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HomeMy WebLinkAbout20215-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. ' CERTIFICATE OF OCCUPANCY No Z-20838 Date JULY 6, 1992 THIS CERTIFIES that the building ONE-FAMILY DWELLING Location of Property 1590 CUSTER AVENUE SOUTHOLD NY House No. Street Hamlet County Tax Map No. 1000 Section 70 Block 9 Lot 41 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 16, 1991 pursuant to which Building Permit No. 20215-Z dated OCTOBER 21, 1991 was issued, and conforms to all o€ the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ONE-FAMILY DWELLING WITH ATTACHED GARAGE & DECK AS APPLIED FOR. The certificate is issued to HELEN JURJEVIC (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 91-SO-28 JULY 1, 1992 UNDERWRITERS CERTIFICATE NO. N 235148 MAY 13 1992 PLUMBERS CERTIFICATION DATED JULY 1 1992 , ~'?~l~Tt, uilding Inspector Rev. 1/81 FORM NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No 2 0 21 5 Z Date ...Q..C~:.r:~-..... ~9.q.1. Permission is hereby granted to: :......o;~;t;~: o1u .......mss...-~.~,~i~..~.....q. ~ ''jj''-~~ _ gyp. ~~e:~..~1..~ of premises located at ~ S.9 ~ ~ ~1....N........~1+ a.!N:G County Tax Map No. 1000 Section .....07 Block Lot No. ~ ~ pursuant to application dated ...5~..~.'1 ......................~..~D................, 19.~. and approved by the Building lgqnspector. Fee 5...`r...l. A. wilding Inspector Rev. 6/30/80 FORM NO, 6 D ~ ~ ~ Q TOWN OF SOUTHOLD yy~ Building Department Town Hall Southold, N.Y. 11971 BLDG.DEP7 765 - 1802 TOWN OF SOU7HOLD APPLICATION FOR CERTIFICATE OF OCCUPAN Instructions A. This application must be filled in typewriter OR ink, and submitted ~ er.e~ to the Building Inspec- torwith the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unuwal 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, acertificate 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 alt 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. C. Fees: Additions $25.00 POOLS $25.00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling $25.00, Accessory 10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $100.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4. Vacant Land C.O. $ 20.00 5.Uodated C.O. $ 50.00 pate NewConstruction_,~„Old or Pre-(ex~ist~i_n~g'~Bu~ilding^ _ VacantLand~(~ l.~ Location of Property . ~ ~ .9.d - , , , , , }'r ; ; ; .~.r~!~ . ~j?,~-~-r:-d~l.~~. / House No. Street Hamlet o Owner or Owners of Property County Tax Map No. 1000 Section Block , Lot . Subdivision . , , , , , , , , , , , ,Filed Map No. ..........Lot No. , Permit No.~,G(~, ~ .SZ Date of Permit 1 ~~Z,!! ~~'qpp licant ,-~,h.~S . , , - . Health Dept. Approval ...4P,~?r , , , , , - , „ , , ,Labor Dept, Approval . . . . . . . . . . . Underwriters Approval ,7,$,'~z7,1 ,~j,/~~/ ,planning Board Approval . Request for Temporary Certificate .....................Final Certificate . Fee Submitted $ , { W , , , _ . Construction on above described building and permit meets all applicable codes and regulations. Applicant . ~ ...YC`/~C,y~1.~IS~a.~ . pev. 10-10-78 . THE NEW YORK BOARD OF FIRE UNDERWRITERS >•A~~ $~(tj 1~}'J} BUREAU OF ELECTF2ICITY 85 JOHN STREET. NEW YORK, NEW YORK 10038 g Dace NAY 14,:1492 Application No. onftla 7`.