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Home My WebLink About8203-zFOB, M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk'~ O~ice Southold, N. Y. Certificnte Of Occupnncy 0 ' ...... l~Iay t9 19 76 No.ZT..3~. Date ............................ , .... THIS CERTIFIES that the building located at N../.~..8.~.r~..i.t...D?. ............ Street Map No~.a.P.t. .K.i.d..d..g.$'~lock No ........... Lot No, l..~ ...... ! .~.~..t~.~:a.e..k...N. :.Y.o ....... conforms substantially to the ApplicatiOn for Building Permit heretofore filed in this office dated .......... .s.~.p~...2.2.., lg .7..~. pursuant to which Building Permit No.8.2.0.3.Z.... dated ......... 5.e,l~;...22 ...., 19 .?~., 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.i.v.~t..e..qn.e.. ~'.a.m..i.ly..d.¥~.l.~i..rig ....................................... The certificate is issued to .~.~9~rfi~...a~l.l.e.r. ~ .......... .0.~..e.~ ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Apl' 16 19~6 by tt, Villa UNDERWRITERS CERTIFICATE No..~.~.8.1.3k6.,, .N.a.y,.. ,~... i..~?.6. .................. HOUSE NUMBER ..... .~..~Ir.iS~e~ ........................................ Building InspectOr FOIL~[ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 8203 Z Permissio~ is hereby granted to: (~eOV g~ '"~ t~" ~u~t~ ."" '~ '" ' '.l~'~" 6eo .............. 2.~...~J~,..L~ ............ G'u~ehe~ue ........ to .. BU.I,I d...n,~w.. ~n~.. ,l'.~,:.l.l.y. · · d.~,~e.:L.~.,i~ ~. ................................................................................... at premises located at ..~..~...i,~....~9,~}.~..~l~,4..~.~..~...~tp~ed...~...]~3,..]~,} .............. ................................................... :Mtl'la~..~o~.d ......... l~JLt, i.t,~e k .... JN ,,:Z ,, .................................... . pursuant to application dated ........................ ~.~..~ ....... ~2 .......... , 19...~.~., and approved by the Building Inspector. SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Re~erence Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Applicant~R~.~N~$.~.~hone 7~'5'010 5. Subdiv~ _ ~ ~ .... ' .6. Section 2. P~rty Location~'-~ ~x~ m~ ~"~"~ 7~ Lot Number 8. Private Wellr.~ 3. Public Water Comp~ Name ~"Distance to main 4. Lot size: Width fee~ Length-~-- feet 10. Sewa~Disposal System: (For Health Services De[~.~se) A. ~-gallon septic tank. · Precast ~Equivalent Block B. ~each~n~ pools: Number o~ pools_ [ ~ Precas~ B1 ock~ Special~ ]]. If private ~ell, ~11 ~n the lo~n~ blanks: ~. ~ank capacSgy ~al]ons ~- C. ~tal well depth ~'~ und~s~gned CERTZF~ES: "Construction of authorized ~nsta]lat~ons w~]l be ~n accordance ~W~th th~Suffo]k County Dep~tment of Hea~th Services' Current standards thereto." Th~s :~app]~c~on w~l~ be va~d for one year from the date of approval ~nd~cated be]ow and may (-be ren~d ~f a current local Build,n9 Department Permit ~s ~n effect. _, =========================================================================== FOR THE DEPARTMENT OF HEALTH SERVICES~ USE ONLY. Based on the information presented here- with, it is the oPinion of ~he Department of ~alth Services that an adequate and satis- factory Sewage Disposal System and Water Supply can be installed on this plato S-15 Rev. 4/1/73 FORM NO. $ 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, end 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 dispasal--(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 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 . :~ .~.~......Z. ~. :.....Z.~ Z~ ................. New Building .......~ ....... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. n._~zmmit Drive and Miriam Road, Mattituck, New York Location Of r,up~,L¥ ..................................................................................... · ............................................... Owner Or Owners Of Property ..... g.¢.~g.~...,J~J,~,.e..~.~.~..,~l~.~..~'.~...~]~g., ............................................... Captain ~idd Es~a~es :^, k~ 1~ Subdivision ................................................................................... Block No ............. House No ............. Permit No. ~.Q~-~. .......... Date Of Permit ~./~,~..~..~....Applicant .~.¢.~'~;f~..~.~.~...~.g,;i,,~.¢.~.,...[~.o.. Health Dept. Approval .... ~.... .................................. Labor Dept. Approval ................................................ Underwriters Approval ..]~..2.,8..~..~..~..~ ........................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ~...~ ........... Applicant ......~ :.~_. ................................ , ............................................. GEORGE AH~ERS, BUILDER, INC. Sworn to before me this ...... LC.. day of or ,e,,,, ' . ~//~,~/~ ~,Z~,~ /j,~6~ N°tery Pubhc ~////~"/Y'~'~" C°unty ~"~ THE NEW 'fORK BOARD OF FiRE r nr im,l,, ,,,,,,,, .