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Home My WebLink About8869-zTOWN OF $OUTHOLD BUILrIING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No...Z92/+7. .... Date .... 0c~:t~ber. 12 .......... , 19.. ?.8 THIS CERTIFIES that the building located at . .3.1/+5.. Donna Dri.v.e ...... ~ Map No ..... 4~256. · · Block No .......... Lot No ........ 63 ...................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ... September...17.., 19..76 pursuant to which Building Permit No .... .8.8.69Z dated . . September...17 .... , 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 ........... I~l.v.~te. One...F..~a~..].. y..I)~..e.~.~..Lng ............................. The certificate is issued to .... k'~anc, ea. Rose. ~o~a ~r~.c. ......................... (owner,:~ of the aforesaid building. Suffolk County Department of Health Approval ...... 8-S0-62 -. September..26,..1978 UNDERWRITERS CERTIFICATE No .... N/402667. .... 9./.23/78 ................... HOUSE NUMBER · - ~ .~/+5 .... Street .......... .Donna.Drive .................. ................................................. Ma~i~tck ~. ~Ie~ .York ....... Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 8869 Z Permission is hereby granted to: ....~..a.~..e..s....~.9..s..e..., .~.Lo.~.e.. ,s. ,..~ ~.~ ....................... .................... .9.~.~h,o.~.e. ..................................... 6~ at premises located at ........ .~.,.0..~. ........... .D...e.?..~...,.H..o.?:...e....C...~.....~..~...~. .......................................................... Dor~a Drive ........ ~;I~ ~.~ .~..tl,~.~ .............................................. --)~- - Sep~ 17 ,9i.?..6... and ~)~uant to application dated ........................................................ , appr0~e.d ! ,~ffu!tding Inspecto~ ]FOIL~ NO. 6 TOWN OF SOUTHOLD ~ Building Depo~tment Town Clerks Office Sou~hold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCGUFANCY 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 disposolm(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. Swam 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 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 Rte ........ ....................... New Bqilding ...~ .......... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..~../..~.~.~..~.~..~2:~..~.D:~.~)~.~..~.~¥..e.~t~.];~.~..8.~.~.~./.~.~.~.e..?.~~t~~ Owner Or Owners Of Property ...... ~.~..~...~.g..e.~....~..o..~...~.o.,.~..,e.~....Z..~...o..: ....................................................... Subdivision :~..D..e...e.~.....~..o...]:,.e.....g.~..e..e..¥....~..~.C...~.~.,e.~]....Lot No.....6,~} ..... Block No ............. House No...]r...Z..~.-5. Permit No ....8..8...6.c)....~.... Date Of Permit ..2/..~.?./.~...6..Applicant ..~.~'.9,D.g.~...J~.9.~.~...];T,g. Ilt~.,...]~g., ....... Health Dept. Approval ...... .,.c)./..~...~'.,~..8. ..................... Labor Dept. Approval ....... ,?!./...~. ................................. Underwriters Approval ..~.?..0...~.~.~..~ ..... ~. /. ~ .];. ./. ~. .8. ...... Planning Board Approval ..~./.~ ............................... Request For Temporary Certificate ..................................... ~?,m=.~ FinoJ Certificate .... .¥.,e..~. .............................. Fee Submitted $ ..~.....0...0. ......................... Construction on above described building\/c~n~r p~,,~,q,et,~,~lLa_gpJ, Lc, gJ~e c~'~ and regulations. ..................... ................ day of ............................................ (stamp or seal) Notary Public .................................... County THE NEW YORK BOARD OF FIRE UNDERWRITERS p r~} BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK. NEW YORK 10038 [~ September 21· /O?R ~67~74 THIS CE~IFIES THAT only the e~t~ equip~nt ~c~ ~ ~ int~ by t~ ~~ ~b~p~,~nu~j ~ t~s of in the foH~ing [~at;on~ ~B~ement ~ Ist FI. ~Z~ Fl. ~tion Bl~k ~t ~as exam~a oR ~O~O~bOr ~ ~ ~ ~ ~ 7 ~ a~ found ~ ~ in compllance ~ith the requlrements of this Board. OUTLETS INCANIDESCENT FLUORESCENT V~A ~Y I~ 39 2P, 16 3 F I 3 S E R NO. OF CC. COND. ! SERVICE DISCONNECT [ HO. OF [ Hotor/s: t-F I-G,F, I, I - $~.o k~. Detector COOKING DECKS OVENS DISH WASHERS OF CC. COND. EXHAUST FANS A/AT, H, P. DII~AERS ND. ii=NEUTRALS A.W. G, OF NEUTRAL Four Point Ele¢. Inc, ~..0 Lake Ave, This certificate must not be altered in any mannerr return to the office of the Board if incorrect. Inspectors may be identified by COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant ,~t~t~'C]~$ R(X.