}12'?791191 N 235148 3 THIS CEiRTIFIES THAT ' only the electrical equipment as described below and introduced by the applicant named on the obove application number in the premises of tl~r.,cr1 aaea~,v~rc, cotta=~~ nva?, a~~ rl~~,~~ LoufiT teor.>hr2} r s~uTxoi;o, N.Y. in thefollawing 4wationr 0 Basement ® 1st Fl. ? 2nd Fi. GA1t/}?~j^1'Sf./UDT •Sertion Block Lol , was examined on PfFIY d?l r 1.9 ~ ~ and found to 6e in comp/iance a/th the rvquirernentr of this Board. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS ECEPTACLES 5'N{iCHES OUTLETS INCANDESCENT FIUOREECENt DTHEn pMi, K W. AMT. K. W qMT. K.W. Ami. K. W AMT. H P I_ DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME ClOCNS BELL UNIT HEATERS MULTI.OUTLET DIMMERS 4$ AMT, K. W. Oll H. P GAS H. P PMT. NO A W G AMi AM9. AMT. AMPS. TRANS. AMT. H. P. SYSTEMS AMT WAiiS NO. OF FEET it N 1. - - 2 1 e SERVICE DISCONNECT No. of S E R V 1 C E AMi. AMP. TYPE ~Ulp I A 4W 19 JW 3 N ~W 3 % 4W NO.OpER A'C~D OF CC COND. NO. Of HLIEG OF H LEG NO. OF NEUTRALS OF EUTIiAI 2 2t1F1 C1s 1 ~ k 21~+ 2 2/~1 i .i OTHER APPARATUS: I E HOTUR51t-3 }4.1',,1.-M" Ii, P. ,1-~ H,1?, G.1r,C.,Cn~-'l SMURC Dk7TEC1'UEiI-1 (ti & 9 L'CINTRACTOR LIC,#578-k~ G!/~~ pax 21'~ SU6TS(6F D r NY. t 11,971 GENERAL MANAGER ' 11 Per ~'S ~I This certificate must not be altered in any manner; return to the office of the Board if incorrect, Inspectors may be identified by their credentials. 4 COPY fOR RWLD{N6 DEPARTMENT. THIS COPY OF CERTIfiCA1`F~"MU~T NaT BE ALTERED INANY~MANNER.' ~ a c~~FF~[r~,C TEL.7G5-1802 o~o,~. , o~~ To~rr or sou~~oa.~a , . ' . T 1. OFFICE OF BUILDIPIG INSPECTOR Ems: ~~'?,r P.O. BOX 728 *r TOWN HALL ~~j, ~ ~ SOUTHULD, N.Y. ] 1971 ~9Q1 ~ yb C E R T I F I C A T I O N . Date Building Permit No. o`ZC/~~lS Z Owner _~~LC--~?'~~r47'e'd~C- (plefase print) Plumber o, Lam` P ' o+~} ~ ~r~. (please rant I certify that the solder used in the water supply system contains less than 2/10 of 1~ lead. _ (plumber_~~mature? Sworn to befcr~ me this /%~~daY of % ~ . 19 ~ , ~ aR-~-~~`--' Notary lic Notary Public, t~G//~~r/G~County EOflii F JACK~N lktYp tab. ~bQ New Ycdk Gwlfod b SufWtlc CounP Tam Expkes Feb, tA, d~f 765-1802 BUILDING DEPT. 1 NSPECTIC?N [ ]FOUNDATION i5T [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ FINAL REMARKS: rt ~ 11~M / SC ~ to " ~ ~ l0, JAS`' ' DATE ~ ~ INSPECTOR ~~~-~s 765.1802 BUILDING DEPT. 1 NSPECTION [ FOUNDATION 1ST [ ROUGH PLBG. ' [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL C~ RE~ S: i ~ I k i i i ~i I \ DATE INSPECTOR ii~ 765-1802 BUILDING DEPT. 1 NSPECTION ] "FOUNDATION 1ST [ ,J, ROUGH PLBG. FOUNDATION 2ND [ ]INSULATION _ [ ]FRAMING [ J FINAL " REMARKS: r "DATE f ~ INSPECTOR ~S_" T65-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION iST [ y~tOUGH PLBG. [ } FOUNDATION 2ND [ ]INSULATION [,~MfNG [)FINAL t REMARKS: ~~r`°`-~v C s~~ DATE ~ INSPECTOR t/ T65-1802 BUILDING DEPT. 1 NSPECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ INSULATION [ ]FRAMING [ ]FINAL REMARKS: ~~~,.~n-t --____~.'~1~. _ DATE / / ~ ~i~ INSPECTOR ass-iso2 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ] fNSULATiON [ ]FRAMING [ ] FINAL REMARKS: ~ ~ ==<~~iGl'7^~ i DATE INSPECTOR i f ENERGY CODE REVIEW (non-slsctris) j X814 (part,$~ 6,000 ds~rreed/aye/ Torte/h %__~.J e r/! o~ per Dw,sy 1~ehn5 L.~, 4.- i 1.