The URL can be used to link to this page

Home My WebLink About7649-zFORM NO. & TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy No. Z?~O.~. ...... Date .............. ~, .u~. ?, ,~.q ...... , 19..7.6 THIS CERTIFIES that the building located at ~a. qk.~.°.n...L.a.n.d.t..rig..R,q.~.d .... Street Map No..,~a~.k..sPa .L. dl~lock No ........... Lot No, .~.3. ...... .I~. ~.t.t.~..u.~k...~.,.~.: ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ p.e.e... 2..., 19.?.~. pursuant to which Building Permit No. ?.6.~.??.. dated ........... D.e.e....2 ..... , 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.i.v. ~.~..o.n.e..f.a..~.i~y...d~e. 1..l!n. g ...................................... The certificate is issued to ...~?.a.]:d..~.a.~..1.~ ........(~Am..97 ............................ (owner, lessee or tenant) of the aforesaid building. 1 Juue 30 1976 by R. Villa Suffolk County Department of Health Approva .................................... ~ UNDERWRITERS CERTIFICATE NO..~.. ~.~..O.?...~. ,~.. .... .~....~..~...I..~.? HOUSE NUMBER ..... .~ ~,~0 .... Street ...~.a.e.k..s.o.n..~.a~.~.i.n.g. ad ................ Building Inspector / FOI~I NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTJ~ENT TOWN CLERK'S OFFICE SOUTHOLD, N; Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 7649 Z Date ~e 2 ]9..~..... Permission is hereby granted to: ~ Lud~a~ ........ ...~..~.~.~. ................................................. t^build new one f~ly dwell~ at promises located at .~...~.~.....~..~J .................................................................... Jackson ~ Road~ ~lle~ R,O~ ~tt~tuek pursuant to application dated .......................~.d..~ ............. ~...., 1~...., and approved by the Building Inspector. Fee ~..2 ,~80 FOl~M ~70. ~ TOWN OF SOUTHOLD , Building Department 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 /1 D te ............. New B~ilding ......~, ...... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Owner Or Owners Of Property ......~..../../.:.~.'..~...~...~. ~...Z...~..I~.~S~. ............................................................... Subdivision .... ..~..~...E~/..L~...o...~..~ ......... ?...~..~/.!..r.,2/.....Lot No.../...~...... Block No ............. House No./....~...~...O. Permit No..Z..~...~...~....'.~'. Dote Of Permit .~...2:..~/.~.//Applicant~'~ .................................................................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ FinaJ Certificate .......................................... Fee Submitted $ .................................... Construction on above descrlbed building and//p~'~,~ ~ appli?~e codes and regulations. Swam to before m~Js ~ ~~/~; ....... .............. THE.` NEWYORK BOARD OF FIRE UNDERWRITERS ak , ! D]('l~ ~ BUREAU OF ELECTR~C*ITY [ -: !" - ' SS JOHN STREET, NEW YORK, NEW YORK 10038 F- ~ '~l ,:~, "i~p.,,~.,,~.~,~.~,. ~1~o~ N 290768 Dare ~. THIS CERTIFIES'~THAT only the eJ~tr~aJ equipm~n~ - Gerald~-j~gs, e/side'Jackson Landing, Mill~Road, Mattituck, L.I. R×TURE ~ - ' .. FIXTURES DIMMERS 3/0 MANAGER Riyerhead, .L.I.: 11901 Lic. 643E Q ~D This ce~tificc~te must nat be altered J~ d~y manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentiaJs. ISUFFOLK. COUNTY DEPARTMENT OF HEALTH Health Department Reference Number APPLICATION FOR APPROVAL TO 'CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Address Xd ~.~,~c~ ~- -- ~-~,~_~ ' . :6. Section- ' 2. 2roper~y Location J~j '%~,~.~ ~, ~ ~.~ 7. Lot Number ~ . t~ .I ~u ~ - 8. Private Well Village~c~]~]~r~[~dC_ TownsMp S'~~ 9. Public Water 3. Public Water Company Name Distance to main 4. Lot size: Width ~-7C) feet Length__l'-~O feet 10. Sewa~isposal System: (For Health Dept. Use) A.