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Home My WebLink About7164-zFORM NO. 4 TOWN OF $OUTHOLD BU1LIHNG DEPARTMENT Town Clerk's Office Southold, N. Y. Cerlificnte Of Occupnncy No. Z~01,8 Date July' 2~ 19. THIS CERTIFIES that the building located at . ~;h...&...~...~....l~.f ........ Street Map No..Cap. t .Xi~ Block No ........... Lot No. 170 Mattituek conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... .&p.r.~......~., 19..~.. pursuant to which Building Permit No. dated ......... ~r~..... 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~iVate o~ family dw~llin~ The certificate is issued to MoS,To Conmtl-uet~on Co~p (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Jul7 1 '19~1' b7 R° UNDERWRITERS CERTIFICATE No..N.~.7.~.~..~......J.t~. ?....~.~....~..~.. ............... HOUSE NUMBER ...... l~..0.... Street Ih~th Rd '~g nspec~or FO~M NO. ~ TOWN O~ ~O~THOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ~ 7.~ /4 '"/Ft "rue, OIL. ~o ...~.. ........ ~. ........... b.. ..................................... z....~.l .......................................................................... pursuant to application dated ............................... ~...~.~.~; .... 1~..., and approv~ by the Building Inspe~or. ..... Building Inspector FORM 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-ex'st'rig 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 dwefling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date ....~.g...~...~....~.?.~..? .~. ?....~... ......... New Building ........ ~'. ........... Addition ........ .... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..~.....~.~'~, .~..~. CO,,'t,~,~r~._ .~...~,,~.~ ~.f]~T J~'~-%'-~-,,~¢_j.~ Owner Or Owners Of Property ............ ...J~...~.'....'~..........~.....~...~.~..'~..!~.~ ...... ...C~...~ ............................... Subdivision ..~...f~..~.-.....~-....~J~.......(,~"~.~....lj~'l~ ...... Lot No...[.~...~..... Black No ............. House No ............. Permit No..'~.[.~..UI:...~.... Dote Of Permit I-j j~J I').~. Applicant I~.S~- C~-~;.r~.~.ur~('i~,-,~ Health Dept. Approval ~J '~ ~'~ ~ Labor Dept. Approvol Underwriters Approval N J'-)l ~cj~.j Planning Board Approval Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ ....:.~............ .................. Construction on above described building and pe, r.m~ meets all applicable codes and regulations. Applicant ................ ~......~ .. %...~...q~.. ~..~ ........ j]__~ ................. Sworn to before me~.~,.~_~ (~ ,,~ ..... ~...Z. doyof ..~I.....L...~..~L..~... (stomp or seo,) Notary Public .................................... County SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Address ~ ~, , h,,~ ~,~c~ ,~ 2. Property Location 6~~'~v~ ,e~. ~ Village ~'~ ~ ..Township 3. Publ i c Water Comp~n~ Na~~ ~'~ ~ 4. Lot size: Width/F feet Length ~ feet lO. ll. Subdiv~P_ . W~p~ ~Srm~'l~J 5. 6. Section ,~ 7. Lot Number 8. Private Well 9. Public Water Distance to main Sewage Disposal System: A.~ ~j~-gallon septic tank: Precast ~Equivalent Block B. Leaching pools: Nu~l~be~of pools Precast ~ Block Special I~,:priva~Well, fill in the fot.)Owin~blanks: ~t (~', A. Tan~apacity._~gallons B. PU~'~ G.P.M. ,i:~Yv C. ~al well Yepth D. ~pth to ground water E. /~nount 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 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 ~," -/'.., 'T SIGNED 169 '~ ~ NOTE: · -' MONUMENT SUBDIVISION MA P FILED OF THE CL E/qK OFSUFFO/ K COUNTYON dAN./9,/949ASFILENO. REVISIONS YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR: I~. S T CONSTRUCT/O/~I COt~P I OT ~ 170, "CAPTAIN KIDD ESTATES" AT MA TTI TUC~ GUA"ANTEED TO: TOWN OF SOUTHOLD s~o~ co., .. ~. ~~~ SCALE: /': ~0' I DAT E: ~ P~. ~1/~ ~:7~ - ~ g/.., THE r. OCATION OF WELLS AND CESSPOOLS SHOWN HEREIN ARE FEOM ~ZIELD OBSERVATIONS AIID/OR FEO~f DATA OBTAINF. D F~OM OTItE~$ NOT£: · -' M 0 NUMENT SUSOIVI$10N MA P FILED IN TIlE OFF/ ¢£ OF rttE CLERK OFSUFFOLK ¢OUNTYON dAl~. 19~ 1949A$ FILE NO, 1~72. R U'I'H REVISIONS YOUNG & YOUNG 4.00 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR: LEONARD HACK ~ MA~ILYW 8. HAC~ ~ OT ~ 17~ "CAPTAIN KIDD ESTA T~ ~r~ TOWN OF SOUTHOLD ~,~ su~o~ co., .. v. ~~~// ~: i"= 30' /_3 TOWN OF SOUT~OLD ~: '~' TOWN CLERK'S OFFICE ~S,~,~,,~_~-~ /,~.~.~,/. ~ ~/~ ~ ~ ~UTHOLD, N.Y. ~/~ ~,/, ~ ~ ~~ , , ,, ......... Examined .................... ~....~:....., 19.....,. ~pp 'c 'o ....... ,. · ~ .... ~,.ov.~ ....................... - ...... .~......, ~¢....z.P..~,~ N. ........ ' .....' .......... ' .............. ~ v~'~ , ~'~~ ......... ......................................... ~..~ .............. , ................ ~s.