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Home My WebLink About4967-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF No Z-25163 Date JULY 30, 1997 THIS CERTIFIES that the buildin~ ADDITION & ALTERATION Location of Property. 1080 DEEP HOLE DR. MATTIT~CE, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 115 Block 12 Lot 15 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPT. 22, 1970 pursuant to which Building Permit No. 4967-Z dated SEPTEMBER 22, 1970 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 ALTER EXISTING GAP~E INTO~ABITABLE ROOM, & NEW GA~AGE ADDITION TO EXISTING ONE FAMILY DWELLING * The certificate is issued to ELSIK DI~ONS (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *THIS UPDATES CO Z-4091 ISSUED ON DEC. 21, 1970. Rev. 1/81 N/A N/A N/A ul ~ng~Inspector FORM NO. ~ TOWN OP $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4967 Permission is hereby granted to: ............ ~'~..M~LtZ.. Ca~t~...Zae....~ ....~. I)egeex ........................ J~t.~taeh ................................. to ..... ~. ,a~l&t ;l~l~..o~..e~et-~..~e-~. -~h~ ................................................................ at premises located at .......................... i~./fj~..t)eep...~le..D,~ ........................................................... ................................................................ ~t.~.:~tuek .......... I~. ...................................................... pursuc~n~ to application dated .......................... .~...e.~).~ ....... ~ ............ , 19...~, and approved by the Building Inspector. Fee $...~.,~(~ ........... Building Inspector( APPLICATION FOR CERTIFICATE OF OCCIJPANCY TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existin~ Buildin~ - $100.00 3. Copy of Certificate of Occupancy - 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 .............. House No. Street Hamlet Onwer or Owners of Property...(.,~m~..~....y...g/~.~.~..~_,~:...~.~' County Tax Map No 1000, Section .... 7/.~. .... Block .... /.~... Subdivision ............................. Permit No .... ~..~..~.Date Of Permit. Health Dept. Approval...~.: ./~.: ........ Filed Map Lot ....... ....... Applicant ............................. ....... Underwriters Approval ......................... Planning Board Approval......... ..... ... Request for: Temporary Certificate ..... Fee Submitted: $ ....................... ...... Final Certicate ........... FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certi[icnte O[ Occupnncy No. '~+09-1 ...... Date ............. Dee ..... 21 , 19. '70 THIS CERTIFIES that the building located at . 'W/S' Deep' Hole- Drive ". Street Map No... ~ ....... Block No...XX ..... Lot No .... xx ....Mat.%f~tuck.- N..~, ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ~ept .... 22 , 1970 pursuant to which Building Permit No.. dated ........... Sep~ .... 22' 19. ~0' was issued, and conforms to ail of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. P~iva.te .one .fam. ity. dwelling ...................................... The certificate is issued to . .,~,. D&gol~s ........ Owlaer ............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~ouse ~ 1080 ELSIE DI~ONS II'CATT-/ TUO'K SUmmo~K CouN ~-~, Al..5". BUILDIN~ DKfAIfl'MINT TOWN CLIlK'S~ IOUTHOLD, N.~ y. p. ,t No. '/-/? 7 7-- Approved ........................................ 0 ......................... . ^.,.t,on No. .......... Disppproved a/c ........ ~.......~......~ ...... .' ............. ~ ...................................................................... ;...~. ........ ,..~ ............. ~USlalng lnepact~lp~ APPUCATIOH FOR BUILDING PIRMrI' Date ....~......:.,:....,.....ae~.t...,...22 .... ,19...2.0. .... INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink und submitted In dupllcato to the Building Inspector. or~, PI.at el.on sho. win~ I .oc.ation of lot ~ of ~Jlding; or, premlm, ralatiormhip to adjoining pri4,nlim or ~11¢ ~treet~ or o~.na glv!.ng O ~Ol! .e~ Ollcriptla? of layout Of p~rly must be drown an. thi diagram wh~'h I~ Po~t of~ application. c. [ ne wort covered by this al:q~llcatlon ~ not be commenced before imluonee of hlldlng Permit. ' d. Upon approval of this application, the Building Inepector will I#ue a Building Permit to the almpliomnt. Such permit shall be kept on the Premiess available for Impection t]n. roughout the progre~ of t9m work. e. No building shall be occupied or used In whole or in port for any purpaee whatever until a Certlfieote of Oocupan¢¥ shall have been granted by the Bullding Inspector. APPLICATION IS HEREBY MADE to the Building Degortmont for the iuuono~ of o Building Plrmlt INamant to the .Build!n~.. Zo~, O~., inonce, of t..he T ,o~(n...of..Seuth~.., Suffolk C. oun~, New York, and other al)pllc~ble ~ ".,JOldinonoes or K_egu[or,..OnS, ?r me C?lstrucl'l,ort or.ou!l?lngS,: ~l.d. ltl.ons or a!.terat:ons, or for removal or demOlition, os hJqln dmcribed. [ne opp.cant agrees to comply with al. app,caole laws, ommonces, building code, housing code, and regukitlonl. ........ ~v..Ab~ta..Ce~t~aete~...Iae .................. .: ..... (Signature cf applicant, or nome, If a Coq)orotlonJ ............. .~t.t~k ............................................................. (Address of applicant) State whether applicant is owner, Imee, agent, architect, engineer, genoral contractor, electrician, plumber or builder. ...................................................... ~.a~t~ac~or ................................................................................................................... Name of owner of prem se$. mT.~ D4_~,)Z~ ........................... If applicant Is a corporate, signature of duly authorized officer. 1. Location of land on which propaeed work will be done. Map No.: ......... ;1~ ......................... Lot No.: ~ ................ Street .~ mber .............. W,/'q: .]3~®~ ..... ~[e~,.e, ~ .,~,~ea.~--~,....~...,~ ........ ...................................... / e'o 2. State existing use a.nd occupancy of premlsm and Intended use and occupancy of prapaeed comtructlon: a. Existing use and occupancy ....~..V.~.~,~I~ ............................................................................................................. b. Intended use and occupan? .....Jl.~e...~K~,l~h,.. ~Iz%..ILcTcLtt~LoG ....... , .............................................................. 3. Nature of work (check which applicable): New Building .................. Addition .~ ......... Alteration ..~. ........ Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...................................... 4. Estimated Cost ....1.1. s~0~ .......................................... Fee ....... ~.Q0. ........................................................................ (to be paid on fi~ing this application) S. If dwei~ling, number of dwelling units ......... 9~,.~ ............. Number of dwelling units on each floor ......................... If garage, number of cars ............................................................................................................................................. 6. If busine~, 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 ............................ · D~pth ................................ Height ............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ....~.~....~..~. ................ ~. Rear ............................ Depth ....¢~/...2~, ........ Height .................... Number of Stories .... ~ ........................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ........ ~,~..4~i.-~t~ ......................................................................... 12. I~es proposed construction viol~, o~ zonina law, ordinance ar regulation? ............... ~Q ........................................ 13, Nome of Owner of premises ~ .................. Address ..~/41,tZ~:L:I;.I~lr .................... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ......~..:....~...~..~...~.~ ............................ Address ....... ]l~.~.~.~ir ...............Phone No .................... Locate clearly and distinctly all buildings, property lines. Give street and blOCk number whether interior or comer Jot. PLOT DIAGRAM whether existing or proposed, and indicate all set-back dimensions from or description according to deed, and show street names and indicate STATE OF NEW YORK. COUNTY OF ...... .~l~.~nllr .......}S.S. ................................ · ¢~..~.~1~,~. ........ ; ................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ....: ........~z~l~.~ .............. : ..................... : ............... ,......:J, .............................................. : ........ (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 app!icotion; 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. Swam to before me this ................. .......... : ....... ....... . . ............. ....~.....;:~..: ................... Natal/Public~(.~?.~/.~ Cou~ ~"~,gnature of applicant'" "~ ELIZABETH ANN NEVILLE NOTARY PUBLIC, State of New York No~ 52-8].2585~, Suffo4k Coug~',m