~t~allon septic tank: Precast ~ Equivalent Block B. Leaching pools: Number of pools r Precast'~Block Special ll. If private well, fill in the following blanks: A. Tank--capacity ~-(~ .gallons ~ZB. Pur~t~ G. P.M. ~'-. Totl~ well depth. O~L Dept~to ground water E. AmouQt' of water in well The undersigne~bCERTIFIES: "Construction of authorized installations Will be in accordance with thJ Suffo)~ County Department of Health's current ~tandards 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 ~, {¢7~ Signed__ :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the ~inion of the Health Department that an adequate and s~tisfactory Sewage Disposal System and Water Supply can be installed on this 'pl~oto APPROVAL DATE S-15 Rev. 4/1/73 CKSON'S LANDING SURVEY FOR GERALD JANIS AT MATTITUCK TOWN OF $OUTHOLO SUFFOLK COUNTY, N.Y. ~CALE', I#~ 40' JULY 25, 1973 ~ -o.~' ' - 16~00' $. 88~ ~4' 40" V~ LOT ' 12 REFERENCE: MAP OF JACKSON'S LANDING FILED MAR. 28,1969 FILE NO. 5280 LAND SURYEYOR N.¥~. LIC. NO. STEVENS $. 8~ 34' 40" W r'r~ DEPA~T~ _ LOT 2he Sewage disposal and rater supply facilities for ~hts location have hee~ .to be sat Chief of Genera! ~gtaeerla~ Services /2 All distances to wdls and cesspools are by location from house owners and field observations, since most wells and ce~s- pools am not visible these dimensions cannot be certified. Unoulhorized allerallon or addition to/h~s survey is a violatioo , ~ecljon 7209 ¢~ Ihe New York Stale Education Law. Copie~ ~ thi~ survey map not bearing the land su~eyo~'s seal or embe,~ed seal shall not be con~ d~-ed inke - , to be a valid copy person ~or whom ho <u~,~,- '- tecJ J.'~reon -'bali run only to the ' "~' ~ prepare~, and on his behalf to the t,lJ~ com~ony, governmental agency and lending institution listed hereon, and to the assignee~ of the lending institution. Guaronlees or certifications are not transferable to additional in~tilutions or ~ubsequenl owners. SURVEY FOR GERALD JANIS AT MATT[TUCK TOt~ OF SOUTHOLD SUFFOLK COUNTY~ N.Y. ~CALE : I", 40' JUL1;' 25, 197~ MA Y 23, 19 7,5 MAY 3, 1976 ~ TOWN OF SOUTHOLD ............... .............................. ' '- ~i~ravd ...... ....... ...................................... ......................................................................... ';/"7 ................. ..................... ....................... APPLI~ F~ BUILDffi~ pE~IT ... ~ST~U~O~S a. This application m~t he c~ple~ly fill~ in by ~ewgter ~ in i~ a~ s~mi~ in tripli~e ~ ~e Buildi~ Insp~tor, with 3 ~ of plans, ~umte pl~ plan ~ ~ale. F~ accoMi~ to ~h~ule. b. PI~ plan shying I~ation 0f lot and of buildings on premises, relationship to adjoining premiss or public stree~ o~ areas, and givi~ a detail~ description of I~out ofp~e~ must be drown on the diagram which is c. ~e work c~ered ~ this a~lication may not be comme~ed before issuance of Building Permit. d. Upon oppr~al of this application, ~e Building Ins~tor will issue a Building Permit to the ~plicant. Such permit~ shall be kept on the premises a~dable for in~ti~ th~h~t t~ ~rk. e. No building shall be ~c~ or u~d in whole or in pa~ for any pu~ose whoever until a Ce~tficate of ~cu~n~ shall h~e been granted by the Building Ink,tar. APPLICATION IS HEREBY ~DE to the Building ~ment for the i~uance of a Building Pe~it ~muant Building Z~e Ordinance of the T~n of ~uthold, Suffolk Count, N~ Yo~, and other applicable ~, O~inanc~ or Regu!~ions, for the co~tr~ion of buildi~s, a~iti~s or altemti~s, or for m~al or de~liti~, as hem!n d~ri~. ~e applicant agr~s to comply with all a~licable I~s, o~nc~, building c~, h~si~ c~e, a~ ~ul~i~s, admit authoriz~ inspectom ~ premiss a~ in ~i~ ~r ~es~ i~ti~s. (Signat co~o~ion) ................. ~ ......... l~.ai~....~,..~~6 (Add~s of applicant) Builder's License No ..................................................... Plumber's License No .... .~...~...~-~..~...~. ........................ Electricion's License No ............................................ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....~..~..~.