The URL can be used to link to this page

Home My WebLink About6884-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..~ .~..0..~ ..~.. Date ~ T~ U [- 7 V ..................... , 19 .... THIS CERTIFIES that the building located at/.~?..~ .L/I .V.~.,-- L .~if?.~....~.~! !Street Map No. 5 ~. ~. ~ . Block No ........... Lot No. { '7 conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... ~.D....~.~.~.7 , 19.W~. pursuant to which Building Permit mo ......... dated . .2..~...~.~..W~..., 197~., 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.~.l..E ........ ~ .~..I,.~. !..L.¥. ..... .~. t.~, .~. ! .~. ,..t,,...~. ................. The certificate is issued to..d..0.~ .~., ~... ~. !'..~.~.? ..... .-'~..T~.. ??./.d..~.~..k~ ! ........ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No. Al HOUSE NUMBER . {.~. ~. ~.... Street...l..~..U. ~ ./..L. ?.~..0. ~ ....... ..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 PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6884 Z Permission is hereby granted to: · T.~..D~.QskJ...~]...wif~ ......................... ........... P~ .. &v~ .... ~a ~t ~.tuc~ .................... to ~J~.ct..~ae.~...o_n. e~..fem~ ~ y...dze Z_~ ~ .................................................................................... at premises located at .~t,...3.~. .......LaM. Z'~I~r. Qort ..F~s:~a,~e.s .......................................................... ................................ ~am'.e l~q~l...~rJ.~.~ ............. ~ve~.]{.~. ................................................. pursuant to application dated ..........................~.]3.q;;.....25. .......... , 19..~.~.., and approved by the Building Inspector. Fee ~ ~,~..,~ ............ ' ' Building Inspector~ FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. Th,s apphcation must be filled in typewriter OR ink, and submitted in DUPLICATE to the Budding Inspector with the following; for new buddings or new use 1. Final survey of property w~th accurate location of all buddings, property hnes, streets, ann unusual natural or topographic features. 2. F~nal approval of Health Dept. of water supply and sewerage disposal (S-9 form or equal). 3. Approval of electrical installation from Board of F~re Underwriters. 4. Commercial buddings, Industrial buddings, Multiple Residences and s~mdar buildings and installations, a certificate of Code cornphance from the Arch,tect or Engineer responsible for the building. 5. Submit Planning Board approval of compleled s~te plan requirements where applicable B. For existing buildings (prior to Aprd 1957), Non-conforming uses, or buildings and "pre-existing" lend uses I Accurate survey of property showing all property hnes, streets, buddings and unusual natural or topographic features. 2 Sworn statement of owner or previous owner as to use, occupancy and condition of buddings. 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: I. Certificate of occupancy $5.00 2 Certificate of occupancy on pre-existing dwelhng or land use $5.00 3 Copy of certificate of occupancy $1 00 Date ...... .............. New Building ...... ~. Add,t~on ............... Old or Pre-ex~sting Budding ................ Vacant Land .............. Location Of Property ........... ..... ......... ............ Owner Or Owners Of Property ...... .J...0(4 ..k.( ....... ..~'.....~....(/..~.....~....~. ........ ...~.....-~....0...~.....~....0...?..L.]..[ ........................ Subdiv,sion ...L.~.,U,..~,...~...Lmm.......~.,.°..0....~,. ..... ..~..G...,..'I~.,.?....,~L. at No..!-,-.l .... Block No ............House No ............ Perm,rNa ...~...~...~....~......~DateOf Permit.~...~..SE'?T. 7V , - Health Dept. Approval ...~-.../..~..U...~....,..I.~r/..~/. .... Labor Dept Approval ................ ~.v..-..~.).. ................... Underwr,ters Approval ...~..../...~....~....~....~...~..-- ....... Planning Board Approval ..............~....~..~..~., ............ Request For Temporary Certificate ...................................... Final Certificate .......................................... Fee Subm,tted $ ........~....~../~..... ............... Construct,on on above described bu,ld,ng~l*ndp~ mee~all eppl~e/ end regulations. Applicant .......~..~.....~.....~.....t..~...~-~.~...~~ ......................................... Sworn to be{ore me this ............ ~n',doy of ..../~..~...CT...~..?.2~-~--- ~...:... .............. t~7.~. (stamp or seal) · ------~'~ Notary Pubhc S a e oF New York Notary Publj,c ..... THE NEW YORK BOARD OF FI~/.UNDERWRITERS BUREAU OF ELECTRICITY.`: !: : ~.' ::: J-- tab 85 JOHN STREET, NEW YORK, NEIW~K IO038' THIS CE~IFIE$ ~AT John ~oskosk~, ~0 La~e~ ~ood ~,m~o. J~e ~5, 197~ ~f°u~rObein~m~ia~ewlththerequi~nts°fth~' ~xm~ RXTU~ ~ ~VENS EXHAUST FANS 3q 38 28 3q D~YERS FURNACE IqJTUlm UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO.O$ FEET srdvICE DISCONNECT S E R V I C Water Heater: 1-~.SKW Moto~/ei 1-3/~hp Ele~to Room Heate~8i 3/0 i 1/o 1-3.0KW 1-2. OKW Soeeph J,Frohenhoefe~ Jr. M~ln Rd. 3outhold, L.I.11971 11 WOOD$~D~ u~ ¥ SUFFOLK COUNTY DEPARTMENT OF HEALTH Heal th Department Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant'~=~Jw ~~Phoneg~°l~ Address a~. ~,~ 2. Property'Locat~onL4~t~ ~**~ ~.