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Home My WebLink About7366-zFORM NO. 4, TOWN OF $OUTHOLD BUII,IHNG DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy No ............. Date ............................, ~I LL I~6 L- THIS CERTIFIES ~at the b~l~g locat~ at ............................ Strut Map No. ~ ~ ~ ~ Block No. .Lot No. confoms substantially to the Application for Building Permit heretofore filed m this office ! ._/~L ,, V ' dated ...................... , zy .... pursuant to Which Building Permit No ......... dated ......................., 1 .,.., was issued, and co~otms to ~ of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ..................... .... ..... The certificate is issued to ........................................................ (owner, l~ssee"or tenant) of the aforesaid building. Suffolk County Department of Health Approval .~..~.c..~.../.~.~. UNDERWRITERS CERTIFICATE No ............................................. ~70 V'IL~./~;.: L ~- HOUSE NUMBER .............. Street .......................................... ..................... ~~ ~.~ Building Inspector FORM NO. 2 TOWN OF $OUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N:. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON T'HE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7366 Z Permission is hereby granted to: Ed, s ~,~..~,~ome ~...~; ~o.-...A./.C,. J~,...l~mt ~.tok,.Ge;is ..... ..~..i.~.h....~.9.~. ~ .................................................. .......... 3J.~lge .......................................................... to .B .~, .l&.. ~e~ .. c~e.-.i:a~.i.t~.. ~t~e;,.Z...~ ..................................................................................... at premises located at .~e/6...~)....~.l..~t~..]~:l-lO~ ................................. ~ ....................................... ................................................... V-i.?~t~ge...~e~ae ........... ~,a.t,t~-%uel+....N.,~.,- ................................ pursuant to app|ication doted ...................... e$I~-~ ....... .-I, .............. , 19.7~.., and approved by the Building Inspector. Fee $...~0.,60 .......... FOKI~ NO. 6 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: I. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date ...10./ll/..'Z~. ......................... New Building ..... ~ ........ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..~...~.~.~....,~.~-..c!.9.....~..~..1...]:~.~..~...,~.~9....8..0.. ....... .~....~.:...~..5.....~..~...~.~.%.~.u·.?.~ ..................... Owner Or Owners Of Property .~.'b.~.i.0.k...c~...~.O~r.~...~.~.$.8. ................................................................ Subdivision Y~-..~.~9...~.~.~.O..~. ................................ Lot No ........ .~. Block No ............. House No...8..?..O. .... Permit No..%~6~.!.~ ...... Date Of Permit ...~../.~L/..~..Zk...Applicant ..F~t.l~.O~..,~ll~t~...~.....(...~:.~..~..ik.z?.~.~..k GeL S Health Dept. Approval ..Z'..Z./....../... ......................... Labor Dept. Approval ............................................ Underwriters Approval ,.,,~,~,,,/,,O~,.,,~).,.~._..~:.....~.. .......... Planning Board Approvql ...... ...~.........~.. ................... Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ....... .~....:~..... ....... Construction on above described building and.,,pefmit ma.ets/alii api~lislable codes ~and regulations. ,' Y'f, . ,/, / A / Apphcant -....6..: ............................ ~.~.../.,.h; ............................... ~....v ................ /°h, M Sworn t~ before me this · .L ............ day at ...k¢¢. ............................. r ....... (stamp or seal) ~- 0, ~- 6 / ~ Notary Public .....~... ............ County SUFFOLK COUNTY DEPARTMENT OF HEALIH SERVICES Health Services Reference Number' APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY · l. ]3o,tPie'. "~"'~ 1. Applicant ~,}d non iomes iI~lo. Phone 9'~4-526~ 5. Subdiv. ' ~ ' f~lla, ,~ i~no aporox. 7. Lot Number 19 2. Property Location_ ,,gs~ ~Id% ~ ' ~ ~ · , .... Village 3. Public Water Company N~ 4, Lot size: Width_~.~d feet 10. 11, Sewage Disposal System: A. gallon septic tank: Precast 3. _Equivalent Block__ Leaching pools: Number of pools 2 ~ln. Precas$ ~ Block ~pecial If private well, fill in the fol- lowinglblanks: A. Tank capacity. ~2 . gallons B. Pu~ G.P.M. ~ C. Total well depth 60 Do D6pth to ground water E. Amount of water in well 8. Private Well ¥,~s TownshiR }oobhold 9. Public Water nonm ~o~e ~tance to main Length e~_feet (For Health Services D%pA, Use) The undersigned CERTIFIES: "Construction of authorize~ installations will be in accordance with the Suffolk County Department of Health Services' 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 ~ ~,./ (. ~(~}eL =============================================================================== FOR THE DEPARTMENT OF HEALTH SERVICES~ USE ONLY. Based on the information presented here- with, it is the opinion of the Department of Health Services that an adequate and satis- factory Sewage Disposal System and Water Supply can be.~ ~/.