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Home My WebLink About9092-z FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, FI. Y. BUILDING PERMIT COMPLETION OF THE WORK AUTHORIZED) N? 9092 Z Date ....................... Ea.~.o ~ ......... .1..~'......, 19-77.. Permission is hereby granted to: Fr a ~e.a .. [~ s~ ..~i. om~ s...] ~......A./C.L~...l'¢en~.o z z a .............. ,Box...c).c~ Z ......... .C.~Jkah~.g~ ................. ~a _ .~:.z.~-.~f....°.~.?,. -f'.~.t..z.Z. - ~Y.:~.~ ?:~:~.~- ................................................................................... at premises located at ..~r~.O.~...~. ......... T.~.¢:e~..~c~..e,..~.~...~s.'F~...~..~ ............................................... ............................................... 2,~/.f~ ...T.h~. a.s a...D ~ ......... .l,~a.t ¢..i,t~ok ................................................ pursuant to application dated ..................... .t.'?.O....Z',....].~.. ................ , 19...~.~7., and approved by the Building Inspector. Fee $...S~...'..~.O, ......... SUFFOLK,COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY DEE? HOLE CPJ~EK 1. ApplicantFRANCES ROSE HO~ES~INCPhone 744-1414 Add res s P. O. BOX 1038, BRO~ui)~WAY, ROCKY P_OINT_m N.Y. 2. Property Location E/S THERESA DRIVE 740' m/o NEW SUFFOLK AVE. Village ~ATTITUCK Township SOUTHOLD 3. Public Wa~ter Company Name NONE 4. Lot size: Width 1:1.0 feet Length 182 feet 5. Subdiv. ESTATES 6. Section~6_6__ 7. Lot Number 29 _ 8. Private ffell 9. Public Water~. D~tance to main lC. Sewage Disposal System: (For Health Services Dept. Us~e) 11. Ac 900-gallon septic tank: Precast ~ Equivalent Block B.:~ Leach~i~g pools: Number of pools Precast~ia filock__ Special. If priJ~ate well, fill in the fol- lowing'~lanks: A. Tank capacity__~2 , gallons B. P~mp G.P.M. ~ gal C. Total well depth ~ 60 Feet D. Depth to ground water E. Amount of water in well The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health Services' current standards thereto," This application will be valid for one year from the date of approval indicated below and may be renewed if a current local Building Department Permit is in effect. FRANCES ROSE HO~ES, INC. Date 10/27/78 Signed =========================================================================== FOR THE DEPARTMENT OF HEALTH SERVICES~ USE ONLY. Based on the information presented here- with, it is the opinion of the Department of Health Services that an adequate and satis- factory Sewage Disposal System and Water Supply can be installed on this plot, APPROVAL DATE SIGNED S-15 Rev, 4/1/73 FOB, M TOWN OF SOUTHOI.D BUILDING DEPARTMENT TOWN C~LI:RK'$ SOUTHOLD, N. Y. ........ Approved ................ ./.! ........... L...~...., 19..?..f.. Permit No....~..~..~..-~,..,~ .......... Disapproved a/c .,~ ................ " - g P Application No. ~...~...Z...-~'.... ............... APPLICATION FOR BUILDING PERMIT Date ..................... INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building 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 or 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. 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 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 Ragu arians, for the construction of bud ngs, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buildir}g~ode, housing code, and regulations, and to admit authorized inspectors on premises and in, buildings for necessary inj/pe,~tions. FRA}~CE~ ~OSB HO,,~ES~ It~C, (Signa/~re of' ~pflicant, or/~me, if a corporation) ...... · v~aaress at applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. BUI LORR Name of owner of premises ......... ]~E[......]~Lt~,D.0.2~ ............ · ................................. if applicant is a corporate, signature of' du y authorized officer. (Name and title of corporate officer) Ben ~endozza~ Pres B~lilder's License No ..................................................... Plumber's License No. 26DP . Electrician's License No. 30 E Other Trade's License No ............................................... DEEP HOLD C~,,1Z.K ESTA~ES 1. Location of land on which proposed work will be done. Map No.: .~;~5.~. .......... ................... Lot No ........ ~3.D. ............ Street and Number .~/..~5...~[~,~k..g~I~ .......... '7.¢,~,O~...s/.G...~..,..~.F.,~O~...~:"c~....f,....~.A~:[:~...~.. ......... .~, 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 ..... ~...~.~..~,,~,~'...~t/..e.'ll-:LD~ ....... 3. Nature of work (check which applicable): New Buildiag.....~. ........... Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) 4. Estimated Cost ..,....Zb.,~0.QO,,.00. ............................... 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 ................................ 8. Dimensions of entire new construction: Front ............ ~. ................... Rear ..... .~9 .................. Depth ....2~. .............. Height ....... ~. .......Number of Stories ..... ~ .............................................................................................................. 9. Size of lot: Front .......... ~0. ...................................... Rear ............. ~ ..................... Depth ...~.8.2 ...................... 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 .....~.e~ ............... Will excess fill be removed from premises: ( ) Yes (~) No ~4. Name of Owner of premises ~'....~.~ ..... Addr~s~.~.~.~..~e No. ~.. Name of Architect .................... ?: ........................................ Address ................................ Phone No. N~m~ o~ Contrector~.AhG~..~..~O~.~...~.~l~.,.,.. Address~,9~0~.. ~.... Phone No ....................... -, PLOT DIAGRAM Resk~=~e~m%T=~ Ou~ohoEue, N .Y, Lmcate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-~ck dimensions from prope~¢y lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. o,~,!s FILED ~LANS STATE OF NEV~-~OI~C . I c S COUNTY OF ............ r ~.~....~.]~[i~.Q.~.~,¢..~.~.~.~.~.,8,~.J4Q~..~O.~;...~Q.~.~/~ing duly sworn, deposes and says that he is the applicem (Name of individual signing contract) above~amed. He is the ............ ~.~. ...... .~Q~¢Q~A.~...Q~I.~ ................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have p~rformed the said work and to make and file this application; that oil statements contained in this application aret~ue to the best of his knowledge and belief; and tha~ the work will be performed in the manner set fo~h in the applicati~ filed therewith.~ Sworn to before me this ~ FRA[~C~S ROS~; .~tO~ES ~ Ii',O. .../~ ....... day of ........... ~ ............... , 19~.~.. // ~ ~'~ BY: ....... ............ cou, ......... ............................... / No, 52-812~850, Suffolk lerm [xpires Uar~h 30~ 1~ Lot 40 40 O0' J Foot 82.00 lot J8 NOTE: I = MONUMENT £1 ~: STAKE 0~ THE C~ERK OF SUFfOlK ~ONTV oN YOUNG & '~, YOUNG 400 [1STRAN[~{R AVENU[, ~{ V['?HEAD, NEW YORK SURVEY, FOR: BEN MENDOZZA t_oT 39 )4 ..t " FRANCES' ROSE HOMESr INC" BROADW. AY 'R:OCK¥ POINT, N. Y, 11718 L I:RANcEs RO$~ HOMFr. S, BROADWAY ROCKY pOINT~ N, Y. 11~76