HomeMy WebLinkAbout12717-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of' the Building Inspector
Town Hall
Southold, N.Y.
Cerfificafe Of Occupancy
No..~J.2p.7.4. Date November 17
.......................................... 1983
THIS CERTIFIES that the building-.z c..a?. ?. e...s.h .....................................
Location of Property 6565 Main Road Ma.ttituck
House No. Street Ham/et
County Tax Map No, 1000 Section . .1.2.5. ....... Block . .0.1 ............ Lot 01 9 · 1' .
Subdivision ..... X. ......................... Filed Map No, X . .Lot No. X
conforrns substantially to the Application for Building Permit heretofore filed in this office dated
·..A..u g.u.s.l;. ~ .........,198..3. pursuant to which Building Permit No .... 3..2.7.1.7...Z ..........
dated.......N o.v.e...m b .... e.r 1... · · · · - · · · · · 19 .8 .3., was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is .........
a commercial car wash.
The certificate is issued to EAST END CAR WASH, INC.
..................... ?o¥,,'o;, ............ ' ..........
of the aforesaid building.
Suffolk County Department of Health Approval . MA~ 1 ,..1.1./. J .6.48. 3. ~..R.q b..~....~:, y.~.~. 1..a., .r'.: E..
UNDERWRITERS CERTIFICATE NO .~ e.m. p: .N.8..8 .~ .87.q ·
Building Inspector
Rev. 1/81
TOWN OF SOU'~HOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Permission is hereby gronted ~,
.... ~.. ....... ../~. .......... .~ ...................
.... ~.~..~.q..~.;>,...~:..%/..: .................
,o ....... ~~.....~.~/~.~.....~.....~ ..................
...... ~ ............. ~~...~....~_/~ ..................... ~ ................. '..
., ,~..,,., ,~.,ed ~, ..,.~Z~....~4x~....~.~...~~~x.~
County Tax Map No. 1000 Section .... ZZS...'~.. ..... Block ....(~)./.. .......... Lot No. 0~,.~...;./..-- .......
to application dated ...~-~'(.~.~.......~... ................. , 19~.~.4 and approved by the
pursuant
Building Inspector.
Fee $~=t~.....~.. ..............
/~ildt'ng Inspector
Rev. 6/30/80
FORM NO, 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in Wpewriter OR ink, and submitted in duplicate to the Building Inspec-
tor wlth the following; for new buildings or new use:
1. Final survey of property with accurate ~ocatlon 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 installa-
tions, 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 peoperty 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 informa-
tion required to prepare a certificate.
C." Fees:
1. Certificate of occupancy $5.00 /
2. Certificate of occupancy on pre-existing dwelling/ land
3. Copy of certificate of occupancy $1.00
use--Pre-Existing C.0. $15.00
Vacant land C.0. $ 5.00
Date , ,t~..I.L~p. ,.t~ .~'~ ......
New Building .... .~.. ..... Old,or Pre-existing Building ............ Vacant Land .............
Location of Property .. ?.'I~2..~.? ..... .~..~.~.~., ?..o, ,~..~, ........ ~. ~.¥~,.~...~..~..~. .............
tYou~e No. Street Ham/et
Owner or Owners of Property ...~..f~.~,~...~,'",~, .~...~.~,~..L~t:~5..~'~. ......................
County Tax Map No. 1000 Section .... ~ .~..~. ...... Block .... .~.~. ....... Lot...~..~9.[. .......
Subdivision ................................. Filed Map No ........... Lot No ..............
Underwriters Approval ............ Planning Boar roval ......................
Request for Temporary Certificate ............... Final Certificate ..
F S bmitted $ ' ·
Construction on above described building andp. ermit meets all applicable codes and regulations.
(~0' (~-O~F~A ,ica "~ ~..[c.~..~c,...---_ ......
