The URL can be used to link to this page

Home My WebLink About4209-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. . Z ·35·14··· Date...... .~µ~y... .3.,..........., 19.~9. THIS CERTIFIES that the building located at .... GlMD . Ita". . . . . . . . . .' Street Map No. Neat.. CxeekBlock No. . . . . . .. .. .Lot No.9,. .8outbolcS.. JUN. .Yoxk . . .. . . Estates 3848 conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . MaxC!Þ. . . . ~4.,. . . ., 19 ~.~. pursuant to which Building Permit No. ~2.~9 .~. . dated ..... Maxch. . . .24.,. . . . ., 19 .69., 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:r;~'Y'I.~". 9~.1! . ~~j,~Y. .~.n~~q . . . .. . . . . . . . . . . . . . . .. .. .. .. . . . . . . The certificate is issued to . . . . . . . .P.et.er. .. .ttar.uet. ..:r.11tttt.. . . . . . . . . . . . . . . . . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .071,1".. .:)0,. .],~~.,. .~~:r;t. Yi,ll!i. . Houae * 700 Glenn Road · FOIIM NO. Z 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) Nt! 4209 z Date .............................å............., 19...69. Permission is hereby granted to: .1....p....&1e........A¡Q...........leUatt..... Wit. .1U....a.·.OOetlA·.Aw·...···....··························· ........~pe1't....................................................... to ...~~~...~...~...~~'.~l..~n.ª'................................................................................ ................................................................................................................................................................ at premises located at ..............'...9.....W~.\..ç%eltk..J..ÌAt.....1I..~8).............................. ....... ... .... ................. ..........I1.....Ioaf... .... .... .... .. ..8eatho14... ..I...I..... ............... .... ............ .... ... ................................................................................................................................................................ pursuant to application dated ...........................~~.....a~L........., 19.~.9.., and approved by the Building Inspector. 110ft ..tbaok to ba .....r.C. in thia block OJ' more. Fee $~9.,,~............. ~!-i~~ ~ '" \)-. ...... f'r¡ , t ~ " '0 f'J !\} t \J (; SUFFOLK COUNTY DEPARTMENT OF HEALTH WESTERN DISTRICT One Old Indian Head Road Cammack, New York 543-1116 H . D . Ref. No. t::;c; - 4'l~ ;-- r-' RECF!\'- , 'FJ MAl 27 f" ie,. r' APPLICATION FOR F NSTALLED PRIVATE SEWAGE DISPOSAL AND WATER SUPPLY SYSTEMS Ins b"" I p roval ia requested, pertinent installation dats herewith. R\ Ie .\ c." I-Name of Owner fr..-;¿í,' )F¿{J_-rt 3-Subdiv. Address 1//-/'7 l/>¡c.f/ ,!'//X 1~,;;¡.,':r"n,"".Phone;:!'~(,,").;·,</·4-Sect1on No. ~~~~-:'f~ 2-Name of Builder_I,,,,'I,,-.} /... /__L'¡:;'; Phone'7'/~ ·!-!.ð , 5-Lot Number Of 'í' Address'''·,··',-'; """."",: !t;.': /?/t',':'I,..... 6-Bldg.pe.~.itNo..q~092..-· 7 -Sewage System ins taIled by () In ,., ~. D Phone «;' tf / to ,;- Address ,5' (, ~' ~. ¡.I c I"/ÐI'>II 8-(a)Deedlocationofproperty '019 It \" (b) Hamlet ar Village )o~'Tt-f (,'__.D 9-Septic tank-Gal L ft.W ft.Liquid Depth ft. lO-Cesspools-(a)No.pools (b) Blacks below inlet-l)/okJ 2) Jðð 3) :ò-r: (c) Block size-L ;;; in.W '( in.H I';' in. (d) Precast pool (f)H ft. in; Diam ft. in. (g) Finished grade to (h) Backfill Material ¿,-::r;x;,;.It -;>:::" -U. ll-Water Supply: Public System '; Private Well x' If Private, the following questions are to be apswered: -- J ¿/ I / ,> ' 12-Private Water Supply System installed by If "'-_''-' ~L¿ Dr;.'!..:!;!?:- Phone "L "" Address ¡) N; 0 ,,0 A·v 0; I S' L j f->· 13(a)-Total Depth of Well ~ (b) Depth to Static Water Level 14-Diameter of well pipe 'J in. IS-Name of Laboratory 17-Date ready for inspection .... r/ '"- :~)~>}í (c)Town _~c.' ,_-'1',;':- 'K ,e'~",-~ " "'-!i".'