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Home My WebLink About6149-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at .N0r.~. $~.a..Dr~L..~. ......... Street Map No.0~..~.el~..t..b.y...S~]~ock No ........... Lot No..1~.~ ..... 0r.~.en.t...N:.Y.o ........... conforms substantially to the Application for Building Permit heretofore fried in this office dated ........... $ol~t.. 2~., 1972. pursuant to which Building Pemit No. 6].~.91~.. dated .......... 5ep.t.. 2~..., 19~2., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . Pr.t,¥a.~e. 9ae .fal~t~z .... ~l~:Lll~g .................................... The certificate is issued to C.&.r?.a.d.o..E.:..l'l.O.~ .Se ..... ...0~..~. .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . J..u~.....]....~.9..~f....by...R:..V.~.l.l.a.... UNDERWRITERS CERTIFICATE No.Ii. .~.~.~.?.0~ ..... .~..~,.y....~....~..~. ............... HOUSE NUMBER....1~.~. ....... Street .... .N.o.x'..t~...~..&. p.r.~.?$. .................... .......... S[ii 'g' ......... FOR~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6149 Z Permission is hereby granted to: at premises located at ,~/li..~...-~,ll~..]~.~ll-.llt..~.~ ....................................................... ........................................ ll~'~l~.~.e~..1~z%~l ............ ~r~m~.....ll.~%... ........................................... pursuant to application dated ............................ ~e~l~'"'i~' ......., 19~ .... and approved by the Building Inspector. '~'11~1 :~11~"1~.~ ~1~' 11~;~l~%1]1~14, I~ ~ ~t ~l I~ Fee $~ ........... ~ ~ v BEildin~ Inspkdi'6r ( FORM NO. a TOWN OF SOUTHOLD Building Depo~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 fallowing; 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 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: ]. 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 k. J / ...... New Building ................ Addition ................ Old .o~e-existing Building ..L>Z.~ Vacant Land .............. Location Of Property ...~..~'..~".,~.....~...~..'....~.~../;,.~...~'. ......................................................................... Owner Or Owners Of Propert, v ...~..'~J[.~...O........~..%....~../.v.........~..~l~....~........~..:......../Vl.o...~..~...~.. .......................... Subdivision ~.~.....~,..~.,~ ......... Lot No. Block No....,,'~,,,.... House No.~ Permit No. ,~./.~....~.. ..... Date Of Permit ~..-.~.~..Z~....Applicant ~...~..~.~.~...' .... Health Dept. Approval .'~., ......................................... Labor Dept. Approval ...~ ..................................... Underwriters Approval ,~. ............................................ Planning Board Approval : ....................................... Request For Temparc~ry Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ....... ~ ................. Applicant ..~.... ~~L....C.~- ...... 7~ .............................................. Sworn to before me this ....... ~,;.~day of ~,,~ ....... [,,,~,.,~,,~,,. (stamp or seal) ~/~_~ Notary Public .................................... County SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference No. APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 1. Applicant ~-~z~ ~'. /~m~'~' Phone 5. Address ~ Z~_~'~ _~/~' ~',F' ~- - 6. 2. Proper~y location ~/~'~ 7. 8. Village. Township ~o~ 9. Subdiv. Section Lot No. Private well Public water 4. 10. Public Water Company name. Distance to main Lot size: Width/7~' feet Length /~ feet (Enter on center plot below) Sewage Disposal System: A. 900 gallon septic tank: Precast~ Equivalent Block B. Leaching pools: Number( Precast~Block Special__ 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 The undersigned IERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current stand- Based on the information presented rewith, it ards theret~ Date Sewage FOR HEALTH DEPARTMENT USE ONLY. is the opinion of the Health Department, that an adequate and satisfactory Disposal System can be installed on this plot. __.~. ~ /~ Date z~/~/~-~ Signed S-15 Revised 4/]/72 APPLICATION. FOR APPROVAL TO CONSTRUCT PRIVATE SRWAGE DISPOSAL SYSTEMS INSTRUCTIONS: Applications must be submitted in triplicate 1-Means Owner or Builder. Address to which mail should be directed. 2-Meaus detailed description o£ property location, together with street name and distance to nearest intersection of main 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. ~hter '~o" 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 PIAN: The following inforr, 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*n on face of this application. 2. Surface waters-Streams, Lakes, & Ba~ys, etc., located within a distance of 100 feet of Applicant's lot lines, must be shown on the plqt 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. ~PELL 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 distance 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 Disposal "tjq~e 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 foundatiem.. 6-Cesspool exterior must be 100 feet minimum distance from surface waters, streams, lakes, & Bays, etc. 7-Cesspools MAst 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. ,? C, OI?.~ADO 17_, MOI:?