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Home My WebLink About5721-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate O[ Occupancy THIS CERTIFIES that the building located at . l[}&.~ll.$~,. ~ .............. Street Map No. I~..~..I~...]~..l]~l~ck No..I.e? ~.]...Lot No...~.~. ..... .M.I.~.~.~i~.~...l~.~? ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... [eb ..... 2...., 19..~.. pursuant to which Building Permit No.. ~ .~.!~. dated .......... .~.&~' .... 1. .... , 19..~.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . P.I'.~..~..~e...o~.t....~.~.~..~.w..e.:]..1...:!.~ ....................................... The certificate is issued to M,$,~.~ .~g~!~.r~.~;~Ol~...~.~ .I~11],~.~. ~!.~.01 ........ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No .... . .~.~..~.~. ....................................... HOUSE NUMBER....~.~0 ...... Street ......~).a:~,!~'..~..~..~' ............................... .... Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT fi'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5721 Z Permission is hereby granted to: to · JliJ,J~.. ~ ·. JJ~ ..J'J~r...~ll~ .................................................................................. at premises located at ...... jj~j..dL..~.....jJ~.Jjjl~ .J~.6~l....~ .............................................. ..................................... kl, my...aea4. ........... I,IJ~tttJ~.... I~.L ................................................... pursuan$ to application dated ....................... ~.~R~....~. ...................... , 19..~., and approved by the Building Inspector. Fee $.. JlJj, e, t31~ ......... Building Inspectt I~ORM NO. 6 TOWN OF SOUTHOLD Building Delmrtment Town Clerks Office Southold, N, ¥. 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 dispasal--(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 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. 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 . b-- New Building .......~..... ....... Old or Pre-existing Buildinl:l ........................ ~... Vacant Land ............................ Locat,on Of Property ..... ~)~.~........~...~ ..........Z~..~...~T..~ ............... ~.....?,..~......~.'. .......................... Owner Or Owners Of Property .......... ..~......~.......-~.......~.......~.~..-~'....~.....~....~f.....O...~. ....... ..(~...~..~1~. ................... · '' e-J- /'(~/%J~ ('~'~')-' L t ~.-~... BI k o House Subd*ws~on ...~.~...~.~. ............................................ o No ........ ac N ............. No ............. Permit No ..................... Date Of Permit .................... Applicant ....~....~.~g~./'.Q.,'.~I... Health Dept. Approval ~ ......... ,~f/.~.C.l.~.Z.....Labor Dept. Approval ................................................ Underwriters Approval ....~...~tJ...~...~X~...~..(. .......Planning Board Approval ........................................ f Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ......~..~..O.~... .................. Construction on above described building and ~rJnit[ L/ /7 ^ .--~------meets all applicable~ codes and regulations. Applicant ......... ~,-~.~..J.~ ............................ Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date MAY 31 ]972 Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located ' (Give deed location}~/' / have been inspected by this department and found to be satisfactory. Chief of General E~ugineering Services MAY 31 1972 FORM NO. 6 TOWN OF SOUTHOLD Building Deportment Town Clerks Office SouthoJd, N. Y. 11971 APPMGATION 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 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. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Dine .....~ ,~, ./,.,,,~,,/~,,,,.,,~,, .................. New Building ...~,,, ....... Old or Pre-existing Buildir~g ....................... :.... Vacant Land ............................ Location Of Property .... .~)~..~.~.....[.~...i~... .......... ~.l~...~...'/..]...'