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Home My WebLink About5875-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..7~..60.. ...... Date ........... 00.~....~. 7. ....... , 19.~2. THIS CERTIFIES that the building located at . P~s~-e. Bd .&. li.&~a~est... Street Map No. 8a~,t&L?S .~.~l~ock No ........... Lot No...~.l~ .... 14attit'lt~il;.. I~.Y~ ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ................. }t&~r.. ,¶~.. 7~ pursuant to which Building Permit No.~{~.~.~... dated ............ .~. ~...~.~..., 19.7~.., 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 . P~q.vate-one..farr.:[.~, .~lwe}}_ing ....................................... The certificate is issued to .K®~r&n..(~,~tl~zl~t ....... Owr~zlt ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... UNDERWRITERS CERTIFICATE No... 1[ .be~,,~,l ...................................... HOUSE NUMBER.. ~-3~0 ...... Street ....~lt~. ~ ..................................... ................... ~5 ............... .~.a~r~t. ......................... ~ ....... ... c,~ .(. . . ~: :'. : .,x. Building Inspector FOBM 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? 5875 Z Permission is hereby granted to: 8~.~ ....... :..~.~, ...................... to ..... ~..%~1~..~.~(...~.~... f.~l~ ..~.V.~!I~=~ ................................................................................ at premises located at ....... ~et..~.-.%h-...-~e.l~i~,e..~ce~e~ .......... ~ ........................................... ...................................... · ee~e..&ve..&..i~evecr e~t...~ane ................. Ma~I%'~ll~ ..................... pursuant to application dated ................... Ma~.....~L~ ................... , 19r~..., and approved by the Building Inspector. Fee $...~o..~ ......... I ~ ~e ~Xaa~ A~ Building 7nspector/ FORM NO. 6 ·OWN OF SOUTHOLD Building De/m~tment Town Cle~cs Office Southold, N. Y. 11971 APPI,ICATION FOR CERTIFICATE OF OCCUPANCY Inltructionl 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 IooatJon of all buildings, property lines, streets, and unusual 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 installations, 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. 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 ./...O....~... J..~...-l.~..~ ................ New Building .....J,~.... ........ Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ¥./..~. Owner Or Owners Of Property .J~'.~/.'./~......~......~....eg...~..~.(/~...t'?.e~.......~..LL...~...¢....~..~... ...................................... Su vis on ....... ............. Lot No....I..UC..... No ............. House No ............. Permit No.4~..r~..~.....~... Date Of Permit .~..'..!..~..'.~..Z'.....Applicant .................................................................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building ood permit meets all applicable codes and regulatibns. Annlicant ....... :..../....07~... ~;~. ~ Sworn to before me this .... · /.~.. ..... day of ..~.~....~...~'../~'...~:'~.... Notary Public ....... ~ Gounty Notary Publlc, $1~tte ©F New York No. 52-034496~ Suffolk Counl~.~ Commission Explm~ Match aO~ 19.~ (stamp or seal) SUFFOI~ COUNTY DEPARTMENT OF HEALTH E~STERN D~TRICT ~RI~R~.Y. H.D.Reference No. ~-~1 APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE $EWAGE DISP0~AL SYST22~ Date ~ ~'-//- Approval to construct said systems is requeste~,pertinent data herewith: Address~'~-~ 5~r/~ //~ ,~",a~' u,' //g_, ,t/y 7-Section 2-Detailed property l~c&tion~ ~c(~ S-Lot No. ~.~t~ t're_~ ~,0~ /-~/~/~ 9-Private well? 3-Public water sup~name Dis~ance to nearest ~a~n t-Lot size: Length~' ft. Width~'O ft. (Also enter on center plot plan below:) 5-D~elling: Single fa~ily?/'~/Two faintly?/ /Cellar?/~/$1ab?/ /Crawl Space?