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Home My WebLink About7095-zFOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at Blossom .l~e~l ............. Street Map N~..t.~.,..~..~.t.:. Block no ........... Lot no.. ~? ....... ~.t.t.~.t~ .~... ~:.~: .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...........~.~.b .... .28.., 19.~.. pursuant to which Building Permit No.? .0~..~Z... dated ........... Feb...~/ .... , 19.7~., 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 . Pl'~l[~;.e...o~..~..f.~.~..~.ly...d.w~..1.1..~. g ....................................... The certificate is issued to . .~[~I$. &..E.l$,~b$.t~ .g..h~.:l. ll.t~' .....0~?~s.. ~.~. ....... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ... ,l'.llly. ~,~...1.97~'....bY. ~ .¥$~1,~& UNDERWRITERS CERTIFICATE No. ~...~.7.2..~.~ .... J..l~..~....2.~... ~..9..7~. .............. HOUSE NUMBER ..... ~l.0. ..... Street ....B.].. 9.s.s..aS..B.c..z~. ........................ e ~ ~ ) ..... Building Inspector FORM NO. ~ TOWN OF ~OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 7095 Z Permission is hereby granted to: ...~.....~a~ms..at ............................................... to ~..~....em...,r.~t~...~tws.13,t,~ ..................................................................................... at premises located at ..~..~.~..1~........~... ........... ]~,.~.lii.~.ll~ll:..,.Z,~ta.t,~ .......................................... L pursuant to application dated ......................ff.~]). ......... ~.~ ............. 19.~..., and approved by the Building Inspector. ]J'O~l 11~1~. el~e lei; ])~liZl 1~ &z'eJi~teet lelL~ Fee $....'t...~..e.! ~. ...... Building Inspector THE NEW YORK BOARD OF FIRE UNDERWRITERS 8. k BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 1OO$8~ ..,t,.:.l:¢ 26. ~7~ ....,,-~o..~,~ 72~o62 ,. N 172993 THIS CE~IFIES THAT in the/oiling ~atlo.; ~ fl~e~nt ~ 1st Fl. ~ 2~ FL outs&de ~tlo. ~t~A ~t ~ ~i~i~ o. July 22. 19 7~ ~/os.d to be ~n ~mplla~e ~ith the requirements of this ~rd. COOKING DECKS OVENS D~SH WASHERS /*,MT, K.W. ] AMT. K.W. MT, K.W. I 1 1.5 MULTI. OUTLET SYSTEMS NO. Of FEET SERVICE DISCONNECT NO. 0 S 1 200 CB 4/0 OTHER APPARATUS: especial receptacles: 1-30amps., 1-50amps. Water heater:l-q. Skw Elco.room heaters: 2-2.0kw, Motor/s: 1-1/2hp V I C Sapana~o & M[neo Inc., 102 Oak Avenue. Shirley, L.I. i1967 EXHAUST FANS DIMMERS OF NEUTRAL 6-1.5kw, 1-1.25kw, 3-1.0kw, 1-. ?5kw, 3-. 5kw m MANn. Bt 11 , Per L..(~._~, , SUFFOLK COUNTY DEPARTMENT OF HEALTH Heal th Department Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 3. 4. 10. Applicant~ Phone Addr,~s Prope3'ty Location Vil~e ~. Township Publ~ Water Company Name Lot~ize: Width feet Length Sewag~isposal System: A. ~)/-gallon septic tank: "Eq Prec. · uivalent Block B. Leaching pools: Nun~ber of pools ~ Precast 7(YOBlock Special Il. If private well, fill in the following blanks: A. Tank capacity B. C. D. E. gallons Pump G.P.M. Total well depth Depth to ground water Amount of water in well feet 5. Subdiv. 6. Section 7. Lot Number 8. Private Well ~ 9. Public Water Distance to main (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 p)ot. APPROVAL DATE ~//~;~F'/z?Y SIGNED S-15 Rev. 4/1/73 APPLICATION FOR BUILDING PERMIT Application No..~....~..,~..f.....'~... ............... INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Buildin Inspector, with 3 sets of plans, accurate plot plan to scale. Dee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets al! areas, and giving a detailed description of layout ofpraperty must be drawn 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 permitt,~l 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 Cert,ficate 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 ren~val 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. ..................... (Signature of aPplicant, ~ name, if a corporation) ....... (Address of /, ~! State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... ................................................................................................... ............................................................... Name of owner of premises ~.~.....~....;'~[.?mt~T~'~...:....~..~..~...~. ........................................................ If. applicont/rgla corporate, signatur, e of duly authorized officer. ....g'~.....l.~!~~ ...... (..~ ...... {~Name and~c~6 of co~lecrate officer) Builder's License No ..................................................... Plumber's License No .... .~ ....... ..'.... Electrician's License No. :~.~'~.~...~..