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Home My WebLink About6229-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. UPDATED CERTIFICATE OF OCCUPANCY No Z-22704 Date NOVEMBER 4r 1993 THIS CERTIFIES that the building. Location of Property 615 GRANGE ROAD House No. County Tax Map No. 1000 Section 75 Subdivision DWELLING Street Block 4 Filed Map No. SOUTHOLDr NEW YORK Hamlet Lot 17 Lot No. conforms substantially to the Application for Building Permit heretofore Oct. 27, 1972 filed in this office dated Jan. 7~ 1975 pursuant to which 6229-Z Nov. 6, 1972 Building Permit No. 7682-Z dated Jan. 7. 1975 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ONE FAMILY DW~T~.ING WITH ATTACHED GARAGE & WOOD DECK * The certificate is issued to MILDRED LONG & OTHERS (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 4/30/73 - R. Villa UNDERWRITERS CERTIFICATE NO. N-100687 - 7/3/1973 PLUMBERS CERTIFICATION DATED N/A *THIS UPDATES CO Z-5241 DATED 7/3/73 & CO Z-6282 DATED t/7/7~,,~ Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..~..5'.'?°.h'.'1 ...... Date .............. .J~'~.Y. ~. ....., 19.?~. THIS CERTIFIES that the building located at .~/~..Orange Road ..... Street Map No. ~. ,. ~alq~ .F~I~I[ No ........... Lot No.. ~ ~. ....... 80u~.hold...I~ ,~.. ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ Q0~; ....27., 19.7.2. pursuant to which Building Permit No. 0229Z.. dated ............ h.'9¥ .... 6..., 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 .Private..Qne. f. am$1y..dwek2, ing ....................................... The certificate is issued to . .ilene..~en&r. on ..... owner ............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .Apr;iA .30..].973...l~r. h.o..V.$.l~... UNDERWRITERS CERTIFICATE No. iv' ~9 5' 5, ,~ '7 ttOUSI! NUMBER... ~.'~.~ ...... Street..O~'l~P-g~, .lt.o.a.d. .................................. FOR~ NO. 2 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? 6229 Z Date ................. ~JCMllJllJl~ ......6 .......... 19~F~" Permission is hereby granted to: to .Bon,t;1A.. ney.. ene..-faUL~3r · dve.3_-l:i.n~ ..................................................................................... at premises located at .......~(~,..~.~ ....... 801Jt~'"J~l~"Tij'j ................................................... ........................ ~.~..4h,~...Ro~t. ........... ~ioutho'].4 .......... lt~T~ .................................................. pursuant to application dated ............................. J~-JJ.....~- ......... , 19.~..., and approved by the Building Inspector. Building Inspector · ./~ j ~r THE NEW. YORK BOARD OF FIRE UNDERWRiTERs~ ~-_ ak BUREAU OF ELECTRiCiTy 8S JOHN STREET, NEW YORK, NEW YORK 10038 0.,~ Jul 1 Y 3, 973 ~..tico,~o.~,. o. ft~ 63~23~ THIS CE~IFIES THAT . N ...... . , 100687 ~En~ ~R~A~ ~ ~'n~nYt~t~oat~a~a~t:~- ' --; -- . ,~...e..~.i.~.. June 28, 1973 FIXTURE and found ,o be in compliance ~it h the requiremen ~# of ~his Board. TIME CLOCKS UNIT HEATERS SYSTEMS DIMMERS 5 E R NO. OF HI-I~G *Furnaces: Oil 1-1/8hp, 1-1/12hp GeorEe Zimlinghaus, a Park Place, Patchogue, L.I. certificate must not be o feted in any manner fearn to t- ' ' P~" ' ' · he od*ce of the ~ard if Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 ~ APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains '" less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and '.'pre-existing" land uses: i. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a~Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. ]. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2.Certificate of Occupancy on Pre-existing Building - $100.00 ~3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 Updated Certificate of Occupancy- $~-0P._ ~'~-,'-~/~/l~'/~"~ 5.Temporary certificate of Occupancy - Kesidential $15.00, Commercial $15.00 Date .................................. ew Construction ........... Old Or Pr_e-existing Building.. . ocation of Property, .......... ~/) ~.~bv~ '~'~'iii'i.i .... Street Hamlet ..... nwer or Owners of Pro ert )~ ...D~... ~J~-~ p y .......... ............... ty lOOO Oun Tax Map No , Section ..... ock.. ...... · .......... Lot ..... . ..... Jbdivision ...................... Filed Map Lot ~rmit No .............. ~ate Of Permit. . .. .......... Applicant .............................. ~alth Dept. Approval ...... . ...... Underwriters ............. Approval ......................... !arming Board Approval ........................ ~quest for: Temporary Certificate ........... Final Certicate.... l~nM NO. 8 TOWN OF SOUTHOLD Building Delm~tmont Town Clerkl 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 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: I. 