Loading...
HomeMy WebLinkAbout6058-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . C~.I~ .IM..(.Gl'a~ld .AVe.). Street Map No... ~'~ ...... Block No ........... Lot No.. (~. & .9.. )la'ct~-~'l~k.. conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ,tl~ .....?. , 19.~.1. pursuant to which Building Permit No. 60.~.. dated .......... ~,ul...1.0 .... , 19.72., 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 ... l~J. va'ce..one, l~.am~.2.y .d¥~,~,~ ..................................... The certificate is issued to . .~V~Cl, .Z&u.~k:L ..... 01~el' ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . D. ee e..].2~..I.~., by. R,..~lla ... UNDERWRITERS CERTIFICATE No...~.. ~]..~....~..~....20..197~ ...................... ItOUSE NUMBER..'12~ ....... Street .....(}O~'1~1'1. ~ ................................ Building Inspector J FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 6058 Z Permission is hereby granted to: at premises located ':at ....... Z~)~;~s..~Jd~....Ge,~e~..~{e~%~s ........................................................... .............................................. ~l~....~c~(L £g~anr~..~ .v.e.).....~-~a.tt &tuc~ ................................. pursuant t~ application dated .......................... ~l~l~t.....~! ....... , 19.~1~..., and approved by the Building In~pector, Fee $.~6.e.~0..:..i.',.!. 10 ;:,£M:~b,~E EXCESS FILL FROM A'.sO'tE PP, EMISES BY REGR'~I??:G t' T ~ CFT~p:.),2~ ::C)~'-4~.~, ~, ~CI ION !. Building Inspector FORM NO. S TOWN OF ~OUTHOLD Building Department 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 disposal--(S-9 form or equal). 3. Approval of electrical installation fram 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 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 3. Copy of certificate of occupancy $1.00 $5.00 Date 14 December 1972 New Building .........~ ........ Old or Pre-existing Building ............................ Vacant Land ............................ Owner Or Owners Of Property ..........................D.~.v..~..~...~.e..s...~..~. .............................................................. Subdivision ......... ..G...a~....~...e..n...~..e..~.g..~.s.. .................... Lot No.....8..&...g... Block No ............. House No ............. Permit No....~.Q,%~;~. ..... Date Of Permit ...8./..]:.2./..7...~..Applicant ..... .~..~..1....a~.....~....~...o..m...e.~j....!.n.c./...~'...C.....D..~...v.~d ~zes Health Dept. Approval ...... ~..~./.[.~./.7...~. .................. Labor Dept. Approval ................................................ Underwriters Approval ...~2./..2..O.../..7...2...~.6..~...3:.7..O. ...... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ......... ~ .............................. Fee Submitted $ ......... .5......Q.Q .................. Construction on above described building and permit meets all applicable codes and regulations. ,,~A~licant ................. INLAND HO~S~ INC./K~W. Thurber, VP ...?...Z. ..... day of ..... ..'~....~~...../....~'~ (stamp or seal) .,--,%v~,~ ,ota~ Public ~~~n, ~ ~~~/~~ / / f f .. DOLORES SCHOMBS ~ARY PUBLIC, State of New Yn~k ~rm Expires Uarch 30, 197~ SUFFOLK COUNTY DEPARTMENT OF BEALTH APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date Approval to construct said systems is requested,pertinent data herewith: 1-Applicant D~ ~ Phone 6-Sub div ~mx~e~ Address~7-Section 2-Detaile~locationproperty VfS $~ A1~m~S, ~a~Za%l~e~8-Lot No. ~ az~ Hamlet ~%~ Town ~1~ 9-Private well? A 3.Public water supply name Distance to nearest main 4-Lot Size: Width lOO ft. Length 1~O ft. (also enter on center plot plan below:) 5-Dwelling: Single Family ~ ~ Two Family? ~ /Cellar? ~ ~ Slab? ~_~ Crawl Space? 10-Proposed system: Septic tank ~ /Precast.J ;Cesspools ~/Shallow pools //Other / / il-Septic tank inside dimensions: ~VDlume ~.