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Home My WebLink About4570-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. ~ERTIFICATE OF O~C~PAN~Y No Z-25334 Date OCTOBER 23, 1997 THIS CERTIFIES that the building Location of Property 2250 DIEDRICKS RD. House No. County Tax Map No. 1000 Section 18 Subdivision ORIENT, N.Y. Street Hamlet Block 3 Lot 2 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 20, 1969 pursuant to which Building Permit No. 4570-Z dated NOVE~ER 28~ 1969 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ONE FAMILY DW~T~.IN~ The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 BRAD MESS $O-593-FEB. 8, 1971 N-424609 - JULY 2~ 1997 N/A ~Inspector FOI~M NO. ~ TOWN OF ~OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 570 Z Permission is hereby granted to: ............. aev-.-~mae~.l'.eed.. Ii ,...lee l, .................. ................. ~ ...... i,,~......ll~liO ................ to ............... lJ~..J~v.ele..-~ell~-.4ve~.~d,~ .................................................................... at premises located at ..... ~/~.....~...~,e0~/~r.~$.~...~/~..M&t~..Ji41a~ ....... t~t~..]31J3~) pursuant to application dated ........................... ~,~ ....... ,~) ........... , 19....~;~ and approved by the Building Inspector. OF To; BUILDING D EPART~iENT This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building or new use: 1. Final su~ay of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Realth Dept. of water supply and sewerage-disposal(S-9 fo~). 3. Approval of electrical installation from Board of Fire Unde~iters. 4. Sworn statement from plumber certifying that the solder used in syst~ contains less than 2/10 of i% lead. 5. Co~erci~ build,g, ~dustriai building, multiple residences and s~ilar buddings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Plann~g Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. k properly completed application and a consent to inspect sig~ed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall s~ate the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildinm - $100.00 3. Copy of Certmficate of Occupancy - ~ .25~ 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ..... ~O~ ........................... New Construction ........... Old Or Pre-existing Building .... , ............ ~ocation of ~ropert~ ...... g.~5 ............... ~L .~..r (.Cy......g~..o% ........ O.. y.i.~. .......... House No. Street Onwer or Owners of Property..~.~...V.....~.~JY}~...~.~ .......... County ~= ~p No ~000, Seotion..O.~.'£~~. .... Bloc~.0~.'~9 ......... Lot..O..~'.q~9 .......... Subdivision .................................... Filed Map ............ Lot ...................... e=it .... Date .... Applicant. ...... Health Dept. Approval ...... .~... ................ Underwriters Approval .... ~ ............... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ........... ~ ~ AP~LIC~w FORM I~O. ~6 TOWN OF SOUTHOLD Bu dd~ng D~pa~tment Town .Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions Th~s apphcat~on must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor w~th the following; for new buddings or new use' 1. Final survey of property w~th accurate location of all buddings, property lines, streets, and unusual natural or topographic features. 2. F~nal approval of Health Dept of water supply and sewerage disposat-(S-9 form or equal). 3. Approval of electrical ~nstallat~on from Board of Fire Underwriters. 4. Commercial buddings, Industrial buildings, Multiple Residences and similar buildings and installa- t~ons, a cert~hcate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s~te plan requirements where applicable. For ex~stmg buddings (prior to Aprd 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peopert¥ show~ng al~ property ~{nes, streets, buildings and unusua~ natura{ or topograph ~c featu res. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buddings. 3. Date of any housing code or safety inspection of build~pgs or premises, or other pertinent mforma- t~on required to prepare a cert~hcate. Fees' 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelhng or land use 3. Copy of cert~hcate of occupancy $1.00 $5.00 Date ~ ! .~...../.f..¢-( ........ New Budding .... ~ .... Old or Pre-ex~sting Building ............ Vacant Land Locat,on of Property ............ p.~. !~?. ?.L-.-..../~..0.~.~ ......... .~....0...~. I..~'.~..77. ......... House IVo, Street Ham/et Owner or Owners of Property . ./~¢,W....w. ~ .r.¢:....~..~..R?..~.0..A~....../~,:..W/..-~7. ~.~ ............... County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subd~wsion ............................. Filed Map No ......... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept, Approval ........................ Labor Dept, Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. C°nstructi°n °n ab°ve descr'bed building and~ee~ a~,,pl~icabl: c~.el ~i°ns'· / ~ Applicant..,.. ..... :...-..,,...