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Home My WebLink About8918-z1~0~ NO. 4 TOWN OF SOUTHOLD BUILDINC, DEPARTMENT Town Clerk's Office Southold, lq. Y. Certificate Of Occupancy No. Z779.6 .' ..... Date ...............$1&l~.... 29.., lg..77 THIS CERTIFIES that the building located at ... W/S .The~.e sa. J}rive ..... Street Map No. D~ep. !:rile. ~l~.o~No ........... Lot No, .7. ...... l~a~;.t~tuck .............. conforms substantmlly, toChe Application for Building Permit heretofore filed in this office dated ................ 0cf~.. $ ~tg. ?~ pursuant to which Building Permit No..(~9.1~7-. dated ............0or. ~t~ ..., 19..76, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is iasued is . P. riva.te, or~e .fa~ly. ~Wel~in& ...................................... The certificate is issued to .. Ban. Mendozza ..... Owner ............................ (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval . Ju,],y...1.8. · .~.977. .... By. Bo .V~3.a. UNDERWRITERS CERTIFICATE No.. 1/3b,21 '~7- .... J. une..1.5...1.977. .............. HOUSE NLTMBER ...... 15.~0.... Street ...Theresa. l~r ....... Matt:Ltu~k ......... Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8918 Z Date ..................... ~eg,. ......... .1~+ ............. , 19..~6. Permission is hereby granted to: ~ Fra~oes...R~se...fi~es..~n~..,.~,/C..~en...l~endoz~a ............ ~e~...~ ......... .~e~,~..R~ ....... C, tt ~,ehegue to ~u~l~..~w..nn~..~L~..d~e~.~&n£ ...................................................................................... at premises located at ..~)~...'~ ....... ~)ee~..~J~Z.e-.Gk..:~;is43 ................................................................ ........................................ .~J.~..~he~.e~..~r. ........ ~{a.t,t, ~.t, ue~ ....................................................... pursuant to application dated ...................... 0~-t.....1._~ .................. 19.?.6.., and approved by the Building Inspector. Fee $.~..35 ........... .......... .................. Bulld,ng Inspector [ FO~M NO. S TOWN OF SOUTHOLD , Building Department Town Clerks Office 5outhold, N. Y. 11971 APPLIGATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in D{JPLICATE to the Building Inspector with the following; for new buildings or new use: ]. Final survey of property with accurate location of oil 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 end "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 .......... ..................... New BHilding .....~...e..8. ..... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ~/.S/.O ~heresa Drive~ 100' S/.O Richar~ S%., Ma~ituc~ NY Owner Or Owners Of Property ......~.~'..a.-~....o..e..s.....~...o..s.,.e.....}[..o.~e.s..,..[..~...c.... ........................................................... Subdivision ..D...e..e.~...~...o..]:..e....C...~..e...e..~...~.s...~.?:.~...e.~ ........ Lot No.....~. ...... Block No ............. House No....]r~..~..0.. Permit No...8..~...]:..8....~ ..... Date Of Permit ..]'..0./..]:./4'../.?...~.Applicant ..... .~...e..~.....~...e.~....o.~..~..a,. ................................ Health Dept. Approval ..... .?./..];..~../..?.~ ...................... Labor Dept. Approval ...... ~..~.. ................................... Underwriters Approval ..N..3...~..2...]:.~.?....~./..]:....~./..?.~ ......... Planning Board Approval ....~../..R. .............................. Request For Temporary Certificate ........................................ Fincd Certificate X Fee Submitted $ '~.:..0..0. ........................... Construction on above described building an~Ro~il~.~F~;~$ss~llp~0c~c~g,blei~c~Je, s and r~ulati~s. ~plicant ....... ~ ~ ..~.~ [.E ~...7~.~.; .................................................... Sworn to ~fore me ~ ~ ........ ..... (stamp or seal~~ 7~7 ~' SUFFOLk( COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number ~ ~o -/$/ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Address~ ........... ~. Section~ 2. PropertyLocation~~ ~v~b~~ Vllla~ To~n%hip ~ 9. Public Water~O~ 3. ~atef Company ame - ~tance to main 4. Lotsize'.Width_~JJ)~feetLength feet 10. Sewage Disposal System: (For Health Services Dept. Use) 11. A. 900-gallon septic tank: Precastt Equivalent Block B. Leaching pools: N~(~er of pools Preca~ .~ B1 ock__~pecial __ If pri.~te well, fill in the fol- lowing blanks: A. Tank--.~capacity ~,' gallons B. Pump~ G.P.M. ~' C. lotal well depth D. Depth to ground water E. /~nount of water in well 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. 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 Water Supply can be installed on this plot. APPROVAL DATE /~y~ SIGNED ~- ~ _ S-15 Rev. 4/1/73 ~-~s~ IUILDINe DEPARTMINT~ -- ~ , ,/ ~,. / ~ ~; ~ ~ ~ K S ~FI~ ~ ~ ......... ........... . Di~pp~ a/c ................. ........................................ ................................................................ .... , ?,-- AP,M~TION FOR BUILDING IE~IT~~~ ~ ~ , a. This a~lication mu~ be c~ple~ly fil]~ in by ~pewriter oe in ink a~ s~m~ in triplicate to the Bui~mg~ Inspector, with 3 ~ of p~ns4 ~6u~ pl~ plan ~ ~ale. F~ acco~g to ~h~e. b. Plot plan shying I~dtion of lot and of buildings ~ premises, relationship to ~joining premises or public streets o~ ar~s, and giving a detail~ d~cription of layout ofpr~e~ must be drown on the diagram which is ~ of this application. . c. ' The ~ork covered ~ ~is a~icatiqn may n~ ~.