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Home My WebLink About7084-z1~0~ NO. 4 TOWN OF $OUTHOLD BU~.~ING DEPART~RNT Town Clerk's Office $outhold, N. Y. Certificete Of Occupancy No..Z.6.~.~.~ ...... Date ..............Feb.-. ~ .... ,19.76. THIS CERTIFIES that the bui]dlng located at .. E./.8 · ]~y .Ave ............. Street Map No. oc~z ........Block No. z~z ......Lot No..z~..~.ttit,mk.. 1~.,¥, ........ conforms substantislly to the Application for Building Permit heretofore filed in ~h~.~ office dated ........... J. an...7...., 19..7.bt pursuant to which Builcl~ng Permit No.."~08~Z. dated ..........F~b ..... 1 ~.., 19.7~., was issued, and conforms to sll of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .P. ri.v. ate. o~le. family..dwelling .......... (a~pr. qv.e.d..b.y..B~I., .A. pp.e.a..lp) The certificate is issued to .. E~wa~d. Ya~ke .......... ?w~er ........................ (owner, lessee or tenant ) of the aforessid building. Suffolk County Depsrtment of Henlth Approvsl .... N.o.v. ,. .1.3. ,..1.9.7. S...-..~ 4..-.~.0.-. 3. .... UNDERWRITERS CERTIFICATE No. ?. .2 .2 .3.2. ~. 7 ................................... HOUSE NUMBER ..... 209~. ....Street .....~ay. A~e ..... l~;.~itu~k ............ Building Ia~-~Ymr I~O~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL · CC~IPLETION OF THE WORK AUTHORIZED) No. 7084 Z Date ..................... F~ ..........1..~ ............. , 19..~. Permission is hereby granted to: ..,~.~ ~.~,..Xa~l~e ................................................. ....... ~L....,~umm~ ~.J~r.i~a .................................. ............ ~l,.t,h~(,-~r~... · .I~.,.X .,. ............................... to ~.!~...~.e.~....°.~,e....~.~.~..~ ~ ...................................................................................... (approved by Bd A ~eals) at premises located at ..,~.S....~&~'..~.Y~* ............................................................................................. .......................................... .~a,f, .t,1 ~,~Y~ .... ~, Y~ ~ ................................................................................. pursuant to application dated ..........................~ ....... Z ............ , 19.?..~...., and approved by the Building Inspector. Fee ~....6..?..0...~. ............ c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of 'this application, the Building 'lnspecto~ 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 pa rt for any purpaee 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 Buildi.ng Permit pursuant to the Buildir~.. 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 alteratians, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and raguldtions, and to admit authorized inspectors on premises and in buildings for necessary ir-mpections. (Signature of~gicant, or name, ,f a corporation) .................. ........ ............ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................... ...... ....................................................................................................... Name ofowner of premises ...~.~... --~.. f,~... ~. ~ ............ /~. A/....~.~.~'~ ............................................................................................ 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 ............................................. Other Trade's License No ............................................... Location of land on which pr.~ work will be done. Map No.: ......... : .............................. Lot No...~ ............... Municipality State existiag use and occupancy of premises and intended use and occupancy of prapmad construction: 2. Nature of work (check which apl New Building . ............ Additi ............... Alteration Repair .................. Removal .................. Demolition .......... .Other Work .................................................... (Description) 4. Estimated Cost ....... t..~. .......................................... 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. ~men$~ons of,ex st,ng structures, If any:. Front ............................ Rear ..EL~g ....................... Depth ~..~ ............. Height .../.D. ................ 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 ....~..~.~. .......................... Rear ...../7....~.. ................ Depth ~,~.~...~ ........... Height .../.,~....~ ....... Number of Stories ..../.. ........................................................................ 9. Size of lot': Front ../..,~...~ .......................................... Rear ...~.....;~.....~ ........................... Depth :~' ~' 10. Dote of.Purchase ~:~...~...~....~........./..~.....~...~.. ................ Name of Former Owner...~..,~...C/.~',(~/E....~,~./;C.J~.~-'.~.... 11. Zone or use district in which premises are situated ......