~.Ia .................................................................................................................................................................... Name of owner of nrem ses / ~ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) '~' Other Trade's License No ............................................... ' Z...~....~..~A~ 1. Location of land on which proposed work will be done. Map No..~..~...~ .... Lot No ......... ./....~.. ......... Street and Number ............................................................................. : ................ ~.....i ......... .~,~lllii~ll.~.#...~..~'...'~...~.y, Municipality~ , 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..... .~.~.~-...]~.~...~... ................................................................ ~,: z[ ..T.~,'~~ ~s e~ ...... '""'"" b. Intended use and occupancy ...... ~. ................. /.., .............. /.~..~....~.. ................................. '"".'..'"' 3. Nature of work (check which applicable): New Building ~ ....... ~.... Addition ..................Alteration ............. "~.. Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) 4. timated Cost ...... ........ ......... ............ ................................................... (to be paid on filing this application) 5.If dwelling, number of dwelling units ........... J ............... Number of dwelling units on each floor ............................ If garage, number of cars ........ ~ ............................................................................................................................... .,~c~'"lf business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ ~ 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 ......... J...7..O..:. .............. Rear ...... -J..7...~..~ .......... Depth ...... /.~.~...~. .... Height ....~.~,..m. ...... Number of Stories ......................................... ~ ...................................................................... .......................................... Depth ............................... 9. Size of lot: Front ........................................................ Rear , Purchase ........................................................ Name of Former Owner ..~.~-~....O..../~....S..........~..~..~...~.x'.~. 10. Date of 11. Zone or use district in which premises are situated ..~....~..~.l~.j~...~'~....f~-.. ............................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... .~...~.. .......................................... (~o 13. Will lot be regraded .......~....~'.....~?. .......... Will excess fill be removed from premises: ( ) Yes 14. Name of Owner of premises .~JJ~..~..~...~.~. ........~'~J~/~t.,~ ........ Address ..--~;~..~..~.~.~ .~./...~.'JPho~e No. 7~.,Z.'7.....9/.....~..? Name of Architect ~ Address ........... Phone No ..................... Name of Contractor ..~ .~..~.. ........ ~./.J.~.. ............. ^ddres$ ."~l'l/..~'.~...°..~..~...t~..'7.-~h°ne No..7.~..,':.~.~....~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, 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 corner lot. STATE OF NEW YOJ~K,//. I/ ~ ~ c COUNTY Of ....~~'~ ................................................................................................./ /'~' being duly sworn, deposes and says ti'mt he is the applicant (Name of i~Jvidual signing contrac~ above name. He is the ................................................................................................................................................................................. (Contractor, agent, co~orate officer, etc.) of said owner or owners, end is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contained in this application are tree to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application filed therewith. Swam to b~ me this . / ~ ~ ~oto~ ~ubli~~Z~..~.~n~ ......... ~~ .................................................. ~ JUDITH ~ JOKEN / (~gnature of applicant) ~ta~ public, Stale of New Yo~ ~ Ne, 82-0344963 Suffolk Coun~ ,~ ~mmllllon Expires March 30, 19~' k 4,"