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HomeMy WebLinkAbout6054-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No ............. Date ............................ , 19 .... THIS CERTIFIES that the building located at ............................ Street Map No ............. Block No ........... Lot No .................................. conforms substantially t~4thCpplication for Building Permit heretofore filed in this office dated ........... q 'A 'U'~" 19. ?~su~t to which Build~g Permit ......... dated ....................... , 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 ........................................................................ The certificate is issued to ........................................................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... UNDERWRITERS C ~P4~ kC. aTE~..__.., No ..... :P',' ki ~--'''' k)~-: 'd')~ .... ~'d ~' ~ ............... [~U. SE UMBER ~Street ................................................. ........................................................ Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6054 Z Permission is hereby granted to: l~ouncter~..J~o~e ~..Inc..A/f:L.l~oae.. ~c.ckLo to...~.d....~.?..'....~?.....t.~.Z..~...d.Y~..Z..Z..~.~ .................................................................................. at premises located at .......... l(~lc].l~[II..k~.~.~..~;..l~Jn~..N.eck..B.o~4~. .............................................. ........................................................ .s..~,.v...t.~.~.~.4 ......... ~.~f.,. .................................................................. pursuant to application dated ................................... .A....~ ........ ~....., 19.....~.., and approved by the Building Inspector. Fee $..~t~.~5 .......... FORM NO. S TOWN OF SOUTHOLD Building Depa~tment 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 dispcsal--(S-9 form or equal). 3. Approval of electrical instaUafion 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 ..L~..O..t~......./a ...... ~..~..'7...~, ........ New Building / Old or Pre-existing Building Vacant Land Location Of Property .~.......~...R..~...i.~..~L~.N.I~K~...~.-~.e~L~-~./~w.~/....-...~..~.~a. LO .......................... Or Owners Of Property Af.S.l~....~.~j,,.~.e,.Lcm~.~.~..O. ................................................................. Owner Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No. ~...O..~..~.. Date Of Permit .~:~......~.~2..Applicant ~.9..~..~.~.~.~....~....e~....g..-~...).l~.~,. ............. Health Dept. Approval ,~/,~..c~../.~.~'~. ...................... Labor Dept. Approval ................................................ Underwriters Approval .../././..~../..~i~. ....................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ ......~ .......................... Construction on above described building.and.~oermit meets alJ~applicable_ codes and regulations. Sworn to before me this .... /J......¢~. day of ....~C)..'o~t~'~¢,~i%,..~..~-. (stamp or seal) Nota~ Public ~..~9~_~ Coun~ RRI LEE ~ ~,m State at New york SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval to construct said systems is requested,pertinent data herewith: Date ~'~ 1-Applicant FJ~ ,~d.~ ~lg~ ~w~. Phone~~6-Sub div Address ,~ ~,, ~ ,~ g~,, ,.~,~ _% ~, ~.,]'~,,~. ,~ ,~ ¥ 7-Section 2-Detailed property location/F/~- C~,v~ ~ ,~._= ,-~ ~,~ ~,- ,~.'~t No.. Hamlet ~,I~L,) ' Town .~¥q'~,) 9-Private well? 3-Public water supply name ~,,,% Distance to nearest main 4-Lot S.ize: Width ~ ;~ ft. Len. gth~._ft. (also enter on center plot plan below:) 5-Dwelling: Singl.e Family ~_~ Two~amily? ~_./,Cellar? ~_~.Slab? ; ;Crawl Space? lO-Proposed system. Septic tank .