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Home My WebLink About7014-zFO~M NO. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . .R.o.I.~.w0..o..d..D.~.~..~. .......... Street Map No. R..~'.e.w.°.Od..E?~lock No ........... Lot No.. ~ ..... .~..t.t.i.t..U~. k... ~;.~.; ...... conforms substantially to the Application for Building Pemit heretofore filed in this office dated ..........N..O? .... 2~...., 19 ?.~. pursuant to which Building Permit No...?.0.~.~.Z. dated ..........D.e.c... ~ ...... , 19. ?~., 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..r!.?a.t..e...~e... f..a~.i.ly..d..w.e..1~..~, g. ....................................... The certificate is issued to . .J...e~...C~ .1!. ~..&..wi.E, ....... . .0~...r.~. ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...A.p.r.l.l....2.9...~..9~.... b.y...R;..V.i..1~..a.. UNDERWRITERS CERTIFICATE No....N..~.~...8~..~....Ma. ?..2.~....1.9..~. ................ HOUSE NUMBER ..... 9.~ ..... Street ...R.o.~.?~..o..o~...D.1,.~.?e. ....................... Building Inspector FOF, M NO. 2 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.o 701 1 Z Permission is hereby granted to: at premises located at ...~g~...;[,,~ ....... ~;~1~o¢ld...Es.t~:l;e~ ............................................................ ..................................... · .~...~.~...q~.,. ~.r;I,l~ .............. ~:tt:Ltuek ..................................................... pursuant to application dated .................. 1t~3'~ .......... ~1~ ................ , 19..~.~.., and approved by the Building Inspector. ~O~W~l ~e ~O~e~ O~t p~l ~0 ~eok ~ ~et~ ~ alosest po~t of bu~ld~n~ Fee ~3.~. ............ ~ORM NO. 6 TOWN OF SOUTHOLD Bnilding Deportment 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 DUPLICATE 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 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 $1.00 New Building ...XX. ....... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ....~//..~...~..~..~.~...~..~....e.~w.-.~..~..d..~..D..~-.-~..~..~.g-.~..'.....w./.~...~.C.g.x....~.~e.g~..~.-~.,.~.~.~.$~ Owner Or Owners Of Property ....,,T..~e~...~.~...~O~,13,Q;I,~. ......................................................................... Subdivision ~o,s.e~..oo.d..E,s.'Le,.t.es ......................... Lot No....;L.5.... Block No ............. House No...?...5..5.... Permit No....'Z.Q.I.~...Z.. Date Of Permit ..~l.P~'~.3/..~.,3. Applicant ..~[~P-~S...~.,...C~X~3.Q~. ...................... Health Dept. Approval ...~/.~.c~/..?...~ ......................... Labor Dept. Approval ................................................ Underwriters Approval ..3~'~2~.~...& ........................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ..... ~, ............................... Fee Submitted $ ..~.,..~.Q ........................ Construction on above described building and permit meets all applicable codes and regulations. Notary Public .................................... County App l ica nt .]r,r~ad.. ~omea ~...lac./.~ce~r~e ~..W. ,...33m,~b.e~: ............... Sworn to before me this ,~'~ ,_~//,,?/~/ (stamp or seal, SUFFOLK COUNTY DEPARTMENT OF HEALTHReference Health Department Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant Inl~d Address , 2. Property Location Village ~ttftt~ 3. Public Water Company Name 4. Lot size: Width 115 feet Township Length Z~/3 feet 5. Subdiv. '~o~t~I~:~3d 6. Section 7. Lot Number 8. Private Well 9. Public Water Distance to main 10. Sewage Disposal System: A. 900-gallon septic tank: Precast ~Equivalent Block B. Leaching pools: Nunber of pools Precast ~Block ll. If private well, fill in the fol~'l~ing blanks: ;~ A. T~3~k capacity ~ gallons ~-'~_ B. :~.mp G.P.M. 5 - C. ,,:~tal well depth. 90 D. ~_[~th to ground water 44) E. ~unt of water in well (For Health Dept. Use) The undersfgned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current standards thereto. This application will be valid for one year from the date of approval indicated below and may be renewed if a current local Building Department Permit is in effect. Date }lov, 3Ge 1973 Siqned Z~ }~s l~c.