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Home My WebLink About5741-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at~/...t~..r.~...D'.~.~.~. ~ ...... ~..~..~.. Street conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... .~..?...~....~., 19~..~. pursuant to which Building Permit No. ~..7. ~. ?.~-, dated ............ ]..~....f~...~f~., 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 ....~....~. N.~ ..... F.~..~../..~.¥ ..... .~. ?..L~.~../-.~..~...~. ...................... The certificate is issued to ..... .~.~./..~.,:.~..~.~. .... ?1..~..~...L~.. ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No ...... .~....~..~..~..~...~ ............................. HOUSE NUMBER...7.~.~..~....Street .... .~..0.~. ?..~ ..... .~'.~.y..~.t.~...1~. .... .'~..0.~..-~. ......... Building Inspector I~ORM 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? 5741 Z Permission is hereby granted to: .............. ~l.*/.....O~ma~e..A.'~e ........................... to ....... ~II~I:L .11~!t'. · 41J~ .. f,,.~. · ~!¥~.~.~.!~- ............................................................................ at premises located at ......... ~..ll~...~t~t..~..~l.%..&...~21.....~ell~lL&~l~em .................. ............................ a ~e~w.~..e~..&~s..ti.,...l~r~se~..s~ ......... ~mm~....ll~ ..................... ................... f..,7~ee..,or..~.~..~ppee~e.) ............................................................................... pursuant to application dated .......................... l~.e~.....~Lq~ ................. , 19...~., and approved by the Building Inspector. Fee $......~eOl~ ...... Building Inspector \MIT INCLUDES APPROVAL -~- REMOVE EXCESS FILL PREMISES BY ',lING LCT ~ r,'AY CONE~AJCTION ~ L~R CQNST~UCTION ~ FORUM 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 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. §. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), No~-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 ...~' ~.~,~......~...C....::.... j...~...~....~. ..... New Building ...~.~.~. ......... Old or Pre-existing Building ............. ..~ ............ Vacant Land ............................ Location Of Property ~{'~ ~...~...~.~.....~..~./..~..I..~:......~l.~. ~ ~/~ ~ -~~ ~ner Or ~ners ~ Prope~y .~.~ ...... ~.~ ..................................................................... Su~ivision ~~....~.~.~.~ ....... ~ot No~.~..~.~ ~,ock No ............. House No..~.~? ~ ~0 ~nt~n ~//~ ~ A cant ~~ ~ Permit No .......................... f Permit ~. /..~ pp ............................. Health ~pt. Approval ............................................ aDor ~pt. Approval ................................................ Unde~rite~ Approval ~...~.~ ........................ P ann ng Board ~proval ........................................ Request For Tempora~ Ce~ficate ........................................ Final Ce~ificate .~ ................................ Fee Submitted $ ......... ~.. ................ Construction on above described building and permit mee~ all applicable c~es and regulations. .............................................................. Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County FO~M NO. S TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. ¥. 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. 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 $5.00 Date .r~..~,,~....~ .~...~ j..~.]~ .............. New Building .¥.1~ ....... ~. Old or Pre-existing Budding ........ :.-. ................. ~/~; /~ ~'Vacant Land ............................ Location Of Pr~e~ ~;~...~...~'~ ....... ~.~....~..i.~.....~.%..~,.~.~.~l~.~..~.~...~'.~ ~ner Or ~ners ~ Prope~y ....~.~.....~....~...~ · ........................................................................... erm * ...... ......................... Health ~pt. Approval ............. ~.u.e ...................... or ~pt. Approval ................................................ Unde~riters Approval ~...~.~.~ ......................... ~lamnim~ ~rd ~prowJ ........................................ R~uest Fo~ Tempora~ Ce~ifJcate ........................................ FinQI Ce~Jficate .~.~ ................................. F~ Submitted $ ...........~ ....................... Construction on above described building and perrr~t mee~ all applicable codes and regulations. Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date \A- _%0 --;1 Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for (Give deed location)t a structure located have been inspected by this department and found to be satisfactory. Chief of District Engineer SUFFOLK COUNTY DE~RTMENT OF HEALTH H.D.Reference Capacity~D. Gals. G.P.M. ~ W.L. Street 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 Se~wage Disposal Systems". Date Signed ~.4~~ ~ ~./(~ ' O~er' o~/-- ~u~lde~ / FOR HEALTH DEPARTMENT USE ONLY. Based on the information p~sented herewith, it is the opinion of the Health Department, that an adequate and satisfactory Sewage Disposal System can be installed on this Plot. Indi No (10/65 Revis.) s-~ ~ate 'th Data Feet ?m~Ul o £,~-~ 2 ~ ~ 4 " 8 ,, 12 " 14 " 18 EASTERN DISTRICT, R1VERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval to construct said systems is requested,pertinent data herewith: Date 1-Applicant hi~.'e'~ ~.~lc~.v-,~ ~'¥1vw'~ Phone ~$-g~ 6-Sub div ,Z~e._u.,~q~'J Address D,.~% O$~oo~or {<h,OC -- '~'VSe~%.~,~. ~k,, W.~'~ 7-Section 2-Detailed~proper~y location ~. ~',~%,,.}~'~,e~o ~Z_4 8-Lot No. /~ o~ 7o7x /! ~--,, Hamlet ~=~\\)~* ~o Town .~o~-~\~ 9-Private'well? 3-Public water ~upply name Distance to nearest main 4-Lot S.ize: Width~ft. Length~__ft. (also enter on center plot plan below:) 5-Dwelling: Single Yamily ~ ~ Tw% Family? /./Cellar? ~//Slab? / /Crawl Space? 10-Proposed system: Septic tank ~ /Precast FF/Cesspools ~//Shallow pools / /Other / / il-Septic tank inside dimensions: ~olume Gals.Length ft. Width ft. Liquid depth ft. 12-Precast sections: /2l/Number/5~Square Ft. Cesspools: Block sizeL incs.D ins. H ins. Total blocks inlet: ~1 ~2 l°~'~ PLOT PLAN APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS INSTRUCTIONS: Applications must be submitted in triplicate i-Means Owner or ~Gilder. 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. ~-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 7-Section Number 8-Lot Number 9-Private well: Enter "No" if Public water supply is available. Enter '~es" otherwise. PROPOSED SYSTEMS: Answers to Items number 10, li, & i2 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 waters-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-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-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 I foot 00, NO~'£: ~.I~DI¥1$10N ~4~ FII ~D tN Og $~rFOL g ~DUNTY ON ~-w~on. YOUNG A YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK suRYEY FOR: · ~ FRANKL YN d. LOt I/ a LOt/2 "L EEWARO ACRES AT SOUTHOL D APPLICATION FOR BUILDING PERMIT INSTRUCTIONS 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 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 port 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 pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk COunty, New York, and other applicable Laws, Ordinances or Regulations, for the construction 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 code, and regulations. ,k~ ......... i~'i'~'~'~';~'g~"~l~l~ii~;;;~;";'r"r~l~;;"if a corporation) ~' v..e.r...h.e...a..d..,.....N.,,.y.t (Address of applicant) \ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~ Gener'a I Con~cr'ac~cor· Name of owner of premiSes ................................................................................................................................................. I{ applicant is a corporate, signature of duly authori2ed officer. (Name and title of corporate officer) F ..~.