HomeMy WebLinkAbout6277-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Cerli[icate Of Occupancy
THIS CERTIFIES that the building located at ...¢®dar. A.~ .............. Street
Map NoAqtmvlel~ .Palltlock No ........... Lot No..1.$ .... ~&m~ .14al'loll.. N..~, .....
conforms substantially to the Application for Building Permit heretofore filed in this office
dated .......... Nov*..30..., 19. ?2. pursuant to which Building Permit No..6~f'~.
dated ............ I~a~... ~Q., 1972., 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 . Prlvat~ .one..fa~i.l.y. d~lling .......................................
The certificate is issued to .. 8.t~911mn .&. B~br&..flehatt ...... Dy, re®rs. .............
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval P~I'..1.~. ·..1.9~.~. · .by. R, .¥11la .....
UNDERWRITERS CERTIFICATE No .... .l~. ~t6'~ ..... FOb...~6..t¢~.3 ..................
HOUSE NUMBER...'l.'~ ...... Street... COd, al'. &~O ...................................
Building Inspector
FORM NO. ~
TOWN OP $OUTNOLD
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)
6277 Z
Permission is hereby granted to:
.... .k'.~...¢/.c..~. ~.t.-z. ....... ~'L....Z...~...?....~..~...A..
........ ,~.,.~....~..r.~..~e..¢t.~f....~.../~.~.~..~.. 6"¢~t~ -rr
at premises located at ...................................... ~.]z:.~.,4)..t~ ........... ~J~./...~..~'~. ...............................
.............................................................................. ~.ff).~.7. ....... ~...-1./I..~..z.~.,~ ...................................
/~o 7.. .... ~.l .... '.~.,,~ V.. ~ ~: ~. .~../~.~. ~ ~..~ ~. ,L
)
Building Inspector.
Fee $...3...~...~
Building Inspector
FOBM NO. 6
TOWN OF SOUTHOLD
Buildfng Depmtment
Town Clerks Office
Sou~hold, 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 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 applioable.
B. For existing buildings (prior to April 1957), No~-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:
1. 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
Date .l~. ~..C~.. ~ J..0..,. ~..~.?..~ ................
New Building ........... ~, ...... Old or Pre-existing Building ............................ Vacant Land ............................
Location Of Property ...~..~.~..1..~.~.~..~.~'.~.~..~.~.~..~.~....~..~L~.i~T.~...~.M~~ ..................
Owner Or Owners Of Property .-~.~BIL.~.~I~..~F]M~I..,Ae...~4~M~ .............................................
Subdivision .... ........................................... .~ ............. ~lNo' . .......... 11~ alacK' Ho" ............. 0 House Nog. ..........
Permit No ..... ~.~.~...~. Date Of Permit .1.t/..~l~.~.~Applicant ....~.;~13~1~.~..~!1.~.~ ....................
Health Dept. Approval ................. ~ ........................... Labor Dept. Approval ................................................
Underwriters Approval ........ .?..~..~..~...1. ......................... Planning Board Approval ........................................
Request For Temporary Certificate ........................................ Final Certificate ......... ~. ..............................
Fee Submitted $ ..?......0~... .........................
................ day of ............................................
Notary Public .................................... County
Construction on above described building and permit meets all appli~"Oble..c,od~ge and regulations.
Sworn to before me this y/~../~)
(stamp or seal) /~_,
THE NEW YORK BOARD OF FIRE UNDERWRITERS
ak BUREAU OF ELECTRICITY
I-- 85 JOHN STREET, NEW YORK, NEW YORK 10038
THI$ ~E~IFIE$ THAT
~. ~teve ~chott, e/z~de gedar ~t.~ at Enter.of Southern B~vd.
off Rocky Point Rd., East Marion, N.Y.L.I.
inthefollowing~catlon; ~ S.~eme.t ~ lstFI. ~ 2~ FI. outside s~tio, m~
~.~i.~o. February 22, 1973 and fou~ to be in compliance with the requiremen~s of rh~ B~.
OUTLETS E~EPTACLGS SWITCHES INCANDE$CEN1
13~ 28 16
13
DRYERS FURNACE MOTORS FUTURE APPUANCE FEEDERS
AMT, K, W, O: H, P, GAS H.P. A,VJ. NO. A.W.G.
SERVICE DISCONNECT
1 100 CB
OTHER APPARATUS:
RANGES
1 30
$ R
METER
TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET
SYSTEMS
A~T. A~P$. TRANS. NO. OF FEET
C
A. W, G, NO. OF HI-LEG A, W. G.
OF CC. COND. OF }~I-~G
EXHAUST FANS
2 F
DIMMERS
NO. OF NEUTRALS A.W.G.