_.BE "O/PI, E/VT L.,~ e~r~'o~ Lo~d' The o~,- .... a~ disposal and water supplF fac~!It~9$ for this location have been inspected by this department and to be satisfactory'~-~~.?~, Chief of General Enginee~' Services 3 "~,41EIVT PO/IVY-' 5 UFFOL Ir' CO~lN~-y~ /1. 7. THE NEIV YORK BOARD OF FIRE UNDERWRITERS ak BUREAU OF ELECTRICITY [-- E5 JOHN STREET. NEW YORK. NEW YORK IOO38 t~t~ July 2, 197q Applleatio.~o. onfile 620625 Cot=ado E. Mo]'ses ~or~h 3ea Dvlve~ orrj waders in the foll~ing l~atlon; ~ B~e, tent ~ 1st FL ~ 2nd FI. outside ~tion Bilk w~ exami~d on J ~n~ 2 ~ ~ ,9 ~ ~ a~ found to be in complia~e with the requirements of th~s B~rd. fiXTURE FIXTURES ~NGES ~KIHG~CKSI O~NS ~SH WASHERS EXHAUST FANS ~ 23 8 ~ ~ ~2.3 DRY~RS FURNACE ~TORS ~TURE A~ANCE ~E~RS S~AL R~PT. T~ CL~S ~1 UNIT HEATE~ ~ MULTI~UT~T DIMMERS SYST~S SERVI~ ~ONN~T ~. OF S E R V I C E METER ~ 200 OB x ~ ~/0 Water heater: 1-4.5k~ Elec.~om heaters: 2-2.0kw, 1-1.5~, 1-1.25kw, 5-1.Okw I 35 Bent Lane, . Levittown, L.]. 11756 ~ ~nA~ Per ~ ( ' . . ...... ;~;~';U~ E ~ ~..._ ,a .......... FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. TOWN ~ ~TH~D · ow~ c~:~'s omc: ~UTH~D, N. Y. ~r~ed ..................... ~ .................. , 1~.......z ~ ~mit No........~...~. .................... ~.... ', o .... .......................................................................................... . ............................. (Buildi~ Ins~tor) I NST~U~ION~ ~. Thi~ ~imtion mu~t ~ ~m~t~l~ fiU~ in b~ ~writ~r or in ink ~nd ~ubmi~*d b. Plot ~l~n ~ho~in~ Io~tion of lot ~nd o~ ~ildin~ on ~mmi~, r~l~tion*hi~ to ~d~oinin~ o. T~ ~o~ ~r~d b~ thi~ ~limtion ma~ not ~ ~mm*n~ ~r~ i~uan~ d. H~n ~m~l of thi~ ~lie~tion, th* 8uildin~ Im~or ~ill i~u~ ~ 8uildin~ ~rmit to th~ th~ ~mmi~ ~lil~ for im~ion throughout t~ ~o~. ~. ~o bui~di~ ~*11 ~ ~i~ or umd in ~ho~ or in ~rt for ~n~ ~urpo~ what~r until gran~ by t~ ~ildi~ Ins~or. ~PPLI~ATI~ ::~E~EBY ~ADE ~o the Building ~p~nt for the issu~n~ of ~ Building Permit pu~u~t to t~ Building Ordin~n~ of t~ To~ of ~uthold, ~ffo~ ~un~, New Yo~, ~nd other ~ppli~ble building, ~diti~s or ~r~tions, or for removal or ~lition, ~s herein deseri~. ordin~n~, building ~, housing code, ~nd reguletions, ~nd to ~mit ~uthorized ins~to~ on ~mises ~nd in .............. S~te ~r a~lim~i~ ~r, I~nt~hit~t, on,in.r, ~n~r~l ~ontr~tor, ~l~ctrician, ~lum~r or builder~ ~,~, o, o~r o, ~r~ ............ a....~..~ .................................................................................. 1. Location of land on which proposed work will be done. Map No.: .................... Lot No .............................................. and Number ...... .../~....&?...~....~........f~..~....~..~'..~.. .............. , .......... ,~./.~.....~.....~....~......~...~.........,:~i~; , 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 end occupancy ..... '....~..~..~.~..~..~....~..C ...................................................................................... · 3. Nature of work (check which applicable): New Building.......................r Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 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 .....~.....~.....~.... ........ ...'~...'.....'T If garage, number of cars ..... 4~. ................................................................................................................................ 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 enti~e new construction: Front ...... ?.....~. ............ Rear ....... ..~....~. .............. Depth .....~....~.. ...................... Height ........ ~.~.. .................................. Number of Stories ............. .~....~. .................................................................. 9. Size of lot: Front /'7~' t Rear /~" '~ De~th / .~...7. ~7 /'~- 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 lot be recJraded 4~..~. ......................... Will excess fill be removed from premises: [ ] Yes [~j No 14. Name of Owner of premises ....... ...~.....~....~.....~......~..:......~.?~..~... ........ ~..~...~..~....~,~.~..~....~..,~..'~...4~... ....... {Address) {Phone No.) Name of Architect ..................................................................................................................................................... ___. {Address) {Phone No.) Name of Contractor ~'- '~J~¢E~' ~o~e'~ ~'A-~' -~' {Address) ~,~,.-.~,~,z.Z) (Phone No,) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. STATE OF NF-..W YORK, ) COUNTY ...... , ,,~. ,~.~.~ .................. ) ............. (Name of indiv~dual~gning c. ont~'a'~'t') .................... being duly sworn, deposes and says that he is the applieent above named. He is the ................................. ...~.....c~.....~...~..~:~,~..~..~<;~.~ ........................................................................................................................................ (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 are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the a[~l~t~l~n Ef~d therewith. 111 ~1~ #~1 s.,[dxt u0!ss!mu~'J J~J~p.P~y~ I~'=[~ [I C, '~-a t e ................... ~.. ~.~Z~68~ ..~~ S6Z~919-~ 'oN/~ · ' ~ in Suifol~t~ ....... ~)~pire~ ~ 30, Notary Public, ..~.~.~ .............. County ................. ~.~.:.._.~...:...[.~.~.~ .................. (Si~te of applic~) L