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Home My WebLink About5770-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~..8 ...... Date .............. Oct, .....~ .... , 1973. THIS CERTIFIES that the building located at i~ill~..Terrace. Lane .... Street ~.~.~-4VI~p No. Igilow. ~err~ock No ........... Lot No...I~ ...... 0rie~tt .... 1~ ,¥., ......... _~_....~'~7)hforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ~ .... 28 .... , 19.72. pursuant to which Building Permit No. dated .......... .1~..1'. .... .~.., 19.72, 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~,~.va.te · one .fal~t. ly. d~ellZu~ ....................................... The certificate is issued to . Zr~g. B~l'lll.te~ll ........ ~r~eF ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ........ Oat.. ~[.. UNDERWRITERS CERTIFICATE No.. ~. ~9~.~ ..... DOC...~.. ~1 ~'_~2 .................... HOUSE NUMBER .... ~ ~.~.O .... Sn-cet ......Igll].O~. T®~rac®. Lane ..................... -. |]tti - g 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? 577O Z Permission is hereby granted to: .q~.$....~..~...~....c.g., .~.... ~ .~........z..~, at premises located at .........~):~...~.....W~eal;..~e~l~Z,&O~ ................................................................ .................................................... M~ll~..Ze~aea..l,az~ ................. O~'Aea~ .............................. pursuant to application dated ............................. ~,Z.....~8 .......... , 19...~r~,, and approved by the Building Inspector. Fee $...~...,.~ ......... ..... ~rr INCLUDES APPROVAL 'TO ~,EMOVE EXCESS FILL F?,OM ABOVE pREMiSES BYi~ Ci~V~WAY coNSTrUCTION ~ CE:~POC'L CO~iSt~UCTION ~ CELLAR CONsTRuCTION z ~ TOWN OF SOUTHOLD Building Depor~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 triplioate to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of oil 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 certifioate 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 ......... ./. ~./..'~../.. 2..~.... New Building ..f~-..~'.... Old or Pre-existing Building ............................Vacant Land ............................ ~ Location Of Property ...... ~..J.~,.~/,~..~ ....... .~....~.'~.~..(~ ................... ~...~ ................. ~ner Or ~ners Of Prope~y .~.~...~..~.e~....~.....~~.~. ....... ~..~.~ ~ Su~ivision .~.].~.A~N ....... ~~.~..Lot No.....~... Bilk No ............. House No ............. Permit No. ~Z~.~.Z Date Of Permit ~/~pplicant ~__~....~ ~,~ ~ ~ Health ~p, Approval ~.~... Lobar ~pt. Approval ......... ~ ~?* . ..................... Un e.w.i,e.s ......... ...................... .oo." *pprovo ..... ............................. Request For Tempora~ Ce~ifioate ........................................ Final Ce~ificate ~. ..................................... Fee Submitted $ ~ ~ Sworn to before me this Applicant ...... .~'/.~.....~ ........ ~ .~-~;~.,. .......... ~ day of ....... ~ ...... /...L-?.-.~...-.- (stamp or seal) Notary Public .................................... County SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No · ~ EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APP~OWAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEF~, , DateJ~/ Approval to construct said_systems is requested,pertinent data herew~n. Address 7-Section ~ r, , 2-Detailc~l property loeation ,,~ '-Lot No. Hamlet ~J~w'~ ~9-Private well? 3-Pablic ~w~.t~r .m~pPly name /t,/~ .~., Distance to nearest main g-Lot Si~e. ~tdth~.~£t. Lengthff. a~[£to (also enter on center plot plan below:) 5-Dwelling: Single Family ~l Two Family? f /Cellar? ~.