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Home My WebLink About8513-zFOItM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No..~7.'1.0.6. ..... Date ............... ~VlY.... 2 .... , 197.6. · THIS CERTIFIES that the building located at . .Cardll'~al. D.~ive .......... Street Map NoMat.t,. Eat .. Block No ........... Lot No, .1.8 .... Mati£tuck...t~ ,Y.,. ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. -Apr...1.9, 19.76 pursuant to which Building Pemit No. 8513Z... dated .......... Apr .... J 9 ...., 197.6.., 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 . P.r. ivate, or~ .family. d.~,le] 1;i~ag ....................................... The certificate is issued to .. ~ol~er.t; .&. ~lel~. ~al~SoI~ .... 9wxxer s ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval July.. 2r .197.6..bY. .l~ :..V.!~.l.a ..... UNDERWRITERS CERTIFICATE No...la~r~dilag .................................. HOUSE NUMBER ... -1.29.~ ...... Street ...Car~inal .Dri.v.e ...... Mat.t.f~t~ ..... Building InspectOr FO~M NO. f~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Yo BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 8513 Z Date AorlI 19 19...7..6.. Permi~ion is hereby granted to: Geot.~9~..~9~..~...~..~g~..~.Etleen Hanse~ .................. g~zu_...~ ........................................ at premises located at ....L...O..~....1..~. ......... ..~.~.~..~.t....E.,q.~$.t,.flE.. ................................................................. ................................................. .c. ~r..~ak..D. rl .w. ............ ~.~.%t £~,~k ............................................ pursuant to application dated .........................~.]9,I:.J,],..~, ............. , 19..7.~.., and approved by the Building Inspector. Fee $..~.~.~ ~Q .......... Building Inspector FOI~M NO. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY In~fructlons 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 ar 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 . ~ .~. ~ .~... ?.. ?....~ ~Z~ .................. New Bt4ilding ...... ~ ....... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property Caz:cl_±Tza'l Dr±ye, Ma~ctJ_¢uck Esta~ces, Ma'~ciCuc~, ~.¥. Owner Or Owners Of Property ...~..o..B..e..~.~.....~..:....8-..~...~e..~..e..~....~..:....~..a..~8.9..~. ............................................... Subdivision ...~e.J;.~J.~.uck..[s."c~J~.~ .................... Lot No. ~ ....... Block No ............. House No ............. Permit No. 851~. Date Of Permit ..4.../..~../.Z.~..Applicant GEORGE AH.L_E. RS ~ BUILDER, INC. Health Dept. Approval ...~.Z...~..0.7..~.~. .......................... Labor Dept. Approval .................~......~.: ...................... Underwriters Approval .... ...~... .~..3[ .................. Planning Board Approva~ ........................................ Request For Temporai,~(t~Certificate ........................................ Final Certificate ....... ~ .......................... Fee Submitted $ .~-~.. ...................... Notary Public ...~.. County Construction on above described building and permit meets all applicable codes and regulations. Applicant~:~_ _..._......~.. ............................................................................. GEORGE AHLERS~ BUILDER, INC.~--.~ Sworn to before me ......... day of ..... .... THE NEW YORK BOARD OF FIRE UNDERWR!TE ~- d I~BUREAU OF' ELECTI~ICITY ~,~ Ju[.~ 27, 1976 ~ppl,~ton.~o~le 860225 :.N./ ' ~ .' -~'- THIS CERTIFIES THAT , :' ' only the electHca~ ~zipment ~ desc~ bel~ a~ in t~duc~ by t~ ~ppl~t ~ on the above epplica(io~t~umbet in t~ premises, of Robert HanSon, Cardinal ~rive Rou~e 25 & qe~ Suffolk Avenue, Mat. tltuck States, L.I. -- ' ~- ~ - ~'~ RANGES C~K~Na ~CZS OVENS 12 ~0 17 12 [- 10.7 2 l0 OTHER APPARATUS: LINIT HEATERS MULT -OUYLI~T SYST~.MS NO. OF FEET *DI,b~AERS Motor/s: Gustav ~arTra 227 E. Breakwater Mattituck, L.I. Rd, I 1952 LIc 1529 G~r~"~RA D Per--- This certificate mus~ not be altered in onv manner; re~urn to the office of the Boord iJ ncorrect, insoeclors m~/ be identified ay ~UTHOLD, N. Y. /~ '~ ~ ~ ~ APP~I~A11ON FOR lUI[DING PIi~IT ~. This ~ppli~tion must be ~ompletely filled in by ~pewriter o~ in ink and submitted in triplicate to the Buildin~ Inspector, ~ith 3 set~ of plans, ~ccurate plot plan to ~le. Fee accordin~ to s~hedule. b. Plot plan Ioc~tion of lot and o~ buildings on premises, Fel~tion~hip to ~djoinin~ premises or publi~ streets o~ ~reas, and ~ivin~ a det~il~ description of layout ofproper~ must be dro~n on the diagram ~h ch is p~ of this applicotlon. c. The wor~ covered by this ~ppli~afion moy not be commenced before, issu~n~ of Buildin~ Permit. d. Upon approval of this application, the Building [nsp~tor will issue o 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 part for any pu~ose whatever until a Ce~ificate of ~cupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment ~or the issuance of a Building Permit pu~uont to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and Other applicable Laws, Ordinances or Regulations, for the construction o~ buildings, additions or alterationsj or for removal or demolition, as herein described. The applicant agrees to comply with all applicable lows, ordinances, building code, housing c~e, and regulations, and to admit authorized inspectors on premises and i~ buildings for n~essary i~ections. (Signature of applicant, or nome, if a corporation) .............. