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Home My WebLink About7513-z~OKM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupancy THIS CERTIFIES that the building located at . .~/.~.. Pe.Oo.~lO..I&.. ~-.Nain ~eet Map No.. ~3:~ ........ Block No .... ~ ..... Lot No..~ .... l~®aonte.. 1io¥o ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ~i~t...3.., 19 ~17. pursuant to which Building Permit No.. dated .......... ~l~t .... 3..., 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 . .~I.S.~. e.S$. b~.i~-d$.~g .... ($~;O;r~s..&. 0f. fic~] .......................... The certificate is issued to l~.o~e .l'.t...~1~.. l~.:l,~;l~. ..... ~ .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Nar. !..1.97.6. ~a.t-e.z'. .rep.o~t.. ~./..2/.76 UNDERWRITERS CERTIFICATE No...~.3~..~. ~ .... ~eb.. 16...~.St/7 .............. HOUSE NUMBER ...... ~ ...... Street .pe.q.o.~.i.q. ~ ...... .Pe.e.o.~L~ ............. FO~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN C:LERK'S OFFIC:E SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7513 Z Permission is hereby granted to: .~.~.1~ ~,r...t,...~l,p J,~ .'~ ~. ......................................... ......... .............................................. Euild an addition & make a~teration on ex~.~.ting buil~i~ to ........................... , .................................................................................................. '~ ..................... at premises located at ..,~'j'.~...P.e~oz:d.c...La~.e .................................................................................... ......................................................... ~.C.~.O.~J,g ....... ~,,.~., ...................................................................... pursuant to application dated ........................ ,~.t ......... ..~ .......... , 19~')~..., and approved by the Building Inspector. Fee $2 ~.,O~l ........... Buil~ I~spector YORK STATE v ,~,.,. ~, D ~PP.,~_,,~,! OP E' VIP0,9.fE~TTAL C0iJSERVATI{I~ B,JILDI.,~G 40, STATE ~'IYERSITY OF N~I YORK STO!YY Bi%OOK~ ?JEW YORK 11794 DearS/r: SPDES Permit No. Reference No. ¢¥ -_ 003 Enclosed please find the S~ate Pollutant Discharge Elimination Please carefully read the general and other conditions and the schedule contained in the permit to insure compliance during The term of the permit. This permit should be kept ~v~ilable on the premises of the ~2seharging f~cilicy a't all times. Sincerely yours, Andrew R. Yez~an, P.E. Regional Water Quality Engineer ARY:rja Enclosures cc: W. Garvey A. Machlin Agency NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION APPLICATION FORM "D" FOR A STATE P.0LLUTANT DISCHARGE ELIMINATION SYSTEM (SPDES) PERMIT (Becomes A SPDES Perm]tWhen Signed By Permit Issuing Official) APPLICATION[] New []TYPERenewal IF Ny--RENEWAL' GIVE PREVIOUS NO, OWNER'S NAME (Corporale, Partnership or Individual) i~ob~r~ Adi;ic-tro OWNER'S MAILING ADDRESS (Street, City, Slate, Zip Code) , I JTYPE OF OWNERSHIP CD [] Corporate [] Individual [] P~rtnership [] Public t~conic Lane tsccnic, I{.Y. 11168 REFER ALL CORRESPONDENCE TO: (Name, Title and Address) '~ ' I JFACILITY LOCATION (Street or Road) · ~J/~' I~ec ohio COUNTY GIVE EXPLICIT DIRECTIONS TO LO~.~TION, IF NECESSARY NATURE OF BUSINESS OR TYPE OF FACILITY ~R~QUE~CV OF TELEPHONE NO..(lnclude Area Code) I 516 CITY, TOWN OR VILLAGE J t ":' POPULAT~ SERVED (See Inslructlons) I All Year? Yes [] NO If "NO", Specify NO. of Months I All Week? ~ Yes [] No If "No", Specify No. of Days DOES YODR DISCHARGE CONTAIN OR IS IT POSSIBLE FOR YOUR DISCHAKGE TO CONTAIN ONE OR MORE OF THE FOLLOWING SUBSTANC£S ADDED AS A RESULT OF YOUR OPERATIONS, ACTIVITIES OR PROCESSESt · Please Check: [] Aluminum [] Ammonia [] Beryllium [] Cadmium [] Chlorine [] Chromium [] Copper [] Cyanid~ ~'~ Grease [] Lead ~ Mercury [] Nickel [] Oil [] Phenols [] Selenium [] Zinc DISCHARGE DATA (Use additional forms, if necessary) (See Instructions) OUTFALL NO. ~ Proposed [] Replacement TYPE (~F WASTE ~/~-Jk~t'TSqTf.t..