~.Slab? f ICrawl Space? lO-Propo$od system: Septic tank g /Precast ~ yCesspools ~j'Shallow pools y yOther il-Septic tank insi.de dimensions: Volume Gals.Length ft. Width ft. Liquid depth ft. 12-Precast sections. ~ FNumber/ /Square Ft. Cesspools: Block sizeL~incs. D~ins. H~ns. Total blocks below inlet: ~1~2~3 PLOT PI~N Capa eity~'~Gals. O T~st ~ ~1~ Data ~eet 4~ 0 ~ ~ l0 ' ~ ~ ~ Indi Lt Nc ~h The Unde~sign~ CERTIF~S: "Construction of authorized installatio~ will be in aeeo~aneo wi~h ~ho Suffolk Court[ a~ amendments thereto, covering Private Sem~e Dis~l Systems". _ , Signe~ it f~ the FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, opinion of the Health Depa~ment, that an adequate and satisfactory Sewage Disposal System can be installed on this Plot. Date / ~' ~/~' (10/65 Revis.) s-15 Signed APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS INSTRUCTIONS: Applications must be submitted in triplicate i-Means Ownpr or ~B~ilder. Address ~to which mail sh_ould be directed. · ~ ~ 2-Means detailedl description of propert~ location, together with ~r~et nAm~ ~nd distance ~o~nearest intersecti~on of main tho.rofare, also Hamlet/Village & Township 3-Enter name ~'f Public Water Supply ~Dist¥ict~i together with 'the distanc,e to their main. ~-Enter Length and Width of Lot und~ 4pp~opriata~h~ading, also enter ~hese~ ~im~nsions on center plot plan shown on the face of this applicat~ion. 5-Dwellings: Check-mark "V" item~ applicable to the proposed .new dwelling. 6-Name of sub-division 7-Section Number · 8-Lot Number~. 9-Private well: Enter "No" if Public water supply i~a avail$~le. Enter '~es" otherwise. PROPOSED SYSTEMS: Answers to Items number 10, li, & 12 please consult the Suffolk County Hea~th Department's Standards, Bulletins and Amendments for Sewage & Waste Disposal Facilities. i.e., .Part II-Residential Sub-surface Disposal Systems covering Cesspools Rart III " " ~ "# ~" ~Septi¢ Tanks Part IV " " "" ~ !" " Unusual soil conditions Part ¥ " " " ~" '~ " " Shallow Leaching Pools PLOT PLAN: The following information is required concerning the Appl-icant's Lot: Lot ~ize-Length and Width in feet to be indica~Yed at the LOt lines of the heavy lined square in the center of Plot Plan sh~own on face of this application. ~Surface waters-Streams, Lakes, & Bays, etc.,~lo~ate~t~in 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 th$ Plo~ Plan together with the distance to the AppliCators prgpos~d 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, l~ft or ~ear, enter street name. WELL LOCATION: To locate the well .&sewage dispo~aI $~stems on Appl~c~n~t~s~.~lot, the folle~ng Sta~dards must be observe~: ~.~W~ll-100 feet minmmum 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 j'~ Well-50 feet minimum below grade for well point /' W~$11-40 feet minimum in_to ground water for ~ell point ~ ~ei~-$~ feet 6 ins. minimUm ~elow grade to well'h~ead and lateral water ~ipe CESSPOOL$?LOcATION: Upon determination of the Sewage & Waste disposal "type of~ systems" required, the following Standards must be observed for~ the location of same: Cesspool-~? feet minimum distance from lot lines to center of cesspool Cesspools exterior must be i00 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 ~c~nter"/mu~t be 15 feet £~om hous~ foundation ~ ~ . · Cesspool exterio~must be 50 feet minimum distance from surface ~aters, S~reams~ La~es & Bays, etc. Cesspools must be 20 feet minimum distance from large trees Cesspool center to Cesspool center must b: at least 16 feet Cesspool cover *top to grade must be held to minimum of 1 food to maximum of 2 feet Bottom of Cessp~o. ol to ground water must be held to minimum of I foot BUILDING DEPARTMENT~_ TOWN CLERK'S OFFICE ~THOLD, N. Y, 19..~.~ ~ 19 ........ Pemit No ..................................... Di~pproved ~/c ............................................................................................. Approved (Building Inspector) L APPLICATION FOR BUILDING PERMIT~ Date .................. iNSTRUCTiONS , ' a. This application must be completely,filled in by b/pewrit&r or, in'Jnk and st~bMitted, 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:~his appl cat on. c. The work covered by this application may not be commenced befOre issuance of Building Permit. d. Upon apptbVOTm-~;,,~ ,~;,,.'U;k,,,, ;;,~ ~...:',J;;.~ L,o~.~.t~, ~ill :;~: ~ .~;;'.~;~.~g..laer~t to the ~ppl~aOt, Such perm't% shalle, beNo,kept on the premises Occupancy shall have been granted by ding l~ctor. APPLICATION IS HEREBY Building Zone Ordinance of the Regulations, for the construction , The applicant agrees to comply v State whether applicant is owner buildings, additions or alte ap. ica,ble lows, the New or for of a Building Permit .pursuant to the and other applicable Laws, Ordinances or or demolition, as herein described. housing code, and regulations. nature or name, if a corporation) applicant) ~ lessee, agent, ,~ral cc~ntractor, electrician, plumber or builder. Name of owner of premises ...................... * S ~ - (Name~nd title of c~ote bfficer) ~ ~ which prior, work w~e done. Mop No.:~~ ~ ~. ...... ~ 1. L~ation of la~ on .......... Str,t ~d Number ..~~~~ . ~~..~*~ .~ // '- · '"' 2. State existing use and ~cuppncy of premis~ and intended use and ~cu~y of p~sed c~str~ti~: o. Exisiting use and occupancy ......... ~ ' ~' -~ ~~'~~"Z .................................................. b. Intendeduseandoccupancy ..... ~ ~'/~~'~'":'JJ~~al~i .................... whether Interic.,,.'" ~...,.' ',,4. 1~ 3. Nature of work (check which applicable): New Building ...... ~.. Addition .................. Alteration .................. Repair ................. .,,~emoval .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ....~'/¢....~..~/..~.I~..~..~..ILO.~" ............. 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, speci.fy nature and extent of each type of use 7. Dimensions of existing structures, if 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 ..... ~"~.. ............. Depth .~..,~...--~ .~....."./~ Height~....~/~-~.^ Number of Stories .............. /... ................................................................................................... 9. Size of lot: Front ..... ~.~...&L..~._,_Rear ...... .~.4~.O...../. ............. Depth ........ _~~__~~..~..1~..~ .... ~-~ 10. Date of Purchase ............ ~../.~.../...~?P -. ............ Name.of Former Owne .g~-.~:ll~s~,..~..~ · i .... ~' ° ii. Zone or use d,str ct:.m wh,d,/prem,ses are s,tuated ~~~.4~e~ ............................. 12. Does proposed construction ~olate any zoning law,_ord,nance or regulation? ..... ~.~. ............................................. 13. Name of Owner of premise~:~'...~l~lr~i~l~.~"'~ddress ...~..~.:~..Phone No ..................... Name of Architect~__--~'"~'"'"" ..~'-.::~...,~..'4~.,~.x..Address~- ............................................~' Phone No ..................... Name of Contracto ~ ~Address ...~.~.-....~1~,. Phone 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 accordin~ to c~e~l~ and ,hn~ ,trinet nnm~_, nnd indicate (Nd~ bf individual signing a~lication) ~ ~~ (Con~ract~,'agent, cor~rate officer, ~c.) of said owner or ~ners, and is duly authorized to perform or have performed the said work and to ~ke ~d file this application; that all statements confined i~ this application ar~, true to the best of his knowledge and belief; and that the work will be performed ~inthe manner ~t ~in t~& applicah~-fil~d therewith. Swam to beforeme this ~~~ ~~ Coun~ ~ ~ (Sign~m of opplican~ ~ Nota~ Public, Stole o~ New York No. 52-0344963 Suffol~ Coun~ OFFICE -- ~ HIg¥3H 30 IN3Hl~¥~30 The 'Te,v~'3 dizpo~al a~ water Supply Chief of GeneraI Engineering SePvicos B4 Y £,~om,