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HomeMy WebLinkAbout8297-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ..~'..~ _.~.-. · .~.. ~Street Map No.~..tf./.~C .~]~ocl~ No ........... Lot No,. ~ ~ ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ f../~..., 19 .~5~pursuant to which Building Permit No. ~. dated ......... ~./~ .... , 19~5~ was issued, ~d conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is (owner, lessee or of ~he aforesaid building. Suffolk County Department of Health Approval ~ '7' Z/2 (.. UNDERWRITERS CERTIFICATE No. /~ a~.~ .~..~...=.~a Xkg~2 ~.... ........ Building Inspector FOBM NO, ~8 TOWN OF SO~JTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTleOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 8297 Z Date ........................ J~g~. .......... 1.3. ......... , 19..2~. Permission is hereby granted to: · .re, n~,e ~...:i~sa. ~0J~s ..3.Go ............................ ............. ~..o.~...lg.:33 .......... ~,~k,x...~oJ. at ........... build new one fa~.~lx at premises located at ..,~g.~..~..bc. ...... ~p..~[D. le..~-,~k..J~&t; ........................................................ ~ .... .............................................. ~ ./..8....~.o....n~..~..~.r ~.~.e .......... ~.~t~ ~,.t,~.....~...~., ................................. pursuant to application dated ...................... l[g~......~,3. ................ , 19.2~.., and approved by the Building Inspector. · ' ~" Building Inspect~ ~ I FORM NO. 6 TOWN OF $OUTHOLD , Building Deportment Town Clerks Office Southold, N. Y. 11971 AFPLIGATION FOR CI:RTIFICA?E 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-0 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 $1.00 Date 9/9/76 New Building ......X, ........ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Owner Or Owners Of Property ....~...8:..~.?...P.~..~...O..$.~...~.O.~?...S.R....~.g.O..: ............................................................ Subdivision D.~..e.~..~.o..];..?;...C.~ ?.e;.~...,~...s.~.~.e...~. .......... Lot No....6..~..... Block No ............. House No...].:.C)..3..~. Permit Ha. 8~97 /~ Date Of Permit .Applicant Frances [~,ose Homes ~ Ioc. Health Dept. Approval ..?../..?../.?..~.......5.....S..0....~:.~..~...Labor Dept. Approval ........ .~.~i...~. ................................. Underwriters Approval N .,2.~9995 Planning Board Approval Request For Temporary Certificate ........................................ FinaJ Certificate Fee Submitted $ ~.....0..0. ........................... / Construction on above described building, nc~/permit me.ets all Opplicable codes and regulations. Applicant~..~ ~..~,~,~....,.~ ............................. ~w~rn t,.~,.b~faor~)fm.e ;?~// ~ ~. ~..f.~ / (s~toYm'~or ~,~,~,~/ ......... Y .............. P ' 180 SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number~-~O~/~/~ ~ ,~ APPLICATION FOR APPROVAL TO CONSTRUCT · ~ A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY' 1. Applicant~t~t~ ~ ~ ,~hone 5. Subdi,V,.-'~.~_ ~ ~ ............... ~'~ ~ ~i~'; ._ 6 Section ~l,]]~ age ~~ Township , ~ 9. Pub!lc ;~ater 3. ~b]~c Water Com~n~ ~e ~.