TEMPORARY CERTIFICATE
The New York Board of Fire Underwriters
BUREAU OF ELECTRICITY
.~/~ 85 JOHN STR£ET
,,,g,NEw ~o,,,N.v. loo.~8 N 884870
~fis Certifies, Ihat the electrical ~e~ice equipment imt~led has been duly reported to this Bureau
a~d lhe use of ~ame i~ he~b~ ~rmitted fo~ n~ ~ore ~an 90 day~ from above dat~ or until recalled.
~ation ~ . ~
~ J.
FOR ELE~RIC ~MPANY INSPE~ION ~ ~ REQUIRED BY
FIELD ~I N ~P~E C T I ON
FOUNDATION (1st)
FOUNDATION (2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
~DE
FINAL
DATE COMMENTS ~!~ ,, ,
ADDITIONAL COMMENTS:
P
HENRY E. RAYNOR, Jr., Chairman
JAMES WALL
BENNETT ORLOWSK/, Jr.
GEORGE RITCHIE LATH.SM,
W[LIAAM F. MULLEN, Jr.
Southold, N.Y. 11971
TELEPHONE
765- 1938
November 10, 1983
Mr. Victor Lessard
Building Administrator
Southold Town Hall
$outhold, New York 11971
Re: East End Car Wash
Robert Ringold
Dear Mr. Lessard:
Regarding Mr. Edward Hinderman's inquiry, please be
advised that we have no objection to the issuance of a
Certificate of Occupancy for East End Car Wash/Robert Ringold,
located at Mattituck.
Our July 25, 1983 approval was made subject to an one
year review, which does allow our Board to correct any prob-
lem that might arise during this time.
If you require additional information, please contact
our office.
Very truly yours,
HENRY E. RAYNOR, JR., CHAIRMAN
SOUTHOLD TOWN PLANNING BOARD
By Susan E. Long, Secretary
SOUTHOLD 765-1128
GLENN F. HEIDTMANN & SON INC.
GLENN F. HEIDTMANN & SON, INC.
P. O. BOX 932 COX LANE ' mO,v, E
CUTCHOGUE, NEW YORK 11935 JA,'v;."$7'O,~T,,,." ",.
MAIL ADDRESS:
............... 11071
To Town of Southold
Building Department
Att.: Hr. E. Hinderman
,Tob
Gentlemen:
We are
(x) Enclosing
( ) Forwarding under separate cover
( ) Handing you
Date: October 6, 1983
East End Car Wash Corp,
Robert Ringold .
Main Road, Mattituck, N.Y.
Copies
1
1
Highway Work Permit f? 10-83-0286
.Dwg. No. Title
New York State Department of Transportation
Which are for
(x) Approval and distribution
( ) Your information
( ) Record
Very truly yours,
Please initial and return copy
By
GLENN F. HEIDTMANN & SON INC,
Clenn F. Heidtmann
Date
N[W YORY, STATE
DEPARTMENT OF TRANSPORTATION
Region 10 Office: New York State Office Building
Veterans Highway, Hauppauge, New York 11787
Date: 10-26-83
Building Department
Town of S0uth0]d
Southold Town Hall
Southold, NY 11971
Permit Issued To: Re:
Glenn F. Heidtman & Sons
PO Box 932 Cox Lane
Curtchogue, NY 11935
Permit ~_10-83-0286 To open thp n/~ Pf.?~ 600+~
9/o Railroad Bridge Msttit, mk= fn in~t"!! 32'.-
wide intersection type entrance, concrete curb.
and sidewalk etc.
Gentlemen:
We have no objection to the issuance of a Certificate of Occupancy for the
Mattituck Car Wash
located at the above noted site. This is not, im any way, to be construed
as final acceptance of the work required under the State Highway Work
Permit,~ since all aspects of this work may not yet be satisfactorily
completed.
We thank you for your continued cooperation.
Sincerely yours,
HARRY R. THYB~
Regional Permit Engineer
Region 10
HRT:mD:VL:GS
cc: File
PERM 42e
Permit Fee~ $
Ins. Fee $
Total Received
Check or M.O. No.~
Liability In}urance
Policy No. -
Di~bility B'enefit Coverage
Policy No.
