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Home My WebLink About6413-zFORM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy No. li~2(~O ...... Date .............. ~.... 1~...., 19. THIS CERTIFIES that the building located at ...~/~..~&~';t'/~. g.~..~...Rd.. .... Street Map No. ]~ass,. 1~,. Block No ........... Lot Bio. 3~1~ .... CB~ChOglI~ ..... ~.~1[, ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... i~reh...¶6, 19.73 pursuant to which Building Permit Bio..61~l~Z. dated ......... ~ ..... lfi ..., 19~.3., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is P~lV~Ie. Ol2,e..fa~y. ~11~ ....................................... The certificate is issued to .. B~oad~ater.s .¢onat;ruc.t1 nn .Cort~ ....... 0e~ ...... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .~..ly....~.6..~97~....~. ~:. ¥.i.l.!.a ..... UNDERWRITERS CERTIFICATE No:...~'...0~.~'~ ..... .$. ,1~.... ~... 'J~i ............... HOUSE NUMBER...~0~. ...... Street ........ ~.~1':1,~011. ]~[g[, ......................... ......................................................... 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? 6 13 Z Date ....................... ~h ........ 1.6 ......... , 19.~3.. Permission is hereby granted to: R~ma~h~t ez:~...Co~ ~.t~ t&on ..C.o~:p .......... ......... B~..t'~.29....'~t...~9~ ................................ ............ Ro~k~7"Foirzt'"'q~-~-Y'~ ............................ to ...T;~;L3~..~a~..~.n~...ga,~L.t~'...~re;b:L.J~g .................................................................................... at premises located at ,.~:O~..~LF ....... .~a'~,~frl"~ ............................................................................. ..................................... ~a~.rJua~.to~..~ ......... ¢~e~o~e-....; ...................................................... pursuant to application dated ................ ~a~'""%6 ....................... , 19..~?.~., and approved by the Building Inspector. Building InspectoI TOWN OF SOUTHOLD Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Insfructions 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 unusua~ 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 3. Copy of certificate of occupancy $1.00 $5.00 Dote ..... .................. New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Lo,or,on Of Property Owner Or Owners Of Property ~'~/~.~.~.. ........ ~.~.~'~-J~ ................................................................ ,vis,on ............. ............. Permit No..~....~.~ ..... Date Of Perm,t~....~.....App ,cat .~ ................... ~Z ......... Health Dept. Approval ~ .......... .~:..~ ....... Labor ~pt. Approval ................................................ Underwriters Approval ~..~x...:~.~.;:.~ ......... Planning Boa~d Approval ........................................ Request For Tempora~ Ce~ificate ........................................ Final Certificate .......................................... Fee Submitted $ ..~ ................ Sworn t~before me~. ' ~~~}0~/~ ' ..... [.~.'~.. day of ...~..~'~.....~..~..~.~.~... (stamp or seal) SUFFOLK COUNTY DEPARTMENT OF HEALTH H.DoReference APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date ~pproval to construct said systems is requested,pertinent'data herewith: , 1-Applicant ~ t~'~g.~~ $ ~m~ ~-f~Phone'~q~0%~6.6-Sub div ~$~f~T Address ~ ~q ~ ~ ~k~,~d~ 7-Section ~ ' 2-Detaile~property locatio~/~~g~/~8-Lot No. ~ .~ Hamlet~ ~)~ To~°*A*f~. 9-Private well? 3-~blic ~ter s~pply name ~ D~stance to nearest ~in 4-Lot Size. Width~ft. Len~t~ ft. (also enter on center plot plan below.) 5-~elling: Singl~ Family ~r~ Family? ~ellar? ~ Slab? ~ Crawl S~ce? 10-Pro~sed system. Septic tank ~re~Cesspools ~ /Shallow pools 11-Septic tank inside dfmensionsf Vol~als.Lengt~ ~t. Width ft. Liquid depth ft. lZ-Precast sections: ~Mumber~$~ySquar~t. Cesspools:' Block size~ ~incs.~ius. H~ns. Total blocks below inlet: ~1 ~2 PLOT PLAN Ca pa cit~0al s. G.P.M. o~ ,Qrade / ! 8~ o Da~a ~ee~ 0 4 6 8 10 12 ~4 ~6 18 The Undersigned CERTIF~S: "Const~ction of authorized installations will be in accordance with the Suffolk County Health De~rtments' current Sta~a~s, Bulletins, and amendments thereto, covering Private Sewag~ Dis~sal ~stems". FOR ~ALTH '~NT USE ONLY. Based on the infomation presented herewith, it is the opinion of the Health Detriment, that an adequate a~ satisfacto~ Se~ge Disposal System can be installed on this Plot. Date .f//~/?~ Signed (10/65 Revis.) APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS INSTRUCTIONS: Applicatione 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 ~tain 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 "Yes" otherwise. PROPOSED SYSTEMS: Answers to Items number 10, il, & 12 please consult the Suffolk County Health Department's Standards, Bulletins and Amendments for Sewage & Waste Disposal Fa c~itie s.~i. e., II~sidential Sub-surface Disposal Systems II~ " " " " " covering Cesspools " Septic Tanks " Unusual soil conditions " Shallow Leaching Pools ~he following information is required concerning the Applicant's Lot: ~t size-Length and Width in feet to be indicated at the Lot lines of the square in the center of Plot Plan shown on face of this application. waters-Streams, Lakes, & Hays, etc., located within a distance of 50 feet~m~Applicant's Lot lines, must be shown on the plot plan also. ~e~lls 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. W]~LL 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 minimumdistance 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 ~ESSPOOLS LOCATION: Upon determination of the Sewage & Waste disposal "type of systems" required, the following Standards must be observed for the location ~ of same: Cesspool-10 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 I food to maximum of 2 feet Bottom of Cesspool to ground water must be held to minimum of 1 foot 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, wit 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, am 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 applicant. Such permit shall be kept or the premises available for inspection throughout the work. e. No buildim~ shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREi~Y MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone~- Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction buildings, additions or alterations, or for removal or derr~lition, as herei.n:described. The applicant agrees to comply with all aDPlicable 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, amhitect, engineer, general contractor, electrician, plumber or builder. g .................... Name of owner of premises .J~.