~..] ....... ~...,..~...~ ........................... ~ner Or ~ners ~ Prope,y ......~..~.~..~....~.~[~.~.C~.~.:~/.......C~ .................... ............. ,o ............. u,,~ ~p~. App,o~.~ Y~...Z~:~.~t.~.~...[~.Z~..L~o, ~,~. App,ow~ ................................................ ........ ........................................ Request For Tempara~ ~e~ificate ........................................ Final Ce~ificate .......................................... ,~ S.~m~tt,~ $ ....~.P~ ................... Construction on above described building and~it meets oll~plicable c~s and regulations. ~plicant ........ .............................. Sworn ~o ~e~or~ m. *~, ~ ff ................ day of ............................................ (stamp or seal) Nota~ Public .................................... Coun~ 2O LOt Are°~ ~ u, RO/ o NOTE: I e ~ONUM_~NT SUBDIVISION t~/.~ FILED IN THE OFFICE OF THE G~ERK OF SUFFO~ COUNTY ON ~P~, 9, IS70 AS ~PHO. 5448 _ YOUNG &. YOUNG 400 OSTRANDER A~,~_NUE, RIVERHEAD. NEW 'fO~K SURVEY FOR: " VASILI$ LOUKATOS · LOT NO. 55 - "SUNSET KNOLLS," SECTION 2 ,.,,r MATTITUCK r'OWN OF SOUTHOLD SUFFOLK CO., N.Y. SCALE: I": 4 O' SUFFOLK COUNTY DEPARTMENT OF HEALTH APPLICATION FOR APPROTAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS ' . . Date Approval to construct said systems is requested,pertxnent data herewith. Address h~. IL TCi~i/Z,~ -;Tt~-~,~.fJ.~' .~f..,,~,.~/~ N,~7-Section- ' ~ 2-Detailed property location t-~A~,,~ ~,~ L~-X'F~r~g 8-Lot No. Hamlet~ -' '~ ~o~ ~,~. ~,~-Private well? 3-~blic ~te~ supply name ~,,,&~.'r~_' Dis%~' nearest ~in ~ 4-~t Size: Width~ft. ~e~hy~ ftC' '~al%~ enter on center plot plan~ 5-~elling: Single Family ~ Fa~ly7 / /Cellar? ;~lab? ; ;Crawl S~ce? 10-Pro~sed system: Septic tank ~recast y ~esspools /~hallow ~ols il-Septic ta~ inside dimensions: Vol~Gals.Length ft. Width ft. Liquid depth ft. 12-Precas% sections: /~/Number~$~quare Ft. Cesspools: Block slzeL incs.D ins. H ins. Total blocks below inlet: ~1__~2 ~T P~N Street H.D.Reference Ind~ e Nc 'th Capacity___Gals. G.P.M. Data ~eet 0 2 4 6 8 ~0 ~6 The Undersigned CERTIFIES: accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendmentSDate -~'/2-/~theret°' covering SignedPrivate Sewaged)//~Disposal{~ (-- System~"__ [ T.(~ / or Builder "Construction of authorized installations will be in 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 ,~/~~'-~ Signed ~'~ (~0/65 Revis.) ..... , 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 ~in thorofare, also Ham_let/Village & Township 3-Enter name of Public Water Supply D%strict, together With the distance to their main. 4-Enter Length and ~idth of Lot undsr 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, & Hays, 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 propo~sed 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-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-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 r~ ~ Cesspool "Center" must be 12 feet minimum distance from nearest water ]~ime ~ Cesspool "Center" must be 15 feet from house foundation ~' ~ Cesspool exterior must be 50 feet minimum distance from surface Waters, St~ams~ 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 maxi~ ~ 2 f~et Bottom of Cesspool to ground water must be held to minimum of 1 foot ~L~J. ~ /v f ~ BUILDING DEPARTMENT_I/ .------,--~ ~ -- /~"~ /~ · ' TOWN CLERK'S OFFICE ~:~.-~ · ~'~/// ~ ~ ~ ~~ ~ S~THOLD, N.Y. ~ ~ ~ ~~ pp, ed ......................... .............. , ........ D sapproved a/c ........................................... ~.: ................ ~/~,~ ~/u ~?~,~ .......... ..... ............................................................................. ~ .................... ~ ..........~ ~ _ ~ ~ ~ ~ ,,~ . · .......................... . ....... ~ ........... , ly ............ ~i~i',~licati~-;ust be~plete~ f,led in by weWriter ~r in ink ~ sub~tt~ i~ duplkae to the ~uilding~ Inspector. ~'/./'3~/7'~-- ']:::>~r~, ~ b. Plot plan showing location of lot and of buildings on premises, relatiOn'ship to adjoiningpremises o~: pul~lic streets or areas, ond giving a detailed description of layout ofproperty musf be drawn on the 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 o Building Permit to the applicant Such permit shall be kept on the prem sas ava lable for inspect on throughout the progress of the work. e. No building shall be occupied or used in Whole or in part for any purpose whatever until a Ce.rl;,if.i_cate of Occupancy shall have been. granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building P~rmit 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 for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinance~v~ilding code, housing code, and regulations, (Signature of applicant, or nome, if a corporation) ................................. r ........... ~ ..................... /, ..../~.. (Address of applicant) State whether owner, applicant is lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of prem,ses ,~,,~,,.~.,, ~Z~.5.t.,.I:~.C~,.~.O;O. CI3.Z:p~ £~z~~~!2_i!t~ 8~,~1,~, ~ ... '":.: I~licant is a co~orate, signature of duly authorized officer. (Nome and t ~-~[~;~te ofhcer) 1. ~ation of land on which m osedwor~w bedone Mop No'~UN[ ~ ~t No .~ 2. State existing ~e and ~cupancy of premises and intended ~e and ~cupancy ~ pr~os~ c~stmct~: a. ~isiting use a~ ~cupancy ................................................................................................................................ b. Intend~ useand ~c~y ~e~l 3. .Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ................... **~....~.~..~'./~..':.~: ....... -'...Fee ...3~,~,..111,...~,~......~**...~.:....~..'.~..~..'/'- ----__ ' (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 .................................... v~eor ............................ Depth ........................ Height .................... Number of Stories ........... r ........................................... .-. ............................................................ 9. Size of lot' Front .... ./'.~l~...... ,Rear ~ Depth 10. Dote of P~rchase"i.iii~.iiiiiii'.~.~.)iiiill ...... iiiiii'l~"~;'Former"j~;~~~ ......... i 1. Zone or use district in which premises are situated ....... ?,l&? ....................................... ~;;~ .................................... 12. Does Proposed construction violate any zoning law, ordinance or regulation.;) ........... ~ .................................... 13. ome aT ~.~ner or prern,,ses ,~-be~t-~l,--Z;~-~/~g ....... ;;~ ......................... . ................. ~'none ~o ..................... Name of Architect ~~,-,~.,¥.,~,..,...Ack~ ,~,_,.,,6~,;~,~.~.~~e/~/,,,.7,~...~,,?.~ Name o, Con,roctor ........ ^ ress PLOT DI^GRAM 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 whether interior or comer lot. STATE OF NEW YORK, ,, l S S , COUNTY OF ....~'~...~:'~...J.~......,,..J' ' ~'~./t.L/.?:~.......~....~,~..~.~,,,~ .................................... being duly sworn, dePbses a~d says that he is the applicant -- ' (Nome'of indNidual signin~ application) above named; He is the ..................... ~....~ff.~....~..~ ............................................................................................................. ,2'~ N (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 .c~.licotion are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the a~pli~ie~ filed therewith. Swam to before me this .... ....... ' ..................... Notary Public(,.~';.~..-,.,.~'~'~.~.(...~..e,,,.c.~J.j~:,,:.;:..,.~.... County 1~- ~ ,_ (Signature of Spplicant) ,,~ ELIZABETH Arr,/NEViLLE · _ NOTARY PUBLIC, StjAe of New York ~ J No 52-8125850 Suffolk Cou~'*3 " Term Expires March 30, 19,~..o( ', L. ot fl DIETZGEN 135 1~46 2O Lof phiSY ~0/~p YOUNG & yOUNG " 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG ~ASI~IS LOUKATOS '~UNSET K~LLS~ SECTION 2 ·OWN O~ S 0 U TH 0L D S0~LD ~Vl.e~ e~NK SUFFOLK ~., N, Y. C'~.?~. / 7a. tt Jr V'~ 41~ __32F- I I ,% ]/ /d .? 0 'o k -- :: T'7'z. -'