The URL can be used to link to this page

Home My WebLink About7521-zFORM NO. 4 TOWN OF SOUTHOLD BUN,DING DEPARTMI~.NT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z6X~O Date Dee THIS CERTIFIES that the building located at Caa~ Ileek Road .............. ? ............. Street Map No. Xx Block No. XX .Lot N-~ I/att:~ok II,Y, conforms substantially to the Application for Building Permit heretofore fried in this office dated ............. 8.e~.t... ~, 19..~.. pursuant to which Bu0ding Permit No..7..~.2.1Z.. Sept g . dated ......................., 19 .... , was issued, and conforms to all of the reqmre- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is Px, iv&t~ o~e flmd. ly The certificate is issued toDaniel & l/a~y 8held~ 0~rnerl (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval D.c.?. ,~.~. 197~ by a. ¥illa~ UNDERWRITERS CERTIFICATE No. 111~30 ~ 19~ HOUSE NUMBER 2~?~ Street Cox Neok Road FOBM NO. 2 TOWN OF $OUTNOLD 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? 7521 z Permission is hereby granted to: P~ ~.~l~..~ ome&..I 1~ c...~/.~ .. ~lan,l. eJ... ~he].d on to .. ~.~,3,~ ..~c~...~...{:~,3,~...0,~m.3,3,;t~ ................................................................................... at premiss I~at~ at ..~..U~.~.~o.~.~..~..~p~.,.~,~, ....................... ~ ....................... ................................................................. ~Z.~2Z~.....H.,.2.,. ........................................................... purs~nt ~ a~{{cat}on ~t~ ........................ .~.~....~ .............. , ]9.~..., and o~prov~ by t~e Bu{{d{ng {n~tor. Fee $..~.~ ,.~0 ........... TOWN OF SOUTHOLD__ /_/~.,, /~.~,,_~' BUILDING DEPARTMEN~'//'/ ~.~r TOWN CLERK'S OFFICE ..... ............. _ .......... Di~ppmvod ~/c .............................................................. : ..... ..... ............. o. Thi~ ~pplicotion mu*t be compl~t~l~ filled in b~ ~owrit~r o~ in i~k ond ~mitt~ in In*peetor~ with 3 ~t, o~ plGn~, accu[~t~ pl~ plan to ~lfi. ~ acco~in~ to ~ch~dulo. b. ~ -Plot plon showino ~otion of lot and o{ buildin0~ on premises, relationship to ad~oinin0 promise* or public o eos, ond ~ v n~ * d~t* led ~cr pt on o{ lo,out o{prope~ mu~t be drown on t~ d *Orem wh ch c. -Th~ work covered by thi* ~pplic*~ion may nat b~ comm~d befor~ i~suonce o{ Buildino ~rmit. d. ~pon opprovol o{ thi~ application, tho Buildino Inspector ~ill iss~ ~ 8uildin~ ~ermit to ~he opplic~nt. Such permit ~holl b~ kept on th~ pr~mi~ avoil~ble {or inspection throughout th~ work. e. No buildin~ ~h~ll b~ ~cupi~d or u*~d in whol~ or in pa~ for ony purpo** whoever until ~ sh~ll h~vo b~n oranted by th~ 8uildin~ Inspector. A~klC~TIO~ IS H[R[SY ~Dfi to th~ Buildin~ D~pa~ment for the i~suonce o{ ~ Buildinfl Permit pu~u~nt to tho Buildin~ Zon~ Ordin~nc* o{ th~ Town o~ Southold, Suffolk Count~, ~ew York, ~nd oth*r ~ppllc~b~ ~*w~, O~in~nc~ Regulations, for th~ con,true,on o{ buildings, oddition~ or olteration~, or {or removal or d*molition, The opplic~nt ~roe~ to comply with oll applicob~ I~w*, orO'inonc*~ buildin~ c~, h~i~ c~, odm~t ~uthori~ed ink,tom ~ promi*e* and i~ buHdino~ ~r n~es~ (Signature of applicant, or name, if a corporation) 1159 West Main Street, Riverhead, NY 11901 (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................... ......................................................................................................................................................... Name of owner of premises Daniel C, Sheldon and MarX Sheldon ......... Builder's License No ..................................................... Plumber's License No. ..