~.~...~..J~.~.~..~.J~.~....,...~.j~.~..~,. If~aDpli.cant is a corporate, signature of duly authorized officer. ~ (Name and title of corporate officer) 1. Location of land on which proposed work wiil be done. Map No.: .~.~ .......................................... Lot No~.l~..~.... Street and Number ~'~....~~.~J~.....~.(~....~ .~......~J.~.~r~.~.~j~'~ .................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy ............................................................................ ~., ..................................................... upanc .... -- ............................. Intended and use Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... J Description) 4. Estimated Cost ..... ..~...~..~..~,-..~.. .............. Fee .....'~....0..:..~...0.. ............................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... ./. ......... Number of dwelling units on each floor .....................v .................. 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 ............................................................................. r)imensions of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front ...... :.~,.../.. .......... Rear ...... r...7.. ............... Depth .... tteight .....~.~., ..................................... Number of Stones ...... .~. .............................................. ~.~ .............................. 9. Size of lot: Front ....~,,~..~,,.,.~..~,, .............. Rear ../,.,O,~ ................................ Depth ...,,~,.~..., ................................... 10. Date of Purchase ...... ..~..~..J..~.. ................... Name ..... ~ [) .~..tl~ ........... ot I-ormer uw,~r .../~..L, ........ .y. .................................... 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 -~y.~...~.. ..................... Will excess fill be removed from premises: [~'Yes [ ] No 14. Name of Owner of premises ]~,~I~LOJ~.T~'.~,~ .0,~.~~....~..L.~/~...I.~..~I~.~.(~. · ' ' J (Phone No.) (Address) Name of Architect ...... i~"~'"~'"~;~"~'"'J~'"'""~'~'~"~-;'''''~'~j~'~'~i~ 1/ k,_~ [ (/ g',[~ ,r/' ................................... iJ~'~'~"~'~"i ............... Name of Contractor ~-~ '~'-~-~ ' "~'~"¢'~"~Jd'r'~ss) ............................ i~'l~'~'~lo.) .... PLOT DIAGRAM I'ocate clearly and distinctlv all buildings, whether existing or proposed, and indicate all set-back dimensions from propertv lines. Give street and block number or description according to deed, and show street names and indicate wheth- er~interior or corner lot. ~} )~Q ~__.. ~ A..) 7-'~ -- --- ) STATE OF NEW YORK, ) SS COUNTY OF ...................................................... ) He is the ....... ~.~.~.....t..~..~. ..................................................................................................................................................................... (Co~¢t~ctor, ~e~t, corporate officer, of said owner or owners, and is duly authorized to ~rform 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 knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. ................. .................. o, ...................... ,, ........................................................... ................ 4O6 40? GUARANTEED TO: SOUTHOLD SAVINGS BANK JOHN R and DIANE M DEMPSEY HOME TITLE DIVISfON--C.T ~ CO. (LOCATIONS AS PER eUILDER) CESSPOOL 0 409 '~/'1 0 WELL ( A~ROX LOC SU~'~O.'LK COUNTY HEALTH DEPARTNEN~, ~ ~he sewage disposal and water supply facilities ~or this location have been inspected by this department and fo~hd R EDATED 6-[5-7:5 Chte~ of General Engineering ~,~ Services SLI/~V~,v OF LOT /~4P OF IV~SS~I/ POIAIT CLU£ P~0~£/~?1£S, /A/C - F/led; May 7~ t926 File /Vo : 806 AT; A/.4S$4L/ PO/NT TOkYlV OF $OUTHOID SUFFOLK COUIVTY~ AL Y WILLIAM G MEIER Wading River, N Y Land Surveyor N Y State License No. 21656 Surveyed 3 - ~2-73 Map No. 733305 CESSPOOL 0 409 ~06 43.0' V A C A 407 N ~ ,=94 J ~08 0 CESSPOOL (APPROX. LOC.) PROB WELL 0 395 <0 WELL (APPROX. LOC) Unauthorized alteration or addition to this survey is a violation ~ section 7209 of the New York State Education Law. I Copies of this survey map not bearing the land surveyor's ink seal or embossed seal shaU not be considered to be o valid copy. Guarantees or certifications indicated hereon shaft run only to the person for whom the survey is prepared, and on his behalf to the title company, governmental agency and lendlng institution listed hereon, and to the assignees of the Fending institution. Guarantees or certifications are not transferable to ad&fio,~al insfitut~ops or subsequent owners. DATUM APPROX, FROM USCG MAP TEST BORING AS PER APPLICANT LoA. --~ ~E*SPOOL ~4' SA.O A.O gNAV~ dOB 382 SURVEY OF LOT ~94 Ni~P OF N~SS~U POINT CLU8 PfFOPE/?TI-FS, /NC - Filed: May F, 1926 File NO.: 806 SEC. O AT: NASSAU POINT TOWN OF SOUTHOID SUFFOLK COUNTY, AL Y WILLIAM G. MEIER Wading River, N. Y. Land Surveyor N Y State License NO 21656 Surveyed 3 Scole't" : 40' Map No. 733305 F l J_ 4-4~ o', /