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Home My WebLink About9455-zFORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z9/,11 Date .J~lap,.a~r.. ~9. 19.7.9. (Emerson) THIS CERTIFIES that the building located at . 17~5. P~.t.. Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated . September '1/4 , 19.(.. pursuant to which Building Permit No. 9/'~55Z dated . .$ep. temhe.~...~./~. ..... , 19.'[?., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... P~.ivat.c; .time..Faml2Ly. Dwelling ............................... The certificate is issued to ........ Ruth .Ememson. ~ooke ........................... (owner, of the aforesaid building. Suffolk County Department of Health Approval ....7.-.S.0.-. ~l~.O. .... ~ .a~?:l.a?.~...2.2.,.. UNDERWRITERS CERTIFICATE No. N /4~2~8~ & N4'1/+990 HOUSE NUMBER ...~.7.8.5 ....... Street ...... .Ff.t:..R. ?.a.d..~...~.~.. (.~.e.r.s. ?.n.). ....... Southold, New York Building Inspector County Tax Number JO00-86-5-Part of 3 N:, Y. BUi'LDiNG ~ERMIT (THIS PERMIT MUST BE'KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9455 Z Date .......................... ~,p.t......$~ ........... , 19.....7.7 Permission is hereby granted to: ..... i~,.~.~..~..]~te.~ s~n..~:~ke ................................ ............... S~u~hold .............................................. to .hu~._'l d...~e.w...o~e... Y.a ra~ ly... r~l~;[ng ..................................................................................... at premises located at ~'~,.~ '~ou'th' ~{~rb~r Ro~d .......................................... ,~omt~o'~ ~ .¥ · pursuant to application dated .......... .~e.l~.~..-...~l+ ....... 19.~.~.., and approved by the Building Inspector. Fee $. ~0.o.~.~. .......... TOWN OF SOUTHOLD Building Delta,imam Town C:ledm Office Southold, N. Y. 11971 APPLIC:ATION FOR CERTIFICATE OF OCCUPANC'Y~ Instructions A. 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: i. 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 installatlon from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple~ Residences and similar buildings and installations, a certificate of Cede 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 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 3. Copy of certificate of occupancy $1.00 Date Jan. c.f~ 1979 X New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ location Of Property Rl~-ht of way off west side South Harbor Ro~d, South~ld Owner Or ~ners Of Pro~ ....................................................................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. 9455 Z ..... 9/14/'77 Ruth ~!~.~r~or~ Cool,~e Permit No .......... i .......... uare uT ~'ermit .................... Applicant .................................................................. jan. 22 '79 n r Heo~th Dept. Approva~ ......~T~4~jgu ....................... ~bor Dept. Apprava~ ................................................ Underwriters Approval ........ ~..l..~:.1..~.1. ........................ Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate X Fee Submitted $ 5. O0 Construction on above described building and permit meets all applicable codes and regulations. Applicant ....] ...... ~,~.~ ................................................. Sworn to before me this ..... ............ Notary Public .................................... County (stamp or seal) THE NEW YORK BOARD OF FIRE UNDERWRITERS ~= BUREAU OF ELECTRICn'Y ~ December 19,19'~ JOHN STREET, NEW YORK, NEW YORK 10038 THI~ CE~IFIES THAT in the f~l~ing ~ot~n; ~ B~nt ~ Ist FI, ~ 2~ Fl. ~t~n B~k DRYERS FURNACE MOTORS FUTURE AII'fqJANCE lIB)ERS AMT. K.W. OIL H.P. GA~ H,P. AMT, NO, A, W. G. IOTHER APPARATUS: ,',~oto~/s: ~-~ Thermal Comfort Inc. 25A CarlouEh Rd. ~ohe~ia, L.I. 11716 EAN~RS siqaAL REC'PT TIMECLOCKS IL%L IUNITfllATEIIS MULTI-OUTI.q ~,. ,,,,,. ,,~.s.l,,~l ,.,.'------- ~.Y~,~, V I C E CC. COND. NO, OF HI-I~G Llc.903-R EXHAUST FANS AMT. I H.P. DIMMERS This certificate must not be altered in any manner;, return to the office of the Board if incorrect, Inspectors may be identified by th~rmedentials. CQPY FOR BUILDING DIP~. THIS ~Y OF CERTIFICATE MUST.NOT ~ AL ~TI~iID~IN~MANN_~. ..... THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK, NEW YORK 10039 THIS CE~IFIES THAT [] 2nd FI. Section Bilk and found co be in compllan~e with the requirements of thi~ ~oard. FIXTURE /EC~I~A LESI IT I EXTURBS DRYERS FURNACE MOTORS FUTURE AF~IANC! AMT, K,W, O~L H*P. GAS H.P* A~T, NO. RANGEs MT. K.W. 1 Lot DECKS ] OVENS DISH WASHBIS K.W. ~/*T. K.W, WT. K.W. TIMEC~OCK$ BELL UNITHEATI~S MULTI'OUTleT .,AtN'S.,O TEAN$,.~H.p. ~ EXHAUST FANS 7 ~0o SERVK~ INSCONNKT NO. OF I S AMT. A/~P. TYPE. ~QU~P. 1.~'2W ]~'3W 3,ff3W 3~,W 1 150 C~ x ].-G.F.I. P-.%moke Detectors 1-~]. ~K~I hot wate~ heater R V I C E 1/0 l~obe~t O' Brlen 2] North Ooean Ave. Center :~orlehe.