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Home My WebLink About6233-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. ~'DATED CERTIFICATE OF OCCUPANCY No: Z-28328 Date: 04/08/02 THIS CERTIFIES that the building NEW DWELLING Location of Property: 1700 NORTH PARISH DR (HOUSE NO.) County Taxi,ap No. 473889 Section 71 subdivision SOUTHOLD (STREET) (HAMLET) Block 1 Lot 20 Filed Map No. -- Lot NO. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated pursuant to which Building Permit No. 6233-Z dated NOVEMBER 7, 1972 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 DWELLING WITH ATTACHED TWO CAR GARAGE AS APPLIED FOR. THIS CERTIFICATE OF OCCUPANCY REPLACES C0#Z5092. The certificate is issued to LOIS C CUNLIFFE (OWNER) of the aforesaid building. SDFFOLK CO%~TFY DEPART~ENT OF ~IEALTH APPRO~KAL BY R. VILLA ELECTRICAL CERTIFICATE NO. N 84395 PLUMBERS CERTIFICATION DA'r~u N/A 03/16/73 03/07/73 Auth~riz ed Si~ature Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ZE092. ...... Date ............ Ap.r.!!...2.0 ..... , 19.73. THIS CERTIFIES that the building located at ...~.o.~'.~h .P?r~.sh. &. Map No.. ~ ......... Block No...~ ...... Lot No. ~.. SO~%h01.~.. ~ ~. ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... ~!.. 30..., 19.7~. p~suani to which Building Permit No. dated ............. No~... 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 . ~.~a~..P~*..f~$%~ .~%~g ....................................... The certificate is issued to . .~r~. & Loiz. C~l~fe ...... ~er.z ................ (owner, lessee or tenant) of the aforesaid building. Suffolk Cowry Department of He~th Approval ~r.. ].6. ~3.. b~ .~k ~11~ ..... UNDERWRITERS CERTIFICATE No..~..~39~. .... ~ .7,..t97~ ...................... HOUSE NUMBER.. ].~ ...... Street ....~h. PR~Sh. ~r ........................... 96~ ~orthf~eld ~ .... Building Inspector ]FO~,,~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N; Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 6233 Z Date .................... ]l~"~ ............. 197~'" Permission is hereby granted to: ........ ~e~t~e~A- .................................................... ~o ...lt~L34...m.. e~ .. ~.,~v~.~ ~ .................................................................................. et premises located at ..... JJ~'.t~..~lll~..-J)~'~--JJ~Z'~,~:e'~.~"Jil~ .......................................... ......................................... · ar~t.~o~c~ ...... 31..~. ................................................................................... pursuant to application dated ........................Oet~ ....... -~ ........... , 1~2....., and approved by the Building Inspector. Fee J.~.l.,,.,~ ........... Building Inspec7 BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Thi's application must be filled in by typewriter OR ink and submitted to the buildi~ inspector with the following: for new building or new use: l. 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 Under%~riters. 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 buildJ 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. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings Vpre-existing" land uses: I. Accurate survey of property showing ail property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicar 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 Buildinm - $i00.00 3. Copy of Certificate of Occupancy - = .25~. 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.O0 Date .April.2..2Q~Z ....................... - updated to include New Construction ........... Old Or Pre-existing Building ....... ~ff~c~dd~rage Location of Property...12OO. Nor£h. Parlsh. Dr.,.So~thql4,.l~ ............................... House No. Street Hamlet Onwer or Owners of Property Lois C Cumliffe . · ...... County Tax Map No 1000, Section...~ ......... Block. I .... Lot. 20 Subdivision .................................... Filed Map ............ Lot ................. Permit No ................ Date Of Permit ................ Applicant ........................ Health Dept. Approval .......................... Underwriters Approval .................... Planning Board Approval ........................ c~ate~updated Request for: Temporary Certificate ........... Final Certfcate ./% ........ /? ~ 50.00 / ~ ~ ~ Fee Submitted:~ ' ..... ,~.~. :~. ~./~'--'// ...........................//7 ~ ~ ~" ............................ ' C ~ {b~ ~ GARY FLANNER 0LSE~ ~ - ~t~c~ Main Rd, PO 8ox 706 Cutchogue, NY 1193~ l~O~t~ NO. 6 TOWN OF SOUTHOLD Building Delmftment 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 triplicate to the Building Inspector with the following; for new buildings or new use: I. Final survey of property with accurate location of aH buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Hea~th Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installation fram Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similor buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit P~anning Board approva~ 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 topograpMc 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 3. Copy of certificate of occupancy $1.00 $5.00 Date . ~J. ~).