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Home My WebLink About9090-z · 'O]P~bl NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N, Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9090 Z Permission is hereby granted to: Frances Rose Homes Inc A/C Ben Mendozza .................. aoa..1.Q3a....~ro, atwa. y. ......... ~o.c.k Pt 11778 at premises located at ..... ],P.t..~.9 .......... Daep...Ho3e..,Ck..~statas .............................................. ............................. ,~./.~q..D. or,~a..Dr.i~e . ~tt.tu~k ... pursuant to application dated .................... ~..~. ....... ~.~'.. ............... , 19..~..~..., and approved by the Building Inspector. Fee $..~'.]. ,..~.Q .......... / Building Inspector · ~OltM NO. 6 TOWN OF $OUTHOLD , Building Depo~tment 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 fallowing; 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 disposol--(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 $1.00 Date 10/12/77 New Building ...~?.~ ...... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property 1~/$/0 Donna Drive, 415' S/O New Suffolk Ave., ~attituck, NY Owner Or Owners Of Property Frances Rose Homes, Inc, Deep Hole Creek Estates ..~. 69 ..4..7..5.. Subdivision .... ~ ........................................................... ~.or rio ............. Block NO ............House No ..... 3/15/77 A--li-'~n Ben ['~iendozza Permit No. ~.?.~.,0...,~. ...... Date Of Permit .......: ............ r~- ,-~ t .................................................................. Health Dept. Approval ............................................ Lobar Dept. Approvol ........ !"!../~! ................................. Underwriters Approval N358123 9/29/77 . Planning Board Approval N/R Request For Temporary Certificate ........................................ Finctl Certificate .......................................... Fee Submitted $ ~.*.?..?. ........................... ~~ Construction on above described building a ermit meets all applicable codes and regulations. Applicant ..................................................... Sworn to before me this (stamp o~1) Notary Public ..-~/~/....... County ®American Title Insurance Company A Meridian Company September 11, i990 T~tle No. 2001866 Tax Map 41000 115.00 16.00 004.000 Buildinq Department Main Road Southold, New York 11971 Please provide this Off/ce with a Duplicate Origina.[ Certificate of Occupancy affectinq the hereinafter described premises. Enclosed find our Checks 4 /~{/ and ~ /~/~ln the Amount of $5.00 each in payment of this service, alonq with a stamped, self-addressed envelope for your convenience. (X ) Street Address: 475 Donna Drive, Mattltuck, N.Y. (X ) Survey attached: (X ) Description attached: (X ) Present Owners are: James S. Atkins & Lorraine D., ux. Your cooperation in this matter ~s qreatly appreciated. Could you please send C.O for orlq~nal dwelllnq built t~y Frances Rose Homes,lnc, between 9/77 and 10/??. Note: We already received copy of C.O. for coal bin 42101?6. SO/ms Eno, Very truly yours, For The Company 130 OSBORNE AVENUE, RIVERHEAD, N.Y. 11901 (516) 727-5500 / (516) 727-4983 (FAX) SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number ~'~ - F ?/ APPLICATION FOR APPROVAL TO CONSTRUCT · A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant~4~C.~ ~lt~ ~(//~>~ Phone'~.c~ -/~/r/c/~ 5. Sub~~~ Address ~___~_~/ ~3 t~,_ z~,o~/ ~m~' ~/y :16. Section~---~---- 2. Property L~oc~nl~/¢ ~~]~ 7. Lot Numoer~_,~_~. ~.~/j~-~_~/~/~l~,r,,~ ~ . "'8. Private Well ~r~iYage~/~ownshi~~ ___9. Public Water---~'~ 3. Public Water Co~p~hy Name_ QJO Distance to main_~4~ 4. Lot size: Width_~//~ feet Length y?~;~-feet 10. Sewage Disposal System: (For Health Services De~to Use) Ao 900-gallon septic tank: Precast~__Equivalent B, Leaching pools: Nam~er ~pools--~ 'Precast Y Block ll. If pri.v.ate well, fill in the fol~ 1 owi n ~'~61 anks: 'A. Taniq--capacity 7: __.gallons¢/, . ~, C. Total well depth ~ ~ D, Depth to ground water~ E. Amount of water in well~~ Block Special~ [~~ The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Heal th Services' current standards thereto." This application will be valid for one year from the date/~iapproval indicated below and may be renewed if a~urrent local Building Department Pe~mi~ is i~effecto Date ~ ~ Signed ============================================================================= FOR THE DEPARTMENT OF HEALTH SERVICES~ USE ONLY. Based on the i~formation presented here- with, it is the opinion of the Department of Health Services that an adequate and satis- factory Sewage Disposal System and Water Supply can be installed on this plot. APPROVA DATE · si ED S-15 Rev. 4/1/73 TOW~ OF SOU?HOLD . ........ ........ I ........................................................... . ................ / INSTRUCTIONS a. This application must be comp[eteiy filled in by Wpewriter o~ in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to ~ale. Fee according to schedule. b. Plot plan showing location of lot and 0f buildings on premises, relationship to adj'oining premises or public streets areas, and giving a detail~ description of layout ofproper~ must be drawn on the diagram which is pa~ of this application. c. The work covered by this-application may not be commenq~d before issuance of Building Permit. ~/. d. Upog approval of this application, the'Building InSpector Will issue a Building Permit to the applicant. Such permit shall be kept on the premise~ available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Departmen~ for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other ~pplicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with all applicable laWs, ordinances, building code, housing c~e, and regulations, and admit authorized inspectors on premises and in buildings for n~ess~ inspections. (Signature of applicant, or name, if a corporation) Ben ~ ~aaress at applicant) ~_ State whether applicant is owner, lessee, agent, architect, engineer, generaJ contractor, electrician, pJumber or buiJder. Builder Name of owner of premises ...............~e~..~en~ozz~. ................................................ ~ ...................................................... If applicant is a corporate, signature of du[Q authorized officer. M (_Ngme and ti. tie of corporate officer) Builder's License No ..................................................... 263 P Plumber's License No ................................................. Electrician's License No. ~.0.~...~ ................................ Other Trade's License No ............................................... DEEP HOLE: CREEK ESTA~S 1. Location of land on which proposed work will be done. Map. No.: .... 4~.~: ..... ............... . ........... Lot No .......~.~. ............... · Street and Number ...~/.~..~O~A..P~.~.~...~...~,.O~.....s/.o..~e.~..~f~olk.:A~e.~..~&~It~ ......... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................................................ b. Intended use and occupancy 1-~.B.~..i.l.~....~..~..e...~..~.$.~.....~..-..~.~l%..a,..t.~P,'Qb.~.~L gsz'.~,g.e ............. Nature of work (check which applicable): New Building, ........~. ......... Addition .................. Alteration ................ Repair .................. Removal .................. DemolitJor, .................... Other Work .................................................... 4. Estimated Cost .......~.~,,,O0.O..t...0g... ............................... Fee SI, ~ 0 (Description) (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 .................... .1. ....................................................................................................................... 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 .............. J~. .................. Rear ..... ~g. .................. Depth ......~.~ ............... Height 18 Number of Stories ]- 9. Size of lot: Front .......... ~,1~. ...................................... Rear ........... ~,I.Q ....................... Depth ...... ~,,8,.~ ................... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. 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 ............ ~.le.8 ........ Will excess fill be removed frompremises: ( ) Yes (X) No 2606 Grant Blvv l_ _ 14. Name of Owner of premises ,,~t~ll.....~(~O.Z~. ....................... AddressDj~$;....Bl~gz,t~O~.~.~.~o. ne No.~z~J~..lz~l.~i .... Name of Architect .................... ::~. ....................................... Address ................. e-],~f~ ....... Phone No Name of Contractor .,~l.~l,.~..~.~.~.....l~J~.~.~...,.H.o...~..~.~.~....I..~..q:.. Address~..:..O..'.....~...O..~....~_~ Phone No..~,,.. Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-bock dimensions frorn property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner Io¢. STA'TE OF NEW '<,q~,,//* I S S COUNTY OF ,.:~.'.,',,;,,.~./.~. ............ ~ ' ~.e.~...~,..e...~..o...~.~l,.~...?.~.~..~........l~..~.,~..~..~.~...~.~.~.., .~..q~,~.~mg duly sworn, deposes and says that he is the applicam (Name of individua~ signing contract) above named. He is the ....... ~.~.~...Z...~.~...~.~.~.~.~,~ ........................................................................................................ (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 aH statements containe~ in this application are 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 therewith. Swom]n to ~efore me th s / , · -- - ~N~S Ra~m HOMES INC. ........................ day of ................................ ' ' ~-~ Z? .......... , 19 ........ ~ (~, ,~ //,./z' ' . .... , Nota~ Publmc , ,~ ,, Coun~ .......... ~'. .................................. f -?. ,, ~ ~ . (S~gnoture of opp cant) ELIZABETH ~NN N~VILL~ ~ NOTARY PUBLI0, Stae ~,~ Yor~ ~o. 52.8125850, Suffolkf~ounty~ S lot ?0 .... 31 87Ol,9 '20"W, c,\\. le2.oo' lB2. oo: YO!UNG &:YOUNG 400 OSTRAND[R AVENUE, ~[VERHEAD, NEW YORK SURVEY FOR: BEN MENDOZZA LOT 69 "DEEP,HOLE CREEK ESTATES ^T MATTITUCK? TOWN OF SOUTHOLD SUFFOLK CO., N. UARANTE~ED .HOWARD W. YOUNG OCT, Iq,1975 No. ;.589'3 )4.1 lYE-ky SUFFOLK SU~O~ GOUTY HEALTH DEPART~E~T The 8ewsge O~spo~a~ and wate~ facilities for this loea inspe$ted by this Chief of General Ssrvices , \ \. £ot &,F [] ~ STAKE OF THE CLERK OF SUFFOLK COUNTY YOUNG & YOUNG 400 OSTRAND[R AVENUE, R}VERHEAD, NEW YORK ~L~N W, YOUNG HOWARD W, YOUN~ SUIWFY FORi BEN MENDOZZA LOT 69 "DEEP HOLE CREEK ESTATES" MATTI TUCK Town OF SOUTHOLD SUFFOLK CO., N.iY. SCALE: I"= 40' GUARANTeEO TO: AMER/CYUl/ T/rLE //VSURANCE CO. SOUTHOLD SAWNGS BANK F. tO, 1975 )No,