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Home My WebLink About7062-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPAIITMENT Town Clerk's Office Southold, BI. Y. Certificnte Of Occupnncy No.. Z..~939 .... Date .............l~Jay.,., 3.1: ..... , 19.71~.. THIS CERTIFIES that the building located at .ldaLnut. Av.~. &..0.~.k..P.I.~..a.e. Street Map No.. xx ........ Block Noxx~ ....... Lot No. XxX...J!la.t.t.J,i;B.c.k....N...Y.: ......... conforms substantially to the Application for Building Pemit heretofore filed in this office dated ..........~a.n.. 2.~..., 19..~ pursuant to which Building Permit No. 7.0.6.25.. dated ...........,~an .... 29.., 19..?bo 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 2rivate. one. £amily. d~el~_~,ng ~ .......................... , ........... The certificate is issued to ...~add_~.e.B.Qllir~g ..... Owner. ~2¥ ) .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . )f~Y...3~.. J. 97~...b.y..R.:..V~.i. 1..a... UNDERWRITERS CERTIFICATE No .... 1~..~.9~ ..... ~.~r.. ~.~...~.7.~. ........... HOUSE NUMBER .... ~0 ........Street... ~4alnu.t..,~¥e ........................... Building Inspector ~roB~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF: THE WORK AUTHORIZED) N.° 7062 Z Date Jallo ~9 1 ~....~. .... Permission is hereby granted to: Biverside Hones Ine A/C Waddle Bolling bax Rlverhead. H,~e 11901 Build ney one iam$1y dvelZing (ZOt &pp~oved by J~ Appeals) .... R,O,W ~E/8 Walnut Ave off Oak Place at premises iocate~ ar ........................... , ................................................................................................ E/S Factory Ave Mattituek ~.Y. Jan 2% 19.?...~. and approved by the pursuant to application dated ........................................................ , ..., Building Inspector. Fee $ ........................ ~ 'B~uildina Inspector THE NEW YORK BOARD OF FIRE UNDERWRITERS SW BUREAU OF ELECTRICI?Y . I--' 85 JOHN STREET, NEW YORK. NEW YORK 10038 ..,..,,ay ,7" Ap.,,.,,o.~o.o.,,,. 72 o2 " 159656 THIB CE~IFIES THAT ~ly t~ e~t~ ~u~nt ~ ~cd~ ~ ~ int~ by t~ ~l~nt ~ on t~ a~ ~ numar ~ ~ ~m~ of Waddle Bolling, e/s Walnut Ave., 22~' e/o Factory Ave., Matt/tuck, L.I. ~...~i~ ~ay 13, 197~ a~fou~incom~ia~ewiththe~ulrementsoft~rd. ~S~ ~AC~S ~ITCHES~ IN~ND E~ ~L~ENT ~ * ~RY~RS I mRNAa ~TOU I mTU.E ~m,~KE ~ S~,~L.K*. T~.S, ~ ~ ~T~m m~ERS SERVICE ~NNKT I ~' OF [ S R I C 1 ~00 CB x ~/0 2/0 OTHER ~ARAT~ ~lec. Eoo~ ~e~e~s: ~-~.0~, 2-1.25~, 2-~.0~, ~-.75~ Towle & Sons, Inc. 33 Llncoln Ave. Mastic Beach, New York 11951 Per 11 COPY FOR THIS COPY OF CERTIFICATE MUST NOT MANNER. FOP~I I~O. 6 TOWN: OF $OUTHOLD 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, o 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 Date ..... ................... New Building ...... ~ ....... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .... ~/~?~n~];~q~.AY~e~;4~2~/~~A~v~e~-~~~d~ ......... Owner Or Owners Of Property ........ ~,~..d.d..~.e....n..~.~...~..[..o.~..~.~.n.~ ............................................................ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No ......7.Q§.Z~. ..... Date Of Permit ....~.~.2..5..'..7.~...Applicant ~.v..e.~?.~.c]..e...,~.o.m..e..?~...~..~.c.... ........................ Health Dept. Approval ............. .6¢.~.O..-..8. ..................... Labor Dept. Approval ................................................ Underwriters Approval .[59656 ................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .5..O0 ........................... Construction on above described building ~ts al~~~, regulations. Applicant ....~.:-.;.m., ............. .~. ......... .¢ ..... Riverside Homes~ Inc. Sworn to before me this NoJ[~ry Publi; .