~mme~ before~ssua~e of Building Permit. d. Up~ approval of ~is ap~icationr~' Building Ins~tor will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for insp~tion thmugh~t ~e work. e. No building shall be ~cupi~ or u~d in ~ole or in pa~ for any pu~ose whoever until a Ce~ificate of ~cupancv~ shall have been granted by the Building Ink,tar. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Z. Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances or Regulations, for the construction of buildings, additions or. alterations; o~Afor removal or. demolition, as herein descr bed Tt]e applicant agrees to comply with all applicable I?.s, ordinances, B~[.~ing code, hous,ng code, and regulations, and to admit authorized inspectors on premises and in buildings for necessa~/y,/inspections. ~en memozza, ~es. ....... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Builder Name of owner of premises :Ben Mendozza If applicant is a corporate, signature of duly authorized officer. ,, ,.(Nacne and titL!,e of .c(~rpor. ate officer) ~en uen~ozzat s'~es~aen~: Builder's License No ..................................................... Plumber's License No ..... .~..6...3....~ ................................ Electrician's License NO..3...0.~...~_ ................................ Other Trade's License No ............................................... Deep Hole 1. Location of land on which proposed work will be dooe. M~p No.: .4...2..5...6......C.~..$~..k...~..~..~.~.e~ot No: .:.~.i..:. ............ W/8 Theresa Drive 100' 8./.0 Richard St. MaS. i uek N.Y. Street and Number ............................................................................................ ! ......... .~....~ ........ ~ ........................... Municipality 2. State existing use and occupancy of premises and intended uSCand occupancy of j)ropos~d construction: a. Exisiting use and occupancy ................................................................................................................................ b. Intended use and occupancy ................. .]:.....~....a~..~.]:~......[~...e...]:.l..~.a.[ ...................................................................... 3. Nature of work (check which applicable): New Building. X Addition Alteration Repair .................. Removal ............. : .... Demolition .................... Other Work ................................................ . (Description) 0o0.0o . 4. Estimated Cost .......................... rea ..................................................................... (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 ................................ Depth .................... Height ........................ 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 ........ ~..g. ................. Rear .....',~ .................. Depth ..2~. ................. Height ......]:..8.. .......... Number of Stories ....... ~, ........................................................................................................... 0 ' ' 200' Rear ......... ~,0D ......................... Depth 9. Size of lot: Front '1....0. ...................... . ............................... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...~.O. ................................................ Will lot be rearaded Yes Will excess f be remove_d,f_ro, mpremises: ( ) Yes (Z) No 13. ~ ' ............ ~ ....... 'j .... . 2b0b Gra~ Blvd. ]4. Nome of Owner of premises .....B..e..D.....~...e...r~,....o..z...~..a.. ................... Address~...~e.~.]:~Ve¥...~hone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ....]~...%D.¢..e..s.....R...o..s_e....H..q.~..e.s..~....[..D...q.... Address .~.~Q.,.~.~[..c~,.... Phone No..2;~=~.6~2.. PLOT DIAGRAM AOll[eho~ues ~ 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. SEE FILED PLANS STATE OF NEVi. ~'~)~lJi !SSL COUN OF ' Ben Iie~c~o~.~.~?re~o ~TG'~S' ~0~~ ~0~ ~Z[~nq dul~ sworn, deposes a~d soys t~t he is the applicam ........................................... t.. ............. ~ (Name o~ fid V dual si~mg contra~r; above named. B~ld~-gor~orate Off~ ......................................................... He is the ......................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duty authorized to perform or have performed the said work and to ~ke and file this applicat o~; that all statements contained ntb ~application a~e true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the applicatio~iled therewith. Swor9 to before me this ~ ~ ~/ ~A~S ROSE HO~S, INC ...... ~..~ .......... day of ...L~...~..:=~U ................. Count' . .. Notaw Public,. ......................... ~~...- ......... No. 52.8125850, 5utlom Term Expires ~arch 30, b°t I~ ' ~..u~.o,ou'' p, reO 6 i.o! NOTE: 9U~OIVI~ION MAP FIdO tN THE OFFICE OF T~ ~ENK ~ 9MFFOLK C~N~ ~ .'~W$,ONS YOUNG & YOI,e.~.- ~.....v.o....... ~,~ .o. ~.... ~RV~ FOR: F~NCES . ~OSE HOMES, INC. ~OT NO. 7; "DEEp HO~E C~EEK ESTATES ~ ~ M~ T TI TUCK ~ ~ ~OUTHO~ D SCATS: / "= 40 DATE: N~. 28,/97~ ' ~5 bot 8 .- / b°t 6 ~ ~ ~ ~ ~ ~ ~ ~ ~C&~ OF WE~ AND C~SgPO0 ~/~/~ ALDEN W. YOUNG ~ ~A~O'W. YO~NC~ SU~EY FOR: ~...~.~ ,, . ~"~*T'O. O' ..~,0. FRANCES HOSE HOMES, INC. ~'" LOT NO. 7, "DEEP HOLE C~EEK ESTATES" GUARANTEED TO: MA TFI FUCK ~mc~ nrt~ /~u~c~ co. SUFFOLK CO., N.Y. "~~ ~p