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HomeMy WebLinkAbout6260-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..~0.]~ ..... Date ............ P~b .... ~6 ..... , 19.73 THIS CERTIFIES that the building located at . l~l~ .DI'IV~ ............ Street Map NoLaUral. 0l;~. Block No ........... Lot No.. h'2 ....... I~tl~.el.. Ii o¥, ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... Iiov ....10..., 19.72. pursuant to which Building Permit No. dated ........ ltOV... 27 ..... , 19.72., 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 .Prl.vat,~..o1~. £a~il~..dVe&l. tng ....................................... The certificate is issued to . .lha~ta .gnt$1~pl'i~es. 1:o .SI~I®i ~ll .... 0~®1' ....... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .Feb..St. ~ 9.73.. b~..Ro. ~:l. lla ...... UNDERWRITERS CERTIFICATE No... l~l. foT~O .... ,]'aD,.. 1-7 -1973 ................... HOUSE NUMBER.. P370 ...... Street .... De.~laa. l'- D-l' .................................. Building Inspector FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6260 Z Permission is hereby granted to: 1~32....~cl.~e...Co.~t~r~...~l~ ................................ ................... ~cle~ ....... N.,.~., .............................. ~o ....~,1~. ~w...~a.. ~.a .~'-~l ~...~'el lir~ ................................................................................. at premises located at ....~e.~..~....~.~ ....... ~.~,l~'~.~,...g.~.t?~.$.l:~'..~,~.~j ............................................. ............................... .~ e...~..~..~.~:..i..v...e. ......... ...~..~r..~.1.....~.,..::., ......................................................... pursuant to application dated .......................... J~o~. ....... :JO .......... , 19~..., and approved by the Building Inspector. Fee $.6...~.......0~.. ............ TOWN OF SOUTHOLD Building Depu~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 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 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 end 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. Date 2/22./73 New Building ....;.~. .......... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ....D..?..~...~.~,,~..,,,D.~..i...v.?..~..,.L...~.,~.,,~.~,,~.~...~.,~. ........................................................................ Owner Or Owners Of Property ...... ~.~.~..~...~.~.]n ...................................................................................... Subdivision Laurel Country Estates Lot I,J,~ 42 Block No. House No ............. Permit No..6..2,.,6.C),,Z. ........ Date Of Permit ...1..]..~,.2...7.{.7...2Applicant .... .~..,~,,1,.~-'~--d...H°.....~,,e.,s.~..,!.~.c.-: ................... Health Dept. Approval .... ,2.,,/.,5./.7...~,. ......................... Labor Dept. Approval ................................................ Underwriters Approval ...... .1,/..]:...7.~.7...3. ....................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ......... ~.~.{ ............................ Fee Submitted ¢ 5. O0 Construction on above described building and permit meets all applicable codes and regulations. Appli ca nt .....~,~, .Z~,. :t~ .. ~..0.~..'~.... ,.....~,?,~.C,. ~./...~.g..l?..e. ~.~.. ~ r.....~!~,,],. ~ .,~. .................. Sworn to before me this ~ ~ ~ ........ ./....~Z? or ....... ~ ..... day of ....'.....-s ...... ~ (stamp seal) THE NEW YORK BOARD OF FIRE UNDERWRITERS BUR. EAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 1973 A. pfle.~o. ~'o. o.fle 623691 N °a'~lanuary 17, CERTIFIES THAT 67280 ~ly the electrical equEprnen~ as described below and introduced by the applicant named on the above appIicatlo~ number ~n th~ £rern~es of Sam Bail, e/s Del~ Lane, Laurel, N.Y. ~9b ~9 ..~-.,,,;,,odo-January 15. 1973 andfoundtobe;nco,,q,l;ancewithtbercguire,,,e,,tsoftldsBoard. XTURE~E EP E [ FIXTURES RA~IGES COOKING DECKS OVENS D SH WASHERS =~HAUST FANS DRYERS ~ FURNACE MOTORS ~ FUTURE APPLIANCE FE~DERS SPECIALREC'PT TIMECLOCKS BELt [UNITHEATERS 'MU[TI-OUT~T O MMERS SERVICE DISCOFINECT lNG. OF s E I V I C : {ER APPARATUS: ~Furnaces: 1-1/8, & 1-1/12 bps George Zzmlinghaus ~, ~'~." [~. Per _.1_ u~ ~ ~ ce f ca e revs not b~ alt.r~d m any manner; return to the office of the Boord ;f incorrect Inspecfors ma,, be dent[fie~ bv~he;r ~entia)s ? Lot Z DATE FEB 5 ~11g?