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Home My WebLink About6271-z// FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~.1;~8 ...... Date ............ }~T ..... 22 .... , 19~3. THIS CERTIFIES that the building located at . .l~g~ood. ~ ........... Street Map No.I~ll~.$O~;...K. llO13illock No.. ~]:. ...... Lot No..37 ..... l~t~;.tit'll~k.. 1~ ~Y ~ ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Ilar.. 29.., 1973. pursuant to which Building Permit No. dated ......... 1!O~ ..... 2~..., 19 7~t ., 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 Pl~tva.t~. on~ .fa~t. ly. d~elllng ........................................ The certificate is issued to .. P. et~x'..& .tt~,en. Ph~,],l~,I~.~ ........ O~tel'.~ ............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .~. y....17..1. 9F~...~Y..B~..V~!!& .... UNDERWRITERS CERTIFICATE No .... ]1. 119086 ..... ltay.. 9...1.973 ................... ttOUSE NUMBER..~6~' ........ Street... ~0gW0.O~. ~ .................................. Building Inspector FORM NO. ~ TOWN O~ SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6271 Z Permission is hereby granted to: pursuant to application dated .......................... ~ ..........~I~ ....... , 19~.., and approved by the Building In~ctor. Fee $.~ ........... I~ORM NO. 6 TOWN OF SOUTHOLD Building Deportment Town C:lerb Office Southold, N. ¥. ]197! APPLICATION FOR CERTIFICATE OF OCCUPANCY 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: 1. Final survey of properly 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 disposol--(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 installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. $. 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: I. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner os 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 $5.00 New Building ~ Old or Pre-existing Building .............. ~ ......... Vacant Land ~-- Location Of -.~-..~ ................................................................................................................ ~ ................. Owner Or Owners Of Property ....................................................................................................................... 'a ~ ~"~'- \~-~,u',5~.~-S ~t~%:. Z~-/,~ ....~..?.... Block No ............. House No ............. Subdivision ~.' .............................................................. No. Permit No...(-,~.:..'/~...-)...I ..... Date Of Permit .}.!.Lt'~.J.?:..z::.Applicant ..... !.~.L.L.~./.?.~ ........................................ Health Dept. Approval ....................... + ................... Laoor Dept. Approval ................................................ Underwriters Approval ...... ..~..?..~........c{t ......... ~Cl7 ~ ......... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ~ Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes ond~egulations. Applicant .............. ~_7.. ....... ..-~. ~......~. ~. X~;; ...... . .............................. Sworn to before me this .......... ..~....~ay of ..... ~....~.......L~.?...~... ...... (stamp or seal) Notary Public .................................... County DIETZGEN 135 11846 LOt 36 Lot 38 SUFFOLK COLrNTY HEALTH DEPARTMENT The sewage disposal and w~ter supply facil~t.~es for this location have been inspected by this department and found Chief of Ge ~eral Engineering REVISIONS MAR. 12,1973 MAR. 21,1973 MAY II, 1973 NOTE.* · = MONUMENT SUBDIVI$1ONM,~P I'/LED IN THE OFF'ICE OF THE C~ E~K ~SUFFOL~ C~NTY ON YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG SURVEY FOR: PETER PHILLIPS & HELENPHILLI LOT NO. 37~S UNSET KNOLLS ", SEC' AT MATTITUCK TOWN OF SOUTHOLD SUFFOLK CO., N.Y. SCALE: I" = 40' I DATE: NOV I, 1972 INO'72_849 R04p sT4~b[Y 36 LOt ~-~ I Lot 38 DIETZGEN 135 11846 NOTE: · --MONUMENT SU~OtllI$1ONMAP F/dO 1N THE O~ICE OF THE ~L E~qK O~UF~OL K ~OUNTY ON APIi'IL ,9~ 19 ~"0 4$ FILE A~. ~4 4,~ R~WSIONS YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W, YOUNG HOWARD W, YOUNG SURVEY FOR: '~ MATTITUCK ~ ~ ~ o . TOW. OF SOUTHOLD ~ j j su~o~ co., ~.~.'~~'~~ I" = 40~ SCALE: I1 1972 '~ 49 J DATE: NOV. TOWN OF $OUTHOLD ~ ~:/~ TOWN cLE~'s OFFICE /~ ~ : ' ~ ~ ~ - ~UTHOLD, N.Y. ~/ ~. ~/~/ ............................................................................................ ........................................................................................ ................ -", ......... ........ / ~,,~,~,~ (Building Ins~tor)/~ :' ~'. ~ :: ~ // ~ ~,~ APPLICATION FOR BUILDING PERMIT ~ / '~ '~P~/ Dote ~,e~.~...~. .... ,9....~.. ~ ~ ~ ........................... , .. ~'~1/' ~ t ' ' ~ INSTRU~IONS : L ~.~li~fiofl taus, ~ ~mple~ely filled iff by ~y~wri,er or in ink ~fld submi~ i~ ,ripli~te ,o ,he Buildi~g Ins,emor, wi~ 3 ~fi of plans, a~urate plot plan to scale. Fee a~ording to schedule. b. Plot plan showing location of lot :and of buiidin~ on premiss, relationship to adjoining ~re~i~s or public str~ or am~, giving a detailed de~ription of layout of Probity mu~ ~ drawn on diagram which is ~ o~ this appli~tion. 