~ .... L___-zzzz____~______-z~z-__ ................... Z .......................... ~L:L,_L,_2__.Z;L .... FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department that an adequate and satisfactory Sewage Disposal System and Water Supply can be installed on this pl, ot. APPROVAL DATE 1/..-- £-")'": S NED ' S-15 Rev. 4/1/73 THE NEW YORK BOARD OF FIRE iUNDERWRITERS al,,' BUREAU OF ELECTRICiTY~.~ .' 85 JOHN STREET. NEW YORK. NEW YORK tOO3B THIS CE~IFIE~ THAT only the el~t~ equipment ~ ~c~ ~ a~ i~t~ b~ t~ ap~t ~ on t~ a~ ~plica~ numar in t~ p~mise~ o~ ~mea P. ~on~o~y, w/side ~ose~oo~ D~., ~000~ ~/o ~ox N~ ~. in the following locat~on; ~ B~ement ~ Ist FI. ~ 2nd FI. o ~ ~ ~ ~ ~ e Section Bilk Lot ~ ~ ~ w~ exami~d on ~ ~ ~ ~ ~ 0 ~ ~ ~ ~ ~ and found to be in compliance with the requlrements of this Board. FIXTURE I `3 BXTURES OUTLETS ECEPTACLES SWITCHES INCANDESCENT FLUORESCENT ~v~-~Y 2,3 q 2.5 23 DRYERs FURNACE MOTORS I ~UTURE APPLIANCE FEEDERS AMT. K.W. O H,P. GAS H.P. AM~T NO. A. W, G. RANGES SPECIAl. EEC'P] TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET SYSTEMS EXHAUST FANS AMT, H, P 1 F DIMMERS AMT* WATTS SERVICE DISCONNECT I NO. OF ] S E ~1METER ND ~4T. AMp. TYPE EQUIP. I.e'2w 1,e'3w 3.,e'3w 3,~'4W NO'OF~CRC,~CO · i 200 C x 1 OTHER APPARATUS: · Future appliance ~eeder/s: 2-3#8, 1-2#12, Water heater: I- a. Skw ~otor/s: 1-1/2hp 1 Po~t ligh~ R V I C NO. OF HI-LEG Of HI-LEG 2/0 Oeorge Z!mllnghaus, Park Place, PatchoL, ueR L.I. 11772 G."~M. MANAGL~ Per ,/ COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. APPLICATION FOR BUILDING PERMIT Lr, Dote ....~..o...v........~..?.F ........................... , 19...7..3.. INSTRUCTIONS o. This application must be completely filled in by typewriter ~ in ink and submitted in triplicate to the Building Inspector, with 3 sets of plOnsi accurate plat plan to scale. Fee according to schedule. b. Pl6t plan showing location of Iot~ond of buddings on premises, relationship to odjolning premises or public streets or areas, and giving o detailed description of layout ofproperty must be drawn on the diagram which Js part of this application. c. The work covered by this opp cot. on may not be commenced before issuance of Building Permit. d. Upon approval of this opplicotlonj the Building Inspector wil.J' issue .d Building Permit to the applicant. Such permit shall be kept on the premises-availeble for: inspection throughout the work. e. No building shall be occupied or used in whole or in pa rt for any purpose whatever until o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit p~/rsuant 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 bemin described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and'regulations, and to admit authorized inspectors on premises and in bu!ldings for necessary inspections. '~ TOWN ~K~ _ ~D,N. Y. ~ ~ ~ ~ ~ ~ ~ ~1~ Examin~ ........ ~.~....., 19....:~ ~ . ~plicat,~ NoL .... .~.~.:..~......:.~ , rov ........................................ .,, ........ .......... D~pprov~ a/c ........................ .. ~ ~/~. ~ Inland Homest Inc,/Kenneth W, Thurber~VP (Signature of applicant, or name, if o corporation) BOX 117s Ma~ituck~ N,Y,~ 11952 (Address of applic~ant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Gener.a...1. C.o..n..~rao~or~. Bu~.l...d..e..r.. . Name of owner of premises John Connelly If al~licant is a cprporate~signature of duly aulL~horized officer. (Name and title of corporate officer) Builder's License No ..................................................... ~ Plumber's License No ..... .5...~7..'.~...Ba/~..,..~..3:.~Lm.~...~..g~' Electrician's License No..~...T..3...-..~.....~C~.o..:...~.]:.~..~.gh&us Other Trade's License No ............................................... ~ ~ 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No. 15 Street and Number W/~ of Rosewood Dr.s Ma. tti~:u~ N.Y.