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Home My WebLink About5767-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate O[ Occupancy No. Z~8~2 ...... Date ............. Oct. 221* ........ , 19..~2.. THIS CERTIFIES that the building located at .Pvt. Roa~,,id/8. ]Bay .A.v.e... Street Map No.ll~ ......... Block No... ~ ..... Lot No..-'~... ~t&$~ btax'~ola~. N.,¥o ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... l¢al%..~6.., 19~2. pursuant to which Building Permit No..~76~¢~. - dated ........... 14~'.. 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~ival;e. o~e. famaily. 6wett- .~l~ ...................................... The certificate is issued to . Geerge .W .. ~mith ........ 0wl~el' ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. 13e1~...1.7.1.9.~.2.. b~..Ro..V, ill& .... UNDERWRITERS CERTIFICATE NO ..... 0. ~ ........ .~..~..~.,. ;1..9.~... ................ HOUSE NUMBER.. '3,~0 ...... Street...1~1;. R~ .1~t. 9 .... lt.a~t; .t4&X'~O~t .................. Building Inspector / FORM NO. 2 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? 5767 Z Date ........................... ]{L~3~.... 2~. ......... , 19...~.~ Permission is hereby granted to: ........ 3a~9.....~e~e~..t~ .................. ............. ll~lmmm~lmm .......... ...Il,%,, ..................... to...~...~...a.....~.......~..~... ~...~,~... 4..,g~3,z:{,~ .................................................................................. ot premises :ocated at .....a,o.at,..~..~.~..t~r..~,,~ .......... .(.~..~..r....s.~). .......... ............................................. ~,~at,. ~t~',t.o~.... ~I oZ, .......................................................................... pursuant to application dated ........................~'~BI~. ......... ~...., 19.~{~.., and approved by the Building Inspector. Fee $... ~.,.~F{~. ........ FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. NOTICE OF DISAPPROVAL File No ................................................................... Date .................... JJ~,~.....~. .............. , 19....~. .......... Ile~mdm~.....~.X.......%:l.799 ............... PLEASE TAKE NOTICE that your application doted .................. JJ~Jlh.....~ll ........... , 19.~.JJ.. for permit to construct ...1~.~ ................. at the premises located at......~e~eW,~..~4~' ............ .... .JlJ~I~..J~...A.~I ..................................... Street MSt J~l,~'~ll! JJe~e Map ........................................ Block ........................................ Lot ................................................ is jj~jj~j~j~j disapproved on the following grounds ........... A]~Jle~.t~Jl,..,~.B~JlJJll~t,tt ..... ~e' 'Jea~ "Del~t'"&Tp~e~'e3~t...~eml...)- Jets.. helm.. ~lamt..&..apl~t4~e~.. ~. ...... t~&i~l~t~. ....... ~..fm.e..~....t~%lt..A~....l~.~.~.J....e~..~....ILe.~.~.e.~..~..e.~. ........ ...... ~..~t~...~ell~ .............................................................................................................. Z~fo~aati~ sheet enelosed Building Inspector '~J FOI~ NO. 6 TOWN OF SOUTHOLD Building Dep. ffment Town Clerks Office Southold, 14. ¥. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, in triplicate to the Building 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: I. 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 X Old or Pre-existing Building ............................ Vacant Land Location Of Property ....~..?0.~..~.......?..~.~....~../._~.....k...~.....~..~.?... ~17..~..~...~...~..~..~....~....~ .............. Owner Or Owners Of Property ....~ll~l~,..,~,.R...~....~...~..;~t~lJ~,~,..~,ql...~l~..,.t~., .......................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No. ,.,~..?..~.?.,~ ......Date Of Permit .,~.~.~.?.L~..~...Applicant .~,.~..,~....~...,[,~,...../~....~..,.,,..~1~..~18 Health Dept. Approval ..... ~,.~..~..,..!.~.~.~ ....... Labor Dept. Approval ......... /.~....(.D%, ........................... Underwriters Approval ..... ~......~...~...~..o.....~... .............. Planning Board Approval .... .~...~!.~.. .......................... Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ ......~.......c..r~,... ................... Construction on above described building and p m~eets ~c~1, a;~pl'icabl~odes and regulations. Applicant ............ /..L.~..i _t ....... Z..k.......L....:~ ................................ ~ ............... Sworn to before me this I) ................ day of ............................................ (stamp or seal) Notary Public .................................... County f~J/ SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No.