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Home My WebLink About8638-zFOII~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerli~icnle O[ Occupnncy No.S~.~2 ....... Date ............ SO~.t ...... 2.?..., 19.7,6. THIS CERTIFIES that the building located at .. I~eStL N~L:L1. l~O~t~ ......... Street Map No. Jaek~o~. L4~Block No ........... Lot No. 26. .... F~t%$.t.Be.k...E. :Y.., ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. ~'.ll,'le...1 ~ 19.~.~. pursuant to which Building Permit No...8.63.8Z. dated ............ ,T~e....1 ~[.., 19.76., 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~i.v. ate..one, f~tl~..dwelling ....................................... The certificate is issued to . .A~elphi. 2aal~d..Co~la .... 0~a~er..,,bILl~Lder .............. (owner, lessee or tenant) o~ the aforesaid building. Suffolk County Department of Health Approval .l~l~.~...~?...![~...~'. ~, .~..11~... UNDERWRITERS CERTIFICATE No..N3~.l.~.~....~e~l;..~0. ~7.~ ................. HOUSE NUMBER ...... ~.~ .... Street.. lge. at. l~lil~L, l~c~d ....................... Building Inspector l~Ol~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT 'TOWN CLERK'S OFFICE $OUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 8638 Z Dote ............................... :.~//~.~,...../.!.., Permission is hereby granted to: ....... ~.'.~'~ .i ~-~..~ ...... ;:~.: :.~ /......~ ~.t~ .............. at ~re~i,e, ~oca~ed at ..................... ~..~,~,~. ...... m,'//.. ...... ~..~.,~. ....................................................... ........ ,z,..~.....~..~..~......~.,..~.~ ? ~ ......... ~.,.~.:.~... ................. .~ ........................................ Buildingpursuant Inspecto~t° opphcahon' ~doted .............................. ~-'"~'"~;?'";~ .............. t t , 1~.....,..,~; and opproved by the Fee $...~'.'..~ ................ Building inspector FOR~ NO. 6 TOWN O~ SOUTHOLD guilding Department Town Clerks O~flce Southold, N. ¥. 11971 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 dispcsal--(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), Nomconforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey aT 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 Date ...... .... New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ....... ..~...!..lu;.....~......I~....O,~...C?......V..~....~..~..'~...~ ......... ...J~....'.~.~..~..'..~..~..~..~..~...~.~..~,...~..,~.~.: .............. Owner Or Owners Of Property ...... .../~.....~...~,'~....?..~.l. ...... ..~....l~.....~.,~.~..~..~..O..,~.~....l~.:. ............................................. Subdivision ..~....~..C:..~.~?,.~..~. ....... ~...~,....t~...~..'~....J..~..fX.. Lot No..~/.....1~..,.. Block No ............. House No ............. Permit No..?.'..~.~....~'...~. Date Of Permit ..~.,/.!!J?..~...Applicant ,..~.~.,~..~....~..).....~....~...~ ...... ..C.~.~../?...~'.: ...... Health Dept. Approval ........ ..~...~.~.,.~...?.,'.~./,.! .............. Labor Dept. Approval ................................................ Underwriters Approval ..J~l...,.'...~...O....'~J..!...~...,~.., ................ Planning Board Approval ........................................ Request For Tempora~icate ........................................ Final Certificate ........... ~ .................... Fee Submitted $ .~ ............................ Construction on above described building an_g~J~permit meets~a, II applicable codes and regulations. Applicant....~..~ .......... : ...... :':',~,, :~-.~: ......................... Sworn to before me this o, ........ SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Appli ~,~ 1. cant ~?< ~. ;~". ' .......... ~ Phone Address ~:,~,¥ .-),'~ ~'-', ,',, '~ ,',- -~ ,~- ~ ~.