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Home My WebLink About5979-zFOKM NO. 4 TOWN OF SOUTHOLD BUILI)ING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occup;,ncy No. Z. 5?6? ..... Date .............,T~.. 2~. ...... ,19. ~. THIS CERTIFIES that the building located at Peao~c. ~&]r. Blvd ......... Street Map No...zx ........ Block No... zz .....Lot No... xx... Lam's2, .. ~.,:~, .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........June .. 3{~ ,~.., 19 7~- pursuant to which Building Permit No, . .~979z dated .......... J.u~e.. ~0..., 19.72., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which t. hi.~ certificate is issued is .... P~:~vat~ .ona .fam~r. d~el~u~ ................................... The certificate is issued to .... l~.e~l~...K.e.],~.e~. ...... .0V~le~, .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .Ja~..8...%97~...b3r. R, .Vt~la .... UNDERWRITERS CERTIFICATE No. ~. 1 ~911~ ...... D~o...~.9 · · l ~7.] ............ HOUSE NUMBER .. 2820 ....... Street .... .Great .?e~.onio. ~y. ~],vd ........... .... ~ ~'~c~~r ' FOB~ NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT ?OWN CLERK'S OFFIGE SOUTHOLD, N. ¥, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5979 Z Permission is hereby granted to: /'/, ,/.,v'/~ /~" Z.' Z L ~ at premises located at ................... '.2 ........................... ~ pursuant to application dated ~ ,' ~'U ~'~/ 19~ ..~'...; and approved by the Building Inspector. Fee $ ........................ Building Inspector ~OILM NO. $ TOWN OF $OUTHOLD Building Delm~tment Town Clarke Office Southold, 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, end unusual natural or topographic features. 2. Final approval~ of Health Dept. of water supply and sewerage disposol--(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, o 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 oil property lines, streets, buildings and unusuel natural or topographic features. 2. Sworn statement of owner or previous owner os 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 //E~..~....~... D~te ....................... New Building ......~..... ....... Old or Pre-existing Building ............................ Vacant Lapd ............................ Location Of Property ...P,~-~.~..~..~ ...... ~ ...... Su~ivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No..~2.~.~a,e Of~erm,~ ~~pplic,nt ~~. ~~. ................ ................ ................................................ Underwriters Approval .... ~.~ .............. Planning Board ~prowl ........................................ Request For Tempore~ Ce~ificote ........................................ Final Ce~ificate ...... ~ .......................... Fee Submitted $ ....~..~ ................ Construction on above described building ~c~ permit meets all/applicable codes ond regulations. Applico n~...v~....~......c~.. ~Y-//' ~''~' ' /~//~/~ ........ ~. ............................. Sworn to before me~ o, Notary Public .................................... County or seal) THE NEW YORK BOARD OF FIRE UNDERWRITERS CE; BUREAU OF ELECTRICITY ~ 85 JOHN STREET. NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the electrical ~quipment as described belo~ and introduced by the applicant named on the abo~e application number in theprernlses of Frank Keller, s/s Peconlc Bay Blvd. 300' e/o Wendy Dr., Laurel, L.I. in the following location; [] Basement [] 1st FI. was examioed on December 13, 1973 [] 2nd FI. outside Section Block Lot and found to be in compliance with the requirements of this Board. RANGES ~)VENS DISH WASHERS EXHAUST FANS RXTURE FIXTURES OUTLETS SWITCHES FLUCRESCENT DRYERS TIME CLOCKS SYSTEMS NO. OF FEET E R V PER ,~ OF CC. COND. 't OTHER APPARATUS: #Wutmace/~; Oil, 3-1/Rhp, 2-1/~hp l-lOamp, compactor, 1-Ston air I C NO. OF HI-LEG A. W- G- NO. OF NEUTRAL$ A.W.G OF HI-LEG OF NEUTRAL 1 2 cond. unit, 1-2ton air cond. unit.. W.[~. ~.~attituck, L.I. 11052 GEN~d~I. MANAGER Per 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 TO CONSTRUCT PRIVATE sEWAGE DISPOSAL SYSTEMS Approval to construct said systems is requested,per_t~nent data herewith: Date JO 6~. ~,)~ 7TM 1-Applicant ¥~ O I ~'LL.~C~. Phone 6-Sub div Address ~ ~e f.~ ~i.,W,O ~vA~ ~.~/' 7-Section Hamlet Town ~o O~'w% ~og.~ 9-Private well? ~ 3-~blic ~ter sup~l~ ~me ~ ~ ~ ~ Distance to nearest ~in N o ~ ~ 4-Lot Size~ Widthq~.~ ft. L~ngt~,Hft. (also enter on center plot plan below:) 5-~elling. Sin~ily ~ T~ly? ~Cellar? ~/~lab? ~ , Crawl S~ce? / ~ lO-Pro~s~ syst~. Septic tank ~Preca~t ~Cess~ols / /Shallow ~ols ~Other / / il-Septic ta~ inside dimensions. Vol~e ~s. Length ft. Width ft. Liquid depth ft. 12-Precas% sections: ~Number~Square Ft--~'~esspools: Block size~incs.~ins. H ins. Total blocks below inlet: ~1__~2 ~3__ Ca,city Gals ~ ~ ,G ~ado GW.L. o~ Indt ~te Nc 'th Data Feet 0 2 6 8 lO 12 14 ~6 18 ~ o The Undersigned CERTIFIES: "Construction of authorized installations will be in aceomlanee with the Suffolk County Health Departments~ current. Standards, Bulletins~ andamendments thereto, covering Private Sewage Disposal ~¥steras". Own~/ ~r Builder FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department, that an adequate and satis£acto~S~w~ge Disposal System can be installed on this Plot. .