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.shell 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 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, Suffotk 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 appl!~ant agrees 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. M.S.T. Construction Corp ~ (Signature of applicant, or name, if a corporation) .. ................. (Address OT applicant) ~' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................................ ..................................................................................... Name of owner of premises ....~..e..t;...e..~.....~....~...e..]:.e...~......J~...~...~.~.lJ .......................................................................................... If applicant is a corporate, signature of duly authorized officer. Builder', License No .......................................................... ~lumber'~ License No ......................................................... ~:lcctri¢ian'~ license No ..................................................... Other Trade', License No ................................................... Sunset 1. Location of land on which proposed work will be done. Map No ............... ?,.., ..................... .,~Lot No....~.?. .................. Street and Number ................ .D...O.j[~...o..o...~...~ ....... /~'~-'~5 ~ ~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... .T.~g~ll.~...~__n~ .................................................................................................... b. Intended use and occupancy ........ .O.~...~'.~...~..el~.:~13~ ......................................... .........~:~_........ ....... ... Nature of work (check which apl)licable): New Bui('ding Addition ..................... Alteration .......... :,:.. Repair ...... Removal ............... Demolition ........................ Other Work .................................... ............................. (Description) bX:), 000 + Fcc .................................................................................. 4. Estimated Cost ......................... m ................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....?~Le. .......Number of dwelling units on each floor ......................................... If garage, number of cars ......~ ......................................................... '.J-" .................... ............................................. 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 ....... .~.~.-..0 ........ Rear ....~.)+~,~ .............. Depth ....2,8/....22 .............. Height ................................................. Number of Stories ...... 0~ ............................................................................. 9. Size of lot: Front ........ ~J~t ....................... Rear .......... .0~l...+. ...................... Depth ........... 2~)~.../...~.~ .................. 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11., Zone or use district in which premises ara s tuated ................. ,~....I:)J.S.~ .................................................... 12.' Does proposed construction violate any zoning law, ordinance or regulation: ....)~t ................................................... 13. Will lot be regraded --~ ......................... Will excess fill be removed from premises: [ ] Yes k,] No 14. Name of Owner of premises .~.e. lb~..&. R~I e~t..Ph~l t~S .................................................................................. (Address) (Phone No.) .... 5 Teontakis ~E .... ~lame ol' ~krcnllecl .................................................................................................................................. (Address) (Phone No.) Name of ContraCtor .~..~.~..P,O~,Z"/Zo.ti).O/:),..C4~=~ .................. ~:[XXBO1~ ..................................................... (Address) (Phone No.) 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 number or description according to deed, and show street names and indicate wheth- er interior or corner lot. See flled pla~ STATE OF NEW YO'~-K~'O~'E'DI,IZ ) SS COUNTY OF .............. ~ ....................................... ) .................................................. ~..*~N~ ..................... being duly sworn, deposes and says that he is the applicant above named. {Name o/individual signing c. on~. act} He is the ........................................ ~,g.~../~.....O..~.....C*.0)~.~'.~.~O,~ ..................................................................................................................... {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 application; that all statements contained in this application are true to the best of his knowledge a~d belief; and that the work will be performed in the manner set forth in the application filed therewith. TERRI LEE ELAK NOTARY PUBLIC. State 0f New York ~'% / 2~. day of NoT.~.~)~e~b. 52-6~L::~C) [ \ / ~ ......................... ',~' .................................... "(~u~liFF6a'~'Su!i~l~°~dh't¥'' J~t~ ) ~X ~'\ ~ ~'~ _ Notary Pubhc, .~.....~.----'--.."~,~e.-TM ........... County ..~...'~...~.._.t ............... ~..~-;.....-.., ..................................... /Signature oy appttcant/ .i '1 l II q