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Home My WebLink About8298-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ..,~.]..i~, p.O.n..I~.a.:pV.ly~. ........ Street Map No. D..~.~.p...ll.o.~.~.. Block No ........... Lot No, .~0... ltattli'~'u~k...~:'./;, ......... conforms substantially to the Application for Building Permit heretolore filed in this office dated .............. lloV...la 19.7~..pursuant to which Building Permit No.. dated ............. l!OV.. 13., 19. ~, was issued, and conforms to all oi the require- ments oi the applicable provisions oi the law. The occupancy Eot which this certificate issued is .. irivate, oae. fa!llY. !~0!!.~t ..................................... The certificate is issued to . P~oea ,ROS~ .~e.S. ~ ............................ (owner, lessee or ten~t) of the aforesaid building. Suffolk County Department of Health Approval ~e.pt. 1 ~ .. 197~.. by .R~. llll~, .... UNDERWRITERS CERTIPICATE No. ]~8~9~... :. ~.. 12. J ~g'76 ............... HOUSE NUMBER . .. 36~ ....... Street ...DO~a. ~I~$ .......................... Building Inspector FOBM 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? 8298 Z Permission is hereby granted to: F~uc~..~c~e..~e~..~uc..: ............................ ..... · ~ac..t O~.....~oc~c~..~.o~t .....' .................. to .]~,d..J~e~..~na..fa~'~.~,,.dze~ng ..................................................................................... at premises located at ...~:~t...~.O.....]~ee~..Mo;l~..l]lll.;F,s.t, ............................................................... ................................................ ~fA..~.m~ue..~z..: ...... ~t~£tu~ ................................................... pursuant t~ application dated ......................... ~eV. ....... $.~ ........... , 19..~.., and approved by the Building In~ector. Building Inspector[ FORM ~0. S TOWN OF SOUTHOLD , Building Department Torn 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: 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-9 form or equal). 3. Approval of electrical installation from Board of Fire U~derwriters. 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 $§.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 New Building ....~ ......... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Owner Or Owners Of Property ..... ..~...~.?.~.~..~o.?.~..~.o..~...~.~..?...~.~.: ......................................................... Subdivision Deep I~Iole C:r eek [Est;ares ~,,~ ~u~, ?0 Block No. House No....$.,~...5.,.. Permit No. ~295 Z Dote Of Permit ].:.]:../.!:..3../..?..5. Applicant F~ances ~ose Homes~ Inc. Health Dept. Approval ,~/.~.~./..?.,~....~.~..~.,.0.7.,]:~..~......Labor Dept. Approval .....~!....~. ..................................... ' 6 N 282993 5/12/? . Underwriters Approvol ..... ;-;....~ .................................. Planning B~rd Approval ........................................ Request For Temporary Certificate ........................................ Find Certificate ..... ~..~.~. .............................. Fee Submitted $ $ ° 00 Construction on above described building and permit meets all applicable codes and regulations. Applicant ......................................................................................................... Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County ]FOlt.,~ NO. 6 TOWN OF $OUTHOLD , Building Deportment Town C:lerks Office Southold, hi. Y. 11971 APPLICATIOhi 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 or 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 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 Owner Or Owners Of Property .,..~.,a.?:.?.~.~..../.{..o.~.~....~,.o..~...e.~.~...~.~.c..: ........................................................ Subdivision JJ.(.C~....[.~.o,.~,e,....C.,~,~.C.e,,~....~.~.~.~..~.~ ........... Lot No..?..0. ....... Block No ............. House No.:.~..5, .... Permit No..~.~.~.