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Home My WebLink About8867-z FORM; NO. 2 TOWN OF $OUT~OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT Fee (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COAAPLETION OF THE WORK AUTHORIZED) No. 8867 Z Sept. 17 76 Date ......................................................... 19 ........ Permission is hereby granted to: Frances Rose Homes Ine ..................... g..u..~.c...n..o. ~..~ ...................................... One family dwelling to ~-~ lot 2k Deep ~ole Ck Est '~'~', _ at' premises located at ................. : ..... .....; .............. :.~/..[ ............... : ........... ~:- ~ _ ..... ~ ................................ t't ....... .......................................................... ~, , ~ ' - ~=~- uu~a~ng InspeCtor. ' ...................., SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services r~ Reference Number ~-S APPLICATION FOR APPROV~ TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant~'~Fll~g~r, t~p~ ~ne .~V~"I~ ~ 5. Subd Address ~'~'~ ,~ '~ ~L, .~ ' , 6. Section~ 2. Ptopert~L~c~ t~[i~ ,~ ~'~.~ ~., ~~ ~/07. Lot NumbeF~- ~.., ~..t~ '~1~-~ ~''~'~ y -~ ~-' .' ~ 8. Private Wel~ ~g~~.~, Township kt~~ , 9. Public Water 3. Public Wa~r'C~~ ~}~ ~ Distance to ~in ,~ 4. Lot size: Width//~ feet Length~fee~ '~ 10. Sewage Disposal System: (For Heal~ S~rv~ces Dept. Use) A. 900-gallon septic tank: Precast Equivalent Block~ B. Leac~ng pools: Num~e-'r of pools PrecastV/ Block Special__ l'f pri~te well, fill in the fol- lowing blanks: A. Tank capacity allons B. Pump G.P.M. ~ ~ C. Total well depth ~0 D. Depth to ground water F. Amount of water in well 11. The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Heal th 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 Per~ is in effect. Dat(~~ ~. -" . 7~''"' Signed Y~[/ ~ (~ ~ FOR FHE 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 Sewag~Disposa~ System and Water Supply can be installed on this plot. Rev. 4/1/73 ~ ~'ob ~ 186 FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. Disapprovc~l afc ..................................................... , / APPLICATION FOR BUILDING PERMIT oo, ............... .............. ..... INSTRUCTIONS o. This apphcation must be completely ftlled in by typewriter or in ink and submitted in triplicate to the I~uildin, Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buddings on pram,sss, relationship to adjoining premises or public streets o areas, and giwng a detaded description of layout ofproperty must be drawn on the diagram which is part of this application c. The work covered by this apphcation may not be commenced before issuance of Building Permit. d Upon approval of this application, the Building Inspector wdl issue a Building Permit to the apphcant. Such permi 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 Occupanc; 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 th, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o, 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, bu. Lldh~ code, housing code, and regulations, and t, admit authorized inspectors on premises and in buildings for necessa~ in.~ections. (a~tur~p~net, or ~q/me, if a corporat,on) (Address of applicant) 1177~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ ................................................................................................................................................................... Name of owner of premises ............. ~z'.azt~3eus..~o~e..1Tom..es.t...I~3e ............................................................................. If applicanl is a co,orate, signature of duly authorized officer. (Name and title of corporate officer) Ben ~erl,dozza, ~res. F~ances Rose Ho~es, Inc. Builde~ s License No ..................................................... Plumber's License No .......... 2~.~..~ ........................... Electrician's License No ...... ..~)...?.....~. ........................... Other Trade's License No ............................................... Deep Hole Creek Estates 1. Location of land on which proposed ~ will be done Map J~....~2.~.6.. ................ l~ ..... Lot No ..~.~ Municipality 2. State ex,sting use and occupancy of premises and intended use and occupancy of proposed construction: o Exis~ting use and occupancy .............................................................................................................................. b. Intended use and occupancy .... .,1,..,~,...:J,~...,gtW.~l].~tJ~ ........ ~...~,~...~l~l~'.ag.e ............................................... 