Loading...
HomeMy WebLinkAbout5742-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certi[icnte Of Occupsncy No..~ ..~JO .... Date ............ g~r,~. · .31 .... , 19. THIS CERTIFIES that the building located at . p~. Rd ~]~- ~)th. 5~ ..... Street Map No..~ ....... Block No...~1~ ...... Lot No.. '~"~ · "6'x'ee~p'ol't¥ ~i~:~ ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ l~rch' $0 .... , 1~.. pursuant to which Building Permit No.. dated ........... 14arch..10., 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 .. l~.r~.va~r,~. ~,~e..f-a~.~l.J:y · d~t].~g ...................................... The certificate is issued to .~'~1~1~. ¢~r®ff ...... (r~m®r ............................ (owner, lessee or tenant) of the aforesaid building. ~,Y, CEPTJLONI Protect piping in cr&~: opaeo fro-, fr~llk Suffolk County Department of Health Approval ~ttl~e'' '~'[.' .1<)~. · by 'Rv '¥111& ..... UNDERWRITERS CERTIFICATE No... l~ '~ ...................................... HOUSF NUMBER. ~ ....... Street... 9~¢~h '~t ....................................... ..... c.V ...... BuildinLz Inspector (THIS PERMIT MUST BE KEPTON THE PREA USES UNTI~L FULL COMPLETION OF THE WORK AUTHOR!zEDi NV 57z1 Z Permission is hereby g~anted at premises Io~a~ed o~' .. ............ :....~ ........ ~.~ ................ ~.-....-.-.. ~; ............. --.' .................................. pursuan,t to application dated ...~..~.:.L.:~:..., 19;~".., and approved by the Building I.spectar. Building'~nspector ( l~O~f[ NO. 6 TOWN OF $OUTHOLD Building DeP°~tment Town (:Jerks Office Southold, N. Y. 11971 APPLICATION FOR ~ERTIFI~ATE OF )GGUPANCY instructions A. This application must be filled in typewriter OR ink, and sul~mitted 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 bOildings, p/operty 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. . where applicable. 5. Submit Planning Board approval of completed site plan ~equ~rements B. For existing buildings (prior to April 1957), Non-conforming u~es, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, s{reets, 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 ........ .~./..~.~ ~, .7..2. ......................... New Building ........~ .......... Old or Pre-existing Building ............................ Vacant Land ............ X .............. Location Of Property ....... .5/.E.,...~tld.....9.~,h..~/a ..... G~.aer~pG~;~i..l~Y. .................................................... Owner Or Owners Of Property ....... :].P..~..e.~.h......~.....~.h..Y.~,.]:;J,D......[]JJ~g.¢.~ ....................................................... Subdivision ................................................................ Lot No .......... ,;.. Block No ............. House No ............. Permit No...,~.7.~?,..Z ..... Date Of Permit ..~./.~.D/..7.~...Applicant ..~.GI;h~...IJ.~l~...~,.m.D,1;'.g.V..e..m..e..0..~....C..q.-.... Health Dept. Approval ........ ~2_f~/.2.~. .................... Labor Dept. ~pproval ................................................ Underwriters Approval ...N...~?..~...9.~.....8./..~.~/.2..2. ......... Planning Boa!d Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ...5~,0.0. ........................ Construction on above described building and/permit meets all a~plicable ~gdes and regulations. Applicant ...'; ............ ~¢(,~ ................ f ...................... Sworn to before me this .;; ............ day of ...... Publ~:? ............................. ~..~..