HomeMy WebLinkAbout18406-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z19194 Date JULY 9, 1990
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property 195 PRIVATE. ROAD #32 SOUTHOLD, NEW YORK
House No. Street Hamlet
County Tax Map No. 1000 Section 59 Block 9 Lot 10.5
MINOR SUB.
Subdivision COMM DEV. AGENCY Filed Map No. 9162 Lot. No. 5
conforms substantially to the Application for Building Permit heretofore
filed in this office dated. JUNE 22., 1989 pursuant to which
Building Permit No. 18406-Z dated AUGUST 25, 1989
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 ONE FAMILY DWELLING WITH WOOD DECK & STEPS
The certificate is issued to TOWN OF SOUTHOLD
(owner)
of the aforesaid-building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 89-SO-39-JUNE 8, 1990
UNDERWRITERS CERTIFICATE NO. N132800 - JUNE. 12, 1990
PLUMBERS CERTIFICATION DATED HARDY PLUMBING & HEATING. MAY 24, 1990
Building Inspector
Rev. 1/81
FORK NO. 9
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N° 18406 Z Date . ... ....... ::5................. 19.v.
Permission is hereby granted to:
... ...... ...... .... .. ...... . ...... ...... ...
�..
.... .. .L/... . . . . ... . . . .
�r�
01
to ......... .. .. .. .. . ... . ........G..L.........1,G-....... .... ... . .. ... ..... . ...
at.premises located at............ .. ....... ...........`.......... ..� ...� . .. ..................
......................................................�.�... ..... . .. .... ....�... ................................
.................................................................................................................................................................
County Tax Map No. 1000 Section ... .y7......... Block ...a.. ......... Lot No. ...t.O.:-'...4�..
pursuant to application dated ....114
...... . ..............
I...%............. 19G7./47, and approved by the
Building Inspector.
Fee $.... . ...`. . .. ..I....
C. . ..... .....
..'... ..... �. ..... ...
Buildin ` Inspector
9 ►uDec
Rev. 6/30/80
A�
_ r
THE NEW YORK :B"OARD .OF FIRE UNDERWRITERS
l'1. 0ti95' BUREAU OF ELECTRICITY
M 85 JOHN STREET,,NEW YORK;;,NEW YORK.10038
Date Application No.on file
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
TWO )UAua fiIJI.1",DERS, PftTVA'!'r, Ft.C110) 1,0)TV, 530. ?.i :i/tr 300,0:])TI.EW s1VE
in thefollolcing location; L] Basement � lst Fl. El2nd Fl. '1`I".I 'i i'�6)ii'p Sertionc' i B(ock £? Lot I'.lU .f.d7
f-! ;14,1990
was examined on and found to be in compliance with the requirements of this Board.
w FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS RECEPTACLES SWITCHES INCANDESCENT.FLUORESCENT I OTHER AMT. I K.W. AMT. I K.W. AMT. I K.W. AMT. I K.W. AMT. H.P.
1.1. 2 C. ? ;. F
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI OUTLET DIMMERS
SYSTEMS
AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. NO.OF FEET AMT. WATTS
SERVICE DISCONNECT NO.OF S E R V I C E
METER NO.OF CC.COND. A.W.G. A.W.G. A.W.G.
AMT. AMP. TYPE EQUIP 1�8'2W 1S,B'3W 3 0 3W 3,0.4W PER Ar OF CC.COND. NO.OF HI-LEG OF HI-LEG NO.OF NEUTRALS OF NEUTRAL
OTHER APPARATUS:
1-3
SNOFE DETECTOR:—]
i-11'z,;.,3.A t`i. T,S 1.C C K T,l:C e 8 P.`?E LE
25(} SxI'P '1'nt�]'d AVt>>i�!lJ:
501!1s1"1%A, NY, 1.3.7 6 GENERAL MANAGER
Per
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. R
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUSS' NOT BE ALTERED IN ANY MANNER.
