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NO. ,& TO~N OF SOUTHOLD BDn.nlNG DEPARTS~T Town Cl~k% O~i~ Southold, N. Y. Certificate Of Occupancy No. Z~52 Date M~.oh ~ 19..?.9. THIS CERTIFIES that the buildLng located at . .~.0, .~..N~..~vf;f.~k. Av.e ~ Map No ............. Block No ...........Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in thi~ office dated .Nove~ba~..27 ....... , 19.7~. pursuant to which Building Permit No...?00~Z dated . .November.27 ........, 19.7~., was issued, and conforms to all of the requh'e. merits of the applicable provisions of the law. The occupancy for which this certificate is ~,ued is ............. .~..~.v.~. ~.e..~.e. ~ .~. $%~,...~.e. %~An.S ........................... The certificate is issued to ......... .H.e?.b..e.r~...H..e.~..~. ............................... (o,,,er,~) . of the aforesaid building. Su~o~k Counts Depa~nent of He,~th Ap~,ro,~,! . .~.~.o?'..S.:. ?..W.S... ?.0..?? .... UNDERWRITERS CERTIFICATE No .................. ....: ......................... HOUSE NUMBER..~.O, .~.0~. ..... Street ...... N~...~Vf.f.o.% .k..A.v.~ .................. ............................................ Cu..t.~.b~,a%te.,.New ...................... ¥o.r.~ BuiMing In~'~'tor 1000-116-06 001.002 FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERIC'S OFFICE SOUTH'OLD, N:. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON TH.E PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NOV 7003 Z Date ..........................................,41,4V' 19�. Permission is hereby granted to: AZt-?-'3F PE T" M r f y ................................................................................ ................................................................................ ................................................................................ to ...."£..P..:..��'.........A..........`".IF............FA 1 Lf'..8.I-.\!..........b W 4 L t:s :pi°..G .............................:.................................................................................................................................. K At at premises located at ..............................:f.................'...dJ/-!�U 1.�............. ...�.:................................ ................................................................................ ................................................................................ ................................................................................................................................................................. pursuant to application dated ....................... ............................... 19� ., and approved by the Building Inspector. Fee $....................... PERMIT INCLUDES APPROVAL TO REMOVE EXCESS FILLi FROMABOVE PREMISES BY ................................................................................ REGRADING LOT Building Inspector DRIVEVYAY CONSTRUCTION CESSPOOL CONS!RL.! :TK0N CELLAR CONSTRUCTION FORM NO. 1 •: ' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. (/2 Examined 7......... 19........................... ......... Application No. ................................ . Approved ................................`r 7, 19 7�. Permit No. .77 . 3..z. Disapproved a/c ^ .............. .......................... ..................... %1W............................................... ............................................. Ir ........... ................................ ................................................... (f (Building Inspector) 0, W APPLICATION FOR BUILDING PERMIT Date ..... /....../............................ 19.. ,. ... 0�1 INSTRUCTIONS a. Thi§ application must be completely filled in by typewriter oe in ink and submitted in triplicate to the Building Inspector, with 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, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must 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 a Building Permit to the applicant. Such permit shall be kept on 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 been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit 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, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises' and in buildings for necessary inspections. J f. ...... ....... / (Signature of applicant, o me, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..............4,-�..�a!�1�.....„/�Cl(.�.��'�.... ................................................................................................ Name of owner of premises . lar{rl<'T../..1.:.. /lr'`/....................................................................................... If applicant is a corporate, signature of duly authorized officer. ........................................................................................ (Name and title of corporate officer) Builder's License No. .................................................... Plumber's License No. ................................................ Electrician's License No. ........................:................... Other Trade's License No. .............................................. 1. Location of land on which proposed work will be done. Map No.: . o.: . .... ............................... Lot No. ........ ........... Street and Number �?�TiY. �1� ..%l/e ? .. �i� 4�/f'. !-f:........................ .................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy T b. Intended use and occupancy .....:r:�(! A., . .�� "•s .F .^........................................................................ 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair Removal Demolition.................... Other Work `_. (Description) 1 0 00 O �L .�Cr. 0 - 4. Estimated Cost .........................I..................................Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ..........�N ........Number of dwelling units on each floor f ..... Ifgarage, 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 ................................................................................................................. Dimension's of same structure with alterations or additions: Front .................................... Rear ............................ Depth ...........::................... Height ............................Number of Stories ............... ................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth .!�X•.............. Height . 1. .t Number of Stori s ...............0.1VL.......................................................................................... 9. Size of, lot: .Front ................../ 7�............................. Rear ...............�...9 ................... Depth � ..5....� ...3 .a.. 3 10 ...Ddte. of Purchase ...::.....2................SCAT................ 73 .... ...Name of Former Owner ..'......... : .. _ .1 1. Zone or use district in which premises are situated ..................tS........... ........ ..g.�rT..C(J L Tv`.. C= /VO — S� al 178� Does proposed construction violate any zoning law, ordinance or regulation: ............. .... ......... l;3 It:lot be:regraded� ............................ Will excess fill be removed from premisEs: ( Yes ( ) No :1. :` °Name.of Owner of premises .................................................... Address?o0<aj<l M Phone No. ...................... r; Name' of Architect ................................................... K -IDAI6-5 ........... Address.FA E .-.K.K"....cD Phone No. ............. ..... .:.. .. Nameof Contractor �....................... ................................ Address ................................ Phone No. ...................... PLOT DIAGRAM Locate"clear'ly 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 corner lot. 1173 STATE OF NEW YORK, COUNTY OF t S.S ... % fi-P13F..'�� .......j!��N.��Y ................being duly sworn, deposes and says that he is the applicant •• •�• •• (Name of individual signing contract') above named. He is the .........oW/V (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 than the-work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ....................7. dayof �/U1� 19�� Sur=roj� NotaryPublic, .................................................... County .. ....... ... .. . .... . .... ........... .............................. (Signature o apD t)_ BUILDING DEPARTMENT TOWN CLERK'S OFFIGE~:~ SOUTHOLD, N. Y. ..... ................. . ........... ................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS (3. This application must be completely filled in by typewriter o~, in ink and submitted in triplicate to the Building Inspector, with 3 set~ of plans, accurate plot plan to ~. scale. Fee according to schedule. b. Plot plan shoWing location of lot and of buildings on premises, relationship to adjoining premises or public streets o~----~' areas, and giving a detailed description of layout ofproperty must 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.J~. '--'~ approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. · -'"~'~ lfl~ bdilding shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit 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, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ame o ow e o~ p em~ses ........................................................... ~. ........... z ........................................................ :j~ ............. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) -- ~ ~ ~' / ,~'J~- '; ~. Builders License No ..................................................... ~,7'~r Plumber's License No ................................................. -7~ / 2- - -~ Electrician's License No ............................................. /~r/~,-- il~'.oo-~6,od d~l.o~_ Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No: ....................... Lot No ................... Street and Number .......... ...~..~../*/ ~-'1/P~ ~ ~ ¢? ~//~- ~.~_____ ...... Municipality State existing us~ and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ,'' ' - ' , b. Intended use and occupancy ............ ./......~ ........ ~..:'~ ......................................................................... 3. Nature of work (check which applicable): New ~u~din~ .............. L... ,A~clition .................. Alteration .................. Re'pair '~ Removal Demolition .................... Other Work '"/~ / /, (Description) 4. Estimated 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 c~rs ................ : ......................................................................................................................... 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 ............................ Nucnber of Stories ........................... ~... ................................ , ,; ~ , '/ 8. Dimensions of entire new construction: Front ........... .~ ........................ Rear ............................ Depth ........................ Height .... t /~ ' Number of Sto,[ries '~ 9. Size of lot: Front r Rear .............................. ....... Death .....,.~ ............... 10. Date of Purchase ........ ~....: ......... ;. ........................... :....Name of Former Owner ......................................~ .......... 11. Zone or use district in which premises ore situated ..................................................................................................... 12. Does proposed construchon v~olate any zoning law, ordinance or regulahon: .... .A..,.~;~ .................. ~..~......'/. ....... 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) N9 ; ,, 14. Name of Owner of premises / ' r' ~ " Address .... ....................... Phone No ....................... Name of Architect ' J Address ............... ~' .............. Phone No. Name of Contractor ........ ./...!...~...'.....~ ................................. Address ................................ Phone No ........=~ ....... PLOT DIAGRAM ._~__.. ., Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicafe whether interior or comer lot. STATE OF NEW YORK, I ¢ c COUNTY OF ................................ ~' ~"~ ............................................................................................... be ng duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. 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 set forth in the application filed therewith. Sworn to before me this ........................ day of ....................................... ./:..'.,~ 19 ........ " Nota~ Public, County (Signature of applicant) FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor 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 installa- tions, 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $§.00 3. Copy of certificate of occupancy $1.00 Date . .~..~.~..~.~..~..a?.., .~..o~..~?.~..~.. New Building .... ~. ..... Old or Pre-exi~ing Building ............ Vacant Land ............. Location of Prope~y~. ~.. ~ .~..~ ?F~. ~ .... ~.~.~ ~. ~'.~, Hou~ No. Steer Hamlet Ow.e o O n.rso Pro..r ff ny C~nty lax Ma~ ~o. 1000 Section ...[. ~ ~. ,. ~.~ .... Block ....~ ~.~. ~.~ .... kot.. 0.~[~.~. ~.. Subdivision ................................. Map No ............... Lot No ............... Permit No. ?~.~j~ ,.~... Date of Permit ./l~.o.v! ./~..~ .Applicant.../~/.~'..~..~.~.,~'/~....'~.'../.~-.~'..~. ....... Health Dept. Approval ..... ~ ............. Labor Dept. Approval ........................ Underwriters Approval../~o .u/.~.·. ~../~7.~. ......... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .. ~ .............. Fee Submitted $. ,~. r/z) Applicant . .//..--: ~.~. ~,..~,~.... ~..(..../. ~. __ H~ ............... Rev. 10-10-78 THE 'THIS CERTIFIES THAT NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 latFl. [] 2nd FI. out;side Section Block Lot and found to be in compliance with the requirements of this Board. in the following location; ~J~ ~ .~.....i,.,~ o. August RXTURE ~WiTCHES FIXTURES RANGES OVENS OUTLETS FLUORESCENT 3~ 37 23 32 EXHAUST FANS DRYERS FURNACE MOTORS RJTURE AFN/ANCE FEE~ERS TIME CLOCKS UNIT HEATEES MULTI-QUT~T ~IMMBRS SYSTIMS NO. OF RILtT SERVK;E DISCONNECT OT ,~otor'/? ~ ~.-1/2hp 5 E R V I C E A, W.G. HO. OF I~-LEG A.W.G. A.W.G. ei~,-15Oamp. I 2/0 2/0 This certificate n ~4 be altered in arty manner;, return to the office of the Board if incorred., Inspectors may be identified LANN Or ll�tfNl(�N�,fC� Lo 215. t 2 12 8s Ap _ q -'� LOT MGM LOT • 2 Ci+ N. 14A137 '60 w i / Ap or- N O.Q � u � [), I r - I I ON 1 LANK A r �'� IAONU/0NT . ALIA J P � L UNAUTHORZDALPERAllON.OR ADDITIOMM r /\./ LL i0 THIS SURVEY IS A V"LA., CIF ---- SECTION 72Dg OF THE.NEW.YORK STATE SITV AT - AT EDUCATION L'AW. U ra ` COPIES OF THIS SURVEY MAP NOi BEARIM # // L �T I I I�U L EM LAND SURVEYOR'S INKED SEAL OR Jinn R,g`v N U L� 2 6 , 19 7 3 it L tF^1 V P` EMBOSSED SEAL SHALL NOT BE 9' TO BE..A VALID TE CONSIDER® �TO\VN 0f- MTQOM 7 N. �. U ���>. N� TU`f L= P. L. � � GUARANTEES INDfGATE .,, '. � s 1. D HEREON SHALL RUN _ -�ONLY,TO THE PE;,SO J FOR'%'li;OM THE SURVE► 'IS