~,L.I. SU F'FOLK COUNTY DEPARTMENT OF HEALTH SERVICES David Harris, M.D., Commi s si oner August 25, 1977 Mrs. Ruth Cooke Box 73 Southold, New York 11971 Dear Mrs. Cooke: Re: Application to Substitute Tile Fields for a Conventional Sewage Disposal System by the Installation of a Clivus Mul.trum Organic Waste Treatment System, w/s South Harbor Road, Southold, Town of Southold At the hearing held on July 19, 197~,.in the office of the Suffolk County Department of Health Services, H. Lee Dennison Executive Office Building, Veterans Memorial Highway, Hauppauge, New York, you had an opportunity to present yQur appeal of the department's ruling on the subject application. In accordance with the provisi, ons of subdi.vision (c), Section 7, Article I of the Suffolk County Sanitary Code, the determination of the Board of Review is as follows: Based on the information submitted, that the applicant is permitted to install a 600 gallon septic tank and tile field installation in accordance with the requirements of the General Engineering Unit, since ~t has been determined that there will be an estimated 40% reduction in water usage by the installation of a Clivus Multrum organic waste treatment system. .. Since the determination of the Board of Review submitted to the Commissioner's office on August 18, 1977, has not been reversed or modified by him, it is therefore deemed to be the determination of the Commissioner. Very truly yours, H.W. Davids, P,E, Chief Bureau of Environmental Heal th HWD/gph cc /Board of Review File ~Robert A. Villa, P.E. ~Southold Town Building Department ~r~ ........................................ , 19..~. Pe~it No ........ ~.....~..~= - ~'=' ~ ~,~' / ~ ......................................................................... ........ - '"-': ................ ~te ............ [.....~,,,, ~..,., 19..~.....~ b. ~lot plan ~in~ I~fion of lot ond o{ buildin~ on pr~mi~, mlotion~hip ~o ~°inin~ pmmi~ or pub ~ ~m~ o~ ~ d. H~n ~pp~ol o{ ~i~ ~pplic~tion, ~ 8uildin~ Im~tor will i~*u~ ~ Buil~n~ ~rmit ~o th~ opplicont Such p~rmit e. mo ,m~m~ ~n~ll be ~cup~ or u~d m ~hol~ or in pa~ {or ~n~ pu~se ~v~r until ~ ~i{i~ o{ ~u~ sholl haw ~n ~mnt~d ~ ~h~ Bulldin~ In~cIor. ~ A~PLIC~TIO~ I$ ~fiRBY ~Dfi to th~ 8uildino D~pa~ment ~or th* i~u~nc~ o{ ~ Bui~din~ ~it pu~uont to tho ~ 8uildinO Zon~ O~i~ne~ o{ th~ To~ o{ ~thold, Suffolk Count, ~ York, and ~*r ~plic~l~ ~, O~in~nc~ or [ R~ul~fion~, for th* c~*tm~ion o{ buildino~, ~lti~ or ~lt~mtion~, or {or m~l' or ~lifi~, ~ h~min d~cri~. ........ ....................... .... - Southold N.Y. J (Add,ss of applicant) ~ State whether a~licant is ~ner, les~e, agent, amhJtect, engineer, general c~tmctor, el~trician, plumber or buJlder~ ~e~ Name of owner of premiss ..~.~a~..~g~ ................................................ If applicant is a co~orate, signature of duly au~oriz~ officer. (Name and title of corporate officer) ...... .~..t. onel Silveraan atchos=e Builder's License No .......................................... ,O 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.: .............~ ....................... Lot No ............. ~ ........ Street and Number I~ South Harbor Road Southold N.Y. Municipality 2. State existing use and occupancy of premises and intended use and OCcupancy of proposed construction: a. Exisiting use and OCcupancy ....... .~.&~.~,~.~...~,,9..1;;. ................................................................................................. b. Intended use and OCcupancy .......... O~l~...~.~l,~...~,Ife~[~,;~. ........................................................................ 3. Nature of work (check which ~l~pJ[cable): New Building' ....~.. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................ . (Description) 4. Estimated Cost ..................... ~.(~)g~t,+ ........................ Fee ...~0.~.~. ........................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... O%1~ .............. Number of dwelling units on each floor ............................ If garage, number of cars ..... O~I.Q ....................................................................................... . ......................................... 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 ..~,~.-..br. ........................ Rear ..... ~._..lf. ............. Depth .....l+3~.B .......... Height .................... Number of Stories ..~ ................................................................................................................ 9. Size of lot: Front .-3.~0 .............................................. Rear ........ ~..8..~...".~..i ..................... Depth ...~.8...0...~'...1..~.~..+. ........ 10.' Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..".A~...dJ.s.~ ................................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ............ %1~ ....................................... 13. Will lot be regraded . ......~'.~.~ .............. Will excess fill be removed from premises: ( ) Yes (st) No 14. Name of Owner of premises JJ~l,~J:l,..g.QO~,JJ ............................ Address ...J~.9.~,.t~.JP, g],~J .......... Phone No ....................... Name of Architect ...(~J'~l.S...fD,~e~teZ'~[ ............................ Address ................................ Phone No ....................... Name of Contractor ..~..i...~..v..~...r.~ ...................................... Address .......~..a..~...~..h....o.~....~. ..... Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly oil 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. See filed plans STATE OF NEW YORK, COUNTY OF ..... ~£f. QZI~ .......... ......... j ........... ~tlt;~..~[~,~.~.O~l..(~.O~.~t ................................ being duly sworn, deposes and says that he is the applicam (Name of individual ~i~ing contract] above named. He is the .......... 9~.~ ............................................... {Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform ar 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 thor the work wiil be performed in the manner set fo~h in the application filed therewith. Sworn to before me this ARY E DAW~N Y ~. 52-4~3721, Suffolk COup~ ' Term Expires ~rch T~-~ ,/~ 'i b.od~ ~bOp( .,& ~,., ,¢0 -? {t I i I~ I I I[ lL;ll 1 I~[ l +4 ................. + I : i/ / , I r