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HomeMy WebLinkAbout6072-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . .][~....~..o~[..~ .~.~,~. g~...]~... Street Map No. ~ ........ Block No..~ ....... Lot No.. ~.. ~h~.. ~Y, ........ confor~ subst~tially to the Applica~on for B~lding Permit heretofore filed ~ ~ office dated .......... ~ ..... ~., 19.~. p~suant to which Build~g Permit No.. ~. dated ........ ~...~ ...... , 19~.., was issued, ~d conforms to all of the requir~ men~ of ~e applicable pro~sions of ~e law. The occup~cy for which this certificate is issued is . ~Yat~..~..~.$~.l~g ....................................... The certificate is issued to .~ .[~. ~ ..... ~*~ ............................ (owner, lessee or tenant) of the Mores~d b~ding. Suffolk Co~ty Depa~ment of He&th Approval J~..~.. ~.. ~. $*. ~g~l~. ..... UNDERWRITERS CERTIFICATE No.. ~..~3~... ~.. ~.. ~ ~ ................... ~ous~ ~UM~R...~.~0~ ~. .... St~t... ~...~,~,)..~..~ ~.~. ~..~ ....... .... Building Inspector / FORM NO. ~ 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? 6072 Z Permission is hereby gronted to: ~.,~ ~.t~ ~.~. ~...~,...~ ..,L ..~.. ~,u~._ ;~.,,..~-,~... ....... Ma~.~.t~.i ................................................. to ~'l.3A.. ~e~ .. ~r~e · · ~,'a~:L.l:y...a~,~.l.]:.~ g ...................................................................................... at premises located at ....Ro~,Id.~..e££...~.~.~/~e§o,~..~,A..&..t~4_~.ge.J~e~ ................................. .......................................... ~.o,.-~ ....... ..q:2~. ................................................................................ pursuant to application dated ....................... ~'..~....~-,~ ............... , 19..~., and approved by the Building Inspector. Fee $...~S~e0~ ......... Building Inspectort FOuM NO. 6 TOWN OF SOUTHOLD Building Depafl'ment Town Clerks Office Southold, N. ¥. 1197] 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 fram Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, o 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), 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 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 TERRI I~E F. IAK N~TARY PUBLIC, State of New No. 52-6166~t~ ~ullified iff ~liou Ocbnly ~bsM ~pires ~rc~ 30, 19 $5.00 New Building ...X ......... Old or Pre-existing Building ............................ Vacant Land ............................ ,oca,,o. Pr e.y Owner Or Owners Of Property .~......~.~..~.../..t~..../J~'~t....[....l~l~"~ ................ Subdivision ................................................................ Lot No ............. Block No ............. J:louse No ............. Permit No. ~,~-~,,. Date Of Permit ...~../~,.~pplicant .~.4 .~..~)..~D...2,...)~-'-~.~..~..'~..~...~..~....', Health Dept. Approval ...~lsl~.~..~..~..?..../.'.~..~)~-abor--'' ~- ' ~' Dept. Approval ............ ~.~. ........................ Underwriters Approval .~/~.~--'--' ~.~.1(~)~'..~.~...',~ ,nih Board rov, l ............ a g App ................................... Request For Temporary Certificate ........................................ Final Certificate .~ ................................. Fee Submitted $ ...~...! ............................ Construction on above described building and perm~ =~ts. ~ll _fe~licob~c.o~.es and regulations. Sworn to before me this '~ ~.....'~... d~of .......~....~..~...:.~.%.~.....~..... (stamp or seal) .....,, Notary Public~.~~ County THE NEW YORK BOARD OF FIRE UNDERWRITERS ~. bk BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK I003S "o,~a~ 2,, ~p73 .'F,,"~.,,,,-',,.,,-/,,. 629320N 092372 THIS CERTIFIES THAT Ma~v Elizabeth Murphy, End of prl. rd., 1100' n/o~ ~ Cut~o~u~, N.Y. end o~ Brld~e~L~ne, FIXTURE ~EPTACLES SWITCHES ~ RXTURES~ ~ ~ ~GES_ ~C~KIN~OECKS/ OVENS ~DSHWASHERS EXHAUST FANS ~0 24 DRYRRS RJRNA~E MOTORS SERVICE DI~ONN~T '1~.~ 2 200 C~ ~otors : 1-1 hns Panelboard: 1-3 c~r. Elec. furnaces: A1r. Oond. unit: ~-2, Garbage compactor: X 125 amns ~ 1-25.0 1-3 ton 1-10 amD 57 ~ ~22.1 ' ' I ~ q q ~ I FUTURE APPUANCE FEEDERS SPECIAL REC'PT~, · ..... ~1_. ~_ _ I 3 10 1. ~0. . . . 1 4.5~w 7' 6 600 1 500~Gm BoxSandstr°~145 Electrlc Co_ W ~ Aqubo~ue, N.Y.iZ931 . This cerlificate must not be altered in any manner: r urn to the office of the ~ord if incorrect Inspectors ay be ,dentifled by their~ed~nt,ols. FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ~ll~ to the Building Inspec- tor 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 disposal-iS-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 installa- tions, 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), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p:operty 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 informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 Date2.8., .d.a.n.u..a ,r.y. ,1..9.8.5 ......... New Building ............. Old or Pre-existing Building ~' Vacant Land Location of Property150.15 0re,on Roadt..Cutchol]ue House No. Street Ham/et Robert D'Urso & Stewart Kauffer Owner or Owners of Property ............................................................ 