/ / lO-Proposed systems:Septic tank/ ./Precast/ /Ceespools~/Sha]low~ecls/ /other/ / il-Septic ~amk inside dimensions.Volu~e~Gals.Length__Ft.Width__ft. Liquid depth ft. 12-Precast sections:// /Number.~/Square ft.Cesspools:Block sizeL~__ins.D ins.H.~ins. PLOT PLAN Capacity ~ls Ind~ N~ Test Hole .ate ~,h Data Feet 0 2 6 10 12 16 18 The Undersigned CERTIFr~ "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards,Bulletins, and a~endmente thereto,covering Private Se~e Disposal Systems". ~ate ~--//-~ Signed~-~~~__~~~ ~ FC~ HEALTH DEPARTMENT USE O~LY. Based onthe t~*ormation presented herewith,it is the opinion of the Health Department,that an adequate and satisfactory Sewage Disposal System can be installed on this Plot. Signed ~'~% (-/ ~' '" BUILDING DEfARTMIN (~ -"~r~ ' ~mln~ .............. ~ .................... , 19 ........ ~ ~ll~tm. N9 ............................. ~ ....................... , ...... ' No ........... ~"~n ~ ~ ~ ~ ' . . ~ .~ ............... .......................... ~ ................ ~ ........... ~~ ............. ~~ ~ ~-,~ ' (Building~ln~tbr) ~ ~ ~~ ....................... .................................... -~ ,. ~ o -:~ ~ ~te ............................... ~ ...................... , 19 ........... aL ~ls Ppplicati~ must be c~pletely flll~ in by ~ewriter or in ink und submitt~ In ~pllc~e ~ the Build~ b. PI~ plan s~ing I~ation of I~ a~ of buildings on prem~s, mlati~ip to adjolnl~ pmm~ ~ ~IK st~ts a~s, ~ glvl~ a d~afl~ ~ri~l~ of I~t of pm~ must ~ drown on t~ dl~mm ~ich ~ ~ ~ c. ~ ~ c~ by ~is ~licati~ may not h c~menc~ b~fore i~ame of Bulldl~ h~lt. d. U~r~al of this applicoti~, the Bul~tng I~ctor will I,ue a Bulldl~ ~lt to ~ ~pll~nt. ~h ~it ~alll~k~t~ the premiss available for inspection throughout the p~re~ of ~e wo~. e. No building s~ll ~ ~cupl~ or u~d In whole or in pa~ for any pu~e ~a~r until a Ce~lflc~ of ~c~y. shall h~ ~en gmn~ by the Bulldi~ In~r. APPLI~TION IS ~REBY ~DE to ~e Buildi~ De~ment for the issuance of a Bulldi~ Pe~lt ~nt to the Buildi~ Z~ ~i~nce of the T~ of ~thold, Suf~lk C~n~, N~ York, end ot~r ~llcoble ~, ~i~ R~ulat~s, for the c~stmction of buildings, additions or alterations, or ~r mmpi or ~molltl~, ~ ~mln ~rl~. ~ applicant ~s to comply with all applicable !a~, ordinances, building c~e, h~slng c~e, and (Signature of a~llcont, or name, If a ~1~) ...................................... ~....~ ......... ~.,.,,..~...~.~ (Address of a6pllcant) State whether applicant is owner, lessee, agent, architect, engJn#r, general contractor, electrician, plumber or builder. ....... d..:.~ ./..~.~.~,~. .......................................................................................................................................................... Name of owner of premises ...... .~./,~'4/.......~..~:../.~....~.. .............................................................................................. If applicant Is a corporate, signature of duly authorized officer. _~ · {N~r~ and title 'o{ co~orate officer) . ~ 1. ~cation o{ land on which pro~o~:l wo~ ~ill I~ done. Map No.: ........................................ L~t Na.: ..... ~..'~.. ......... ~ st~ and Number ..~¥~...C*.~....~.~.~.~.~4....~..~.t~.~.~ ........... ~..~:~.~.....~.y.. .............. 2. State existing u~ and ~cu~n~ of premiss and intended use and ~cu~ncy of p~ c~l~: Existing use and occupancy ................................................................................................................................... Intended use and occupant-, . ......... ./...'~,/~...'~Z.;~/¥....~'...~..,~.~.'~.~/C~. ...... * ........................................................... 3. Nature of wo~k (check which applicable): New Building ~.. . ..... Addition .................. Alteration ............. ?. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...................................... 