The URL can be used to link to this page

Home My WebLink About7705-z FOR~I I~O. Z TOWN O1: $OUTHOLD BUILDING DI;PARTMENT TOWN ~I.£RK'$ OFFI¢I~ $OUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7705 Z Permission is hereby granted to: ~a~ees Ho~e Home~ A/~ Je~ Me~do~a ......... hox.....lO3.3 ................................................. at premises located at ..]~¢4...~.....]0.~.p..Hole...~.~,,.ek...~,~t ................... , ...................................... De~,~ Hole Drive Mattltuck pursuant to application dated ...................... .~...~.~'.....~.0. ................. , 19.~.~...., and approved by the Building Inspector. . Fee $..~O..9.~ ........... '"'~-~ Buddtng Inspector '~'/ FORM NO. $ TOWN OF $OUTHOLD , Building Deper~ment 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: I. Final survey of prqperty 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 dispdsal--(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 New Building .~..~...~. ......... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property W/S I)]~EP HOLE DRIVE. t 200.38' N/O THERESA OR. t mATTITUCK Owner Or Owners Of Property JEA~ mENDOZZA . Subdivision ...... ~-~.'~.'~....~,0.~.~.~...-C..~,.~ .~.,,...~...S.,~...A.~.~..Lot No...,~,?,,.i... Block No ............. House No ............. 1/27t?~5 ' BEN ~.ENDOZZAt ?~'es., Permit No...?.?..0..~....~.... Date Of Permit .................... Applicant ~J~E~E~"R'0S]~"~0;~S'½""Z'~,:(~'~ .......... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. Sworn to before me this Applicant ......................................................................................................... BEN mENDOZZA~ Pries.., FRANCES ROSE HOMES, INC. ................ day of ............................................ Notary Public .................................... County (stamp or seal) ~0~ ,~1,66 SUFFOLK COUNTY DEPARTMENT OF HEALTH 4. 10. BEl~ ~iE~DOZZA Ap p 1 i can t ]aA i~%'q T~'~:q~, ¥1[)i'J'~g. l ~[; Address ~D~'~A~AV_ }~f~X I~[PDCKY' P~..~.-Y ~6. Section Property ~6-E~Ei0~ W/S DEEP HOLE DRIVE~' 200.38'7. Lot ~o. ~? N/O T~RESA DRIVE 18. Private well YES Village. NATTITUCK Township SOU%~OLD !9. Public water ~0 Public Water Company name ~ Distance to main Lot size: Width ll2.8~eet Length i87 feet ~(Enter on center plot Sewage ~-~, Dispos~System: A. /~0~ gallon septic tank: Precast ~ Equivalent Block 1 Preca~ X Block 'Special B.(~e'aching pools: Number ~$~ '' If in Phon~Z!~l~l~. :Subd~v. O~P HOLE CREER E~A~S below) private well blanks below: Street i)ti'~SP HOLE DRIVE fill Tank capacity ~2Gals. Pump G.P.M. 8 Gals Total well depth 60' 20' Depth to G.W. Amount of water in well ~0 Gals, Test Hole Data Feet 0 2 4 6 8 t0 \/ 12 16 18 The undersigned CERTIFIES: "Constructio~of~ ~%t~%o~r!ized installations will be in accordance with the Suffolk County Depar~m~//I~alth~s current stand- ards thereto." BEN MEN~3OZZ~ ~p/q~S. FOR HEALTH DEPARTMENT USE ONLY. Based on the i~f~rma%ion presented herewith, it is the opinion of the Health Department. that an adequate and satisfactory Sewage Disposal System can be instal 9~ ~'~i~:Tp~O~ S-15 Re¥~sed 4/1/72~ 5~ L O/ NOTE ~ ~ · ~ MONUMEN~ i SUBOI V/SION ~AFr FILED IN THE OFFICE OF THE CLER~O~ ~UFFOLK COUNTY Ok dAN 28, 19GS~AS MAP NO 4258 ALDEN W, SURVEY FOR! BEN MEND LOT 57 !~ [ iRHEAO, NEW YORK -qA / ~Q /07 GG 1o7 I t '7'0 i L 0 O~ '7-0 FPE D *..~, I~L0 ,, _.z ..... I1-0 -~¥A ~J