73 2 3.1 County Tax Map No. 1000 Section .... - ........... Block ............... Lot ................ Subdivision '50 ?'2Z' - - '~'' ?'-'/'gfi' ................ Filed Map No ........... Lot No .............. 8123Z /.~,~31 Peter W. Kren Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for_Temporary Certificate ..................... Final Certificate ....................... 15.00 Fee Submitted $ ............................. Rev. 10-10-78 Construction on above described building and permit ~eets all applicable codes and regulations. Applicant .... , ~rL~... - .~-', .~r.~:TT...,: ;-:~7-:5.. I~UM NO. S TOWN OF SOUTHOLD Building Depamnent Town Clerks Office Southold, N. Y. 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), 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 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 $5.00 3. Copy of certificate of occupancy $1.00 pete .... .... New Building ...... ~ ....... Old or Pre-existing Building ............................ Vacant Land ............................ Owner Or Owners Of Property .......~. ~).l)~.....(~t~.~l~./~A.le~.....~.{~..,.~{'~ ..................... Subdivision No ............. Block No ............. House No ............. ................................................................ Lot Permit No. ~O..~..Z Date Of Permit ...~[~.l~/.~'...Applicont .~ll~..~,.~....~.,,..~(/~.~.~..~...J.~...~..~.VC0 Health Dept. Approval Approval .......~...-~ ........................... Underwriters Approval .....~.,l...~...~.~/.~.~.~..t~#~...~anning Board Approval .... ...~..~ ...................... Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ...... ~...'. ........................ Construction on above described building and permit ~eets all ap~r~.~able ~j~es and regulations. Applicant ......................... ~ ..... ~ ................. Sworn to before me this '~J ~' · ..~.. ........ da~,,~f ....?~....~..~..:...~...~....~...~_ ~- ~,~,~,~ \\<- (stamp or seal) ~.,~'/C~,~ TERRI LEE ELAK NOTARY pUBLiC, State of Hew Yor;~ gelemission Expires ~,'larch 30, lg -/q £ UFFOLK COUNTY DEPARTHENT OF HEALTH APPLICATION FOR ~P~OVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 2. P.~oper~ locatign }]OOFT. HCKI. cFJ~E~EC~OH Village COTCHO~U~ Township name NA ' 3. Public Water Comp~ 4. Lot size: Width ~ feet Length ~60 feet 10. Sewage Disposal System: A. B. 5. Subdiv. NA 6. Section Kh 7. Lot No. Nh 8. Private well Y~b 9. Public water ;{o Distance to main NA (Enter on center plot below) 900 gallon septic tank: Precast /E~uivalent Block Leaching pools: Number ~ Precast ~"Block Special -- If private well fill Z55.o Street in blanks below: Tank capacity ~ Gals. Pump G.P.M. Total well depth~O Depth to G.W. ~ O_ Amount of water in well Test Hole Data Feet To~ ~o~ 0 4 10 12 14 16 18 The undersigned CE~ ~IFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's/~rrent stand- ards there to." ~ ~ / ~/ ~0R HEALTH DEPARTMENT USE ONLY. Based on the i~mation presented herewith, it is the opinion of the Mealth Department, that an adequate and satisfactory Sewage Disposal S ystem¢/~/~can be installed on this p l~~ ~~ ~ ~~~~ Date o/ ~//2~ Signed S-15 Revised 4/]/72 APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE S~.~WAGE DISPOSAL SYSTEMS INSTRUCTIONS: Applications must be submitted in triplicate 1-Means O~ner 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-£nter name of Public Water Supply District. together with the distance to their ,min. 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 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: 1. 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 shm~n on face of this application. 2. Surface waters-Streams, Lakes, & Bays, etc., located within a distance of 1OO 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. ~LL 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 diste~nce 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 DisposaI "t)qoe of systems', re- quired, 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 1OO 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 foundati~n~ 6-Cesspool exterior must be 1OO feet minimum distance from surface waters, streams, lakes, & Bays, etc. 7-Cesspools ~st 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 1 foot to maximum of 2 feet. lO-Bottom of cesspool to ground water ~xst be held to minimum of 2 feet. ~WN OFSOUT.~O 0.,<, // ~' ~ ' ~ I' BUILDING DEPARTMENT ~,,~.~~ '~~ TOWN CLERK'S OFFICE S~THO~, N. Y. ~.