~..c..~.......I.~ ... 1..~...~.. ~ ....... New Building ...... ~ ......... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ~~i~L--[~1%L~H~p~j~`e~i~Ln~~ Owner Or Owners Of Property ..~,~.~l,~/....~.~....~,.g..~..,~.....~.,....(~..~....~...~..~..~...F-...~, ................................ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No. ~,,.~...~... Date Of Permit [~.9.~...}..[~[~'~Applicant ..F..t.~...~..Q.~=.~,~......~...~..x3.~.....)...~...~.: ........ Health Dept. Approval ....~.~../...~...f.?..~..~. ..........Labor Dept. Approval ........... .~...:....~... ....................... Underwriters Approval .~.....~..~.//..-~......~,(~..'7....(7.,~....Planning Board Approval ...... .../~..~./...~... .................... Request For Temporary Certificate ........................................ Final Certificate .....~ ........................ Fee Submitted $ .....~....~ ..................... Construction on above described building =and_permit meets all applicable codes and regulations. Sworn to before me this ..~.... ...... day of ...~...:...X..'~....I...~.... (stamp or seal) c',, , Notary Public~ .~-.~%~County TERRI LEE ELAK #O~ARY PUBLIC, State of New York No. Qualified in Su21c[i County ~m~i~ion Expires I~,~rch 30, SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference No. O~--/~/~ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM be ards Applicantr'~a,)~{{~ .~ t~G Phone}~)2,~.~. Subdiv. Address ~,o~$){p~ ~= b~,l,,~,) 6. Section Property location~ GW~W~ ~'%~W F"~~w ~K 7. Lot No. ~ ~r~,eu,; C.~ 8. Private well Village~o~&~ Township$,~ 9. Public water Public Water Company name ~(~ ; Distance to main Lot size: Width /~ feet Length ~ feet (Enter on center plot below) Sewage Dispos~ystem: / m. ~ gallon septic tank: ~recast E~uivalentWBlock B. ~aching pools. Number ~ Precast~Block ~cial If private well fill in blanks below: The undersigned CERTIFIES: "Construction of authorized in accordance with the Tank Pump capacity~4Gals. G.P.M. -~ Total well depth Depth to G.W. Amount of water in well thereto." ! Test Hole Data Feet 0 2 4 6 8 10 12 14 16 18 installations will Suffolk County Department of Health's current stand- Owner or ~uilder FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the ~Health Department, that an adequate and Disposal System can be installed on this plot. Date ~- Signed satisfactory Sewage S-15 Revised 4/l/72 APPLTCATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS INSTRUCTIONS: Applications must be submitted in triplicate 1-Means Owner or B~ilder. Address to which mail should be directed. 2-Means detailed description of property location, together with street name and distance to nearest intersection of ma~n thoroughfare, also Hamlet/Village & Township. 3-Enter name of Public Water Supply District, together with the distance to their ,min. 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: hhter "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 SYSTE~£: Answer to Item number lO, 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 information 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 shmen 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. WELL LOCATION: To locate the well & sewage disposal systems on Applicant's lot, the following Standards must be observed: Well-lOC feet minimum 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 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 "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 m~st 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 foundatie~.. 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 ~xst be held to minimum of 2 feet. f TOWN OF $OUTHOLD · BUILDING DEPARTMENT ~ ~,~-~-'/-'_~..,~ . ...?.~. . TOWN C~RK'S OFFICE /~ ~-~ ~ - ~ ~UTH~D, N. Y. ~ ~ ~ ~ ................... . ................. ~pr~ed ....... ~ ....... .~ ................... , '/ ~ ~ ~ ~ ~ ~ ~ // ' '~ ~" Di~pproved a/c ~ ~ ..... . ~~ .~/~~ ............................................................................................... . ~. ~lot pll~ showi~ Io~tio~ of lot ~d of Buildin~ on pr~mi~, r.l~tion~hip t~ ~djoini~ pr. mi~ or puBli~ ltr.,ti or Jreas, J~ d. ~ a~rov~l of t~i~ a~li~tio~, t~ ~uildi~ I~s~t~r will iJ~ ~ B~ildi~ ~.r~il to lh~ applicant. ~.~h ~r~it sh~ll ~. ~ th~ ~.~i.~ a~ail~l~ for i~lio~ tBro~Bout tB. wor~. ~ ~.'~ ~il~i~ shall ~ o~pie~ or ~.d i~ whol. or in p~rt for ~ ~r~os. w~t,~r ~ntil ~ ~.~ifi~t~ of 0~.~ ~Bill hav, ~i ~LI~TIO~ IS ~Y ~A~ to t~. ~uildin~ ~p~nt for th~ i~s~ of ~ ~uildi~ ~r~it ~.r~.l to th. J~ildi~ ~ Ordi.a~ of l~ Tow~ of ~.tBold, ~uffol~ ~o~nt~, ~ Yor~, ~d otB.r a~li~a~l~ L~, Ordinates or ~latio~s, for Ih. ~tr.~io~ ot B~ildJ~, a~itiom or Jlt~r~tio~. or for r~o~l or d,~olilio~, ~ ~r~i~ d.