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Home My WebLink About8416-zNO. 4 TOWN OF SOUTHOLD BU~I)ING DEPARTMENT Town Clerk's O~ice Southold, N. Y. Certific l'e Of Occupancy No. Z797.9 ..... Date ...........0c.t.. 27- ........ , 197.7.. THIS CERTIFIES that the building located at Elijah .Lar~ .............. Street Map No .... X~ ..... Block No..XX~ ..... Lot No.. Y.Y,Z .... F~at.~ituck..I/,I/, ...... conforms substantially to the Application for Building Permit heretofore ~ed in t_hi~ office dated ............. h~.. ~Cl, 19.76. pursuant to which Building Permit No. 8~16Z... dated ...........: ¥~-- 1 (~.., 19. ?6, was issued, and conforms to all o! the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is Pri.v. ate..One. £a~lly..dvelling ........................................ The certificate is issued to .Donald. & ~usan .Dee~.oski ..... 0~n~.s ................. of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant ) .Oct. 26.1.~77.. by.I/....Villa .(se~ note on final survey i~E.~tr&tes UNDERWRITERS CERTIFICATE No...N.3~.1.95S ..... Aug. 1 ~- .$977 ................ HOUSE NUMBER .... FO J5 .....Street .. EliJ ah..Lana... 1~att i~uck ........... Building Inspector FORM' NO. 2 TO~N OF SO~TgOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. JtUILDING PERMIT (THI~ PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL .~"OMPLETION ·OF THE WORKx~,..; AUTHORIZED)_ ~ N? 8416 zr,~ Permission is hereby gr(]nted ton ' __.~_...,.,....:_ · ~~..~ ...... :::.:~ ...... ........ /Y ........... ~ ,, ~..~'. )lication do~ed; ...... ;.~.~~../-0 .......... , 19 ond opproved by the FORM NO. 6 TOWN OF $OUTHOLD ~ Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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 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 comphance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s~te plan requirements where applicable. B. For existing buildings (prior to April 1957), Nan-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 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 Date New Building ................ Addition ................ Old or Pre-existing Building ................ Vocant Land .............. Location Of Property ~ $'.~'% L,~nr... Owner Or owne Of Pro rty Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No. <~J~ 7~ Date Of Permit ~..J.l.9.1 ].~. ..... Applicant Hearth Dept. Approval .... !.._..~.~..~...~. ...................... Labor Dept. Approval ................................................ Underwriters Approval ..... ,,~..,~.~..,'1..1:~,,'] ...................... Planning Boord Approval ............ .~,,,-.~ Request For Temporary Certificate ........................................ Fincd Certificate .......................................... Fee Submitted $ ...~..~....,~.:: .............. Construction on above described building and permit meets oii applicable codes and regulations. ............................................................... Sworn to before me this THE NEW' YdRK' BOA'RD OF'FIRE uNDERWRITERS hh ~' ,, :., -BUREAU OF ELECTRICITY 85 JOHN .STREET, NEW YORK, NEW YORK 10038 THIS CE~IFIES THAT Donald Dee~kow~ki,~ EliJ~'~ L~e, Rte.27 ~ Oregon Rd., biattituck,~ i,, th~ fo~to,o~5 t~o~; ' ~ a~,~,~* ~ t~t rt. ~ 2~d ~'t. out side s~ao, ~t~ ,~a~exa,nla~on August 15, 1977 OUT[ETS ECEPTACLES SWITCHES iNCANDESCENT FI. UO~ESC~Iqr 23 26 22 SERVICE DISCONNECT NO OF ' S E R V I C OTHER A~ARATUS= 1-G.F.C.I. 1-Smoke detector and fottnd to be in compliance wtth the requirements of this Board. I RANGES COOKINGDECKS OVENS DISH WASHERSI_EXNAUST FAN' MUtII-OUTLE~1 DIMMERS~ SYSTEMS ~ NO. OF FEET [ OF NEUTRAl. '1/o Glenn R. Bradley Horton Ave. ~ , M. attituck, L.I. 11952 Lic.1227 OlENiRAt ~A~G~-..-.~ Tbs ce.,f t t , ' Per D Th;s 'ica e taus not be altered 'n any manner; return to the office of the Board if incorrect. Inspectors may be ident,fled~h~;r credentials. COUNTY OF SUFFOL:( DEPARTMENT OF HEALTH SERVICES I, IA~Y C. McLAUGHLIN, M.D., M.P.H. The attached approval was issued sub~'ect to the notation contained below: our approval stamp. )~ould you please type the £ollo~:ing condition of approval oH the final C of 0 as this will ensure that any future ~lll be made aware of the nitrate probler,~. '~Private well with high nitrates - see Health Depart~ent note on final survey". Th~ you, Hobert A. Vil!a~ P. E. Examined Disapproved a/c ............................... ~ .................................................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This application must be completely filled in by typewriter o~ in ink ond submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot Plan showing location of lot and of buildings on premises, relationship t.o. adjoining premises or public streets o~ areas, and giving a detailed description o.f layout ofpraperty must be drqwn on the d~agram 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 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 purpose whatever until a Certificate 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, Ordlnance~ or Regulations, for the construction of buildings, additions or alterations, or for rem. ov.al or. demo!ltion, .as he.rein descri .bed. The applicant agrees to comply with all applicable laws, ordinances, building code, housing coae, aha regulations, and to admit authorized inspectors on premises and in buildings for n~jce~ssary inspect~l~. L J ,, (Signature of applicant, or name, if a corporation) Sou'cholct, ~lew ¥o.z'...k. . ~l (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. owner Nome of owner of premises ............ D~,.~l.d...De. erJ~{~.l~t...an.d...qu-an-...D~e~'.l~oaki ................................................. If applicant is a corporate, signature of duly authorized officer. (Name and officer) title of c~rporate . Builder's L,cense Nol .~.~ Electrician's Licehse Other Trade's License No. ""~--'"X'--~'"~ ....... 1. Location of land on w~hi~, work wi!l be done. Map No.: .............. ~ .................... Lot No..~ .............. umber r~.t. Rli~ah Lan.e... Ma,$.I;L.1;~. ................ Street and N lg~lr-~. ................................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed comtmction: Wood land - No oooupanoy ........... a. Exisiting use and occupancy .......................................................... b. Intended use and occupancy .D?. e.~l..tnlil~r'Jf,~-..~'' ............................. 3. Nature of work (check which applicable): New Building......X.. ........... Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) 4. Estimated Cost ...........~D.,.(::)D.0 ................................ Fee ...... ~...t~.:.f...T.; ........ ~ii:"'"'~t? ......... i:""~:'"'; .................. ~ro oe pa a on ng s app ca on; 5. If dwelling, number of dwelling units ............ .:]: .............. Number of dwelling units on each floor ............................ If garage, number of cars ............................... ,1, ........................................................................................................... 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 ...... .~Z..£e.e.~ ............ Rear .../~.2...f~.e.~. ........ Depth ...~.1..2. ............ Height ....]...Ll:....~.e...e.~. Number of Stories. ..................... .~. ............................................................................................. 9. Size of lot: Front ..1.~,O...f~e.t .................................. Rear ...3,.~O...$~e.t ........... ; ....... Depth ...~,9~O~ ............... 10. Date of Purchase ...~T.~.I'L~,~',Y:...~.9..~...6. ........................ Name of Former Owner .:E'..e.::l.,~..~..~...~'.~,t;.~.,...~.e.~.~,~.~.~..~. 11. Zone or use district in which premises are situated ............ .~...~.~..~.~..~..u:..o...k. ....... '~.jl~.~...~...~..~....~... ................... NO 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded . ......... .~...O. ............. Will excess fill be removed from I~remises: (X) Yes ( ) No 14. Name of Owner of premisesD~-tn-~.d..~c..,~u~.aD...]~ee~..~o~lJ~ldress ~qOlJ.:l;J~alrte...N~t... Phone No. Name of Architect ..C.[e. ud~..~[q, ueZle....~.sso~.... Address ~. .................... Phone No...~.1:~..~.5..-. Name of Contractor same..as...awne~. ............................ Address ................................ Phone No. ~c)0c) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock 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, ~ ¢ ¢ COUNTY OF ..... ,~lJ~f~l]~ ......... ~'~'~ ............................. ~..~;]~:~..~,...~,l~]~j. ........................ being duly sworn, deposes and says that he is the applicam (Name of individual signing contracf) above named; He is the ......................................... ~ga'~'. ........................................................................................................................... (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 contained in this application are true to the best of his knowledge and belief; and that the work will be performed in th~ manner set forth in the application filed therewith. Sworn to before me this ~_~ ......... .'l~Dth ..... day of ....... ~a~-o~ ........................ ' 19"'"'76 £ Notary Public, .............................. ~l~;~.::J.~.... County ...;~.,~rr-,~..~;...~..('...~..'. .................. NOTARY PUBLIC, ~'ate of New Yor~ No. 52-8]25850, Suffoll( Cou~ Term Expires March 30, [9~ ~, ~0 ¢. 'f~fb' <~ gb..~O0 MiDDL-E ROAO (¢. R. ·: MONOM~N ~' UNAUTHORIZED ALTERATION OR ADDITION TO THiS SURVEY IS A VIOLATION OF SECTION ?~09 OF THE NEW YORK STATE EDUCATION LAW COPIES OF THIS SURVEY MAP NOT BEARINg TEST HOLE RZV,S,ONS YOUNG & YOH£tD, NI~}~ ~."'4~'1--%~ J L ~oo O~T,A.O~, ^v~,u~. ~,v[~i ~ -~ ~,w.~u[ ..o.~..,o.^,...~...~...,, ~ \L.e..o-~'u.v.¥o~, j SURVEY FOR: DONALD DEERKOSK t AT GUARANTEED TO: MATTITUCK TOWN OF SOUTHOLD SUFFOLK CO., N.Y. '¥/~,,v/.~./.~: ,~//7...~. SCALE: 1"=50' IDATE: dAN. IS,1976 JNO. 76-28 TO THE TITLE COMPANY~ GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED C)eer~<o~ld ___J-- ROAD 27) RI[VISIONS JUNE ~, 19 YE SEPT2E, 19T/ OC~ I0, 197Y TEST HOLE YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR: )ONALD DEERKOSK AT MATTITUCK 'row. o~ SOUTHOLD SUFFOLK CO., N.Y. RIVERHEAD SAVINGS.BANK ~-~t - ' ': :' 'v ~ CO'RIGHT BY C~UDE H. MIQUELLE .,, , ,.,, ,~, . ~ ~ ~ , , ' ol~Rde aueN ... . z ... ~ ,- ...... =' .. , i ~ - - IIll . ,I I . ~, , --~-~__ : l, i r ~ CO~ GHT BY ~uDE H~ M QUEL~E~ ' ' , ~ , , , . ~ ' . ,',,~' ; 'c,=.... M,q~.,.. ~; .=.~,~,~ ~,~thi,.d ': 20 west eme~son:,,stree}~.' ' ~ m.lt~ol.; ,r ' ' ~ ma'...' "' 02176,' 617.665.6909. ares,