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Home My WebLink About6409-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office South&d, N. Y. Certificate Of Occupancy No.Z .~J[',~ ..... Date ............. ~).C.t... ].0 ....., 19.73. THIS CERTIFIES that the building located at 8ounclv:tew. Ave .......... Street Map No. ~ ......... Block No, ~ ...... Lot No. ~... 8.~o~ ..... N,Y~ ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ ~g~ ..... ~6..., 19.~. pursuant to which Building Permit No. dated ......... Hae ..... 16..., 19.73., 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 . ~..q~e. ~am$~X The certificate is issued to . .P0~.al4. &..~aae..8e$~.le ..... ~er~ .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .OO~...~. 1973 ..Dy .~,. ~ilSa ....... UNDERWRITIiRS CERTIFICATE No.P'~!~' .... ~/~/~ '~.~..~/~/~ .S~ ...... [{OUSIi NUMBI~R.. 1.6~1 [ ..... S~reet .... ~O.~. ~i~W. J~ ............................ Building Inspector BUILD. ING 0E~R'~ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6 09 Z Date ................ JJll, l~llh....,.~ .................. , 19..~'3.. Permission is hereby granted to: Go~ge.-Aht-e~'.s~...Ih~t6e~,..Za.e...k/C..~eal~ & ;oJU~ Pe~Xe ....... 2~/(~'"'¢o~"~ .............................................. ....... C-Ut~Ue ....... 1~-,¥-, .................................. to .. Bl~;L!d...n~.. ~p~ .~ ~'a,~J,l.~..d~m.l.t..~g. ................................................................................... ot premises located at .*.-~./.R-..S~tU'te~:-.-~.~e~,-.-A.~ll ........ ~..~l-.J~i...~t~.-II~,itgF...~lF, b.) .............. ........................................ I~W~hetd--..-~I-,''Z'', ...................................................................................... pursuont to applicotion dated ................... ~ ......... ,~ ............... , 19~F~..., ond opproved by the Building Inspector. Fee $ .~.8~teO. ........... Building InspectoI TO~M OF Building D~partment Town Clerks Office Snuthoid, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions 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 aH buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewer;age 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, 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 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 ~ ~- , /. ~7.~-~ Date ...... ~ ......... .~/. ....................... New Building .................... Old or ere-existing Building ................ 2 ........... Vacant Land ............................ Location Of Property .,~.(J-~.~[ ........... /. ...... ; ....................... Owner Or Owners Of Property .~-,.,~....~.......~~ ................................................................... Subdivision ................................................................ Lot No .......... ;.. B ack No ............. House No ............. Permit No...~...~..~2....~....~. Dote Of Permit~../..~;.~2~.Applicant ~:-~..., ..~...~~' ....... Health Dept. Approval .....~'.....C~.....~...//,~..~..~:~ .......... Labor Dept. Approval ................................................ Request For Temporary Certificate ........................................ Final Certificate .....~ .................................. Fee Submitted $ ,...~..,:..~ ................ Construction on above described building and I~ermit meets all g,P~licable codes and regulations, Sworn to before me this /~' ~ ? //C?..~ ....... day ........ .omp or sea, Z Notary Public .................................... Cou.,y ~ 7 ~ ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU Of: ELECTRICITY . [~ 85 JOHN STREET. NEW YORK. NEW YORK !0038 CS THIS CEFITIFIES THAT ' only the electrical equipment os described below and introduced by the applicant named on the abo~e application number in the premises of Donald Petrie, rt/$ Sou3]d~e~ Ave. cor. Soundview Ave., So~thold, L.I. in the foliowing location; [] Basement [] 1st FI. [] 2fid FI. Section Block Lot outside aad found to be in compliance ~v;th the requirements of this Board. FIXTURE FIXTURES RANGES OVENS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT TIME CLOCKS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET E R V I C NO. OF CC, COND, A.W.G. NO, OF HI-LEG A.W.G, NO. OF NEUTRALS A,W,G, PER ~ OF CC. COND. OF HI-LEG OF NEUTRAL OTHER Ai~ARATUS: Water heater/s: 1-~.5kw Electric room heater/s: 3-2.0kw, ~-.TUkw W.B. Ruland ~attltuck, ~,.Y. · ~IEEAL MANAG~ Per ' ' COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. SUFFOLK COUNTY DEPARTMENT OF ~EALTH H.O.Reference No._~_~L~__~'~.P"~)~ EASTERN DISTRICT, RIVEHHEAD,N.Y. APFLICATION FOR APPROVAL TO CONSTRUCT .PRIVATE SEWAGE.DISPQSAL SYSTEMS Date Approval to construct said systems is requested,pertinent 'data herewith: '' Phone .6-Sub div 1-Applicant ~, ....... ~,,. Address .. · 7-Section 2-Detailed property locatioh . 