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Home My WebLink About7526-zFOKM NO. & TOWN OF SOUTHOLD BUH.DING DEPARTMI~NT Town Clerk's Office Southold, N. Y. Cerlificnte Of Occupnncy No.. g637q ..... Date ............ l~.arch... 2q .... , 19.75. THIS CERTIFIES that the building located at .l~e~ .8~f.f. olk- &ye. &..Dem~S~r~eet Map No~eep. Iinle..C~lo~c~t~to.e .s ......... Lot No..1~ ...... gatti.tuck...~ ,¥., ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...........A~g.. 20.., 197~.. pursuant to which Building Permit No.. 7.~26Z. dated ..........Sept;. 9 ...... , 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.~lvate. o~e. f~il¥. ~lwell~,$ ...................................... The certificate is issued to .. J. eatr hend~z$& ........ (~mez' ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . l~r...5.. 19.7.~-. hi. R,..~/illa .... UNDERWRITERS CERTIFICATE No. N..~0~7.~0 · · · J~n. ~.. 1 ~7.~ ................ HOUSE NUMBER.. ?~; ......... Street...Donna. D~. ............................. 6860 New Suffolk Ave Building inspector ~ FO'~.M NO. ~ TOWN O~ SOUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7526 Z Permission is hereby granted to: at premises located at .3. r~t...~. ......... g~e~..~Lo:l,~..C~.e~k;..~,,~.t, aA~8$ ........................................... ................................ ].~.~..AY.o..~.. ~1 om~...DziYo ............... N~ t .tJ.:l;~e,,k.... ~J ~ ~/~ ........................ pursuant to application dated ............ A~I~...-.~) ........................... ,. 19.7be..., and approved by the Building Inspector. ~ ~'"' ' ~;~'"' ...... r ........ I"" ,- ~ ~ .. ~ ~. ~ ~ - , ~ (Bui~ai~ ~~ ~?, ~, ........ :.: ....... ~...~......, ~...~... ~. This ~licotion r ~ ~ c~t*l~ fil~ in by ~w~r ~ in i~ ~ s~mi~ in triol~ ~'~ ~i~i~ In~tOr. with 3 ~ ~ ~..~~ ~!~ ~ ~ F, ~!~ to ~g~le. ~ ~ ~r~s. ~ tivi~ ~ ~t~il g d~riot~ of I~ut of~,~ n~ ~ d~n ~ t~ di~mm which ~ ~ ~ ~ ~1~. ~ c. ~, w~ Cz, r~ ~ $~ ~1i~i~ ~ ~ ~ cP~ ~ i~. of_~ldi~ P,~tt. ~ d d. U~'~oI of hi~ ~1~i~..~ ~,i1~1~ I~tor will iss~ ~ Building Permit to the ~lico~. ~h ~ ~ sh~ll ~ ~t ~ the Or,~ ~i~ ~i~ ~r in~ ~ ~ ~k. ' . ~ ~ ~. No ~ildi~ ~11 ~, ~ig or ~ i~ ~1, or in ~ for ~.y pu~ ~ot~,r until ~ ¢e~ific~ of ~c~ ~ shol~ hov, ~,im.~ [ ~ ~i~i~ In--or. ~ ~1 APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to t~ Building Zone Orclinance ef the Tov~ of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the ¢Omtruction of buildings, additions.ll~4a. Iteration=, or for removal or demolition, as herein descnl~ed. The applicant agrees to comply with all -; ' ' ' ' apphcable ~ms, otcltnanc~., build,ng code, ho~ng code, and regula~ions, and to of ........ · .................... State whether applicant is owner, lessee, agent, archi ~l, nera, contractor, electricio_n, ptulmber or~ ...... Nome of owner o~ premi~'~l~.~.l.~_...l .... gl ............. &.~. .~- ~ ..1 ......... ~ ................ II .................... ....... 1 ............ If applicant is a corpCrate,~gnature of duly autlioHzed c~i~ .................. ::.: ............ .:":::'.'""-: .............. :.....';::.....: ......... I II ~,ome ono r,,,e o, co~a,o,e a,,ce,, I II,/ Builders License No ................................................. Electrician's License No....~l~jl~..~ .......... ~her ~,ade's Ucen. No ............................................... 1. Location o~ ~a,d o, which p,~osed work wn~ ~e do,.. MOp No.: ...