~cri~d. Th. ~licant a~r~ to ~o~1~ wJt~ ~11 a~li~l. I~. ordi~, B~ildi~g ~od~, ho.~in~ ~od., and re~.l~tio~, ~d t~ ~dmit ~ut~ori~d i~.~tor~ ~ ~r.~i~.~ ~nd i~ B. ildi~ for ~.~.~r~ i~.~tio~.~ (Signature of applicant, or name, if a corporation) ..(~.~..~.. ~..s..~. ~.~....1~.~..~.........~.~..~ .~...~.~. ....... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder~ ...................................... .~.~ ~..~ .....~.~.~.~..?..~..~..8, ............................................................................................ Name of owner of premises ~c~,~.I~.&...~r...~..~......L~....L~.,.C~...:..~.P../~...~..I.~ .................................................................. If alDplic~nt is a corporate, signature of duly authorized officer. (Name and title ot corpOYate officer) 1. Location of land on which proposed work will be done. Map No.: .................... Lot No .............................................. Street and Number ..'S/...~T.......~.~....~I~..I~...'~...t~....~..~....~..~.~.....~..~.....~....~J~.P..~...-'~.~.~...~.~....~.~.~... /' 7 ~0 ~ ~ ~ ~ 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 ....O..~iJ~......~..~..~!.t..~.'~......~..l~,~..~.~..~...~., ............................. ~.. ................. ~.'" ~'~tar~of work (check which applicable): New Building ....¢...... ............. Addition; .................... Alteration.;...:..;..2.. Repair ......................... Removal ......................... Demolition ........................ Other Work (Description) 4. Estimated Cost. .~ .................................. O 0 Fee (to be paid on filing this application) 5. If dwelling, number of d~lling units ...... ~ ........ Numar of dwelling units on e~h floor~ ............... .~ ................... If gara~, number of cars ..~ .................................................................................................................................... 6. If busine~, commercial or mixed ~cupan~. s~cify nature and extent of each Wpe of u~ ..................................... 7. Dimensions of existing ~ructures. if any: Front ..................... Rear ........................... Depth ................................... Height ........................................................... Numar of Stories ................. Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories... ................ . .......... · ......... ~. Dimensions of entire new con,ruction: Front ...... ~ .............Henr ..~ .................... D.pth ..~;~..~. .................... ~ ,~ ....... Height ...~ ........................................ Numar of Stories I ~ ..................................... ~ ..................... g. Size of lot: Front ....~.~ .......................... H.nr ....... ~.~ .......................... D,Dth ....~ ............................................. Height .................................................... Numar of ~tories ............. ~0. D,te of Purchn~ ..................................... Nnme of Former Owner ............................................................................ ] ~. Zone or u~ distriot in whioh Dremi~s nre situnted ........... ]2. D~s DroDo~d construction violnte nn~ zoning Inw, ordinnno~ or r~gulntion: ..... ~ ................................................ ]~. ~illlotberegrnded ~ ............................. ~ill excess fill be r~moved frompmmi~s: [ ] Yes ~ No ] 4. Nnm, of Own,r of premiss ~.~.....~.l ......................... I ....... .~ .............. IPhon. No.~ (Address) Name of Architect .............................................. , ....................... ~;~j~ .................................................................. (Phone No.) Name of Contractor ..~.~.~.~JJ.....~.~.~ ....... ~.~ .................................... ~.~T.~'~-~ ............... "' (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from properW lines: Give'street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. "/'- ...... ~~ ....................................... ~ing duly sworn, deposes and says that he is the appliant above named. He i~ .......................................................................................................................................... ~ Contmctor, agent, co.orate officer, of said o~ner or owners, and i~ dul~ authorized to ~r~orm or ha~ ~rform~d the ~aid work and to mak~ and fil~ thi~ ap~lie~tion~ that ~11 statement~ contained in thi~ application ~re tru* to th~ be~t of hi~ knowl~d~ and b~li~f; and that the ~ork set forth in th~ application filed thorewlth. Y^rv ~-z ~' 5o,,, /~A/:= of- ,~,~O~c~,W/~.v'Y DEPARTH~NT OF HEALTH RIVERHEAD. N.Y. & SUFFOLK COUNTY HEALTH DEPARTMENT DA~E H.D. REF. The sewage disposal and ~,~a~er sunply fac~]~t~es for this toc~on have been inspected by this dens--n% ~d found to be sat~.sfactory. ~~ ~. Chief of Genera~ Engineering Services V-- r , , I I 40 ~-0~ ,/4TZ~,.q '7-/0 ...... 14"-7" /-///wq; 4 ~-7" , ~OOH 'I