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Home My WebLink About6141-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnle Of Occupnncy No. Z~[108 ...... Date .......... P~*b... 16 ........ , 19.73. THIS CERTIFIES that the building located at Do~ood. I~ ............... Street Map No. ltUnS®t; .Kno~l~:k No.. ~rl ...... Lot No.l~l ..... l~t.~.tuok..Ii,Il. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ l~apl;...22, 19. ~ pursuant to which Building Permit No..61 dated ............ 8ept...~-2., 19.~.~-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 . .~.I,¥&J;.~...o.~..i'..~a. J..~y. 4.~.~.1. ~..g ........................................ The certificate is issued to . Ha~&l~ liill.~ ....... 0vllal*. ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval De~,,.12~..1972..by. R,. ¥t.ll& ...... UNDERWRITERS CERTIFICATE No. Ii .67~.81 .. ,lan. 17.~..1973 ....................... [lOUSE NUMBER.-~6~ ........ Street ......I)O~'4ood. ~ ............................... · · '!" :"' "l'- Building Inspector FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 61 1 Z Permission is hereby granted to: Xn~e~d'"ti~m~"A'~'"~a~l'-Mills .............. · ..K~d~ .le ..C~u~. ~j.. F.~& ................................... .......... ~e.:L~te~ ............ N.¥¥., .................................. Bui 6 ew e fa ~ w ~ ~o ........ ~....~ ....... ~ ......... ~...~...9.1i~g ..................................................................................... ot premises located at .......... ~..~+~.i.....~m~s~:"~'m~l:9?'~e~'"~'~' ............................................ ............................... E~..D~...Le~e .............. l~t.t ~ ~k......~ ..Y.. ........................................ pursuant to application doted ........................... ~..~.]3~; ........ ~, ...... , 19.~,,.., and approved by the Building Inspector. Fee $. ~'.,.60. .......... Building Inspector/ lrO~l~ NO. TOWN OF SOUTHOLD Building APPLICATION FOR CERTIFICATE OF OCCUPANCY IndTucflom 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: I. 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 dispasal--(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, a certificate of Cede 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 o~ 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 ~ccupancy $1.00 Date ...... ......................... New Building .....~'P~& ........ Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ....,~../..S......D~.. ~~e~5~.~S~/~.S~1:~a~e~~t~ ............... Owner Or Owners Of Property .............. .~,...o~,,.a~..d......a:~...~....R..u,..t..~.....M.~,~.s. ...................................................... Subdivision ........S...~..rt...s..e...l:......I~...o...~.~.s.. ......................... Lot No.....4.~..... Block No ............. House No ............. Permit No .......6..]....4.~..Z.... Date Of Permit ..?./..~...5../.?...2..Applicant ....... .Z...~.~..~...z~.....~9)~.~.~.~...~:g,.c..t ................ 12/29/72 Health Dept. Approval ............................................ Labor Dept. Approval ................................................ 1/17/73 Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......,Y.,e,.,~. ............................ Fee Submitted $ .......5..t..O..O. .................... Construction on above described building and permit meets all applicable codes and regulations. Sworn to before me this ...... (stamp or seal) NOTARY PUBLIC, State of Hew York No. 52-88~00, Suffolk CoL~nty Term ~pires March 30, ~97 SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No O-//f APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval to const~ct said systems is requested,pertinent data herewith: ~o o*~ Date 9/~0/~ 1-Applicant llO~q~ DM ~4~ Phone 6-Sub div ~ F~ Address ....... ~ . _ 7-Section 2 2-Detailed property locatzon~~~ 8-Lot No. ~ ~mlet ~A~ To~ ~ 9-~ivate well? 3-~blic ~ter ~pply ~me Distance to nearest ~in 4-~t Size: Width~ft. Length~ft. (also enter on center plot plan below:) 5-~elli~: Singl~ Family ~ T~ F~ly? ~ ~Cellar? ~lab? ~ ~Crawl S~ce? ~ ~ 10-~o~s~ syst~. Septic ~nk ~ ~ecast ~Cess~ols ~S~llow ~ols Y yOther / / Il-Septic ~ ~ide dimensions: ~V~l~e ~s.Length ft. Wmdth ft. Liquid depth ft. 12-~ecast sectmons: ~N~ber~Sq~re Ft. Cess~ols: Block sizeL incs. D ins. H ins. Total blocks below i~et: ~1 ~2 ~3 PLOT PLAN Capacity Gals. Street Ind~ No ~th Data ~eet 0 2 6 8 10 12 14 18 can be installed on this Plot. Date (10/65 Revis.) The Undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Systems". Date 9/~0/~ Signed X~ }X~,'~,~! ~e/~e ~hlC~8~ ~e· Owner or Builder ',~. /~ _. FOR HEALTH DEPART~NT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department, that an adequate and satisfactory Sewage Disposal System APPLICATION FOR APPFOVAL TO CONSTRUCT PRIVATE sEWAGE DISPOSAL SYSTEMS INSTRUCTIONS.' Applications must be submitted in triplicate 1-Means O~ner or Builder. Address to ~_ich mail should be directed. 