~.~.~.T.~. ................................... Electrician's License No. ..~v~ ............................... ~her Tmde's License No ............................................... 1. k~ctiom of [and on which pr~osed work wi[[ be done. M~p No.: ........................................ Lot No ......................... Street and Number ~fi..~..~.~..~.t~...~.~L.~[.0...~.~.rl~mi~i,.,..~k .............................................. Munlcip~li~ 2. State existing use cad ~cupcmcy of premises crud intended use ~nd ~cuponcy o~ propped comstructlom: a. Exisiting use ~nd ~cupancy ...... .~9.~nt ~and b. Intended use and occupancy ...... lln~...fa~Ll~..d~e~Li~ ................................................................................... 3. Nature of work (check which applicable): New Building ....... .X ........ Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work ...................................................... ~. ~ ~_ /-~/,,~ .(~ (Description) 4. Estimated Cost ............/....A.~ ....................................... Fee ..:./...v... .............................................................................. (to be paid on filing this application] 5. If dwelling, number of dwelling units ........ ~. ................. Number of dwelling units on each floor .1..~.~...-....~. .............. 2nd - 2 If garage, number of cars ...... .o.g.e. ................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of u~e ............................ 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 44' Rear.....4..4.~ ................... Depth 26' Height ....... ~).'. ....... Number of Stories ..... ~ ................................................................................................................ ............ 100 ........................ Depth ZSO.! ........................ 9. Size of lot: Front .... 1D0.! ............................................ Rear Mar. 29. 1971 10. Date of Purchase .................. ~. .................................... ~'~ome of Former Owner ...W..i..1..l..i..a.m...a..n...d....M~....rY....?...i..?d.s..a...Y. ..... 11. Zone or use district in which premises ore situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded . ...... ."~...~--~... ......... Will excess fill be removed from premises: (z~"~ Yes ( ) No 14. Name of Owner of premises Dani~l...C,...amd..Ma~',y..~.~l,~.o~ Address ~95~..~b.o.r.e..~,~.~. Phone No..~.~..-.~.~..0.~.. ..... Church La. ,,, 727-3395 Name of Architect .,~:?.h.~E~...~.~.°.~.°.?..!c~. .......................... Address ................. .~l~cs~zrenone No ....................... Name of Contractor ..IU..v~.~id~..B~me~...~,¢ .................. Address ~,~,Y.~.~.b,~.~ .............. Phone No....7..2.7...-.~..3..g..5.... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fram property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ~EE ATTACHED ~dRVEY STATE OF NEW YORK, ~ ¢ S COUNTY OF .......... .q ~.Q~4~ ........ ............ be ing duly sworn, deposes and soys that he is the applicon! (Name of individual signing contracf) t c above named. He is the .............................. .A.~.q.~..t;. ......................................................................................................................................... (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 b_,,ef,,~ me this ........... Nota~ Public,~~..¥,~..~nty //~.-.~-..t'~i~.r~oture of ......... applicant~ ~-")' ............................ FOI~M NO. 6 TOWN OF SOUTHOLD Building Department 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 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 orEngineer 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: I. 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 $1.00 New Building ....x. ........... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property W/S Cox Neck Road. 450' S/O Bergen Ave. Matt~h,~t- ........................... z .......................... .~.. ..............,,.. .-f- .,;..,* '-..-; ..................... Owner Or Owners Of Property ...I~ttj,~J,...C.,....~.n..d...M..a..r,.v...$.h..¢..1.~l.o..n' ............................. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No...7..5..2..1...Z. ....... Date Of Permit ..9../..5../..7..4. ....... Applicant Riverside Homes, Inc. Health Dept. Approval ....4..S..0..-..1..2.9. ........................... Labor Dept. Approval ................................................ Underwriters Approval ..N..1..9..7..4..3..0. ............................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ......... ~ ............................... Fee Submitted $ 5.00 Construction on above described building and permit meeJ's all applicabl~ code~.,pnd/~regulations. Sworn to before me this · ...~..?..../~... day of ~~.~./...¥. ..... (stamp or seal) Nota Pub,,c .......... f~ : / _ / ~ ~ ~ qwa~a~ rur:,i~, ,~a,e of New Yor~ ~UFFOLK COUNTY D[PARTMENT OF HEALTH Health Department ~. ~ Reference Number ~ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A ~ATER SUPPLY Address _~~/-~z~9~_-~.~~ <z~¢~)' ~. Lot Nu~ber~~ 2. ~ronert~~~~ ~'~' ~ ~ ~. Private Well ~.~1~~ I~n~p~o~' ~ Dis,ance to ~in 3. Public Water Compan~ ~am -- 4. Lot size: Width~[~ fe~ Length~ yeet (For Health Dept. Use) S~posal System: A~ 900~allon septic tank: Precast~Equivalent_ Block_ B. Leaching pools: Nu~i~er of pools / Precast~_z'~'~B. loc~__~Special llo ~f private well, fill in the o!lowing blanks: A. Tank capacity~all°ns B. Pump G.P.~4, ___ C. Total well depth. wil- be valid for one year from the date of approva.~indicated be)ow and may be renewed if a c~rrent local Buildtng Department Permit is in e~q'~ct. / ~, -. ~//'~.~'~//~ ~ Si gneiSS/" ~/~,,4~~ ..... !~--' FO'* HEALTH DEPARIM~ USE ONLY. Based on the information presented herewith, it is the o-~ ~ien of ~e- ~a'~th ~ar~nt that an adequate and satisfactory Sewage Disposal System ar] Water Supply can be installed on this plot. ~/_~_~ SIGNED '~,,~~.-~ ~ -- D. Dept to ground water E Amount of water in well · The undersigned CERTIFIES: "Construction of authorized installations will be ~n accordance with the Sufiolk County Department of Health's current standards thereto. This application ., ~ .... . ? CAPE COD ~-'- [~T~'CT~n'~' --I),'~ nbc all materials and e ut ment to be b cluded in the prol~osed w,.'k ~v h:rc .?.:~'e'~~ :"~ ~a~:-t',,:~ c,,, .r ,.c.,,, h~c an,l dca'ct/be under item 31. or attach addtllOhal sheets, ~li u ork ~ot . . ~;F' ro ..... ~ ,,~t ~t~.~ ~,~ material and equipment shall eauat or av~',ed fhat described ~ ',, ':, ,Ned. ~z-L' h. Pc-' ,'m, .1 ?r~manlike manner an tn ~cordance with the best pract/ce. ................................ Spccial foundatwns .................................... 3. CK~ vi?.: ~. ,' prgfabrlcated {maka ~no qize~ ........................................ c : ~ hr, ' tc ............... ;thlckncs$ ............ ; faci~ ........ ....Backup ............ Bo'hu~ .......... Li,:tcls G-;~. . , .c,m,~ ~ 5p. me as main wall; ~ other .......................... 