~../...~...&..~..~..~........~...~..dl'4~.~... ....... ~...L~..~,~.~.../...~'....IC~.. .......... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........... ~..~. ............................... 13. Will lot be~regraded ...~..~'~.~. ........... Will excess fill be removed from premises: J,.- )_ _Yes ( X~ No Name of'Xrchitect ..... ~.._~....~. ~ ........................................ Address .::F..6~'....~../a~.. ............... Phone No....~./~...~...~.T... ..... Name of Contractor .,~...~....~..~-:'.. ........................................ Address ....~./~.../.~...~i~T.. ............. Phone No. ~/~..,~..'~.. ..... PLOT DIAGRAM Locate clearly and distinctry all buildings, whether exist ng or proposed, and indicate all set-back dimensions from p.r~.erfy 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 ......... ~.~.,~.,~.~l~. ...... ; that he is the applicant (Name of i~ividual signing contrac~ above name. He is the ....~A......~.....~.~~ ........................................................................................................... , (Contr~or, agar, co~mte officer, etc.) of said OWner or owners, and is duly' authorized to peHorm. ~ have peH~med the said work and to ~ke and file l~ ~ FOR~[ 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: 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 .~'...'~.~.~.:... i .~....~..,..../. ¢.~...Z...~.Z ...... New Building .../~' .......... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .~.~.....~.:~,¢J..~'~..j~..~ .......~z~......~..6......,~.. /.~ ....... ~,~..¢...~.~..~../...~......~..'.~.. ......... Owner Or Owners Of Property ....~.~¢~.~.~../.~ ~Z .......'.~...~..~..'.~.~..: ................................................. Subdivision ........................................ ..~. ..................... Lot No...z~.. ....... Block No.....~ ....... House No~.~,...~....~- Permit No. ~..~.-..~..~...~... Date Of Permit .//.2/.~/.....Applicant .~.,¢~... ...... ~..~.~.x~..~.'...'~-..: .............. Health Dept. Approval 'i/~.?.?.~.~.......~.~...~...0.~.....~.. ...... Labor Dept. Approval ................................ : ............... Underwriters Approval ...~..I.,...~...~:....~..,..~,....~....7... ............ Planning Board Approval Request For Temporary Certificate ........................................ Final Certificate l ' Fee Submitted $ .................................... Sworn to before me this, .... · .~......~... day of ..~.~..~.....~.. ..... Construction on above described building and permit me~.,~ all applicable codes and regulations. pplicant ....~'¢~.~,~. . ........... '~"'~; ~?~'~'~; ........ (stomp or seol) ;~¢' LOUIS M. DEMEO Notary Public, State of New York Ho. 52-4508548 Qualified in Suffolk County --~ Core.ss:on Expires March 30, ~9.~. SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant~L'-~/~z~ ,~2W,/~'~~''~ Phone ~;~_~/-.~/~(~ Address '~1 ~~ ~. ~/~1/~ ' ' ' 2.Property L6cati6n. ~/~, ' ~ ~,}~ .~ ~ ' ' V~llag~ ~,~.;~_~ Township ~,~Z~ 3. Publ i c W~t~W Cb~ny '~me /~x~ ~ ..... 4. Lot size: Width I~D' feet Length -~D feet lO. Sewage Disposal System: A.~gallon septic tank: Precast ~Equivalent Block B. Leaching pools: mum~er o~/pools PrecastlF~Block__~pecial ll. If private well, fill in the following blanks: 5. Subdiv. 6. Section 7. Lot Number 8. Private Well 9. Public Water Distance to n~in (For Health Dept. Use) A. Tank capacity J~'o gallons B. Pump G.P.M. C. Total well depth D...Depth to ground water E. Amount of water in well '-j'~: J The undersigned CERTIFIES: "Construction of authorized installations will be in accordance With thcs: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 curren%ilocal Building Department Permit is in effect. ......................... ::::::::::::::: ..................... ~ ............ 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 inst~lled on this plot. APPROVAL DATE ,/",~"~,~),, SIGNED S-15 Rev. 4/1/73 , '~ ' YORK BOARD OF FIRE UNDERWRITERS ~: ,' i,~ ~,' THE, NEW ' R~^U OF ~C~R,C'TY .K ~OO~ ~ ., BU W YO I i, .... _. .... T NEW yORK, NE I~.! O r')"~t'~q7 ~, ~-- ~ . ~ [1[ ~ ,~ ,' , ~ ~ A"O ca onNo. onJd~ '~5~u . ~ ' T~IS"CERTIFIES THAT ; t , ', "ed below and introduced by the apptlcu -- ~ I theelectrcalequipment~descr~° ~oe~ue~ Mattituck, '~'~* ',, ~,,' =award Yankee,' ~"' 7 ~ s~t,o- ,,,o ' [975 ,~ ~xamlned,an. ,May 2, 27 ' ~u~u.~ APPL ,DRYERS URNACE MOTORS 1 APPARATUS: : L~l/ShP~ 2-1/12bP *Furnace/s . ~_~/ : 1-2#12, aFuture Appliance ~=~ .... s Motor/s: 1-1bP. 1-3#6 ~rkel Electric Inc_. ~ Blvd. lO .Drawer" G"-Tll urana D Deer Park, L.I. 11729 D .... N.~ 2o58'~0"W 94 "'"' BAY ELEVATIONS ARE REFER~CED TOAN ASSUMED DATUM. -' ~': o~ GOLD KEY ESTATES,. INC. MATTITUCK ,ow. o~ ~o,~ ~;~ ~ SUFF. CO., N.Y. ///*~ ~ RIV[R~ ~ N.Y. 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