4. Estimated Cost ~...... ...~........~............... ~ ..... o.....................Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ ./.. ................. Number of dwelling units on each floor ............................ If garage, number of cars / . 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 ................................ / , B. Dimensions of entire new construction: Front ..... ~../. .................... Rear ....~....x. ............. Height ...~. .............. Number of Stories ...................................................................................................................... 9. Size of lot Front ...... ~'..~...~... : Rear ..~.....'~..?.../. ....... Depth °°c~ ' r X YX ............................. 10. Date of Pu chase ......... ~.. ...................................... Name of Former Owner ... ~ /~.C~.. ..................... 11. Zone or use district in ~vhich premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordnance or regulation:~ ............................................................ 13. Name of Owner of premises .....'/~'..~'..c/.'.:./?....~-z:/.~..¢'.~'..?c.....Address ...~.~/~'..~../T..~....../~....~.= ...... Phone No Name of Architect ...... 4~.,......~.~.~,~. ............... :i.i..Address .~.,<,/./z~/~/x4ff'.#~:t..~...../~....,~,~" Phone No ..................... Nome of Contractor ~../~.~..~....~.e...x/,,t .~,.,~%~c,.....Ad~ress . .~..~...~..~.../Z..~.~ .,~I.....~ ..... Phone No. ~..~.T..~.~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or l~r°Posed, and indicate all set-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW~OI~I$, COU N,TY/OF .:.,~/.~4/~. ........... J' ~' ........ ~.~...~Cx:~.f ...................................... being duly sworn, d~es and says t~ he is the app cant (NaMe of individua~i~ning application) ,~ve named. He is the ..... ~.~.~ ............................................................ ~ ........................................................ (~ntmctor, agar, co~orate officer, etc.) of said owner or owners, and is duly authorized to pe6orm or have performed the said work and to ~ke and file this application; that all statements contained in this application are true to the ~st of his knowl~ge a~ belief; and that the work will be perfo~d in the manner ~t fo~h in the application fil~ ~er~ith. Swam ta ~re me .... ...... N fo NOTES: El, MONUMENT SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON AUG. 3, ~66 AB MAP NO. 4~8E. .EV,S,ONS YOUN~ & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR:------- -- KEVIN GILBERT ~&'~EC~GIANNA GILBERT LOT NO.I~ 'SALTAIRE ESTATES" MATTITUCK Town o~ 50UTHOLD "~ SUFFOLK CO., N.Y. TOM4RK CONSTRUCTION INC. Building -- Conztruction 5250 SUNRISE HIGHWAY SAYVlLLE, NEW YORK L~.i"T r L[VATIO~ J j ~-~030 TOMARK CONSTRUCTION Building -- Construclior~ 5250 SUNRISE HIGHWAY SAYVILLE, NEW YORK INc. ~TF.Y I~IOMT NOTES: I=MONUMENT SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON AUG.~I966 AS MAP NO, 4682. .E~,s,o.s YO ~ . at YOUNG 0CT.21,1971 400 OSTRANbEI;~ AVENUE, RtVERHEAD, NEW YORK ,.JUNE 6~ 197;~ ALOE~ W. YOUNG I ; HOWARD W. YOUNG SURVEY FOR: KEVIN GILBERT'~ ~E!ORGIANNA GILBERT LOT ~ARANTEED TO; " ' AT MATTITUCK ,]~ ~:, ,~CURITY TITLE, GUARANTY CO. I ' I I S~F~ ~UNTY FEDERALSAVINGS ~ TOWN OFsouTHOLD SUFmLK CO., N!:Y. ~ : _ NOTES: I=MONUMENT SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON AUG.~I966 AS MAP NO. 498~, 0CT.21,1971 400 OSTRANDE~ A~,ENUE RIVERHEAD NEW YORK JUNE 6,197Z ALDEN W. YOUNG ~ HOWARD W. YOUNG LAND SURVEYOR, N,Y.S. LIC. "0, {;~e4~ N.Y.s. L IC. NO. 4S893 SURVEY FO~: ' ~ ~ ' KEVIN GILBERT ~ ~ORGIANNA GI~ LOT NO.14 ~ ~ ~- ~C~'~ M~T/ITUCK { ~ S~CURI~~AN~ O. · o~. o~ ~ '" ~ ~ S~L~~A~V~N~5 ~c.~=1,,=40, ~ g*Y~: [. T 15~1971