~.~.....~_.~ County SUFFOLK COUNTY DEPARTMENT OF HEALTH Reference Health Department Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant Waddle M. Bolling Jr Phone Address Box 166~ Mattituck~ New York 2. Property Location East side of Walnul Avenue~, 224' East of Factory. Avenue, Village Mattituck - Tow,,~hlp Southold 3. Public Water Company Name 4. Lot size: Width/~ feet Length ~g~ feet 10. ll. Sewage Disposal System: A.~gallon septic tank: Precast ~Equivalent Block 5. Subdiv. 6. Section 7. Lot Number 8. Private Well 9. Public Water Distance to main B. Leaching pools: Number of pools f Precast~PBlock Special If priva~fe well, ~ill in the following blanks: A. Ta~C~ capacity ¢-TZZ~allons :~B. P~m~p G.P.M. C. TO¢~l well depth D. De~h to ground water E. Am6unt of water in well The undersig~d CERTIFIES: (For Health Dept. Use) NOTE CHANGE "Construction of authorized installations will be in accordance with the Suf~folk 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 i~l~,~o~,~~ Rf'-~m?~/?., j/c,.~-~v ~o Date /// ~,/~ ~ Signed ~IV~i,~ ,~, bL~ H~;02 :~:ZiZZi:iZ/Z_Z2ZiiZrZ_ZiZ_:i2Z ................................................................ 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. S-15 Rev. 4/1/73 TOWN OF SOUTHOLD BUIU)INQToWN ¢IA~K'$DEPA~TMF'NT~F'~ ~ ~-~ ~UTHOLD, N.Y. ~-~-~ '~ ~/ ~ r ~ ~'' ~: ........ : ............ ' .-'~' - .., 7~ ~ ~'~' ...... i~~ ~p ov~ ........................................ , lY ........ ~it ~o ..................................... (~ '~-' '' ~ ...... ............... .......... = ....... ............................................................................, ...............'~']]]~[,_~ .............. /~ ~ o. Thi~ ~llc0tion mint ~ compl~t~l~ fill~ in b~ ~p*wrlt~r ~ in i~ ~ ~mi~ in ~ripli~at~ to In~or,, ~ th ~ ~ o~ pl~,, Oc~u~te ~ plan ~ ~l~. ~ ~o~i~ ~o ~h~. ~ b. ~1~ ~l~n ~h~inO I~afion o~ lot and o{ building~ ~ pr~mise~, m ~t om~ip to ~djoin~ prem oreo~, ~nd'~ivi~ ~ d~toil*d d~criphon 6{ lo,out ofpr~ mu~t b* dm~n on th, diaor~m which i~ c. ~ W~c~r~ by ~ ~licotlon'm~y n~ b~ comme~ b~{or~ i~u~ o{~ldin~ ~rmit d. H~ ~1 o{ tBi~ oppllc~fion/th~ Buildin~ In,~tor will issu~ a Buildi~ ~rmit to th* opplicont Such ~hoU b~ k~ ~ th~ preml~ ~il~bl~ ~or in~ti~ th~hout th~ ~ork. e. ~o building ~h~ll ~ ~eupi~ or u~d in whol~ or in ~ {or any pu~se wh~r until ~ Ce~ifie~ sh~ll h,w ~en flrant~ ~ th~ Buildino In~p~tor. APPLICATION IS HEREBY MADE to the Building Deportment 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 lows, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. Rtveratde Homes, Inc. (Signature of applicant, or name, if a corporation) P.O. Box 2~/4, Riverhead, N.Y. 11901 (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ......W..~I~.~...~..D~Dg,..]~F~..~.~..],.~.,.....M~....J~....~..~..~.e..~.~ ...... .(..C. patz"zct ................ If~ oP~rat. __.........~~ficer. Builder's License No .................. -..~.~.~ ............................ Plumber's License No .... ,.~.,-~, ..'...~. ............................... Electrician's License No. ~.~..~..0..-..~ .............................. Other Trade's License No ............................................... Location of land on which proposed work will be done. M~p No.: ........................................Lot No ......................... Street and Number .~./..S.~..w~..~.~..t.~..~.v..e.~.~.~.~..4..t~..E./..~.f.~..~[~.~.~F~~ ...................................... 'Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ........ ,~.ACi]ZiL.]~lZ~ ............................................. b. Intended use and occupancy ......... .q...l~...-.~[~...l~.~J~l~ ............................................................................... 