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Home My WebLink About5762-zFOB,M NO. ~ TOWN OF $OUTHOLD BUII~ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z.7.~.9..0 ...... Date .............. .]l.q~.. .... I~).. -, 19.?~. THIS CERTIFIES that the building located at .......~.~. F~....~.~.l~ .......... Street -- - I~aters Map No..m~...e.~..°~a..... Block No ........... Lot Ho. 22...~..o~...t~.q.~.d...~. :.~.. ............ conforms substantially to the Application for Building Permit heretofore fried in this office dated ............ .!~..r.. 2.~..., 19 .~.2. pursuant to which Building Permit No.. ~.~.~. Z dated ............. N..~.. 2.1~.., 19.?.~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .~.$?.~.~.~...~o...$~,lY..d.W~l.~g ....................................... The certificate is issued to Niehael Sta~k O~ner (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .S'e'p.t.. 6... 797~...b?..!~. :..?~.1..1.~ ...... UNDERWRITERS CERTIFICATE No..~.1.~1 .~... :.. H~.. ;2~...~.~ ............... HOUSE NUMBER .. ~3.3 ........ Street .... .~..a~.~.1~...~.~y .......................... ~+~ Teepe trail Building I FO~I,~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5762 Z Date ~la ~l~ 19~1~ Permission is hereby granted to: .............. ~.:D,.~..~..e.~ .................................... ............ ~e:t~k#.t ....ll,]~,......tll.~ ................. ~o ..... ~...~..~...~....~.e....~....~l,~....c!.~e~,x~ ................................................................................ at premises located at pursuant to application dated ............................... ~..?..~....~........~....., 19....~...., and approved by the Building Inspector. FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z. ~tl*.2 ..... Date .............. IBep$ . .~ ..... , 19. ~3 THIS CERTIFIES that the building located at . .We~p.U~..W.a~ .............. Street Waters Map NoJ~CkO~a ... Block No ........... Lot No.22 ..... ~.0 .u.t.h.Q!d .... Iq ,[... ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... 14a2..2k,...., 19. [2 pursuant to which Building Permit No..578~. dated ........... ;4ar2~ ...... , 1~.~.2., 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 P. riv&te, ol~e. falnllY. ~.~ll~t~ ....................................... The certificate is issued to . lqilliam. Bell ....... 01dae~ ........................... of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant) · ae~t...6...t9.7.3., by...a.,..Vx. ~.~.a.... UNDERWRITERS CERTIFICATE No... polldSutlg ....................................... HOUSE NUMBER.. ~'~3 · W.~..~.~ ]~.aIr 6~_. ...... Street .... Tepee Trail .................. Building Inspector / FO]tM NO. 6 TOWN OF $OUTHOLD , Building Department Town Cle~s Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Initructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE 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. Swam 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 New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Health Dept. Approval ...................... Labor Dept. Approval ...,~/.,L..~.'. ........................... ~equest For Temporary Certificote ........................................ FinGI Certificate .....~.. ........................ Sworn to before me this ~__~ ................ day of ............................................ (stamp or seal) ~-~--f'° .................................... County Notary Public S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date SEP 6 1973 TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deed loc~tlon) have been inspected by this department and found to be satisfactory. SEP 6 1973 Chief of Csneral Engineering Services TOWN OF SoU*rHOLD " BUILDING DE~RTME~T T~N CLERKS !L a. This application must be completely filled in by typewriter or in ink and submitted n duplcate to the Building~.~ Inspector.-4~, b, Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or-- areas,r and g ~'~eta led descr pt on of layout ofproperty must be drawn on. the diagram wh ch s part of this application.~' ~ c. The work Cover, ed by this application may not be commenced before ~ssuance of Building Permit. . d. Upon apprcJFal bf this application, the Building Inspector will issj,~,~-Building Permit to the applicant. Such permit Shall be kept on t~ll~ premises available for inspection thr~jgheut4C~'~rogress of the work. '; e. NO buJldir~Gall be occupied or used in Whole or i~port for any purpose whatever until o Certificate of Occupancy s~611 have*been granted by the Building Inspector. . APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursucint 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, os herein described. The applicant agrees to comply with all applicable laws, ordi nances, building cede, housing cede, and regulations. (Signature of applicant, or name, if a corporation) ............................ ::.....: ....... . ......... ,,.....:...,,..._.../....7......7. .... u-~aaress o~ app icanU State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. I~ applicant is a corporate, signature of duly authorized officer. /~,,,~.~./,~./¢,.~.4.p,,~,,~?,~,_~..~c~, . .................. ........ 1. L~ation of land on which prior,ark will be done. Map No.:~....~ ............... ~ ....... ~t No ......................... ~. ~r-~t nnd N-mber ~~ ~ .................................... ............. ...................................... 