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Home My WebLink About6396-zNO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerfi icnte Occul:,nncy No. Z~.~ ...... Date .............. A~lg... ¶ 7 ......, 19 THIS CERTIFIES that the building located at ... S~S 'Lewl~e' ttoa¢~ ....... Street Map No.. Bay' H~me! Block No ........... Lot No..be... C~ll;eho~ue...N,~a ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... Plat' ' '6 ..... , 19.73 pursuant to which Building Permit No... dated ........... 14~1'. · 9 .... , 19. '7~ 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 .. 'Pl'~,vat~' .ozie. £tmlty .6~'e]::[ .~g ..................................... The certificate is issued to . Olatls~n. Collstlmot~on-¢olep ..... (k~®le .............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health App~bval · .&Iai. · '7" '1'973' · .by. Ro .Vl;l~a .... UNDERWRITERS CERTIFICATE No..Ali~...1be...$97~...by. J., .Kuhaokt, ......... HOUSE NUMBER .. ~ ........ Street ... leslie .Ro~ ......................... I~ORM 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? 6396 Z Dote ......................... .~ ............ ~. ......... 19.~.,~.. Permission is hereby granted to: .... .~.~u~.~r^..~.t~.uc.t,~.....~.oz~ ............. ................ ~.~.~....~.~e~ele..~a~h ............... .............. · el~en ......... I~.Z, ................................ ~o ..~..i. !~..~.e.~....o.~.e... f.~...~l~ ~e. ................................................................................... at premises located at .....~...o.~....~. ......... ..B..~.~.....~..o..~...e.~. ............................................................................. Leslie Road .......................................................................................... .~.~,.~-,~ ................................................ pursuant to application dated .......................... I~:;~. ......... ~ .......... , 19r~,~..., and approved by the Building Inspector. Building Inspector ( FO~M NO. 6 TOWN OF SOUTHOLD Building Delmr~ment Town Clerks Office Southold, N. ¥. ]]97] 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 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 $5.00 3. Copy of certificate of occupancy $1.00 New Building .................... Old o~ Pre-existing Building ............................ Vacant land ............................ Owner Or Owners Of Property ..~.~x~.~...~.....,~.......~..~...~....~.~........~/'...~..~.. ............................................ ~...~.~..~-~...~.. ...................... Lot No......~.-.... Block No ............. House No Subdivision 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~eets al~p~icable codes and regulations. Applicant .......... .~..~..~..~~ ......................................... Sworn to before me thi~ '~r~ /'~' ............ ,... aay aT ....... .~ ..... ~' ...................... or Notary Public .................................... County SUFFOLK COUNTY DEPARTMENT OF HEALTH APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 1 Applicant Address ~.,'~ ~:~;, (.~ /~F~, %,~/~/~-~,/~,/~-6. Section 2. Property location ~'~/V~ /~/ / ' 7. Lot No. ~9 8. Private well Village cC~7,,'~'5 Township ~',~,~/~ 9. Public water 3. Public Water C~mpany name Distance to main 4. Lot size: Width /$~-feet Length 3~~ feet (Enter on center plot below) 10. Sewage Disposa~ystem: A. ~0~gallon septic tank: Precast ~Egpivalent Block B. ~aching pools: Number ~Precas~lock Special__ be in accordance with the Suffolk aras thereto." Date /~' t~ ~J Signed If private well fill in blanks below: Tank capacity ~'~als. Pump G.P.M. ~ Total well depth ~ Depth to G.W. ~ AmoUntwellof wa~.~.in Test Hole Data ..,, Feet o 4 6 10 12 14 16 18 The undersigned ERTIFIES: "Construction of authorized County Department of Health's current installations will stand- ~wner or Builder FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the ~Health Department, that an adequate and Disposal System can be installed on this plot. Date ~7/~ .-~ S i g n e d ~---~---'-'7-~~. satisfactory Sewage S-15 Revised 4/]/72 APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE S~.~AGE DISPOSAL SYSTEMS INSTRUCTIONS: Applications must be submitted in triplicate 1-Means Owner or Builder. Address to which mail should be directed. 