~'~ 1. L~ation of la~ on which pr~osed work will be done. Map No.: .L~.~N~..~.~.~ ........ '~L,Eot ~. LL~ ........... o~ ~.~. Street and Number .No~.~..~.~.~w...~d., .................. ~g.~9.L~,..:~.,.~., ............................... ~...~.~ ............... ~ 7~0 ~ ~/ ~d~~ Municipali~ 2. State existing u~ a~ ~upancy of premis~ and intended use and ~cupancy of pr~osed c~structi~: a. Exisiting use and occupancy ......... -..m.-.=.~ ............................................................................................................. b. Intended use and occupancy ..J~I~.Sj..~J~.D.~.J..i~J .................................................................................................... 3. Nature of work (check which applicable): New Building ..... ~'N ..... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ · 4. Estimated Cost ..... 018~;~'~ .............................. Fee ...~..¥: ........... ~ ............................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units '"~1~11 .................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 ..-I~l~ ............... Rear .....~.e~,- ................. 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 ........ 60"~'i' ............. Rear ...... ~l~:.~l~ ......... Depth ....~..~ ........ Height ....t.~..tl~rl.. Number of Stories .~1~ ............................................................................................................. 9. Size of lot: Front ....I.~'.~..¢~11 .......... Rear ..... I.~.~..~l~ ................. Depth '"~'16"~11'~' ............ 10. Date of Purchase ......... Jt~.~ ..................................... Name of Former Owner -.-.~lly~J~V~-.~-~r ......................... 11. Zone or use district in which premises are situated ..... ,~eel~lenCltl ..................................................................... 12. Does proposed ~onstruction violate any zoning law, ordinance or regulation? ..... ~ ................................................. 13. Name of Owner of premises ...~¢~..A~It~ ...... Address "~"~lllll~ll~ll"/~r ..... Phone No. Name of Architect ...................................................... Address ...~..!.~..N..".~.R ........ Phone No ..................... Name of Contractor ...... .¢111l~ ................................... 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' Y~..ORK,~j' ~1/ ~Sc COUNTY Of ..... '~..~..~.J~.:,.(. "~ ............. ~l'JJl~J~..JlJl'~ .......................................................... being duly sworn, deposes arid says that he is the applicant -(N6me~)T iHdividual 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 ~ke 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 fo~h in the applicati~ filed therewith. S;~°~re d~;tho~ ~~ b~~ ,19~ ~ ~ ~ --/ i~ TH~ ~ BUREAU OF ELECTRICITY ,~! ~ B5 JOHN STREET. NEW YORK, NEW YORK 10~3~ ~ T HIS CERTIFIES THAT Far,view Bldrs., s/s North Bayview RD.~ 250' - 700~ e/o Jacobs L~ne, Southpld, L.I. ,,~ the.folh,,r,n~h,c.~,o,~: 'X; Ila.e,nent [~] Ist ~1. [ J 2nd FI. outside Section Bh.'k I~,t ,~o ....... i..,I .... January 18, 1973 FIXTURE FIXTURES RANGES S E i R V I I- 1 )100 ] CB ~ I x 1 oTIt~R~PPARATUS: *nurnaces: Oil 1-1/Shp, 1-1/15hp ?;otcr/s: 1-3/4hp OVERS DISH WASHERS EXHA~JST FANS I I I MUt ~')- DIMMERS L ~ ' C E i ~ Sapanaro & MineD Elec. Conts., ' lO2 A e.ue ~ Shirley, L.I. 11967 · This certificate must not be altered in any manner; return to the office of the Board if incorr~t. Inspectors 'may be identified L MANAGER y thel[ credentials. ~0, 05~ · ~'MONUNEN T * ..J · YOUNG & YOUNG / 400 OSTRANDER AVENUE. RIV£RHEAD, NEW YORK AJ.DEN W. YOUNG HOWARd) W. YOUNG FRANKLYN J. BORN LOTII& LOT 12 "LEEWARD ACRES AT BAYVlEW" i^T BAYV-I'E W OU~.ANT""D TO: TOWN OF' SOUTHOLD SUFFOLK CO.,.N'Y' mY ~/~ ~.~!,~~ BCAL~r: ' 40' I"AT~I::MAR.6, Ig72 IN°' 1'2- 126 I" YOUNG & YOUNG FRANKLYN J BORN r' i~¢g~;~ LOTII~ LOT 12 "~w~.~ ~c~s ~ ~v,,~w', ~ ~ow. o~ ~ SOUTHOLD I L_ ?. ........... FH