2-Means detailed description of Property location, together with street name and distance to nearest intersection of -rain thorofare, also Hamlet/Village & Township 3-Enter name of Public Water Supply District, together with the distance to their main~ ~-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-Dwellings: Check-mark "V" items applicable to the proposed new dwelling. 6-Name of sub-division ?-Section Number 8-Lot Number 9-Private well: Enter "No" if Public water supply is available. Enter "fee" otherwise. P~0POSED SYSTEMS: Answers to Items number i0, ii, & 12 please consult the Suffolk County Health Department's Standards, Bulletins and Amendments for Sewage & Waste Disposal Facilities. i.e., Part II-Residential Sub-surface Disposal Systems covering Cesspools Part III " " " " " " Septic Tanks Part IV " " " " " " Unusual soil conditions Part V " . . . m m Shallow Leaching Pools PICT PLAN: The following information is required concerning the Applicant's Lot: 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 sho~ on face of this application. Surface waters-Streams, Lakes, & Bays, etc., located within a distance of ~0 feet of Applicant's Lot lines, must be shown on the plot plan aisc. Wells and Cesspools now on adjacent lots must be shown on the Plot Plan together with the distance to the Applicants proposed Sewage Disposal Systems and Well. Where no Buildings exist on adjacent lots, state "Vacant" on the plot plan. Streets adjoining applicant's lot to the right, left or rear, enter street name. WELL LOCATION: To locate the well & sewage disposal systems on Applicant's lot, the following Standards must be observed: Well-100 feet minimum distance from the nearest cesspools Well-25 feet minimum distance from rear, and rear sides of property lines Well-10 feet minimum distance from front, and front sides of property lines Well-~0 feet minimum below grade for well point Well-40 feet minimum into ground water for well point Well-4 feet 6 ins. minimum below grade to well head and lateral water pipe CESSPOOLS LOCATION: Upon determination of the Sewage & Waste disposal "type of systems" required, the following Standards must be observed for the location of same: . . Cesspool-i0 feet minimum cl~$~'~d~lines to center of cesspool Cesspools exterior must be 165 ~fe~ ~[~j~tance from nearest well Septic tank exterior must be 75 feet from nearest well Cesspool "Center~ mustbell'5 ~ ~f~e ~e~undation Cesspool exterior must be 50 feet minimum die,ncc from surface Waters, Streams, Lakes & Bays, etc. Cesspools must be 20 feet~ce_.~,~;%~__~ from large trees Cesspool center to Cesspool ..uer ~ms~ ~e at least 16 feet Cesspool cover top to grade must be held to minimum of 1 food to maximum of 2 feet Bottom of Cesspool to ground water must be held to minimum of 1 foot THE NEW YORK BOARD OF FIRE UNDERWRITERS -- b~ BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 aa,January 17, 1973 ~pplic.~,~nNo..nfle62ZlS12 N 67281 ~IS CERTIFIES THAT the electrical equipment az described below and introduced by the applicant named on the above application number in t~ l~eo:~es of Howard Mills, e/s Bravo Rd., 479' s/o Stanley Rd., Mattituck, N.Y. he/ollowinglocatlon; X[] Basement ~ IstrL [] 2nd FI. outside ~tlo. Bilk ~ e.a.,ined on January 15, 19 7 3 and found to be in compliance tvlth the requirements of this Board. TT[UE~-E ~ECEPTACLES SWITCHES FIXTURES 6/32 21 16 RANGES SPECIAL REC'PT~ ERVICE DISCONNECT NO. OF S R · ::Furnaces: 1-1/8, & l-l/12 ~.-' Fut ute appliance COOKING DECKS l OiENS DISH WASHERS c, ,s ,=,. u.,,..,.,, ¥ ! feeders: 1-2 #12, & 2-3 #8 awgs. FANS SYSTEMS Patchogue, N.Y. ll??2 Per certificate must n.,_ · ~.o.t ~e ol~d in any manner; .... return to the o~_/y~, f~c/e of the Board if incorre~,~C~,~t,~n~,~t. Inspecfo~7~,~?.~,d~.~m~s may be idenfifi~ by/heir TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .........~....~.....~....,..., J92....~. ~ Application NO ......... ~'.....f/... ............. Approved ..................... ::.~.....:.l. ........ , 19.Z..~.. Remit No..~.../.....~..../..~ ......... Disapproved a/¢ ............................................................................................ · ~e~A~LICATION ~ILDINC~ PERMIT 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, a~u~ete plot plan to acale. Fee according to schedule. b. Plot plan She~ing location of lot end of buildings on premises, relationship to adjoining premises or public streets or areas, and~ giving a detailed de~r~gtion of layout of property must be drawn on diagram which is pert of this application. c. The work, covered by this application may not be commenced before issuance of Building Permit. d. Upon approval ef tiffs application, the Building Inspector will issue a Building Permi~o'~he 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 been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building I~ermit pursuant to the Building Zone'~ Ordinance of tt~ :~own ~f' ~outhold, ~J/Je~ Oem~/, ~ Yerl~, and othe~ applicable LaWs, O~dinancas or Regulations, for the construction of buildings, additions or alterations, or for removal or de~/lolition, 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 bqildings for necessary inspections. (Signature of applicant, or name; if a corporation) (Address of applicant)i,. State whether applicant is owner, lessee; agent, architect, engineer~ general contractor, electrician, plumber or builder. .............................................................. i ....... ,.....