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Home My WebLink About6187-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.~01 ~. ...... Date ........... rOD. .... ~ ...... , 19. THIS CERTIFIES that the building located at ][~l~].Olt .lielul ............. Street Map N~ .~ Block No ........... Lot No. ~ .... $.0~$h0~.. N.*~* ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... 0~..-]~..., 19.~2. pursuant to which Building Permit No. dated ....... ~.~ ..... ~.9 ....., 1~2.., was issued, ~d conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .[~age..~n~. f~l~ .dw~lng ....................................... The certificate is issued to . .~th~. ~ · .gr~or~ ....... ~ ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .F~b...]~...~9~...by R, .~... UNDERWRITERS CERTIFICATE No... ~..~90~... Fe .. al..t 3 ..................... HOUSE NUMBER.~ ........ Street...~O~. ROa~ ................................ FOR~ NO. :~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6187 Z Permission is hereby granted to: I1~ ~.~ ~..~...~.~;;:,.;.~....c.:::~:;......~: .Z4.~. ....... ~ ~.~m~...~...O~'ele~ · . ii~......~ 4.~..--.',¢e ~'oz,ll- ...................................... ~o .....~?~.~...~2~...~.~...~.~..7....~:.~L~-.~.n..~ ................................................................................. ot premises Iocoted at ...... ..'[,(~"~..~ ....... .T..O.}~,y..:,;~..~..~.Z'~ ................................................................... ............................ W~I..P,p~:Le.r...~. ............ ~.o~,~;l,~,....l~,~, ................................................ pursuant to application dated ................... 0.~.~ .......... ~.~ ............... , 19(~"~...., and approved by the Building Inspector. Fee ~.~.~..1. 5 .............. Building InspecVor FO~ NO. S TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. ¥. 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 fallowing; 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 dispcsal--(S-9 form or equal). 3. Approval of electrical installation fram 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 oi~ 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 SB.O0 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 New Building ...../... ........... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ...~'/~.....j~.~.!~..~..~..~....~. ................................................................................ Owner Or Owners Of Property ..../~..~..~...~...~....D~... ....... ~.z..r~.~.,~. ........................................................ Su ,v,s,on ....... ........ ........... .B,oc .o ............. .ouse,o ............. No ~'!~. ~.. ~' Date Of Permit ..D.....~.../..~.T.?..~pplicant..~--~..'~.. Permit Health Dept. Approval .~...¢..'~...../....~.......~.~..)..~......Labor Dept.VApproval ................................................ Underwriters Approval .~'..~......~..~. ...... ../..~..¢).....~... ...... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .....,~.~....2.~/.~...~ ....... Fee Submitted $ ..... ..,¢~..'~.. ...................... Construction on above described building and permit meets all applicab, le codes and regulations. ^ p,,con, .......... Sworn to before me this ~o/~ ff~_r~u /4 '~/'~' ~--e0 W,~ ..... ...~...~..... da~,~ ....~.-~.:....{ .~...~..~... ........ (stamp or seal) Notary Public ."~..~.~ounty FORM NO, 6 TOWN OF SOUTHOLD Buildlng Depo~mont Town Clerb 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 dispcsol--(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. 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 New Building ...Z ........... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ...~/~.....~.~.!~..L..~..~....~. ................................................................................ Owner Or Owners Of Property ....~..~..~:...~...U:....l~.. ........ /~.x..~.~.,~ ........................................................ Subdivision ........~..~- .J~...~T..~ ......... 4/~l~ ........... Lot No....~...~'..~. Block No ............. House No ............. Permit No. ~[~. ~.. ~' Date Of Permit ..~.....~'J~...Z'..6~.T.?..~?'Applicant .~.. ~..~Z . Health Dept. Approval .f...¢..'~...../....'~.......~.~JP..)..~,~......Labor Dept. Approval ................................................ Underwriters Approval ..L~..~.....~../. ...... ../..~..~...~... ...... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .....,~.~....2.~'/.~....~ ....... Fee Submitted $ ..... ,-.~.":.. ...................... Construction on above described building and, permit meets all applicable codes and regulations. App,cont .......... Sworn to before me this ..... do,of ........ Notory Public~\~ounty (stamp or seal) Disapproved a/c ........................................................................................ ,.'~,~ ~ "~'~/ ~'~ ~ ~/~-- TOWN OF SOUTHOLD ~"~e ~" ~/~' m /./- ~..L m BUILDING DEPARTMENT ~ /~ ~ d~ ~ ~ TOWN CLERK'S OFFICE ~ - Application No .............. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. /~ 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 of property must be drawn on 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 appli,cant. Such permit shall be kept on the premises available for inspection throughout the work. : ~ e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occ'~upency shall have bee granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance o~f 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, as herein described. The applicant agrees to comply with ell applicable lews, ordinances,'building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ...... ........................... State whether applicant is owner, lessee, agent, architect, engineer~ner;I ~electrician, plumber or builder. ~'~ 'of owner of premises "' ...~iiiii ............................... i ................. i..iiiiiiiiiiiiiiiiiiiiiiii If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) eo/ 1. Location of land on which prqgosed work will be done. Map No.~.~...~'~.'~.~, ............... ,Lot No.~.~ Str,t and Num~rl' "~-~~~- ~~~/~...~.~..~~..~/~..~~.~~ ~ ~'~ Mumc~liW 2. ~ta~ exi~ing u~ ~nd ~u~ncy o~ p~mi~s ~nd intanded u~ ~nd ~cup~ncy of propo~ concretion; ~. Exi~ing u~ ~nd ~cup~ncy .................................................................................................................................... 3. Nature of work (check which applicable): New Building ...... ~ ....... Addition ..................... Alteration ............... Repair ......................... Removal ................... ; ..... Demolition ........................ Other Work (Description) 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, specif~ nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front .~..~ear ........................... 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 ....... .~...~...E. ................... Rear ..... ~.~...~.. ........................ Depth ....~.~...~.. ................................. 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: ............................................................ 13. Will lot be regraded ......................... ~ ....... Will excess fill be removed from premises: [ ~J'~es [ ] No.. · . 14. Name of Owner of pram.sas "~'~'"~'(Address) ...... '"~" ~Fr'(~'l~;~'~;- Z~ Name of Architect .....................................................................//4 , n /1 /-) ,,~ /~-). , (A_~ldre~s)~ ~')~_ ,~ . ~on~o~: ........... " ....... ~ ........................... ~"~'~°"l~'~'.i .......... " .... Name of Contractor~~..~...~P--,~-~'{~dd~J~r~ss~l.i ..X~..~../- -~.-.~.'~.)~3'~.~'-~'-~ PLOT DIAGRAM I.ocate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. STATE OF NE~OI~,., ) COUNTY OF ..~..~....,~.'...~.~.~.~...~ ....................... ) ~ (Name of individual signing contract) 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 ell statements contained in this appliCation are true to the best of his knowledge and belief; and that the w~_rk will be performed in the manner set forth in the application filed therewith. ................................. ~"-" ...... ~:6~Z~O ........................................... Nota~ Pubiic,~~ County ~,~,,,~....~ ............... ~~ SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference / EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date~ Approval to construct said systems is requested.pertinent data herewith: 1-Applicant;% ' l,P Phon _6 _6-Sub Address~,~7'F~ /~;"~u- ~C. ~r~,~ ~D~/F,~,. 