TEL. 76;-1802_
S('
• `,` J' �O TON OF .�iJT•�C��C. _
OFFICE OF II:UI&Di34G. I.1SPF-A37T-OR
y : TO V-N-I5-'.LL
SOUTHO"D, N-.Y. 1:1-971
C E R T I F I CAT I. O: N:
Date MAY 24, 1990
Building Permit No. 18406
Owner TWO BEARS
(please print)
PlU rb-ex HARDY PL. & HTG. NORTH, INC.
(please print)
I certify that the solder used _n the water supply system
contains less than 2!10 of 1% lead.
(plumber ' s signatur
Sworn to before me this -
�� day of
1900 - AiAinio -
Votary P,•blic
Nota_•• ht�h_ic , (/��Ou� Coun-y
MELANIE V.BROWN
Notary PubQc,State of New Yak
No.4908712
Ouudfied In Suffolk County
Commission E;Vm Od.19,19
cWit vk_� Q
Ali-
FOUNDA ( 1st)
FOUNDATION ( 2nd ) �y
2 .
z
ROUGH FRAME
PLUMBING '
3 . / � ►�
` a
IIISULATIOPI PER N . Y.
STATE ENERGY V,
CODE
4,. —..1.
FINAL
ADDITIONAL COMMENTS :
Me
- 1
-3
-_ m4.
/ /
BOARD OF HEALTH .
3 SETS OE PLANS . . . . . . . . . . . .
FORM NO. 1 SURVEY V
y . . . . . . . . . . . . . . . . . . .
TOWN OFSOUTHOLD CHECK . . . . . . . . . . . . . . . . . . . . . .
BUILDING DEPARTMENT SEPTIC FORM . . . . . . . . . . . . . . . .
TOWN HALL
SOUTHOLD, N.Y. 11971 NOTIFY
TEL.: 765.1802 CALL JameS. f: . 0.00hQn. . . . .
Examined . . . . . ./. ., 1960 f MAIL TO
Town Hall , Main-Road
Approved . . :�. . ., 19�9Permit No. .` ,J06 � Southold, New York 1,1,971
Disapprovedac . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . L5 U
D
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �! . . . . . . . . ��.. JJMM 2 2 1989
(Building Inspector) BLDG. DFPT.
APPLICATION FOR BUILDING PERMI TOUVNOFSi�UlNOLD
Date .flay, 8, , 1989.
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.
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
Re-ulations, 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 authorized inspectors on premises and in building for necessary inspections.
Town of Sout-hold - Community Develop.
•(Signature�ot applicant, or name, if a corporation)
Town Ha11 , Southold, NY 11971
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Mailing address of applicant) •
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
OWNER
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Name of owner of premises ,TOWN• •OF• SOUTHOLD : . . . . _
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
James C . McMahon, Administrator, C . D .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..
.
(Name and title of corporate officer)
Builder's License No. . . . . . . . . . . . . . . . . . . . . . . . . .
Plumber's License No. . . . 1,5V3. /„ . . . . . . . . .
Electrician's License No. . .p. . . . . . . . . .
Other Trade's License No. . . . . . . . . . . . . . . . . . . . . .
Location of land on which proposed work will be done. . . . ___ -y 1�;(Z l,U. }�y;F, , ,��,�, , , , , q`�. . • • . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ f . . . . . 96
�� �'l. . . . . . . . . . . . . ..
House Humber Street, Hamlet
County Tax Map No. 1000 Section . . . . .,�. !. . . . . . . . . . Block . . . . 0. . , . , . , , , , , Lot . . . .��
Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot .
(Nance) ..
State existing use and occupancy of premises and intended use and Occupancy of proposed construction:
a. Existing use and occupancy . . .VA C A N,T . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Intended u Single—Fam•ily• Residence. . . • • . • • . . . • . . . • .
use and occupancy . . . . . . . . .