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................... .............................................................................................................................................................. Nome of owner of premises ...... If applicant is a corporate, signature of duly authorized officer. ........................................................................................ George (Name and title of corporate officer) Builder's License No ..... .q...~..0...~J[~ .................................. Plumber's License No ................ i.~.~ .............. Electrician's License No ...... ....~...~..c~... .............. Other T rade's License No ............................................... ./...K~ ~ ~.' ~ 1. Location of land on which proposed work will be done. Map No.: ............ Lot No. Street and Number C~T'(:].J.[~T~]_ ~e~.~e~..~J:'~c~?~~ ................................. /V[unicipolity 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...................................................... : ......................................................................... b. Intended use and occupancy ...]?/~/.~.],~T~,~, ......................................................................................................... 3. Nature of work (check which applicable): New Building' ....~ ........... Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................ ..., (Description) 4. Estimated Cost ........................ 2 ................................ Fee ~-~) CgO~ ............... (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 .....,1. .......................................................................................................... Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........ .6..0..'. ...................... Rear 60' Depth 26' Height .................... Number of Stories ...3, ............................................................................................................... 9. Size of lot: Front 236' Rear 0 Depth 289' 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ~Zq.~..&..~,..~.,...HcTCQ~a~.. Address ..;Bp,g..,,~ ................ Phone No ....................... Name of Architect .............................................................. Address$~Q~f~112,~...~'.... Phone No ....................... Nome of Contractor .?z.~.O.~..Ag],f~Z'.~.~...]~.~.i~d~.~ ..... Address ..;~.0...g.q~..[,.9.~.~.. Phone No ....................... PLOT DIAGRAM Cutchogue, NY 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 YORK, lc c COUNTY OF .... Suf. folk ........... .............................. ~.Z2,gZ't~..M~9.~U~'.aZ'~D .............................. being d~uly sworn, deposes and says that he is the applicant (Name of individu61 signing contract) above named. Fie is the .......................................... .8.~;.e~.t;...£.o.~...qgD..'t;x:f~a.t;.ct~' ...................................................................................... (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 oil statements contained 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. Swam to before me this ...... .1.~.t5h. ........ day of ................ Notary Public ............................. ,Stzf fO.l~ .....County ...... ).~.~.....~ ........... ~ _ . ~ ~'x__ , _ /~ (Signature at appdcant) NOTARY PUBIIC~ Stat. of New York / No. 52.8~258§0, Suffolk Cotutty.~ Term Explrb~ ~arch 30, 19~7..~"- 7 THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELO OBSERVATIONS AND/OR FROM DATA OGTAINED FROM OTHERS THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY B~PARTMENT OF HEALTH SERVICES .......... O. fl <: .z~ -- _ ,,~,r-~,:SS_ _ '---6"~ __ ~-_.C'_~r__ -- ~V~: -- SUFFOU( CO~,t-".' ' '. ' ¥ C7 EEALTH SERVICES FOR ~)-'-: "4 '* ~'.. L C;q ONLY ATE APPROVED ~ NOTE: I= MONUMENT ~ SUBDIVISION MAP FILED INTHE OFFICE OF / THE CLERK OF SUFF. CO. ON SEPT. 8, 1965 / AS FILE N0.4453,, REVISIONS YOUNG & YOUNG 400 OSTRANOER AVENUE, RIVERHEAD, NEW YORK w. ou. w. ou. SURVEY FOR: ROBERT 8 EILEEN HANSEN ~OF~ LOT I8 MATTITUCK ESTATES, IN~~,~ SCALE. I": 50' DATE: MAR. 30, 1976 / ' ~ ''~:i ~ ~! ~,-~'~r ~ / ~ .~ /' ~ , ~' ~.~ I ~ ~ ' ~ ~ u q~ ' ~ ~ ' '~ J~ J ~ SUBDIVISION MAP F LEO IN THE OFF CE OF ~ ~ IJ ~ THE CLERK ~ SUFF. CO. ON SEPT. 8, 1965 ' x I% /~ NEAREST WATER,~AIN- 4t MILES '~ /~ KNOLLS, SECT. 2 ~~ ~ ~ I YOUNG, Y~U~, ~ /*1' ~ ,.~ ~ I ~'- I..o...o..~...,...... ~~"" ~' ' 'l ' I LOT 18 "MATTITUCK ESTATES. INC." MATTITUCK · ~'Y IS PREPAR[D, AN" ~ HIS BEHALF SOUTHOLD : I <.~., ... ~o ~.~ ~..,a... ~ ~ SUFFOLK CO, N Y ~ ~ ' ~..~ ~.s~,*u~,o.. ,~.*.~.' ~.~ I~ .o IN~T~UTIONS~ ~UB~*"E"TO'NE"~ I : 50 ' MAR. 30. 1976 76-497 A~-~OVED AS ~ 7~-5-2660 9AM '[O 4PM FOR REQ~ t.L, INSPECTIONS: 1 BEFOAE BACKFILLING FCUNDA TION OR STAAT FRAMING 2. BEFORE COVE~IN~ PIPELINE 3. FINAL WHEN JOB COMPLETED NOT RESPONSIBLE FOR DESIGN OR ~ON- $TRUCTION ERROR5 .//'