[ ~ JTYPE ~ T~ATME~ SURFACE DISCHARGE~ Yes ~No j rf ",es', Name of Receivin~ Waters jC'assrfica.on jwaters ,ndex No. SUBSURFACE DISCHARGE If "Yes", Name Of nearesl 5u~ace Waler D slance SOIL T~E [] None of These OUTFALL NO. [] Proposed [] Replacement TYPE OF WASTE Exisling [] Expansion SURFACE DISCHARGE i If "Yes'~ Name of Receiving Waters [] Yes [] No J SUBSURFACE DISCHARGE, If "Yes", Name of nearest Surface Water [] Yes [] NO J OUTFALL NO.[][] ExistlngPr°posed [][~ ExpanslonReplacement TYPE OF WASTE SURFACE DISCHARGE If "Yes", Name of Receiving Walers J TYPE OF TREATMENT iClassJfication iWate~-s Index No. Distance I Ft'lSOIL TYPE TYPE OF TREATMENT D,epth to Water Table J DESIGN FL(~Wa I/Day Depth to Water Table APP4JC~/kI~LT'S SIGNATURE (See/instructions) Date )~./3~Y~./'~- ~~__ J ~0--~¢'--~5 Pr,ntedName Title J Robez.~ A~zFze~ro PERMIT VALIDATION SECTION (Department of Enviro, nmental Conservation Use Only) This SPDES permit is issued in compliance with Title 8 of Article ~7 of the Environmental Conservation Law of New York State and in compliance with the provisions of the Federal Water Pollution Control Act, as amended by the Federal Water Pollution Control Act Amendments of 1972, P.L. 92-500, October 18, 1972 (33 U.S.C. §1251 et. seq.) (hereinafter referred to as "'the ct ), and subject to the attached cond~trons./ / / ~', 'gnat,re of t ermit Is~uin~ Official / Date CA, D Type 66 68 Type lSIC Code 70 73 74 #Out Dis 76j CARD Region Coun,~ Major SubO AreaC°m~c' j, ~St Own Fails Class j ~ Basin Basin ~ j 71 72 j 74 76 78 II /lllll III I I,Illll Region Z(Reg. ReE. ~47-0799) ATTACHMENTS: Other Conditions CONDITIONS: T}[~T design and construction'~of all sewage and waste disposal systems be in 'accordance with the applicable standards of the Suffolk County Dspartment of Health Service's "Design of ~Non-Residential Subs ~urface Sewage Disposal Facili- tles~ Part II. 2. THAT use of the disposal Facility not take place ~ithout the written approval of the Suffolk County Department of Health Services. 3. THAT the system be maintain%d to the satisfaction of the Suffolk County Depart- ment of Health Services. h. T.~, no industrial wastes ~oe disposed of into the sanitary system. ~. THE applicable ground water standards not be violated. 6. AT the discretion of t~e Suffolk County Department of Health Services, a me&ns of flow measurement of wastes shall be provided. (Water Meter R~ading) . T~DtT a representative of the Suffolk County Department of t~alth Services shall inspect the excavation, construction, and backfilling operations for all non- residential sewage disposal facilities to ascertain tbmt the system Pms been constructed in accordance ~th the approved plans. THAT the approval of the waste disposal facilities does not constitute the ap- proval of the structural stability of the system by the Suffolk County Depart- ment of health Services. T}~T if cbmnge or re%~sion to the approved plsns are contemplated, such changes or revisions are to be submitted in writing to the Suffolk. C~mty Department of Health Services prior to any further approvals. 10. THAT the s~wage disposal system is designed and the permit issued for the fo!- l~.~iug type building R~£~u~t Any change in use or occu- pancy other ~Pmnthat'initially approved (e.g. d~-store to a wet-stere)will require a new submittal of plans and specifications tc the Suffolk County De- partment of Health Services prior to said change. ~ ll. ~ the event tbmt a ~anicips! or com-~m~nal sewage disposal system or facility connecting therewith becomes availsble, any building or prerises shall be con- nected to such ~,_nic~pa! er co~uunal se~mge.disposal systems and immediately thereafter the use cf any other s¢+~ge disposal system or facilities shall be discontinued. 12. 