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Home My WebLink About8188-zNO. 4 TOWN OF SOUTHOLD BI..m'.nl~G DEPAR~ Town Clerk's Office $outhold, lq. Y. Certificate Of Occupancy No..Z.c.::)~.9..~ ..... Date ....Ap.r%.~....9. ............... , 19.7.9.. THIS CERTIFIES that the buildfn~ located at ....'[.~..D..o~..o.o..d...I~l...e ...... Street Map No ............. Block No ...........Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in tM~ o~ice dated .. Sep~:~-~nber...c) ..... , 19. ?~. pursuant to which Bui]dfn~ Permit No..~.~.8.8.Z.. dated ...Sep2mmber...9 ......, 197~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is Private One Family Dwelling The certificate is issued to Wal%er T. Hulse (owner, of the aforesaid building. Suffolk County Department of Health Approval 5-S0-118 March 19, 17~. ?. ........ ROber~c 'A;' V~lla' ...... UNDERV~RITERS CERTIFICATE No ......... N~$~95.7. ........................... HOUSE NUMBER ~5 Street Dogwood Lane Sou,:hold, New York ....... Building Inspector County Tax Ila~ Number 1000-5~-5-25 TO~ OF SOfT,OLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8188 z Permission is hereby granted to: ...... ;.~:L~e~..l~,u3..~,~ ................................................ .............................. ~.~(~.~...1~ ..................... ........................................ ~ o~k.v.i ~.ie...C ~.]n ~ z~.. to ...~.!~lJ...n~-.~,z...or~...l~m~Ll~:..d~eZlXng ................................................................................... at premises located at ..~'~..(~..~O~,.~d..~ ....................................................................................... ............................................................... ~.¢b,o~..... l¢, .~., ................................. pursuant to application dated ................................ ,a~;~.j:,......c) ....... , 19.~..~.., and approved by the Building Inspector. Fee $..~ ,,.~0 ........... Building Inspector ~ SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Service~c~. Reference Number APPLICATION FOR APPROVAL TO CONSTR~CT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY · 5. Subdiv. Address i)~:~ ~,~r? z~y~h,~ Property Location Pe~:~u~ ~ ,~,~ r~zz./~ 6. Section F]~:~xx~K'~ ~ /qx~/; ~'~?¥~z~ 7. Lot Number :::~ - ~ ' 8. Private Well~ 3. Public ~mpany ~me 4. Lot size Width ~z~'~eet 10. Sewage Disposal System:· Township ,~#~.J9 9. Public Water Distance to main Length~f~'et' (For Health Services Dept. Use.) A. 900-gallon septic tank: · ll. Precast .Equivalent Block Number of ~dols -~ ~ ~ '/.Specia'l Prec~st//~ Block If'~ivate~well, fill in the fol- low~ng blQ.~ks: ~i:Tank ~acity gallons B'. Pump,~P.M.. Total well depth D. De,'th 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 Services' 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. 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 on this plot. SIGNED APPROVAL DATE' S-15 Rev. 4/1/73 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. 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 D ate . ~?...~f~..'.4.'../,~. ?,, .~ ........ New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ../..~5..: , '.J/9,~.~/,/~. ~.~.~...Z.....~...~..~ .......................................... House No. Street Hamlet Owner or Owners of Property . .~,~. ~.~.~,"=./~....7~.,., ./~..U.L,,.%.~...~...DJ..1./~'.-:(~~' ......................... County Tax Map No, 1000 Section /. ~.//.f(! .......... Block ... ?..L-. ........ Lot...~I.5-. .......... Subdivision ................................. Map No ............... Lot No ............... Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $, Construction on above described building and permit meets all applicable codes and regulations. Applicant .......... ~.~..~ ......................... ERS Pster P~o~o r ri ,_. ~aain ~d. ' -: ~ Southotd, L.I. 1~971 Lio. 137E GENERAL This certificate must not be altered in any manner; return to the office of the Board if incorrect, Inspectors may be ~dentlfied-by t~eir '~r~de'~tiois DEPARTMENT' OF ttEALTII SERVICES ~ recent check of our files indicates that this off~ce has never issued a final approval for the above referenced job. ' Please be advised that it is illegal to occupy the building until the f~l- )owing paperwork is submitted to this office and/or the following inspec- tion(s) are completed: ..?ell Drillers Certificate :..-: ;. :.:' . ~Uater Anal5 ' ~Other Should you have any questions, please feel free to contact this office. Very truly yours, lown Duilding Department P~TO~ H2M CORFo / Environmental EDgineers & Scientists 500 BROAD HOLLOW ROAD, MELVILLE, NEW YORK, Il746 (SIG) MY4-3043 [,Ali. NO. FIELD TIME COL. BY CLIENT'S NAME AND ADDRESS HARRY GOL[',lViA N 235 ROUTE 58 R}'VERHEAD,~ NY 11901 DISTRIBLITION WELL OTHER (SPECIFY) POINT OR .__,~EC. CODE IDATE 3 WELL NO. ~ ,: 071.75 TEST RESULT J TEST APC~ml Nitrates (mg/I N) MPN/100ml Demand (mo/I) .~_C~.lor (units) Chlorides (mo/I) t Turbidity (units) DATES: COLLECTED RECEIVED 07115/78 07/I~/7~ ANALYSIS PREMISES OF SAMPLING POINT HULSE N/S DOGWOCD LN ~ST , HSE E/O KENNY RD POINT OF COLLECTION; ROUTINE RE-SAMPi~E Alkal;nity (mg/I C¢C03) MISCELLANEOUS __~. Test Code Rc~uh / dot: cold Copper (rog/It Sdlfate {fT!g/J SO4) Acidity (mg/I CaC03) Sodium {rag/I) Magnesium COPI ES TO: 'HEMARKS: J4ATTZTUCK P & H, SOUTHOLD ,-%f~TTSFACTORY-' SA~PL£ NEETs + U.S~, DRINKING WATER STDS. INSTEU~I~ a. This application must be completely fil!ed in by .tyi~_wrtter o~.. in ink a. nd. ?bmitted in triplicate to the Building Inspector, with 3 esle of plans, Qocurate plc~ plan to male. P# aocoraing to scaeau,e. b. Plat plan showing' [ocatio~ of lot and of buil.