-; :'-.1_ > (e)l 2 3 cover ~ - ft. t /"1 16-Method of Disinfection Jh~/6')' . The undersigned CERTIFIES: Above systems have been constructed and are in compliance with the Suffol ty Health ep tmenty'~ c;pn/t '.Sta,/~. dS,' Bulletins and Amendments thereto. '~ ':,-----"""')..... (.:;- 18-Date .' " I Signed -' - /. /-c. ............~ - Builder / l-/ 19-Insert sketch of location of Water ~~ewerage~lities with accurate dimensions. ; ,,;---¡- I. ~ , \, \' . -------------------------------------------------------------------------------------- Inspected by Based above systems can FOR HEAL ¡ EP T USE ONLY r . Date ~- ¿~C q upon the information state above, satisfactory fun/tioning be expected with proper maintenance and care. of the Date JUN 3 0 1969 Kd/.d- (l. Utfø. Dløtrlct Englne~ Approved 5-5 Instructions far Submission of Installed Private SewaRe Disposal and Water System Application Applications are to be submitted in duplicate. Required information should be typed or leaibly printed in ink. Inspectors are nat permitted ta make inspections of installations until applications have been submitted to and accepted by this de- psrtment. The item number on the applicatian form and item number listed below are the same: 1. Owner's name and address - if owner and builder are same, so indicate. 2. Builder's name and address - approvals will be mailed to this address. 3. Give name of filed realty subdivision map. 4. Section number of realty subdivision map. 5. Lot number of plot on which disposal unit is constructed. 6. Building permit number assigned by the Building Department. 7. Name of person or firm who actually constructed the sewage disposal facilities. 8. (a) For example: s/s Jones St., 100' e/o Smith St. (b) Hamlet, (unincorporated area in township), far example: East Moriches. Village (incorporated srea) , for example: Northport. (c) Township, for example: Brookhaven, etc. 9. Give inside length and width in feet. Liquid depth is measured in feet from bottom of outlet pipe to bottom af tank. 10. (a) State number of pools. (b) State number of blocks below inlet pipe for each pool. (c) State length, width, and height of cesspool blocks in inches. (d) Indicate by check if precast sections are used. (e) Give number of leach- ing sections per pool. (f) Give height and diameter of each leaching section. (g) Give depth in feet from finished grade to cesspool cover. (h) Describe backfill material used. ~l. Indicate by check if water supply is public or private. 12. Name of person or firm who actually installed the water supply facilities. 13. (a) Give depth in feet from top of well pipe or casing to well point. (b) Depth in feet from top of well pipe or casing to water level in well. 14. Inside diameter of well casing. 15. Name of laboratory performing the examinations. 16. Describe method of disinfection, for example: quart of laundry bleach in ten gallons of water pou~ed into well and allowed to stand six hours. 17. State date on which installation will be ready for inspection. 18. Application must be signed by builder· or óWner. Signatures of subcontractor, superintendent, etc., will B£! be accepted. 19. Indicate location of Water & Sewerage Facilities with accurate dimensions on sketch. FORM NO.1 ?z.1 ~ ~ l\ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~ \.. } ( E.xamined ............... "'...", , Í' 19.. .. 1-(;;'0'; Z- Application No. ................ Appl'oved . . . . . . . . . . . . . . . . . . . ., 19 . . . . Permit No. . . . . .... . . . . . . -- l "- Disapproved a..'c ............ .. . . .. .. .... .. .. .. . . .. . . . ..... .. .. .. .. .. ........................~7....................... (Building Inspect:JT) ..................... .......... .... .... .... ...... .... ...... APPLICATIO:l FOR BUILDING PERMIT .J ~ 6;: Date.. ... .. ..... ..l.~Y. .. .... .. ... 19.... 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 tot and of buildings 0 n premises, relationship to adjoining premises or public streets .or areas, and giving a detailed description of layout of property must be drawn.on the diagram which is part of this application. c. The work covered by this applicaÜon may not be commenced before issuance of Building Pennit. d. Upon approval ,of this applicatkJn, the Building In spector will issue a Building Permit to the applicant. Such permit shall be kept {In the premises available fo I' inspection throughout the progress of the work. e. No building shall be occupied or used in whole CI1 in part foOl' 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 Penn it pursuant to the Building Zone Ordinance of the Town of S8'Jtho ld, Suffolk Oounty, New Y.ork, and other applicable Laws, Ordinances or Regulations, for the construction CIf build ings, additions or alte'rations, .:JT for removal or demo- lition, as herein described. The applicant agrees to com~l with all applicable laws, ordinances, building code, housing code, and regulations. ... . ...../?/çØ.~. 2.... .......... ..... r (Signature of applicant, or name if a corporation) Ie.?:....? ,Ç?Ç?;-"A .~.... kl:'¿. .B.ft)(t7;'.1'.r (Address of applicant) State whether applicant is owner, lessee, agent, archit ect, engineer, general contract{]!', electrician, plumber or builder.. . .B.c,.:I./:-" .l)t';:; tf.:.. . . .. .. . . .. .... ............................................................. Name .of owner of premises. J?eTEJ;'..Y.-. /11fi;(ßA(f.~... ..J.c:r??-.#. .t.r·.................. If applicant is a c:>rporate, signature of duly authorize d ·officer. .......................... .......................... (Name and title of corporate officer) 1. Location.of land .on which proposed wark will be done. Map No. . 3.~.~ r... Lot No. .../...... Street and Number . .6.-I,.,.~/V.(!--:'.... .f). P... ..... .$'.ç.t!.rd'.ð.ç~...þ......................... Municipality 2. State existing use and occupancy .of premises an d intended use and .occupancy of proposed canstruction. a. Existing use and occupancy .....t( A:C. A.I-:< C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended use and .occupancy.. .é? ~.ç.. ..F1'J!!.?/~>,<.... .p.~. ~.¿.ç/ ~.c.'-:........ 9. 10. 11. 12. 13. 3. Nature of work (check which applicable): New Building Addition..... ... Alteration........ Repair... . . . . " Removal....... .,,:QI=molition .. . .. . .. Other Wark (Describe) ...................... 4. Estimated C~st .... .l"ì;¡ .S?!('.. .. . . . . .... " . Fee. . . .. .. ................ . .. . . .. .. .. .. ...... .. .. .. . (to be paid .on filing this application) 5. If dwelling, number of dwel1ing units .....f.... Number of dwel1ing units on each floor ............. . If garage, number of cars .../.................. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. . .. . . .. .. .. . .. .. G. If business, commercial ,~ mixed occupa:1cy, spec ify nature and extent of each type of use. . . . . . . . . . . . . . 7. Dimensions of existing structures, if any: Fr:mt . . . . .... . . . . " Rear ............. Depth ............. Height ................ Number of Stories .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front .............. Rear ............... Depth ................ Height ................ Number of Stories ..................... 8. Di~ensions of eïtire new constructi~n: Front ... . . . fC. ~. . . .. Rear..... ~'Ý". .. Depth .. ~..f.