~.~'/' V4 1 ~ Dated p Envalone Component R-Value Exterior Wall R-18 Aoof~Ce111n~ R-19 Floor R_19 , Foundation Wall R-10 Slah Edna Insulation A-10 Clazln~ ;G 3• A-1.~ Entrance Doors R-2.5 All HVAC Equlpnsnt to nest rsquirsnsnts of yfl14.11 All HVAC Control Rys~~ns to nest rsquirsnsnts of y814,12 All 8uat Oystsns to nest rsquirsnsnts of ~A14,13 All Vsntllatlnr Systsns to nest rsquirsnsnts of ?x14.14 All PSp1nK Insulation to nest rsquirsnsnts of X814,1$ All Servlcs Water Hsatigq Syatsns and Equipment to nest rsquirsnsnts of X814,21 All ectrle Systsns to neat rsa~irsnents of gA14,31 To the beat of ny knoKlsdgs, belief, and professional . ,1udeKsnent, them plans are in comt~liance Hlth the ands ~EO~ r:~wr ~~'P `~at. T`pq,~ > T t C R'W ~ i w s~,' ati i~~ 63 frf-1 p9~fESS10w* ~ ~3 n~ ENERGY CODE REVIEW (non-electrls) 7814 (Part 9~ 6,000 de~rreedays For~~n fv 4 e, r/1 ~ Psr Dx fs ;3np, ~ ~ l33" `G v y Dated Te , _ _ .._.4' ll'ev 1 i-~ 1 l _ Envalone Component A-Values ` Exterior Wall R-18 Roof~Ce]11n~ M1 R-19 Floor R-19 Foundation Wall R-10 Slab Edxe Insulation R-10 - - Clazin~r . ~ - - -R=1.7 - - - Entrance Doors R-2.5 All HYAC Equipnent to naet requlrenents of 7814.11 All HVAC Control iCystYns to neat requlrenents of 7814.12 All 8uat ~yatens to neat requlrenents of 7814,13 All Ventilating Systens 'to neat requlrenents of 7$14.14 All PipinK Insulation to naet requirenanis of 7814.19 All Servlr.• Water Heatln~ Systens and Equipnent to naet requlrenents of 7814.21 All ectrle Systens to neat rea~lrsnents of 7814.31 To the beat of ny knoxlsdge, belief, and professional , ,iudaenent, these plans are in aomnlianee xlth the aode ,t~ pf tJEby y ~1P~~C~ M. rGa9~ T ~ T < • J Q - - r - ~ - - - tU R {IJ `nfi~ 032254-1 ~V p9~~'ESS10Ml*~~• 3 a1 f l F COUNTY OF SUFFOLK PATRICK G. HALPIN SUFFOLK COUNTY EXECUTIVE DEPARTMENT OF HEALTH SERVIGES Mary B. Hibberd-Brandt, M.D., M.P.H. October 9, 1991 Acting Commissioner Mr. Chester Orlowski 235 Pequash Avenue Cutchogue, New Yoxk 11935 Dear Mr. Orlowski: Subject: Board of Review Hearing -September 26, 1991 91-SO-28, Property Located S/E/C Custer Avenue & Mailler Court, Southold; SCTM 1000-070-09-041. Enclosed is a copy of the Board of Review's determination concerning the subject application. Based on the information submitted, the Board granted the request for variance with the provisions indicated in the determination. The granting of this waiver does not imply that your application will be automatically approved. It is your responsibility to ensure that your application is complete; otherwise, your approval will be subject to unnecessary delay. ^Very truly yo/.u~rs, V~--uu~~, `V Dennis Moran, P.E. Chairman Board of Review DM/ist Enclosure cc: Mr. Walter G. Lindley Ms. Susan D. Windesheim 225 RABRO DRIVE EAST HAUPPAUGE. N.Y. 1 1788.4280 (318)948-2800 - , SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES DIVISION OF ENVIRONMENTAL QUALITY 1 y` ~ Article 2, Section 760-220, Suffolk County Sanitary Code '91 OCT 7 AM - 45 pFi~CG tii t'( To: Mary E. Hibberd-Bra,tdt, M.D., M.P.H. ~~pi~~gc~';p;Ed Of HEGIiH Acting Commissioner From: Dennis Moran, P.E. Chairman, Board of Review Subject: Report of Findings and Recommendations of the Review Board Regarding: 91-SO-28, Property located S/E/C Custer Avenue & Mailler Court, Southold; SCTM 1000-070-09-041 Applicant: Mr. Chester Orlowski, 235 Pequash Avenue, Cutchogue, NY 11935 Notice of Hearing: N/A (Screening) - Heazing Date: September 26, 1991 Statement of Problem Residential construction standazds require that the distance between sanitary systems and shallow private wells be at least 150 feet. The applicant is proposing to install the sanitary system less than 150 feet from a private well. Water tests from the on-site well indicate water source exceeds drinking water standazds. Findings and Facts 1. Site is a 15,319 square foot pazcel. 2. Site is in Groundwater Management Zone TV. 3. The proposed sanitary system is 125 feet from two neighbors' wells and the on-site well. Applicant provided "No Objection" letters from affected neighbors. 4. Public water is not available. 5. Test well results fora 50-foot well with 24 feet of water in the casing indicate 12.3 mg/1 of nitrates, 7 ppb of 1,1 dichlorcethane, and 7 ppb 1,1,1, trichlorcethane. 6. Depth to groundwater is about 23 feet. 7. Soils are good with sand materials 4.5 feet below grade. I Mary E. Ilibberd-Brandt, M.D., M.P.H. Page Two Subject: Report of Findings and Recottvnendations of the Review Boani Regarding; 91-SO-28, Property located S/E/C Custer Avenue & Mahler Court, Southold; SCTM 1000-070-09-041. Deternunation It was a 3 to 0 determination of the Boazd to grant the request for a variance provided the applicant installs water treatment acceptable to the department (granulaz activated carbon and reverse osmosis). Further, the applicant shall covenant, in language acceptable to the County Attorney, that the raw water source does not meet standards and that the separation distance between the well and sanitary systems does not comply with department requirements. Article 6 is intended to protect groundwater quality. Approval of this variance should not have any substantial adverse effect on groundwater, 1'~3~0.1 t V \9'~~.~.. 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Repair Removal Demolition Other 1Vork . ~ ..xt (Desch Lion ~7 p ) Q. Estimated Cost ...~.~.7,.~? : 1W Fee .~~..~i.t`:~~ . (to be paid on filing this application) 5. If dwelling, nurnber of dwelling units Number of dwelling units on each floor ...f, , , , , , , , , , , , If gara;e, number of cars . 6. If business, comtnercial or mixed occupancy, specify nature and extent of each type of use , , , 7. Dimensions of exis~ing structures, if any: Front Rear Depth , , , , , , , . _ Height Num ber of Stories .....0"Y.~~'-r.~ . Dimensions of same structure with alterations or additions: Front - Rear . Depth rr Ileight .......r'............. Number of Stories 8. Dimensions of entire new construction: Front .'2.., Rear ...'~..7~, , Depth .3 : Height , , , , , , , Number of Stories r0~'~---:........ . 9. Size of lot: rout . fj.......... Rear . L.`)p.~ Depth/S? ~-u^^A? /,3 ~ , . 10. Date of Purchase , , . , ,Name of Fotmer Owner . 11. Zone or use district in which prem~ ses are sued , , d ,n.,, _ "i~"~" ` 12. Does proposed construction violate any zoning law, ordinance or regulation: ~.~.°~?!u!L-?~ , 13. Will lot be regraded i , , , , , , , ,Will excess fill be rem vd ed from premise : Yes . 14. Name of Owner of p~mis s s~ Address ~i ft~.n.ScrY.. H: !?f -..,t'aione N~l~".