-,~ , Village ~-(- Township ~ em~ 3. Public Water Company Name 4. Lot size: Width feet Length, feet 6. Section ~ 7. Lot Number /) 8. Private Well 9. Public Water Distance to n~in 10. Sewage Disposal System: (For Health Dept. Use) A. 900-g~llon septic tank: Precastlj Equivalent Block B. Leaching pools: Number of pools Precast Block ~pecial ll. If private well, fill in the following blanks: ~. Tan~capacity ~-' gallons , B. Pq~J G.P.M. /0 ~ ' C. T~I well depth D. ~th to ground water E. /~i)~unt of water in well~ · TJt~ underj~Jgned CERTIFIES: "Construction of authorized installations will be in accordance with the ~uffolk County Department of Health's current standards thereto. This application will be valid for one year from the date of approval indicated below and may be renewed if~ a current local Building Department Permit is in effect. FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department that an adequate and satisfactory Sewage DispJ~al System and Water Supply can be installed on this plot. APPROVAL DATE~ SIGNED S-15 Rev. 4/1/73 APPLICATION. FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTE~ INSTRUCTIONS: Applications must be submitted in triplicate 1-Means Owner or Bui].der. 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 thoroughfare, 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-Name of subdivision. 6-Section number. 7-Lot number. 8-Private well: Enter "No" if Public water supply is available. Enter "Yes" otherwise. 9-Public water: Enter "Yes" if Public water supply is available. Enter '~o" otherwise. PROPOSED SYSTEMS: Answer to Item number 10, consult the Suffolk County Health Department's Standards for Sewage And Waste Disposal Systems Design of Residential Subsurface Sewage Disposal Facilities. Part I-Residential Subsurface Disposal Systems covering cesspools. PLOT PLAN: The following information is required concerning the Applicant's lot: ~ size-Length and Width in feet to be indicated at the lot 11nes of the heavy lined square in the center of Plot Plan shown on face of this application. 2. Surface waters-Streams, Lakes, & Hays, etc., located within a distance of 1OO feet of Applicant's lot lines, must be sho~n on the plot plan also. 3. Wells and cesspools now on adjacent lots must be shown on the plot plan, together with the distance to the Applicant's proposed Sewage Disposal Systems and well. 4. Where no buildings exist on adjacent lots, state "Vacant" on the plot plan. 5. 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-lOO feet minimum distance from the nearest cesspools. Well- 25 feet distance from rear and rear sides of property lines when possible. Well- 10 feet distance from front, and front sides of property lines when possible. Well- 50 feet minimum below grade for well point. Well- 40 feet minimum into ground water for well point. Well- 4 feet 6 inches minimum below grade to well head and lateral water pipe. CESSPOOL LOCATIOn: Upon determination of the Sewage & Waste Disposal "type of systems" re- quired, the following Standards must be observed for the location of same: 1-Cesspool- 5 feet minimum distance from lot lines to exterior of cesspool. 2-Cesspools exterior must be 1OO feet minimum distance from nearest well. 3-Septic tank exterior must be 75 feet from nearest well. 4-Cesspool exterior m~st be 7 feet minimum distance from nearest water line. 5-Cesspool exterior must be 10 feet from house foundatie~z. 6-Cesspool exterior must be 1OO feet minimum distance from surface waters, streams, lakes, &Bays, etc. 7-Cesspools must be 20 feet minimum distance from large trees. 8-Cesspool exterior to cesspool exterior, must be at least 8 feet. 9-Cesspool cover top to grade must be held to minimum of 1 foot to maximum of 2 feet. 10-Bottom of cesspool to ground water ~lst be held to minimum of 2 feet. FO~ NO. I ,~t~ ~t~e,~~ 4 ~ ~,~b TOWN OF ~UTHOLD ~]7~ ~ ~ ~t~ ~ BUILDING DE~RTMEN~/~¥/~ /~ ~ TO~N ~ERK S OFFICE ~UTHOLD, N.Y. ~ ~'~ ~ I~ ~ ~ ................ ~l~ation No......~.~...l ............... ~proved .............~. ....... ~. ..... , 19~. Permit No.~~ ...~ ~ /~ ~ . ................... ~ ~e'~ ~.~' '- ,so oved ....................................................................... ..................................._ , ........................................................................................ ~l~ ~ ................... .......................... ( APPLIGATI~ FOR BUILDING PE~IT Date ................................ ..... ............ INSTRU~IONS ~. This ~ppllcotion must be complet~l~ fill~ n b~ ~*writer o~ in i~k ond s~mi~ed in triplicat, to th~ In~p~tor, with 3 ~t~ o{ plonk, ~ocurato plot plan to ~al~. F~e aocordino to ~h~u e b. ~lot plan showin0 Iocotion of lot ond of buildino, on premises, re orion*hip to adjoininfl premise~ or public ~reos, ond ~ivin~ a dot, lied do*cription o{ la,out o{prop~ must be drown on th~ dioorom which i~ ~ o{ thi~ app c. lhe ~ork covered by thi~ a~licotion ma~ not be comm*~d befor~ i~uanc~ of Bu Id n~ P*rm t d. Opon opprovol of thls opplication~ the Buildin~ In~p~tor will issue o Buildin~ ~rm t to tho opplicont Such p~rmit shall be kept on tho pr~mises ~voilabl~ {or inaction throu~h~t the work. ' e. No buildin~ sholl be ~cupled or used in whole or in part for an~ pu~ose wh~t*ver until o C~i{icat~ o{ shall hove been granted by the Building Inspector. APPLICATION IS HEREBY ~DE to the Building Department for the issuance of a Building Pe~it pumuant to the Building Zone Ordinance of the Town of Southold, Suffo k County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or a terations, or for removal or demOlit~, os herein de~ribed. The applicant agrees to comply with all applicable laws, ordinance, building c~, housin~c~ d~d regulations, and admit authoriz~ in~tors on premises a~ in buildings for n~essa~ ' ~tio~~~.~~ ...... ~..~...~ '. ................................. ~of nt, or name, if a co~oration) ............................. {Addm~ of ~pplic~nt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No Plumber's License No ................................................. Electrician's License No. ~/~ ~ -' ~- Other Trode's License No ............................................... I. Location of land on which proposed work will be done Map i~o ,~...~?.~. Lot No /~ Street°nd Number "~'"~'~"/"~'f~"Jt~"'°"°'.'~" ..~. ..~f. ...........~i i ...... ......... i' ''/'~"'"i .............. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ~.....~...~ ~ b. Intended Use and occupancy ................ ~ ....................................................................................................... 3. Nature of work (check which applicable): New Building ...... ~... Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ............................................. : ....... 4. Estimated Cost ...............~.~.~ ............................ Fee &~-~ (Description) (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 .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ Height .....(.~.. .......... Number of Stories ...........~ ...................................................................................................... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... .../~.?...'. ......................................... 13. VV'JI[ lot be regraded ....... .?J..e..~.... ........... Will excess fill be removed from premises: ( ) Yes (~() No Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ...............~ ....................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate 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 whether interior or corner lot. STATE OE NEW YOJ~I~,i~' ~ ¢ e ....... ....................~ .~~. "-- ....................... ' be ng duly sworn, deposes and says that he is the applicant "~"/~Ji~,idual signing contract) above n~med. 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 know. ge and belief; and that the work will be performed in the manner set forth in the application ~ed therewith. ~ ~/ Sworn to before me this ~.~ .~ // ~ // // ............. ~...~... day of ....~i ........................ , 19.....~. /~J ,4// ,,-// ///~. Notary Public,. ................................................... County ...... .~..~.., .~.,.- .~........~~~ :., .............................. (Signature at applicant) SUFFOLK COUNTY DEPARTMENT OF HEALTH Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant~'~)~ ~ Address ~ ~' 2. Property Location Length feet Vil'lage ~(- 3. Public Water Company Name 4. Lot size: Width feet 10. Sewage Disposal System: A. 900-gallon septic tank: Precast/Equivalent Block B. Leaching pools: Number of pools 5. Subdiv&m¢~ 6. Section i 7. Lot Number /? 8. Private Well 9. Public Water Distance to main (For Health Dept. Use) Precast Block Special ll. If private well, fill in the following blanks: ::~. Tan~capacity ~' gallons ,~B. Pq)~))G.P.M. /0 "~ ,C. T~al wel 1 depth ~ D. De~th to ground water ~ . E. /~Ount of water in well .l~ ~' T~ under11~Izjned CERTIFIES: "Construction of authorized installations will be in accordanc= with the ~uffolk County Department of Health's current standards thereto. This applicatio~ will be valid for one year from the date of approval indicated below and may be renewed if a current local Building Department Permit is in effect. Date ~-/~?~ Signed~/~ FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department that an adequate and satisfactory Sewage Dis~po~al System and Water Supply can be installed on this plot. .~ APPROVAL DATE~[~_~' SIGNED~'~ S-15 Rev. 4/1/73 765-2660 9AM TO 4PM FOR REQUIR- ED INSPECTIONS: 1. BEFORE BkCKFILL~ FOUNDA- TION OA START F~k STAUCTION ERRORS : L. £ VAT'! £L£ VA, VIo~ 47'-o" 47,_o,, t tv/ Mm£R ............... 5:? o