13. W}{'A'I%E plans and construction have been approved for the installation of a private well supply, and sub~quently a public water so%~ce is made available, said build- ins or prerlscs shall ccnnect to such public water source and the use of the private well supply discontinued. THAT if transfer of this permit and its attendant obligations to ~ucther perx&ttee is desired, the per.nltteo cf record and the assuw!ng perwittee shall so petition the Suffolk Cc%~nty Department cf Health ~ud the i~ew Yeti State Department of ~n- vlr~n.~:_n~a! C~n~rvaticn in ~'rfting. Transfer ~b~!! h<'?u'~ eff~ei~v~ cn th~ ~scri%cd in th2 ~.~it~n n~ii£!cttlon cf such transfer to he furnished tc ~' - .... ~ ce b~t the l~ew York State Department tho original and th~ pssur~g ~ ..... %~ ~ronmenta! Conservation. H2M CORP. ! Environmental Engineers & Scientists HOLZMACHER. McLENDON & MURRELL 500 BROAD HOLLOW ROAD, MELVILLE, NEW YORK, ].1746 (516) MY4-3043 HARRY GOLDNAN 255 ROUTE 58 ',' RIVERHEAD~ NY ~0~ RIEUTION WELL OTHER (SPECIFY) NTOR REC. CODE DATE L NO, TEST RESULT TEST APC~ml Collform Bacteria MPN/1 Color (units) Nitrates (mg/I N) Chemical Oxygen Demand (rog/{) Chlorides (rog/I) Total Hardness (mg/I as CaCO3) Totat AIkaliniW (mg/I as CaCO3) pH Total Solids Specific Cond. (pmho$) Detergents (mg/I as MBAS) Dissolved Oxygen {rog/I) Chromium (mg/I Cr +6 ) Calcium Harness (mg/I as CaCO3) Turbidity (units) , Odor: Cold Odor: Hot Total Iron (mg/l) Manganese (mgJl) Free CO2 (rog/I) Nomograph - Titration Fluoride {rog/I) Free Ammonia (mg/I N) Ammonia (mg/I N) Nitrites (mg/I N) LAB. NO. 601.815, FIELD NO. ~ TIME COL. BY DATES: COLLECTED RECEIVED ANALYSIS 5/30/76 3/53./76 q./ 2/76 PREMISES OF SAMPLING POINT R, ADEP3[ETR0 W/S PEC0N~[C LN u, 0t N/0 RTE 25 PEC0NTC POINT OF COLLECTION: CWF ROUTINE RE*SAMPLE SPECIAL COMPLAINT WELL [Z] RAw.)C]TREATEO,=)[]OTHERIS) LAS. ONLY I.D. 03 RESULT TEST Phenol Alkalinity (m9/I CaCO3) Total Phosphate (mg/I P) Ortho Phosphate (mg/I P) MISCELLANEOUS Test Code Copper (rog/I) Sulfate (mg/I SO4) Acidity (mg/I CaCO3) Sodium (rog/I) RESULT Result Magnesium (rog/I) lES TO: 4ARKS: I ISFACTORY S.C. McLENDON LAB~)RATORY DIRECTOR DATE ~'/ 2/76 REPORTED :, THE NEW YORK BOARD OF FIRE UNDERWRITERS tab" ' ':: ::i I ~ = ' BUREAU OF ELECTRICITY ~- ; "!~' '" 'i' :! ~'~ ' ~: 85 JOHN STREET, NEW YORK, NEW YORK 10038 R. Adtepet:°, w/s peConic Ave,i,.; !50" ~ n/o Route 25, Pecan,lc, n thefoBow=ng Iocatmn Basement let FI. 2nd FI. OIAtS £de , Section Block Lot 14, 1977 ' - wazexantinedonFeb:uary ~ [[.r and found to be in compllance wlth the requlrements of thls Board., · DRYERS t FURNACE A/AT. K.W. t. (~L H.P, 5 SERVICE DISCONNECT FIXTURE f 40 , IFIXTURES ~ OUTLETS ECEPTACLES SWITCHES 21: 13 MOTORS I FLITURE APPLIANCE F~EDERS OTHER APPARATUS~ RANGES SPECIAL REC'PT COOKING DECKS ' OVENS ~.,. K.W. mt'. K.W DIS~~ W AS~wE.R S TIME CLOCKS BELt UNIT HEATERS *Se:vice Disconn~t:' 1-200amp CB.' 1G.F.I. l'SmokeDetecto~ 1-4.010~ tlot water Booste: 1-4.5KI~ ~ot Wate: Heate: · ~oto:/a: 1-1/2bp MULTI-OUTLET SYSTEMS NO. OF FEET EXHAUST FANS DIMMERS OF NEUTRAL Joseph C:ocombe~ Box 1175 E OENERALMANAO~, Cente:tto:iches, L.1.11934 Lic.746 _' ~A~/ This certificate mbst not be altered in any manner;· return to the office of. the Board if incurred, inspectors may be identif~ / BUILDING DEPARTMENT '.~_'./j' ' I~ ,.,- x-' ~,1--,L "~ TOW~ CLERK'S OFFICE ~ ~ ~ v ~ ~ -- T sou .OLD, N. T. Exam,n ..... ........... --' PP ............................ ~. ................. ~,~ ................................................. . ............................................................................. 