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Home My WebLink About10838-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPAi~TMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z17472 Date OCTOBER 31r 1988 THIS CERTIFIES that the buildinq Location of Property. 7405 House No. County Tax Map No. 1000 Section 101 Subdivision POOL Street Block 1 Filed Map No. CUTCHOGUE Hamlet Lot 16.2 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 13, 1980 pursuant to which Building Permit No. 10838Z dated AUGUST 21~ 1980 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ABOVE GROUND SWIMMING POOL. The certificate is issued to DAVID M. & NANCY J. GRIGONIS (owner, of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N498365 PLUMBERS CERTIFICATION DATED N/A Building' Inspector Rev. 1/81 1'0838 Permission is hereby graqted to: (THIS PERMIT MUST BE KEPT ON ~HE PRE~IS~S UNTIL ~ULL COMPLETION OF THE WORK AUTH(~RIZEDi ] '~ at premises located at ......... County Tax Map No. luuO Section..,... '"" 'i' Block ...~,~.~,, ...... .,.., p~rsuant to application~dated ......... ;..:.., 19. BUf ~llng Inspector. ,../.. .................. Rev. 6/30/80 LLot No. 4~.~..~...'...~... .... ~., and approved by the FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall $outhold, N,¥, 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 featu res. 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 Underwr!ters. 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 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 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 Date .......................... New Building ..... .~ ..... Old or Pre-existing Building ............ Vacant Land ............. · .............. Location of Property . -.~.~..~¥~. .... .~.V~'~ .~G/..~ ............. House No, Street ~ Ham/et Owner or Owners of Property ... ' : ...... County Tax Map NO. 1000 Section ... ].~, ! ........ Block ..... l, ......... Lot.,/..~,'..',~ ...... Subdivision ................................. Filed Map No ........... Lot No .............. I~:z~ Date of Permit '~1 ?'1)'~'~'~'Applicant Permit No. ~ ~ 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. ~'0 '~"1~ /-~ L~ '~,~ O Applicant ~.~.~... F~/,.~-~ SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 2. Property Location Lot Number Private Well Village ~~ Township 3. Public Water Company Name ~. Lot size: Width/70 feet Length ~ feet 10. Sewage Disposal System: (For Health Services Dept. Use) A. 900-gallon septic tank: ll. Precast _Equivalent Block~ B. Leaching pools: Number of pools Precast__Block__~pecialI If private well, fill in the fol- lowing blanks: A. Tank capacity. .gallons B.:~ Pump~;~P.M. C~ Total~well depth ,D. Depth to ground water E~ Am~c~t of water in well The, undersigned CERTIFIES: "Construction of authorized installations will be in accordance wi~h the ~olk County Department of Health Services' current standards thereto." This applicatio~will be valid for one year from the date of approval indicated below and may be renewed~i~f 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_~]~e, i~kstalled o~this.~t~t,~l~ S-15 Rev. 4/1/73 APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS INSTRUCTIONS: iApplications must be submitted i~triplicate 1-Means Owner or Builder. iAddress 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-Enter name of Public Water Supply District, together with the distance to their main. 4-Enter Length and Width o,f Lot under appropriate heading; also enter these dimensions on center plot plan shown o'n 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 "~es" if public water supply is available. Enter "No" otherwise. PROPOSED S¥STENS: Answer!to ~tem Number 10, consult the Suffolk County Department of lq-ealth Services' Standards for Sewage and Waste Disposal Systems Design of Residential Subsurface Sewage Disposal, Facilities. Part ~ - Residential Subsurface Disposal Systems Covering Cesspools. WELL LOCATION: To locatelthe well and sewage disposal systems on applicant's lot, the ~-o'llowing standards must ~e observed: Well-lO0 feet minimum distance from the ~earest 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" ~equi~ed, 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 mu§t be 75 feet from nearest well. 4,-Cesspool exterior must be 7 feet minimum distance from nearest water line. 5-Cesspool exterior must be l0 feet from house foundation. 6-Cesspool exterior must 5e 100 feet minimum distance from surface waters, streams, lak6s, and bays, etc. ' 7rCes~pools must be 20 feet minimum distance from large trees. 