~;~s.Length ft. Width ft. Liquid depth ft. 12-Precast sections: ~FNumber~quare Ft. Cesspools: Block sizeL___incs.D___ins. H ins. Total blocks below inlet: ~1 ~2 PLOT PLAN ~ 0 ® Data ~eet 0 2 6 8 ~0 12 ~6 ~ ~, ~ Street ~A~ A~e~m~ om~ ~+~ ~= ~ ~ Ind~ e ~o ~ ~ No ~th The Undersign~ CERTIF~S: "Const~ction of authorized installations will be in accordance with the Suffolk County H~lth De~rtments' current Standers, Bulletins, a~ amendments thereto, covering Private Se~ge Dis~sal Systems". Date 1 ~ 1~2 Sign~ ~ ~' ~C./~I~ ~ ~ ~ or ~ilder ~ :~ ~ c~ /j ~ ~ FOR ~ALTH DEPART~NT USE ONLY. Bas~ on the info,etlon presented here~th, it is the opinion of the Health De~ment, that an adequate and satisfacto~ Se~ge Dis~sal System can be installed on this ~ot. Date ~~ S~gn~ ~ (10/65 Revis.) S-15 ApPLICATION FOR APPROVAL TO CONSTBNCT PRl~ATE 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 ~ain 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 ?-Section Number 8-Lot Number 9-Private well: Enter "No" if Public water supply is available. Enter "les" 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 " " ~ " ~ ~ Septic Tanks Part IV " " " " " " UnUsual soil conditions Part V " " " " " " Shallow ~eaching Pools PLOT PLAN: The following information is required concerni'ng the Applicant's Lot: Lot size-Length and Width in feet to be i~dicated at the Lot line~ of the heavy lined square in the center of Plot Plan' shown on face 9f this a~plication. 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 ~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-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 mini ..mu..m~.~ ,~G~l~r,o~m_nearest well ~e~s~oCo~"~e~et~'r'~s~et ~ 7feSe~e~'~nStc~e~f~r~om~n~earest water line Cesspool "Center~ must be 15 feet from house foundatio~ Cesspool exterior must be 50 feet min~i_~, di~n~ f~ s~face Waters, Streams, Lakes & Bays, etc. ~ · ~'[' Cesspools must be 20 feet minimum distance from large t. rees Cesspool center to Cesspool center must be~a~, !,e~.st ~1~ '~-~eet Cesspool cover top to grade must be held t~$~4~m~o'f~ food to maximum of 2 feet Bottom of Cesspool to ground water must be held to minimum of 1 foot THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~- ak 85 JOHN STREET, NEW YORK, NEW YORK 10038 /)a,~ December 20, 1972 jpplicaEion;¥o.o~,.f, le 605237 N THIS CERTIFIEs THAT only the electrical equipment as described belotv and introduced by the applicant named on'the above application number in the premises of Zazeski, w/side Grand Ave., s/o Freeman Ave., Mattituck, L.I. JOb 163 inthe.follo.'it~gloc, tlon; ~lta~e,nent ~ lst~t. [] ~.d ,w; outside $~tlo. ~to~n rot December 18, 1972 andfoundtobelncompllancewitbtherequirementsofthisBoard' 16 31 16 16 EXHAUST FANS DRYERS FURNACE MOTORS FL~TURE APPLIANCE FEEDERS SERVICE DISCONNECT OTHER APPARATUS: ~tNGES 'ECIAL REC'PT R TIME CLOCKS BELL V I UNIT HEATERS ¢ A. W.G. NOOF HILEG *Furnaces: Oil 1-1/8hp, 1-1/12hp *Future appliance feeder/s: 1-3#8, 1-3#6 Motor/s: 1-3/~hp MUtTI-OUTL~T I DIMMERS SYSTEMS A~T. WAT~S NO. OF FEET George Zimlinghaus, ~ Park Place, Patchogue, L.I. 11772 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials· Lot Lot SUFFOLK COUNTY HEALTH DEPARTMENT The seance disposal and ~ater supply NO · -* MONUM£NT SUODI¥1SION MAP FKEO IN THE OFF/CE OF TNE CLff ~K OF $O~OLK COUNTY ON dONff ~4, 19~ A$MAP ~ OlETZGEN 135 11846 aEV,S,ONS YOUNG & YOU~ DEC.'. ,,"r2 ALDEN W. YOUNG SURVEY FOR: DAVID ZAZE,S, KI la. JEAN Z~[ZI~SK~ LOTS 8 ' ~ 'GARDEN HEIGHk~.+~.~.~ssoSj/ AT G UARANTEE[~R~q~m~-- MATT I TUCK SECURITY TITLE & GUARANTY CO. BOUTHOLD SAVINGS BANK TOWN OF SOUTHOLD = JULY 28, 1972 72- 542 0,0 YOUNG A YOUNG 400 OSTRANDER AVENUE, RIVERH~EAD, NEW YORK ALDEN W. YOUNG ,F'AND ~UiRVriFOR,, N.Y,'- ~,..1~.~ NO, l:~f~4B ~VIO ZAZE~K' e dEAN Z~*; LOTS 8a9 ~UTHOLD SCALE: DAT~ DIETZGEN 135 11846 TOWN OF SOUTHOLD ,,~_~ f ~, BUILDING DEPARTMENT ~,. /~ ~ TOWN CLERK'S OFFICE [~ /~ ~/: ~ sou~.o~, ~. ~. //x~ ~ ~ Application No. ~..g..