OF NEUTRAL
*Furnaces., O11 1-1/Shp, 1-1/12bp
Motor/s: 1-3/~hp
Brtteltte Elec. Co.,
6~ Lincoln
Mastic Beach, L.I. 11951
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEH
Address ~'//O/O ~ ~ '6.
Property location Q~ ~ 7.
Subdiv. P
Lot No.
Private well
Public water
3. Public Water Company name Distance to main
4. Lot size: Width/~o~/ feet Length ~7~O feet. (~nter on center plot below)
10. Sewage Disposal System:
A. ~gallon septic tank: Precast / ~uivalent__Block
B. Leaching pools: Number :~ Precast~__~Block Special
If private well fill
in blanks below:
Tank capacity~Gals.
Pump G.P.M. ,~
Total well depth
Depth to G.W.
Amount of water in
Test Hole
Data Feet
8
lO
12
16
18
The undersigned CERTIFIES: "Construction of authorized installations will
be in accordance with the Suffolk County Department of Health's current stand-
ards thereto."
DateASC~ ;'~ I(P"12,' Signed ~)tl~PO~ o~?2-~ild~e~r~'
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 ~-'~'z* Signed ~~----
S-15
Revised 4/1/72
EXCAVATION INSPECTION EQUIRED
APPLICATION. FOR APPROVAL TO CONSTRUCT PRIVATE S~.~WAGE DISPOSAL SYSTEMS
INSTRUCTIONS: Applications must be submitted in triplicate
1-Means O~ner or Builder. Address to which mail should be directed.
2-Meaus 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 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 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 PLAN: The following informmtion 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, & 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.
~LL 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 "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 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 foundatie~..
6-Cesspool exterior must be 1OO feet minimum distance from surface waters~ streams, lakes,
& Bays, etc.
7-Cesspoo!s ~Ast 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 ~st be held to minimum of 2 feet.
S - 266239
sOUTHERN
BOU LEVA R D
ELEVATIONS
'2
LOT I0
LO1- II
ANDREW J.
ARE REFERENCED TO AN
C
122.91 '
DZENKOWSKI
Unauthorized alteration or addition fo f~T! survey Is a
section 7209 of the New York State Education Law.
Copies of this survey map not bearing the land surveyor's
seal or embossed seal .~half not be considered to be a valid
Guarcntoes or cart!,,r ~,~ ~ ,r,~cated hereon shall run only k
person for whom the survey is prepared, and on his behalf I
tit[~comoa~, aQvernmental agency and lending institution
AS S U/~'rJ~on.~tl~T,ut~/~e assignees of the lending institution.
SURVEY FOR
STEPHEN d. 8~ BARBARA A, SCHOTT
AT EAST MARION
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N.Y.
SCALE: I'% 40'
NOV. 27,1972
JAN. ;?:5, 1973
MAR. 7, 1973
REFERENCE:
"AQUAVIEW PARK"
FILED dULY30~1971~ FI LE NO. 5621
eUARANTEED TO ~
USA FARMER~ HOME ADMINIST~ATION
USL. I~'E TITL~ INSURANCE COMPANY OF,
STEPH£N ~. g~ BARBARA A. $CHO 'rT'
LAND SURVEYOR
N.Y.$. LIC. NO.
N.Y.
SUFFOLX COUNTY HEALTH
p~,~ MAR 1 4 1973 ~. ~.
to be s~cto~,__
S -266239
SOUTHERN
BOULEVARD
2
LOT
C
0
$.88 c'16 '20"E.
51.21 '
ANDREW. , j.
ELEVATIONS ARE REFERENCED TO AN
N. 88e 16'20"W.
122.91 '
ey SCop.e · y p
leal or embossed seal shall not be considered to be o valid
Gu6rcn~ · c' c d ,cations indicated hereon shall run only
person ~o~ wi~um the survey is prepared, and on his behalf
titte company, governmental agency and lending institution
hereon, and to the assignees of the lending institution. Guar~
or certifications are not transferable to additional
AS S U M~Se~T~te..rs*
SURVEY FOR
STEPHEN d. 8~ BARBARA A. SCHOTT
AT EAST MARION
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N.Y.
SCALE: I"= 40'
NOV. 27,1972
REFERENCE ~
"AQUAVIEW P~GRK"
FILED ,JULY 10,197'1, FI LE NO. ~~
USLIFE TITLE INSUR~CE C~NY ~OR~ ~
RIVERHEAD~ N.Y.
~-J , 5-266239 ' '' '
SOUTHERN
BOULEVARD
ELEVATION$
N.?~.
LoT I0
LoT II
0
S.88 016
\1~ 51.21'
ANDREW j.