~....;?;' ...... Date Of Permit ].~../..];.~../.?..~,..Applicant .~.a..O..C.?..~...~.{..°.~.?L.~.°..~.~.?.~..~.....~.,~..c,.*, .......... Health Dept. Approval ~/..][,.~./.~..~....~.-.~,.~,],,~.~, .... Labor Dept, Approval ..,~..J.~ ...................................... Underwriters Approval ~j...~.~..~,~.~......~/..~l~'../..~..~. ...... Planning Board Approval .... ,t,~...~, ............................ Request For Temporary Certificate ........................................ Fin~ Certificate ....~.~.~.~ ............................... ~ 0 Fee Submitted $o...s..0. .............................. Construction on above described building and permit meets all applicable codes and regulations. Applicant ......................................................................................................... Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) THE NEW YORK BOARD OF FIRE UNDERWRITERS 85 JOHN STREEt'. NEW YORK. NEW YORK 10038 I 2, 1976 .f,,,,~i,..,io. ~o. ,,,, /u,. 844937 N -,/'~.-, ~' F~-~nces Rose Homes Inc.. e/s Donna Drive 30~~ s/o New Suffolk Ave.. 13 - o2~ACE-MOTORS D SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number A PR~ Applican Address 3. Public Water~pa~v_ 4. Lot size: Width /~) feet 10. Sewage Disposal System: 11. A. 900-gallon septic tank: Precast Equivalent.__ B. Leaching pools: Number of pools_ Precast ~/ Block Block Special If private well, fill in the fol- lowing blanks: A. Tank capacity / gallons B. Pump G.P.M. ~ ~ C. Total well depth D. Depth~to ground water Amours of water in well 'ION FOR APPROVAL TO CONSTRUCT DISPOSAL SYSTEM AND A WATER SUPPLY 6o Section ' _~ 7. Lot Number ~_~ 8. Private g. Public Water ~'~ - Distance to main ~ Length J~'~6{ The undersi9~d CERTIFIES: "Construction of authorized installations will be in accordance with' the Suffolk County Department of Health ServiceS' current standards thereto." This appllication wi.ll be valid for one year from the dg;t~=~lo~ approval indicated below and may be re~ewed~ h'f~,~ current local Building Departmen~ Permit is in effect. 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- / /' S-15 Rev. 4/1/73 BUILDING DEPARTMENT I~'/',o/?.(. 19..~.~. -- ~licati~ No..~..~..9 ................ 19. Z.~.. Pe~it No ..~.~ ...... ~.. ............... Di~ a/c ................ ................................................................................ .......................... ........................ / ~PPLI~TI~ ~ BUILDIHG PE~IT ~e . ......... ..................... b. ~lot plan ~h~in~ I~fio~ o{ lot ~nd o{ building* ~ pr~mise~, r~l~tion~hip to ~ioinino pr~mi~ or public or~, and ~ivl~ ~ d~t~il~ d~ripti~ o{ I~ o{p~ mu~t ~ dm~n ~ d. H~ ~pp~ol o{ ~i~ ~li~i~, ~ 8ui~di~ I~or will i~u~ ~ e. ~o buildi~ ~h~ll b~ ~eupi~ or u~ in ~1~ or in pa~ {or ~n~ pu~se ~r until APPLI~TION IS HEREBY ~DE to the Building ~a~ment ~r ~e issuance of a Bulldi~ Pe~it pumuant to the Buildi~ Z~e O~i~e of the T~ of ~old, ~ffolk C~, N~ York, and ~er ~lic~le ~, ~i~nc~ or Regulations, for the con~m~i~ of buildi~s, ~iti~s or alte~ti~s, or for m~al or de~liti~, ~ nemm ~ri~. The applicant ogres to comply with all a~licable I~s, ordinances, bulldl~ c~, h~sl~ c~, a~ ~1~I~, a~ to admit aut~riz~ in--om ~ pmmi~ a~ in ~lldl~ ~ ~ I~ti~. (,S, ignature of applicant, or name, if a corporation) aendossa t ~-,~naress at appllCam; 1[?78 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premise~LlJ~..j~)~,..~fi~,/...~i~ ..................................................................... i~ ...................... If applicant is a corporate, signature of duly autl~orized officer. ~, (blame and_title of corporate officer) Ben ~eno. oss& t BuiJder's License No ..................................................... Plumber's License No .... ~(~ ................................... Electrician's License No. ~"~..~ ................................ Other Trade's License No ............................................... D~P ~OL~ 1. Location of Iond on which proposed work will be done. Map No.: .