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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 ~.