HomeMy WebLinkAbout6111-zNO. 4[
TOWN OF $OUTHOLD
BuH.r~ING DEPARTM~.NT
Town Clerk's Office
$outhold, N. Y.
Certificate Of Occupancy
No.Z.~.I. 2..$ ....... Date ...........Sel~t ..... 26 ..... , 19~..
THIS CERTIFIES that the building located at 1~.~ .Ro~d~. J.oknS. ~ ......Street
Map No. gx~ ........ Block No...XXX .... Lot No.. ~X....F~ .t.t~.~9]~...~;.Y.; ......
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ..............Altg.. 2~ 19 .?2. pursuant to which Building Permit No...611 .~Z
dated .........~apt..1.l ..... , 19.72., was issued, and conforms to all of the require-
merits of the applicable provisions of the law. The occupancy for which this certificate is
issued is .?r/.v. ate..one, family..dvellSug .......................................
The certificate is issued to .J.,. P~1~11.~ .tO...GEO..L:. Perw~Y... ~[;I.~ .... .0kro. ~. .......
(owner, lessee or tenant )
of the aforesaid building.
Suffolk County Department of Health Approval .~ep.t... 2~...
UNDERWRITERS CERTIFICATE No. ~. 1 .~.. ,~ .... 0.c.t.. 5.1.,..1.9.7.3 ..................
HOUSE NUMBER .... (~00. ...... Street ....J.q~..~9~.d... ~ .P.V.~...Rp...~)) ...........
.... .............
l~OR~ NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
$OUTHOLD, N~ Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 6111 z
Permission is hereby gronted to:
....... ~~ ....... ~,,~... .............
at premises located at ............................ ~..Z ...... ~.b......:~... ...... ~ ....................... ,,~/:Li~.,~.....i'~ 'E3
............................................................................... ~.~:.~.~.c~. ......................................
pursuant to application dated ...........................~....~......~...../~.....~..~..., 19Z.~,.~nd approved by the
Building Inspector.
Fee $...5~. ..............
FORM NO. 6
TOWN. OF SOUTHOLD
Building Delm~tment
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 DUPLICATE 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 disposal--(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 applicoN&
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
o, ,.00
Date ..................
New Building ................ Addition ............ ~.... Old or Pre-existing Building ......... '~. ...... Vacant kond
Location Of Property ................. DJ,'__ ,~ _;'~-'""~"~':~'-~t~'-"~"~';2'"~'~''''~L'"~~ ........... : .............
Owner Or Owners Of ProPerty ,,~.~r;~...~~..~ ........ .~...~.~.. ~.~..~..~...
Subdivision ................. ~ ......................................... Lot No...........'---Z.. Block No ............. House No .............
Permit No ........ /...../.~-Dote Of Permit ....~ ..~.~....?..~....Applicant ......................................................... .~ .....
7--'/
9 /-r' Ar
Health Dept. Approval ............ J.. .......... J.... .............. Labor Dept. pp oval ................................................
Underwriters Approval -~ //~ / 2- ~ o ~ ~ Planning Board Approval
Request For Temporary Certificate ........................................ Final Certificate ..........................................
Fee Submitted $ '~ ~-"~--
Construction on above described building and per/~ meets all .~ble codes and regulations.
Sworn to before me this
...... ~.....~.. day of ...~....~..~ .7,...~.~. .... (stamp or seal)
Notary Public .......... ~~ounty
TE~T we
0.0
TOII~OII.
Ll-- --
Unauthorized alteration or addition to this suwey is a vio~tion of
section '7209 of the New Yod( State Education Law.
Copies of this survey ,naa not bea~ing Ihs land su~,eyor's inked
seal or embossea seal shall not be considered to be a valid copy.
EI.EWIT/OMI~ AN' I~EFEN'NGE~I TO AM A~W DATU~____~
8URt~Y FOR
dO SEPH PUMtLI_O
TOWM OF
SCALE '
~EPT:. Sp
ellklMl~r~ TO,
SUFFOLK COUNTY DEPARTMENT OF HEALTH
N.D. Reference
APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM
1. Applicant ]~I£DH ~T[tD Pho~~'499~5. Subdiv.
Address ~ 6. Sectionllhm~__ .... ~TAK .n~-: &~R
· location-' 7. Lot No.