~.....~ ....................... 'L~; No.....~... ................. Street and Number~.~,..D0~lA.J3~,T.]~+..~o~.....I/G..~iem..~4)lM..A~ee.sJl~t4,~ttek, ................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of propased construction: a. Exisiting use and occupancy ................................................................................................................................ b. Intended use and occupancy ..~'~t~,~lr..4~1,l:~ ......... ~,,~iK..~'~e ............................................... 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................ Repair .................. R6mbgal '' Demolition .................... Other Work ..................................................... (Description) 11!6 000 00 F ' 4. Estimated Cost· (to be paid on filing this application) §. If dwelling, number o~ dwelling units ...... .~. .................... Number of dwelling units on each floor ............................ If garage, number of c~rs ...... ~. .................................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimens!pns 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 ...... ..~'....'~.. .......... Height .................... Number of Stories ........ ./ ............................................................................................................ 9. Size of lot: Front .... .)...~. ............. ~.~0.. ......................... Rear ............ .~.~.0.. ...................... Depth ......... ~,.~ ................ 10. Date of Purchase .............................. ~ ......................... Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... ~ ............................................. 13. Will lot be regraded . ............ ~8 ....... Will excess fill be removed from premises: ( ) Yes (Z) No 14. Name of Owner of premises .~.~ll~O~.lL.~O~e...~,O~e.~9~:~dclress .~.p...0,R...~..~.~. Phone No...?.,~..~..~....~:...~... 744.1414 Name of Architect .............................................................. Address .,j~.~...~O~,~j.~.. t~h~lae No..'77.T".T...'~'...T.. Name of Contractor ............................ ..~..~.?...~. ...................... Address ......... jl[I.~?.~. ............. Phone No .......... I~.~.~..e .... 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....YO, I~Q , ~ ~ S S .. · ........ ~..:T~.' -~..v~O ./l~..~:)Wt~g.being duly sworn, deposes and says that he is the applicant (Name of individual signing contract~ ab°ve n-~med' ~[~O~.... ~ He is the ....... ~00~:~0[~,~,..O.tt'[l~, ............................................................................................................. (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 forth in the application filed therewith. Swam to before me this ~/ . _ .j .... ...... ...... of ............... , Nota~ Public,. ....................... ~~.._____ ~n~ .................... ~.~;~~.~~__~~~ ..... ~ ~ (SigHature Or oppli~m~ es. ELI~B~H ~ NEVILLE ~ PUB/lC. ~ ef New ~ NO. 52-Blg585G~.~k ~u~ Lo! 71 182. 00' NOTE: · -- MONUMENT SUBDI VISION MAP FIz. ED tV TNi )FPlC~ OF TN~ C£Ef~K OF SU~FOLIq COUYTY ON JAN. 28, 19,~5 A9 ,ell £ ¥0 425C' YOUNG & YOUNG c.~ RVFY FC R' ~ ~ ' . / ,..,,:~ W SUFFOLK ~ facilities fo~ this supply lnspeete~ location have been ~< to be satt~e~ ~ I~ ~ Chief of ~eneral Englneerln~ q ~ot FI ~: ~ LOt NO r~: SUBDIVISION M~P FIL~O IN rN~ OFFIC~ ~ OF rM~ CA~ O~ SUFFO~ couNtY ON ~H[ ZOCA~ION OF W~ AND C~S~O0~ I ~ % REVISIONS YOUNG & YOUNG NOV. ~1,~975 400 OST~ANDER AVENUE, RIVERHEAD, NEW YORK SURVEY FOR: ~.,~ ~.~ ,~ ~ ~,o~.,o~ o..~.,o. BEN MENDOZZA LOT 70 "DEEP HOLE CREEK ESTATES" MATTITUCK SOUTHOLD SAVINGS B~K CNLY TO THE PERSON FOR WHOM THE TOWN OFSOUTHOLD GUARANTEED TI~E DIVISI~ SURVey ,s ~e~, ~ 0~ .~s ~H~ AMERICAN TIT~ INSURANCE CO. INSTITUTIONS OR SU"SEQUENT OWN~R~ I = 40 OCT. 10, I / t 'l T t L IJJJ APPROVED A.~ NOTED '1 tP,t~ '~',~-/,~="- '4. I