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Home My WebLink About7584-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. ~63.~.5 ...... Date ............J~Ja...28 ........ , 19.?~. THIS CERTIFIES that the building located at .Pee.onl¢..~y--Blv~ ........ Street Map No. ~ ......... Block No.. ~ ...... Lot No. ~..~1 .... ~,~.. ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated ..........0et ..... 8..., 19.7h p~suant to which Building Pemit No.. dated ...........~}..~0...., 19~., was issued, ~d conforms to ~1 of the requk~ ments of the applicable provisions of the law. The occupancy for which ~is certificate is issued is . Pr~$~. ~n~. f~7. ~.~ ...................................... The certificate is issued to .. HiO~I. Fl~SP~$~k..~ .~ite...~eT8 ............. (owner, lessee or ten,t) of the aforesaid bufld~g. Suffolk County Department of Health Approv~ . ~...~.~ .... !97~..bY ~. Y~!I~.. UNDERWRITERS CERTIFICATE No.~?~...~..~...~7~ .................. HOUSE NUMBER ... ~28~ ...... Street .Pq~9~. ~. ~ ...................... ~ ~ B~r~h Dr B~lding Inspector FOB, M NO. ~ TOWN OF ~OUTHOLD BUll,DING DEFARTMENT 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? 758~ Z Date .....................t 0 C.~. 7' , 19.....7 Permission is hereby granted to: at premises located at ...... ~ .................................................................................................................... ........................................................................................... /.=~..u.Z..L'~..!~,. ........ ~./.:..~'~ ........................... pursuant to application dated ~, ~t'7 19...~./..., and approved by the Building Inspector. Fee $ Building Inspector (Building Inspector) APPLICATION FOR BUILDING PIP, MIT Date October 8 .. 74 ~ a. This application must be completely filled in by typewriter aC. in ink and submitted in triplk:ate to the Bui~ng Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee according to SChedule. b. Plot plan showing location of lot and of buildings on premises, re at onsh p to adjoining premises or publicstreefs~o~' areas, and giving a detailed description of layout ofpreperty must be drown on the diagram which is part of this application. c. The work covered by this application may nat 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 avai ab e for inspection throughout the work. e. No building shall be occupied or used in whole or in port for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. Bui'~c~tr~LI zCA2elOoNrdliSnaHncE, RE?~Y" MA~DE to .the B.,uil,d!ng~ D..ep.a. rt~ment, for. the .issu, ance .of a Building Permit pursuant'to the Re-ul~i--- z__ .L_ _e. m' ~ne i .o?.,o,t. bout'no.l,a..~, buttOlP..L.ou.n, ty, I~lew YORK, and ~her appllc.able Laws, Ordinances or-1 Th~ ~-~i~u~a~-~sC~,ns~ruc~'°n o..t, ou~?,ng,s: a,a,a, it!on$ or a!terat,ons, or .for removal or. demolit,on, a~ herein described .............................. ( ,g.ature of app,,¢ont, o .me. ,fa .... - ! P.O..B. ox 117 Matt~tuck NY 11c, 52 -- (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. General Contractor Name of owner of premises ~i.c.h..a. el ...a. nd .J. ane Fitzpatrick If a~con, is a~[¥rp%ra~,~ sign~t~lre of duJ~)authorized officer. ..... z ..... - ............. .V.-..L..:. ......... (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ...... ~,1...7....~. ............................... Electrician's License No..~.7..3....~. .............................. Other Trade's License No ............................................... 1 Location of land an which proposed work will be done. Map No.: '72-8~ · · ................................ Lot No. Street and Number ...... ..~..e..c...o..~..~g.....~..~...B..1...v..d..~ .L...a..u..r...~.l. ' Southold Munk:lpality 2. State existing use and occupancy of premises and intended use and, 0¢cupa,n.cy of.~ .Iq~,~ed construction: a. Exisiting use and occupancy .....V...a...c..e..~t Intended use and occupancy ....~...~'...c~:~.~'....~...~.~..~,.~.~g ...................................... .~.. ..... , ................. b. 3. Nature of work (check which applicable): New Building.......~ ......... Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ..................................................... . ~ (Description) 4. Estimated Cost ........ .~....~.~.~...O~....~..~...O~.. ......................... Fee ... '.~......~... ............................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling unitsqlJ~l...~JJ~J~.....Number of dwelling units on each floor ............................ If garage, number of cars ..JIIIJJ ............................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and eXtent of each type of use ............................ 7. Dimensions of existing structures, if any: F~ont ............................ 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 ........ .lJ~ ....................... Rear ....~O ................... Depth ...~Jl ............... Height ........... ..~..~..... Number of Stories .............. ~i~ ................................................................................................ Size of lot: Front ....JJ~. ............................................... Rear .............. .JJ~ ...................... Depth ......... J, gJ~ ............... Date of Purchase ....lJJlglllJa.~..JJl~a...~J ..................... Name of Former Owner ........................................................ Zone or use district in which premises are situated ..................................................................................................... Does proposed construction violate any zoning Iow, ordir~nce or regulation: ...... Jl~ ............................................ ~Jll lot be regraded ...J~... ................. Will excess fill be removed from premises: ( ) Yes (ill) No 10~ 11. 12. 13. 14. Name of Owner of premises ...~J,~lJl~.~ ................... Address ..JlllllllJ~J~ ..........PhoneNo. JJUJ..JJr~. Name of Architect .............................................................. Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fram property lines. Give street and block number or description according to deed, and show street names and tndicats whether interior or corner lot. STATE OF NEW YORK,· ~S S COUNTY OF ......................:; ........ ~ ' ........ ~[.~IJ~C~.~..]J~A...'~I~,JI~ItJ~I~ ..................................... L ...... being duly sworn, deposes and says that he is the applicon! (Name of individual signing contract) above named. ' He is the ......... ~ ...... ,.¢~iJ. ll~....~.~..~...l~...~...~..Z'.. .................................................................................................................. (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 ore .t~ue to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this day of ............................................ , 19 ........ Notary Public, .................................................... County ...................... (Signature of applicant) FOKM NO. $ TOWN OF SOUTHOLD , Building 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: h 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 naturo~ 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 ..... ..~. ....... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...~.fi~.G. QD,:~.~...~...~.V.~.,.~..~.~.~,~,~-,~,~...~ ....... ..1,39.52. ................................ Owner Or Owners Of Property .M..~.~..~.&...e.~...&.....~.~..~..e.....~..~.~..~.~.~.~...~..~..~.. ...................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No .......7...5...8..4.....~.. Date Of Permit ..~..O../..1...O./...7..4Applicant X]~nl~..~O/~.,....~[~[.~.^ ....................... Health Dept. Approval .... ,1./.1.6/..~.5 ....................... Labor Dept. Approval ................................................ Underwriters Approval ..~.....~..~3...3..5...8........1../..~..~/.Z.5.....Planning Board Approval ........................................ Request For Temporary Certificate ....... .~..o. ............................ Fin~ Certificate ....... ~.~.s. ............................ Fee Submitted $ .......5..:..0...0. .................... Construction on above described building,~nd~appl~ble codes and regulations. Applicant . m~.lq, x~,~..~...'~,~;.... ........................................ Kenneth W. Sworn to before ~.s~,~ ~ ....... a. doy Notary Public .......~..///..~/:?~/J..> County Thurber- ZNLAND H~ ZNC. (stamp Z. J~ ~-,~, 14 1975 768311 : ~ UOOO0 ~i:~.ael Fits Patrick, w/s Peconic Ba yBtvd. Laurel, L.I. 1 ~ 103 CB x 1 4 Motor.'~: 1-3/4hp. C~ 2 pge Zi~inghaus ~ F~rk Pl. ?at chogue, L.I. 11772 ~N~A~ mANA~ Ih~s ced~c='~ -.~v ~ot be ~ered ~n ~ny m~nner; re*urn to ~he o~ke o~ the Board ;{ {ncorrecL ~nspedo~s m~y be ~denfi~ed by ~he;~ creden~;~[s. SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY l. Applicant INLAINqD HOMES; INC. Ph0ne298-9696 Address P.O. Box 117~ Mattituck. NY 11952 2. Property Location N/S Peconic Bay Blvd., 75' W/Q Birch D~iv~, Laurel. NY Village. Laurel Township 3. Public Water Company Name 4. Lot size: Width 65 feet Length 19o feet 5. Subdiv. 6. Section 7. Lot Number 8. Private Well Yes 9. Public Water No Distance to main 10. Sewage Disposal System: (For Health Dept. Use) 11. A. 900-gallon septic tank: Precast x Equivalent Block B. Leaching pools: Number of pools ONE Precast × Block Special If private well, fill following blanks: A. Tank capacity ~2 B. C. D. E. in the gallons Pump G.P.M. 5 Total well depth. 84 Depth to ground water Amount of water in well 42 4O 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. INLAND HOMES, INC. Date October 7, 1974 Signed Kenneth W. Thurber 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 ,/ NOTE: · -' MONUMENT REVISIONS YOUNG & YOUNG AUG.22~I974 400 OSTRANDER AVENUE, RIVERHEAD, N~~~ ALDEN W. YOUNG SURVEY FOR: FITZPATI ~= · MICHAEL FITZPATRICK 8~JANE I~(~ ~ )~ GUARANTEED TO: AT ~U~EL USUFE TITLE INSURANCE CO. OF N.Y. TOWN OF 50UTHOLD SUF~OU~ co., ..Y. SCAL~: I" = 40' DATE: OCT. 26~197Z ~2- 84~ .'~V,S,ONS YOUNG & YOUNG AU~.22~II?4 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK NO~ 5~ 1974 ALDEN W. YOUNG HOWARD W. YOUN~ SURV~ FOR: MICHAEL. FITZP~ICK ~ J~E FITZ~TRICK SU~LK CO., N.Y. ~ ~ ~// ~ COUI~/~ MEALTN DEPS~TNEN~ The sewage disposal and water facilities for ~',~ suppl7 ~-~s locaL.ion have beea inspected by LJ~:!s d ........ . ~a-~ment and found Chief of G~neral Engtr~erl~ Services · IRETZGEN 135 NOr£: ·-'MONUMENt ANDIO~ FEO~I DATA O~YA~fIED ~'EO~! OTBE~S .EV,S.ONS YOUNG & YOUNG AUG.~,Ig?4 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK NOV, 5, 1974 ALDEN W, YOUNG HOWARD W, YOUNG SURVEY FOR: MICHAEL FITZPATRICK 8, JANE FITZPATRICK AT LAUREL USLIFE TITLE INSURANCE CO, OF N.Y. RIVE RHEAD SAVI N6 S BANK TOW. oF SOUTHOLD SUFFOLK CO., N.Y. SCALE: I": 40' [DATE:oCT. 26,197Z ~?/2-84~ 3 FINAL WHEN JOl~ COMPLETED J 7 // -1 7'- //' ,,, 7-// ' 14 ~o