~..E ............... ~, ~ ~ ~,~_~ - APPLICATION FOR BUILDING PER~T /; .......... ...................... , ...... I NSTRU~IONS a. This application must ~ completely filled in by ty~writer or in ink and submitted in triplicate to the Building Inspemor, wit~ 3 sets of plans, accurate plot plan to saale. Fee according to schedule. b. Pict plan showing Io~tion of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, 8nd giving a detailed description of layout of pro~rty must be drawn on diagram which is part of this application. ~. The work aovered by this application may not ~ ~ommenaed before issuance of Building Permit. d. Upon approval of this application, the Building Inspeator will issue a Building Permit to the appliaant. Such ~rmit shell be kept on the premises available for ins~otion throughout the work. e. No building shall be occupied or u~d in whole or in part for any purpose whatever until a 0ertificate of Ooaupanay shall have been grant~ by the Building Ins~ator. APPLICATION IS HEREBY MADE to the Building Depa,ment for the issuance of a Building Permit pursuant t of or thethe Ordinance of the Town of ~uthold, Suffolb County, New York, and other applicable Laws, Ordinances or Regulations, building, additions o~ 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 ne~ssary inspections. ~ ~ ~i,~ /~ .......... ~..~...~.~ .................................... ~ ~ ~ ~ ~?~ ~ ..........~..~..!~..~~,,~.~ o, ~,~, ........................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ............................................. ~..~ .......................................................................... If app~cant is a corporate, si~gnature of duly authorized officer. ................... i ......... ..... 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~..]JlJJIl~t~ ........................................................................ 1. Location of land on which proposed work will be done. Map No.: ..... ...~.... ........ ' ' 8 alJJ ~ . Lot NO ............................................. Street and Number ...... ~L~~(~~)~~~t~i~I~j~ .......................... Nature of work (check which applicable): New Building ............ ~ ........ Addition ..................... Alteration ............... Repair ......... ......... Removal ......................... Demolition ........................ Other Work (Description) 4. Estimated Cost ........~ ........................ Fee ................................................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... .1. ......... 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 .......~1~.? ....................... Rear ............... ~ .................... Depth ............... ~ ........................... 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: ....... , ...~. .............................................. 13. Will lot be regraded ....... ...~.... ................... Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises ....................................................................................................................................... si. Name of Architect ~1~ ~e ~ll~e ~ ~ ~,.,.~ m, ee ~ll~e ~ (Address) (Phone No.) mmmmmm m mmmam~..m,,,,.~w m,aam, m,~ma Name of Contractor ...... ~..~*.....~.........."~.....~..~......'WR~....~..?.."..~ ........................ (Address) (Phone No.) PLOT DIAGRAM 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,, wheth- er interior or corner lot. ! f~t' (Signature of applicant) STATE OF NEW YORK, ) S~ COUNTY OF ...................................................... ) -- ~"~ N ~,~4~..-~,~ ~ '~.~ '~ U,J~ l~ ,~' ~ being duly sworn, deposes and says that he is the applicant above named. (Name o£ individual signing contract} .e is the ........................... ................... '.i ................................................... i ........................................................... (Contractor, agent, corporate officer, etc.} of said owner or owners and is duly authorized to perforr~r have Iserformed the said work and to make and file this application; that aH : T. OKE~ . statements contained in this application are true t~t~ha.best. 0fdb ~,~(ng~vi~edM ~nd belief; and that the work will be performed in the manner set forth in the application filed therewith, t; '.'_ ,:-~4J7~2 ~L,!tork Cc~n / -- . ./ ~/. ........................... ~.~,..,day of ................................ ,~../...'.....~..., 19 .~........'~... / ~r - . ~ /~ /. Notary Pu bi,~ .~..~?. ......... ~.?~,;~:y .......................................................................... ~.. ...........................