~ngs on premi.ses,.relationsh, ip t,o. Qd]oini .rig .p~rn. is~. or...1~, llc ~.me~.. m areas, and giving Q detailed description of layout otpraperty must be drawn on the alagram wmcn is pa~ at mm (q~)llCatlOn. c. The work covered by this application may nat be commenced before issuance of Building Permit. d. Upon ~1 of this application, the Building Inapector will issue a Building Permit to the applicant. Such permit shall be kept on premises available for inspection throughout the work. e. No I~li .Idt~g,ahqll be occupied or used in whole or in part for any purpose whatever until a Certif!cale of Occupancy shall have .i~l.$i/~j~l~nled by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Pe .r~Jt pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New .York, and ..other applicable La?, ~ o.r Regulatlom, for the comtructlon of buildings, additions or alterations, o.r mr re .mov?l o~i clemel, itlan, .as The applicant agrees to comply with all applicable laws, ordinances, building ccae, nous ng coae, aha regu , admit authorized inspectors on premises and In buildings for necessary inspections. ..... ......... ..................................... (Signature of applicant, or name, If a coITx)ratlon) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ...l//A;~+~e~'...~,~,~.~ .................................................................................................................... I If applicant is a corporate, signature of duly authorized off~r.~J~ (Name and title of corporate officer) Builder's License No. ~ Plumber's License No. ? Electrician's License No ............................................. Other Trade's License No ................ Location of land on which proposed work will be clone. Map No~:;.....[:...~v .......................... Lot No ......................... ....... N/S Do~wood Lane Southo-~ x~.~. . ..... State existing use and occupancy of premises and intended use and occupancy of proposed construction: vacant o. Exlsiting use and occupancy ................................................................................................................................. one family dwelling b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building· ...~ ....... Addition .................. Alteration : ............... Repair .................. Removal ................. "Demolition .................... Other Work ................................................. (Description) ... ' .. + . ..................... · 4. Estimated Cost ........................................... F .......................................... : (to b~e paid on filing this application) .: ? 5. If d~ai~g,'~umber of dwelling units ....... ~ .............. Number of d~l~pg units ........................ If garage, number of cars ................ .,.~...'-~;~,..~.,~, ............... ~ ........ .~.:~ ................... 7' ......... 'ti .............................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of e~i~4~astructures, if a~t~ot ....... .... ---~..~__...~, ...,..~ -~ ..... ~ .... /--~.~,;.~ ................ Height ........................ Number of Storie~; .................................. 4........-- ............... ~.~ ...........~ ............. Dimensions of same structure with alterati~ns or a~'~~ .................................... Rear ............................ Depth ................................ Height ....~. ~.~ ber'~ $'~ries ................................ · B. D mens o of e,,re ........... .................... Reor ..... .................. ..... · Height. ................... Number of Stories:.~....~31~ ................................................... i-'~ 9. Size of lot: Front ....... ~2~ .......................................... Rear .......... .~L~.,.~. ...................... Depth ~ 10~ Date of Purchase ........................................................ Name of Former Owner ....................................................... ~ 1 1. Zone or use district in which premises are situated . .~,~."...~,S.~ ................................................... : t2. Does proposed construction violate any zoning law, ordinance or regulation: ................................................. "~ 13. Will lot be regraded ...... ~'J~ .............. Will excess fill be removed from premises: ( ) Yes ( · No ~';14. Name of Owner of premises11~n3 ~I:..J~I.1.'L-~IL ....................... Axklress ..~0.(~1~.~] _'l_~_..~.t~]3~hone No. ................. ~ ... :~ Name of Architect .............................................................. Address ................................ .Phone No. ...................... ~ Name of Contractor. ......... ~l~t~ ......................................... Address ................................ Phone No ....................... PLOT DIAGRAM ~ ' Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat-bacl~.~inonsions from "p~Ofeet~er~r '!nes. Give street and block number or description according tO deed, and show street nan~ and indicate ii w erner interior or corner ,ot. STATE OF NEW YORK, [ c c COUNTY OF ....... S~Aff. oZ~ ........ ~'~'~ ............................... ~a~L~,~..,~l~,~. ..................................... being duly sworn; d~es and says t~t he is the ~plicam (Name of i~ividual s~ni~ c~tm~ a~e ~m~. He is the ~er - builder (Contractor, agar, co~ra~ officer, ~c.) of ~id ~ner or ow~rs, and is ~ly aut~riz~ ~ ~rform or h~e perfo~d the ~ work and to ~ke and file · is a~i~; ~ot all st~em~ c~tain~ in this applicotlon are tree to t~ be~ of his kn~l~ge and ~llef; and that ~'~ will ~ perform~ in ~e 'manner ~t fo~h in the application fil~ ther~ith. ~S~m to ~ ~ ~is "'N~a-- ................. --,ie~:'" ............ ~y of ................... "~fo~'~ ............... , ~,,,' 1~.~.~. V.~~~.~. ELIZAB~H ANN N~I~E NOT~ ~8iIC, ~ of N~ Y~k No. 52-812~5n. Sd~m ~ FDTO~,~.I ( f ?xow~g /'0/£A '. ?,; ~7-0 / ~ II 7- /o ' .3¢.0 ..,-- Ot'TIoNA I 4" &/,vt:. 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