3 m,a _ ~'3-5 ..~ imckn,:s; .... ~- .... )'; reinforcing ............. insulation ......... rnmmu .nc - thickness ...................................... 7. ~T ~ , [.c "'N' , f),3 ' t~rdcr'7,?o~ing /or ~peclal Ooor~ under ~rem ~ ............. ' th,ckn~s ......................................................... ' ~t,, -- Asphalt ; l' adc ~tandard Wci,~, . ,~' ~ ~J~ ..... Y~-~"~ ...... : :;' =~ .......e.: ,~,ur,. ' ..................... <,:,h % ia cri:U ................ ; weigh{ or {hicllness .......... [ lnsY r Coa:: ........ : ~-t ~ 318" ......... i.,,- . ~ing ~o~ / ~-~ I ........ i~~::-~ ...... ~'Y_'2 .... Double hqng.< make .... ~' ;~atcrial Wood Clamshell_ ,,:,~er,am white pinD. P~int ' Latex ........ Friction ............ ; n,~{o ,u{ ..... aluminum .,r:~u-,. , KX ~2 whit~__~ ......... ; Paint ..... oil ......... ' ,~;,..r -. ....... if ...... ~ ................, .~_.~.~.~.~_~_ -~o~-- - 2 ....................... ~-$-~'~ .......... s,._ ~.-- c~. ~ / Bathr°~ -"~r~gg-~ ............................................ L,, ~c~ ~ copper hxbing; El otl~m - ......... - U' ; Electric ................... m;,k¢ ~d model ..... ~eem ............ ~ - ~. ~._ pneu~atie ~alvan~zed ................................ c.mac~,~ - ~ECTRI~__ .t~EAT ....... Legend_~r-~o~,--- h,put ---2-50 ..... Watts al_ _~LQ .... Volts Output -- ............ ~ ............. ~ .... ~.---;-;. ......... ~ - _ -~ ,,. I ,,..I [~,~¢ box ~] circui break: Number of branch circuits .... [~ Range. ~ wa,ct hc~ier. ~] furl,ace. [_] dryer. ~] other ~'r ..... mrcs ......... ~ ................. Total allowance for fixtures 3 ~O~Ce[ ~tn_ ~$x~u~es-~ ~a~m~ ......................................... Front and rear stopp~s - concrete as ~_lan t.'ll _ 100 .. ft Foundation ........ ft.. Nearest lot line: I~x, '.,'~fl~lL PI.AN'FIN{;. WALKg, DRIVE~. AND FINISI! GRADING: ~ugh-grade _to_~pO~¢ hQU~_~-W-~hin 30' area ......................................... ~ .............................................. . In _the.~e~_filk-im-g~-b~ ~_~gh~ tp ~he lobsite er wiii a" ~-'-C~W~r'~i~l bury trees . ' te he ~ - .................. .~h~ .j~b~!__~_~ ........ ~ ......... ~.M .......................... tn oho 8~ot on ~ner 8 property. ................................... ~ ......... ; ...................... /F~e~ / Submitted I,y: ..~ ............................... . ~pproved by: .... ~ .. Y =7 FI 2 t HAWKINS. WEBB. JAEGER. ASSOCIArE'S P C. SURVEYING ~ ENGINEERING 200 EAST BROADWAY A~T HIC, H S~ fEET PORT JEFFERSON N. Y 11777 ~173 0469 SUFFOLK COUNTY. N. Y, FILED M~P NO.. DATE FILED .... CONSTR~CTION DATES ii o ,¸% NO. 7W -178 ~' PROPERTY OF SITUATE AT /4~/~ HALL NOT BE CONSIDERED TO BE SCALE ./ r s~'~t~. DATE GUARANTEED B~K & PAGE _/~/T ~/~ I~ ~ CONSTRUCTION DATES FDN. UND. CONST ..... FINAL ,~ .; - ' ~ ' HAWKINS. ~E~, JAEGER. ASSOCIATES. ~~e~L.s. -' 2oo ~6T B~OABWAY AT HiGH THE NEW YORK BOARD OF FIRE UNDERWRITERS flk BUREAU OF ELECTRICITY . ' ' ~-- 85 JOHN STREET. NEW YORK, NEW'YORK 10~)38 r ~teDeeembez' 5, 197/1 ~ppficotio,~o. on~t, 76~855 N 197430 THIS CE~IFIES THAT ~a~e~ ~heldon~ w/s~de ~ox N~ok Rd.. ~0 n/o ~ergen Ave.. Mat t ltuok~ ~. Z. in the/~ifl~ ~at~n; ~ ~t ~ 1st FI. ~ ~ n. OUtnlde ~tion B~k ~t .xTu~ ~XTU~ES ~A~ ~ING ~ I OVENS ~ WA~ EXHAUST FANS 13 30 ~8 ~3 { 1 I DRY~ {RNACE ~TORS ~TURE~A~ {~ ~IMRK'~{ TI~ ~{ UNIT~ATE~ M~TI~T~T ~ERS ~ 200 OB x ~ ~/0 ~ 2/0 COPY .F~,. ~UILDING DEPART~OpY OF CERTIFICAT~.~ .MUST N~'~L ,~ ~AN~.Y ~JN.~,____: ~.~ , ~?, :. . ~ ~/ ...,.~ _ /o .. -'~-' .... . _.._. / ~ ' ,. P