-(~. .; .................... ? Rev 10-10-78 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION iST [ ] ROUGH PLBG. [ ] FOUNDATION2ND [ ] INSULATION [ ] FI:U~.MING [ ~-~"I~NAL [ ] FIREPLACE & CHIMNEY _ REMARKS: ~ DATE 7~5-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION2ND [ ] INSULATION [ ] FRAMING [ ,,"J'~AL [ ] FIREPLACE & CHIMNEY THE NEW YORK' BOARD OF FIRE UNDERWRITERS 1085~77 BUREAU OF ELECTRICITY i--'- 85 JOHN STREET, NEW YORK, NY 10088 /~,,e JULY O2,1997 ~/~'l~.fion Ho. o,J~l, 14189197/97 N 424~ THIS CE~IFIES THAT BB'I'~U-~ TOWNBBND, 2205 in ~he ~ollowin~ loc.~ton~ [] B~.wmen~ was exarnined on ~ 26,1997 D~RICK8 ~OAD, ~, N.Y. [] Iht FL [] 2~ FI. .~'~tio, Block and ~ound to be in compliance ~th the NaMonal Eiectrica~ Code. COOKING DECKS oVENs DISH WASHEE I .Rv~ mSC:O~ECT INo*o~ I S MITER ~ '~,. I --. I ~', I.~,.I,.~l,.~,l-~l,.,~r~.~.~o.I R V I C E EXHAUST FANS OO~M~RS OF CC. C~D. D~.%~I~ R~{OVBD AS PER {}4-O3-97-1 MICHAEL J. HUP, L~ 99~5 RASSAU FT. ROAD CUTCHOGUE, I{Y, 11935 LIC.#4221 GENERAL MANAGER 11 Per il ~' This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED 1N ANY HANNER. INSTRUCTIONS a. This application must be completely filled in .by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to odjoinJng premises or publie streets or areas, and giving a detailed description of layout of property must be drawn on the diagram whieh is port of this applieatton~i 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 on the premises available for inspection throughout the progress of the work. of Occupan~.~f: e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate shall hove been granted by the Building Inspector. - APPLICATION 'IS HEREBY ~DE to the Building DePartment for the issuarice of a Building Permit pursuant to Building Zone. Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, cz. for removal or demolition, as· herein described. The applicant agrees to comply with all applicable laws, ordinances,~r'~ing code,~ousing code, and 9egulations Fern,Avemue/Nyack, Ne~ York 10~60 (Address of opplieant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... Rev. Bradfard N. lleee . , ~'i~ If applicant is a corporate, signature of duly authorized officer. ~ / (Name and title of corporate officer) I. Location of land on which proposed work will be done· Ntap No.: ........................................Lot No.: ...; .................... Street ...... ._...: ._. : ...................... . 'fl! p ,r. .u,,c pu ity ...... ~,, State existing use and occupancy of premises and intended use and occupancTof proposed construction: ' gndevel..o~ed land . Ex,sting use and occupancy ........................................................... : .................................................................... lntended use and occupancy ...-qmm~r..c~fJm~t..f~.~i~e..uee ............................. , ........................... i ...... 3. Nature of work (check which applicable): New Building .~ ...... .~. ......... Addition Alteration, ...~......1~ ~ Repair .................. Removal .................. Demolition .................. Other Work (Describe) ................................ ; ....... 4. Estimated Cost ...... $2DD~..DD. ..................................... 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 of c.~rs (X~ ~TJII~ .......................................................................... 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 some structure with alterations or additions: Front Roar Depth ................................ Height ............................ N'umber of Stories ............... ~ ............... 8. Dimensions of entire new construction: Front t ........... ;[6 ..................... Rear Depth ....... .~. ............. Height f~,~mJ~i~ N~mber of Stories ......................................................................................... 9. Size of lot: Front ........],~1,5 .............. t Rear ......... ],05.~. ................... Depth December ~ 1969 ]0. Dote of Purchase ....................................................... N~, .... of Former Ownerl~..#~l...E..'y.e.~g..~...e.~.f~ ........... ] ]. Zone or use district in which premises are situated ......... ~,....~.~.~E~ ........................................ ]2. Does proposed construction vialate any zoning law, ordnance or regulation:~ ....... Ho ................................................. Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from whether property interior fines. Give or comer street lot. and block number or description according to deed, and show street names and indicate STATE OF NEW Y~RK, tS.$ COUNTY OE~...~ .~.../.~ ~ ~....~ ,9-D /=o .D ............ · /.~.... .............. .~ ....... ~:.~f ................................. being duly sworn, d~oses and says t~t he is the applicant / (Name of individual signing a~licotion) above named. He is the .,....~..~.~.~.