The URL can be used to link to this page

Home My WebLink About8296-zFORM NO. · TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Otiice $outhold, N. Y. Certificate Of Occupancy No. 7'7188 Date .A.u~. 23 19.76 THIS CERTIFIES that the building located at $/~..l)~.r.n.~..D.r.$.v.e. .......... Street ~ Hole Ck ~st Map No ............. Block No ...........Lot No. 66 ..... .~.a.t.~..~.t~c.k.. ~ :.~: ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ Oct...20.., 19.~.~. pursuant to which Building Permit No. 8~96z. · dated ............. Eo.~...13.., 19.?~., was issued, and confoms to ail of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .?r~.~.~te..c~e. ~.~. $~y..~.~.e?.l.~. ~ ....................................... The certificate is issued to . .Frances. Bo~e. ~ome$..I~c ..... ~.e~..-.. ~.B~.~.~.r. ..... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ,&Itg...~ 9.. J. 97~ .................... UNDERWRITERS CERTIFICATE No. 1/2829.~1~... Eay...~.2...~.9.76 ................. HOUSE NUMBER 8/~ .......... Street .. D.c~oa. D.~ ....... ~4.~ .t.u.c.l~ ............ ~0~,~ 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) N? 8296 Z Date .......................... ,~;~¥ ........ 1..:} .......... , 19~.~... Permission is hereby granted to: P ~ ~,~ ~.~ .. ~,~ ...~.i ~;;~ ,~...~ ~ ............................... ............. L~x...~, ~.~.~ .......... ~ k.y...P.~£n~ ........... to .b~.,L.L. ~, e~ ..o~e...£a~.,J~l,~'.. g,~ ~,1.~z~ ..................................................................................... at premises located at ...].D.t,..~u ....... .gle~.p../-J.o"l e...~l~..~,~.t; ............................................................. .................................................. /)O1~ ..D.:~;L'~I. ........ l~tL~t~ -'~, ....N.,~ .~ ..................................... pursuant to application dated .................... ~.~.~ ........ 2~. ................ , 19.~..~.., and approved by the Building Inspector. Fee $.LI.9,~e~ .......... Building Inspector -THE NEW yORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY NEW YORK. NEW YORK 10038 ..'""'. e4,c~:~8 N 282." q'94 Oonna Oft ve 745! s/o New Sutto.ik~- Ave. OVENS I g-Fl TOWN OF SOUTHOLD , Building Deportment Town Clerks Offlco Soutbold, 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 ar 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 Uhderwriters. 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 oil property lines, streets, buildings and unusual noturo~ or topographic features. 2. Sworn statement of owner or previous owner os 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 $1.00 New Bqilding ...~. ............ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .... .8...0.~...?..?,~.a....O...~.~..~.?..g~!.a.~.~,J:..~..L]..~...~. .................................................................. Owner Or Owners Of Property ._..~...~.~.~...~.O..$.f~....~.0.~.~.~.a...~.D..O.~. ........................................................... Subdivision D...e.',,e.~.....~..°...Z.~....C.~.~R~..~.s..~..a.~.e.~. .......... Lot No..~.~ ....... Block No, ...z. ....... House No...~..0.~.... Permit No...8,~.?..6....~ ..... Date Of Permit .Z...]:./..].;.3./.?..5..Applicant ..~/...a..~.e.~..,~..°..~.~...,~..°..~..~.s...~.~..(l~ ......... Health Dept. Approval 8/lg/76 5 ~0 16,SLabor Dept. Approval ~T .............................................. Planning Board Approval ........................................ Underwriters Approval ~T 28299A I~T R Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ .5......o..0.. .......................... Construction on above described building permit me_ets all ap_olicable Codes and regulations. Applicant~ ~L -~/~.; .; ,', .. ,, .