~ 11952 ' Municipality 2. Store existing use and occupancy of premises and intended use ond occupancy of proposed collstr~ction: a. Exisiting use ond occupancy ....... ..V..~...~...I~...~....(N.,°..~.?.) .......................................................................................... b. Intended use and occupancy ..... ..(~...e....~..'.a~....~..~.y.....d..w...e..3:..3...~..~..c:,J ............................................................................. 3. Nature of work (check which applicable): New Building '.~ ........ Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work .................................................... · ,~ L ~-...~ (Description) " 4. Estimated Cost ...$..~D.~.3D.0,.Q0. ............................. Fee (to be paid on filing this appficatian) 5, If dwelling, number of dwelling units ........ .o...~..e. ............. Number of dwelling units on each floor ............................ If garage, number -f - - one 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 ..... .~..~ .......................... Rear .,~.~ ...................... Depth t Height .................... Number of Stories oT~e ...................................................................... i .................... 9. Size of lot: Front .....Z..Z...5..~. ........................................... Rear ......Z..Z...5..t. ............................ Depth ...... .Z...7..5...~. ................ 10. Date of Purchase ..... ~ ......... =. ........................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................... 12. Does proposed construction violate any zoning law, ordinance or regulatiom ...... T~.o. ................................ 13. Will lot be regrade~l, ...~..e,..s......: ........... Will excess fill be removed f~p~ ~:~oyes ( ) No 14. Name of Owner of premises .~.o.~.~.....~..o....z~...e..~.. ................... Address g~.4ger..~,.~.. ...... Phone No.'7....4.~.T..O..~...O..~. .... Name of Architect ............. ........... .................... · .................. Address ......; ......................... Phone No ....................... Name of Contractor ~D,~,f~..~.9..~.q..s.~.. ~...~..~ Address ..Bg...x. ~3.? Phone No ....................... 398-9696 "I~-OT DIAGRAM I~l&ttituck~N.¥o Locate clearly and distinctly oil 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 comer lot. STATE OF NEWr'Y'OR~. ~' t S $ ....................... ~..~Y,; ...... ~-~-.-: ...... .~...~ ......... ~ ......... beigg duly sworn, deposes and says that he is the applicom (Nome of individual Sigmng controcf) ' ~ ' above named. He is the . Conl;3:&o'l;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 and belief; and that the work will he performed in the manner set forth in the application filed therewith. Sworn to before me this ,~ .... ' ..............,.r ........... ' 19.."~...~.. Notary Publ~.;~ County ... . JUDITH ~ (Signature of applicant) Notary Public, Stole of ,~lq~Yorl~/ No. 52-0344963 Suffolk Cou.r~' ~lemmission Expires March 30, I.Ot 15 L.Ot 13 DATE H.D. REF. . The sewage disposal and water supplT facilities for this location have been inspected by this d$~.~en%~nd found to be satisfactory.- Chief of General Engineeriag Services · UOD/VISt~N M&P~TLFO IN T~tF OFF/CF d4~ E4, 1~6~ 4S F~ E ~ ~E LOCATION OF WE~ AND CEsSPOO~ SHOW~ HEREIN ARE FROM FIELD AND/O~ FROM DAT~ O~T~NED F~OM OTHERS ..v,,.,o..YOUNG & YOUNG FEB. 7, 1974 400 OSTRAND£R AVENUE, RiVERHEAD, NEW YORK APR. 19,1974 su.w~ ~o.: ~!x ~ES ~ c~..o~ a c~ .E F~~ ~ AT MATTiTUCK euA ~ ~/ vow. o~ SOUTHOLD ~ su.o~ c0., .. ~. "~~ ~~ ..~: ,.: ~. JO*T.:,O~,e.,~ ~.o. ~_,,~ Lot I? \ x Lot Lot 13 NOTE ~ · * MONUMENT .~IODIVI$10N MAP FI~D IN THE OFFIGE LAW COP~E$ OF THIS SURVEY MAP NOT BEARINg THE LAND SURVEYOR'S INKED SEAL OR (~JARANTEES INDICATED HEREON SHALL RUN O~Ly TO THE PERSON FOR WHOM THE REVISIONS YOUNG & YOUNG 400 0STRANDER AVE:HUE, RiVERHEAD, NEW YORK ALDEN W. YOUNG HOWARO W. YOUNG PRO~'ESlIONAL ENGINEER AND L~ND EURVEYOR !SURVEY FOR: ,JOHN CONNELLY LOT NO. 15, ROSEWOOD ESTATES AT MATTITUCK aUA.~ TOWN OF SOUTHOLD su