~ H~tl~hone Addressl~oO, ~ IO~:~AY; 2. Property Location ~m ~,~ Vi 11 ag6- ~T~ Township 3. Publ i c Wat~-C~Wp~' Name 4. Lot size:'Width~feet ...... Length~feet lO. Sewage Disposal System: A. 900-gallon septic tank: Precast X Equivalent Block B.Leaching pools: Number of pools Precast T Block Special__ If p~'~'~ate well, fill in the lol- l owi ng~b 1 anks: A. Ta~ capacity ~ gallons ,B. Pu~__j G.P.M. 6 c. To ql well depth_ ~ D. De~h to ground water E. Amo'unt of water in well 5. Subdiv.~ 6. Section~_ 7. Lot Number 8. Private ~eil 9. Public Water Distance ~m~'in (For Health Services. Dept. Use) The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health 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 Permit is in effect, lq~kl~C~S Date 10/27/~5 Signed ========================================================================= FOR THE 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 Sewage Disposal System and Wa ten Supply c an be insta~~t. APPROVAL DATE /,/'//~ z//?)"' S]'GNED<~ ~ S-15 Rev. 4/1/73 BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~U~OLD, N.Y. ~'~ · ............... Inspector, with 3 sets of pla.ns, accurate pl~ plan to ~ale. Fee acco~ing to sch~ule. b. Plot plan showing l~atiOn of lot a~ of buildings on premises, relationship tO adjoining premises or public streets areas, and giving a detail~ description of layout ofpr~e~ must be drawn on the diagram which is ~ of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon bpproval of this application, the Building InsPector will issue a Building Permit to the applicant. Such permit shall be kept on the premise~ available for inspection throughout the work. e. No building shall be ~cupied or used Jn whole or in pa~ for any pu~ose whoever until a Ce~ificate of ~cupanc~ shall have been granted by the Building lnsp~tor. APPLICATION IS HEREBY ~DE to the Building Depa~ment for the issuance of a Building Permit pu~uant to the~ Building Z~e Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the constru~ion of buildings, additions or alteratic ~or for removal or demolition, as herein described. The applicant agrees to comply with all applicable I~s, ordinance~ ~ilding c~e, housing c~e, and regulations, admit authorized insp~tors on premises and in buildings for n~e[ 7 i~ections. ........ (Address o~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. BUILDER Name of owner of premises ............. .]~...~..~.....~....~.. .......................................................................................................... If applicant is a corporate, signature of duly authorized officer. %. ~-~l~l~a~n$~,of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's license No ............................................. ~her Tr~de's License No ............................................... DE~ H0~ gB~ ~STA~S ]. k~a(ion o( land on which proposed work will be do.e. ~aO No.: ......... ~ ..................... Lot No ....... ~.~ ............. ON ' ' Street and Number ~L.~..~.....~..~.,.....~.~.....S/O..~..~-.~.i.....~.~ .................. . Municipali~ 2, State existing use and occupancy of premises and intended use and occupancy of pr~osed construction: a. Exisiting use and occupancy ................................................................................................................................. b. Intended use and occupancy ........... ~,..-.$.e,.~.~.~,Y...dg. etl3113~..1.-.~,er...g~a~e ............................................. 3. Nature of work (check which applicaNe) New Building ......... X .... Addition ...............Alteration ... ~ .. Repair .................. Removal .................. Demoht~o~....'~ ......... Other Work .................................. ~' .... ..'~... 4. Estimated Cost .........$..]:..5...~.....0~...:...0~... ....................... Fee ~'-~J ~_(~2 (Description) (to be pa~d on fihng this apphcatlon) 5 If dwelhng, number of dwelhng un,ts ....... 1.. ................ Number of dwelhng umts on each floor ...................... If garage, number of cars ......... ~-. .................. 