~;~. C~nty (stamp or seal) s-9 ~ SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH JUJt 28 197~ Date Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure (Give deed~location) located have been inspected by this department and found to be satisfactory. SUFFOLK COUNTY DEPARTMENT OF HEALTH ~(-)~ ' H.D.Reference No /D ~L~ .APPLICATION FOR APP~OV,&L TO CO~ ~RIVATE S~AGE DIS~SA~ SYSTE~ /77~ Approval to const~ct said systems is requosted,pe~tinont~ data '~ere~th: Date /fei //~ Address ~7~' ~7,~~ $~ ~ ~&~%~Lo*~ ~ ~ ~ 7-Section , , , 2-Detailed property location /~/'~$ ~/~' j/~- ~' O ~ ~ 8-Lot No. ., Hamlet To~ 3~o~o/~ ~ 9-Private well7 /~O_ ~ 3-~blio ~ter supply name, ~/6~D~w~ Distahce 'to nearest main ~$ ~ ~-~eltzng: Szngi~ '~mily I~l Two Family? /./ Cellar?' ~ .... /Slab? / ~ Crawl S~ce? ~/ 10-Pro~sed system: Septic tank ~ /Precast ~Cesspo~ls / /Shallow pools / /Other / / il-Septic tank inside dimensions: Vol~e Gals. Lengt~ ft. Width .. ft. Liquid depth . .ft. 12-Precast sections: ~Number~Square Ft. Cesspools: Block SizeL incs. D ins.H ...ins. Total blocks below inlet' : ~i~2~3 /~ PLOT PLAN Tat Capacity Gals. G.P.M. ,G ~ 'ad~> O W.E. Data lO ..... _,, ~ ~, ~ Street ~) . . ~ ~ ~ ' Indi[at , ~ ~ ~ .... ' No~tD The Undersigned CE~TIFES: "Const~ction of authorized lnstallatio~./w~ll be in accordance with the Suffolk County Health De~tments' cup.rent Standa~s,/~ulletins, and amendments thereto, covering Private Sg~ge Disposal Systems". ~ ~ ~er o~ : Builder F0~ Et~T~ DE~WE~T ,~USE O~Y, sase~ on the into~ati0~ '~e~ented beneath," 'it is '~he opinion of the Health De~rtment, that an adequate and ~abisfacto~ Se~ge Disposal System can be installed on this Plot. Date (10/65 Revis.) S-15 APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS INSTRUCTIONS: Applications must be submitted in triplicate 1-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 r~ain 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 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 wa bers-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 he 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 ~st 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 1 food to maximum of 2 feet Bottom of Cesspool to ground water must be held to minimum of 1 foot ,-- -~55'+'t .... ..,e o 59. ~4 SUP-.kZE"r'ED :FO!~ ' ~ ':. d©,5 E..PI:-I.., PHYLtL . 5 CAR.OFF &T ' GP_EEN POPJ TOWN OF ~ ~ ~' . :OUTH¢ LDI N,7 ~ P._ 0 "¢,/N sT.q6E_T DI C~XO %,V,.5 ~ 1 % ;.82 44 ~_O E. F.- _z ,.¢ 2.4o~ SCALE- SO ~- E2: MONU~'~EFd' .! TES F HOLE 8 TE5T HOLE Z C 0 VE Tf~- le VAN TUi'¢'[~ 501',t .__IZ. V¢¢.- "F_~,i.~ bJCENSE~, LAND S~L.~r~VEYO~:5 'i 143 -i I[ I'-0" ,..¢t,¢ , .... pal,4 E L~ ~zt pANI E.L-2 2_ PANE'L- QI PAt,-,/~L - I0 % F. ~Tr.;H E~4 L&YoL'T PA, NEL -Cf Iq A ff CAULK'I NfG- GE.(:T I ON A q ;.ZP~" -B; Y4"= f'-O# lOC 91,?' SILL FILL S~EW ON F-F p~L, ~-X4 NAI L~R C~.y ) ,G~.TIO N F-~ IOLo# _j -AT THE DOTTO&& (,~y ~OILI)~ c, I NF~L ALL FoUtqPAT1Of,~$¢ ~?~lN~ke ANP C · te Ji 0 If ~L ~CTI 0 I'-4 CAULK1 N'~ 'S/8*P~Y F'IN/GH F-LOO~ ('~K AT' LIVING .. '---2×8 HEAI;,Ei~ ~C:9-1Of~-,] ~-E5 ~Ec 1- l.. fro" FLOOR P- P--- A/k,'~ I ~-.I ¢,~ PLAN I ~o '1 NG PLA~ .i [?ETA I L - --~/%2 -2~ '4 P'L. AN/K I N ~ %--PB,L. Z×& 5ILL} FILLEE ~C1NIOTU I~ C~O~ S~CTIoNJ A-B SLAt~ '~AV~L FILL / D~E'TFAI L- H / lO SEC'F~O~,4 PAN'EL P~'TAt L - ,PANEL Il 574"~ Il" Z~Z:oN, F-F/~ / ,il J SONOTU ~,E N~ I D: 7,4 I£ A D~-7,4/K DETAIL-- <~ OF_TAIL Cz "- y4 'PF__TAI L - F O~TAIL - ~ D~TA~ L - H T~OLL ~OdP~Uq43 .... ~"?L¥ ~¢0}= PLAk~KU4O O F_.-TAI L -- K /JLATtON D.F--.I'AI L. - L 7 E)ETAIL- U -' ~4t'X, 7~ (~ H ~ATt-d h4 ~ PP--TAIL-- N PANEL ROUND' ...... 'BET, Al L -- ~-- ELEVATfOM CAULKIN~ P~-.E A~I~A~LE~I~ BENCHF~AIL' L~MI~¢ IO'~ALUMINU M FLA~HI i'4 ~ 5U~GESTF-P CUT OFF ?O~r~LE ~UT' OFF E)~I"AI L -- T FINISHED '¸7, ~,~'~ ' ",, },,, ' ,':' ' ' ~ ~, ~ , ~ % ~ ..... ~ ', :~K~,~ENT ............ ~ "~ ' ' ~ ~"~ ' / ' ~ ' ' ' '; : -/' ' ' ' ' : ,' ..... ' ,,~' ~.: ~ ;- ' NO B~O,¢hNE,, ~ ~ '* ~, , . , ,r' ,;, ~Z/ :~: . : '7 ~ .,_ "" ' ' ~)" ' .... '" .... ~CTION THRu PATIO ,. ,__ ,,, ,. , ,,-, , ,~ , ~. ~NO 8059~ INSIDE ~ OIl-I , ~ I .... " -.~ -*I~ ~' ~ '; F ~ I ~/ ,,,.,, ,, ~i '" ¢" PLAN VIEW .... .... '"" '~ : PARTITION CORNERS , ,~ , ,:,' , , ' PAD TDIU ' ' ' ~: ' ' ' ' bi.: "' ' ' H' "' ~" k I' ~ ~ " E XlE:RtOR WALL SECTION V~' ~ ' t " ' ' ........'.- ~T~O~ s , . .......... ~ :~ k~t ~ ', , ~ ~ ~ ~' ~F: , . .., . . . , ~ - . ~ ~ ~ , ~ ~ -- ,. - - . . ~ ~ ' .,., , ,t' ', ~ , ~v~ '~ ~- ~ ............... ., , ,~-~" :,-,,¢,~ ,:,,-,,, ,~,5¢~,~ ,,,~,' .... ,. , , ,,[[: ,~ :' ,?,' -:,,- " ' ,