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HomeMy WebLinkAbout5774-zFORM NO. · TOWN OF $OUTHOLD BUH.DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Z.~.~.8.7. ...... Date .............~,;a~.... 2.9 ..... , 19.7.~. THIS CERTIFIES that the building located at .. I~reton' -Driv~ ........... Street Map No. xxx ........ Block No. x~c ......Lot No... x~x. · Southo~L~ · · 1~..~ · ........ conforms substantially to the Application for Building Pemit heretofore filed in this office dated ............l';ar.. 29., 19..7.2 pursuant to which Building Pemit No.. p.7.71+g. dated ..........~la.r... 2~ .... , 19.7.R., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...P. ri.vate, one. farnil.y..dwe.].].img ..................................... The certificate is issued to James. ~olloy .... O~r~er ............................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval · Sept..~ · · 19.7~ .................... UNDERWRITERS CERTIFICATE No. ~.1.$~8 ..... S~P~;' '~'~ .' f ~'3 ............... HOUSE NUMBER . .. ~.~ ...... Street ...l~ee-bom. D.~ive.~ .... 8outhe~<l .......... ....... ............. FO~ NO. 2 TOWN OF SOUTHOLD , BUILDING DEPART,~ENT TOWN CLERK'S OFF[CE SOUTHGLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 577~ Z Date ............................................... 19 ........ Permission is hereby granted to: ........ ~ ........ ~..~.......47..:....>..~..~.,..?..?... Building Inspector. Building Inspector FORM NO. TOWN OF SOUTHOLD! , Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF~ OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and sabmitted in DUPLICATE to the Building Inspector with the fallowing; for new buildings or new 6se: 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 seW~erage 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 tt~e Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plar~ 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 oil property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner os to use, ~bccupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildihgs 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 :. New B~ilding ..... ~ ........ Addition ................ Old or Pre-existing B~ilding ................ ~xJ Vacant Land .............. Location Of Property ~.e..~..~...O..~. D~.ive Sou.~hold~ N. :Y. Owner Or Owners Of Property ........... ~.~..~f)],[.O.y. ...............i ............................................................... Subdivision ..,~ ......................................................... Lot No. "~'i'" Block No..~ ..... House No..~.~.~.~.. Permit No. ~'.Z~..br...~. ........ Date Of Permit ..~.../..~.~.../.~..~...Applicant ~ I~n~eth Schold Health Dept. Approval ..... ~.,)..~.ZL.!...O....~...~ ............ Labor Dept. Approval ................................................ Underwriters Approval .~....J.]...[.~.....L..~.....~.....~.. ............ Planning BOard Approval ........................................ Request For Temporary Certificate ........................................ Fined': Certificate .-. ........................................ Fee Submitted $ ....~.:.,0.0. ...................... Construction on above described building and pe/~n~it meets all applicable codes and regulations. ..........: ,-. ............................. Applicant Sworn to before me this ~ (/ ~//~77~ ...... L'~"" day °f~~''~'~'' ''''/'' '~' · '~ (stamp ~or seal) Pub,,c Coun .._ LEETON C C£NTEAL S-9 $CHD TO WHOM at IT MAY CONCERN: SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. The sewagef~tspo~sal faciliti~s for a structure located (~ve de~d have been inspected by this department and found to be satisfactory. Chief of General Engineering Services TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ORDER TO REMEDY VIOLATION TOJa~eS..~oll~ ............................................... (owner or autBorized agent of owner) .... 26..T~emonl~...~Lt~.,.~.t....-..-.....~.~.~.e..n....g..l..t.7, t~. Y. L1530 (address of owner or authorized agent of owner) PLEASE TAKE NOTICE there exists a violation of: Zoning Ordinance 0h~,[0~O~ ~L00 .... ~...A3~J,g,~..~..~. ....... Other Applicable Laws, Ordinances or Regulations .... : ...................................... at premises hereinafter described in that .~,~.~.,~,~.~;..~.~7~.~..~§.~..e..~.,.....1;~..~.~.~...~?..g.~..~.[...~.f]fl~t (state character of violation) .... .w~thca~t .. ~.e~.ti~.i~a.t.~ ...~f...O.c.~D~u~Y. .............................................................................. in violation of Section lO0-1~J+ A (State section or paragraph of applicable law, ordir~ance or regulation) YOU ARE THEREFORE DIRECTED AND ORDERED to compl~ conditions above mentioned forthwith in or before the day of ....April ....................................... 19....~.~ with the law and to remedy the The premises to which this ORDER TO REMEDY VIOLATiOi~ refers are situated at ..... ,~,~,~.,~..~,e.,.~,,o,,~,,,,,D,~,,*,a..,~.O...~.~?.~..