3.~' N'atu~e of work (check which applicable): New Building .: ...... ~ ....... Addition .................. Alteration ......~ .......... - Repair .................. Removal .................. Demolition .~ .................. Other Work ................................................ . ..... 4. Estimated Cost ....... ~[~,..~.~..0......0..0. ............................... Fee ~' ~' .o,o ...... (Description) (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 ~d ....................... Depth ....... ~'-" . ..... Height ......... ' ~ .......... Number of Stories ............................................................................................................ ' Dimensions of same structure with alterations or odd,[tions: 'Front .................................... Rear ............................ Depth ................................ Height ................ ~.,~'. ....... Number of Stories ................................ 8. Dimensions of entire new construction: \Front 38' Rear 38' Depth ....~..? Height ...~. ............. Number of StoriesI ..........[. ........................................................................................................... 9. Size of lot: Front ...... !.~.~ ........................................ Rear .......................................... Depth .~1.~..: .................... ~ uwner ........................................................ ] 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... [~.,~.~.~[~1'10. ....................................... 13. Will lot be regradecF ....... ~:~eS .......... Will excess fill be removed frj~l~ises: ( ) Yes (X) No 14. NameofOwneCr°o~pt?e~'ct ve~te~.~, o...,_~,..~.~:, ......... Address Me, ttttuc]~ Phone No. none 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 corner lot. STATE OF NEW ~0~,_~ COUNTY OF ~ ....... ................................................................................................. being .duly sworn, deposes and says that he is the applicanl (Name of individual signin§ contract) above named. He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of ~id owner or owners, and is duly authorized to perform or hove performed the said work and to m~ke 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 forth in the opplicoti6n filed therewith. Swam tO.~l~fore me this .. of ....... .......................................... J~ffi.t ? B~k~'~ (Signoture of opplicont) Note~/ Public, Ste~e 1283424 N/O/F (~) (~) SKI RuTH I N0~1 SUFFOL]( COUnty ~EAL_.; b ..... ~.~ _ ~he pewage disposal and water supply facilities for ~hls location have been inspected by this department ~d N/O/F KoNCHALSKI ORS. Unauthorized alteration or addition to this survey is a violation ot section 7209 of the New York State Education Law. Cop~es of this survey map net bearing the land surveyor's inked seal or embossed se~l ~hall not be considered to be a valid copy or certifications are not transferable to additional institutions or SURVEY FOR WADDLE M. JR. 8 GLORIA AT MATTITUCK TOWN OF SOUTHO£D . suFFOLK COUNTY, N.Y. SCALE: I" = 40' BOLLING · UARA NTE'EO TO: THE TITLE MIARANTE~ COMPAIIY U.S.A. FARMERS HOME ADMIniSTRATION WADDLE M. JR. S GLORIA All distances to ~lls o~ c~s am o ~ _ ~ ~1~ I~,~ by location from hou. o~ers and field OC~ ~1, J~ ~ ~,~ obse~ations, since most wells and c~- MAY 14, 1974 ~ ~. I ~b am not visible ~ dimensio~ I ~ ~ ~ ~ ~n~t ~ ce~ifi~ I dr APII~OVED A~ NOTED DATE: ~:~~.~--~-~ ~"~ EE':= ~ :-~Y NOTIFY BUILDING DEPARTMENT 765-2660 9~ TO ~ FOR ED INSUliNS: 1, BEFORE ~CKFILLING FOU' TION O~ START FRYING 2. BEFORE COVERING PIPEUN[ 3, FINAL WHEN JOB COMFLET~ NOT RESPONSIBLE FOR DESIGN OR // ·