ARE REFERENCED TO AN
N. 88e 16'20"W. 122.91'
DZEIVKOWSKI
Unauthorized oIterolion or oddltlon to this
section 7209 of the New York State Education
Copies of this s~Jrvey map not bearing lhe Ion,
seal or embossed seal shcll not be cor~ idercd to be a valid
person for whom lhe ~u~v y is prepared, and on his behalf
hereon, and to the c~ss~gnees of the lending institution.
or certifications are not honsferable to additional
AS s U M ~'~Fr~?~
SURVEY FOR
STEPHEN d. 81 BARBARA A. SCHOTT
AT EAST MARION
TOWN OF SOUTHOLD
SUFFOLK COUNTY~ N.
SCALE: I"-' 40'
NOV. 27, 19 72
REFERENCE:
"AQUAVIEW PARK"
FILED JULY 10,19 71, FILE NO. 5~
eUANANTEED TO, /~'~/~T
US LIFE TITLE INSUR~CE C~M~NY~W YO~
STEPHEN J. a BARBARA A , [~.[ TT~ )
~IVE~HEAD~ N.Y.
MUTHOLD~.~. ~
(Building Inspector) ~
APPLICATION FOR BUILDING PERMIT ~j
Dote .....~.~..' ............................. .~-.~?. , 19....~...'.... \
' INSTRUCTIONS ~
a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wi~'~
3 sets of plans, accurate plot plan to scale. Fee according to schedule. ~
· ~. Plot plan showing location of lot and of buildings on premises, relatiOnship to adjoining premises or public streets or areas, a~'~
g~wng a detailed description of layout of property must be drawn on diagram which is part of this application.
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 o~,
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 bee~
grantl~ 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, Suffolk County, New York, and otheF 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)
........ ......
~7~t~ (Address of applicant)
State whether applicant is owner, leSSee, agen~,"~rchitect, engineer, general contractor, electrician, plumber or builder~
Name of owner of rem see~ ~ ~.. ~.~.ig~.~.~.. ~.~........~. ~/.(:~.'J-~"
p ......... .................................................................
If applicant is a corporate, signature of duly authorized officer·
(Name and title of corporate officer)
ao
Existing use and occupancy ..........
Intended use and occupancy .......................... JE~?..~..~.~...~.../i.~/.'. ........................................................................
1. Location of land on whi~h~ro'p~d~'work will be done. Map No.: ~-....~.~. ....... LotNo ......... // ............
/~ 3 ~ / Municipali~
2. 5tare ex~ng um and occu~ncy of pr~ims and intended u~ and ~cupancy of propomd con.ruction:
3. Nature of work (check which applicable): New Budd,ng ............ Add,t,on ..................... Alterat,on ...............
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 .........................................
If garage, number of cars .................... ~). ...................................................................................................................
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 ...~.....~.~....~.....~..~...i ........
Height. ............. .~..~...~ ........................... Number of Stories .......................... ! ..............................................................
9. Size of lot: Front ...... ..~..~..~...i .................... Rear ....~.~.1.'...?.~..~..: ................. Depth .../..~...~....~.....~...../..'~.:.~.(~. .......
Height .................................................... Number of Stories ......................................................................................
10. Date of Purchase ..................................... Name of Former Owner ............................................................................
1 I. Zone or usa district in which premises are situated .....................................................................................................
12. Does proposed construction violate any zoning law, ordinance or regu(ation: ............................................................
13. Will lot be regraded ......... y..c~.. .................... Will excess fill be removed from premises: [ ] Yes [~v~"o
14. Name of Owner of premises -""r ...... ;'"": .................................................. ; ........... /~..~o/. .............................
(Address) (Phone No.)
Name of Architect ................................................
/ ~ _ _ (Address) . (Phone No.)
Name of Contractor..~./.'/~.L.c.'~.. ~.......~.'~.~..~...~.~..; ........ J.~..~..'.~:..q .~'. · · · ~ ...... ~.. ~.~./i./.! .~ .......... ,~- ~.~.-~...'~..~-..~.~.. :.
.............. / (Address) (Phone No.)
PLOT DIAG RAM
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 NEW YORK, -~:~/~r..~ ,.~"'~' ---- )
COUNTY OF ........................... ..'~'... ~..~.. [..~...~.....~,.. )
.......................................................................................................... being duly sworn, deposes and says that he is the applicant above named.
(Name of individual signing contract)
He is the .................................................................................................................................................................................................................
(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 application filed therew;th.
...................................... day of .................................................. 19 .............
Notary Public ................................................................... ~._. County
(Signature of applicant)
HEN DINING
5/Z
)1~ ?,' f0
,: ~ O'X 3 ;! 0 '
MA~I'ER BEDROOM
13£DROOA,t - 2
$1Z £ B
ooum.-£
OF BRtD(~I N G .... ~
FOOTINGS 8X/6 POURED CONCRETE
FL. OOP~ ,4"POURED CONCRETE
FOUNDATION WAI IS 6"CONCRETE
$'~L~ ~-'-- /'-o"
OF I~RiD£~ING
I_INE OF CANDELEAVER ~.