~ ..................... - ~ '~'~:"~~....., ..~. ~,~: ...... ,ree, and .um r ......... State eXisting use and occupar~y of premises and intended Use and occupancy of propaeed conl~ructi0n: o. Exisiting use and occupancy ....... .~...~ .............................................................................................. b. Intended use and occupancy ..... ~..~.~1~.~1~..i~.~1.~1~ ......................... ;~,.; ...... : ........................................ ~ ..... 3. Nature of work (check which applicable): New Building 'x Additiqn Alteration Repair .................. .Removal .:.; .............. Demolition .................... Other Work ................................................ . ..... ~.. ~ (Description) 4. Estimated Cost ....~...~...~l--0~.e....(~... ................................ Fee ...~..~.. ............................................................................... (to be paid on filing this applic?tion) 5. If dwelling, number of dwelling units ........... .]: ............... Number of dwelling units on each floor ............................ ~ ' If garage, number of cars ............................. . .~... ............................................................................. : ............................ If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ Dir~ensions of existing structures, if any: Front ......~ ~ ............ Rear ....~ ...... i .......... Depth ~ ........ Height ...... ~ ........... Number of Stories ....... ~ ....................... : ........................................................................... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ S. Dimensions oLe re new construction: Front .......... ................. Rear ...... ........... Depth Height ......~..~. ....... Number of Stories ............,/ ....................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase .....~.~,:,::..]~..t...~,ti~.~...:-- .................. Name of Former Owner ..... ~..~..~ ............. 1-1. Zone or use district in'which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ..~...u.... ............................................ 13. Will lot be re~roded ...~ ............... ,. Will excess fill 2.'~1r i~' ~'~e~,,,,,,,,,.~t~em~,,~ ~_Nl,°.. 14. Name of Owner of premises .~'J~[..~J~[~t0~,.. ~mb'~F~°~m' -~) ................. Address ................................ Phorm N0,8..~.L[~..~.. Name of Architect .............................................................. ~c~rej~..~ ................. Phone No ....................... Name of Contractor ....~..~.i~..~..~.?..~.......e... Address ~.(~I(~X..~e.,~['... Pho~ 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 whether interior or comer lot. STATE OF NEW~J~IRJ~,~ ~ [cc ' (Name of indi~ual signi~'contrac~ _ 0ven.m (Cont~tor, agent, corporate off!ce~ etc.) of said ~ner or owners, and is duly authorized to pe~orm or have performed the said work and to make and file this application; that all statementS contoin~ in this application are tmeto the best of his knowledge and belief; and that the work will ~ perform~ in the manner ~t fo~h in the o~afion:'f~d therewith. Swom to before methis f. I I - ............ ....... ......................... / ~A ~ SCH~M ~~2;~Signatu~ ~ applicant) NOTA~ P~L~, Sta~ of N~ Y~ No. 52-3530650, Suffelk Coun~ FORM NO. 6 TOWN OF $OUTHOLD , Building Deportment Town Clerks Office Sou~hold, 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 ..7. · y.~..