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Home My WebLink About6614-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Sonthold, N. Y. NoZ62D~5 ...... Certificate Of Occupancy Date ....... Dec ....... Street THIS CERTIFIES that the building located at Donna. Drive Ck Est, Map No.D~ep. Hole Block No ........ Lot No...25 .. ~a.t.t~.t.u. qk., . .~. :.~., ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... 14ay 30 . , 19.7.3 pursuant to which Building Permit No. 6.6.~..br.Z.. dated ....... May .-.30-., 19.7'3., 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-rivate. one. family dwe.~lin~ ............................... The certificate is issued to ROSs Man&ral .... 0~rnar ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .Dec ~ .8... ] 97~ by R:..Vil.l.a. UNDERWRITERS CERTIFICATE No...1~, .~ .97,9.2. .~ ..... .D.~.C.., ? .~,., ~, ,97k ............. HOUSE NUMBER 7.90 ..... Street ..... Donna .Dr~,¥e ...................... . .t ~.~.'.. ....... .~ ...... Building Inspeeto! " FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N~, Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6614 Z Date .......................... J/~;7 ....... '~0 ........... , 19.~3.. Permission is hereby granted to: John..~J~asna~.....A/~....ao~..Jlamar~a:L ....... ......... ~4aJ;tlt~e-~_ ................................................. to ~..~L~,~ .. ~ ~{....~e...£~.~ilg...dwa tling ..................................................................................... at premises located at .... L.~..~...~.~. ......... D. ee.p..Kole..Cre~k..~ata:t;e,e, ........................................ .......................................... ~.OD/%a,.-gr-:Lv.e ................ M'_~_ttitlu~3~ ........... .~ ....................................... pursuant to application dated ............... ~ .......... ~.D,~.....:....~Q. ...... , 19~.~..., and approved by the Building Inspector. Fee $.~ ,.QQ ............ THE NEW YORK BOARD OF FIRE UNDERWRITERS 8,]~ BUREAU OF ELECTRICITY; ~ ' [~ 85 JOHN STREET. NEW YORK, NEw,YORK 10038 · .,s c=~,.,.s...~ N 197925 ~e d. ~el~ DOB~ ~1~ B/Or[ Ne~ ~U~OAK inthefol~i~.t~n; ~ B~e~n' t ~ lstF1. ~ 2~ FI. .Y~w. o .. ; =EH S ~ 200 CB x 1 ~/0 1 ~/0 l~utu~e ~pplJ~n~e fee~e~/~ 1 1-]~10~ 2-2~12 Wate~ he~e~ t MoCo~/~t 1- 1/2bp TOWN BUILDING TOWN C~K'S ' ~TH~D, N. Y. cxomned ~.~4~ ~ 19/~ ~proved ........................................ , 19.~.. Permit No. ' ...................................................... ............. {Sudd~ ~ INSTRUCTIONS ~ a. This application must be completely filled in by typewriter o~, in ink and submitted in triplicate to the Building% Inspector, with 3 set~ of plan~ 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 o~ areas, and giving a detailed description of layout ofproperty must be drawn onThe diagram which is part of this application.~, 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 Perr~it to, the applicant. Such permit[ shall be kept on the premises available for inspection throughout the work. ~ ' ~ e. No building shall be OCCUpied or used it whole or in pa rt 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 Perm t pursuant 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 herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing cede, and regulations, and to admit authorized inspectors on premises: and in buildings for necessary inspections. ............................................ , ........... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Owner - builcter Name of owner of premises ~OSS Manarel If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No .... .S...o..~...~..1...1.e.~. ......................... Electrician's License No...D~e.1a ......................... Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ...D...e..e.~....H...o...1..e....,C.k.....E.'s".t~o..2...8. .................. Street and Number Donna .D..~..v.e Matt..i. tuek Municipality 2. State existing use and occupancy of premises and intended use and occupancy, of proposed construction: a. Exisiting use and occupancy vacant b. Intended use and occupancy one famil~ clwelling 3. Nature of work (check which applicable): New Building .~ .......... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition ................. ~... Other Work ...................................................... (Description) 4. Estimated Cost .................. ~...2..t..0...C~.....+ ...................... Fee ..... ~.n.QQ ......................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... .Q13,e, .............. Number of dwelling units on each floor ............................ If garage, number of cars .......................................................................................... 6. If business, commercial or mixed occupancy, speci~ nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ......................................................................................... j ....................... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ............................... 8. Dimensions of entire new construction: Front ......... .~}+ ...................... Rear ..... ~..Jl:. .................. Depth ...~.~...../.~.6. ..... Height .................... Number of Stories ..... g~'l~ ......................................................................................................... 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 ..... ~.....~1,,~,~.~ ................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ~Q ................................................... 13. Will lot be regraded ....~.Jt ................ Will excess fill be removed from premises: (Z) Yes ( ) No .e...Z.1 ss ..N ttituck 14. Name of Owner of premises ....TI..o..~§ ........... E ....................... Addre .............................. Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ...~A..~I~S~JtZ'. ................................ Address " Phone No. PLOT DIAGRAM Loca.te clea~rly and distinctly all buildings, whether existing or proposed, and ind cate all set-beck dimensions from property lines. ~ive street and block number or description according to deed, and show street names and indicate whether Interior or corner lot. STATE OF NEW' YQ~I~, COUNTY OF ........ .e..: ....... ...................... ~..o..~...~.....~..e...:J.~..~..~..z]'. ............................................ being duly sworn, deposes and says that he is the applican~ (Name of individual signing contractO above named. He is the .................................. .~..j~.e...~.~....o..~.....o....~g..e...~. ............................................................................................................. (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 be performed in the manner set forth in the application filed the. rewith. Sworn to before me this 30 f 73 ............................. CommiSsioll J~xpites March 30, 19..(.. SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant A~S~ f~/~l)/~Y~'~ Phone ~-,~-~/~ 5. Subdiv.~-)££~ Address ~o~ ~/ ~~7~c~, ~/,~/,'tt~- 6. Section . 2. PEoperty Loc~ion ~ ~ ~/'~Y~ , ~m~/~r/~ ' 7. Lot Number Private 1 ~ ~- ~ ~m(~ ~ ~ ~ yi/~r~c~/~/ t~/~ '~ ~/~q8. Wel Village ~,~ Township ~7~m,/~ 9. Public Water 3. Public Water'Company Name Distance to ~in 4. Lot size: Width ~J ~ feet Length~feet 10. Sewage Disposal System: A.~X~y~n septic tank: Pre~ t ?r.~__Equi val ent B1 ock ~. Lea~ing pools: ~'~ Nu~er of pools J ~ .P~ecas ~)B1 ock Speci al ll.[~,I,f pri~te well, fill in the C.~ ~ follow~ng blanks: A. Taf~k capacity~allons B. Pump G.P.M. C. Total well depth D. Depth to ground water E. Amount of water in well (For Health Dept. Use) The undersigned 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 ~'/~-~/~ ~ Signed ~ ~z~/_ >~/~ ~///~ :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: 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 plot. APPROVAL DATE ~/~?~ SIGNED (,,_ ~ ~ S-15 Rev. 4/1/73 The sewage d~sDosal focilities fo~' this inspected by this dc~artrent arid ' L APPROVED AS ,NOTED