~,,. ,,. r~l.' ~2 ~501 I,..,,' May 3, 1976 L.I. ~m,, ....... ..,,, ~ ~,,~ _X~ a *' outside !150 CB _. ~ ' × ' ' 1 Gust aY ~artra Break~'~ater Rd. Lic. 15~9E 227 East per- Mattituck ~ b.I. 11952 be identltied Disapproved a/c ............... INSTRUCTIONS a, This application must be completely filled in by typewriter aC, in ink and submitted in triplicate to the Building Inspector, with 3 sete of plans, accurate plat plan to ~cale. Fee according to schedule. b. Plat plan showing location" of lot and of buildings on premises~ relationship ~ adjoining, pre. mises or pu.blic str. ee.~. of areas, and giving a detailed description of layout ofpraperty must be drawn on the dmgram wh,ch ~s part of this ppphcot~on. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this apl~lication, the Build!ng 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 Building Zone Ordinance of the Town of Southold, Suffolk County, New .York, and ..other applicable LO~s., .(~ .nanc~s.. o ~-~ Regulations, for the construction of buildings, additions Or alterations, or tar remava, or demolition, as n .~e~n aescn .oea. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and re~latlor~, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) Cox Laz e (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Bu ].dez' If applicant i~a coq:~, rate, si~/~.~.,dfly/a~,)thorized off icer. ............... ....... George A_h. Zez-e, ?z'e Lden c of ......... Builder's License No. I-T0 ~]~ . Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed w~rkswill be dane. Map No.: ........................................ Lot Not ..,~;~'~ .............. Street and Number .C~a,~.~..~LLc~d,.~/~l~&l;~,~,...qoz~lner~4r...~s~e...o~. Manicipallty State exisfiKig use and occupancy of premise~ and in~,ended use and occupancy of proposed construction: a. ~xisiting use and occupancy ................................................................................................................................. Intended use and occupancy .................da~],;;L~Lla~ ................................................................................ ~ ........... q 3. Nature of work (check which applicable): New Building......~. .......... Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) 4'. EStimated Cost ............................................................ Fee (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 2 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 ,c~.d~ti6ns: Front .................................... Rear ............................ Depth ................................ Height ...,.- ..................... Number b~f Stones ................................ 8. Dimensions of entire new construction: Front .......... .~0 ..................... Rear ....~C~ ................... D~oth ...~,8 ................ Height ......... ~ ......... Number of Stories ....~. ................................................................................................................ 10, Date of Purchase ........................................................ Name of Former Owner ....................................................... 12. Does proposed construction violate any zomng law, ordinance or regulation: ........................................................ 13. Will lot be regraded ............................ Wil excess fill be removed from premises: ( ) Yes ( ) No Name of Architect .............................................................. Address ........................ ~ ....... Ph°r~ No ....................... Name of Contractor ......... D,e~z:&e..Al~.~.ezt. s,...]3~±]_cte~Address C~1:c~o~..~,~. PI~ No. ,.~.~..~..;5,~],(~. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat-brick dimensions from or description according to deed, and show street names and indicate property lines. Give street and block number whether interior or corner lot. STATE OF NEWr'Y'OI;~/' I c S ........................ ~.~'..~.~.F.~.. .................... being duly sworn, deposes and says that he is the applican~ (Narj~i~6f indigidual signing c~trac~ ~ above name. ~ He is the .................................................. ~.~..~~ .................................... r ............................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the ~id work and to ~ke and file this application; that all statements contain~ in this application are tree to the best of his kn~ledge and belief; and that the work will be performed in the manner set foffh in the application filed therewith. ~ //' ~ (Si~a~r, of opplica~) Jt L~P 4- ,qL4J~ -? A- 4J O~NERSHIP OF DOCUMENTS THE~ DRAWINGS AND SP~CIFI~TIONS ARE INSTRUMENTS OF S~RVIC~ FOR PROJECT LO' APPROVED AS NOTED __ DATE: ~ ~7~ ~::E: ~'7Z-~B¥ ~ / F I I I I I I I ! I 1 ! / ~L~M M IT / 1 I DONAI~D Jk DENIs, AIA. AQUEB,OGUE SQUARE MAIN ROAD - RT. 25 ,AQUEBOCUE, iff'. Y 11991, 72- 14 - ~1 ,1_ t il ,r ~ f