Permittee
Address
STATE OF NEW YORK - DEPARTMENT 0~: TRAN~PORT~TION
~, . . ;~ · '~: SH NO. ~.?~
~ ~ Est'. ~omp.,. Date __
n,~, ,,,~, WV''" ', De~t Rec. for $ 3~500
Expiring ...... Checkor M.O. ~o.
Dated
or
.$
Chargeabte~to Bond. NO.
!'GLENN F. HEIDTMANN & SON? INC.
or Undertaking on File
City : Cm)tEh_~'!e; State MY zip: !!O~ ~oj~k eQ'sC~mpen.ti~n
~ ~ ~' ~ ~:Retd~h of;Deposit Made Payable To
Ma(Compl,teng Address fo~ Return of Bond or DepoSitonly if different from above.) ~~ ~ ~:; --~ ~~ ~ ~ --~ ~ mete Only "Omfferont Fr°m Perm'ttee~
AddressName ~ ~ Add~e~ ~
City ~ State . Zil City ~ State Zip
Under th~ ~rovJsi~ns of the Highway La~or Vehicle & Traffic Law p~rmiss~~he p~rmittee to ~
. , . ~, ~ . . . - .
~)~ as set forth and repre~nted m the a~taqhed apphcatmpn, at the pa~rcular location or area, or
over the robtes as stated therein, if required; and pursuant to the Condit. one ~nd. r~ulattons ~hether general or special, and methods
of perform ng work if any; all of which are ~t forth m the apphcat~on and fo[m part of this permit.
~ ' D~tbdat Un,lnnn n~ ,NY Comm~sipne~ranspo~tation // /.
': ~ ---;-~, --~- ' ' '~'~/ , ~ /:/~ .l~ /
~ ~1 , IMPORTANT:: :~ ' / ~( ~r~
~ ~ ~ THIS PERMIT, WITH APPLICATIDN AND DRAWING ~OR~OPIESTHEREOE) ATTACHED,
~ J~SHALL eE PLACED N THE HANDS OF THE CONY~'~c~OR BEFOR~AN*W0~K IS STARTED.I
NOTICE -~lt is absolutely necessary that the permittee notify ~ ~ ~: ~e; NY~ mT
p~{~ ~ ~Engineer whose add[ess is' ~'e¢~ ~!:a~:~-~v-
, 2~ h~;. ~a~ca~; ~eou~ ~ Tel. No. ~ 3~ bef0~e~ork is sta~ed and upen its completion.3 ] 78!
~f~re or ddr)ng the o~perat'ons author'zed '.~ ~
* drat )age, etc.
(SEE OTHER SIDE)
HENRY E. RAYNOR, Jr., Chairman
JAMES WALL
BENNETT ORLOWSKI, Jr.
GEORGE RITCHIE LATHAM, Jr.
WILLIAM F. MULLEN, Jr.
Southold, N.Y. 11971
TELEPHONE
765-1938
July 26, 1983
Mr. Irving L. Price, Jr.
Attorney at Law
828 Front Street
Greenport, New York 11944
Re: Robert Ringold
East End Car Wash Corp.
Dear Mr. Price:
The following action was taken by the Southold Town
Planning Board, Monday, July 25, 1983.
RESOLVED that the Soutkold Town Planning Board approve
the site plan "Robert Ringold/East End Car Wash Corp." dated
July 21, 1983, to be located at Mattituck, subject to a one
year review and an on site field inspection of the Planning
Board prior to the issuance of a certificate of occupancy.
Very truly yours,
HENRY E. RAYNOR, JR., CHAIRMAN
SOUTHOLD TOWN PLANNING BOARD
By Susan E. Long, Secretary
cc: Building Department~//~
JUL.
