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Home My WebLink About8216-zFOB,M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, BI. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at . .~ .8. ,. .~. .0..' LFI..a.:l-.n..R..o.o..d. ...... Street Map No .... .bJ453 .... Block No ........... Lot No ....... .q .......................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ... June .... l~! ........ , 19.7.5. pursuant to which Building Permit No... dated .. Sept;ember. · 29 ..... , 19..?J 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 ......... Pr. irate · One .Family. Dwelling ............................... The certificate is issued to ... Frances..Rose .Homes .X~c. .......................... ( owner ,:~~4ff~x of the aforesaid building. Suffolk County Department of Health Approval ..... 9./22/.7.8... ~.-.$0.-.~ .......... UNDERWRITERS CERTIFICATE No...BI2~;.'1.3(~8 ...... .'12,/.'17/.?',5. .................. HOUSE NUMBER . .'1.8.: .8.0.0. ..... Street ......... .~.~.J:..n..R.o.?.d ...................... ............................................... ~.t. ~.~..~.o..k:..~....~.. ............... Building Inspector TOWN OF SOUTI'IOLD BUILDIFIG DEPAP, T/~/.EFIT TOWFI CLERK'S OFFICE SOUTHOLD, FI.. Ye BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8216 Z Permission is hereby granted to: to ~B',~'Lid...new...e~ · · .f'~,~.~.~:. · &~eZ- !..~. ...................................................................................... at premises located at~l~...$ ......... .~&.t~.J:~4~k..~:b&-t,e~ .............................................................. ........................................................ -~/.~,..~a' -~-. ~eatt .......... t,~:~,t~"m~ k, .................... ,: ................. ,pursuant to application doted'. ...................... ~t,~$.....1:,~,.:..,..~% .... 191~;.., and appro~;,ed by the Building Inspector. SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number ~5~.¢~ APPLICATION FOR APPROVAL TO CONSlRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY LIattttuek Estates 1. Applicant~ances Rose Ho~,es~Inc~hone 744-I~.14 5. Subdiv. Into Address P.O. }3ox i0[~2 ~loe~sy Point~ ~.k, ~i£~/~8 6. Section~ap // 2. Property Location .S/t~ ~a:~ ~lo~) $o~j- ~/o ~inai 7. Lot Number 1 Dro 8. Private Well Village ~attituek Township 8oubhold 9. Public Water no 3. Distance to main 4. Length ~'feet 10. Public Water Company ~ame Lot size: WidthlO~i,6~eet Sewage Disposal System: A. (~O/D;-gallon septic tank: Precast }L _Equivalent Block B. Leaching pools: Number of pools i Precast°C~) Block Special__ 11. If prate well, fill in the fol- .~l owin~l anks: ~ Tan~$~apacity. /____~ gallons ~.Pump~. P.M. ~:~ ~.~, Tot~well depth_ 60' ~ Dept.!to~ ground water ~. Amou~'~ of water in well ~i0 (For Health Services Dept. Use) H 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 Permi~ is in effect. Date June ll, lOTS Signed , , FOR IHE DEPARIMENT OF HEALTH SERVICES' USE ONLY. Based o, the information prese,ted here- with. it i~ t~e opinion of the Department ~fEealth Services that an adequate and satis- factory Sewage D~sposal System and Water Snpply can be instal]ed on this APPROVAL DATE ~/~7/ SIGNED (..~__~ ~ ---- S-15 Rev. 4/1/73 IRC. 11787 2 1 a LIC. 307E FORM ~0. $ TOWN OF $OUTHOLD , Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions ^. 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 dlsposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences end 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 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 ate .......... ..................... New Bqilding ......~ ........ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property Owner Or ~ners Of Prope~y ....~.~.~..~,~.~.,.~.~.z...~.~.~ ......................................................... Subdivision ...?.~.~.~=~.~g~..~.~.~.~.~.~...~.t.'.'..Lot No....~....... Bilk No ............. House No ............. Permit No....~.~...~... Dote Of Permit ..~Z~.~Z~.~.Applicant ..~.~P.(..~.~D.~..}~fl~fiD.,...X~E., ....... HeaJth Dept. Approval ......... ?Z~.~/.Z~ ................... ~bor ~t. Approval .......... ~ .............................. Unde~riters Approval ,~,~,~,,,~Z~.~[~.~ ...... Planning B~rd ApptovOl ..~ ............................... Request For Tempora~ Cedlficate ........................................ Fin~ Ce~iflcate .... ,~, .............................. Fee Submitted $ ,.~.u~ ......................... ~'~ Construction on above described buildinga~ R~i~ me~s al~oppJ~ab!~c~o~d regulations. ipp,,c nC.L ................ Sworn ,o before me this ................ ............................................ NY a. This application must be completely filled in by typewriter off in nk and submitted in triplicate to the Building nspector, with 3 set~ of plans, accurate plot plan to scale. Fee according to schedule. b. PJot p!an showing Iocotioh of lot and Df buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detaiJed description of layout of Proporty must be drawn on the diagram which is port of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval o:f 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. ~ .A.P..PLICATION ,IS HEREB.¥ MADE to the Building Department~e issuance of a Building Permit pursuant to the ~uaiar~tioZnsO~. ~orO~hdien~setr~.t~he T,o~. n.,o.f. Soul,al,cl.:. Suffolk .Cou.n~y, ~ew .York, and other applic.able lows, Ordinances or ~ The .applJc~'nt agrees to coml~l~nw~h~aUll~no~g~(cna~rl~n~vs~ o_r.aj?_e_r_ot~n/~, o.,r~?r rem. ov.al or. demo!,t,on, .ns herein described. admit authorize~l inspectors on premises a~j ~-I~iJdin~sU~;'~r~,"iar~ge~'aeoll~.nous'ng coae, ana regulot,ons, and to i [Address of appli~:ant) '" State whether applicant is owner, lessee, ~gent, architect, engineer, general Name of owner of premises ......~..~.~..~.,.~.q..s..e....~..e.~.~...~:. ................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No. .... ~,~..~. ............................... Electrician's License No..~"..~. ............................... Other Trade's License No...~ ........................................... :ontractor, electrici~n, plumber or builder. 1. Location of land on which proposed work will be done. Map No.: ........ .~ ..................... Lot No ...... ~,, ................ Street and Number ~L~~~`~&~~?~j~~?~?~ .............. Mt. mlcipolity 2. State existing use and occupancy/of premises and intended use and oc'cupancy 0f pro~..osed construction: a. ~.xlsiting use and occupancy ................................................................................................................................. b. Intended use and occupancy ...'I.-.~'~I~L].~...i~I[~I.~I~ ........................................................ 3. Nature of work (check which applicable): New Building........X. .......... Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ................................................ .... (Description) 4. Estimated Cost 16~000.00 Fee b ~',? ~'~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ........... 1. .............. 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 ........ .~9 ....................... Rear ......... .~,~. .............. Depth ...... .2.,~. ............. Iqeight ....... ~,.8.. ........ Number of Stories .... ,1, ........................................................................... ................................... 9. Size of 1at: Front ......... ~ ....... Z.C~,,.~?.'. ......... Rear .......... 92,.~? .................... Depth ......2.0.Q,,Q0.'. ........... 10. Date of Purchase ..4~It.~..,~...3.9.%,~ ....................... Name of Former Owner ~.teven G, & Al~].&'la C. ............................ T ..... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ..~..O. ............................................... 13. Will lot be regraded ........Y$,.S. .............. Will excess fill be removed from premises: ( ) Yes (X) No 14. Name of Owner of premises ..2'r.~tl~es,..~G~es..}Io~e.$.... Address ~.~0.o...]~x..1.CI;3,3 Phone No. Rocky Point, N.Y. Name of Architect .............................................................. Address ................................ -Pl~one No ....................... Name of Contractor .......... Sa~e....a...s....a...b..o...v..e. ................... Address .....~1.~. ................. Phone No ......~.~11~ ........ PLOT DIAGRAM 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 ~AIN ROAD ....... ~'~)¥';~,';?'J z .~b,~ ..... beiHa duly sworn, c eooses ar STA'rE OF NE,V~ cou T-v ........ ~.~../.[.. says that he is the applicanf (Name of individual signing contracO above named. ]FEN ~END~JJ~A,Preso FRANCES RO~ H0~S~ INC. He is the .......... ....................................................................................................... (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 qre true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set fo~h in the application filed ~herewith. Sworn to,before me th .......... aay OT ....~ ;, .......... '......, ................. , I~ ......... / ~//~ / , "-~.~.. / ....... , ' ,~"~m ~pires M~r~R 30, ~9~ ROAD (N.¥S. 'RTE. 18,:67 I/ ,e~oo~'oo"E!. ~6.oo'. N.88o08 _2,0 E. , 380.00 LoI I:1 Lot I 92,67 Lot 12 25) g .m ;~400 OSTR,~NiDE~ AVENUE, ~IV£RHEAD, NEW YORK SURVE~ FOR: ~ BEN MEN~OZZA , ~ LOT I OF' MAT~iT~CK:,. ,, ESTATE C) MAIN ROAD (N.¥S. RTE. 25) .agoo.~ oO E. N.88~08 2,0 E. 380.00 RE~I$1C~N5 NOV.: 26,,!975 0 0 Lot; I I 86.00' Z Lot I s. oS.45'3o;'w. Lot 12 0 92.67' NOTE: · = MO~NUJ~EN'I; :~ : ~ . SUBDI~/I$'ION MA~' FILJ~D IN THE'O~E~E O~ ~E CLERk' 0~ SUFFOEE ~UNTY ON S~PT. 8, 1965 PROFEaJlONA~ itNE~ ~N ~' LAN~ ~URVEYOR BENMEN.DOZZ~ ,.~, , APPRCJ.VED. AS NOTED__ D^T~: ~ ;;~ 1~ FE~ ~.~ .?,.~'~BY ~ =J II,