3. Nature of work (check wMch applicable). New Building ..... .~.. ...... Addmon ................ Alteration ........... Repair ................ Removal ................. Demohhor. .......... Other Work ................................................. (Description) 4. Estimated Cost .... .~.~.~.~,..~.. ............................. Fee ..."./...~....~ ..................................................... (to be paid on filing th~s apphcahon) 5. If dwelhng, number of dwelling umts ............ .~. ............. Number of dwelhng umts on each floor .......................... If garage, number of cars ..... ], .......................................................................................................................... 6. If business, commercial or m~xed occupancy, spec,fy nature and extent of each type of use .......................... 7. D~rnensions of exmting structures, if any: Front ........................... Rear ................................ Depth .................. Height ........................ Number of Stones ......................................................................................................... D~mensions of same structure with alterations or addmons. Front .................................... Rear ........................ Depfh ......... ~. ............ Height ...................... Number of Stones ............................... 8 D,mens~ons of ent,re new construct,on Front ...... ...~..~...:..,~. ............... Rear ..A~...~.....~. ........ : ..... Depth ...~ ......... Height .....~..~ ........ Number of Stories ....... ~...~.~ ........................................................................................ 9 S,ze of lot Front ..... ..~..~...0. .......................................... Rear .... .]:..]....0. .............................. Depth ........ ~..8..~. ............... 10. Date of Purchase ................................................... Name of Former Owner ...................................................... 1 1. Zone or use dmtnct in which premises are s~tuated ........................................................................................... 12 Does proposed construchon violate any zoning law, ordinance or regulahon: .......... DO ........................................ 13. W, II lot be regraded .......z.e..~ ............. Will excess f,II be removed fromjprerajses:.L L~'(O4-Yes (X) No Jf ~ L]. ~OX 14. Name of Owner of premmes ...]~...1~. g..e.~....~..o...8..e. ~..O.?..e..~.,..I.p..~Address .~,~oe~,en.,~.o,:j,mt,.. Phone No..,~.,...1~,~.... Name of Architect ........................................ Address................................~T'~' Phone No ...................... Name of Contractor .... .E}..~.~.e. .................................. Address ......~..~.?..e.. ................ Phone No .... ~.~..~.e.. ........ PLOT DIAGRAM Locate clearly and d~st~nctly all buddings, whether ex~stmg or proposed, and red,cate all set-back dimensions fron property hnes Gwe street and block number or description according to deed, and show street names and indmat: whether interior or corner lot STATE OF NEWr~OIZJCF~ /X,/ / COUNTY OF ....~%.. :~./~.. ¢/./C~ ..... ~ S.S .......................................................................................... bmng duly sworn, deposes and says thot he ~s the opphcan (Name of ~dlvidual signincl contract0 above horned ~--~ ~ * F2,DOZZA~ Pres. F~'ances Rose Ho'~es, Irc. He ,s the ........ ~..l~..!.~...e..zT.....~...o..~.]!.o..zT.a.~..e.....o...~.f..~..a..e...~.~ ............................................................................................. (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and is duty authorized to perform Or have performed the sa~d work and to make and f~l~ this application, that all statements contained in this applicahon ore true to the best of his knowledge and behef; that the work wdl be performed in the manner set forth in the appJ~c~'d~n filed therewith. Sworn t.o before me this _ I ~.,/ /~' ..... z...'z.,;:.;; .... o, .................... . ,f". ,_ . Notary b 'c, r ................................................. Coumty ...,~ui4f~....~..~L~..'...!..~.....~C~r,¢~ ........................ ~ /J ~ /7 .,~ /' /I~ (Signature of ~l.~l~cant) ~LIZABETH ANN NEVILLE NOTARY PUBLIC. State of New Yorl, No 52-~,125850, Suffoll~ County..- Term Expires March 30. 19~..~' AIE-Vy SUFF~OL K VENUE lot 2~T Lot ~5 NOTE: J = MONUA~ENT SUBDIVISION MA~ MIL~D IN THE OFFIC~ O~ TH~ CLERK O~ SUFFOLK COUN?Y ON , JAN, ~, REVISIONS YOUNG & YOUNG 400 OSTRANDFR AVFNUL, RIV'ERHE,~,D, NEW YORK ALDEN VV YOUNG HOWARD W YOUNG SURVEY FOR ": 75 -69~ t I