HomeMy WebLinkAbout7465-zTOW~ OF $OUT~OLD
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? 7465 Z Oa~e ............. ............... ,~..u~ ........ a ........... , '?~
19..~...l'..
Permission is hereby granted to:
G~l~smi22..Bn~td~n~...~L..Co~a2rnc.~imn Co A/C Frederick Joke
.............. ~o~th~l ............................ ; .................
to ~.~.~...~...9~.e.....f..~..~.~z ...d. ~ ~.~ ~. ........................... i .........................................................
at premises located at ..~.,O.~..;.2.~. ....... .~..~..~...~..~..~...:[.~.~...d:...~.a.,~...~. ...... i .........................................................
........................................ .~ ~.! .a e.z...C o~tr_t, ............. .8o~th~ld~.....],1,,X., ...........................................
pursuant to application dated ............. ~ .......... ..~.g.~.....~. ........... .i....., 19.~..L.~..., and approved by the
Building Inspector.
!~ Buii~ing Inspector ~k .......
FOB31 NO. 4
TOWN OF SOUTHOLD~
BUILDING DEPARTMENT
Town Clerk's Of[ice
Southold, N. Y.
Certificnte Of OccupnJ~cy
No. rate ............... P 5.,
THIS CERTIFIES that the building located at ~tJ~. 0!. t'~/~ t ~ t. ~ .'~....f. ~).V. !~..T Street
Map No..~/:/~./. D .... Block No .... ,_._. .... Lot No ..... :,Z~. ........................
conforms substantially to the Application for Building Per:mit heretofore filed in this office
dated .......... .~.~ f?...7.., 197~.~,/. pursuant to which Building Pemit No. '?.q.~ ~.7....
dated .......... ~A.~.f.-~-.. ~'..., 19~, .~/, was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occulJancy for which this certificate is
issued is . ./~...-~:f~.uvi. I~TLE .... .(! ~J.( . . . ~. f~.~ I t .'( .... ~. .(.d. if. 1.1.-! .r,:. ,. ~.-:.. ...............
The certificate is issued to ...l(~.l.: .'D.t; ~ ¢.\I .... ~.~..q ~.~ .~ ............................
( owner,
of the aforesaid building.
Suffolk County Department of Health Approval ff.] 0'-,
· .,~.:?:,. ~-)~./.'.,T ...
UNDERWRITERS CERTIFICATE No ..........fd ~- q i~ O. 5. ~, ....................
HOUSE NUMBER ..... L.i./~j i~.... Street .. · ~%,:v~'~' 1' l~ ']~; .... (~t~¢ ~W' ............
.......................................... ~d.¢. ~/· ~ ~ ~.~. b. ~,~ ......................
TOWN OF SOUTHOLD,
, Building Department
Town Clerks Office
$outhold, N. Y. 11971i
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and sgbmitted in DUPLICATE to the Building
Inspector with the following; for new buildings or new Use:
I, 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 disposaJ--(S-9 form or equal).
3. Approval of electrical installation from Board of Fire ~nderwriters.
4. Commercial buildings, Industrial buildings, Multiple I~esidences and similar buildings and
installations, a certificate of Code compliance from the Architecf or Engineer responsible for
the building.
5. Submit Planning Board approval of completed site pla0 requirements where oppllcable.
B. For existing buildings (prior to April 1957), Nomconforming ~,uses, or buildings and "pre-existing"
land uses:
]. 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. Dote of any housing code or safety inspection of bu Idi.hgs or premises, or other pertinent in-
formation required to prepare a certificate.
C. Fees:
l. 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
Date
New Bqilding .....'.~..". ....... Addition ................ Old or Pre-existing B~ lilding ................ Vacant Land ..............
Health Dept. Approval .~.~.~'Z~..~ ................. ~bor ~pt. Approval ................................................
Unde~riters Approval .~.~..~.~.,~.~ .......... Planning B~rd Approval ........................................
Request For Tempora~ Ce~ificate ........................................ Fin~ Certificate~ ................................
Fee Submitted $ ....................................
Construction on above described building and permit meets, all ~pplicable c~es and regulations.
~ NOTARY PUB[IC, S~te of Ne~ Yor~
i~DO0
SUFFOLK COUNTY DEPARTMENT OF HEALTH
H~al th Department
Reference Number
10o
ll.
APPLICATION FOR APPROVAL TO CONSTRUCT
A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY
Applicant . · , ,Y~F~ ,', /:~m~-TPhone
Property Location y ~- y>/ ~'/m ;~, '..
Village :~, ~,,:,.:, / ~ ~ownship
Public Water Company Name ....
Lot size: Width ? ~> feet Length
5. Subdiv.':"~x~:~'/~]
6, Section
~d~,7. Lot Number
8. Private Well ~,.
9. Public Water
Distance to main
Sewage Disposal System:
A. ~O~gallon septic tank:
Precast k" ~quivalent, Block ,
B. Leaching pools:
Number of pools /
Precas~__~_~Block Special
If private well, fill in the
following blanks:
A. ~ank capacity.
B.
