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Home My WebLink About8590-zFOI~I NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Ot~ice Southold, N. Y. Certificate Of Occupancy No. ~ 73~D f',~'~/ $ 76 Date .................. 19 THIS CERTIFIES that the building located at ............................ Street Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...................... , 19 .... pursuant to which Building Permit No. dated ....................... ~ I~ , 19~ ., was issued, and conforms to all of the require- ments of the applicable provisio~ of the law. The oecup~cy for which this certificate is issued is The certificate (owner, of the aforesaid building. Suffolk County Departmen~ of Health Approval UNDERWRITERS CERTIFICATE HOUSE NUMBER {W~O Street H~~ ~ ~H Building Inspector $590 OF THE Z Permission is hereby grc~nted to: FOI~M NO. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office 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 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 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. 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 unusuaJ natura~ 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 ................... B New qilding ....~ .........Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ....... J.~-~..~?.~..~..~.,(~,..1~.......~'../?...~..~ ...... ,....,~,,q..~,:~./..~, ............................................... Owner Or Owners Of Property .......... .~...: ....................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. ................... Permit No.~.'~..~....~ ..... Date Of Permit ~.~ !~ Applicant Health Dept. Approval ................. f ........................ Labor Dept, Approval ................................................ Underwriters Approval .............................................. ~ nmg Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building an~ permit~mee,es'~all al?plicabl%codes and regulations. .................................. (stomp or seal) '_SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number 3. Public Water Company Name 4. Lot size: Width feet 10,~ Sewa§~sposal System: A. ?YITO~gallon septic tank: Preca§t' Z .Equivalent Block .+~ B. L.e~hing pools: Number of pools_ Precast~0 ._Block _Special __ 11. If prfg&te well, fill in the fol- lowing blanks: A. Tank ~capacity ~?~gallons B. Pump' G.P.M,_ ],] APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Applicant~eu~]~- m .T.m~ ~]~.~Phone ' 5. Subdiv._j~Ii~l~lF_~_ Property 16catffo~'-~Iia~a~h~~;.~'-' ~. Lot Numbe~o.~ 8' Private Wel 1~__~ Village '~o~ ....... T6WnSh~P ~tho~d~ ~.v~ 9. Public Water~ ~ NO~E Distance to main_~ Length feet C. Total well depth D. Degth to ground water E. Amount of water in well. (For Health Services De_~9_p~t. Us~ee) The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health Services' ~urrent 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 P.~rmit i~ ef~f-~t~. Date~ ~ ~o~ , S i g n e ~/~/~f~ ~c2~ ~ ~ , _ :::~:::::::::::- ~--~-::::::::::::::::::::::::::::::::::::: =================================== FOR THE DEPARTMENT OF HEALTH SERVICES' USE ONLY. Based on the information presented here- with, it is the opinion of the Department of Health Services that an,adequate and satis- factory Sewage Disposal /System and Water Supply can be installed o~ this^pkot. S-15 Rev. 4/1/73 APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS INSTRUCTIONS: Applications must be submitted in triplicate 1-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 main thoroughfare, also Hamlet/Village and.Township. 3-£nter 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 -- Enter "No" if public water supply is available. Enter "Yes" otherwise. 9-Public water -- Enter "Yes" if public water supply is available. Enter "No" otherwise. PROPOSED SYSTEMS: Answer to Item Number 10, consult the Suffolk County Department of Heal th Services' Standards for Sewage and Waste Disposal Systems Design of Residential Subsurface Sewage Disposal Facilities. Part I - Residential Subsurface Disposal Systems Covering Cesspools. WELL LOCATION: To locate the well and 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 distance from rear and rear sides of property lines when possible. Well-lO 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 and Waste Disposal "type of systems" required, 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 fee~ minimum distance from surface waters, streams, lakes, and bays, etc. 7-Cesspools must be 20 feet minimum distance fro~.].arge tree~.