8-Lot No. Hamlet Town ~ 9-Private well? 3-1%/bltc water supply name Dfstance to nearest main 4-Lot Size: Width ft. Length ft. (also enter on center plot plan below:) 5-Dwelling: Single Family; I Two Family? / /~ellar? lO-Proposed system: Septic tank f /Preca~Cesspools/ /Shallow pools ii-Septic tank inside dimensions. Voluble f~als. Length ,,ft. Width ft. Liquid depth ft. i2-Precast sections: /'l~Number~_~Squar~-~.Cesspools: Block sizeL incs.D ins. H ins. Total blocks below inlet: ~1_~j~2_~_~3 , FLOT PLAN Street The Undersigned CERTIFIES: apacity. .P.M. radell rote 'th Data ~eet 0 2 4 6 8 10 14 16 18 Ind~ "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Systems". Date , ~ , , Signed , ,, Owner or ' Buii'der FOR HEALTH ~EPA.RTMENT USE QNL~. Based on the information presented herewith, it is the Gals. opinion of the Health Department, that an adequate and satisfactory Sewage Disposal System can be installed on this Plot. ( 10/65 Revis. ) · ~ , S-15 SUFFOLK COUNTY DEPART~NT OF HEALTH EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT ,pRi~,ATE S, .EWAGE ,DISPOSAL SYSTEMS Approval tn constnlct said systems is requested,pertinent data herewith: Date /. ~..~.~ i-Applicant /- ..... ~SL ;, % ~ '~ '~/ l,,vPhon~6-Sub div Address ~ ,i~ ~, ~' ' '~' s. ~ '~ ..... 7-Section 2-Detailed p~o~perty~10c~tio-n .... 4=~ 8-Lot No. Hamlet ~, ,, ~n'~,~T~n'- ~;~ ~ 9-Private well? 3.Public ~t~'~name ~ .' ~,~'stance to nearest main W-l 4-Lot Size: Width . _ft. Length,~_~ft. (also enter on center plot plan below:) 5-Dwelling: Single-'~amily ~ ~ Two Family? ~ Cellar? ~_~,Slab? ; ; Crawl space? ~ ~ 10-Proposed syste~: Septic tank F~-~Precas~Cesspools / /Shallow pools ~ YOther / / il-Septic tank .inside dimensions: Volu~e~als.Length ft. Width.__ft. Liquid depth ft. 12-Precast sections: /~'~umber~Squar~. Cesspools.T--Block sizeL.__incs.D_._ins. H ins. Total blocks below inlet: ~1_~2_~$3._._ PLOT PLAN Capac ty Oals' _~G. P.M. W.L. H.D.Reference No ~q~_ Street The Undersigned CERTIFIES: I e No~th "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Systems". ~- Date ~/V~ Signed ~ ~i ~ I {', ~?~ omie~ ,.~ or--'~5%i~der FOR HEALTH DEPART~NT 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. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ....... i ...... ~ ........ ~.~........7,, ~ -..- ........ a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, witl~ 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, r~.lationsbip to adjoining premises or public streets or areas, an~ giving a detailed description of layout of property must be drawn o~ 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 pu'rpose whate~? until a Certificate of Occupancy shall have beer~ granted by the Building Inspector. , ' APPLICATION IS HEREBY MADE to the Building Department for the issuance of.a BdiJding Permit pursuant to the Building Zon~ Ordinam~e of the Town of Southold, Suffolk County, New York, and other a~pliqabJe Laws, Ordir~ances or Regulations. for the construction of buildings, additions or alterations, or for removal or demolition, as herein descr~'~'d~ 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;- - '~l'~ant. or name, if"~ corporation)' (Address of applicant) ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .... .~~........~..~....~ ........ ~ ............................................~..,, .............. If applicant is a corpora, l~,.signature of duly authorized officer. (~ame and title of corporate officer) 1. Location of land on which proposed..~ ~w°rk will~ . ~/~be done. Map No.: ............... (/ ,~ ,~~'~ ................................... Lo~t No ............. Street and Number ...............~ ...... .~..~....~.....,~ ....... ~...~ ............. 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 3. Nature of work (check which applicable): New Building ...... .~'....... ........ Addition .... Repair ......................... Removal ..................... ,... Demolition ........................ Off" 4.Estimated ...................... Fee ........ ......................... (to be paid on filing this 5. If dwelling, number of dwelling units ........ ./.. ...... Number of dwelling unitS on each If garage, number of cars ........................................................................................... 