~. ...... Addition//____ ,~. ~ ~ ~OId ar Pre-existing Building ................ Yacont Land .............. ~ew B~ilding Owner Or Owners Of Property ~....~~ ................................................................. Subdivision ~.~..~....~~t ~N .~_ ..~...~.~. Block No ............. House No ............. Permit No..~....~....'~.....~.... Dote Of Permit-~...~. ........ Applicant .~....~...c:~...../.~..~...~ Health Dept. Approval ..... ..~.....'~..Z~..~..././..~........Lobor~' Dept. Approval Underwriters Approval/~ ........................................ Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fincd Certificate ..~. .................................... Fee Submitted $ ........ ~...~ ........... Construction on above described building and ~/~rm,,it meets all applicable codes and regulations. ....... ............................. ............ ........... Sworn to before me this, A _ ~ //'-' ,, r'-~ '~-~, ,-- ,--~4~C~' I/~t'~t'v'~l ~ L/*day of ~..~../~ ~ 7(~ c~ /--x' (stamp .... or/'~ ~eol) _,~,Z(~ ~ c/ JOB #160 · SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference No. APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM e/oI~A~UFS ROSE HO~ES,INC. 1. Applicant R~-N ~f~.~4,~F. ZA Phone?~:]4~t Subdiv.b~F HOLE ~JK ESTA~:S Addres~ I~;~K~ PT_ .N~ 6. Section 2. Property lo~ation i.~J ~ ~ ~'~ ;~ 7. Lot No. ~ ~I~ 8. Private well Village. ~,~IToC~ Township ~O~OLO 9. Public water 3. Public Water Company name Distance to main 4. Lot size: Widthl~O~eet Lengthl~,O feet (Enter on center plot below) 10. Sewage Dtspos~ystem. . A. /~0~ gallon septic tank. Precast X Equivalent Block B. ~aching pools: Number~ Precast~Block ~cial If private well fill ,~n blanks below: Tank capacity.~ Gals. Pump G.P.M. Total well depth 60' Depth to G.W. 20' Amount of water in well 40 Gals. Test Hole Data Feet 0 2 4 6 8 10 F 12 16 18 The undersigned CERTIFIES: "Construction !of auGhorized installations will be in accordance with the Suffolk County Department of He~lth's current stand- ards thereto." Sl~ned~''~ ~ ~/ ~- ~ ~:, "-2 .... 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 can be installed on this plot. S-15 Revised ~/]/7~ am J~HN ~rl'~ET. ~ YORK. NEW YORK 10038 Jenuary 20,~97~ and found to be in compllam.e with the requirements of this *Future Appl:L~nce Feede=3: 1-3t~8, 1-2f12 i- Four Point Ehc.~oc. l 863 #. Jericho T~ke. , Smithtown,L.l.ll~87 ~is c~ificote must not be alter~ in any manner; return to the office of t~ ~ard if incorrect. Inspectors may ~ identified SUFFo I K ~ VENUE Lot 45 ~ Area = 25125 sq. ff / 120. O0 '~ "~ ~ lot 4G Lot 7/ .EWS~ONS YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARID W. YOUNG SURVEY FOR: BEN MENDOZZ A LOT NO. 45 "DEEP HOLE CR .ow.o. s0, ., 0L0 SUFFOLK COUNTY HEALTH DEPARTMENT //, lot 45 Area = 25125 sq.M 120. O0 ~ ~ Lot 4~ Lot 71 NOTE 5[IBDIVISION /~AP PI£ffD IAI THE OFFICE ~ I, OC~T/O/~' OF ~ ~D ~S~O0~ OF TH~ CL~K O~ SUFFOLK COUNTY ON SHOWN HE~EI~ A~E F~O~ FIELD OBSERVATIONS AND/OR FRO~ DATA OBTAINED FROM OTHERS REVISIONS YOUNG & YOUNG dAN~O, 19?~ 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK FffB. ~ /.-Q~'..~ ALDEN W. YOUNG HOWARD W. YOUNG SURVEY .FOR: BEN MENDOZZ A LOT NO, 45 "DEEP HOLE CREEK ESTATES" AT GUARANTEED TO: MATTI TUCK SourHO~OSAV/N$$OANK ~U~u~rl'ffgO TITLE O/V/S/ON OF TOWN OF SOUTHOLD ,4MERICANT/TI.~INSU~ANCECO. SUFFOLK CO., N.Y. I API~RovED ,AS ,NOTED H)P 't C'0£.$ ,o~ 13o,'uo.q~eYE 0 '7-0 FLoo ~,, ',9 L_iV DJ