~....; ......................................................... ~,....j~...: .............................................. (Contractor, agent, co,rate officer, etc.) cf ;;~'ner or owners, and is duly authorized to perform or have perform~ the said work and to ~:ke ~d file this application; that all statements contained in this application are tree to fhe best of his knowledge and belief; and that the work will be performed in the manner ~t fo~h in the application filed therewith. Swam to ~fom me this ~ . ..... ..... ........... . ....... ............. ...................... ,~uT~RY PH~LIC, STATE 0F N~ YORK Tefra expir~ Ma~ 3~ BUILDING DEPARTMENT/ TOWN CLERK'S ...~...~.~ .......... ~UTHOLO, N. Examined ., .... pra ed ......... ............. , Di~pp~ved a/c ................................ if ......................................................... (Building Inspector) APPLICATION FOR 'BUILDING PERMIT ,~ __.__.__ INSTRUCTIONS a. This apl) ication must be completely filled in by typewriter oe in ink and submitted in triplicate to the Building_./ Inspector~ with 3 set, of plans, accurate plat 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, 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 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 on the premises available for inspection throughout the work. e. No building 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 HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the e pp 'ca ag ees to comply with all applicable laws, orainances, building code, housing ce,e, ancl regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. al~p ican~r, c~r name, if '~ corporat ' (Si~ature/app~li~al ............................... .................... "";'"" State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.' Name of owner of premises If applicant is a corporate, signature of duly authorized 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.: .....~..~.....:....~......aj~. ........Lot No~..~...~'.. .......... : ...... Street and Number .... ~l~...~..~../.~......~..'. ...... C..~..?...~..~..~.7...../J~J..~.~....~.......~....~. .............................. .°....~..I...~...M...T.,.. ( ' ' Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ......... .r~.....?...s.....~..~...~.....~. ....................................................................................... b. Intended use and occupancy (,~lgJl~lq~'l'L Nature of work (check which applicable): New Building .................. Addition .....~... ......... AIterotion~ .~..~.~....~ .... Repair .................. Removal .................. Demolition .................... Other Work .... .~...~. ~ ~o /~/~ (Description) 4. Estimated Cost ........................... /Z~..~.....'~.. ................ Fee ......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... ~ ............ il.....Number of dwelling units on each floor ............................ If garage, number of Cars ............ ./.. ...................... t.....il ................................................................................................ 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../..v..L..~....~.../:'.?.?....~.. ......................................... Dimensions of same structure W th a terations or additions: Front · ...~.~/. .................... Rear ...?../. .................... Depth ......... ~....~...~. .... Height .~.~.Number of Stories ........... ~.. 8. Dimensions of entire new construction: Front ........ ./...~..~.. .................... Rear ..... ../.....~'.. ...... ; ....... Depth .~..~..~.: ........ Height .................... Number ?f Stories ...~....~...~.~...~'....?......~.~.'..~..~'..Jm. ...................................................................... Size of lot: Front ........ ./...~..~...~ ................................... Rear ........... /...~...~...J. .................... Depth ....~...~...~. Date of Purchase ....~...'....~....?. ...... .?..~ ........................... Name of Former Owner ~...~...~?..~........~(....~...~..~..A~...~. ................ Zone or use district in which premises ore situated ........ A ..................................................................................... .?,. Does proposed construction violate any zoning law, ordinance or regulation: ..... .~.~ ......................................... ~l Will lot be regraded' ......Y.~..,~. ............. Will excess fill ,be removed from premises: ( ) Yes , (~') No ~ Nome of OWner of premises ~,l~p o ~.ll).~.~-'01L~. ~, ...~...~. Address7..~..?.~..~...~.. ~1~, le~cl~,'k~^~l¢-gu'-r-i?~ ........................................ rt lg- ................................... / Name of Architect ...~ ................................................ Address ................................ Phone No ....................... "'~, /, Name of Contractor ..... ~ ......................................... Address ................................ Phone No ....................... i~ PLOT DIAGRAM L~ca,t.e clea,.rly and distinct y a. II buildings, whether existing or proposed, and indicate a set-back dimensions from property ,roes. hive street aha mock number or description according to deed, and show street names and indicate whether interior or corner lot. __ __ ,~ ~- / ~-~ 10. ~11. 