C.
D.
~ump G.P.M.
Total well depth ~
Depth to ground water
'/~lons
E. Amount of water in well ,, ....
(For Health Dept. Use)
The undersigned CERTIFIES: "Construction of authorized'installations will be in accordance
with the Suffolk County Department of Health's current ~tandards 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 informatioh presented herewith, it is the
opinion of the Health Department that an adequate and satisfactory Sewage Disposal System
and Water Supply can be installed on this plot.
A?PROVAL DATE ~ /~77 SIGNED
S-15
Rev. 4/1/75
APPLICATION. FOR APPROVAL TO CONSTRUCT PRIVATE S~WJAGE ~_IS.pOSAL 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 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: ~ter "No" if Public water supply is available. Enter "Yes" otherwise.
9-Public water: F~ter "Yes" if Public water supply is available. ~ter '~o" otherwise.
~OPOSED 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 lines of the heavy lined
square in the center of Plot Plan sheen 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 shown 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 "tj~pe of systems', re-
''' ~uireS, 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 foundatien..
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.
~ 1o?
TOWN OF
BUILDING
~UTHOLD,
· .......... ............. ,
Disapproved a/c ............
........................
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
o. This application must be completely filled in by typewriter or, inlink and submitted in triplicate to the Buildin
Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according'to schedule.
b. Plat plan showing location of lot and of buildings on premises, relat onshlp to adjoining premises or public streets atP-
areas, and giving a detailed description of layout ofproperty must be drawrj on the 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 opprovel of this application, the Building Inspector will issue e Building Permit to the applicant. Such permit/~
shall be kept on the premises available for inspection throughout the wo~k
shalle' haveN° buildingbeen grantedShall bybe the°CCupiedBuilding°r usedlnspector.in whale or in part for any purpose whatever until a Certificate of Occupancy
Building Department for th~ issuance of a Building Permit pursuant to the
APPLICATION
IS
HEREBY
MADE
to
the
Building Zone Ordinance of the Town of Southo d, Sulfa k County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, add tons or alterat oas or for remov,,I
The a~l cant a-r~e~ t ...... ' .., ,, , , ,. , . -, ,,- ,~,,,,~,,,,,~,,, os here n aescr nea.
~'~' u ~ ~ u ~ump,y w m au appncaDm ~aws, ora nonces, bud~ng code, housing code, and regular ons, and to"~
admit authorized inspectors on premises and in buildings for necessary i~hspections.
....... .....
(SignatUre of applicant, or name, if a corporation)
..................... .............................
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, geneFal contractor, electrician, plumber or builder.
Name of owner of premises /..~..'.~.
..... 3
(Nm d title of corporate officer) '
Builder's License No .....................................................
Plumber's License No .................................................
Electrician's License No .............................................
O
Other Trade's License No ...............................................
1. Location of land on which propo, sed work will be done. Map No.: ........... ~ ................... Lot No ..~......~...
Street and Number /~..,~./4,~'-/.~ ..~/M,,~,.~..:~C-,~.,, ' ~:'~-t.d,~ .................
~: Municipality
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
e. Exisiting use and occupancy ...~'~_~,Ko/,A/:..~U......~..'.~-.....'.
b. Intended use and occupancy .......... ~.~'/.,~O.~C..~.... ......
3. Nature f work (check which applicable): New Building.. ................. Addition .................. AlterotJo~ ........
Repair .................. Removal .................. Demolitior~ .................... Other Work ....................................................
(Description)
4. Estimated Cost ........... ,-~.....~.,. .................................. Fee .L...~....~....'''''''' ....................................................................
(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 same structure with alterations or additions: Front ....................................Rear ............................
Depth ................................ Height ............................ Number of Stories ..../..2 ..................
8. Dimensions of entire new construction: Front ........ ................... Rear ....... ~....:~... ............ Depth ..~./~.. ...............
·
Height ....~,~.. ........ Number of Stories ..... ~ff~ .....................................................................................................
9. Size of lot: Front ........... /..~. .................................... Rear .............. /<..~. ................... Depth ....~ ....................
10. Date of Purchase ........................................................ Name of Former Owner Z~-,~-,¢~........~.~,~ .~.... ........
1 1. Zone or use district in which premises ore situated ....... ,~=~.~..~..'/~c./~ ...........................................................
12. Does proposed construction violate any zoning law, ordinance or regulatiom' '.~...~......~..'.~ ........ ~ ...... ~..~ ....................
13. Will lot be regraded . .... ~ ............ Will excess fill be removed from premises: ~ ~ No
' .....
]4. Name of Owner of premises ........... Address
.... i PhQne' N~: ......................
Name of Architect .............................................................. Address ............... ,~ ......... ~,~.i..,Phone No .......................
Nome of Contractor .~.~..~..~;~.4~/../.'~'~f... ...... ~./~/...~.~?/.~ddress ..~.~4~i',~f~.l~.~... ..... I~one 'No,..~.~....~..~'.~.~.'..~
PLOT DIAGRAM
Locate clearly end distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions frora
property lines. Give street and block number ar description according to deed, and show street names and indicate
whether interior or corner lot.
