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Home My WebLink About5878-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33024 Date: 05/13/08 THIS ~TIFIES that the buildlmg NEW DWELLING Lo~ation of Property: 4430 BRIDGE LANE CUTCHOGUE (HOUSE NO.) (STREET) (HAMLET) County Tax Map NO. 473889 Section 84 Block 5 Lot 5 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 4, 1972 pursuant to which Bui]~--g Permit NO. 5878-Z dated MAY 16, 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 PRIVATE ONE FAMILY DWELLING. THIS CORRECTED C/O REPLACES C/O Z-5055 ISSUED 4/3/73. The certificate is issued to AUGUST N & CHRISTOPHER J GARDIA (OWNER) of the aforesaid building. SuffOLK ~ DEPART~]~T OF HEALTH /~PROVi~ ~.~JrKICAL C~RTIFICATE NO. PLIERS C~KTIFICATION DA'r~o 03/27/73 N/A N 45513 09/28/72 R VILLA ized Signature Rev. 1/81 Form No. 6 TOWN OF SOUTItOLD BUILDING DEPARTMENT TOWN ItALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Tiffs appli*:ation must be filled in by typewriter or ink and submitted to the Building Department with the following: A, For new building or new use: l~lltal smw'ey ot propert> with accurate locatiou of ail buildings, prope~W 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 installatMn from Board of Fire Underwriters. S worn statement fi-om plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5 Co~mnercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6 Submit Plamfing Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1 Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. A properly completed application and consent to inspect signed by the applicant. [fa Certificate of¢)ceupaney is deoied, the Building h~spector shall state the reasons therefor in writing to the app leant C. Fees Certificate oi Occupancy ~ New dwelling $25.00, Additions to dwelling $25 00, Alterations to dwelling $25.00, Swinwning pool $25 00, Accessow building $25.00, Additions to accessory building $25 00 Businesses $50 00 2 Certificate of Occupancy on Pre-existing Building - $100 00 3 Cop'/of ( ~erti ftcate of C)ecupancy - $.25 4 Llpdated CeIlificate ofOccupano/~ $50 00 5 F{:mporaiv C. ertificale ofc)ccopan% - Residential $15 00, Connnercial $15 t>u )Id or Pre-existing Building: (check ()ne~ - _ Filed Map . Underwrite]s App~c, val. Final i :crtifi~_at¢ TOWN OF $OUTHOLD Southotd, N.Y. 11971~ FORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Occupancy No. Z ~0~ Date Apx'::L1. I 197.~. THIS CERTIFIES that the building located at .B/~..B~d~..L~ t- -" .._ \/ ..... Street XX BlockNo. ~ ...LotNo. ~X ~uteho/C, te Map No. confom subst~tially to ~e Application for B~ld~g Permit heretof~e ffl~ ~ ~is office dat~ ........... ~.. ~..~, 19~. pmu~t to which B~ding~P~it No.. ~. dated ............... ~.. ~ 19.~., was ~u~, ~d confoms to~l~ of ~e r~u~ ments of ~e applicable pro~sions of ~e law. The occup~cy for Whi~ ~h ~ffica~ h The certificate is issued to . A.~.e. hg~...~........~.~. P.~..~..~...~/.~.e....0~...1~..~: ........... (owner, I~ssee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .l(.,.R.,. ............................... UNDERWRITERS CERTIFICATE No ......................... ~ ........................ Building InsPector FORM NO. 2 TOWN OF ,SOUTHOLD BUILDING DEP~RT~EIqT $OUTH~LD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P'REMISE~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) · N? 5878 Z Permission is hereby granted to,: · pursuant to application' dated ' .......... "" ..~.,," ~ . 19,' '*., and · ~ , ..... ~, . oppro~: by the BuilSJh'd':, In*hector. ' ' - pE~,:,FAW INCL.MOES APPROVAL TO f:.EMOVE ,E~C~.fiS FiLL FI(OM ABOVE pREM',SES REGI~ADi%% LoT DRiVeWAY CO~:,T ~UCT~ON C~5$POOL CONSTRUCTION CELLAP~ CONSfRUCIlON TOWN OF $OUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF instructions )GGUPANGY Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) 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 us~: l. Final survey of property with accurate location of all b~ild..'ings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. af water supply and sewe~gge! disposal--(S-9 form ar equal). 3. Approval of electrical installation from Board of Fire Und~riters, 4. Commercial buildings, Industrial buildings, Multiple ReJidebces and similar buildings and installations, a certificate of Code compliance from the !Arc~hitect Or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan reqgirements 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; s?eets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, o¢cul~ancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings dr 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 i$5.00 3. Copy of certificate of occupancy $1.00 Location Of Property ..... .~.?.~..~.~ ...... ..~.~..~..~.$'~-....~.~ )i ......................................... Subdivision .................................................... Lot No ............. Biock No ............. House No ............. Health Dept. Approval ....... 31~ ............................... Labor Dept. Apprpval ................................................ Underwriters Approval ......... .~..e...~. .............................. Planning Boa~ ~proval ........................................ Request For Temporary Certificate ...... ~.o. .............................. FinallCe~tificate. ......................................... Fee Submitted $ Construction an above described building an~eets ,al~a~pli{able codes and regulations. Apphcant TOWI, I OF $OIJTtiOLD Building Depor~ment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF ~)GCUPANCY Instructions A. This application must be filled in typewriter OR ink, and su~bmij'ted 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 5uilclings, 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 Un~lerv~.riters. 4. Commercial buildings, Industrial buildings, Multiple Rei~ide~nces 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 ireqbirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming u~es, or buildings and "pre-existing" land uses: , 1. Accurate survey of property showing all property lines, s~ree}s, buildings and unusual natural or topographic features. 2.Sworn statement of owner or previous owner as to use, o~cu~ancy and condmon of buddings. 3. Date of any housing code or safety inspection of buildings Or premises, or other pertinent in- formation required to prepare o certificate. C. Fees: J. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 ~' Date., ~*$ ~.. 5~...[~.3 .................. New Building.........,.......,..~t:~t Old or Pre-existing Bu ding ................ ~....i .....Vacant Land ............................ Location Of Property ?~'&~L",'-; ~t,~,~ } ~.~,?,b~G 4.~ . , Owner Or Owners Of Property ..... ~.;%¢lh~t;~..~.~e4:~:~.~..~t/~..~.~e~ .......................... Subdivision ................................................................ Lot No .......... i.. Block No ............. House No ............. Permit No.....~;.~.?.:.~...:~.... Date Of Perm,t ..~].~.~..[~....App cant ...~,~..~.~.~..:9..~L~.~..~?.~. ............................ Health Dept. Approval ......... ;~r¢~,~ ............................. Labor Dept. ~pp~oval ................................................ Underwriters Approval .............................................. Planning Board ~.Approval · Request For Temporary Certificate ........ ~,0. ............................ FinalICe!tificate . ......................................... Fee Submitted $ .................................... Construction on above described building and perm? meets,all a~pli~able codes and regulations. Sworn to before me this ................ day of ............................................ (stamp or seal) Notar~ ~ublic .................................... County SUFFOLK COUNTY DEPARTMENT OF HEALTH H,D,Reference N~5~"'///''~ APPLICATION FOR APPRO%~AL TO CONSTRUCT PRIV,ATE SEWAGE DIS~SA~ SYSTSMS Approval to construc'~ 'said systems is requested,pertinent'data herewith: Date~8 ...... ~.,~, i2~Precast sections: /~.~q. umberL_~squaF~. Total blocks below inlet. i-Applicant ~-~-- L n ...... Phone~_6-Sub div Address ............... i ~ 7-Sectio~ 2-Detailed p~o~e~l~t~ ._ ~ ..... ~. ~. v~ ! i 8-Lot No. Hamlet 3-Public '~at~y ~4 ~"''~"TB~a~ ~'~"g[~ .i~ i 9-Private well? ........ D~celto nearest main 4-Lot Size: Width . ft, Length ~ ft. (also enterlonlcenter plot plan below:) ' ' 5.Dwelling: Singl-~-~amily ~T~-~ily? lO-Proposed system: Septic t~nk L~/Precast ~Cesspo~ls~_/Shallow pools / /Oth~/ Il-Septic tank inside dimensions:Volume Gals.Length !ft. Width' ft. Liquid depth Cesspool~: Block SizeL___incsoD___ins. H PLOT PLAN ins, .Grade GW.L. Indi e ' : NO Street Capacity ~als. G. P.M. --~ Data -- ~ee~t 0 2 10 The Undersigned CERTIFIES: "Construction of author{zed installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Sys!ems". Date Signe~~ , ~ ~ t ~it~. / Owner'/ "0{/~' i B~ilder FOR ~ALTH ~EPART~NT USE ONLY. Based ~ the ~nfo~atidn ~Prflsented here~th, it is the opinion of the Health De~rtment, that an adequate and sa~is~acto~ Se~ge Disposal System can be installed on this Plot. Date ....... ~ f~z~ ~_. (10/~5 Revis. ) S-15 Signed APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS INSTRUCTIONS: Applications must be submitted in triplicate i-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 m~in thorofare, also Hamlet/Village & Township 3-~hter name of Public Water Supply District, together with the distance to their main. ~hter 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-Iot 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 PIZ)T 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. W%lls 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-lO0 feet minimum distance from the nearest cesspools Well-25 feet minimum distance from rear, and rear sides of property lines Well-lO feet ~inimum distance from front, and front sides of property lines Well-50 feet minimum below grade for well point Well-40 feet ~'lnimum 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 near~st 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 I foot FOI~M NO. 1 TOWN OF SOUTHOLD ~ BUILDING DEP,A RTMIE~I3~ TOWN CLERK;S OFFIbE SOUTHOLD, N. Y. 19 ........ ]0..".'" Pemit No ............................ ,.,..... Application No. ,~c-~L~ Disapproved o/c ........................................................................................ ~,. __. , APPLICATION FOR BUILDING PER~IT i INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and Jbntitted in triplicate to the Building Inspector, wit 3 sets of plans, accurate plot plan to scale. Fee according to schedule. ~, b. Plot plan showing location of lot and of buildings on premises, relationshi; toladjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on diagram whiz hisI part of'this application. c. The work covered by this application may not be commenced before issuance, [ B~.ilding Permit. d. Upon approval of this application, the Building Inspector will issue a Buildir Per,nit to tlSe applicant. Such permit shall be kept o n7 the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose w~tev,er until a Certificate of Occupancy shall have been granted by the Building Inspector. ~ APPLICATION IS HEREBY MADE to the Budding Department for the ~ssuanc~ of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Su.ff01N County, New York, and other applicaSle~aw , Ordinances or Regulations, for the construction of buildings, addit ons or alterations, or for ~emoval or demo t on, as here n described. ~e ]pplican~ agrees to comply with all applicable laws~ ordinances, building code, housing code, and regulations, and to admit authorized inspectors o ~ premises and in buildings for necessary inspections. . .~L~:~r ~ame, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general Contractor, electrician, plumber or builder. Name of owner of premises A~9~, ~ A A~oi~e~e ~ee2~es If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. kocation of land on which proposed work will be done. ~ap ~o.: ....... ko~ ~o ...................................... Stroet and ~umber ...... ~.~..~g.~.....~.g~.~9..~.~.'~. .................. ~ ..................................................................... ~ Municipality 2~Sram existin~ use and oecu~ane~ o~ premises and ~ntended use and o%dpa~ :~ o~ p~o~Osed con.ruction: ~. Existinfl use and occupancg ~ ~' b. Intended use and occupancy ...~. ..................................... ................................................................. Nature of work (check which applicable): New Building ..~. .................. Addition ..................... Alteration.,.....' ......... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost ..........~....~.~. ~...0....O......~ ........ 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 ....~!;~./....~.~:...~. ........... Height ................................................. Number of Stories ..........~ ................................................................ 9. Size of lot: Front .....;J.~&t.. ..................... Rear ...... ~;JeO ............................ Depth ..~5~?~47. ................................... Height .................................................... Number of Stories ....... ~. .......................................................................... 10. Date of Purchase ........ ~.....~. ......... Name of Former Owner~.~..{~...~.....~.~ ............................................. 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ hQ ............................................... 13. Will lot be regraded -----~'~e ....................... Will excess fill be removed from premises: [ ] Yes [~] No 14. Name of Owner of premises ..&.t~l~ee..~.&.,~e~u~.J~lle~e....3J~..~..D~..~3~te~....~3~ ........... (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor ......................... ~ ................................................................................................................... (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all builxdings, 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 indical~e wheth- er interior or corner lot. .....b_, O ......... STATE OF NEW YORK, ) SS / &or x COUNTY OF ...................................................... ) / J ~ ,,~'~' 0 ~' beinlt~-s~vorn, deposes,antiC' 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 o~r_bave perform, ed the said work and to make and file this application; that all statements contained in this application are true to the~best,of his knowledg~ and belief; and that the work will be performed in the manner set forth in the application filed therewith. No. 52 oo,~4,,,~,,~ ~dk,I, .... ,.~ ~ ~5~' ~ ~ Commission Expi,os Mumh 3L~, I</~L.]~ ...................................... davy of ............... ./._<~..~,,....,. ......... 19/.,~... ~ /~;/'~ / Notary Pubii~..-.''C~''''''''~'~~°unty~ ......... '~'""7 ........ · .................................... / -' d w [Signattgre of applicant) ~ c3~g3 PSWLUCZYK j~'± ' ' SU~OBK C 0~TY HEA~TH DE~ART',~% iO % k>N ~ ~ ~ % - ~ n= ~'e di~aasal and water SUa~!y SITUATE AT PECONIC TOWN OF cJOUTROLD, SCALE - 50'- ARE~ = ~0,000 5Q. FT. · TEST ¼0'LE · DATUM = A$SUMF-D 50.0 ELEVATION VAN TUYL ~SON /,A_' v