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 D te ........................ New Building .~ ................ Old or Pre-existing Building ............................ Vacant Land ~ ......................... Location Of Property .~,.~.:~..¢~K~'¢~.~...~....~..~.~./..~....r. ........................................... Owner Or Owners O, Property ..... Subdivision at No ................................................................... Block No ............. House No ............. Permit No.~..~..~...~...-~... ...... Date Of Permit/.~.?~..7,.~...7.~--..Applioant .... ~~~ ................... Health Dept. Approval ~..~.~.~.~;.~..~...~. ..................... Labor Dept. Approval ...:...,~[ ............................ Underwriters Approval .............................................. Planning Board Approval Request For Temporary Certificate ........................................ Final Certificate .~. ........................................ Fee Submitted $ .~.....--~... .......................... Construction on above described building and ~mit meets,all applicable codes and regulations. Sworn to before me this ~ ~.- ................ dayof ...... ~,,,~,., .......~,,....~ ..... (stamp or seal) ~/ ;~"~1~ ( Notary Public .......................... '. ......... County ~'/~-c~ 7~'~ ~'~ SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference No. APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 1. Applicant/~f/~/.~¢~Np/;~/~ Address ~OL~-# J-~4;~- 2. Property location Village 3. Public Water Company 4. Lot size: Width /~D 10. Township ~Df3 F/~tJLD feet Length /~D feet P' none 5. Sub d iv. S~f?j~l~f 6. Section ~ .... 7. Lot No. 8. Private well 9. Public water Distance to main (Enter on center plot below) Sewage Disposa~ystem: A. ~0JY gallon septic tank: Precast ~ Equivalent Block B. ~.L~aching pools: Number ~ Precast~Block ~' Special Street The undersigned CERTIFIES: be in accordance with ards thereto." "Construction of If private well fill in blanks below: Date /¢/~ f-~ Depth to G.W. { ~, Amount of water in well Test Hole Data Feet 0 2 4 6 8 10 12 14 16 18 authorized installations will the Suffolk County Department of Health's current stand- Owner or Builder FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, 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 SEWAGE DISPOSAL SYSTEF~ INSTRUCTIONS: Applications must be submitted in triplicate 1-Means Owner 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-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 '~o" otherwise. ..PROPOSED SYSTE~.~M · 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. PIA)T PLAN: The following information is required concerning the Applicant's 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 show~ on face of this application. 2. Surface waters-Streams, Lakes, & Bays, etc., located within a distance of 100 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. WELL LOCATION: To locate the well & sewage disposal systems on Applicant's lot, the following Standards must be observed: Well-lO0 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 "type 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 100 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~%. 6-Cesspool exterior must be 100 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. 10-Bottom of cesspool to ground water must be held to minimum of 2 feet. SUFFOLK COUNTY HEALTH DEFARTMENT DA~E APR 3 0 1973 H. D. REF. #'~-/~ The sewage disoosal and v;ater suoply // GRANGE RoAD f~cilitiez for thiz l~cat~on h~vo been inspe~o8 by th~rt~nt ~nd found . General Engineering Chief of Servlcem . / ~ ~ , OFTHF~ 0 S~ F~KCO~N YON ~ lu h, A ~ ....... T'i[ ~E~.OIHG INSTI- JUAYI4, 1~64AS~LF~ 4096. L o t 15 ~w~.~. . .EV,S,O.S YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W, YOUNG HOWARD W. YOUNG SURVEY FOR: ~. ' RENE GENDRON / ~' _.--fi-?.~ >b~ LOT NO. 15, "SOUTH HARBOR HOM~.j'/(o.~'-Fv~./:--~-oc~-~_ ~:~11 '~' AT SOUTHOLD , ~ ~ / j TOW. OF SOUTHOLD ~~/ SUFFOLK CO., N.Y. ~~ SCAL~: I" = 40' MAR.B now or £ormer ly B. W. Stepnoski DIETZGEN 135 11846 Examined ............ ~ ................., Approved .............. ~.....~.. ...... , TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CL'RK'S OFF,CE SOUTHOLO, N. Y. Pemit No ..................................... Application No..~....~....~..[ ................ Disapproved a/c .................................................. :.:.' ................................. ........................................................................... ..... (Building Inspector) ~, APPLICATION FOR BUILDING PERMIT ~, 'Date October 27 'l~ 72 wi INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in tr p cate to the Building Inspector, wit~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on prim scs, re ationsh p to adjoining premises or publi~ streets or areas, ar~ giving a detailed description of I~yout of property must be drawn on diagram which s part of this applicat on. 