~ T~e sewage disposal and water supply fr~]it~es for this location have been inspected by this department and found Se~vice8 SO~O/ VIMON MAP Fll.~fO IN T~ OF~ dUNE ~, l~ ~m,~.~ ~w. omc .~VmONS YOUNG & YOUNG DEC. I$,Ig72 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK dAN. $, IH?& Al. DEaN W. YOUNG HOWARD W. YOUNG INLAND HOMES, INC. ~ SAMUEL Bi~L ~ ~ TOWN OF SOUTHOLD SE~m~.~ 41 jO$~?H .EWS:ONS YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR: INLAND HOMES, INC. ~ SAMUEL B A~ L A U R E LSou~0~S~N~ SECU~'~~. sram c0., .. ~. "~~~ SCAL~: I" = 40' I"AT~:NOV. 14, 1972 INO. 72-878 I I SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference APPLICATION FOR APPROFAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date Approval to construct said systems is requested,pertinent data herewith: i-Applicant X~ul~d P'&xae$I X~$. Phone ?~-217~-Sub div ].~0 Address ~ ~ %' 1;~4 _ .7-Section property 4~ 2-Detail~ location ~: 91S 0 -Lot No. Hamlet ~1 Town ~ 9-Private well? 3-Public water supply name Distance to nearest main 4-Lot Size: Width~ft. Length_~ft. (also enter on center plot plan below:) 5-Dwelling: Single Family /~ Two Family? ~_~Cellar? ~.Slab? / ]Crawl Space? 10-Proposed syste~: Septic tank ~ /Precast ~ pCesspools ~_xdShallow pools j POther / / ii-Septic tank inside dimensions: Volume Gals.Length ft. Width ft. Liquid depth ft. 12-Precast sections: / /Number/ /Square--~. Cesspools: Block sizeLl~incs.D$ ins. H__~_ins. Total blocks below inlet: ~1~2~3 PLOT PLAN Street ra~ ,G ~ad9 G ,W.L. Capacity Gals. --1 G.P.M. ~th Data ?eet 0 2 4 6 8 10 12 18 Indi No 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 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 can be installed on this Plot. Date/f- (10/65 Revis.) S-15 APPLICATION FOR APPROVAL TO CONSTRUCT PRi~ATE SEWAGE DISPOSAL SYSTEMS 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 thorofare, also Hamlet/Village & Township 3-Enter name of Public Water Supply District, together with the distance to their m~in. ~-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 7-Section Number 8-Lot Number 9-Private well: Enter "No" if Public water supply is available. Enter "Yes" otherwise. PROPOSED SYSTEMS: Answers to Items number 10, 11, & 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 " - ', " " " Shallow Leaching Pools PlOT 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 shown on face of this application. Surface waters-Streams, Lakes, & Bays, etc., located within a distance of 50 feet of Applicant's Lot lines, must be shown on the plot plan also. 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-lO feet minimum distance from front, and front sides of property lines Well-50 feet minimum below grade for well point Well-~O 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-10 feet minimum distance from lot lines to center of cesspool Cesspools exterior must be 100 feet minimum distance from nearest well Septic tank exterior must be 75 feet from nearest well Cesspool "Center" must be 12 feet minimum distance from nearest water line Cesspool "Center" must be 15 feet from house foundation Cesspool exterior must be 50 feet minimum distance from surface Waters, Streams, Lakes & Bays, etc. Cesspools must be 20 feet minimum distance from large trees Cesspool center to Cesspool center must be at least 16 feet Cesspool cover top to grade must be held to minimum of I food to maximum of 2 feet Bottom of Cesspool to ground water must be held to minimum of 1 foot BUILDING DEPARTMENT · ow, CLERk'S OF.CE ........................................ ........ ................................... ~pr~ed APPLICATION F{~R BUILDING PERMIT Date Nov 10 ................................................. 19..7...g.. ...... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submit-ted 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 tot; and of buildings on premises, relationship to adjoining premises or public streets or areas, ana giving a detailed description of taYout of~:~eperty must be drawn on diagram which is pert of this application. c. The work covered by this application ~y 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 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 shill hove beeH granted by the Building Inspector. APPLICATIQN 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 othe~ 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~ ~ng 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 corpora'don) ......................