1000174 THE
Date December
THIS CERTIFIES THAT
NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
8.5 JOHN STREET, NEW YORK, NEW YORK 1003~
20, 1933 A..l~c..o,,No.o.~.e 233~,5-83 N 627112
only the electrical equipment as described below and introduced by the applicamt na~ned on the above application mu tnber in the premises of
East End Carwash Inc., N/S/O Rt.25 E/O Laurel Lake Dr., Mattituck~ N.¥~
in the followlng location; [] Basement [~ 1st FI. [] 2nd FI, Sectio~t Block Lot
*oase~a,ni,~don December 8 , 1933 and found to be in compliance with the requirements of thls Board.
FIXTURE
OUTLETS
11
~ECEPTACLES SWITCHES
4 7 11
FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS
FLUORESCENT
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIMECLOCKS
UNIT HEATERS MULTI-OUTLET
SYSTEMS
NO. OF FEET
DIMMERS
SERVICE DISCONNECT
OTHER APPARATUS:
Motors:2-15 HP, 1-5 HP,
3-60amp. disconnect
2.-30amp. disconnect
1-photo lite cell.
S E R V I C E
OF HI-LEG
NO OF CC COND, A.W O NO OF HI-LEO
PER ~' OF CC CONO
1 500 mcm
1-3 HP, 1-2 HP, 4-]..6 HP, 1-,1~ HI'.
NO, OF NEUTRALS A, W, G
OF NEUTRAL
1 500 mcat
EECO Elecg. Corp.
Cliff Cornell
325 Willow Point Rd.
Sonthold~ N.Y~, 11971
LIC,~2816
This certificate must not be altered in any manner; return to the office of the Board if nco~rect. Inspectors may be
MANAGER
S COPY OF CERTIFI! MANNER.
/
1. Requested duration from 19
2. Protective Liability Insurance covered by policy No.
3. Workmen's Compensation Insurance policy No.
STATE OF NEW YORK - DEPARTMENT OF TI~)~qSPORTATION
PERM 33d (3/81)
HIGHWAY WORK PERMIT APPLICATION FOR NON-UT~LITY WORK
Application is hereby made for a highway work permit Highway Permit No.
Effective Date
ENTER NAME AND
MAILING ADDRESS
IN THIS SPACE
_1
thru _ 19
,t. Disability Benefits Coverage policy No.
expiring
PREPARE
3COPIES
~0~ $~.~00 (codified Cheek)
, to apply to the operation(s) checked below:
expires on 19
Check Type Permit ;how Ins,Fee in Total Amount Guarantee
Fee Amt, or PERM* ,f Fee and / Deposit Amount
of Operation 17 pr Under- or Insurance and/or Bond
~Comr. e,c'o' $~00 $2.~0 $102,9/ X
J~ Commercial $ 20
clear land M brush, etc.
~ Pruning, app[zing~he~ical~ to~tum~s,~tc~ .....................
--~- - _
~ Temporary signs, banners, Christmas decorations $ 20
$ 20
~ MisceHaneous
.... ~.mo~.,o~ __ ~ ~o~nz .............. "Z
TOTAL PAID
Work may be described briefly as follows:
~ Additional work description is attached; ~ Plans pages and/or ~Map i~ tried showing wor~ to oe performed att
LOCATION ( ~ ~ ~ State Highway No., ~ between station
..d ,~.*io. i. tho To~n of ~ Cou.ty of ~'~
Acceptance of t~e reques d permit subjects the permittee to the restrictions, regulations and obligations stated on this application and on the permit·
Approval recommended lg__ By Resident Engineer ,, // ./,
Approved_
/
/
PERM33d (3/81) i R_~eSPONSIBILITIES OF PERMITTEE
REVERSE
1. PRoTECTiVE LIABILITY INSURANCE COVERAGE
JSe'rmittee must have protective liability insurance coverage in accordance with Department requirements, (See Infor-
mation on Protective Liability Insurance Required for Highway Work Permits and/or Special Hauling Permits, Form
PERM-27).
Expiration of, or lack of, Jiab,;iJify insurance automatically terminates the permit.