2 Property
_~_~ ~_~9~_~ O~ ~ey ~Yg; 8. Private well ¥~
Village
~ Public water
~°wns~ip~.~stance to main
3. Public ny name ,,~
4 Lot size: Width~feet "~gth__l~feet (Enter on center plot below)
10~ Sewage Dispos~y~tem: /
A. ~00/gallon septic tank: Precast ~Equivalent Block
B. ~aching pools: Number ~ Precast ~Block ~cial
If private well fill
in blanks below:
Tank capacity ~ ~als.
Pump G.P.M. ~
Total well depth
Depth to G.W.
Amount of water in
well
Test Hole
Data Feet
0
2
4
6
8
10
12
14
16
18
Date August 5 1972
The undersigned CERTIFIES: "Constructi( ,f authorized installations will
be in accordance with the Suffolk County Department of Health's current stand-
Ow 9 -or
on thi~/information presented herewith,
FOR HEALTH DEPARTMENT USE ONLY. Based it
is the opinion of the ~Health Department, that an adequate and satisfactory Sewage
Disposal System can be installed on this plot.
Date ~/~__'" 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 Owner or Builder. Address to which mail should be directed.
2-N2aus detailed description of property location, together with street name and distance to
nearest intersection of ms~n 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: Enter "No" if Public water supply is available. Enter "Yes" otherwise.
9-Public water: Enter "Yes" if Public water supply is available. Enter 'Ho" otherwise.
PROPOSED SYSTE~: 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 infor~mtion 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~ 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 ~inimum distance from the nearest cesspools.
Well- 25 feet distance from rear and rear sides of property lines when possible.
Well- l0 feet distance from front, and front sides of property lines when possible.
Well- 50 feet ~inimum 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 LO~ATION: Upon determination of the Sewage & Waste Disposal "t~pe 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 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 1 foot to maximum of 2 feet.
lO-Bottom of cesspool to ground water ~xst be held to minimum of 2 feet.
~A~ ~wa~o disposal and water supply
faciiitie~ for this location have been
~nspected by this department and found
Chief e~ ~eneral ~nee ~
TOPSOIL
SAND&
GRAVEL
Ali dhtances to ,~11s and cesspools are
by location from house owners and field
observations, since most wells and cess-
pooJ~ am not visible throe dimen~/oll~
cannot be certified.
WATER
Unauthorized alteration or addition to this suwey Is a violation of
~ectlon 7209 of the New York State Education Law.
Copies of this survey map not bearinQ the land surveyor's inked
senl or embossed seal shall not be considered to be a valid copy.
G~
~lr c~rtifica ohs indicated hereon sba
pe g,~m ~he survey is ~re~ar~-S ~ ..w,n only o the
ELEYATWNi ARE REFERENCED TO AM ASSUMED DATUM
SUHVEY FOR
GEORGE'/_. P NNY, TIT
AT ~ATTITUCK
TOWN OF SOUTHOL. D
SUFFOLK COUNTYt N.Y.
SCAL.E : I"' 40'
SEPT. 8, 1972
MAY 9, 197'3
S£PT. 24, 1974
REFERENCE,
eUARANTE~ED TO ~
FLORAL PARK FEDERAL SAVIN6S I LOAN AS.~CIATIGN
LAIIB ~URVEYOR
#.¥& LIC. IIG Mm I
mV R# A , . I
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
~UTHOLD, N. Y.
Approved ............................... ~ ly.....~e-r m r, lo.
Disapproved a/c ..............
.......................................................................................................... ~ ~ /~.~ ~ ~.~z ~'.
~ ~.. ~ww~ ......... (Building Ins~tor) ................................
~,~
APPLICATION FOR BUILDING PERMIT c~
D,~te ........ .~.~ .~.....~..~., ................. , 19..?..~.. .....
INSTRUCTIONS ~
a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with
3 sets of plans, accurate plot 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, an
giving a detailed description of layout of property must be drawn on diagram which is part of this application.
c. The work covered by this application may not be commenced before issuance of Building Permit. II
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 I~e~
granted by the Building Inspector. i!
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, and to admit authorized inspectors on premises and in buildings for necessary inspections.
(Address of applicant)
State whet,~er 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.
(Name and title of corporate officer)
1. Location of land on which, proposed work will be done. Map No.: .................... Lot No ..............................................
