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HomeMy WebLinkAbout6425-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at N/~ biatn Road Street Map No. (~ ......... Block No. XX .Lot No. XX Orient conforms substantially to the Application for Building Permit heretofore filed in this office .................... 7 . which Building Permit No. 6L~2~Z dated March 21~ ., 19. ~. pursuant to ........ dated ...... M~.eh..2.~. ~ ...... , 197.3.., was issued, a~d conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .P.~i¥.a.t.e. ?n.e. .f..a~!l.y..dM. 9.1~,.i. ng' ...................................... The certificate is issued to ..... 9.e.o!l .C. :. :.~.~.~_7~?!,~.~ .................................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...D.a..t.~a.'.0¢.t.'..2.3~..1.9..7.3..b.~..~,..V..itZa UNDERWRITERS CERTIFICATE No, . ~e.n.d..i~.g. .................................. tIOUSE NUMBER .266.1.~. ....... Street Main ~oa/ Orient ..... /~i1'~i~'n ~~ ......... FOi~i~I 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? 6425 Z Date ......................... .~..~,r. ....... Permission is hereby granted to: ................ .9~.~.~.~.~.~.~. .......................................... at premises located at ~,,0.1,~,, O..~..~....~/...~.....~.~.~ ~.f~.(], ~ ~ ~g) ....................... Orient N .'~ · pursuant to application dated .........................~.....2.1 ............ ~., 19..~., and approved by the Building Inspector. Fee $~.0.,.~'.0. ............ Building Inspector / FORM NO. 6 TOWN OF SOUTHOLD Building Departmenl' Town Clerks Office Sout~so~d, N. Y. 1~971 APPLICATION FOR C~RTIF~CAT~ O,~ GCCUPANCY A. This application must be filled in typewriter OR ink, arid s~bmitted in DUPLICATE to the Building Inspector with the following; for new buildings or new ,~se: 1, Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Healt.h Dept. of water supply and sewerage disposal--(S-9 form or equaD. 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industria~ 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 compJeted 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 buddings or premises, or other pertinent 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 Dote ....... New Building ..... ~,~i ...... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..... ..~....~....~...........~..~..~.S ........ ~,.~...~...v~::~.......-..~.-~ Propert~..;~.~' '~ ~?~-d-~ ~ Owner Or Owners Of ....... ' ......... i ............................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............ Permit No...~¢..~//.,~,~zDate Of Permit ,.~..Applicant Health Dept. Approvo~ .... .Z..~.~.?.-~../.~.~'('~ ............. Labor Dept. Approval ................................................ Underwriters Approval ..... /~.Z.~..~.,!-/.~Y].~':/:&.~ ............... Planning Board Approval ........................................ Request For Temporary Cerdficete ........................................ Final Certificate ..... Fee Submitted $ ,..:~.~,.~. .................. Construction on above described building and permit meets oil ~pplicable codes and regulations. App I ica nt ~..¢~....~.~ ......... ·..~. ~..~..~..~.. · .~.. ~. · .~ Sworn to before me this ,,~rlf ~7 Notary Public .................................... County (stamp or seal) /~7~'~'¢ SUFFOLK COUNTY DEPARTMENT OF ,HEALTH EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE S..E~AGE DISPerSAL SYSTEMS. Approval to cons6ruct said systems is requested,pertinent'data herewith: ,, Phone C" ~ ,i?,.6-Sub div 1-Applicant~ ~ ~ ~ -Section Address 2-Detailed property location ,~ ~ . ~ . / .... ~," No. , Hamlet Town <~ ~ ~ [ , 9-Private well? 3.Public water supply name Distance to nearest main 4-Lot Size: Width ft. Length. ~ ~ft. (al~ enter~on center plot plan below:) 10-PropOsed system. Septic tank f~./Preca~CesspoOls · /Shallow pools tank inside qimensions: Volum$/ O~ls. Lengt[. f%. Width ft. Liquid depth ft. it~Septic 12~Precast sections..~._Number~Squae~.~. CesspoolS~ Block sisaL incs.D ins. H ins. Total blocks below inlet: PLOT PLAN Capacity '~' Gals. 0 H.D.Reference No~[)~/~z~ Date Street ~ate ~th Data ~eet 0 2 4 6 8 12 18 Indi No The Undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' cuFrent Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Systems". Date Signed : ,, Owner or Builder FOR HEALTH DEPARTMENT .USE ON~. Based on the informationpresented herewith, it is the opinion of the Health Department, that an adequate and satisfactory Sewage Disposal System can be installed on this Plot. Date ., Signed ~---''~_-- --- (10/65 Hevis.) APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS INSTRUCTIONS: Applications must be submitted in triplicate 1.Means Owner or Builder. Address to which mail should be directed° 2-Means detailed description of property location~ together ~*lth street name and distance to nearest intersection of main thorofare, also Hamlet/Village & Township 3-Enter name of Publi~ 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. 5nter "Yes" otherwise. PROPOSED SYSTEMS: Answers to Items number 10, 11, & i2 please consult the Suffolk County ~ealth 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 PLOT PLAN: The following information is required concerning the Applicant's Lot: Lot size-Length and Width in feet to be indicated at the Lot linei of the heavy lined square in the center of Plot Plan sho~m on face of this application. Surface waters-Streams, Lakes, & Bays, etc., locate~ 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-100 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-5© feet minimum below grade for well point Well-~O 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-l~ feet minimum distance from lot lines to center of cesspool Cesspools exterior must be lO0 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 i5 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 i foot