8-Cesspool exterior to cesspool exterior must be at least 8 feet. 9-Cesspool cover top to Wade must be held to minimum of 1 foot to maximum of 2 feet. 10-Bottom of cesspool to 'round water must be held to minimum of 2 feet. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRIC!TY~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT ordy the electrical equiprne~t as described below and introduced by the applicant ~trned or~ the above application number in the premises of David I~L G~igc~is, 7405 Alvah'~ Lmm, Cm:~, N. Y. 101 O1 016-2 in the followl,.g loca£1on; [] Basement [] l~t FI [] 2nd FI. Ot~tmld~ Section Block LOT was examined on C~Eo~d~? 27 ~ 19~0 and found to be tn compliatwe with the requirements of this Board. FIXTURE FIXTURES RANGES OVENS EXHAUST FANS DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS iPECIAL REC'I TIMECLOCKS UNIT HEATERS MULTI-OUTLET SYSTEMS NO OF FEET DIMMERS SERVICE DISCONNECT S E R ~V I NO OF CC COND A W G NO OF HI LEG PER ~' OF CC CONO ($ P '£ s' ~: f to t~m fr~l~C test md/or rep~ C E A W G NO OF NEUTRALS A W G OF HI LEG OF NEUTRAL David & Nmmy ~rigo~li~ This certificate must not be altered ~n any manner, return to the office of the Board ~f incorrect. Inspectors may be ~denhfled b~ ~O~y ~OR ~UI~DING DEPARTMENT. THIS COPy DE KE~TIF~¢~T~' T ~97~BE~LTEREu~ IN ANY FIELD INSPECTION FOUNDATION (Jst ROUGH F~E & ,. PL~BiNG INS~ATION P~ N.Y. STATE E~GY , CODE FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c - ----=~ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 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, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. 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 purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector APPLICATION IS HEREBY MADE 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 agnes 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. .. .&. ' (Signature of appliffant, or name, if a corporation) ...... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .%.0. g'~ .~...fS~O...Q~.~...~.%...~.*.'..~.~.'(h '..% ............... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's L~cense No ....... .(fl..V3..~i'?-ff..~. ....... Plumber's License No ....................... Electrician's License No...zk~,f~...' ........... Other Trade s License No ..................... Location of land on which proposed work will be done.'~.~.O.~...~.L.~..~.~.~ .~..~.: ~ .~9...~..~..k~.~..~.~.OZ .~.q..-~ .~..~ / House Nmnber Street Hamlet County Tax Map No. 1000 Section .... /.~./. ......... Block .... .O./. ........... Lot....~. (fi.; ~.Z~. ....... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . ~).~."..Q..(~..e:...~..o..o_..L.L. '.,~.\c~ ............................................ b. Intended use and occupancy . .~.~.'? .%. ~...~. O..~.~...,43. ~...o.~.: .~...o~..o. ??~.~.~......~..o.o. ~.. ............... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Remo~al~ .............. Demolition .............. Other Work .'~.o. ? , ~, , (Description) 4. Estimated Cost 3~.~o o, Fee l .~...o..~ (to be paid on filing this application) 5. If dwelling, number of dwelling ~'nits ............... Number of dwelling units on each floor ................ If garage number of cars ' 6. If business, commercial or mixedloccupancy, 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 wifh alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height"~ ............... Number of Stories ............... 9. 9. Size of lot: Front ... I i .......... Rear...[.~. ............ Depth .~? o...o o .............. 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 lei be regraded ...o.~, ...................... Will excess fill be removed from premises: q.~.~Y._e.~.~./..-. Name of Owner of premises ... t ................ Address ................... Phone No.. .ff. Name of Architect ' Address Phone No Name of Contractor ......... ; ................ Address ................... Phone No ................ 10. 11. 12. 13. 14. 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 gumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF....(.) ...-v. ~r~,. above named. .... being duly sworn, deposes and says that he is the applicant He is the ................ 0 '~F": .............................................................. (Contractor, agent, corporate officer, etc.) of saki 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. Sworn to before me this ............ ..... day ...... ' Notary Public, ................. :...~.~./'p. County . ~ ' ~1~ ~N N[VlLLE ~r ' ,/(Signature et' appiic~t) I N~TARY PUBliC,State of New York N0 52-81'25~50. ; ierm Expires garc~19~