~.. ~F~.~. Sworn to before me this ~ ' (stamp or seal)~'~ 7/~ ........ ....... ..... SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number~,~'~ 1. Appl Address 2. 4. Lot size: Width feet APPLICATION FOR APPROVAL TO CONSTRUCT 6. Section Lot Number ~-~ Private Wel 1~.~ 9. Public Water-m~-m~-~ Distance to main '~ 10. Sewage Disposal System: A. 900-gallon septic tank: Precast ~ .Equivalent Block Length_~f~''~ feet (For Health Services Dept. Use) B. Leaching pools: Number of pools £~?'~ / Precast ~lock __Special____ ll. If private well, fill in the fol- lowing blanks: A. Tank capacity /~ ~--gallons Pump .. C. T6~al well depth ~7~ ~C~,. D. Depth to ground Water ~/~'~-~ E. A~6unt of water in well /~ The,~nder~gned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health Services' current standards thereto." This applicatio6 will be valid for one year from the date of approval indicated below and may be renewe'd'if a current local Building Department Permi~ is in ~e~ffect. Date ~"i',i~ /~'~ ~'~ '''?'': '~'~'''~F~,) __:__:__~ ...................................................... L .....~ .............. FOR THE DEPARTMENT OF HEALTH SERVICES~ USE ONLY. Based on the information presented here- with, it is the opinion of the Department of Health Services that an adequate and satis- factory Sewage Disposa~ System and Water Supply can ~ installed o,~ thisip/l~t, S-l§ Rev. 4/1/73 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~. ~o~,~.. ~/.~ ............. . ,~L~ ~ _~ ....... ~ ...... ;; ,~... ~.=, ,o '.~ r~ ~ ........................................ . . · ............................. Di~pp~v~ ~ ............... ................................................................... ...... INSTRUCTIONS t~ a. This application must be completely filled in by typewriter orr in ink and submitted in triplicate to the Buildin~ 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 to adjoining premises or public streets az~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram 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. :r~ 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 NLADE to the Building Department for the issuance of a Building Permit pursuant to ther~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and tcL~ admit authorized inspectors on premises and in buildings fo~ections. ~ r ( $ ig nat u r :~~' '~'~',' "i"~ ' [~l~';~i[~i ........ ~_~..~d.../..o.~..~....~.~.~:~... / --' (AdcTres~ of app~6nt) / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ......~..~..i~..~.~..: ................................................................... If ap.~cant is 9, corporate, signature of d~l~ authorized, officer. ....---- (Narne'and title~;~ft~:orporate oicer) Builder's License No ..................................................... Plumber's License No ...... ~...~....~.....~.. ....................... Electrician's License No...~.~..0.'Z... -~r~. ..................... Other Trode's License No ............................................... ~I~__~71~,/~~:~ · 1. Location of land on which pcoposg~J work will be don,~. Ma'~o../.....~.~:~.: ...... · .A~....~'.-..J.... Lot No......~f....~.. ............. Street and Number ....~..~....~....o~......~/~:'""~' ~ ~ .................. .-.~..~..~_~.~'.~..~..~ ................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work ................................................ . ; ~'"'~d:/~O fi? ~ (Description) 4. Estimated Cost ..../..~ .................................................. Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............ I ............... 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 .....