2. State existing use and ~cupancy of premises and intended use an~'~nay of pr~sed construction: a. ~isiting ~se a~ ~cupancy ................ ~ ......................................................................................................... 3. Nature of work (check which applicable): New Building................../ Addition .................. Alteration ......... ,....~.. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ../. ........................................................ 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 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 .................... iHeight ........................ 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 .......... ..z/_...d. ................... Rear ........ ..~....~...~. .......... Depth .....~.....~....~ ......... Height ~?, 0 / Number of Stories 9. Size of lot: Front ......~:.....~....O,..~ ........ Rear ......... ..~-.....~..../....~ .......... Depth .......... /..~.O...~. ........ 10. Date of Purchase ........... .~....;....~:....O..~..-....Z..~-.. .............. Name of Former Owner ............................... ~..~..'~...~.~.. 11. Zone or use district in which premises are situated ............. ~ ........................... ~.~,~ ............................................... 12. Does proposed construction violate any zoning aw, ordinance or regu at on? ~..?..O.. ...................... 13. Name of Owner of remses~/Z*~/.~.?~/ ~',~-'Z'"/A~l~lr~= .~...e.x'6;-l/~',~;,~'/~'-/f/~/x~'~>~ ' '"'~'~;'"'-~';'~'~- . P .................................................................. ~ ................. 7~ rnone r~o. ~....T.~........--- Name of Architect ............................. ~.~ ..................... Address ............................................ Phone No ..................... PLOT DIAGEAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW ~ORI~-_ COUNTY OF ..~..~.~..~....~.....~.. ...... ....................... ~. ............................................ being 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 tha~ the work will be performe~ Jn the manner set forth in the application filed therewith. Sworn to before me this Natal" .......... ~.v ........................................ , .~ .... ~ .................. rY ~~:y:~ · .~:....~. · .'~..C ............. CoUnty (Signature of applicant) Qualified in Suffolk County No. 62-0508300 Cornmi~Jon SUFFOLK COUNTY DEPAHTHENT OF HEALTH ,%~ - H.D.Reference No /~ ~/ APPLICATION FOR ~PPRO~AD TO~coNSTRuCT PM 5U~E SYSTF~MS, Date ~ - / -- ~ 2_ Approval to construct said systems is requested,pertinent data herewith: i-Applicant ~%/I/--4/'~,~1 '~/-f- PhoneT~fT-~F~Y26-Sub div Address ~o,~, ~,t/ S~',~, ~7- A/P/ //75.~ 7-Section//u~/~///~/w;/; ~ 2-Detailed property location ~-/;~/~i ~'~{~- __~.~d~ No. ~ 2. Hamlet Town Q9*K~7o~ Y) 9-Private well? ?/~-__f 3-Public water supply, name Distance to nearest main S-Lot Size: Width/Jo ft. Len~thiz~ft. (also enter on .center plot plan below:) ~ 5-Dwelling: Single Family ~Two Family? ~ /Cellar? ~'LSlab? ] ~ Crawl Space? ~ 10-Proposed system: Septic tank ~__/Precast ~ ~Cesspools ~'/Shallow pools ~Other ~ il-Septic tank inside dimensions: Volume Gals.Length ft. Width f.t. Liquid depth ft. 12-Precast sections: ~Number~._/Square'-~. Cesspools: Block sizeL/6 mncs.D 9/ins. HF_~_ins. Total blocks below inlet: ~1_~2 /~3_y_~ PLOT PLAN Street Nc ~th Tes~ ~ze Data Feet 0 2 10 12 (10/65 Revis. ) -- 8-15 -'- The Undersigned CERTIFIES: "Construction of authorized installation: will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewa~eDisposal Systems". Owner or Builder FOR HEALTH DEPART~NT 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. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS INSTRUCTIONS: Applications must be submitted in triplicate 1-Means Owner or Builder. Address to which ~mil 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 "V" items applicable to the proposed new dwelling. 6-Name of sub-division ?-Section Number 8-Let Number 9-Private well: Enter "No" if Public water supply is available. Enter '"les" otherwise. PROPOSED SYSTEMS: Answers to Items number 10, il, & 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: Let 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, & Hays, 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-~O 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 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 8W ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 161944 T~IS C~lFIE~ THAT William Bell-Stack, ~pum Way, e/o Tepee Trail, Southold, L.I. 22 ~,..mi~o, May 23, 197~ andfoundtobein~mplia~ewiththerequirementsofth~rd. FIXTURE RXTUIIES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT 18 18 DRYERS FURNACE MOTORS FEEDERS TIME CLOCKS SERVICE DISCONNECT S E E V I C OTHER A~ARATUS: ~Fu~naoes: l~/ShpS ~-l/12hp !,:otor/s: 1-3/qhp i 1/0 I 1/O ~itewood Electric Co. 11 WhitewOod Dr. Locky Point, Ne~ York 11778 COPY FOR BUILDING DEPARTMENT. THIS COPY OF \ ZI 1 o'. I* I IV.W, 5CAL'E CH ACC. DR. I:R.E A,P.. -ELeVATiON. r' ' SCALE V'~": 170" FR ON "1" ' ELE VAT i OIN ......... ~ ..... :~: ._C'"~"~"-. Lt:"_'t~'~~ ..... _- ·'" OPTIONAL ..... LIC,, I~,, E, .lq.Y. CH ACC. NA'T'H/kt,,i ,.5t LVIE I~ 0,120 q 1'; DR. SHT. 1,, PLAN ALL f~LUMBINC~ + ELECT~..~C~L. ~t~.~LL CON~O~t,~ TO Df~A,W t~ 15Y hi/K'T"H,,~N %i C.X/E' ~ 'A, ID O~IT I or,4 2.^"~ ~LO0 ~. D~ TA.H. i/I .... i:L -- , :r__T' SCALE DF. TAIL OF 2~"'FLO0~ IBEA, I"q5 5~CTION A, A BY N A'FN A N OIZ09l SCALE ACC. CH, DR. ~HT OF