~l -/U~/~- APPLICATION FOR APPROFAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date S/6/72 Approval to construct said systems is requested,pertinent data herewith: 1-Applicant ~,e~p W, S~.~:h PhoneWA'l'2Sg$6-Sub div aS 4e~C~'~d Address . ~ ·, ~ae_~, .Y. --~79~--7-Section 2-Detaile~Vmc~..A~,~.~: ~-;U ~ Bay A~ Hamlet ~SZ ~ To~ ~h~ .9-Private well? 3-~blic ~ter sump/2 ~me Distance to nearest ~in $-~t Size. WidthA~ ft. Length A~ft. (also enter on center plot plan below:) 5-~elting: Single Family~ ~T~ Family? ~ /Cellar? ~ /~lab? / ~Crawl S~ce? / / lO-Pro~s~ syst~: Septic tank ~ /Precast ~ /Cess~ols ~/Shallow pools / /Other / / il-Septic ta~ inside dimensions: Vol~e Gals.Length ft. Width f~. Liquid depth ft. 12-~eoast sections: /~NumbeF~Sq~re Ft. Cesspools~lock size~ ~ncs. Dle~s.H~ns. Total blocks below inlet. ~1/~ ~2 f~P~3 PLOT PLAN Ca.city 42Gals. V~ G.P.M. 5 VACANT VACANT Street ~tva~e R~ad VACANT VACanT VACANT :ate ~th Data Feet 0 2 4 6 8 10 ~6 Indi No 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"./ Date3/6/7~ Signed - - '~ ~ Bull FOR HEALTH DEPARTMENT USE ONLY. Based on the information presenSed herewith, it is the opinion of the Health Department, that an adequate and satisfactory Sewage Disposal System can be installed on this Plot. Date ~/~ ~'-- Signed ( 10/65 Revis. ) S-15 APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS INSTRUCTIONS: Applications must be submitted in triplicate i-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 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 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, 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, & 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-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 l~ atj~n of same: ,n Cesspool lO feet mmnlmum distance from lot lines to center of cesspoo~ Cesspools exterior must be 100 feet minimum distance from nearest wel~ Septic tank exterior must be 75 feet from nearest well ~ Cesspool "Center" must be 12 feet minimum distance from nearest water ~in~ Cesspool "Center" must be 15 feet from house foundation~- Cesspool exterior must be 50 feet minimum distance from surface WaterS~ S~eamSl Lakes & Bays, etc. ': Cesspools must be 20 feet minimum distance from large trees ~ ~ 3 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 FOl~I NO. 6 TOWN OF SOUTHOLD Building Depor~ment Town Clerks Office Soutbold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instruction* 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. New Building ......... ..X. ........ Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property .....R.:..~......W..:.....q.f..f.....W.../.'S.....B..a.~y..~..A..v...e..n..~/..e.~......F..~......s..t......M~....r..i..9.n..E....N...e...w.~.Y..9.r...k. ............. Owner Or Owners Of Property ....G~_,Qr~fL.W,...Sm~,~h..~...Ba~]:;,~ra...Marie..Rm~ lzb, ......................... Radford Minor Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No...~5.~.~.~.~ ...... Date Of Permit ..3~/.~.7../.7..~..Applicant ..~.a..G.~'..~.~..~t~.fl.-.$..a..1..~..~,.i...r. fL.~-~...t..e...r, prises Health Dept. Approval ............................................ Labor Dept. Approval .................~......~. ....................... Underwriters Approval .......... ../~. ................................ Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ / Construction on above described building and permLt me'ts/ all ap~(cal:f/e3znfles and regulations. App,icont ............... .............. Sworn to before m,F'~his . ~ ~) ....''~ .f?Z.... day ......~....~....~....~'...~..LZ~.. ......... "~1 .(.//C~-,, (stamp or seal) No. 52-140-~,250 Qualified In Sutfoik Count'/ "'~ '~"~ ~ommission Expires March 30, 197~/ *$~' 'ZO "E, - Z~.O u ~ :~ $ca/~: EO ': 1" f/! ~.,q. $rown E6t. ZgS. O ~.°.,~,,.~,s,,,~.,,s,.,~:,?~.~ ;.~ ~~ SEAL SHALL NOt 8E 51DER~ wu~ Tnu: cctv/ ~ I~Dr$VATI,~N.5 A~J~ ~_Z,,ITIV~ T6 res,+ tlo/~ 3' i~lov. /6, t97'1. tv9. Srov/n £a1~. ~Q Z95.0 APPLICATION FOR BUILDING PIP, MIT March 16, 1972 Date ............................................................ , 19 ............ INSTRUCTIONS ~ a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. PI .~.. P!~ sho.'