~..,~, ........................ Rear .....,,~,,-~. ................ Depth .....,.~'t,.,.-~,,. .......... Height .................... Numbs[ of Stories .................... ! ................................................................................................. Size of lot: Front........ -'"i./U. ....................................... Rear...../.ZO.-........................... Depth ./.~....~.. .................... 10. Date of Purchas~..:.-~.'. I.~. -- .'~..~ N me of~or~n~r Owner ~ ~' 1 1. Zone or use district in which premises are situated ....... .C~.....~? .......................... ~..~ .................................... 12. Does proposed construction violate any zoning law, ordinance or regulation' ,v . 13. will lot be regraded. ........ __ ............ Wi ces l le reread_ed from pr, mis.:() '14. Name of Owner of premise~.'~~~ess.~(~.~?/~'.,~-- Phone No~.~...~..~....~.. Name of Arch tect ................ .~. ........... Address. -- . Phon Name of Contractor ................ ~.......~:;,4.. .............................. J, Address ................................Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-back dimensions from proper~y 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 YOI~,.~. COUNT'/OF .~J,J~.........-m~. ~, ,..b It , ~-~ ~ /~ ~ , .......... ~ .............. ~ .......................................... being duly sworn~ deposes end seys t~t he is the epplicom (Neme of indivi~ ~ignlng ~ptrec~ above name. He is the .......................... ~ ............................................................................................................... J .... ~oc~o~ age,t, corporate officer, etc.) of said owner or owners, and is duty authorized to perform or have performed the said work and to make and file this application; that all statements contained in this applicati( ~ t~e to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the ag Ii,ion fil~d therewith. Sworn to before me this J .... ............. Nota~ Public,~ .............................. Coun~ ..... No. ~-~125850, Suffolk Co~ty~ SUFFOLK VENUE lot G7 t -~ Al. 87o1.¢ ' " · 20 v/ Foot ~ot 1~2. O0 ' G5 NOTE; · = MONUMENT ~ = STAKE' SM~OIVI$10N M,~P F/LED IN T~E OFMICE OF THE CLERK OP SUPPOLK COUNTY' ON YOUNG & YOUNG 400 OSTRANDER ,AVE ,~ JL RIV£-F;'H~,~[~ N[-:W YORK ALDEN W, YOUNC, HOWARD W YOUNG SCALe 1":40' ]{~A~E 0CT. 10,!975 .JNO 75-694 SUFF'OL K /o/ ~7 40 O0 ' 182. O0 ' , - AL 87Ol..O, '20"~/ r ~ ~ ~ ?00t Io/,_ 65 182.00' NOTE: · = MONUMENT r~ = STAKE SUBDIVISION MAP FI~.ED IN TIlE OFF/CF OF THE CLERK OF SUKFOLK COUNTY ON ~IAN 28, 19~ AS FIL £ ,¥0 425G Path YOUNG & YOUNG 400 OSTRAND~R AV£t~HE RIVERH[A[~ NEW YORK ALDEN W YOUNG HOWARD W YOUNG SURVEY FOR: BEN MENDOZZA LOT 66 "DEEP HOLE CREEK *" MATTiTUCK I GUA~N~EEO ~'~ 5CAL. E 1"=40' IDATE 0CT. 10,1975 IN° 75-694 SUFFOLK V -NUE- SUFFOLK COUNTY HEALTH DEPA~T~T, · ~,A~,[-,~I J(~ 191976 The sewage dtzposal and water facilities for this location have been tnzpected by this department and found Chief of General Englneer~nr Services Lot 182. O0 ' N. ~_~ / O~'20,,W.~Fool Lot ~5 NOTE: · = MONUMENT 6UBOIVISION MAP F/LEO IN THE OFF/CE OF THE CA~/~K OF SUFFOLK COUNTY ON JRN. 28, 1965 AS P/AE NO 4~. 7209 OFTHE NEW YORK STATE EDUCATION A~DIO~ FkOM DATA OIT~D F~ON ,Ev,s,oas YOUNG & YOUNG NOV. ~1~1975 400 OSTRANDER AVENUE. RIVERHEAD, NEW YORK M~Y I~, 1976 ALDEN W. YOUNG ~OWARD W. YOUNG SURVEY FOE: BEN MENDOZZA LOT 66 "DEEP HOtE CREEK ESTATES" AT GUARANTEED TO: MATTITUCK SOUTHOLD SA~NGS BANK GUARANTEED TITLE DIVISION OF =own o~ SOUTHOLD AME~CAN TTTL~IN%URANCE CO. SUFFOLK C0., N.Y. SCALE: 1":40' IDATE:0cT. 10,.1975 INo' 75-694 j / 't