~/,~Precast ~_~/Cesspools / /Shallow pools / /Other / / il-Septic tank inside dimensions. Volume {~Gals. Length___ft. Width ft. Liquid depth ft. 12-Precast sections: /~ ;Number/~Square--~. Cesspools: Block sizeL incs. D ins.H ins. Total blocks below inlet: ~1 PLOT PLAN Street Wa¸ ,G ~de Capacity ~als. Y Indi ;ate No ~th The Undersigned CERTIFIES: "Construction of authorized installation will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private ,S~ge Disposal Systems". ' ~ Owner or Budder 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. (10/65 Revis.) S-15 Data ?eet 0 2 4 6 8 lO 12 ~6 18 A~PLICATION FOR APPROVAL TO CONST~CT PRIVATE SEWAGE DISPOSAL SYSTEMS INSTRUCTIONS: Applications must be submitte~ in triplicate i-Means Owner or Bn41der. 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. 4-Enter Length and Width of LOt under appropriate heading, also enter these d/mensions on center plot plan shown on the face of this application. ~-Dwellings: Check-mark "V~ items applicable to the proposed new dwelling. 6-Name of sub-division ?-Section Number 8-LOt Number 9-Private well: Enter "No" if Public water supply is available. Enter '~/es" oth~rwise.' 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 ~ ~ ~ ~ ~ e Septic Tanks Part IV " " " " " " UnUsual soil cor. ditions Part V " " " " # ~ Shallow ~.eaching Pools PLOT PLAN: The following information is requmred concerning the Applicant's Lot: Lot size-Length and Width in feet to be i~dicated at the Lot lin~s of the heavy lined square in the center of Plot Pla6 shown on face 9f this a~plication. Surface waters-Streams, Lakes, & Bays, etc., located within a distance of ~0 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 ~o the Applicants proposed Sewage Disposal Systems and Well. Where no Buildings exist on adjacen( 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-10 feet minimum distance from front, and front sides of property lines Well-50 feet minimum below grade for well point Well-SO feet minimum into ground water for well point Well-$ 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 ~0 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 groundwater must be held to minimum of 1 foot · ~ ~_~ .. ............. ....... ,,, ........ _ ............. .r.7 ........... ........................................ . ,, ........ ..... ............................. ~i~p~o~ed ~1~ ......... ~, ~-----~ ....................... ,,,. .......................................................................................................... , (Building In~ APPLICA~ON FOR B~ILDING PE~IT-- -- ' ., ~te .~.~,....~ ........................., 19..~... INSTRU~IONS *. lhi* ~ll~tion mu*t ~ eompl~t~l~ fill~d in b~ W~writ~r or in ink and ~ubmi~d ~t~ of pl~n~, ~ur~t~ ~lot ~lan to ~eal~. ~ ~ordi~ to ~h~dul~. B. ~lot ~l~n ~m~ location of lot ~nd of buddm~ on ~r~m~, ~i~in~ ~ d~tail~ ~ri~tion of I~out of ~o~rW mu~ ~ dr~n on di~r~m ~hieh i~ ~a~ of thi* ap~li~ion. ' o. Th~ ~ ~r~d b~ thi~ ~lie~tion m~ not ~ ~mm*n~d ~for~ i~u~n~ of Buildin~ ~rmiI. d. H~n ~ro~l o~ Ihi~ ~pli~tion, th* 8uildin~ I~eto~ will i~u~ th~ ~r~mi~* ~il~ for in~ion throughout th~ ~ork. ~. ~o buil~'~ '~h~ '~ ~u~i~d 'or u~d in ~ol~ Or in~ for ~n~ ~ur~ ~a~r until ~ C~ifie~t~ of Oeeu~ne~ ~h~ll h~ gran~ b~ the BUilding~lg~or..~~ .~-- APPLICATION IS HEREBY MADE to the Building Depan~nt for t~ issuan~ of a Building Permit pursuant to t~ Building Zone Ordinan~ of the Town of ~uthold, Suffolk County, New Yo~, and other applicable ~, Ordinaries or Regulations, for t~ ~nstru~ion of building, additions or al~rations, or for removal or demolition, as herein descried. The appli~nt agrees to comply with all applicable laws, ordinaries, building ~de, housing ~de, and regulations, and to admit authorized ins~ors on p~mi~s and in buildin~ for ne~ary ins~ions. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................................... C~ r.