641'66- M d)'F16 S&T
3. Nature of work (check which applicable): New Building • • . ... . . . . Addition . . . . . . . . . . Alteration
Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other 1Vork . . . . . . . . . . . .
11 }� (Description
t .
4. Estimated Cos . ,,1.�64!T.�/6'4:�T.p . . . . . . . . . . . . . . . . . . . . . . . . Fee . W,aived .- . Town . Project . . . . . . .
(to be paid on filing this application)
5. If dwelling,number of dwelling units . . . . . . . . . .1 . . . . Number of dwelling units on each floor. N.�A .
If garage, number of cars .191A. .
6. If business, commercial or mixed occupancy, specify nature and.extent of each•type.of use . N./.A . . . :..:. :
7.' Dimensions of existing structures, if any: Front . N./.A . . . . . . . Rear .NIA . . . . . . . . . Depth . N/A
Height . .N 1A. . . .. . . Niim ber b f Stories . .N�A, , , , , , , , ' ' ' ' ' ' '
Dimensions of same structure with"alterations or additions: Front . NSA • . . . . . . •Rear NIA. . . . . . . . . . .
Depth . .N/A. . . . . . . . . . . . . . . . . Height . N/A . Number of Stories . N/A
S. Dimensions of entire new co'tistructioh:_Front . . ..3'y , , , , , , ,..Rear . .3:y�. . . . . . . . . Depth '5,�,°
Height . .". X . , Number of Stories : . . , . ,
9. Size of lot: Front . . . . J&3 ... . . . Rear i. . . . . . . . . . . . . .Depth
. . . .. . . . . .
10. Date of Purchase . . . . . . . . . . . . . . ... . . . . . . . . . . . . .� � � • � � Re • • •,l`J.�' ' ' ' ' • ' • • • • • • Depth .,(,�,a�,o?3�, , , , , , ,
. Name of Former Owner . . . . . . . . . . . . . .
11. Zone or use district in which premises•are situated . . . . . .4.e51b&W.4. .1f1W�l, a?P�QA.L, , • _•
12. Does proposed construction violate any zoning law, ordinance or regulation: ,N 0 . . • . . . .
13. Will lot be regraded . . . . . . . . . . . . . . . . . . . . . . . . . . . . Will excess fill be removed from premises: . • • •- Yes • • • . I
14. Name of Owner of premisesTown. .cLf ., PAtihOA. Address Ms3in!'Rid Southc ldphone No.765-1892
Name of Architect . .NSA. . . . , Address . . X4 . . . . . . . • . . . . PI on�•�no.N�?• • • • .
Name of Contractor .T W o, ,Bears ,Builders.-,.• , .I Mdress P.O. ,Q g X, ,q 1 ' ' m a 9p%oihe No. 3 . . .. . . . . . , ..
15 .Is this property located within 300 feet of a tidal wetland? *YES. . . .N0 X. . .
*If yes , Southold Town Trustees Permit may be, required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and,indicate all set-back dimensions fro
property lines. Give street and block number or description according to deed, and show street names and indicate wheth
interior or corner lot.
SEE ATTACHED SURVEY
V
STATE OF NEW YORK, S.S
COUNTY OF . . . . . . . . . . . . . . . . .
• . • • •
James C • McMahon , , , , , , , . . being duly sworn, deposes and says that lie is the applican
(Name of individual signing contract)
above named.
lie is the . , Community• Development. Administrator.
(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 thi!
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.
Sworn-to before me this
. . . . . . . . . . At. . . . . . . . .day of. . . . . . . . . . . . . . .. 19 /.
+tiotary Public, , , , ,Suffolk. . v.y7Y. .pR.*County
HELEN A.DE V'OE . . . . . . . . . .'.