~l.1~4~- Other Trade's License No ............................................... proposed be done. No.: 1. Location of land on which work will Mop ....... ........ ~ ...................... Lot No..,~..~ T Street and Number ~1~.~j~.~.~$s~2~.~..~j~F"~`4~~.~/~-~E~.~.~.~1~j~.~~ '- '- ----%-~~ ! Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .....~L~~... .................................................................................................... b. Intended use and occupancy ....... .~....I.~.~.~l~u,, .......................................................................... '.~. ..... 3. Nature of work (check which applicable): New Building '..~.~..~-~ ..... Addition ......... ~ ........Alteration ....~. ............. Repair .................. Removal .................. Demolition .................... Other Work ...................................................... ~-- (Description) 4. Estimated Cost .?...~..~.J.O~l~.....~... ............................... Fee .~J...O...~..:....'..:. ..................................................................... (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 ............. "T. .................. Depth .................... Height ........................ Number of Stories ............................................................ ~1 ........................................... ~i'/ ...... Dimensions of same structure with alterations or additions: Front ...~. .............. Rear ..~ ......... Depth ................................ Height ............................ ~umber of Stories ................................ 8. Dimensions of en.,tire new construction: Front ....~,'~...~.......JtJT ................ Rear ....~-.~...J.. ........... Depth ...-A..'~.....%~. ........ Height ....~ .... Number of Stories ..... ~ .......i ................................................................................................... 9. Size of lot: Front ...... ~J0.0.~ ......................................... Rear ...... ~......I. o4Q .......... Depth ...~.~....I. .............. 10. Date of Purchase ....'. ................................................... Nome of Former Owner ..... ..'T ................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... ]~2..-.. ....................................... 13. Will lot be regraded' ......~-~. ............Will excess fill be removed from premises: ( ) Yes (~,~[ No 14. Name of Owner of premises .~l,[..ll~.l~.,~.Jr.J='--,...f~.~..~...T~..'~!.... Address ......... ~ .................... Phon~ No ....................... Nome of Architect L~t[~.~'j~.l/..(~.....~J..~.......i-- -- ..... Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... 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 v~.p,K~,/, . COUN%OF ~.['~"~ ................. ~....~. ~j~-.'~J~.'~.~.. ..................................... being duly sworn, depose, s and says that he is the applicam . ~ ~'. (Name 'of individual signing contraCtO -~ove named. He is the ......... ~o.I~.~.I~..~.~....¢Z .~.~..l...¢:1~"~ ................................................................................................................ (Contractor, agent, corporate officer, etc.) 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 contcfined 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 application filed therewith. Sworn to, before me this ........ n , ............. Notary Publi~~,,,~~County ............. "~ '~"" ' ~~l~ii~ ~ n t ) ...................... JUDITH ?. ~OKEN Notory Public, State ef Ne~ ~or~ No. 52-0344963 S~ffolk Counl~,~-~'' Commission Expires March 30, SUF~-OLK AV~_/~U~' ~ r TITLE NO 1280022 ~ v. ;~::~ - ~ ; o~ H,$ e~,^~ ~o tH~ · :MONUMENT ~¢ ~U~,~N US~[~ ~ON, A~O OFTHECLE~OFSUF~OLK COUNTY~ ~. ~uA~s A~[ ~o~ ~ ~P~O~Ig~ASF/LENO. 4453. REVISIONS YOUNG & YOUNG APRIL26~I973 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W YOUNG JAMES M. CHRISTY 8~ ELIZABETHt~IS TOWN OF SOUTHOLD ~' ' ~ TITLE NO. 1280022 V ~ ~-~ _~ I CO~IES OF THIS SURVEY ~AP NOT ~ARIN~ tJ ~ J ~~ THE LAND SURVEYOR'S INKED SEAL OR H ~ I~ o ~ ~ ~ X. NOFF~DIO~ FROM DATA OBT~HED FROM OTHE~ ~ =MONUMENT SUBOIVlSION mAP F/~ EO IN THE OFFICE ~ TH~ C~ ~ OF SUFFOLK QOUNTY~ S~P~,Ig~ASFI~ENO. 4453. A VE-iVU~ Lot DIETZG£N 135 11846 REVISIONS YOUNG & YOUNG~ SURVEY FOR: ~. JAMES M. CHRISTY ~ ELIZABETH A.CHIJlST, Y~ LOT NO. 27, "MATTITUCK E STAT E S,I NC?~.*,~~ , GUARANTE:£D TO: AT M ATT I T U C K THE TITLE GUA R AN TEE CO. SUFFOLK COUNTY NATIONAL BANK TOWN OF SOUTHOLD SU FFOLK CO., N.Y. e~,/~.,~ SCALE: I" = 40' J°^TE:APR. 25,1973 73 - 372 4 APP~.OVED AS NOTED 1. BEFORE BACKFILLING FOUNDA, 2. BEFOEE COVEEING PIPELINE ~, FINAL WHEN JOB COMPLETED T I /3'¥ -~