~ 8-Cesspool exterior to cesspool exterior must be at leas~ 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. THE NEW YORK BOARD Of FIRE UNDERWRITERS 85 JOHN STREET, NEW YORK, NEW THiS CERTIFIES THAT ' only the eJ~trical equipment ~ ~scrlbed belo~ and intr~uced by t~ appllc~t ~ on the able ap~a t~o~ nu m~r tn the prem~es of, M~. P.G. A!esei, Hiawatha's Path, 259' n/o Nokomis Rd., Southold, Lau~inE ~ters, L~ 1000-78 in~hefollowinglocat~on; ~Basement~ ~tFI. ~2ndFI. ~ .... ~c~ion Bilk ~ outside.~. ~ 18 16 OTHER APPARATUS: 2 Smoke ~Detectors AleseiElec. Corp., 47 Island St., Plainview, L.I. 11803 Lic.127E GTAL~~ Per This certificate must not be altered in any manner;, return to the office of the Board if incorrect. ~nspectors may be identified by ~r~cre~entlals. TOWN OF .~OUTHOLD .,/ .... BUILDING DEPARTMENT ~//~/~'~ TOWN CLERK'S OFFICE :- : >. ..... ......... 7w ~ I~,~ ~:-/ L -n ~ ~- ~- ~'~ - (:'~ ' , ' INSTRUCTIONS ~ a. This application must be completely filled in by typewriter o, in ink a~d submitted Inspector, with 3 set~ of plans, accurate plot plan to ~ale. Fe~ according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detail~ description of layout ofproperty must be drawn on the diagram which is pa~ of this application. c. The work covered by this application may not be commenced before Jssuance 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 ~t jar an~u , ~ Certificate of ~cupancy shall have been granted by the Building lnspector. Q~~ AP~klCATIO~ IS H[RfiBY ~ADE to the Buildin~ Do~~h~uu~e ~ ~u~dm0~it pursuont to the ~uildin0 Zono Ordinonce o~ tho Town of Southold, Suffolk CounW, New York, ond othor opplicoble kows, Ordinonces or Re~ulotions, for tho constru~ion o{ buildings, odditions or olterotion% or {or romovol or domolition, as horoin described. The opplicont ~rees to comply with ~11 opplicob~e lows, ordinonces, buildin~ code, hous~n~ codo, ond re~ulotions, ond to odmit ~uthorhod inspectors on prom[sos ~nd in buildin~ {or n~ess~ inspoctions. PERA Building Group, Inc. (Signature of applicant, or nome, if a corporation) Hobart Road, S~thold (Address of applicant) Statb whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............... G. en.er ~1 .,.Cont r.~c t.or ................................................. . .................... Name of owner of premises ..... ~.~i~.~.fil~...G.,...,~l~,%ci ............................................................................... applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No..~.,~.q~.~,...,~..q.~.~7.,..'~,;~..~.? 0 ~ '~i ~/ Electrician's License No. Other Trade's License No ............................................... 079- 3- 1. Location of land on which proposed work will be done. Map No.: ........................................Lot No ......................... Street and Number ...... ~aw.a~_hi~...Ra.t~ .................................................................................. ~.~.~.9.:J,.c]. ....... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ................................................................................................................................ b:' Intended use and occupancy ..... .~&~gle...£amiLy...~.e~J. de~e ................................................................... 3. N~'ture o~' work (check which applicable): New IBuilding.....~ .......... Addition .................. Alteration .............. Repair .................. Removal .................. Demolitior. .................... Other Work .................................................. ~- (Description) 4. Estimated Cost .........3..3..,.Q.0..0 ...................................... Fee ........................................................................................ (to be paid on filing this application) 5. If dwelling, nu~qber of dwelling units ........ .o...n..e. ............. Nt~'mbcr of dwelling units on each floor - If garage, number of cars ...... 