~. ~ ~ ~~, ~- (Building Insp~tor) ~ ~ ~ '~' / ' ' APJ~'~ON FQR-'S'U~ING PERMIT ' ~ 4Fl/~/~.:'~- ~"~* ' Date . .. This application m~~ by ~pewriter o~ in i,k and s~mitt~ in triplicate to t~ Buil~g Inspirer, with 3 ~t, of pla~mte ~o ~ale. Fee acceding to ~h~ule. b. P~t plan s~wi~g ~ation of lot and of buildings on premises, relationship to adjoining premises or public struts areas, and givi~ a detail~ description of layout ofpr~ must be drawn on the diagram which is ~ of th~ ~lica~. c. ~e Work. Covered by this application may n~ be comme~ed before i~uance of Building Permit. d. Upon approval of this applicati~, the Building Insurer will issue a Building Permit to the applicant· Such permit shall be kept on the premises ~ailabl. for inspection throughout the work. e. No building shall be ~cupi~ or used in ~ole or in pa~ for any pu~ose whatever until a Ce~ificate of ~ncy shall have been gmnt~ by the Building I~ector. APPLICATION IS HEREBY/vtADE 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, end 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 in buildings for necessary inspections. ~ gnature et app, cant, or name, ir a corporattoru (^ddress of applicant) State whether apphcant ~s owner, le~ssee, agent, architect, engineer, general contractor, electrician, plumber or buil~ Ow~-~-- / ~,~. t)~ . .' ...... ....................................... ; ................__~' ..... ~ ......................................................................................................... ~...... Name of owner of premises ~ ~~C*l~ C~. :~ If applicant is a corporate, signature of duly' authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No. ''~ ~O ° ~ ' Other Trade's License No ............................................... 1. Location of 'and on which.~(zooseclwork_wi,l be done. Map No.:~,:.:.?~..?....~.....~.~,..~ot No. Street and Number ...................................... ........ ~.,,.r~.,,....,l.,r~,.,,l~,,.:..~ ...... Municipality 2. 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 ~.t~ %{;:)~t"~,~. 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) 4. Estimated Cost .................. 7~ ........................................ Fee '~')"' (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 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 ....... t.,~.~..,.,.t~ .............. Rear ......... ~-~.-..1~1,.... Depth ...... Height .......~...t. ..... Number of Stories ................... .~)~..~..~..'"'~... ............................................................................... 9. Size of lot: Front ......... .~.~...~ ................................... Rear ............... .j...~..?~ ............... ,~ ----Depth ....... ...'~ ................ 10. Date of Purchase ....................... -'t. ............................. Name of Former Owner ..~l~...t~..ee~ 11. Zone or use district in which premises are situated ..~q...,...~:~.~,~ ......................................... 12 Does proposed constrUction.violate any zoning law, ordinance or (egulation: ............... J~,4.~.....~....: ................. t3.~ Wi -Iot'be reg~c~le~l ,. ...... ..~..-[ ......... W excess f be removed from premises: ( ) Yes ( ~ 14. Nameef~Qwner of premises ....l~.,~.1~......~.~...~_['.t~...~ ........... Address ................................ Phone No.~.~;~:.~. Name of Architect .............................................................. Addre~:s ~ ..................... ' .......... Phone No.;..;..;,~..',,.'. ' '.,~.,~.~:~ Name of Contractor ......~...~.?.......~l~.~.31~.~l~f~w~. Address ................................ Phone No. - PLOT DIAGRAM Locate ClearLy and distinctly all. buildings, whether existing or proposed, and indicate al'l set-back dimensions from property lines. Give street and block .number or description according to deed, and show street names and indicate w~ether interior br corner lot'. STATE OF NEVV~X)RK, J S S COUNTY OF .~ ....... J ' ................... ;.~rj[. ................................................... being duly sworn, deposes and says that he is the applicam (Name of individual signing controcf) above nbmed. He is the ..................... : ............ ..~...~...A~,..?~.~.. ,~..~...~....~.....~ ...................................................................................................... (Contracfor, age~nt, corporate officer, etc.) of said owner or owners, and is duly ~'~horized to perform or have performed the said work and to mal~e and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner Set fo'rrb in the applicati~,j~led therewith, Sworn to before me this ' / ~/ . .... ..................... JUDITH T, BOKEN No. ~'034~963 Suffolk County .~ Cornmls~ie~ F-~pires March 30, 19.__ THE NEW YORK BOARD OF FiRE UNDERWRITERS ak BUREAU OF EL,ECTRIC¥1'Y I~ 85 JOHN STREET, NEW Y~RK, NEW yoRK 10038 THIS CE~IFIE5 THAT ~.S.T. Const~., Ruth Road, Ma~t~uck, L.I. inthefollowing~ation; ~ement ~ IztFL ~ 2~ FL outside ~t~. s~k ~.~a~i~o. July 15, 197~ andf~tobeincompliancewiththe~uirementsofthis~rd, DRYERS FURNACE MOTORS SERVICE DISCONNECT NO. OF ! METER 1 100 CB ' COOKING DECKS OVENS DISH WASHERS AMT. I(. W. [ AtAT. K.W. k~T. K.W. TIMECLOCKS BLR1 UNITHEATER~ MULTI-OUTLET V I C EXHAUST FANS DIMMERS WATTS A. W. G, NO, OF NEUTRALS A. W, G. IFurnaees~Otl 1-1/Shp, 1-1/12bp Ronald R. Ennls, P.O.Box 202 ~lddle Island, L.I.11953 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. 2 D'L'D '~ F