Insurance coverage may be pr,ovided by furnishing the Department with one of the following:
a.' A Certificate of Protectiye /~abdlty Insurance for Permits on State H~ghways (Form PERM 17, NYSDoT).
b. A $2.50 remittance (checkI drawn on e New York State Bank or Certified) for coverage under the Departmental Blanket
! Policy. i'
c. An Undertaking may be furnished by Public Service Corporations and Government Units only and must include the
wording required by the D~partment.
2. COMPENSATION INSURANCE AND DISABILITY COVERAGE
The applicant is required to tlave compensation insurance and disabilitycoverage as noted inthe provisions of the
Workmen~s Compensation Law!and Acts amendatorythereof for the entire period of the permit, or the permJtis invalid.
3. NOTIFICATIONS
Nbtify Commissioner, throughI Regional Office, one week prior to commencing work, except emergency work by public
service utilities which should be reported the next work day.
W6rk must start within 30 da~s from date of permit.
Notify area gas distributors 72 hours prior to any blasting.
Notify Utility Companies wlt~ facilities in work area (permission must be obtained before doing work affecting utilities'
facilities) before starting woik.
Nqtify land owners of abutting lands, before disturbing trees.
Notify Department of Transpertation at conclusion of work and return original copy of permit to Regional Office.
A~nual Maintenance Permit Notifications:
N6tify by telephone the DIsmct or Resident Office, one week in advance, each time regular maintenance work
is:to be performed. In emerge'ncies, notification by telephone should be made the next work day.
SITE CARE AND RESTORATION
An Undertaking, a bond or ceitified check in an amount designated by the DepartmentofTransportatlon may berequired
by the Regional Office, before a permit is issued, to guarantee restoration of the site to its original condition. If the
Department is obliged to restore the site of its original condition, the costs to the Department will be deducted from
the amount of the permlttee si guarantee deposit at the conclusion of the work.
The permittee is responsible for traffic protection and maintenance, including adequate use of signs and barriers during
w6rk and evening hours. Anv6ne working within the R.O.W. will wear an orange vest and hard hat.
Nc) unnecessary obstruction i~ to be left on the pavement or the right of way or in such a position as to block warning
signs during or between work hours.
No work shall be done to obsltruct drainage or divert creeks, water courses or sluices onto the right of way.
All falsework must be removed and all excavations must be filled in and restored to the satisfaction of the Regional
Traffic Engineer.
5. COSTS INCURRED BY ISSUANCE OF, THIS PERMIT
AJJ costs beyond the limits o'f the protective llability insurance, surety deposits, efc.~ are the responsibility of the
permittee. :
The State shall be held free pf any costs incurred by the issuance of this permit, direct or indirect.
6. SUBMITTING WORK PLANS
The applicant will submit wark plans and/or a map as required by the Department. This shall include such details as
measurements of driveways with relation to nearest corner, poslfions of guys supporting poles and a schedule of the
number of poles and feet of excavation necessary for completion of the work on the State right of way, A description
of the proposed method of construction will be included.
Plan work with future adjustments in mind, as any relocation~ replacement or removal of the installation authorized by
this permit and made necessary by future highway maintenancet reconstruction or new construction, will be the respon-
si, biJity of the permittee.
The'permittee must coordinate his work with any state construction being conducted.
7. TRAFFIC MAINTENANCE I
T~affic shall be maintained byjthe perm[tree on the highway, in a safe manner, during working and non-working hours until con-
s~ruction is completed. Suitable safeguards, to reduce conditions dangerous to life, limb and property to a minimum, must be pro-
vided by the permJttee {including flagman when requested by the Department),
8. COST OF INSPECTION AND SUPERVISION
If, Jn the accounts kept by the Department, costs of supervision are found to be exceedingly high, the Department re-
serves the right to bill the permittee for actual expenses incurred by the supervision and inspection of the permittee~s
project.