~ ~L.....~e.~..T.~ a~..~-~ ................................................................................ Name of owner of premises .~.~, ....... .~...L'l.~.~..~..~.~.l.t:~ ............... ~ ..................................................................... If apl~lica~is a corporate, signature o.~f dulY authorized officer. -" (Name and title-ot'corpora~e officer) 1. Location of land On which proposed work will be done. Map No.: .................... Lot No .............................................. Street and Number,/.~.....~....L.~a.e..t~a~......A~...~...Oa.~.~e .............. ........................... ,~ .~ '~Z~-- ~ _~ ~ ~ 0 -~ 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 ...~.J~J.J~m...~'.~J~l.f.~.~.......J,,~J,~[/fM.~ ................................... 'c~r ............ Nature of work check wh ch a ca ~ ' 3. ( pp ' b e) New Building ....................... Addition ........... .......... Alteration ......... ~... Repair ......................... Removal ......................... Demolition ........................ Other Work ......................... ..~.~.~...~,, (Descrlption~ 4. Estimated Cost ........,,~,i~.~.~...~.. .................. Fee ........................................................................... ;"" '"-"'~'"~'i (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... .~[. ....... Number of dwelling unl~l on each fl~°~ ..~..,,~..r..o.~l.~. .......... if garage, number of cars ~ · 6. If business, commercial or mixed occupancy, specify nature end extent of each type of um ..................................... 7. Dimensions of existing stm~c~tes, If afiy: Froht ..................... Rear ..~,..; ........ : ........... Depth ................................... Height ........................................................... N6'mb~rof Storle! ?.;......, .................................................................. Dimensions of #me gtructure with alterations:or additions: Front ......, ............ ' ....... Rear ......................................... Depth ............................................. Height ..,, ................................... Nu~ber?f Storlag ........................................ Height .,., ~/~. ........................................ Number of Storlag ,,,,~.~, ................. ~ ........... , .......................... ,,,,,,,.,, .......... Height .................................................... Number of Storl,g ............... ,,, ............................................. ....., ............ of O ,,of .... . ............. of ~id owner or ~wn~r~, ~nd i~ dgl¥ ~g~h~ri~d t~, mrf~rm 9r h~v~ ~rf~r~d ~h~ ~i~ wg[l~ ~nd ~9 m~kp ~nd fil~q ~hi~ ~Bl~li~ip~n; t~t~t ~?lmment~ ~n~tei8~ in tchi~ A!DRli~ie~ ~e ~ruP t~ ~ hP~ ~f hiq kn~wl~ find ~tip. fi ~nd' ~hqtc tch~ wgrk will ~ B~Ff~r~ iR ~hq p~JnnP, r m! fe~h in ~tha {Ippli~l'~iep~ fil~ thPrPwi~h. (~ J O I/ff. ~ I · ,% Soo/e .GO ' =/" ~ 3 ~ 3' 'k~f - ~0.0 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK. NEW YORK 10038 ,b,,,. November 9, 1972 .Ipp,i,..t,.,,.,'o..,,.~b. 60~030 N [~ ~ ,.dy. the electrical eq~tipment as described below and introd~ced by the applicant named on the abo~ application n~mber in the premises R. Pullchichio, Pine Neck Rd., Southold, N.Y. ~,,~,,. ,,u,,,,,~,,./,,,'.~i ..... [~i .. ........ .,. ix] ~l.'a ~] ~,,d Ft. outside .s~ti,,. ~t,,~ ~.,,, ,,.~,.,..,i,,edo,, November 6. 1972 .,,dfo.,,dto r, 'o. II ,,'owlththereq,,irer,,eats¢~[thi~Board. saav,ca o,~cb..ic; ~.% OF [ S t . V C E Water heater: 1-4.5 kw Eleo Poom heater: 2-2.0~ 2-1.5~ 2-1..25~ 1-1.0, 4-.75, ~ 2-.5 kws Notors: 1-1/ 2 Charles H. Hall ~ox 417 Southold, N.Y. 11971 . I ~! Th,s certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors'may be identifie~ 6Y their ~:redentiols. ~{ ?