STATE OF NEW YORK,
COUNTY OF ................................
(Name of individual signing contracf)
above named.
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 knowledge and belief; and
that the work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
Noto Publ,c ...........................
FEE:. BY
NOTIFY BUILDING DEP/~RTML~N]
7¢,$.26~so ')AM :1'O 4PM
TION ~R,,STAR'[ FRA,~,
2. BEt",~,RE COVERING
3. FhqAL WHEN JOB C~MFI~f~fED
S rRUCTION ERRORS
FORM NO. 1
TOWN OF $OUTHOLD
BUILDING DEPARTME~ T
TOWN CLERK'S OFFIG
SOUTNOLD, N. Y;
........................................ ,7(/
Disapproved ale ....... ~ ..................... :~._~ ....................... ...~.~...~..
...... ..........................
APPLICATION FOR BUILDING
INSTRUCTIONS
~ERMIT
.......................... ............. , 9 .'Z..q. .....
a. This application must be completely filled in by typewriter o¢ in link and submitted in triplicate to the Building
Inspector, with 3 sets of plans, accurate plot plan to scale. Fee accordinglto schedule.
b. Plot plan showing location of lot and of buildings on premises, relatJ0nship to adjo n ng premises or public streets oF
areas, and giving a detailed description Of layout ofproperty must be drawn~on the diagram which is part of this application.
c. The work covered by this application may not be commenced befol-e issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issueia Building Permit to the applicant. Such permit
shall be kept on the premises available for inspection throughout the wot~k.
e. No building shall be occupied or used in whole or in part for any pu}pose whatever until a Certificate of Occupancy
shall have been granted by the Building Inspector. r )
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 Southald, Suffolk County, NewlYork, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or ilar removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, bu cling code, housing code, and regulations, and to
admit authorized inspectors on premises and in build!ngs for necessary i~,spections.
(Signature of applicant or name, if a corporal on)
...................... : ..... O.. ~. ~:/.../~')~. ,d.~). ..............................
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ........... 1.¢,/.~ .......... b..~.~ .........................................................................
If applicant is a corporate, signature of duly authoz-ized officer.
...... ~.,,,,..;~ ........................... ~ ............................... ,...... - _
//(Name and title of corporate officer)
Builder's License No .....................................................
Plumber's License No .................................................
Electrician's License No .............................................
Other Trade's License No ...............................................
1. Location of land on which proposed work will be done. Map No.:
.... ; .................................... Lot No .........................
Street ond Number .. /.~.(~. ~t~.~... ,... , .........
: Municipality
2. State existing use and occupancy of premises and intended use an4 o/c~up~q6~prop~ed construction:
a. Exisiting use and occupancy ....jg~7.&~/~/...~........~.~g~.j...:.:..:...~..~..~..
b. Intended use and occupancy ........... ~'~:--~./.,¢~.~.~.C.~ .................................................................................
3. Nature of work (check which applicable): New Building' ......~'...... ..... Addition .................. Alterotior~ ........
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 af 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 same structure with alterations or additions: Front ....................................Rear ............................
!
Depth ................................ Height ............................ Number of Stories ..../.4 ....................
8. Dimensions of entire new construction: Front ....... .~.m~..../. ................... Rear ....... ~...,~.. ............. Depth ...~..~....~. ............
Height ....~,~..~ ....... Number of Stories ..... /..~ .....................................................................................................
9. Size of lot: Front ........... /..~,~ ..................................... Rear ............. ~..(47,~ .................... Depth ...~",'~. ....................
10. Date of Purchase ....?. ................................................. Name of Former Owner ~.~,~,~./~.......~.0,J~.~'...~'~. .........
1 1. Zone or use district in which premises are situated ....... ,~J~r~f,)..~.4.~/./~.L ............................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: .~..O.......~. ..........................................
13. Will lot be regraded ..~.C~.....;'.~. ............ Will excess fill be removed from premises: (~k'~ Yes ( ) No
14. Name of Owner of premises ...... ~. ........... Address :.~.~.~T'./.~/~..~.. ....... Phone No .......................
Name of Architect .............................................................. Address ................................ Phone No .......................
Name of Contractor (~.~.~,./.-2~I~/./..~Z~.. ....... ,/.~.~.¥..'¢...(.~.f .,~Address ...~.O.~"~../.~/.~J.~ ..... 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 OF NEW YORK, ~ ¢ c
COUNTY OF ................................ ~ ""~
....,,~?.~..~g~,,e~,,~ ........ ~'.~:2.~, .,¢'~/,,~.1.2.-/:..1.~. ......................... being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
Fie is the ..~.~,....~/~.~?~ ..............................................................................................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is du[y 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 knowledge and belief; and
tha~ the work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
day of ,19
................................................................ ':" ....... 7 .
.................................................... ................... ............. L
Nota~ Public, ~ (Signature at applicant)