NOTARY PUSLic,State of New York
No.4767S7A,Suffolk Caun (Signature of applicant)
Term Exoress March 30,1
G 4
TEST HOLE JV 1
P
s
BROWNISH y
GREY SANDY ! 70 WELL
CLAY WITH v y
100/0 GRAVEL J`
3' `O p
PALE BROWN N <11
COARSE SAND O�BROWN CLAYEY v`p
SAND WITH s
LAYERS OF CLAY
13'
BROWN COARSE \
SAND
15.8' �z R =25.00' , �o
WATER IN BROWN ��• ec L= 59.27' `
COARSE SAND
o �1,
32 �
22, c` C P.
s o
Q 50 ' �°' ,� ,p /'t
F p O
o
Q- ? eo' i
o a
L 5�
VIP
29� 1¢ Q •
LIN
6
o _ OA
v
O.
• 2 -
x 70 %
c�0"
41
-o V
o
AREA = 30,000 SQ . FT. F, 0�\
1 Dy 0C3 rlQ
THE LOCATIONS OF WELLS AND CESSPOOLS SHOWN HgREON ARE ,aE
FROM FIELD OBSERVATIONS AND OR DATA OBTAINED ROM OTHERS
�s...^T 1 C4
OF APPROVAL
ZEXPI�RES
47 1 Od �'f•a ! .�1� 77 :. R b
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
FOR AP OV L OF CONSTRUC ION ONLY CV S SURVEY OF PROPERTY
DATE � 3 c l REF. NO. FOR
APPROVED COMMUNITY DEVELOPMENT AGENCY
EB
THE A R SUPPLY AND SEWAGE DISPOSAL
AT SOUTHOL D
S EMS R THIS RESIDENCE WILL CONFORM TOWN 0 F SOUTHOL D
0 THE ST DARDS OF THE SUFFOLK COUNTY
DEPARTMENT F HEALTH SERVICES. FEB S
SUFFOLK COUNTY, N.Y.
'1000 - 59 - 09 - P/O 10
�0 SCALE 1 = 30
k49 J, � ��� NOV. 23 , 1988
JAMES C. McMAHON ���
c0 MUMTV DEVELOPMENT OFFICE
� TOWN HALL Prepared in accordance with the minimum
�
.. � 'T SOUT LD, NEW YORK 11971 0'
standards for title surveys as estabiishad o-
the L.I.A.L.S. and approved and adopt,
Y S I C. N 0. 4 9 6 6 8 /�/ for such use by The New York State Land
i+ ® Title Association.
n °
P. N `c$' V S P. C. oec
20
���
wE ,�
P. 0.'B='0'k:,909 ELEVATIONS ARE REFERENCED
MAIN ROAD LOT NUMBERS REFER TO " MINOR SUBDIVISION " TO AN ASSUMED DATUM.
SOUTHOLD , N.Y. 11971 MADE FOR COMMUNITY DEVELOPMENT AGENCY.
�l 99
1-1O
\
\
Q.t2o R =25_00' �
. o
�Z•
nOP o 'Sr
! 0bP 1,10
.�1
70
op
0 0
NO i
O�\ Gi
DIP
e 5 � J ,
2g. / -off 10 �0
699 j
. F
LOT 5
Fo
9V
All
\0\
Get.
LOT 4 raQP
AREA = 30,000 SQ. FT.
5
ti c\V., 5 � �oQ�
Q
SURVEY OF PROPERTY
FOR
COMMUNITY DEVELOPMENT AGENCY
AT SOUTHOL D
TOWN OF SOUTHOL D
SU F FOL K COUNTY, N.Y.
1000 - 59 - 09 - P/O 10
SCALE 1 'l = 30'I
NOV. 23 , 1988
Sept. 1, 1989 (found. loc.
LINOS
• i�c�
S. LIC. NO. 49668
PECON `1JiftX/ ' y RS , P. C.
( 516 ) 765 - 5020
P. 0. BOX 909
ELEVATIONS ARE REFERENCED
MAIN ROAD LOT NUMBERS REFER TO " MINOR SUBDIVISION " TO AN ASSUMED DATUM.
