .Z..~/.~ lO , 19/ ,, · ~=lication No ~...~.~ .... ............................................... ~ w~/~3--'~-~ ........ ~.~ ~proved 19.'..t. Pemit No..,~..~..~.~..~ ......................... ............. , .... .... ....................................... ...... ~ ................................................ , ~ ............ o. lhi~ application must be completoly fill~ in b~ ~*writ~r or in ink ~nd ~ubmitt~ in ~lic~t~ to th~ 8uildinfl b. Plot plon *howinfl I~otion of lot ond o{ buildin~ on pr~mi~e~, relotion*hip to ~djoinin0 premi~, or public ~tre~ or ~re~s, ond ~ivin~ ~ detoiled de~rlption o{ la,out o{pr~ mu~t be drawn on the die,ram which i~ pa~ c. Th~ work coy*red by thi~ o~lication may not ~ comm~m~d before i~uance o{ 8uildln~ ~rmit. d. Opon oppmv~l o{ thi~ ~pplicotion, th, Buildin0 In~p~tor will is~u~ a Buildin~ ~rmit to th~ ~lic~nt. ~h~ll be kept on the premi~ ~iloble {or in~p~ti~ thmu~h~t th~ p~re~ o{ th~ work. e. ~o buildin~ ~h~ll be ~cupi*d or u~d in whol~ or in part {or ony pu~us~ wh~t*wr until a C~ificot~ ~holl haw be~n ~ront~d by th~ Buildin~ APPLICATION IS HEREBY NLADE to the Building Department for the issuance of o Building Permit pursuant to the Building Zon.e Ordinance of tl~e Town of Southold,_Suffalk County, New. Y~rk, and. ether applicable Laws, Ordin~naes or Regulations, tar the constructien of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, hOUsing code, and regulations. , . ~Sig a ute of applicant, or name, i'f a corporation) .... ... ' (Address of op~Ji;;;;;~i ................... State Whether applicant is owner, lessee, agent, architect, engineer,, general contractor, electrician, plumber or builder. .................. i .............. ........ ...... . Name of owner of premises .................................................................................................................................................. p~nt~ is~_a~T~ra _s.~J~.ature of duly authorized officer. If a te, 7'("~am~ar;~'title of, corpore~*o~i~'~';) ...... I. Location of land on which proposed work will be done. Map No.: ./..~.Z.~..~. ~~ '~-~c./~Lot No.././.'z....../..~..?..~..e..~,?-. Street and Number ................ ~..9.~.~...l'~.....l~ag~..~.V.)..~...~.. ~.~. ..~.~.~...~...~.~ (-/~ ~'.~/ · --"// '~ ~ ' --~ ~/-/3.'~ ...... ~'~'~il~ii~ ................ C;r ................. 2. State existing use and occupancy of premises and intended use and L~roposed construction: a. Exisiting use and occupancy b. Intended use and occupancy 1~.5.1.~..~.,~...~..~..~ .~ .............. 3. Nature of work (~h~clk v~hich applicable): New Building ..... IiCiI ..... Addition .................. Alteration' ................. Repair ....... ~ .......... Removal .................. Demolition .................. Other Work (l~scribe) ........................................ 4. Est mated Cost ~tB t~--~ .......................... 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 -.-I¢1~ .................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front -"--I1~11t~' ............. 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 ..~1~.4~11} .....................Rear ...~l~..4I~.e .......... Depth ..... ~..~ ....... Height ....I.~..~*.. Number of Stories ..... ~ ......................................................................................................... 9. Size of lot: Front ..... l~.i~--.~,* ...... Rear ....~..~1~e ................ Depth ....~,J~..~; ............. 10. Date of Purchase ........ II~'Q ...................................... Name of Former Owner ...~Illa/l~...~4~.e .......................... ] ]. Zone or use district in which premises are situated ....... I1¢1t~¢~ ................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ....... R~ ................................................ 13. Name of Owner of premises ..lal~lll~-4~ ...... Address .~[~...~I~I~IMII.A~ ...... Phone No.~.~...~.5.. Name of Architect ...................................................... Address .~!.~ ..................... Phone No ..................... Name of Contractor ...I~Ict ...................................... Address ............................................ 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 NEW~-YQI~__,/~. ~l (' COUNTY OF ...'~..~/..¥..'~....H..~......~TM .......... ~.lqIk.l~llt ............................................................ beiog 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 and 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. Swom to before me this / .... ..... day ......... , /2 ......... .......... (Signature of applicant) / OF ,q'OirFOl. ff LOt, W1')' O# · · MONUMENT / AL.DBN W. YOUNG._. SURVEY FOR: FRANKLYN d. BORN LOTII& LOTIt '"LEEWARD ACRES AT BAYVlEW" YOtlHG A YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK HOWARD W. YOUNG TOWN OF SOUTHOLD SUFFOLK CO., N.Y. DY ~ ~ ~ r SCALE: I" 40' MAR.6,1972 NO. T2- 126 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK, NEW YORK 10038 v,,,,, January 2~. 1973 ~p~,.,.~.,,~,,.,,.~.~ 6132~0 N ~ ' 1 THIS CERTIFIES THAT Farmview Bldrs., s/s North Bayview Rd., 700' e/o3acobs Lane, Southold~ ~L. I. ~,, ~,~fm~...~,,~ ~,,~,,,~,,,,~ ~ N ~.~,,,~,,, ~ ~ r~.~ ~,,,~ r~. outside ,ca~e.,,mined,,n January 18, 1~73 ,mdf,,undfohelnco,,ptianceu'ithther~quiremenlsofthisBoard. RXTUR~-- : ~ ..... ' FIXTURES ~ RANGES ~ECKS~VENS ~I~H~E~'~N~UST DRYERS" ' ~' ~URNACE ~T~RS ~ FUIURE AP~ANCE FEEDERS ~SPECIALREC'P1 ~IMECL~K5 ~ 8ElL ~UNHNEATEES I ~[TI-OU~LE1 ~ DIMMERS o,,~. fpp~.~us:~ ....... J___ I ~ ~_ - - .,~u~naces.~ il l-1/Shp, 101/15hp Motor/s :l-3/4hp Sapanaro ?~ Mineo Elec.Cont., _~__~J~l._0 102 Oak Avenue, ~~~ Shirley, L.I. 11967 GENI~,,I. ~ANA~GER This certificate must ~ot be altered in any monner; return to the office of the Board if incorrect, inspectors may be identified by elr c~edentiols. #Ot~r: $1.1~1V1510t/ /1AP IrlL£D IIII 1'//£ o/rlrl¢£ Otr 1'//£ C/ oF su/~/~ot~r ¢ou#rr o# JIIN~ 4~ Ig~I AS MAPNO ~ · ~ MONUM~N 7' REVISIONS ~'.'~R 27:1972 YOUNG & YOUNG 400 OSTRAND~"AVENUE, RIVERHEAD, NEW YORK I SURVEY FOR: / /o~'' _ 'o.\' % II I FRANKLYN J BORN I¥/'~ j~Zt',~ ~ % II I LOT II 8~ LOT 12 I"LEEWARDACRESA~VI~ / 7 II rl I~'~': '"~~-.,,,,-I~' ,~-,,~ I 'L