~. .............. County of Suffdlk, New York. Eoilure to remedy the conditions aforesoid end to comply with the opplicable provisions of law may constitute an offense punishable by fine or imprisonmen~/~? b~th. .......... ......................... THE NEW YORK BOARD OF FIRE UNDERWRITERS CS BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK~IOO3E "ate September' 13, 1973 .4ppUcatlonNo. on/ile ~050~jl N 114468 THIS CERTIFIES THAT ~. ~,~olloy, Leeyto~ Dr., ~/s uf Keen¥ Rd., ~outhoi , . . in the followlng location; [] Basement [] 1st FI. ~/oasexaminedo. Septe~er 10, 1973 / t I EXTURES fiXTURE r E~EPTACLESi S,~ViTCHES [,NCANDESCENTi FLUORESCENT i ~F~nY [ DRYERS I mRNACE MOTORS I ~TURE AKANCE KEDERS SER~ m~NNECT I NO. OF I S E ~ ~ C~ METER. ~ ~ D [] 2nd FI. OL[~sid~ Section Block Lot and found to be in compliance with the requirements of this Board. RANGES COOKING DECKS OVENS DISH WASHERS SFEaALREC'K TIMECLOCKS BELLIUfilTHEATERSUNITHEATERS MULTI-OUTLET T A,~PS TR S HO. OF FEET R V I C A* W.G. NO. OF HI-~EG A* W.G. NO. OFNEUTRALS OF CC. COND. OF HI-~EG EXHAUST FANS DIMMERS OF NEUTRAL 5 Chaz'les H. ~x ~ 17 $outhold, L.I. 11971 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No APPLICATION FOR APPROVAL T© 'C~NSTRucT PRIVATE SEWAGE DISPOSAL SYSTEMS D L Approval to construct said~ systems is requested,pertinent data herewith: a~e/~/9~ ~'! i-Applicant/~;~/~ ~, ~/~ Phgne~ -2~ ~ 6-Sub div Address '~z~_~ /~.. ~;~- ~ ~'~,/< 7-Section -- ~. -- 2-Detailed property, lo~tion X¢.'~A ~'~e ~ 8-Lot No. Hamlet ~;~/ Town ~'~ ~;~.~ 9-Private we-~ 3-Public water supply name ~- Distance to nearest main 4-Lot Size: Width/~ ft. Length~oft. (also enter on center plot plan below:) 7~ 5-Dwelling: Single Family I~Two Family? 10-Proposed system: Septic tank il-Septic tank inside dimensions: Volume Gals.Length ft. Width ft. Liquid depth__ft. 12-Precast sections: /~;Number/ /Square Ft. Cesspools: Block sizeL incs. D ins. H_~ins. Total blocks below inlet: PLOT PLAN Data Feet 0 10 12 ~6 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 }//-~Y~ ~ Signed (10/65 Revis.) S-15 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". ~ or Builder BUILDING DEPARTMENT ~'~~ TOWN CLERK'S OFFICE ~ SOUTHOLD, N.Y. .¢y~,,,~~- Exam,ned ............... ~.¢......ZZZ...~..-, ,*....Z ~ "App,,cat,on ~....~ZZ~ ........... ,~,p,-aved .............. ¢...2.......~.....'r.~ I'*.Z.z.. "'""'"'"" ~ ?'~ ~ Z_./_W-,.,,,z,,~.:/¢,.,- Disapproved a/c ................... ~ ............................................................. ~,// ~ ..~ .-, / . ~~:.. . .?,/(~- ...................................................................... ~,, .................................... ........ ~~....~..,/.~..x~...z...:.~..~.. -- (Building In~l~:tor) /~--'~~d ,~''" ~ APPLICATI(~N FOR BUILDING P ........ ........ ~¢.,e~cJ_- ~ ¢~4.~e' ~e'/.¢'./.). INSTRUCTIONS ,,,~_.~~~, o. This apphcat~on must be completely filled in by typewriter or in ink J nspector. b. Plot plan showing location af lot and of buildings on promises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is pert of tills appJi¢,~tion. c. The work covered by this application may 'not be commenced before issuance af Building Permit. d. Upon approval of this application, the Building Inspector wi!l issue a Building Permit to 'tl~ ~opl~ar~t. shall be kept on the premises available for inspection throughout the progress of the work. ' e. No building shall be occupied ar used in whole or in part far any purpose whatever until o Certificate of OccUpency shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance af a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk COunty, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or far removal Or demolition, os herein described. The applicant agrees to comply with oil applicable laws, ordinances, building code, housing code, and re§ulatior~s. ....... : ........ ' --~($igna ut re-of al~pifc~ant, ar nem~, if a (Address of applicant) State whether applicant is owner, lessee, agent~ architect, engineer, general contractor, electrician, plumber or builder. ..................... ,¢..~.~...L.~.:¢..~. ................................................................................................................................ Name of owner of premises ............. ~.~ ................................................................................................... If applicant isaco~orate, signature of duly author~ed officer.~ ~O ' 0 &~ (Name and title of corporate officer) 1. L~ation of la~ on which pr~o~d work will be done. Map No.: ........................................ ~t No ......................... Street and Number ..... ~.~.~.~ ...... ~.~...~....~.'~./~..~.,~..~ ............................ Mumcipadw /~ ~ 2. State existing use a~ ~cupancy of premises and intended use and ~cuponcy of .pr~ed c~mcti~: Exisiting use and occupancy ................................................................................................................................ Intended use and occupancy .............. .~..~..~..J.~.-/°~-4.