~1 2. Property Location '-,t: ~',,.,. ,":~ q~--=,' ~-~ Vi'llage ~'-,~,~- ~ ,~ ~c ¢/ Township 3. Public Water Company Name ~,~-~-,:,' 4. Lot size: Width ~,~feet Length 2- ~ feet 6. Section 7. Lot Number 8. Private Well 9. Public Water Distance to main lO. 11. Sewage Disposal System: A. ~-~llon septic tank: Precast ~ ~quivalent B, Leacb'ing pools: Number of pools Precast~'Block__ If private well, lowing blanks: A. Tank capacity. B. Pump G.P.M. C. D. E. Block ~pecial fill in the fol- t} L- .gallons Total well depth. ~'~ .... Depth to ground water /~-~ Amount of water in well ~l~ (For Health Services Dept. Use) The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health Services' 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 THE DEPARTMENT OF HEALTH SERVICES' USE ONLY. Based on the information presented here- with, it is the opinion of the Department of Health Services that an adequate and satis- factory Sewage Disposal 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 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 and 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 "No" otherwise. PROPOSED SYSTEMS: Answer to Item Number 10, consult the Suffolk County Department of ~ealth Services' Standards for Sewage and Waste Disposal Systems Design of Residential Subsurface Sewage Disposal Facilities. Part I - Residential Subsurface Disposal Systems Covering Cesspools. W~ELL LOCATION: To locate the well and 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 distance from rear and rear sides of property lines when possible. Well-lO 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. ~ell-4 feet 6 inches minimum below grade to well head and lateral water pipe. CESSPOOL LOCATION: Upon determination of the Sewage and Waste Disposal "type of systems" ~equired, the fol~lowing 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 1'00 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 10 feet from house ~oundation. 6-Cesspool exterior must be 100 feet minimum distance from surface waters, streams, lakes, and 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 De held to minimum of 1 foot to maximum of 2 feet. 10-Bottom of cesspool to ground water must be held to minimum of 2 feet. now or forrner/y Bergen s. 80"04 '20 "E. NORTH LINE OF LOT.._ I0,~ .... SUF~__. 325.74' T, 25 Lot TOWN OF $OUTHOLD ~/2~.7(. ,~7~.-~ b,~, ~/b(~ BUILDING DEPARTMENT ~/~- ~ ~'~ ~ TOWN CLERK'S OFFICE ~/ry/~ ~ ~ ~ ~' ~ Exam ed .................................. 19 ....... ~ ~ ~./ ~ ~ ~e/~ ~phc~n No pp ................. .~'~ ......... , 19 ........ Perm,t No...~( ............................ ~.~ ~/~ ~- ~_~.4~ ~. umsapproved a/c .... ~ ,.~ ....... ............................................................... ~. '_ ,. ~ ~ ~, ,'. ~ I ' ~ ...........~t~ ....... (.~....Z.<~..~ .......... ~. ~z~..;k~ dg/~ (. ~_ _, ~1~ ~a (Building Inspector) APPLICATION ~OR ~UIL~IN~ P~RMIT ................. I~STRUCTIO~S o. This opplicotion must be completely {Hl~d in by tgpowriter o~ in ink and submitted in triplic*te to the Inspector, with 3 set~ of plons, occumto plot plon to sc~lo. Fee accordin~ to schedule. b. Plot plon showM~ Iocotion of lot ond of buildinfls on premises~ robHonship to od~oinin~ premises or public streets oeeos, ond ~ivlnO o dot~iled descdpt~on of lo,out ofproperty must be dr~wn on the dioorom which is part of this opplicotion. c. The work covered by this opplicotion m~ not be commenced before issuonce o{ ~uildin~ Permit. d. Upon opprow[ o{ ~his ~pplic~tion, the Cuildino lnspec~or will issue o Buildin~ Permit to the applicont. Such permit shaft be kept on the premises avoilablo for inspection throughout tho work. e. ~o buildin~ sholl be occupied or used in whole or in p~rt for ony purpose whatever until o Certificoto of Occupancy shah hove been omnted b~ the Buildin~ Inspector. APPNCATION 15 H[REBY ~ADE to the Buildin~ Deportment for the issuonce of o Buildin0 Permit pursuant to tho Buildin0 Zone Ordinonce of the Town of Southold, Suffolk County, New York, ond othor opplicoblo k~ws, Ordinonces Re~ulotions, f~r the construction o{ buildings, odditions or o~temtions, or {or removol or demolition, os herein described. The opplicont o~rees to comply with olt opplicoble bws~ ordinances, buHdin~ code, housM~ code, ~nd ro~ul~tions, ond ~dmit outhorized inspectors on premises and in buildings for necessory inspections. ..... ...... (Signature of applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumbeF or builder. Name of owner of premises ..... ~..~a.~k.,C)...~...t ........ .~..~..~..g ........ -- .C.~.~: .................................................. If applicant is a corporate, signature of duly authorized officer. - uName anq,~citle c~t corporate officer) Builder's bicense No ..................................................... Plumber's License No. L~-~ ....... .