2...c~rs ........................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..... .N..~.. .................. 7. Dimensions of existing structures, if any: Fron~ ........... .-. ............... Rear .......... :Z. .................... Depth ........ .'7. .......... Height ......... .'7 ............. Number of Stories ............... .':' ................................................................................................ Dimensions of same structure with alterations or additions: Front ........ ..N.~-. ...................... Rear ........ .N...~. ................ Depth .......... = .................... Height .......... .-z ................ Number of Stories ..........-z ..................... 8. Dirnensions of entire new construction: Front ........ .5..6..].%.0. ................. Rear ...... 5..6..~..7..0. .......... Depth 28' -0 Height .2.Q.'.m0 .......Number of Stories ....T.W~ .......................................................................................................... 9. Size of lot: Front ........ 12..Q.,.5.~ .................................. Rear ....,1-.:~Q,,.51 ....................... Depth ...... ~,.~kQ ................... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ......... z:f~.£~en.c¢ ..................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................ F~Q .................................... 13. Will lot be regraded ...........n...o. ............. Will excess fill be removed from premises: ( ) Yes (×) No 53-20 196th St. 14. Name of Owner of premises .P.i~.~..q.g, fi~-.~....g.,~...~.,],.~.g.;i, ........ Address ]~.?l,~'.~ii~le ................ Phone No.~..~,,.~:T..~.Q.2.,~.(.$12 ..... Dartmouth Pi. Name of Architect .....H.f~.~S'....A..,...~..!4g.~i~,r.~.~,I3, ............... Address$.ho.~'.ei~.ar~ ............. Phone No. ix!~_~me of Contractor ..?..E.~....B~.u..~.~..$..n.cJ.~..G.~..~..u.R~.....Z.p~g.~AddressH...~..b..a..~.%~....'R..~.'.a..d. ....... Phone No. Southold PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fron~ property lines. Give street and block number or description according to deed, and show street names and indicate whether interior o,~ corner lot. SEE ATTACHED SHEET Sa'AlE OF NEW YORI(, [ ¢ S COUNYY OF .....S..u..~.:E.o. lk ............ ....................... ..~..o...~..e.~.h.....~.~..~.g.i);...e.~..~..$..,...~:K.,....~..,..E.., .......... being duly sworn, deposes and says that he is the applicar, t (Name of individual signing contract) above named. Fie is the .......................... g.gD.~q~.~ ............................................................................................................................... (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 ere true to the best of his knowledge and belief; tha~ the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this ~ ~~~ ............. of ....................... , ............... .... ............................. now or former/y H/'cflor~ DeMorio $.8zo5/,~ liD. OD'- now or formerly NOHOM i.? HO, qD NOT[F: ~ -'/O¢ONU4fEAIT EI. EVIITIONS ARE REFERENCED ~0 AN AS~MED DA TU~ ~ YOUNG & YOUNG FEB 10,1976 ~ 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK J~PA23~/.976 ~ SURVEY FOR: PASQUALE AT SOUTHOLD TOWN o~ $OUTHOLD SLJFFOLK CO., N.Y. SCALE: I" '?' 301 I DATE'. DEC. 17~ 1975 u 1Chief o~ ~ fWchard DeMaria now or formerly N. 87°§1 ~E. I1000' S. 87'51'Vt UNAUTHORIZED ALTERATION OR ADDITION TO THIS 8~RVEY I$ A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EOUCATiON LAW COPIES OF THIS SURVEY MAp NOT aEARING TRE LAND SURVEYOR'S INKEO SEAL OR Boergesson now or rorme,,y AT SOUTHOLD TOWN OF $OUTHOLD SCALE: SUFFOLK CO., N.Y. I" = 30' PASOUALE G. ALESCI & JUDY ALESCI GUARANTEED TO: FIRST AMERICAN TITLE INSURANCE COMPANY OF NEW YORK DEc. '7, oTs GUARANTEES INDICATED HEREON SHALL RUN ONLy TO THE PERSON FOR WHOM THE SURVEY 15 PREPARED~ AND ON H~S BEHALF TO THE TITLE COMPANy, GOVERNMENTAL NOKOMIS D NO FE ~ ! =MONUMENt' ,I_,V4T/ONSARER, F,'E'NCEDYO,N SHOW~ HEREIN AEE FRO~ FIELD OBSE~ 7A~T~ ~SSU~O ~ TU~ ANDIO~ F~OM DATA ORTAINED F~ SEP~ 23/976 ..O~ESSiO.~U ~.~. ~.n kk %~o~v~vo~ /~// , \ :FTY~ C eof ~-~;-d~. "74~ = I ,_ o,, " '"-4- 4." v-/':~ o Itl 013072