12. 13. 14. STATE OF NEW~ORK~ , I ~ ~ ~.COUNTY OF ...~..d..c.~../..~...~...d. ........ ................. /~.. E..~.. ~ ..~?/....~...~..../¥..:./..~..c..[ .~.. ................................ being (Name of individual signing contracO above named. duly sworn, deposes and says that he is the applicant He is the ................... ..~../~Z..#..~...~.. ...................................................... ; ................................................................................ (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 ore 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. Swam to before me this~ ,- ...................... .............. ." ........ /2..,%., > Nom~ Public,. ....... ZZ.~../.L.s.~ ......... C~n~ ...~..... ~..~~....r~..T..~.~ ~ / ~ig~re of appli~nt~ .RMy K L~ o~ OF N~ YORK ~u~ Fed :n ~or~l~d Coun SUFFOL~ COUHTY DEPARTHENT OF HEALTH EASTERN DISTRICT County Center, Riverhead, Ney York PA 7-4700 APPLICATION FOR APPROVAL OF INSTALLED PRIVATE SE~A~E DISPOSAL AND WATER SUPPLY SYSTEHS Inspection for approval is requested, pertinent installation data herewith. . 1-Name of Ov~er J~/~J~J~}/ /~lr~q~f % ~-~i ~ ~-~ 3-Subdiv. 2-N~e of Builder ~e¢. ~ ~ ~g v-Phou~ ~-/7~ 5-Lot N~ber Address ~ ~6. A~ ~'~ ;~o 6-Blds. Pemi~ No.~7~ ~ 7-S~age $ys~ ins~ell~ by ~ ~ ~6~ Phone ~/i- ~z ~- a~ 8-(a)Deed locl~ion of prop~r~y ~ ~ ~ ~o~ a~/ 9-Septic tank~al L f~.~ f~.Liquid Depth ft.~Tr~ ~ ~~ 10-Cesspools-(~)No~~(b)Bloc~ bel~ inlet-1)-~) 3)~ ln.g in.H in.(d)Pre~st pool ~ (e)~2 ,(f)H ~ ft. inl Di~ ~.~in.(g)Finished grad~ to cover ~ ft. (h)Backfill ~teri~l ~ ~ ; Private Well / il-Water Supply: Public Syst~ If Private, the follovin$ questions are to be answered: 12-Private ~.~er Supply Syete~ installed by Address ~ ~F~ ~' ~d~ ~. ~ ~/( 13(a)-Total Depth of ~ell ~ ~" (b)Dept~ Co Static Water L~el /~,' 14-Di~etar of well pipe~. 15-Name of ~boratory~~~16-Hethod of Disinfection 17-Date ready for inspection The undersi$~ekl'cERTIFIE$: Above system,s have been constructed and are in co~plience with the Suffolk County Health Department's current Standards, Bulletins and Amendments thereto. /'~ / ~ ~ .~,~, ~ . . 18-Date · ' ~° ? / Sisned~ ;/..~v 19-Insert sketch of l~ation of VaCer & S~erase Facilities with accurate d~ensions. (G-uu)cso,~ S~EET Inspected by /)( ~,~'"~'x.,~,~ Based upon the inf6t~ation stated able, 'sa~isfac~ory fun~tioning of ~he above sys~s can be ~pec~ed ~i~h ProPer main~e~nce and care. Date EEB 8 1971 Approved ~iof of Ceuora].~giueertr~ ~vices S-Se Instructions for Submission of Installed Private Sewage Disposal and Water System Application Applications are to be submitted in duplicate. Required inforuation should be typed or lesibly printed in ink. Inspectors are not permitted to make inspections of installation8 until applications have been submitted to and accepted by thb de- par~nenC. The item number on the application for~ and item number listed belo~ are the 1. Owner's name and address - if owner and builder are sums, so indicate. · 2. Builder's name and address - approvals will be nailed to this address. 3. Give name of filed realty subdivision map. ~. Section number of real~y subdivision map. 5, Lot number of plot on which disposal unit is constructed. 6. Buildins peruit number essisned by the Buildins Depar~3nant. 7. Hans of person,or firu who actually constructed the sevase dispoe&l 8. (a) For exanple: 8/8 Jones St., 100' e/o Smith St. (b) Henley, (unincorporated area in township), for exumple: hot Horichea. Villase (incorporated area), for exanple: Horthport. (c) Township. for exanple: Brookheven. etc. 9. Give inside length and width in feet. Liquid depth is ueseured in feeC frou bottou of outlet pipe to bottum of tank. 10. (a) State number of pools. (b) State number of blocks below inlet pipe for each pool. (c) Scare lanSth, width, and heisht of cesspool blocks in*:~ncbes. (d) Indicate by check if precest sections are used. (e) Give nunber of leach- ins sections Per Pool. (f) Give heisht and diumeter of each leachius section. (S) Give depth in feet frou finished srade co cesspool cover.' (h) Describe backfill material used. ;1. Indicate by check if water supply i8 public or private. 12. Hone .of person or firu who actually installed the water supply facilities. 13. (a) Give depth in feet frum top of yell pipe or canins to veil po~nt. (b) Depth in feet frou top of veil pipe or cesin~ to water level in veil. l~. Inside diameter of veil ceoins. 15. Hume of l&boratol~ perforuin$ the 16. Describe uethod of dioinfec~ion, for exumple: quart of laundry bleach in ten Sallou8 of water poured into yell and alloyed to stand s~x hours. 17. Scats dace on which ~nstallation will be reedy for 18. Application must be siSned by builde~ or owner. Sisnaturee of subcontractor. superintendent, etc., will not beo4ceptad. 19. ~adiceCe location of ~ater & Severase Facilities rich accurate diuenelon8 on sketch. Yo~ -t