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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.