9. SCOPE
~,reas Cavered
Permits issued are for hi]ghways! bridges and culverts over which the New York Stat? Deparm~ent of Transportation
has jurisdiction. (Local:governments issue permits for their own jurisdict¥on~)
b. Legal
The privilege granted byithe permit does not authorize any infringement of federal, state or local laws or regu)ations~
is limited to the extent of the authority of this Departme_nt in the premises and is transferable and assignable only
with the written consentlof theCommJss~onerto~Transpor~t,atmn..
c. Commissioner s Reservations
: ~TheC~ommi~sione~' of;T~a~psportation reserves ~the right to modify fees and to revoke or annul the permit at ony time,
at his discretion wlthoutj' a hearing or the necessity of showing cause,
d'. Locations i
Work locations must meant approval of the Department.
(Additional pages to thi{ application vary according to the purpose, and type of work to be permitted)
t ~ ~ FORM NO. 1
,, TOWN OF SOUTHOLD
' ' BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
/~----')//? ] 9~:'..~ TEL.: 765-1802
Examined . · .,./ .......... ,
Approved .: .......... , l .. .Permi' No.- .dZr. Z.Z
Disapproved · · .........
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date ...A.u. gu..s~..5 ...... , 198.3..
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted 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 of property must be drawn on the diagram which is part of this appli-
cation.
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 issued 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.
APPLICATIdN 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 constraction 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 regulsti0Bs~, and to
admit authorized inspectors on premises and in building for necessary inspections.
...... E~. ~ .d.t.~v.u..s.. 5?. ,.. T.'q~. .. ..............
(Signature of applicant, or name, if a corporation)
.. p.,.o.,. 3.qx.. 9.~.2.,..C.u.~..c.h.o. gu..e.,..8, ¥....~. ~&~.5..
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder.
Builder
' ~ ~ m' s g~.st ~nO Car ~ash I.q ,
~agn~ o~ owner ox pre ]s,e ·. ...................................................................
~,~,~ 2 (~ ~2~~~ ~ on the tax roll or latest deed)
If~r~tl~, ~'gn~T~ ofdiil~ authorized officer.
(Name and title of corporate office:r)
Builder's License No ........ ~)./LO .............
Dohm Services
Plumber's License No .........................
Electrician's License No .... G.. & .S ...Contr. acting
Other Trade's License No ......................
1. Location of land on which proposed work will be done .... .n./?..l}.t....2..5?..~0..0.'..w..e.s.g..o..f..B.r.a..y..A.v..a: .....
~ b-~ ~- Mattituck, N.Y.
House Number Street Hamlet
County Tax Map No. 1000 Section ... ~[.2.5. ........... Block .... Q1. ............ Lot ...... .1.9...1:. ........
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
Zoning YB-1 ,~;/:'.,~(~r~M-r- /.~%wL>
a. Existing use and occupancy ............. ........................................................
b. Intended use and occt~pancy ....... .~.?.((... !~..'(2..5[K ..............................................
3. Nature of work (check which agplicable): New Building ....x ...... Addition .......... Alteration 0. .........
Repair .............. RemOval .............. Demolition .......... Other Work '. ..............
; ,l~,~o ~ · (Hescription)
4. l?,stimatedCost ........ ~..9.qi,99.°.'.99................. Fee ...............................
(to be paid on filing this application)
5. If dwelling, number of dwelling pnits ............... Number of dwelling units on each floor ................
If garage number of cars '
6. If business, ommerclal or mixed occupancy, specify nature and extent of each type of use . .qO 1:..w.,~ Oh ..........
7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ...............
Height ............... Nurr}ber of Stones
r)imensions of same structure w!th alterations or additions: Front ................. Rear ..................
Depth ' Height Number of Stories
8. Dimensions of entire new construction: Front ..... 24 ! ....... Rear ...'. 2.6, ~. ....... Depth . .40 ! ..........
Height 16 ' Nuntber of Stories one .
9. Size of lot: Front .... ],38:...i ........... Rear .. lP,.1. ~ ............... Depth .... ~05.' ..............
10. ][)ate of Purchase ........... : .................. Name of Former Owner .............................