6. If business, commemial or mixed occupancy, specify nature and extent of each typ~ 7. Dimensions of existing structures, if any: Front ..................... Rear ......................... o 10. 11. 12. 13. 14. ................. Alteration ............... er Work .................................... ! Description) application) floor ......................................... of use ..' ............................. .. 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 ............ .n~.......~.... Depth ............. ~ .......... ~ ........ Height ~' Number of Stories ! :./...a~.. Size of lot: FrOnt ......... ,/...°....°...~. ................ Rear ......... ./...%:~.....: ..................... Depth ............ ~.~.~...~'. .............. Date of Purchase ..................................... Name of Former Owner ........................................................................... Zone or use district in which premises are situated ..... ; ............................................ Does proposed construction violate any zoning law, ordinance or regulation: ........ Will lot be regraded .............. .~..~ ............ Will excess fill be 'remoVed from premi Name of Owner of premises .[~.~..f:~)~...~..~..~....t:~......~.~)..~.......[~,~[l~..D, (Address) Name of Architect ................................................................................................... /'t A... ~ .. (Address)._ , Name of Contractor .<_______________~{. a~.:~,~.~,..~T,~3=,~......~J.[.~l,~,~..2~V;~c,,.. (Address} ~ PLOT DIAGRAM {'or, ate clearly and distinctly all buildings, whether existing or proposed, and inc property lines. GiVe street and block number or description according to deed, and shov er interior or corner lot. ~es: [ ] Yes ,,Y~] No .............. ......... ~. tv~X, (Phone No.) J~hqne No.) ~.~.. ............. ~..~..-...~:...~..~.~..~,.~... ~,~e__ (Phone No.) icate all set-beck dimensions from street names and indicate wheth- STATE OF NEW YOR K.K.K.K.~.~'~'/~ ) .~, ~ COUNTY OF ............. ~~.t.__ .,.~, ....... ) -- ........ ~- ~'f-]~t~ ~-~ -~ ~',~'~J*~//-'~ .................... being duly sworn, deposes and S~VS that he is the applicant above named. He is the ..................................................................... ~.......~ ............. i ............................................................... (Co~ltractor, agent, fot~drate officer, etc./ I of said owner or owners, and is duly authorized to perform or have performed the said work and io make and file this application; that ell statements contained in this application are true to the best of his knowledge and belief; and that tl~e work will be performed in the manner set forth in the application filed therewith./.~ _ iF.k~i tEE EtAK ' ' State of New ............................ o, ................. ~ . Qualred Il, s,.,~ ......... ~ ~. Notary Public, ......x~,,,~..~R-~,,~..~ ......... County .................. "~""~"~ture ............................................................... of applicant} ....[)ON, aLD J. ¢ ,J.,~/VE /,~. ~:::~ET~IE -IT+l,. Iq~ ,, 2 APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS INSTRUCTIONS: Applications must be sub~mltted in triplicate 1-Means Owner or Builder. Address to which mail should be directed, 2-Means detailed description of property location, together ~.th street name and distance to nearest intersection of main thorofare, also Hamlet/Village & Township 3-Enter name of Publid 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-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 "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 line~ of the heavy lined square in the center of Plot Plan sh~m on face of this application. Surface waters-Streams, Lakes, & Bays, etc., locate.~ 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 sho~m 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 "Vacant" on the plot plan. Streets adjoining applicant's lot to the right, left or rear, enter street name. WEIJ~ 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 grodnd 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 semen, Cesspool-l~ feet minimum distance fro.m lot lines to center of cess~pool ..~ Cesspools exterior must be lO0 feet manimum distance from neare~t~well ~[y Septic tank exterior must be 75 feet from nearest well ~. ~ Cesspool "Center" must be 12 feet minimum distance from nearest Water .Zl~ne Cesspool "Center" must be 15 feet from house foundation ~ ~ Cesspool exterior must be 50 feet minimum distance from surface Water~~ Stream~, Lakes & Bays, etc. ~ .