~u~~~-ance 4. [~6tr s{ze: Wfdth~fee~' ~ -~th~feet~ ' 10. gewage Disposal System: (,For Heal,th A. 900-gallon septic tank: Precast_ ~_Equivalent Block B. Leaching pools: Number of pools_. Precast. ~_Block_ _ If private well, fill lowing blanks: A~ Tank capacity~gallons B. Pump G.P.M. ~ ~ al ~C. To~l well '~. De~h to ground wate~, 17 - 'E;: Amdunt of water in well Special in the fol- 11o The,un~Jers~g]Ted CERTIFIES: "Construction of authorized installations will be in accordance wit~]tSe Suffolk County Department of Health Services' current standards thereto." This appl:~cation~j~ll be valid for one year from the date of approval indicated below and may be r6newed if a current local Building Department Permit is in effect.. Date~, Sig~ed , ~, ';' ' ======================================================================= FOR~,TH~ DEPARTMENT OF HEALTH SERVICES~ USE ONLY. Based' on the informatdon presented here- with; it is the opi'nion 6t~ the Department of Health Services that ah adequate and satis- factory-Sewage Disposal System and Water Supply c APPROVAL DATE ;,//h/~'~ a/~,e insta S-15 Rev. 4/1/73 THE NEW YORK BOARD OF FIRE UNDERWRIT-ER$ , - ~5 JOHN STREET 'NEW YORK NEW YORK Fraaces Rose Homes Inc., e/,s Donna Drive 975' ,s/o FO r ~oint £lec. 3!~, ua~e Ave. iJ7~7 4_,d-.,,.'~' TOWN OF SOUTNOLD .,7'*/?~ ~4~,tt~'W'o,~ 0~<~ ~- ,,~v-- t ~ ~'~ BUILDING DEPARTMENT~ ~ ~ 0 ~ ~ (~ ~ TOWN CLERK'S ~FI~ ~ ~ ~/~ . ~ ...... ....... ...... ..... .......................... I~$TRH~IO~$ ~. ~his ~lic~tion mu~t b~ compl~t~l~ fill~ in b~ ~pewriter o~ in ink ond ~mi~ in ~ripli~ to ~ Buildlng Insp~tor, with 3 ~ts of plans, accurate pl~ plan ~ ~ale. F~ occo~ing to sch~ule. b. Plot plan shying l~ation of lot and of buildings on premises, relationship to adjoining premiss or public streets az areas; and giving a d~ail~ de~riptJon of I~out ofpr~e~ must be drown on the diagram which is ~ of this application. c. The work covered by this a~Hcation may n~ be commenced before issuance of Building Permit. d. Upon approval of ~is application, the Building Insp~tor will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection through~t the work. e. No building shall be ~cupied or used in whole or in Pa~ for any pu~ose whoever until a Ce~ificate of ~c~pancy shall have been granted by the Building In~ector. 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, 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 to,~ admit authorizfid inspectors on premises and in buildings for necessary inspections.. R' ~ F~dCu'~S ROS~ HO~ES, IlCC. ............................. .'.. ........................................................... ~ [' ~ , ~z, (~q~9~4~ al:~l~Cd~t, or name, if a corporation) c-~ '~ .. ~ ~- ~ _-~ BOX ~033.Ba~oId~aY, Roe..k~..Pg.~.nt, N..~.... ............ B'JZLDF_~ , ....~.., , . Name af owner of premises .................. ~.~..s....a...o.~...a.~.,...~.q... ......................................................................... applicant is a corporate, signature of duly authorized officer. a~R~.orl~l~bLeo of corporate officer) BF2~ [~ilder's Lic~ No ..................................................... Plum~r's License No ....... .~.~..? ............................. Electrician's License No ............................................. Other Trade's License No ............................................... DEEP HOLE CREEK ESTATES 1. Location of land on which proposed work will be done. Map No.: ..... .4:1~.~6 ......................... Lot No...~.~ ................. Street and Number .....1[./..,~...D....0..I~I...N..A...~)...P.~......'...v~....s.....,~..I~..*.....~/..O....N,.O'~'...~...1..-~.-..-~.-O.-.-I~....,A.?'..e..&.-~.~-~.~Xe'..... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ................................................................................................................................ b. Intended use and occupancy ...'l.