.... hp' ' ]31.
11. Zone or use district in whlc r~mlses are situated ...... : ......... -. ..................................
12. Does proposed construction rio!ate any zoning law, ordinance or regulation: .... tuo ..........................
13. Will lot be regraded ......... ,:. · y.e.§ ............. Will excess fill be removed from premises: _ _ ~Y.e~_ _ _ XNo
14. Name 6fOwner of premises .E.q .sT..E.n.c/...C.a.r...~.q.a.s.h. Address ................... Phone No.../.~..3..2.3..8? ....
Name 0fArchitect ¥;[0rreB ¢latthesen
· · · : · · · , ................ Address ................... Phone No ..............
Name of Contractor .H. eldtmann. .. .& .S°n. ....Add Pho e N 734-74~4
...... ~ ........ ress ......... n o ....
PLOT DIAGRAM
Locate clearly and distinctly alii buildings, whether existing or proposed, and. indicate all set-back dimensions from
property lines. Give street and block inumber or description according to deed, and show street names and indicate whether
interior or c.orner lot. ~
See attach'~ Survey
STATE OF NEW Y/OI~,
COUNTY OF v~,~_,,d~L--" ~.~'~
.... -- (Name(of individu~ signing contra~.~ '~' '~' ' ' being duly'swo}n, dep6ses ~d says that he is the applicant
above named. "
He is the ..................... i .......................................... ~. ·
...... i ; ) ..............
: .~ (Contractor. :agent, corpora e office , etc.
of said owaer or owners, ~d is dul~ authorized to perform or have perfomeO the said work and to m~e and file ~is
application; that all statements contained ~ this application are true to the best of his ~owledge and belief; and that the
wbrk will be perfomed in the m~ner set forth in the application filed therewith.
Sworn to before m~t~¢~
........................ .... ....
~ ~ JUDITH T. TERRY
~ota~ P~b[ic, S~ate of N~Y~ ~ ~ ~ ~ ~~ ....
~ .o. m-o3a~a s.fotk mun~ ~' ·: ~'~' ' 'k%[ ........................
' ~,~ ~,,~ ~,h ~, lSa~ ~~ ~' (Signature of applic~t)
f
21.5
~
22 0
?
0o
0o¢
Of
21¸5
19 5
RO/~P .
SITE PLAIV PREPARED FOt~
ROBERT RINGOLD
AT MiTTITUGK
TO~/IV OF SOUTHOLD
SUFF CO, IV Y.
SCALE I"= 20'
JULY 5, 1983
JULY/2, 1985
JULY 21, 1983
RECEIVED BY
DAlE
property is located in o? agricultural
SUFFOLK ~;OUNTY DEPARTMENT OF HEALTH SERVICES oreo, the possibility ~x~sts.that
For Construction Only H.D. Ref, No, tlr
d,spasal and water supply facilitie~ for ~AG~ _
ood
~' -- Z~ -,~. V~-'A
00'
N.Y5.
~.L~JAGEk ;[DI~F~O~AL BY,ST.'iv
25 )¸
ROBERT RINGOLD
AT MATTITUOK
TO~YN OF SOUTHOLD
SUFF CO., N. Y
SCALE I "- 20'
JULY 5, 1885
JULY 12, 1885
JULY 2/; /98J
JOL~ 29, /985
GO.
o0`8
ot
C, OO8~1'0~1~00
M~IN
T~IS FINAL APPROVAL WILL E~IP~E ON DECEMBER 15~
1983
SUEFOLK COUNY¥ g.eA~a~{ENI O~ liLAJH SEMICES
App~'o,.'al of ConstmcteO ~Varks
H.D, Eel,
~e sewage dispo:;91 Ind wrater supply famhties at this Iocatm
SURVEY FOR
ROBERT RINGOLD
,4T Af~TTITUCK
SUFFOLK COUNTY, N, E
SCALE: / "= 20 '
DATE .' NOW 2, 1983
/' : /'-,o'
.I
1,
765-1
4.