~-~... ........................................................................... 3' Nature of work (check which applicable): New Building ....... .~......... Addition .................. Alteration .................. Repair .................. 1~gmoval .................. Demolition .................. Other Work (Describe) ........................................ (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 ................................ B. Dimensions of entire new construction: Front ....... ~...~'. ...................... Rear ........ Z~..~. ............. Depth ...-~'..o..t. ............ Height ....../..~... ........ Number of Stories .................. ./. .................................................................................................. Date of Purchase ............/.~..~.._~.. .............................. Name of Former Owner ...... Z~.~'...~,~.~.. ........................... Zone or use district in which premises are situated .................~. ............................................................................... Does proposed construct on via ate any zoning law, ordinance or regulation:> ....... .~....~. .............. Name af Architect ..................................................... Address ............................................ Phone Na ..................... 10. 11. 12. 13. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. T STATE OF NEW YORK, COUNTY OF .................. a.;.. ....... · . ./.~..~;~..~.../?.~.....7..../~.. ............................~¢Z~...... being duly sworn, d~o~s and says that he is the applicam (Name of individual signing application) a~ve n~ed. He is the ........... ~.~.~..~.~.~.~< ................................................................................................. (Contractor, ag~t, corporate officer, etc.) of said ~ner or ~ners, and is duly authorized to perform or have performed the said work and to ~ke 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 fo~h in the applicati~ filed therewith. Swam to ~fore me this ......................................................... ,, .......... ...... ......... . .: ................... Nota~ public, Slate o~ New york No. 52-0~44963 suffolk Counly Commission Expires March 30, LD£TON -- TE.; ~ HOLE ....... WAU~5 -L MAP OF' LAND ~UEVEY£D FOti~ JAMES '"E 4. MAP-.GAP-.IET MOLI~OY AT SOUTHOLD TOWN OF' SiDUTHOLD, N,'YI -- TEST I--~LE-- MAP OF LAND o ~SU~VEYED : dAHE$ "'E4 MAIP...GAP--..IET ': AT ? o ~ a SOUTHOLD MOLLOY 04 CENTP-.AL (NO~ D 12_.... 1 ¥,' IE SUFFOLK COUNTY DEPARTMENT OF HEALTH APPLICATION FOR AP~AL"T$'~cb~s~uCT PR~ATE S~AGE pIS~SAL SYSTE~ ' ' ' . , DaLe Approval to eons%~c~ said systems is reques~ed~per~mn~n~ da~a here~h: ~ · / "' 2-Detailed ~roperty. lo~ion ~ l~& ~,t'~ , 8-Lot No. H~mlet ~/ ... To~ ~~ 9-Private ~117 ' ~ ... 3-~bli~ ~ter supply name ~ gistahce to nearest ~in 4-Lot Size: Width/~ ft. Lengt'h~.ft. (also enter~ on center plot plan below:) 5-~elling: Single Family ~T~ Family? ~ /Cellar?~/.,/~lab? / ~Crawl S~ce? / lO-Pro,ned system: Septic tank ~Precast F~Cesspobls ~ /Shallow ~ols / /0tber ~, / il-Septic tank inside dimensions: Vol~e ,Gals. Lengt5 . ft. Width ft. Liquid depth ~ ,ft. 12-Precast sections: /~;Number/ /Square Ft. Cesspools: Block size~ incs.~ins. H ,ins. Total blocks below inlet: ~1 ~2~ ,~3 ~ PLOT PLAN Capacity ~8als. G. P.M. Data ~ ~;- 2 i0 1~-- ~ ~ ~ Street , ~ ~,a . , t. I ~ ~ .. o ~ ~ lT. dl/ The Undersigned CERTIF~S: "Const~ction of author~ zed installations will be in accordance with the Suffolk County Health De~rtments' current Standa~s, Bulletins, and amendments thereto, covering Private Se~g8 Dis~sal Systems". ~*~ _ 8~ ~ Builder FO~ ~LTH DEPART~NT 'USE ON':Y. Based o~"the opinion of the Health De~rtment, that an adequate and satisfacto~ Se~ge Disposal System can be installed on this ~ot. Date ~ Signed. ( 10/65 Revis. ) APPLICATION FOR APPROVAL TO CONSTRUCT PR/VATE 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 &~stance to nearest intersection of main thorofare, also Hamlet/Village & Township 3-~ater name of Public Water Supply District, together with the distance to their main. ~-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, & i2 please consult the Suffolk County Health Department's Standands, 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 PIAN: 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 wabers-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 t~gether with the distance to the Applicants proposed Sewage Disposal Systems and Well. i 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. WE~J~ 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 minimum distance from rear, and rear sides of property lines Well-lO feet minimum distance from front, and front sides of property lines Well-30 feet minimum below grade for well point Well-40 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-lO 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 1 food to maximum of 2 feet Bottom of Cesspool to ground water must be held to minimum of 1 foot /3' / / ,/ / /