~ .............. ~ ........ ~ ........... , ~,~t~o, No..~.~..~..~. ........... A~r~ed ........................................ , 19 . Pe~it No. ~ D (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS (3. 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 adjoining premises or public streets areas, and giving a detailed description of layout of property must be drawn on the diagram which is port 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 opp cant Such perm shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever unt a Certificate of Occupanc¥~; 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~,~ 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, or for removal or demolition, as herein described/- The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. _ (Signature of applicant, or name, if a corporation) ..... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .............. .,~,..~,~..~...~ ....... ~=.~..!.;./-;.h...~...~'...?..!~ ........ [~).~.~.~.~.~ .................................................... If appl~ant is a corp~te, si~ature of duly authorized officer. ' ........ · ...... .......... ~ (Name and title of comorate officer) ~'~ 1. L~ation of land on which proposed work will be done. Map No.: ........................... ~ Lot No .......... 2. S ate e's ' g use and occupancy of premiss and intended use and occu~ncy of pro~ const~ctio~ 3. Nature of work (check which applicable): New Building ...... ..~'... ...... Addition .................. Alteration .................. Repair .................. Reljpoyal .................. Demolition .................. Other Work (Describe) ........................................ 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 of cars ............... ~ ........................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ....... ~ ............... 7. Di~nsions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Nu~er of Stories Dimensions of same structure with alterations or additions: Front ............ ~ .............. Rear ...~ .............. Depth ~ Height ......... ,~ ........... Number of Stories ....~ ................. 8. Dimensions of entire new construction: Front ............ ~.~.~ ............... Rear ....... ~.~ ............D~th ...~ ............. Height .~.Z.~ ...... Number of Stories ... ~ ?. ................. ~ ............................................... ' ....... ~ ~ .~ ............. Depth .....~ .............. '" 9. Size of lot: Front ....... ~ ............ Rear 10. Date of Purchase ............I..~,..J.~.~ ................... Name of Former Owner ~..~.V~...~.~ .......... 1]. Zone or use district in which premises are situated .............. ~.~J.~L ........................................................... 12. Does proposed construction violate any zoning law, ordinance or regul~ion? ........... ~.~ .......................................... 13. Name of Owner of premises .~...L..HP~....Add~,~ ~.~.I~C.~...~.YO~.... Phone Name of Architect ~..~....~~ ........ Address ~..~,..~..~..~.~Q~... Phone No ....... ~ .......... Name of Contractor H~0kD...~E~.~.$D~J~Address ~fl.~.~J~.... Phone No.~Z.~J PLOT DIAG~M Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-~ck dimensions from prope~ lines. Give street and block number or description according to deed, and show street names and indicate wheth, ~~t~ lot .... J6~,5' > J ~kcp~ ~S VACANT AS STATE OF NE~ ~RK, ~O ~/ COUN~ OF ~.~.~=¢ ......... ~'~ .... : ............ ....... ....................... o,, i, (Nome of individuol signing opp~icotion) obove homed. He is the ............................................. ~..~.....~.~.)~.~.~ ......................................... (Controctor, ogent, corporote officer, etc.) of sold owner or owners, ond is duly outhorized to perform or hove performed the sold work ond to ~ke ond file this opplicotiong thor ~lI stotements contoined in this opplicotion ore true to the best of his knowledge ond belief; ond thor the work will be performed in the monner set foRh in the opplicotion filed therewith. :, · ........................................................... Cou. ;';. ............... DEPARTMENT OF HEALTH RIVERHEAD, N.Y. ' FOLI ~ DATI,_,' ~"'::: pL,~ [',] I/LI:L lie :: N PKAV, kL B'y : CC, W. "// ? IRE) OF ~- RAA\IN'G ?LAN S E COND F LOO'~ F ~AA,\iN~.~ *, ~' PLANJ , ? '2] Q [ $ E CT o i'.l ~, - A" /~AP-,¥ ELIZADETH X~LI~PHY OFFICE OF C,G oST~VE WOR,'AUTH, ARCHFFeCTS 25 EAST TEh.]TH ~R~V YO~K, N~W ¥OR~ ~HEET OF B -t ~ ~_B.¥AT._!O_N/?__,_ F LEVATIO)',J <6i.z / '%, NOTE 5 : '0% ELEX/ATiofq GECOND FLOOR PLAN E LEVAT.I ON Z~}o ,, / q LZ !:i/,w,;s w r:sc, -I ELEVAFI ON ~(~ VAT rE: N / '\.% SECONP FLO©~ ELEuTRICAL PLAN F R-~ F LQO~: - LE C, TClaS, L. FL-\tl EE¢IDENCE /~\AE'f ELIZASETH ,,v, Li~'~r'"' QLiT CHGGL~Er NE.V/