~.. ,dil}installed,°n ti)is plot. S-15 Rev, 4/1/73 THE NEW YORK BOARD OF FIRE~'UNDERWRITERS ak BUREAU OF ELECTRIC~ ): ' F- 85 JOHN STREET. NEW YORK. NEW:yoRK IO03~ .~,.0ctohe~ 2, ~ ~.,~.,~.~o.o.~ ~sO~e~.'~:~'~: .': N 185688 THIS CE~IFIES THAT ~ ~.m~ ~ep~e~er FIXTURE ~IXTU~S RANOES OVENS EXHAUST FANS OUTLETS SWITCHES FL~0~ESCE~T 12 27 17 12 DRYERS FURNACE MOTORS FUTURE AI~UANCE NEDEE$ SERVIC~ D~S(~hlNE~T S E R V I C 1-1/12bp Towle & Sons Inc., 33 Lincoln Ave., Mastic Beach, L.T. 11951 Per. ~.~ ~,-COPY ~BUILDING~_ DEPARTMENT. THIS COPY OF CERTIFICATE ~$¥~NOT BE ALTER= IN ANY MANNER, ZO Zl ,,07 ~/ ¥07 , 90'OZ g R~ ~o7 FOE~ NO. TOWN OF $OUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. ~proved ........................................ , 1~2.~ Permit No. Disapproved a/c ...... ~ ................... ~..; :.~.. ~. :..:~. .......... ~..~.~.~ .... . ................................................ ........................ (Buildin~ Inspector) Application No. '? ~ ~ ' APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 ~et~ of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing Iocufibn of lot and of buildings on premises, relationship to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproperty musl be drown on the 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 Permit 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 in whole or in part 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 Permit 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 code, and regulations, and to admit authorized inspectors on premises and ir~ buildings for necessary inspections. (Signature of applicant, or name, if o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. J:~uilctor & d-c,~nerr:',l ~ontrsctor J. Patrick Gels Name of owner of premises .................................................................................................................................................... If o~ican~7/is q corporate, signa/ture of duly authorized ~fficer. .................. i~ a~ title 5f coq~orate ~ffice~:i ......... Builder's License No ..................................................... Plumber's License No ................. .~.J'.'~-.,: ..................... Electrician's License No ............................................. Other Trode's License No ............................................... Localion of land on which proposed work will be done. M,~p Nc.:f.f...1.?:.a..¢,~.a.'...t'¢~t.:.°..?. ........... Lot No ..................... \r~] ~,-.- .ba~e tau,~J~tttok Street and Number ................................................................................................................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy b. intended use and occupancy orte ....................... g. 7:7...,. :'d, ........................................................................................... 3. Nature of work (check which applicable): New Building ....~{g..V. ....... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) O~ A)O Fee ................................................................................... 4. Estimated Cost ...........,7.,,.~ .......................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........... .1. .............. Number of dwelling units on each floor ............................ If garage, number of cars ........................ ·O..'.u..~...9.~ ....................................................................................................... 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 ............................ De th ................................ Height ............................ Number of Stories ................................ P 8. Dimensions of entire new construction: Front ...... ..4 ........................... ~ear ......... ~.. ................ ep n ........................ ~- ~ OlqG .................. Height . .]r.~. .......... Number of Storms .......................................... , .............................................. i4~,'( ..... 9. Size of at: ~ront .......... .~:l ................................................................................... ~ ......................... ' '" ~ 'it ............... Name of Former Owner ,,;.. .............................. 10. Date of Purchase 1 1. Zone or use district in which premises are situated .................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation; ......... l%P .......................................... 13. Will lot be regraded . ........... ~..~.i~ ......... Will excess fill be removed from premises: ( ) Yes (X) No 14. Name of Owner o~ p~m,ses .................................................... Address ...r ............................ Phone No. ~.~..7....6~.-~... Nome of Architect iqo:,?mau ,,',aul z,:u Address H&uppau~e Phone No. PlOT D~AGRAM Locate deaHy and distincHy all build ngs, whether existing or proposed, and indicate aH set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and nd cate whether interior or corner ~ot. STATE OF NEW YORK, ~ S S COUNTY OF .............. .~ ............... f ' - ............ ~.