(10/65 Revis.) / S-15 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 main thorofare, also Hamlet/Village & Township 3-Enter 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, ll, & 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, & 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 together with the distance to the Applicants proposed Sewage Disposal Systems and Well. Where no Buildings exist on adjacent lots, state '"~acant" 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 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-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 TOWN OF SOUTHOLD BUILDING DEPARTMENT D J~/t/~" ~ O ate ................................................ ,19./..,~....,. INSTRUCTIONS c~ a. This applicatior~, must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate ~ plan to scale. Fee according to schedule. b. Plot plan showin'g, ,~cation of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and~' giving a detailed descriptibn 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. kept on d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit Shall be ~ 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 granted by the Building Inspector. APPLICATION' IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zon~ Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction 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 inspection7 State whether applicant is owner, lessee, agent, amhitect, engineer, general contractor, electrician, plumber or builder. ................................ ................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1, Location of land on which proposed work will be done, Map No.: .................................................. v, Lot No ............. Streetand Number .~"~"~ ..~....~..~...~....~...tC ...~...~....."~..L-~/..~... ....... ~..~..~.'....~....."L ............... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a, Existing use and occupancy .................................................................................................................................... b, Intended use and occupancy ............................................................................................................................... ,/ 3. Nature of work (check which applicable): New Building ...:.. ................. Addition ..................... Alteration ............... Repair .................. ~ ..... Removal ......................... De .m. olition ........................ Other Work .................................... · ~',~.~ r.K.. ~::>~,~A ~ , ~"= ~.-, ~'-"t ~.~ {Description) 4. Est, mated 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 usa ......... :~. ......................... 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 ........................................ Rear ......... ~ ............... Depth .....~.....~... ............ 8. Dimensions of entire new construction: Front .....~.:..~.. ....... ~' '~' ~ ~ u rof tories '~' ~'~o.~.3,~'~ ..5~......~..~e~..I. .............. Height ................................................. N mbe S .................................................... I g. Size of lot: Front ....... .~...!:....~...~...~. .......... Rear ..../.~..."~..~.~.~..~. .............. Depth ...... ,,-~,..~.~.,.../.~ ........................ 10. Date of Purchasa ...~...o..~.~....!..~..~?...... Name of Former Owner ~....~......?~...?...?...1~....~. .................................... 11. Zone or usa district in which premisas are situated ........ ~..~..!...~.,.~.~,.~....~... ............................................... 12. Does proposad construction violate any zoning law, ordinance or regulation: ....... ..~...~ ............................................ 13. Will lot be regraded ......... ?Z~..~ .............. Will excass fill be removed from premisas: [ ]_Yes ~>~] No Name of Owner of rem,sas .......~...~....~....~....~'.........~........~..~.c.~ ~,~ -r~ ...~..~?......~..?..?.~..y..~....~..~...q~..~ ~J~ 14. p ' . ............................................................ ~ ....... (A es ) (Phone , Name of Architect ~--i~o.~.f~:> ~)~-'~tL~ (si,~_~,,,~...~.~.. ~1~.~...~. Name 0f Contractor '[~q.~.~..~...O.I~'T'--~-~P-~V~ ..~.~.,..~.. (Addres f'l~ ~ ~:.~_{Phone .......................................................................... ........... ... ........................... ................. (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat-back dimensions from property lines. G ve street and bock number or description according to deed, and show street names and indicate whath- er interior or corner lot. STATE OF NEW YORK, ) COUNTY OF ................ ~ ..........................) L"--~.-(~ ..~....~.., ~ '~ ~='7'-'('~'~- being duly sworn, deposes and says that he is the applicant above named. (Name o/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 sat forth in the apgli,~on filed therewith. · .~...~.........day~ ~ ofk.,~,~'..., ¢, ~ ' "., - ~ ./,...~ _ '/~ ........... UNAUTHORIZED ALTERATION OR ADDITIOi, I TO TIllS SURVEY IS A VIOLATION OF ~EC?I~N 7209 OE THE NEW YORK STATE EMBOSSED SEAL SHALL NOT BE CONSIDERED TO ~A VALID TP, UE COPY. ~(~ ~'~ ASS ~N~[~ OF T~ L ND NG INSTI- ,b' ~,,., t .~' i t · I' ~M ,I Ii _/ i h ,. j