2-Meaus detailed description of property location, together with street o~me and distance to nearest intersection of m~in thoroughfare, also Hamlet/Village & Township. 3-Enter name of Public Water Supply District. together with the distance to their main. h-~ter 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: ~ter "No" if Public water supply is available. Enter "Yes" otherwise. 9-Public water: Enter "Yes" if Public water supply is available. Enter 'I~o" otherwise. PROPOSED SYSTEY£: Answer to Item number lO, 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. PI~T PLAN: The following infor~.~tion is required concerning the Applicant's 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 sh~*n on face of this application. 2. Surface waters-Streams, Lakes, & Bays, etc., located within a distance of 100 feet of Applicant's lot lines, must be showu on the plot plan also. 3. YJells 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. h. ~here 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. ~ELL 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- 2~ feet distance from rear and rear sides of property lines when possible. Well- l0 feet distance from front, and front sides of property lines when possible. Well- 50 feet minimum below grade for well point. Well- hO feet minimum into ground water for well point. Well- h feet 6 inches minimum below grade to well head and lateral water pipe. CESSPOOL LOC~ATION: Upon determination of the Sewage & Waste Disposal "tj~pe 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 100 feet minimum distance from nearest well. 3-Septic tank exterior must be 75 feet from nearest well. 4-Cesspool exterior must be 7 feet minimum distance from nearest water line. 5-Cesspool exterior must be lO feet from house foundatie~. 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 I foot to maximum of 2 feet. lO-Bottom of cesspool to ground water ~st be held to minimum of 2 feet. /~pproved ........................................ , Disapproved o/c ............................................................................ [,~ ~ ,~ ~. ~ ,,~.~ ~/~ t ui ding Inspector] ~rO~3~ NO. ! TOWH OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE APPLICATION FOR BUILDING PERMIT · INSTRUCTIONS . a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building 'Inspector, ~ 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 OF public streets or areas, a~d giving a detailed description of layObt of property must be drawn on diagram which is part of this applicetion;~ 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 ke the premises available for inspection throughout the wQrk. . e. No building shall be'occUpied or used in whole or in part for any purpose Whatever until a Certificate of Occupancy shall have~een 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 of the Town of Southold, Suffo[I¢ 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 all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder; owner of premises ,.,~.~....,~-~....~.~..~.....~..~/..~...~....~....~..~..~.. ................................................................. Name of If applicant is~ corporate, signjture of duly authorized Officer. (Name and title of corporate officer) 1, ocation of land on which proposed ~v.ork wil, bedone/Map ,o.:~..~.....d~. ~-No .......... ~ ........................... 5-Ltreet and Number ............ ,,~, ,~,,~', ,~,,~,,,,,,,~,~ .............................. :,,i,: ....... :,,,~',~',,,/~,~,,~,,"~'~",,~,',, ,~,, ............. : ' . . . . . M6nicipality 2, State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... ~,~....~'...~..~..~'... ............................................................................................... b. Intended use and occupancy ......... .~.......~..~1..~'..~.:/~......~....~...~...~,~../..'..~...~'.---- Nature of work (check which applicable): New Building ..... ..'....~.... ....... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demoli~ioi ........................ Other Work .................................... I (Description) (to be paid on filing this application) / 5. If dwelling, number of dwelling units ................. Number of dwelling units on each floor ......................................... J If garage, number of cars ............ ~ ............................................................................................................................. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................................... 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 ...... .~i."~ .......... Rear ....~.~,~. ................ Depth .....~..~.....~.././. ............. Height ........... .~..~'..i ............................. Number of Stories ..... /. ................................................................................. 9. Size of lot: Front ...... ./~.~.'.'. .................... Rear ........ ,/..~.~ ......................... Depth ...'.~..~...¢.~. .................................... Height ...................... ~ .......................... Number of Stories ...................................................................................... 10. Date of Purchase ...'~-~ ...... ~..~, ........... Name of Former Owner ...f~.~..~.....'~../~...,'~'....~.../Z'~Z~../~...~.....~....'~...~. ~.."' /~ ..... 11. Zone or use district in which premises are situated ....... +~.u~...~.. ................................................................................. / 12. Does proposed construction violate any zoning law, ordinance or regulation: ......Z~....4~. ................................................ 13. Will lot be regraded .................................... Will excess fill be removed from premiss: [ ] Y, es ~ [/No Name of Owner of remises ..(~.~.~.dl~.,,~',$~''~' ~-~4¢/Y5'~/'~"~ ~ f/O,~ ,~.,~,(. ',~..Z/~..'..~..,~..(.~, ,~2~,l~,Z.~.~..~.x P ............................................... .................. .... ........ Name of Architect ..... ,~.., ~'.. ............................................................................................ ~ S//~j ~/ (Address Phone No. Name of Contractor .................................................................... i~;J~J';~;~') .................................... i~'t~;;~'~;;~i ............... PLOT DIAGRAM Locate clearly and distinctly all bui!dings, 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 NEW YORK, ) SS COUNTY OF ...................................................... ) ................... ~~~ ....................... being duly sworn, deposes and says that he is the applicant above named. ," ; (Contractor, agent, corporate officd~, etc.) ef 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 ,;tatements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith, T~-,~BI LEE £LAK ~'t'~- ~ ~I[~I'/~J~Y PUBLIC, Sta'~ ,,; 1'~ York ........................ ~ ...................................... '~liiliff~"r~"~,,~7'U,~'Z~fy" ~ ~ /~' / Notary Public, ~~... County ...~~,"~...'. ................................. / (Signature of applicant) SUFFOLKAu~ ? COUNTYl~73 MEALTH~ART,L'EL'T The sewage disposal and ~'a*er facilities for this locai2on have been inspected by this department and found to be satisfactor~__.~ Services NOFF : ~ ~ MONUMENT $UBDIVI$ION ~P FILED IN rH~ OFFICE REVISIONS YOUNG & YOUNG MAY 17tl97~ 400 OSTRAHDER AVENUE, RIVERHEAD, NEW YORK ALDEN W* YOUNG HOWARD W. YOUNG I SURVEY FOR: CORP. LOT NO. 4, :' BAY HOMES" I AT Gu, ~R^ PECONIC \~,~ TOWN OF S OUTH OLD ~~/ BY~" ;G-' - SUFFOLK CO., N.Y. SCALE: I" = 50' DATE:JAN. 25, 1973,IN°' 73-75 /2 Il Il [I! RIGHT SIDE ELEVATION J REAR ELEVATION · I I /2 $ Il-- -- LEFT SIDE ELEVATION FRONT ELEVATION DESIGN 5 54 ISHEET-I PLAN - i TOTAL-$ APPROVED AS NOTED RE: ~/, Z~ BY NOTIFY BUILDING DEPARTMEN] 765-2660 9AM TO 4PM FOR REC ED INSPECTIONS: 1. BEFORE ~ACKFILLING FOU~ TION OR START FRAMIN~ 2, BEFORE COVERING PIPELINE 3. RNAL WHEN JOB COMFLETEE NOT RESFONS:BLE FOR DESIGN OR 5TRUCTION ERRORS AT DA. SINK & REF'G. KITCHEN WALL CABINET ROOF lB, PLOT PLAN RANGE WALL ELEVATIONS GE'N ERAL NOTES PATIO,\ ~ , .. STORAGE *'-~"~'-~'~ ,. , ,'~' [ ~ !-~'), ~ q<'"' ,~:~:,.. 1¢~ -, ,,.,., ' ~ ' ' ' ~*~"~' ~ FAMILY RM. eLIVING R~. ~ ' ~~ ~:~,,~-'~,,~/ n~ -- __,.,..... ~..~. ,~:~;. ~ 0 ~(,-~",,~' ~ ~ ~ ~c~, ~.~ , -?~_~. -~I~FOYE~ 0 ~..0, ' ~ ~'- ...~"~ ~ ,~:~.'~ ~' ~ . O, ~ ~BED RM. BED RM. : ' ~ ~ 0 ~ ,,~. i ~z/¢" /¢- ¢, ~/,_ ~ ,, i SECTION C-C EAM DETAIL FLOOR PLAN DESIGN - 554 PLANe- I SHEET TOTAL-$ SECTION "A" WALL SECTION STAIR SECTION 4-0 L , i_ /qZq ,, IZlq,z BASEMENT PLAN DESIGN - 554 SHEET-$ PLAN - I TO?~L-~