~...~..-.~,*.~ ..................................................... : .................... .' Name of owner of premises ~ ...... ~. If apphcant is a corporate, signature of duly authorized officer. ................. .>, / ~...o..., 1. Location of land on which propo~l ~or.k will be dona. Map No.: .............. · , ~, ~, ........ ,~ .. ...,........;....... .......... .. st~t and ~um~r ........... ~..~.~.........~..~..~...'...~..~.~.'...,,,~. ......................................... - .: . Municipality 2. b'~ta exit:ins use and occupancy of promises and intended use and occupancy of proposed construction: a. fi~i~ingu~ ~nd o~u~an¢¥ ............... ~ ........ ,...., ..................................................................................................... " .................................... i ........... ......... ....... ............................... 3. Nature of work (check which applicable): · ' ' * X · New Bu Idlng ....................... Add t on ..................... Alteretlon ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost ............................................... Fee ................................................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... ~..~1,.... Number of dwelling units on each floor 6 !f garage, number of ~ cars ............................................................................................................................................ 6. If business, commemial or mixed occupancy, specify nature and extent.of each t¥? of use ......................... ~ ........... 7. Dimensions of existing structures, if any: Front ..................... Rear ........................... Depth ................................... Height ........................................................... Number of Stories ............................................................................. Dimensions of same structure yth alterations or additions: Front .......................... Rear ........ .,. ............................... Depth ............................................. Height ......................................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front ........,~i!~.:,i~i.?.... Rear ...~.~i~...~J~.. .... Depth ..... .,~I~ ...................... Height ........ ..1..8..~.....' ................. ~ ............ Number of Stories .~ ......... .1. .................. ~ ................ i ....................................... 9[ Size of lot: IOO ~ ~OO Front ...................................... Rear .......................................... Depth .................................................. Height .................................................... Number of Stories ...................................................................................... 10. Dam of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or usa district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................... ..N~ ............................ 13. Will lot be regreded ............. Z~I~: .............. Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises ....................................................................................................................................... (Address) (Phone No.} Name of Architect ......... ~..~J~[l~a...:~:~ .......... ~a..~l~l~...~ ........... .~..~...2;.-.~..7~... ................... (Address) (Phone No.) Name of Contractor ....... ~..~.....Z~....C.R~, ........ ~Z~.~..~r~/~:.. ............ .?..~.?,...-...~....'~.. .................... (Address} (Phmle No.) PLOT DIAGRAM :**, u,.a..~ :, ~J,f~cat. e. CJ.ear~ly:and di. sti~nctly;al~,b~i[~Ji.rlgs, whether existing or proposed, and indicate all set-beck dimensions from proP6~ lines. Give stree~ arid b[~;?k numbe~ Or d, escription according to deed, and show street names and indicate wheth- er inte * /,~ .... ior or iorner lot. COUNTY OF ............. . I ~ .~.. ~ VP · being. ~uly sworn, deposes and says that he is the applicant above named. He is the ~alk~ of said owner or owners, and is duly authoriz~ to ~dorm or ha~ ~or~d the said work and to make and file this application; ~at all s~ ~ntained in this a~li~tion are true to t~ ~st of his knowle~ and ~lief; a~ that t~ work will ~ ~or~ in the ~nner ~t forth in t~ ap~i~tion filed t~mwith. ' ~ ' r r ~ ; r ~R~ ....... ~A~ ~BUC, ~te of NeW 0 0 L.o~ 40 $~cn~e¥ J' 5 ~e~en NOTE: · = MONUMENT SUBDIVISION MAI) FIt. ED iN THE OFFIGE OF THE CL.ENK OF SUFFOLK COUNTY ON APRIL. 9, 1970 AS FILE NO. 5448. REVISIONS YOUNG & YOUNG 400 0STRANDER AV£NUK, RIVERHEAD, NEW YORK ALDG'N Wo YOUNG SURVEY FOR: HOWARD D MILLS 8~ RUTH LOT 41 OF "SUNSET KNO~ HOWARD.W. YOUNG AT MATTITUCK TOWN OF · - SOUTHOLD SUFFOLK CO., N.Y. SCALE': I "= 40' DATE'.' SEPT. 14, 1972 'I ~1 '4' 0 ir ~t 1,2 o 24 o'j