~ Cesspools must be 20 feet minimum distance from large trees :~ ~ ~. Cesspool center to Cesspool center must be at least 16 feet ~ ~ -~ cover top to grade must be held to minimum of. .1 food~,~to,~ maximum. · o~/2~, feet Cesspogl Bottom of Cesspool to ground water most be held to mmnmmum of 1 fo~ TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. Disapproved a/c ......... ~ ........................................................ .~.. ............ Z>' ~ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ............................................................ INSTRUCTIONS a. Th~s application must be completely filled ~n by typewriter or in mk and submitted in triplicate to the Building Inspeetor, witl~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Pict plan showing location of lot and of buddings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on diagram which is part of this application. \\ c. The work covered by th~s application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Budding inspector will issue a Building Perrmt to the applicant. Such permit shall be kept ar~ the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or ,n part for any pu'rposewhat'~,e~intila Certificate of Occupancy shall have bee~ 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, SuffoJk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as hereto described. ~l-he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectS)rs on premises and in buildings for necessary inspections· , (Signature ~'f applicant, or name, if a corporation) ' (Address of applicant) ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................................................. ...................................................................................... Name of owner of premises ......... ,,...~.~ ....... ,.......~...l...Zqc .......... :~,~.¥x'..¢ .................................................................... If applicant is a corporat~,§i~nature of duly authorized officer. ......... "'"~"'~"i~'~:'~ n d'" - '~i;~ig 'gl' ~: ~g'~te o'"'" ff; ' Ti ..................... 1. Location of land an which proposed work will be done. Map No.: ................................... ~ ................. Lot No ............. Street and Number ................. ~.~,.,.2.4¢.~.: ...... (,.:.f.:.....'....~: .............. ;, ...................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction; a. Existing use and occupancy ,zc¢,/,~f: ........................................................................................ b. Intended use and occupancy '~'~' ~ /~'~'~- . ..... ............................... ..................................................................... .....: ............. 3. Nature of work (check which applicable): New Building ............... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... I Description) 4. Estimated Cost ...~.,~.~ ...~.~?. ...................... Fee .....~...~...~. ~ ..O. ......................................................... '~ (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 ....... ~.-..~.~ ........... Rear ............ ~ ..........ueptn ................................. Height I ~' '/' Number of Stories ~ o~ze of lot: Front .......... /......;. ................... Rear ......... .~...~..~.'..; ..................... ~ ~-D ' ~ Depth ............ /~..~. ...... ~..?....~' ............... 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 ..'~.~..!~..~..?~.~.~...~J~....~.~..~.~.....(.~..'.f.?~.~tr,~.%~?.?..: ............~.);SL~..~.'.?.~. .~;.Y.'.~.,. (Address) ¢~t~t-~_~', [~, (Phone Noj Name of Arch tect .............................................................................................................................. /,~ ^,~, ~--~ ,~ ~ (Add[ess)_. J~,hgne No.) Name of Contractor ~. Z;~..r.z.¢~..~, T.) ..%~.~,~......~j~z~//.~.r4.~...~.-~! ................... ×.~.~4~ ................ .~'.&....::~..t ............. (Address) ~d'~-~-r72 ~) ~,,, ~__ (Phone PLOT DIAGRAM I.ocate 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. COUNTY OF ............. ~,~.'~,,, ,~.',~,,, .~,,,,..(.. ,t~.. ........ He is the ..................................................................... (.~.,~,-',('~.;'[.f~.~ Z~..~C,~ ........ .~.~ .Z?~,".~ .~,~ ............................................................................. ( Cofitractor, agent, cofft~f~ate o#~cer, etc.) of said owner or owners, and is du~y 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, ~ . TERRI LIE ELAK ' ............................. . .. . Notarv Public, .~~'-.J~?~!'.:~C~ .................. AP~.~VED AS NOTED NOTIFY ~UILDING DEPARTMENT AT ED INSPECTIONS: 1 BEFORE BACKFILLING FOUNDA- 3, FINAL WHEN JOB COMFLETED