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Home My WebLink About5766-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.~.~.[~?. ...... Date ............. 0~.t ...... 2 .... , 19 .~2. THIS CERTIFIES that the building located at . liOl'tlS- Ro~..~0 .]l&~Wie¥ · Street Map No. ~ ........ Block No...~ ..... Lot No. ~... 8Olitt~o14 · · ll-,~e ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... Naa'Oil..2?., 19.~. pursuant to which Building Permit No.. ~:~66~. dated ............ llar~t.. 2.~, 19.~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~.i~t~..one. ~amil~..dwelling ...................................... The certificate is issued to ...lto~,ald. & .Nargaret. 8~;ever~ot .... a~raer~ .......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . ~ept.. '25' '1972- · ~y.R.o. 'Villa..- UNDERWRITERS CERTIFICATE No..~.l~ ......................................... HOUSE NUMBER.. ~.~1~5 ...... Street .... NCr. th. llOitd, tO- ,B&~J~I' .................... Building Inspector TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N~ ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UI' COMPLETION OF THE WORK AUTHORIZED) N? 5766 r'lL FULL Z Dote ........................................... !ff,~ ................ Permission is hereby gronted to: ...... aie~.lt~.~me.~ ......................... I. ........... at premises located at ...... ~"~"~ili~"~"~;~ ...................................... 7i ................. pursuant to opplic:otion doted ............................. #I~....~l~ .......... , ,9...~., ond opproT? by the Building Inspector. i ~ Fee $...~,~ ......... Building Inspector SUFFOLK COUNTY DEPARTMENT OF HEALTH APPLICATION FOR AP~AL TO ~NSTRUCT PR~ATE S~AGE DIS~SAL SYST~ Date M~ Approval to const~ct said systems ts r~uested,pertinent data here~th: 1-Applicant~ ~, ~T~ ~ Phone~-~-4~5~6-Sub div Address ~ ~ ~. ~ ~N.~ ~ ?-Section' 2-Detailed p~pe~y location B~yu~6~ ~, 8-Lot No. Hamlet ~ To~ ~v%~ u~ 9-Private well? 3-~blic ~ter supply ~me ~ Distance to nearest ~in 4-Lot Size: Width~$ ft. Lengthen5 ft. (also enter Qn center plot plan below:) 5-~elling: Single Family ~ r~ily? ~ /Cellar? ~N/Slab? ~ fCrawl S~ce? lO-Pro~s~ system: Septic tank f /Precast ~yCess~ols / /Shallow ~ols il-Septic ta~ inside dimensions: Vol~e Gals.Length ft. Width ft. Liquid depth ft. 12-Precast sections: /~Number/ /Square Ft. Cesspools: Block sizeL incs. D ~s.H . ins. Total blocks below inlet.~*' ~lf ~ ~2 ~T P~N rade Capacity~L Gals. 6 k,z~,~-,~, t~T Nobt Data ?eet ~aw 0 ~ 2 6 8 ~ 10 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 Sewage Disposal~ Systems". Owner 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. Date APPLICATION FOR APPROVAL TO CONSTE~CT 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 ~ain 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 ?-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, 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 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-lO 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 graSe 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 I~ORM NO. $ TOWN: OF SOUTHOLD Building Delmr~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: I. Final survey of property with accurate location of all buildings, property lines, streets, anti 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. Date ~.q..'?.~..-:.~.. ~ ............................ New Building .--~..?... ............... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ..~,..~...YI.~J.\~......~... ............................................................................................... Owner Or Owners Of Property ...~/~./~.~..~....~..~,~.~.'TZ.. ...... .~..~:...~...~..~.-'~'T.. ............................ Subdivision ................................................................ Lot No.......---*. ..... Block No..'~.... ....... House N~ Permit No.~.~.-P,~.I~..-~.. ...... Date Of Permit .~...T.'l...-..')....~:......Applicant ..~.'~.. J~.~.~.~.....~.....,~t..~......~.....~....~..o...-['. ..... Health Dept. Approval .?..~...2:..~.::.?....~.. .................... Labor Dept. Approval ...... ~ ................................. Underwriters Approval ...~.~...'~....~..:...~....~.. .................. Planning Board Approval ...... ~ .......................... Request For Temporary Certificate ........................................ Final Certificate ........"~.. .............................. Fee Submitted $ .................................... Constructionon above described building and permit meets all a~ulations. Sworn to before me this ...~. ........ day of .....(~..%..~:...?...x~.....%..% ............... (stomp or seal) ~¢+% 7 Nota~ Public~.~.. County TERR[ LEE ELAK tIOTARY PUULIC, State No. 52-616~;~,'~ Qualified in S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date SEP 25 1972 Bldg. Permit No. TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located have been inspected by this department and found to be satisfactory. SEP P, 5 1972 Chief of General Engineering Services I~OEM NO. $ TOWN OF $OUTHOLD Building Del~tment Town Clerk~ 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 ar 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 ~ Old or Pre-existing Building ............................ Vacant Land Location Of Property ..~.,....~..~.~/?d.k~J.....~ .......................................................................................... Owner Or Owners Of Propert;-..\....'..~.. ~¥..~....~...~Y~..1.~(~.~,(~,-...~"..~. ....... ~..~'~-.9...~,,~.e..'~'.. ......................... Subdivision ................................................................ Lot No ......... ~-.... Block No....~-~T....... House No ............. Permit No..~....-/k~.~.."~.... Date Of Permit ..~.~.-)..-..~..~.....Applicant .~..Q~.~.~..~........~. ~....~.-~'..~..~...~..~...9.?~... ..... Health Dept. Approval ...°1,.':...~...~...~..~....~. ................. Labor Dept. Approval Underwriters Approval ...,,~....'T....'~..~.T...~..~ ............. Planning Board Approval Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ .................................... Construction on above described building and~permit meets a~~___and regulations. App'icont ..~........~.~.....~.. ......................,~ ........................................ Sworn to before me this . .~.....~....... dc~y~f ......(~.....¢-.~...°...~....~,.,..~...~...~.....~'.. (stamp or seal) Notary Public~..-~...~~. County T[RRI LEE F,~ J~GTA,qY PUBLIC, State al Hew York No. 52-616~95 Qualified in Sulfo~k Coufi[~ ~ission Expues ~8rch 3~ [9 TITLE NUMBER ~ ~ ~/O~__~ BUILDER'S NO. SU~¥EY NO. KENI~TH' C: FRfNI(> "' ROCKY POINT , L.t., N.Y. LOCATED IN /~A'f"V/EW. SUFFOLK CO, N.Y. CHIICKI:D .~CALE ! IN. -~4'0 FT. LOCATED IN SUFFOLK CO. N.Y. C~ECKEO SCALE I IN. ',,,dO FT. TITLE NUMBER BUILDER'S NO. SURVEY OF' ,~-.~c,~/~'~-/c/~- .~.~,~c~-~ K E NNETH C~r F R IN K SURV~'YOR ROCKY POINT ~ L.i,~ N.Y. LOCATED IN ,~AYV/E'~.I, fOg, L/c,,':' SUFFOLK CO. N.Y. C.~CKEO ,.E~.,... JUeV~ SCALE 1 IN. "~4rO FT. <,, FINAl. ~.~"'~=~X~. TOWN OF SOUTHOLD BUILDING DEPART~NT TOWN CLERK'S OFFICE S~THOLD, N. Y. INSTRUCTIONS o. 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 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 o Building Permit pursuant to the'~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, OrdJnanc..es or~ Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descnbed. The applicant agrees to comply with all applicable laws, ordi nonces, building code, housing code, and regulations, ............................................ (Signature of applicant, or name, if o corporation) .... .......... ........... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumbe~ or builder. Name of owner of premises .....~..~.J~.k~.....~.~....~.T~;~....~..~. ............................................................................................. If applicant is o corporate, signature of duly authorized officer. ~ ~~ .................. ......... Location of land on which proposed work will be done. Map No.: ........................................Lot No ......................... Street and Number ..~J~:t.~..~......~Jh......'~.....~JJ~.~l~/.~.J~ ........................................................................................... ~l -'-- .~ ~'-~'.J~ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ......'~.~..~.~I~....T. ................................... ~ .................................................................. b. Intended use and occupancy ...3....?..~...~...~.k-.~/.....~....~).~..~Id..T..I.I~L- ............................................................. 3. 4. 5. 6. 7. Nature of work (check whi~[ cable): New Building....:.............""J Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ Estimated Cost~ ............... ~..~..~....~.. ............. Fee ....... .~....~......°.;..~........HZ..~.. ...................................................... (to be paid on filing this application) If dwelling, number of dwelling units ..... ~ ......... Number of dwelling units on each floor~.~...-f~.....~..~......~...~...c...~'. If garage, number of cars ...... ..-~...~...~.. ............................................................................................................................. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ Dimensions of existing structures, Jf 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 ...~..~.c. ................. Depth ..."~...~..~. ............. Height ~..~...~ ............. Number of Stories ...... !...~-... ......................................................................................................... 9. Size of lot: Front .~.~:.~. .............. Rear ...~.b~.'~ ................. Depth~..~.~.~.~.?......Y=..~(~.~..O 10. Date of Purchase ........................................................ Name of Former Owner ...~...~.. ................................. 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ....~.l~ .................................................. 13. Name of Owner of premises~.-i~.Q....~t~g~..~...Address ...... .~,..~[M,~I.....~.~¥. ....... Phone No.~..~..-..~..:..~% Name of Architect ..~..~s..~.g'..,...~,...[.J~d.~.t$~. ................. Address ...'~..~..~['. ....... .~:.x/. ......... Phone No.~,.'~'....T..q.-J..~..I Name of Contractor ~.~.~.. ...... ~..~l~.6~......Address ...~T.~...~.~I~B,t.¥.~.~. ............Phone No.~..~...~...~.°0 PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock 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 NEV'/XYJDRI~,/. ~, / ~'S S C° NT ° ......... ,¢':=~T.~.: ................. being duly sworn, d~oses and says that he is the applicant tmame of individual signing application) above named. He is the ...................................... ~ ........................... (Contractor, agent, corporate officer, etc.) of said owner or ~ners, 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 ~at the work will be ~rformed in the manner set fo~h in ~e applicatim filed therewith. Swam to ~for~me this . , z' .................................... Nofa~ Pub[ic, State of New Ye~ No. 52-0344~63 Suffolk County Commission Expires ~ 30, 19 ~ ~J L Z !t