~l,qli-'l-lr..~l~l~l,D~g ........ ~,,,O~t...~l~.ll~ ................................................ 3. Nature of work (check which applicable): New Building.. ....... ..X. ....... Addition .................. Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work .... (Description) 4. Estimated Cost ....~.~.5..~......(~... ............................... 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 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 ................................ 0 Dime~;ions .~.f/entire Nn~uWn co~st;uction: Front ..... ~....~j ....................... Rear .....~'...~ ................. Depth ...~...$.~. ............... Heigh .... t .............robe o Stories ............... ..................................................................................................... 9. Size of lot: Front .......... ~,]1,0 ....................................... Rear ...... 2,1,0 ............................. Depth ....... '1~2 ................. 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... N0. ........................................... 13. Will lot be regraded .......~...~ ................ Will excess fill be removed from premises: ( ) Yes ( ~ No 14. Name of Owner of prem ses F]~t,]/~ B.0.q~. i~...F.~ Z]ii~,ddress .BDX..10~ ............ Phone No ..~..4~...-14'1_4. · m ' 'r h' ~ BZ,,,~,~,= ~, Pd)ok,Y 1~0~1~ ~ N~'~ ....... ma e or ~ c rect .............................................................. Address ......~.~.~,j..~ .......... Fl~one I~1o ....................... Name of Contractor ............. ~.~..~......~..~....~. ............... Address ................................ Phone No ....................... 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. STATE OF NEW'"2r'O~. ~. ~ ~ (Nome of individugl signing contrac~ above nom~. (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 the manner set fo~h in the application filed therewith. Swam to before me this ~S ROSE H~ES~ IN~. ~ ~~ {Si~noIure or oppl~nt) ~OTARY PUBLIC, S~te No. S2-8125850, SufMIk Term [xpirbs M~r~W /-o/ ~5 Lot ~3 1~2. 00' tB£.O0' NO TE ' · = ZdONUM£NT ri = STAKE SUBDIVISION MAP ~I~ED IN ~NE OFFICE OF THE CLERK O~ ~U~POLK COUNT~ ON J~N, 2~, 19~& A~ FILE ~ 426G LAW ~WSIONS YOUNG & YOUNG 400 ©$TRANDER AVENU[, RIV[{RHEAD, NEW YORK ALDEN W. YOUN~ HOWAR~ W. YOU~ SURVEY FOR. / ~~' G UAEA~TE~ TO: · ow~ o. SOUTHOLD SCALE:: I''= 40' IDATE:ocT. 10,1975 ~NO. 75E693 I ol ~Z Lo/ ~5 182. 00' NO TE: · = MONUMENT D = STAKE SUBDIVISION M`4P FILED IN THE OFFICE OF THE CLERK OK SUKFOLK COUNTY' ON REW$~ONS YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD. NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR: ~-~ -' BEN MENDOZZA , LOT64 DEEP HOLE CREEK t~...~: AT GUARANTEED *°w~ °~' SOUTHOLD f ', sc..~r 1"=40' I~=:0CT. 10,1975 INm SUFFOLK t~$pec%ed by t~s de~r~ent ~d fo~d lot &5 /~ $7°19 '~0"~ L o/ 63 182, O0 ' 182. O0 ' NOTE: · -' MONUMENT SUBDIVISION MAP FILED IN TNE OFF/CE J&N. 28, 1965 AS FILE NO. 4256. ~DIOR FROM DAT~ OBTAIneD FROM OTHERS REVISIONS YOUNG & YOUNG NOV. 21,1975 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK MAY '-I~) /9~ ALDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR: BEN MENDOZZA LOT 64 "DEEP HOLE CREEK ESTATES" AT GUARANTEED TO: M AT TI TO C K sou THOLD SAVINGS BANK GUARANTEED TITLE DIVISION OF TOWN Or SOUTHOLD AMERICAN TITLE IN;,~IRANCE CO. SUF'FOLK CO., N. Y, sY ,4/'tt4r-~ SCALE: I" = 40' [ [:)ATE: OCT. 10, 1975 I NO. 75U.'693 :1 '1