SOJTHOLD , N.Y. 11971 MADE FOR COMMUNITY DEVELOPMENT AGENCY. REVISION _ e-19-e'
88 - 143 (5)
V` 1770
yC 9,
Io
GJD ss
o
2500' ,
33.2.7'
0
�z•
e�•
OC' 40 •` ce ° o��
� F �
�poll ,p
\ 5 F 'o O
h`
o\\ 04
Dh \ .yoQ 00
/ r
2 LOT 5
• st
70
S7
0
\r
WELL
LOT 4 gQP
AREA = 30,000 SQ. FT. F , 5\\ C
SUFFOLK COUNTY DEPARTMENT OF HEALTH Q�
SINGLEFAMIL•Y DWELLING ONLY
DATE' I.S. REF. NO.
The sewage disposal and water sup p acilities for this
H.S. 4 89—SO-39 location have been inspected by t Department and/or
other age ies d foun to sa 'star-torl
Chief of 6reau of wastewater Management SURVEY OF PROPERTY
FOR
CSOUTHOLD SAVINGS BANK COMMUNITY DEVELOPMENT AGENCY
PHYLLIS ATKINSON
AT SOUTHOLD
Prepared in accordance with the minimum TOWN OF SOUTHOL D
stun dt.ards .far title surveys as estal;lishErl by S U F FO L K COUNTY N.Y.
the L.I.A.L.S. and approved and adopted f
for such use by The New York State Land 1000 - 59 09 P/O 10
Title Association. d
SCALE 1 = 30
NOV. 23 , 1988
Sept. 1, 1989 (found loc. )
y Feb. 13, 1990 (final)
Fop �
s 1_ANI)
ZQN A. 1NC
,
_N:" . LIC. NO. 49668
I•r Pri'G:1F
PECON 1I �C ' , P. C.
q
( 516 ) 7 �—''S 0 2 0
P. 0. BOX 909
ELEVATIONS ARE REFERENCED
MAIN ROAD LOT NUMBERS REFER TO " MINOR SUBDIVISION TO AN ASSUMED DATUM.
SOUTHOLD , N.Y. 11971 MADE FOR COMMUNITY DEVELOPMENT AGENCY. AEWSXN _ e_taep
88. 143, (5)
occut
-4 VIM
USL
I TT`rIQU R ,61RCATE
I P
XCUPANC"vol
1 i' X18"H -S cAS
Sol
r { � oLLY l�Ia.aM� f , � •� {` �
\./ - O • -
E �- I MF o.G 10, OJ.
I
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�e
t'
e,��a
PLUMBING
aI LhO a� 1 O ALL PLUMBING WASTE
Ion ( &WATER LINES NEED
�
_
_- TESTING BEFORE COVERING
a
- A-1 YKax .0
v' V
LM
r
t
a v y a o Wik
! 0 -
10/�
i p
,/ If copper tubirt �+� x 1(olt Lp l h, �� n ,� K
for waterdistributingot,I� lotlG
�•�,. I System; � ����� � ` ° ' •"a'','•••• .' '
Piping shall be _.
of types K oLLonfX
t ;, � Ztl f's1�,,.�rl� �Cl,•�'./at-! fit;V
L�'{s-rt►�U��S
fW g�NG wAst�
mG
JAILL PLUM
& NG WATER
TES TIBEFORE COVERING
A\
TOLERANCES REVISIONS }
(EXCEPT AS NOTEDI "
NO. DATE BY
DECIMAL _
_ 2
FRACTIONAL
3 DRAWN R i SCALE MATERIAL t.
.� �0
Z 4 i
CHK<D DATE DRAWING NUMBER i
ANGULAR fiq
' t,
TRACED APP'D "•:<
e
_. 18 X 24 GPRINTED ON NO. t000N CLEARPRINT•
uU
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IS II ! FlL
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