.w..la~ I.ac.ation of lot ,a.nd of buildings on premises, relationship to adjoining pmmleee or public itreets or~ areas, anegRqng a ~n~,eo aescrlptlon or layout or properly must be drawn on the diagram whlch Il l~ff of thio appllco~ c. The work c~ by this application may not be commenced before issuance of Building Permit. ~ d. Upon approvdl, of this application, the Building Inspector will issue a Build ng Perm t to the applicant. ,~aeh permit shall be kept on thel~remlses available for inspection throughout the progress of the work. At e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of O~cupancy shall have been granted by the Building Inspector. R~e.A..P, PLI_CATIO~N .!S,HEREB, Y.MA. DE to the Building Department for, the issuance of a Building Permit punmant to the u,a.,ng &nrta urn,nonce or me ~own of .Southold, Suffolk Count, New York, and other applicable Lawl, O~llnances or ulatkm$, for the construction of buildings, additions or alterahons, or for removal or demolition, al hem~n d~cr bed · applicant agrees to comply with all applicable laws, ordinances, building code, hOUsing cede, and regulations. Salt-Aire Enterprises, Inc. (Signature cf applicant, or name, If a ~mtton) 3289 Veterans Hemorial Highway Rm~konkoma, New York 11779 (Address of applicant) State whether applicant is oWner, lessee, agent, architect, engineer, general contractor, elRtrlclan, plumber or builder. BUILDER (Name and title'of corporate officer) Harold Lacy-RecreCazT as described 1. Locat,on of land on which proposed work will be done. ,M~p No.'. ........................................ Lot No.: ....................... c,--~ ~ ~..-~.. N/S Private Road 293' ~/0 Bay Ave. East Marion, N.Y. State existing use a~d occupancy of premises and Intended use and occupancy of proposed comtmctlon: -' cu n '. .V.?:cant Land Existing use aha oc pa cy .......................................................................................................................... go Intended use and occupan:*, New Construction - 1-family dwelling 3. Nature of walk (check which applicable): New Building ...... · ......... Addition ................. Alteration ............ Repair .............. ~..,~.Remova~ .................. Demolition .................. Other Work (Describe) ...................................... 4. Estimated Cost ...~..~..l.~.~g..:...~ ................................ Fee .......................................................................................... (to be paid on fi!lng this application) 5.If dwelling, number of dwelling units .....O~...e. .................. Number of dwelling units on each floor ..................... If garage, number of cars ..... ~ ................................................................................................................................ 6. If business, commercial or mixed occupancy, speci~ nature and extent of each type of use ............................ 7. Dimensions,~w°f q~jsting;' s~ructures, if any: Front.~-. ........ >'-~ ..........Rear ........ ~ ............. Depth ...'~.~ .... Dimensions of same structure with alterations or additions: Front .................................... Rear ......................... Depth ................................ Height ........................... Number of Stories ....... : ........................ 8. Dimensions of entire new construction: Front ....6..0. ............................. Rear ...... ~ .................. Depth ..... .2...8. .............. ..... '/' Otle Height ,~um~bnej' of Stories ...... ].6~].' 77"":'""'"'""' ............... ._. ............ ¥~., ......................................................... 9. Size o~: lot: Front ............................ Rear ................................... Depth ................................ 10. Date of Purcho~ .....D..e..g.~.e...~.f..~.~...[~...7.~; ............. Nome of Former Owner .[~l~xeJ~.t;..G~..~lJal;iJjll31~ ................ 1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ..... .~..0.. .................................................. 13. Name of Owner of premises ....J~....*.....CT...e..°.?..~..e......~...~.t:...JlAddress .....o.~....~.?....O~...t:. ..................... Phone No ..................... Name of Architect ...~j ................................................. Address ............................................ Phone No ..................... Name of ContraCtor Zd~...~.....~ddress ..~...~..~.~ ..... Phone No. ~.?.~.:.?..~..?. · PLOT DIAGRAM LOCate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property I~ines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer Jot. ................ ,--~;~-~.:.-.~.:,.~.~.. ................. ~ ................. being duly sworn, d~oses and says ~ he is the appdcant above named He is the ..................... ~ ............................................. ~ ................................................. (~ co~orate officer, ~ 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 Jn the manner set fo~h in the applicati~ filed therewith. Swam to ~f~ me this ~ ~ --/ __ Natow Publ'¢, ~~~~ ....... Cou,~ WALTER P gEO~ ~ignature of app cant) ' I N~TARY PU~- 'State o~' , York ..i? Z93.0 ~,9¢o/0: $0'= i" F/t/~ b,'o. Building · Constructio? ........ 60 c Building * Constructio~ 3289 VETERAN'S HIGHWAY RONKONKOMA, NEW YORK 11~79