< . . Height ...; .€-. . . " Number <Jf Stories ......... . . .2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Size of lot: Front ../ ð-i). . . . . " Rear ........ '.-.//. C Depth ..:A .l.(7-, . .. . '¡,-li kæ (I¿ D Date of Purchase 1l1.~/..I.~. /!¿ f.-.. .. . . .... . Name erf Former Owner t;11~e.!?!.. .. t.<';.'<-.S.ß¿¡~ .C!... Zone or use district in which premises are situated. . . .. .. .. ./Ç (;,.5.. .. A,.. . . .. . . ...... ...... .. ...... . D d t t· . I t " 1 . d· I t'? /VO oes propose cons ruc Ion VIO a e any z::mmg a w, or mance or regu a Ian. ................. 2.' 72' . . . . . Name of Owner af premises !'..f7~/h. f.if~~. kddresslt.?-(~.. ~"!'{~~. .l:r/?"!( PhŒle No. ç:~.. >-.5:7?"1 . I<. e(.V· C-Á ¡!! p[;:"'µ.s.' "-X- Name of Architect ............................. kddress ...................... Phone No. ........... Name of Contractor . ~ Po #~. .e.. Is: LFI..J.... . Address ~e.'2;-'?" .<;q .';-.t~. -:":'. ~~Y;hŒle No. ~~.':? .2;~~ BAyf'C'¡~7 / .:X.. .. Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property Jines. Give street and block number .or de scription acoording to deed, and show street names and indicate whether interior ,or corner lot. I / -, PLOT DIAGRAM IVJ A- P ~8 7' J'- /-6'ì ... ;7 (:oJ '" I.\¡ r-.j )." ~ ßL P-38'1 ~ATE OF NEW ~ftK, ~~, COUNTY OF S"'I(HlC . . . . . ) . . . . . . rJl9. tI. to/: . . . . p. . kl-.11I >.. . . . ...¡ fi.. . . . . . . . .. being duly sworn, deposes and says that he is the appli- cant ab~~:::;:~~~:i~::~:i~ni~~.~. .. .. . . .. .. .. .... . . .. ... . .... .. ........ ........ .: . (Oontractor, agent, OGrpOrate officer, etc.) of said owner or .owners, and is duly authorized to perform or have perlormed the said wark and to make and file this application; that an statements oontained in th is applicati.on are true to the best of his knowledge and belief; and that the work wil1 be perfocmed in the mann er set forth! in the application filed therewith. Sworn to before me this ~ ~ J ~ /cro 6;.t..e f.-' tv ~ D. I~ ,,'q(~JHHHHH d ~ O, TOO, FAc~ of ~?ODf ~ O, ToO. FAc~ oF LO W E ~ L E ~E L PLAN UPP g~ LE Vg L PLAN -- : , .-- = ~ : , - '~ =--- - ~ ~llrll~ : _.r _~,~ ,== ..... ~ ~ ......................... ~__~ ..... ~ ~ .................. ~ ........ , ~ _ _ ~ ....... ~ " L g F T 5 I D ~ g L ~ V, F ~ 0 ~ T g L E V A T I 0 .. ....... ~ ~ , ~ ~ ~ ~ $ - ~ ~.~.~,.,~/ ~ I, ~ ~ ~ ~ s -T'q ~ ~ ~ ~ S~SS~ ...... -~ I ...... ~ ~ -- F , ~---~- ................... I -- ~ ~~-'-==="---:'=~' ~ , ~ .............. ~: -Z -~ ...... : ~li I ........................ I ....... ~~~.:~ ~_.~-~ ~,~ ..... _~ _ ............ _ __ _ _ __ ~ ~-- ~ .... . __ ----~ .~ . ~~----~ __~ -- " :JI 1 ~~, , ,~~ ~ - '' , ~ ..... ~ ~ ~ , , '' ~- ~ ~o ~m~ ~ ' · ' , ,, -, ................... ~ ~- ~2 ........ ~ ..... - = ........... I I ' I ~ ................ I ~ I ISSUED FOR DATE REVISIONS BY DATE ~~RICHARD ..POEEMA,. DESIGNER · IRVING ,. PALMQUI,,. A.I.A. DESIGN ,O. 1355 16]10 GRAND RIVER AVENUE DETROIT 2~. MICHIGAN /~ ~;I ~jj#. ,,,,, ''~ r / ~ IIllI .~ ~ -, II IPIlI '. ~ , ~ I1~1~ _, I~ IHII ~ ~ ~ ..... ~ ~ ~ , ~..~ , ,,,, , I I IH I ~ ,/~ ~~'-~ , ~ ~ III1~ Hill ~,, , , ~SDL L SIZE . TYP, T ~.t~ DETAI L S .._......... '" ......... ""'"*'"~-- -~ome p! ~ ~'an n ers, I ~ .... ~ I I " I -'~ I i~ ! , , , I I I : I I I I I ~ I ....... ~ I - . ' : ~., ---- --- ~ .,'~ .~.- -~? ~ , ~ , > ~. ~ '"' " L I pRELIMINARY CHECKED APPROVED Lin,Ft. IAn.Ft 2 2 , J ad. hr Ta~e ~t,e~-tor Wa1!! 73 74 75 76 54 R EVISIONE* BY 2 Tile Pleer , h~m Do~r Yt_.tlah Pall & Bifold Sliding D~r T~ Cmide Track Bntt~ ~J[~et Polo~ Loot~ &~+.,o~ _ __ Sash Leek~ 66 67 69 70 72 73 74 75 tme anners, inc. t t NO. OF