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Home My WebLink About5827-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at a~a~.ey. Bo~ .............. Street Map No.$~e~; .]/~2~ock No.. ~'~e' XX ' Lot No..2b~ ...... M&tt;if/~l~k.. ][,][ · ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... Al~l~' .... 7., 19~.. pursuant to which Building Permit No.. dated ........... April.. A 7', 19 .~12., 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 l~iva~ce 'onw 'fa:ai'Iy' &,rell:Ltxg ........................................ The certificate is issued to . Xxl.tan&--/xo~e.s' 'I~c'/~/Ig. 5'u~set' K11olls' De~·' ~l'~' (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval "~'11.~' · .21+. ~ 9~2.. by 'Rs' UNDHRWRITERS CHRTIFICATE No.. ~ .~2.be(~ ....................................... HOUSE NUMBER..,1.975 ....... Street...~.~.~.ll~e:f .HO~d, ................................ Building Inspector / FO~M NO. ~ TOWN OF SOUTHOLD 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? 5827 Z ~,'~ ~L ~M 19...~.... Date .......................... ~.:..~,~ ................... , Permission is hereby granted to: · ~.:L, ,~ ~ ~...~.....~-,:~...~, ~..<, .. ~,/¢...&m~e.t, ..Ir~e~.t s Dev, .... .~.3.~. · · ..:,.:.~:d ~-:t~....~ur:~,,,,7. · ~ ................. ..... ~eleen. ......... ~'.~.~- ......................................... to .l].~],c~....n.~:C.~.~-~...£..~.~.3,Y...~?.'.~.,~.~r,g. et premises located at .........t,.,.t...~.l~. ........... Ia.~o~ ~ Z.,I (~_-..~...&.~ ][~ .......................................... pursuant to application dated ............................ ,.:>_~.j:~......~. ......... , 19.~;j..., and approved by the Building Inspector. Fee $...~1..~.1.0 ......... TO REMOVE EXCESS~FILL J / " FROM ABOVE PREMISr.=S BY ~ FORM NO. s TOWN OF SOUTHOLD Building Delmfimeet Town Clerks Office Southold, N. Y. 11971 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 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 dispcsal--(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 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 $5.00~ 3. Copy of certificate of occupancy $1.00 ~ _ , /,, - · ._~., Date ..~ ~ y, /~. e Bud n '"7 ............................ N w ' ' g ........ .~... ....... Old ~, Pre-existing B~uilding ........................... ,V(~ant L.~nd r, .......................... Location Of Property ...~...~.~..,.~.'..~...~ ...... ,~.~..~.~.. ...... Permit No.~..~.~.,?..~.... Date Of Permit .//~.~..~...Applicant ...,~..~.~.~....~:..:-...:....':~... .............. Health Dept. Approval ~....~/....~...~./.:.~...~..z~.. .......... Labor Dept. Approve, Approval ....~t~/- -- N'~. ·/..~. /..~. / ..~... :.~.....~.i.. :.~.?..~...~la n ning-- "--"'' Board Approval ................................... __..~ Underwriters Request For Tempora-~C;rtificate ...................................... Fna Cert f cate "~'"""~//~r~ Construction on above described building ~Tct-l~d:mit meets, all apRI,/~:gble codes and regulations. Sworn ,o before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROFAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTE~ Approval tn construct said systems is requested,pertinent data herewith: Date 1-Applicant ~a~d He,es X'~c. Phone 73Z-217~-Sub div $~aet ~olla Address . . .~ ~ - ~ _~" ~7-Section ~ 2-Detaile p~pe~y location ~ B Of Bt~e ~d, 8-Lot No. ~ Hamlet ~l~O~ To~ .9-Private well? 3-~blic ~ter supply ~me Oagt. ~ Distance to nearest ~in ~-~t Size: Width~f%. Length~ft. (also enter on center plot plan below:) 5-~elli~: Single Family ~ ~ T~ F~ly? / /Cellar? ~X/Slab? ~ ~Crawl S~ce? / / lO-Pro~s~ ~st~: Septic tank ~X/Precast ~X/Cess~ols ~ /Shallow ~ols / /Other / / ll-Se~%ic ~ inside ~imensionsl_~ol~e ~als.Length ft. Width ft. Liquid depth ft. 12-Precas% sections: /{ ;Number~Sq~re Ft. Cesspools: Block sizeL incs. D ins. H ' ins. Total blocks below inlet: ~1 ~2 ~3 ~T PLAN Street BTANLEY ~OAD ~apacity~Gals. ~o ~ ~ Indi ~te No ~h The Undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Systems". Date ~/7/?~ Signed ~NLAND ~O~EB XNCo/~O~E~T ~LTZ . / FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it i~ 'the opinion of the Health Department, that an adequate and satisfactory Sewage Disposal System can be installed on this Plot. Date (10/65 Revis. ) s l~ · Data Feet 0 2 4 6 8 10 12 14 18 Exomined ' I ..... ....... 2..., ........................................ , 1 ........ emit No .................................. Disapproved a/c ................................................................... · ................. .......................... APPLICATION FOR BUILDING PI=lIMIT INSTRUCTIONS . a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wit 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 de~ription of layout of ~operty must be drawn on diagram which is pert of this epplicat~n, ~- 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 ava!labia for inspection throughout the work. e. No building shaft be occupied or used in whole or in pert 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 eppl'icable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, es herein described. The applicant agrees to comply with all applicable laws. ordinances, building code, housing code, end regulations, and to admit authorized inspectors on premises end in buildings for necessary inspections. (Signature of applicant, or name, if e corporation) S~te whether applicant is owner, I~, a~nt, amhit~t, engm~r, ~neral contr~tor, el~triclan, plum~r or bmlder~ ................................... aeae~ · Name of owner of premix, ............................... ~a.~..~9~.L~ff.~...g~ ........................................ If appli~nt is a corporam, signa~re of duly authoriz~ offi~r. (Name and title ~ corpora~ officer) 1. Location of land on which proposed work will be done. Map No.: :..-.~:'..///~47'/'=' ............. Lot No ............. ;....~... ......................... q7- , Number / ~ 8 of ~tanle Rd 205 ~ 0 ~set D~, Ilattltuek Street and ........................................... /. ......................... :~'. ....................... !L~ ................................................... MuniciPality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................................................................................................................................... ....................... ~. ]P~IZ D~ellt .. b. Intended use and occupancy ............................................ ..~ .................................. .~. ~.g.. Nature of work (check which applicable): New Building ....... ~ ............. Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... { Description') 20 000, O0 4. Estimatsd Cost ...... .~.....~ ................................ Fee .....~.../..:....~ ........................................................ ' ................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... ..1. ....... Number of dwelling units on each floor ............... .$..., ..................... If garage, number of cars ........................ ,..l....~..a~... ............................................................ : ........................................ 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: Frdnt., ......................... Rear ......................................... Depth ........... .................................. Height ......................................... Number of Stories ........................................ .......... .~.~ .......... Rear ....... ~;.~. ................ Depth 8. Dimensions of entire new construction: Front t au t 8" ....... .~.~.. .................... Height ............ .1...6. ................................ Number of StOries ......................................................................................... 9.' Size of lot: Front '..,~,,],1,,,],), .................. Rear ........... ~,~,l. .......... , ..... Depth ............ 1...8..0. ............................... Height ................. .1...~. .............................. Number of Stories ............................... .~,..~ ................................................. 10. Date of Purchase ....1...O.....A.~..~...I..1.....]:.~..~..2.... Name of Former owner .§.t~.e..~....ff~...~,:~.~...:J:~.~..~t~.A...I;.~[~. ........... 11. Zone or usa district in which premises are situated ..................................................................................................... 12. Does proposad construction violate any zoning law, ordinance or regulation: ............................................................ 13. Will lot be regraded ........ ~.e..~ ..................... Will excess fill be removed from premises: [ ] Yes ~[] No 14. Name of Owner of premises ....... ~T-~"~1~a~d~~c~)&~~q~M~~=~[~ .... (Address) (Phone No.) ' Name of Architect ..... .T..".?....a~..,.d:..~..e~-..?..e......I~..,c. ............ ..~..e.,l. d..e...a.,,....-]~'....,1..l..7..8..~ ....................... .7.~)~..'..2...1.Z.7. ............ (Address) (Phone No.) ZI~.~ Se~es Inc Selden, N~ ll?l~ .?.~.2...-...~....7..7.. Nameof Contractor .................................................................................................................... . · · · .... .. .. · (Address) (Phone No.) PLOT DIAG RAM ~,Locats clearly and distinctly =11 buildings, whether existing or proposed, and indicate all set-beck dimensions from property line~. Give street and block number or description according to deed, and show street names and indicate wheth- er Interior or corner lot. /~ d'~"~ )~ /// S'rATE OF NEW YOR K, ) ,.~ COUNTY OF ...................................................... ) ...... . ...................................... :....:..: ........ ; ........ ~ .................................. being duly sworn, deposes and says that he is the applicant above named. (N=r~ oy ~ndi,~l ==g,in,. conrn~ct) He is the ................................................................................................................................................................................................................. (Contractor, affent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make end file this epplication; thet ell statements contained in this epplication ere true to the best of his knowledge and belief; and that the work will be performed in the manner sat forth in the application filed therewith. · ...................................... dayof .................................................. ............ · Notery Public, ....~ ................................................................ County ........ (s~,=n,~ o~' ~vpt~nO SUFFOLK COUNTY lgAL~II DEPAI~MEI~ ~e sewage disposal and ~ter facill~l~ fer the s~ctur~ lo~te~ at /VOTE: 7#£ ¢1. £1flt OF,.eulr~ol.l( 6'~JISY ON L°t p, reO ~ Lot 29 ~ .EV,e,ONS YOUNG & YOUNG MAY 1,197; 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUHG JULYI~, liT2 ~OFEII~NAL [NGINE[R AND ~N~ IU~Y~ SURVEY' FOR: NISSIM ALHAD~, ' PETER DEMETRIOUS HELEN DE~T~~ MATT~ ' SOUTHO~ ~ANK SUFFOLK CO.. N.Y. SCALE: I" = $O' 15, 1972 J 040 i.01 t~O sq'ft' ~reo ~ Lot 29 L°t ~ .EV,S,ONS YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR: NISSIM ALHADEFF&CATHERINE ALHADEFF/~ PETER DEMETRIOWS, HELEN DEMETRIOW LOT 24 "SUNSET KNOLLS,SECTION 2" AT ,~ GUARANTEED TO: MATTITUCK $OUTHOLO S&VI#6$ BA#K 8£CURITY TITLE & 6UARANT~ CO. TOWN or SOUT HOLD DATE: NO. ~' SCALE: I" = 40' MAR. 15, 1972 72-- 181 ~7o at