~ ........................... ¢ ....................... ~. ........................ being duly sworn, deposes and says that he is the appiicam (Name of individual signing contracf) He is the ....~.~{~...~..~.~.~.~ ........~.L.L.I..~:.~.....fl.~.~..~X:{~:4..a.~ ...................................................................................... (Contractor, agent, corporate officer, eta,) 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 tha~ the work will be performed in the manner set fo~h in the application filed therewith. Swornto before me this n --/) ~ · / .................... . ............ /"~ ........ (S gnature of applicant) INSTRUCTIONS 'reldtion'$hlP fo ~dJotning pmmia~ or public ~ m'Jl~ must be drown on rtjl~,~mm wJ~ ~ ~ ~J$ ~. ~'~ ~ of Building Rarmtt.. ~ {~ Permit to g~ al~ar~. Such I~ff I~ work. ~n I~rt for any purpose ~nateve~r ,.u~ C,~tificate of OccM~e~y adr~t pmmis~ an~ lt~ I , ! c~te, s of duly authoriz~cl icer. Builder's License No ................... Plumber's Liceme No ................... '~1.-.~ .................. Electrician's License No ..................... Street and Number ............ .~i~..~ .................................. ~[.~.~.IR~.~. ......................... 2. Stetdextsting ~use a~nd occiapency o~ Pre~i~es'ctnd i~ten~ed u~e 4~ncl~ of p ~NN~i~ ~eist~u~t~bn: a. Exisitlng use and occupancy .................. ~ ........................................................................................... ture of work (check which applicable): New Building ....~e~. ....... Addition .................. Alteration ........ Repair .................. Removal ..................Demolition .................... Other Work .................................................... .~..~ ~ O (Description) 4. Estimated Cost ...... ~..2.~QOQ .................................. Fee ......................................................................................... (to be paid on filing this application) ' 5. If dwelling, number of dwelling units ........... '1 .............. Number of dwelling units on each floor ............................ If garage, number of cars ........................ D~'lf~...{3~ .................................................................................................... 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 ....... 5.~.! ....................... Rear ......... 5~.! ............ Depth ...... ,.2..8..! ........... Height .....~5.! ........ Number of Stories .......... g~.e. ..................................................................................................... 9. Size of lot: Front .......... ]..0.Q.! ..................................... Rear ...... ~.~..0..~....~...~.,. .......... Depth ,..2..~...8. ...................... 10. Date of Purchase ............ .~./~,~/.?.~ ........................... Name of Former Owner W~l~.i~m..~.,...~$~.e.~ ............... ] 1. Zone or use district Jn which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .......... ~;~ ......................................... 13. Will lot be regraded, ............ ~ea ........Will excess fill be removed from premises: ( ) Yes (X) No 14. Name of Owner of premises ~^P.~,~.;~.0.k...C~;~I~ ..................Address~.~.~...,~,t...~9~-~..~..~ Name of Architect .ND~m3,~..~$.l~.~f~ ........................... Address ..~.~.u..]g~g.e.. ......... Phone No ....................... Name of Contractor .~,~oz~..H~;~me.a..Z,~0.c., ..................... Address~,~t,l,.~..~r,.,,.~,~f~eehone No.~.2...~..-.~...2..~...0. ..... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all setq3ack 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 YORK, · COUNTY OF ................................ ............ ~..~.~',,/'./..~.. ....... ..~...~......~..,,.~...~.....~.....~..:.~.. ....................... being duly sworn, deposes and says that he is the applicon, (Nome of individual signing car{trace) above named. He is the ....~.-~.C?...O....~...~../.~../~.. ....... .......... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove 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 appfica~t~gn fjled therewith. Sworn to before me this ......... ~,..~.~.'&:... day of ...... Notary Public,. .......... ~..~ ................ County ........ .....~. ............................... ~ r , ' (Signature of oppl c(:~t) / i.ot TIT£E IVO. 74S-71~$0 bot NOY£~ Lot UNAUTHORIZED ALTEEATION OR AO~ T ON TO THIS SURVEY 18 A VioLATIoN'OF ~ECTION 7209 OF THE NEW YORK ~TA?E E~UCAT ON COPIES OF THIS SURVEY ~Ap NOT,EARING WS ONS YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W, YOUNG HOWARD W. YOUNG PROFESSIONAL ENGINEER AND LAND SURVEYOR LANO SURVEYO.. N.Y.$* LIC. NO. 12e45 ~ ~0. 45893 SURVEY FOR: ~sx" -'" ~ PATR/C~ GELS8 SONYA GElS/~ ~ >~ ~ ~OTNO. 19,"VI~AGE MANO~"~(~ ~o~ ~ G UAR~NT~ED T~~ ~ i.ot NOTE: · -= MONUMENT SUBDIVI~ON MAP F/LEO IN TN£ OPPICE OF THE ¢£ EBI~ OF SUPPD L K ¢OUNTY ON dULY/8,1974 YOUNG & YOUN¢ 400 OSTRANDEE AVENUE, RIVERHE/ ALDEN W, YOUNG · SURVEY FOR: PATRICK GE/SS SONYA GElS \ IOTNO. 19,. WIIAGE MANOR" AT MATTITUCK TOWN OF .~'I311TH/")I I') I J I ,i' I II , i T ?