7 ...... ~ ........... o~~ APPLICATI~ FOR BUILDING PE~IT/~. ~~m?t be completely fil~ in by ~p~writer or in i~k and s~mi~ed in triplicate to~e Building ~ sp~Tor, w~tfl 3 ~s ot p:~s, accurate pl~ p an ~ ~am. r~ acco~ing to sch~ule. b. Plot plan sh~iflg I~ation of lot ~nd of buildings on premises relationship to ~joining premiss or pub c stree~ ore,s, and giving a detail~ description of I~out ofpr~e~ must be drown on t~e diagram which is ~ of this ~pficati~. c. The work c~er~ by this application may n~ be commenc~ before issuance of Building Permit. d. Upon apparel Gf this application, ~e Building Ins~tor will i~sue s~all be kept on ~e premises awilable for insp~tlofl throughout the work. e. No buildi~ shall be ~cupi~ or u~d in w~o[e or i~ pa~ for ~ny pu~ose whoever until a Ce~ificate of ~cupa~y s~Gll have ~en granted ~ the BuJ[ding Inspector. APPLIC_~TION IS HEREBY N~DE 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 a~uthorized inspectors on pre. mises add in buildings for necessary inspections. ./~.-~-~._ ~ '/-- ~/~ ........ (~Si~natu r; · ;~. -;-. ~-r~i;· ...................... ; ........ .~ ~ ~- _ ..~/. . _ ~ ~_ . . g pp a,F~, or name, i? a corporatiom '- ' --~--, _/~ / . - _ (Address of applicant) State whether.~icant is ,o~wner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................... .Gd...~.~.!: ...................................................................................................................................................... Name of owner of premises ~'~ ..~..~.~.,. A.~,.t.,h,/,~,~,,~, If oppl cant s a corporate, signature of duly authorize~ officer. ' .................................................................. (Nome and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trode's License No ............................................... L~atonof andonwhch r ~dwor' w b done 'Street and tuber ~Pr~ ~ ~°r~ D~/~. P ~': ....................................... ~ ~'~ ~/~°~m°'~ ........ ~ ~ ............. '.- ................ ............................. , ............................................. ~/~ ~, /~ ~/~ Ny · M~ici~li~ 2. State existing use and ~cu~ncy of p~emises and in,ended use and ~cupancy of pr~osed c~stmcti~: .. .. .. ...... .................................................................. .....~_~. '. Intended use ,nd ~cu~ncy ...~.~ ~ .... ~,~'~ ~.~ / 3. Natu of rk (check which applicable): New Building.. ................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ..................................................... 4. Estimated Cost ... : ............. ; ............... Fee .................................................................................... (to be paid on filing this appli,cation) 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 t~pe of use .~.....~..~..~....'~:~..~'..~. ...... 7. Dimensions ofexistingstructures, ifany: Front....~.~ ............... Rear .....c~....~. ..................... Depth .~.~.~.../. ......... Height ........................ Number of Stories ....~.... ...................................................................................................... Dimensions of same structure with alterations o~' 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 ............... ,.~__ --~-. -- ................................ Rear ...... ~7..~.. ............................ De~h ...~..~.,~ ..................... Date of Purchase ....... ~......../....~...~ .~... ........... Nam~::~f 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 e~xce~ fill be removed fror~premises: ( ) Yes ( ) No ,' 14. Name 0f Owner of premises .~.X~..~..~......~..~...C..'~.~. ..... Address ~..~...~,~,~..,Z~. Pharm No. Z.~.~..~.~?' Name of Architect .............................................................. 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-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. STATE OF NEW Y. ORI~, . COUNTY 01~~.... ~'''''~ (Hame of individual signing cantract~ 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. Swam to before ma this Notary Public, ......~F,-~-~.~ ............ County .............. .~....v_.~.....~; ...... ~....L.~ ............ .~ .......................... _..--- ~,~ (Signature o,,f/applicant) NOTARY PUBLIC, ~fafe Of New YorJr Ne. 52-4522026 . Suffo;J~ Counfv