Street and Number ...... ~?~`~`~~?~?~M~?~L~~ ................................................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ....................................................................................................................................
b. Intended use and occupancy ................................. : .......................................................... ~~ ............... ..~
3. Nature of wore (che~k, which applicable): New Budding ....~ .............. Add,t~on .......... ;~...~:... Alteratlo, n ........ : ......
Repair ................. ; ....... Removal ......................... Demolition ........................ Other Work' ............................... .~-..
(Description)
4. Estimated Cost ...'.l..J~,,~l],,,~ ................ Fee ................. .,~..; ..........................................................................
(to be paid on filing this application)
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 ........................................
8. Dimensions of entire new construction: Front .....&[~. .............. Rear ..... .~.?. ....... ' ....... Depth ...... .2..~ ....................
Height ....~.t. ...................................... Number of Stories .......... [ .............................................................................
9. Size of lot: Front ....... .[~.t. ..................... Rear ....... ~t~[ ......................... Depth ...... ~.~§~ ...................................
Height .................................................... Number of Stories ......................................................................................
10. Date of Purchase .....~.~. ...................... Name of Former Owner ............................................................................
11. Zone or use district in which premises are situated .....................................................................................................
12. DOes proposed construction violate any zoning law. ordinance or regulation: ....... ~ ................................................
13. Will tot beregraded-.~.~l~ ........................ Will excess fill be removed from premises: [ ] Yes [ll~ No
14. Name of Owner of premises ...,....~MIEI~..~tJI~I~.I~- ............................................................................................
(Address) (Phone No.)
Name of Architect ................................
(Address) (Phone No.)
ame eT ~onzracTor ..... ~.~ .m .~em ......... m,~.?~ ............................................................
(Address) (Phone No.}
PLOT DIAGRAM
' Lo~ ate clearly and distinctly all buildings, whether existin
property lines. Give street and blOCk number or description according to ~
er interior or corner lot. \.\. I(' ~
I0O'
STATE OF NEW YORK, ) ~~
COU.TY OF ......... tutt~Tk ......................... ) SS
ill set-back dimensions from ~
vheth,
~~ .................... being duly sworn, deposes and says that he is the applicant above named.
He is the .............. ~III~...~L.~#II~II~ .................................................................................................................................................
(Contractor, effect, corponzte of~r, etc.)
of said owner or owners, and is duly authorized to ~rform or have ~rformed the ~id work and to make and file this application; that all
statements contained in this application are true to t~ ~st of his knowled~and ~lief; and that the work will ~ ~ormed in the ~nner
set forth in the application filed t~rewit~
. ...................... ....
,otar? ..........
if' THE NEW YORK BOARD OF FIRE UNDERWRITERS
t,~b BUREAU OF ELECTRICITY
~ 85 JOHN STREET, NEW YORK. NEW YORKIO038
Bt. October 31, 1973 ,~,,llc.tlo. No.o,~leb1952 N 1240U3
THIS CE~IFIE~ THAT
only the e~t~al ~uipment ~ ~cdb~ ~ a~ int~ by t~ ~pli~nt ~ on t~ able ap~l~ nu~[in t~ p~m~s of
Joseoh Pumillo, s/~ Private Rd., ~/off Ma~n Rd., 300' e/o ~ay ~ve.,
Mattituck, L.I.
in the fotl~ing location; ~ement ~Ist rt. ~ 2.a rt. ' Out side Section Bilk ~t
~e~.mi.~o. October 25, 1973 andfoundtob~incompliancewiththerequirementsofthisBoard.
FIXTURE I I FIXTURES
OUTLETS ECEPTACLES SWITCHES INCANDESCENT FLUORESCENT
18 38 18 18
J"YER~w' I OlL FUR~cE MGO~TORSH. p. I EUT~T,E APEl;I~2CE FE~DwE.RG$
I :~ 3 6
RANGES
SPECIAl; REC'PT
SERVICE DISCONNECT NO. O
METEI
I 100 CB
S E R
COOKING DECKS OVENS DISH WASHERS
TIMECLOCKS E ~UNITHEATERS MULTI-OUTLET
I I
V I C
NO, OF HI-LEG
OF HI-LEG
EXHAUST FANS
Z
DIMMERS
A~T, WATTS
NO. OF NEUTRALS A.W.G.
OF NEUTRAL
i 4
~Furnace/s: Oil, !-l/Shp 2-!/12bp
Motor/s: 1,1/2bp
W,L . ~u~an
Mattituck, L.I.
11 '~/ /"
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.