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 applicant. Such permit shall be kept the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for an,/ purpose whatever until a Certificate of Occupancy shall have 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, SuffoU~ 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. (Signature of applicant, or name, if a corporation) ~ ........ J.~,a~,~ ,~ ~o.~..t, ........ !~..'..Y...'. ................................... k.~ (Address of applicant) .~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder; .......................................................... .......................................................................................................................... Name of owner of premises ..... L~e~..C,~[~.~ .......................................................................................................... If applicant is corporate, signature of duly authorized officer. ~ a ..................... i ..................... 1. Location of land on which proposed work will be done. Map No.: ..~;~[~...~Et~tdTo.~Q~¢.~ ................. ~ ............... Street and Number ................. -,.%..~-:~-~t~..~-- ........... '~<~;~o&~.....~,.~ .................................................... ~ ~ ~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .~.~..c.~.~..~..~.~..~.. .............. b. Intended use and occupancy .... ,~_~...~.~.~ ~.~,~3.~=~ Nature of work (check which applicable): New Building .....,Yw¥.7~ .......... Addition ..................... Alteration~L..k....'.... Repair ......................... Removal ......................... Demolition ........................ Other Work (Description) 4. Estimated Cost ............................................... Fee ~. ......... .............................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ....on~, ...... Number of dwelling units on each floor ...- ...................................... If garage, number of cars ......~lqe ............................................................................................................................... 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 .~,?-~".....~,.~ ............... Height ................................................. Number of Stories ..... ~D.~ ............................................................................. 1~ * .... 9. Size of lot: Front ........%.0(~ ....................... Rear ....... .~,0D. ........................... Depth ...... .,~.~A.~ ............................... Height .................................................... Number of Stories ........................................................... 10. Date of Purchase ..................................... Name of Former Owner ................ "As' dist 1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does ~roposed construction violete any zoning lew, ordinance or regulation: ....... R~ ................................................ 13. Will lot be regraded ._._~D.~ ...................... Will excess fill be removed from premises: ix] Yes [ ] No a es rt ...... 14. Name of Owner.of premises ...,~,.¢~...~k~'.Q33. ...................... ~..~.....D.Q. ................... (Address) (Phone No.) Name of Architect ................ ~brm~a~..;zQ~C...~3.~LJa~.,~ ............................................................................. (Address) (Phone No.) Name of Contractor ....~D_n~...Q~ag.r.a~ ........................................ $....~.~.DQ,T.J~ .................................................... (Address) (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. ~ ~o ~ ;J (~ C~ ~- 9 ~ ~ STATE OF NEW YORK, ) COUNTY OF ........ ~q.%L~..-f.G]~4[ .......................... ) .......................................... ~l%e ......... ~.Et~ad.I'.OZ1 ......................... being duly sworn, deposes and says that he is the a~li~nt above named. (N~me of indiwd~l sJ~ing con.act) He is the ......................................... ~e~ ...... .~ .............................................................................................................................. ( ~ntractor, of said owner or owners, and is duly authorized to ~r~orm or haw ~rfor~d t~ said work and to make and fi~ ~is aeration; that all statements contained in this application are true to t~ ~ b~ ~9,~ ~lief; and ~at the w~k will ~ ~do~ in ~e ~n~r set forth in the application filed therewith w . ....... ................................................... Notary Public, ~~ ............. W (Si~e of applic~t}