PREPARED, A(,D O!HIS G�rIALF !O ME ""E COMPANY, GOVERNMEN-iA1 A ,.CY Alm. LA �,1 j�t t �/[ O LENDING INSTITUTION LISTED HEREON; A.D Lit�N J M �,AN I .1 V k4Y R J TU THE ASSIGNEES OF THE LENDING INSTI- ' w'_�` `'I'y�I� 4UilON.'GUARANTEES ARE NOT TRANSFEfAgE EV tL♦ NOV Y�J'I` I J ADDITIONAL INSTITUTIONS OR-SURSEQUE1W' �r � "� ���' � J G G� its 7d � O SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department u Reference. Number' APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1 . Applicant / ' Phone 4 5. Subdiv. Address 6. Section 2. Property Location 7. Lot Number ; 8. -Private Well Village Township 9. Public Water 3. Public Water Company Name Distance to main 4. Lot size: Width/ feet Length feet 10. Sewage Disposal System: (For Health Dept. Use) A. 900-gallon septic tank: Precast Equivalent' Block B. Leaching pools: Number of pools Precast Block Special 11 . If private well , fill in the following blanks: A. Tank capacity gallons B. Pump G.P.M. C. Total well depth D. Depth to ground water � E. Amount of water in well The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current standards thereto. This application will be valid for one year from the date of approval indicated below and may be renewed. if a current local Building Department Permit is in effect. Date i / Signed e ---------------- 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 and Water Supply can be installed on this plot. APPROVAL DATE/ SIGNED S-15 ; : MARRUH INSPECTION RQI�IM Rev . 4%1 /73 APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS INSTRUCTIONS: Applications must be submitted in triplicate 1-P?eans 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 thoroughfare, 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 dimensions on center plot plan shown on the face of this application. 5-Name of subdivision. 6-Section number. 7-Lot number. 8-Private well: Inter "No" if Public water supply is available. Enter "Yes" otherwise. 9-Public water: Enter "Yes" if Public water supply is available. Inter 'Ttoll. otherwise. PROPOSED SYSTEMS: Answer to Item number 10, consult the Suffolk County Health Department's Standards for Sewage And Waste Disposal Systems Design of Residential Subsurface Sewage Disposal Facilities. Part I-Residential Subsurface Disposal Systems covering cesspools. PLOT PLAN: The following information is required concerning the Applicant's lot: 1. 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. 2. Surface waters-Streams, Lakes, & Bays, etc., located within a distance of 100 feet of Applicant's lot lines, must be shown on the plot plan also. 3. 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. 4. Where no buildings exist on adjacent lots, state "Vacant" on the plot plan. 5. Streets adjoining applicant's lot to the right, left or rear, enter street name. WELL LOCATION: To locate the well & sewage disposal systems on Applicantts lot, the following Standards must be observed: Well-100 feet minimum distance from the nearest cesspools. Well- 25 feet distance from rear and rear sides of property lines when possible. Well- 10 feet distance from front, and front sides of property lines when possible. Well- 50 feet minimum below grade for well point. Well- 40 feet minimum into ground water for well point. Well- 4 feet-6 inches minimum below grade to well head and lateral water pipe. CESSPOOL LOCATION: Upon determination of the Sewage & Waste Disposal "type of systems" re- quired, the following Standards must be 'observed for the location of same: 1-Cesspool- 5 feet minimum distance from lot lines to exterior of cesspool. 2-Cesspools exterior must be 100 feet minimum distance from nearest well. 3-Septic tank exterior must be 75 feet from nearest well. 4-Cesspool exterior must be 7 feet minimum distance from nearest water line. 5-Cesspool exterior must be 10 feet from house foundation.. 6-Cesspool exterior must be 100 feet minimum distance from surface waters, streams, lakes, & Bays, etc. 7-Cesspools must be 20 feet minimum distance from large trees. 8-Cesspool exterior to cesspool exterior, must be at least 8 feet.. 9-Cesspool cover top to grade must be held to minimum of 1 foot to maximum of 2 feet. 10-Bottom of cesspool to ground water must be held to minimum of 2 feet. vV4-Ili��FXrI'6%LW�II,*��l5��tkir���-;1FI�I.�ir,����i4,4 l�-,k�1"i-,�i�4�,"�z`*'1;.'F-�-.��1:Z�`"li�P(�.,a�;".'1,..-Ll!�:I-".o,.',�l�It,,l%,l'I l-;"�'-I.,.-.:l,'.�l-�I1��1 I-I-1'�,",1�,�I;�,--,-'�* AlIV1 t- .,,,1":',-,.--'"��.._�.,,��,.-�.-..,L,-'-I-�,_'.,.!,I.1,,1 N-!:-,.�-..,,.'.�.�-,.-:-1:-,-,I...-,�,.%,,;�,,,,-:L..j-_,-.,-.I�,1,�.-.-..,,,,I;.,--L-.,:;i--I�.,�-.O,.r�:,"',1..,'I,.,.�--.,�,�"i,,,1 I,,.-;.,.:I 1,�".,-I-_1L.!,�e-.�:���.-:,--.�I�,.i,-,IL,,,."I.�-,I,��.1,,,f1".,�-I�1t�--�--,,,,.-,I--,.,-,,-,,-,.-"--:,,.�,,."�..�,I.,.,.�-I*l.'�.�1'--"_.L.,.�-I,-..,"��"-�,-�-,.,,.,..�1,,I,,,-1�,.,1��,-.....'�-�-I��,L,,l.�� '"�,,�,'"%l�,I.I,.-I"-,;�-I1,�,-.�.."-..IeI, ,.-0-I-I,-t:i.-.,.:-.,.-.�. 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