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...................................... ~.~......%~....~..e.~.~..~..e...s. .................................................................... If applicant ia a corporate, signature of duly authorized officer. ................. ,... ............. : ............. (Name and title of corporate officer) Laugel Country · 5486 42 I. Location of land on which proposed work will be done· Map No ...................... Lot No .............................................. Street and Number ......... ~/.~..~i~t~T..~.~,.Y.~.~ ..................................................................................................... ~- '~ '~ O Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................ [~.~3,1; ................................................. ..................................... b. Intended use*and occupancy ...................................................................................................... ,~":~*"'-~:~' 3. Nature of work (check which applicable): New BUilding .~ ........X.. ........... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) ..... ................. F. ..... ................................. 4. Estimated Cost 5. If dwelling, number of dwelling units ....... .1.. ....... Number of dwelling units on each floor ............ .6. .......................... If garage, number of cars ............................................................................................................................ 6. I.f business, commemial 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 ........ ~'j~.J.~l.~.~. Rear ....~.~.~.I.~.~...~ ........ Depth ...~:.~...~....~i;.~. .............. Height ......... .~1,~} ................................... Number of Stories ..~ ...... .....1.. ............................................................. .... . .... .. . 9.' 'Size of lot: Front ...... .1.~....~.Z.0...6. .................. Rear 3.24.~4 nnn~ 194.Z7 Height .................................................... Number of ~tories ...................................................................................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or usa district in which premises am situated ..., ................................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ..........i~.~. ............................................. 13. Will lot be '~-'a"e'~ Yes Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises ....... ~RIR~%..]j~t.l~.ff~$~.~..~§.~.~. ......................................................................................... (Address} (Phone No.) Name of Architect .Z...a~...~ ~..s.~ ~.....S..e...1...d~....~.,~ ...1~... 732-2177 (Address) (Phone No.) Name Of Contractor Tnla~d Nemeso Zaco Selden, ~P/ 732-2177 (Address) (Phone No.) PLOT DIAGRAM Locate clearly and disfi,r~. :t!y aU~,~ildings, whether existing or proposed, and indicate all sat-back dimensions from property lines. Give ~tr~et ahd block nUh~be~or description according to deed, and show street names and indicate wheth- er interior or corner lot. STATEOFNEWYORK, ~. ~/'~//~. ) cou. o ........ ................. ~.'~'.--~,...~.....~ ..................... ~ing duly s~rn de~,s and says that he is the appli~nt above named. (Na~ of i~iv~ si~tng con~t) He is the .................................... ~9~ ................................................................................................. ' ( ~n~cmr, a~nt, ~te o~cer, of said owner or owners, and is duly authorized to ~dorm or have ~o~d t~ ~id ~ and to make and file this application; ~at all sta~n~ ~n~ined in this a~li~tion a~e ~o t~ ~st of ~]~ ~'e~ a~ ~tief; and ~a~ t~ work will ~ ~or~ in me ~nner ~t forth in the ap~i~tion filed ~x,~: ' ' ..... . ................................. oay o~ ........ o~ ~ublm ........... ~u .................................