6. If business, commercial or m~xed occupancy, specify nature and extent of each type of use ..................... 7. D~mensions of ex~st,ng structures, ff any' Front ........................Rear ................................ Depth ................... Height ........................ Number of Star,es ................................................................................................. D~mens~ons of same structure with alterations or addmons' Front .................................. Rear .................... Deplh ............................ Height ................... Number of Stories ............................ 8 Dimensions of ent, re new construct,on' Front ..... ..%~..-..9. ............... Rear .....?...9'.~..~.. ............. Depth ..?....S.. Height ....'~..?. ......... Number of Star,es ..... .~.....~. ...................................................................................... 9 Size of lot. Front ................. .11.Q ........................... Rear ......1.~t..0. .......................... Depth .....~.8..I~ .................. 10 Date of Purchase ....................................................... Name of Former Owner ........................................................ 1 1 Zone or use district in which premises are s~tuated ............................................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation' . ....... ..N.O. ........................................... I3. Will lot be regraded ...~.~. ................. Will excess f,~61~re~9~le~fr~.~e.m,ses' ( ) Yes (Z) No 1 4. Name of Owner of prem~se~Irl....l~, l:~l.O.~ ......................... Address ..NO,.Be.'l-llrilo~.~.NPlt'one No ....................... Name of Architect ............... ~ ............................. Address ................................ Phone No ....................... Name of Contractor ~~..?':0..~.E..H..0a/iE~...~ .TN..C.t.... AddressP..:..0..:...t~...X...~.O..3..3. .... Phone No.7.~.-..]:..4..~.4.. .... ~ PLOT DIAGRAM ~O0~y Point~ N.Y. 11778 Locate clearly and dist,nctly all buildings, whether ex,sting or proposed, and indicate all set-back d~mens,ons from property hines G,ve street and block number or descr~pt,on accord,ng to deed, and show street names and indicate ,vhether ,nter,or or corner lot STATE OF NE-~-IY~I~, ~9~. ~S S cOUnTY ....... ~]~iNI....~.~INIJ[~.(~~.~,~'~I~.~W'--~..~0~..H .{~.~F.-o~.~Z]N.Cbe,ng duly sworn, deposes and says that he ,s the apphcam (Na~ of ,ndiv,dual signing contracO~ above ~omed He ,s the ~~-~0~0~ 0~ (Contractor, agent, corporate officer, eta ) of said ow~ner or owners, and is duly authorized to perform or have performed the said work and to make and fha this application; that all statements contained ~n th~s apphcat,on are true to the best of his knowledge and behef, tk, a~ the work will be performed ~ the manner set fo~h in the opphcatio~filed therewith. Sworn t~efore me this~O ~ ~Z ~~ ROSE HOmES~ INC. ..... ....... of ...................... z u' ...................................................-- co.. ........ ................... · ~ (Signature et a~l~ant) ~H ANN NEVILLE ~ ~OTARY PUBLIG, State pi New Yolk H0 52 8125850, SuftalN lot G,~ lot ~2 1~2. 00' 1~2.00' NO TE~ · = MON~IM£NY OP THE CLERK O~ SU~OL~ CO~T~ O~ YOUNG & YOUNG 400 OSTRANDER /~VENUE. RiVERti~AD, NEW YO~K ARDEN W YOUNG ' HOWAI~D W, YOUNG SURVEY FOR: BEN MENDOZZA LOT 6:3 ~' DEEP HOLE CREEKi~' MATTITUCK G TOWN or SOUTHOLD SUFFOLK C0, N.Y. ' 5CAL[: I": 40' [~ATE: 0CT. 10, 1975 ~No; NEW SUFFOLK A VEIVU - Lot ~2 1~2. O0 ' NO · = I~ONUMENT SUBD/V/SION MAP FILED IN TNE OFFICE OF THE CLERK ~U~FOLK COUNTY ON dAN. ~a, 1~5 AS FI~E NO, THELOCATION OF ~ELL ~ SEPTIC TANK ~ C~SSPOOLS SHO~N HEREON ~REFROM FIELD OBSERVATIONS AND OR DATA OBTAINED FRO~ OTHERS REVISIONS NOV $, 197~ MAY R$,I g YB '~:A'~*" GUARANTEED TO' MAT TI TUCK 4,~'mC,4N nrLe /NSURANCE co. sourHoLO SAVINGS ~ow. oF SOUTHOLD SCAL~ Il' = 40' [bAT~' OCT. 10, 1975 ' IN°'75-692 J APPROVED AS NOTED DATE r - 0 " NOT~FY EU~LD~Ng DEP~TMENT 765~2660 9AM TO ~P,~ FOR REQUIR- ED ,INSPECTIONS: 1 BEFORE BACKFILLING F~)UNDA~ TION OR START FRAMING 2. BEFORE COVERING PIPELINE 3. FINAL WHEN JOB COMPLETED NOT RESPON$11LE FOR DESIGN 'DE C~N. II ~L eL bac I< FULL I 21Lo~'