-, 211~r~F.&5°' Name of Architect ...........r . £'Addtess :~^".'"~".'`.°,~.h ; :Phone No.....~ Name of Contractor .l,.~s~-.wv-~^~ S-P.-; .Address . y.. i ~t Phone No. 73...°~.°~r~... IS.Is this property located within 300 feet of a tidal wetland? *YES... 0~ *If yes, Southold Town Trustees Permit may be required. , _ PLOT DIAGRAM Locate cleazly 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. n ~ STATE OF NE\V~YORIj,, ~ S.S COUNTY OF .~../~4-s-,,~jt.~..... + f~, ~-'°s S~'~ •1! • • l::h0. ~15.45 !r , being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. / ~ n (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 Gle 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 sled therewith. Sworn to before me this ~ ........~~...........dayjo~f~. 19~~.. Notary Public,~~~.!~-p~}-ar~~ !~1~ unty ~ , - ~ HELENE D. WORNE . " " . Notary Public, State of Newyork (Signature of applicant) Oualffl da(n Suffo1C ouMy S Commisston Expires May 22, 7g~ i BOARD OF HEALTH ' 3 SETS OF PLr1NS FORM NO. t SURVEY . . TOWN OFSOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORM TOWN HALL j SOUTHOLD, N. Y. 11971 NOTIFY • TEL.:765~1802 CALL Examined . f"~c~. . ~ ~ 19~ 1, i' MAIL TO : • . - . . Approved .G.S~!.~"'~:tiL.. ~ 1991.. ~'ermit No.o?Ol..l•.~',1'u~, Disapproved a/c . . ! . I ..4,c4~M1.. i (Building Inspector} • 'i APPLICATION FOR BUILDING PERMIT Date ...................15... INSTRUCTIONS a. Tlus application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale;. Fee according to schedule: b.' Plot plan showing location of I,ot 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- catiop. 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 issued a Building Permit to the applicant. Such permit shall be kept on the premises available ~'or inspection throughout the work. e. No building shall be occupied pr 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 agrees to comply with ~11 applicable laws, ordinances, bullding code, housing code, and regulations, and to p p is and in building for necessary ' e tions. a mit authonzed ins ectors on remise ~1 nn (Si nature of applicant, or name, if a corporation) ' (Mailing address of applicant) • State whether~applicQant/is owner, le~see, agent, architect, engineer, general contractor, electrician, plumber or builder. ~ ~ I Name of owner of premises ~dti-?4-F~. . (as on the tax roll or latest deed) If applicant is a corporation, signature!of duly authorized officer. (Name and title of corpora~e officer) Builder's License No. ~.•.a>. SI 3, •n~:~, , • • Plumber's License No. . ~ (D • ,G. t , . Electrician's License No. ~..~1, ~ . , . Other Trade's License No. J 1. Location of lannd on which proposed work will be done.(. :t^;~:°,",~•(.!~~•-r!~ !-!!"`'•.i~-.~1ri! a,.~en-C=rrunJ . S , . i ~!~-ca'2~?:".'...~t'.'.'.:.2.' C1~iK"~.t.h'w-~c1? ! . . House Number I Streets Hamlet • ~ ~ • • County Tax Map No. 1000 Section ~ ~ BI'pck , q, , , • , , • , , . • • • . , . • • • • Subdivision , Riled Alap No. Lot . • ..Name) V 2. State existing use and occupancy c~f peremises~and¢intended use and occupancy of proposed construction; a. Existing use and occupancy . ,°f6~^:`:.-.^'.^.: • • • • • • YYY , , . .,tri.- . Q p 'e'F • b. Intended use and occupancy .^,rP.: !r!^:':! ~•L~• •".M.'. _ _ _ i ~