7-Sectior~T'/~_,~_~./,~,~ ~- 2-Detailed prope~y l'cca~io~/[~;j~ ~ ~ 2>~-~,,7,~ ,~=,~~ Hamlet,~,~ .... .,~,~ ~'-'~ T~{~h-~,~-/'4~g~'f ..... 9-~Private well? 3-Public {~a't~ supply name /~/~n~,~_,- Distance to nearest main / 4-Lot Size~ Widt~p~7 ft. Lengthy ? ft. (also enter on,center plot plan b~io{~{)-- - 5-Dwelling. Single Family ~/~ Two ~amily? ~ /Cellar? ~J,Slab? / ~ Crawl Space? lO-Proposed system: Septic tank ~ /Preca/~___/Cesspools / /Shallow pools //Other / / il-Septic tank inside dimensions: ,V9lume Y~Gals.Length ft. Width f.t. Liquid depth ft. 12-Precast sections: /~Number~/Square Ft. Cesspools: Block sizeL zncs.D ins. H ins. Total blocks below inlet: ~1__~2__~ ~3_ Y'~ PLOT ?L~N Capaci~__Gals. ,G ~ade/ ! G .W.L. Data ~eet 0 r 2 6 ~ 8 ~'. 10 ~ ~ ~ Iud5 ate ~ Nc th The Undersign~ CERTIF~S: "Const~ction of authorized installations ~ll be in acco~ance with the Suffolk County Health De~rtments' current Stauda~*~ Bulletins, and amendments thereto, covering Private Sewage D~sal Systems". Date Signed ~ ' FOR ~LTH D~P~T~T US~ ONLY. Based on [ho 5nfomagSon p~o~on~od hor~h~ 5~ ~, ~h, opSnSon of ghe Heal[h De~gmon~, ~hag an adoqua~ and aagSsfaego~ can be installed on this Plot. Date ~/~---- (10/65 Revis.) s-~ Signed ~/"~-~ 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 ~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 Nnmber 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 PIOT 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-lO0 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 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 TITLE NO. 72 SURVEY FOR ARTHUR a EDYTHE AT BAYVIEW TOWN OF SOUTHOLO MAIN BAYVIEW ROAD ?.:,g:-..... · ; ,_... -°.,-%- / REFERENCE: M. GREGORY M~. OF TERRY WATERS MAP NO. ~901. FILED ~C. SUFFOLK COUNTY, N.Y. SCAL.*E ~ I"= 40' MARCH I,~, 1972 SEPT. 18,1972 GUARANTEED TO: CHIGA40 TITLE INSURAN¢~ ~,OMPANY Unauthorized alteration or addition to this surve~4fl~Midlliol&ofEDYTHE M. section 7209 of the New York State Education Law. Copies of this survey map not beadng the land sun, eyor's inked seal or embo~ed seal shall not be considered to be a valid copy. C~uaronte~ or certiScot;ons indicated hereon shall run'only to ,he person for whom the survey is prepared, and on his behalf to the title company, governmental agency and lending institution listed h.r~n .nd to the assignees of the lending JnstitutJorl. Guarantees or certifications am not transferable to additional institutions 'or LAND St,I~ItVEYOR ' NtYERHEAD, N. Y. Un~utherized alteration or addition fo this suwey is a violatio ,f TI TLE NO. 72 S - 01111 survey map n~t beadng fhe land sut~eyor'~ ini mmbossed seal s~aJl not be considered to be a valid co ~s or certifications indicated hereon shall m~ ~ly to is prepared, and on his behalf to governmental agency and lending institution lided 1o the assignees of lhe lending inslitution. not transferable to addilional instituliem MAIN BAYVIEW ROAD e/ SURVEY FOR ,ARTHUR EDYTHE M. AT BAYVIEW TOWN OF SOUT'NOL. D SUFFOLK COUNTY, N. Y. SCALE: I"= 40' MARCH 14s 1972 SEPT. 18,1972 NOV. 27, 1972 FEB. 6, 1973 FEB. 13,1973 GREGORY REFERENCE ~ MAP OF TERRY WATERS MAP NO. ;gOI, FILED DEC.~D, I958 EUARANTEED TO: CHICASO TITLE INSURANCE COMPANY ARTHUR a EDYTHE M. 6RESORY SUFFOLK COUNTY FEDERAL SA'VIN~S ~ LOAN A550C. LAND SURVEYOR RIVERHEAD~ N. ti'. . J SUFFOLK COL~TY EEALTM DEFARTI~ENT DAy,FIB I 3 1973 ~. D. ~F. The sewa~.e disposal snd facilit~e~ for th~S ]oco:~on have bcen ~ ,~ ~ ~ and found inspected by this dod ' ~[ef Of ~ene~!' Services /aRTHUR 8, £DYTH£ AT BAYVIEW TOWN CF SOUTHOLD GREGORY REFERENCE: MAP OF TERRY WATERS MAP NO. 2901, FILED DEC. E9,1958 GUARANTE£D TO: COUNTY, : 40~ 1972 1~,197~ N.Y, CHICAGO TITLE INSURANCE COMPANY 'd=.outh~iz,d ai,e,~lic:~ o~ oddi~ion to this survmART;HlgiRio~efEDYTHE M. GREGORY LAND SURVEYOR N.Y$.LIC. NO.£B?E5 RIYERHEAD~N.Y. =1 ~-C IIL 11' i I T way 'Fi2 MCF. T I%.t- 4I' TITLE GAGLtARDO r,c, oOOlA, ES Ze i .... I~:~--~- "" Il ~l, ~ JOL ~," 1~~- o" ~L aIr ~, ~ ~ ............... :--~-~ ................ ~ ..... ~ ......... ~-p ....................... ~ ....... ~'- ............ ~-- ~l ..... = % ~,* ~ ~ ~_~' ~ ~ ~ I , ', ! ~ ?L 4~ [ -'~ ~.~ ~ ~ ...... ~" ~" ~ ~' 11" _~ ........ I~} 4~ - 698 ~EO~DWAY~ I I'-'1 t' / S p,L.¥v,/rx .p 'l ,/ i No,