~...k,.kJ.w:~'~'.J.,tm~ ..... Electrician's License No. ..(~,~,':~,~..L~.',X,.~,,,,...fr~,~,~.~..~ /~- ¢*,- Other Trade's License No ............................................... ]. Location of land on which proposed work will be done, Map No.; Street and Number ........... t~...\.*~.~...~.~.....~.~.:..~...~. ...... ..I~...~...~.L.~...k..~...~....C./..~. .................................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy Of proposed construction: a. Exisiting use and occupancy .~..~....c~..~.~ b. Intended use and occupancy .................. ,~...~.k,~....~..~t~...,..~..~ .................................................................. 3. Nbture of work (check which applicable): New Building .................. Addition .................. Alteration ................. Repgir .................. Removal ... ............... Demolition .................... Other Work .................................................... 4. Estimated Cost .......... ..~..r..~....~..~....~ ............... Fee ~'~' ~...~ (Description) (to be paid on filing this application) I 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ........ .I. ................. If garage, number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ....... ..l~'....f..~. ........ 7, Dimensions of existing struc~ ........................... Rear ................................ Depth .................... Di~i.~ .-th alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories 8. Dimensions of entire new construction: Front. .......... !"~'"~'~'~' ......... Rear ....... ..~..,..~.. ............ Depth ......'~...~ Height ...[..~.. ........... Number of Stories ............................................................................................. ~: .......... ,~ ...... 9. Size of lot: Front I ~I,~ ~ ~ '~, ........................................................ Rear .......................................... Depth ................................ 10. Date of'PurChase ..... .~...~.....~¢..:~..t..t~.c.t..~,..~ .................. Nome of Former OwnerJl~"l~.......~.~c~4.~ .... 11. ' Zone or use district in which premises are situated ............... /:~....~,.g~..G.t~;~.~,~.~.~.~,.z ....................................... 12.Does proposed construction violate any zoning law, ordinance or regulation: ......... .f~....~. ..................................... 13. Will lot be regraded, .....~j...~.~ ............. Will excess fill be removed from premises: ( ) Yes 14. Name of Owner of premises .~....g..k'.~.,'..~..~.~......~..~..'~".O......C.'~..~.. Addresst~..)~l,ir...~..e..~...~Z..~., Phone No~/,-..~.X..'...~.,~-..~..~.. Name of ,Architect .............................................................. Address ................ ,..., .......... Phone No ....................... Name of Contractor,.~..~..?..~..~.....%.'.~...~...~.. ...... .~g/~...~.... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or descript,on according to deed, and show street names and indicate whether interior or corner lot. N STATE OF NEW YORK, ~c c COUNTY OF ................................ ~'~ ......... · ~----~.~.?...~....~:¢.,..,..,~...:..~$,,g,,,~Z.,~-,,,~,,,,~,,,',,~,, ................. being duly sworn, deposes and says that he is the app[icam (Name of individual signing contract) a'bow,= named. He is the .................................... ,~..~....~....~..'...0~..~'~...~ .......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work a,nd 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. S~/orn to before me this ............ · //..; ..... day of ....... ~ ......... ~,. ....................... 19:.~... c , ? ~ \x, ~.) ~ ~ Notary Publlcr~ ,..~',.:.. ......... ~...,..:..~,,,.; ........ /. ...... Cou~y~/ .................. ~ ........ ..~ ........ ;....'../...~ ............... ,- ~' , (Sig not u r~'~'~ applicant) APPLI CAN T 7he sewage disposal and water a:'~ply 'aclltties fo~, t;;ts loc,~t..u.~ have bee~ nSpeoted by this deRa~'~m~;~ dA CKSONs L'~NDING ~p/ a4 MATTITUCK SOU THOL D =50 YOUNG & YOUNG STEPHEN NOSTHOM CHICAGO T/FAF INSUt~ANCE CO. --- SOUTHO£D SAVINGS BANK dU£ Y I,/976 76-53F APPROVED AS NOTED NOTIFY BUILDING DEPARTMENT AT 765-2660 9AM TO 'CPM FOK REQUIR. ED INSPECTioNs: 1, BEFORE BACKFILLING FOUND,S,, TION OR START FRAMING