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Home My WebLink About12474-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No Z12?q7 Date Auguot 23 19.8) THIS CERTIFIES that the building ...... ~..e?..d.~. e..1.1.~.n.g ............................ Location of Property 290 H±am± Ave. ?econ±c County Tax Map No. 1000 Section .... 0. 6. 7 ..... Block ....... .6 .......Lot .... 1.5. ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. 6I~g... ~ ........... , 19 ~3.3. pursuant to which Building Permit No ..... ~..2.4.7.~ .Z .......... dated ...... .~.u.g,..9 ............... 1~ 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 ......... New one famil~ dwelling Tho certificate is issued to Robert Waddington (owner, ~,.~Y~.~Z ~]{~X) of the aforesaid building. Suffolk County Department of Health Approval .... 1 3-S0- 1 1 0 UNDERWRITERS CERTIFICATE NO ............. P..e.n.d.~.n. g ............................. Rev. 1/81 Building Inspector FOEI~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPART/vlENT TOWN HALL SOUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 1~7~ Z ~ate ...... ~ .......... ..Cl ............... , ~..~.~ Permission is hereby granted~t~o.'. . . . ....... .................. ~c'_>~... ~, ~/~ .. at premises located at .....~...~..~.........~..~..C~..~....~:~..C~... ........................... County Tax Map No. 1000 Section~.......(~.....Q?..~.. .......Block ........ ..~. .......... Lot No ....... ]...~.~.~. ........... pursuant to application doted ...~..~.o~...~...~.......~.. ................... , 19.~..~, and approved by' the Building Inspector. Fee $....~I....: ............. ................... Building Inspector Rev. 6/30/80 FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall ,(,~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitte~to the Building Inspec- tor 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 featu res. 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. 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. Fees: 1, Certificate of occupancy $5,00 / 2. Certificate of occupancy on pre-existing dwelling ! ~and use 3. Copy of certificate of occupancy $1.00 / --Pre-Existing C.O. $15.00 Vacant l~d C.O. $ 5.00 Date.. ?; ~/x_,~, .~,~., ¢. ~, ........., New Building ~ - Old or Pre existin,g Building .............. ..................... Vacant Land Location ofProperty .~. ?.~. ~f~.~. ,/?..( ./¢. ¢..C'. ~0~ ~ ~ . Owner or Owners of Property ...' 'r~5 County Tax Map No. 1000 Section ............. Block ............... Lot ................ Subdivision ................................. Filed Map No ............ Lot.No .............. PermitNo.[~.~.~..~.'~. Date of Permit .C/.~..f.f.A~pplicant. [.~o/.~ -//o Health Dept. Approval ....................... Labor Dept. Approval ........................ Underwriters Approval . . .~.~./'~. ~. ~ .............. Planning Board Approval ~ . .... Request for Temporary Certificate .................... Certificate ....................... Fee Submitted $.. ~. t ~..-. .................... Construction on above described building and permit II applicable codes and regulations. Applicant .... Rev. 10-10-78 Environmental Engineers & Scientists HOLZMACHER, McLENDON and MURRELL, P.C. 575 BROAD HOLLOW ROAD, MELVILLE, NEW YORK 11'~47 i(516) 694-304~0 ~ WATER RESOURCES · WATER SUPPLY & TREATMENT · SEWERAGE & TREATMENT · A~UATJO & MARINE ECOLOGY MODEL STUDIES · PILOT PLANT STUDIES · WATER/WASTE WATER LABORATORY A,ND ANALYTI~ALi SERVICES CLIENT'S NAME AND ADDRESS DATES: GOL!~ECTED RECEIVED HA Rt~'Y G~,~L.:0H AN LAB. NO. FIELD NO TIME COL. BY ANALYSIS HAI'T];I'UCK, NY :t. 19;~;2 POINT OF COLLEcTION: . ~,,WI" DISTRIBUTION WELL OTHER (SPECIFY) ROUTII~E RE-SAMPLE SPECIAL COMPLAINT WELL NO. ONLY I,D. 03 TEsT RESULT Bacteria APC/ml Coliform Bacteria MPN/100ml Color (units) Turbidity (unds) Odor: Cold Odor. Hot Total iron (mg/Ii Manganese (rog/I) Free CO~ (rog/I) Nomograph -- Tdragon Fluoride (rog/l) Free Ammonia (mg/I N) Ammonia (mg/I N) Nitrites (mg/I N) TEST RESULT Nitrates (mg/I N) Chemical Oxygen Demand (mg/i) Chlorides (mg/I) Total Hardness (mg/I as CaCO3) Total Alkahnity (mg/I as CaCO~) pH Total Solids (rog/I) Spec~hc Cond. ~mhos) Detergents (mg/I as MBAS) Dissolved Oxygen (rog/I) Hexavalent Chromium (mg/I Cr +~) Calcium Hardness (mg/I as CaCO3) Temp. (Field) ~F TEST RESULT ~lkahnlty (mg/I CaCO~) Total Phosphate (mg/I P) (~rtho Phosphate (m~g/I P) MISCELLANEOUS Test Code Result Oopper (mg/I) Sulfate ((ng/I SO~) Acidity (mg/I CaCO~) S?dlU m (mg/I) ~agneslum cOPIES TO: WATER t.,UNN,I. NG REMARKS: BOB oA1 .... ACTORY. SIGNATURE /' / . . C ENDON ~ ,.~ + [J,~,, RINK?:NG WATER .~ ~l~l.g,~l TITLE LABORATOR~ DI~ECTOR , DATE REPORTED -- ' ~ HOLZMACHER, McLENDON and MURRELL, P,C · CONSULTING ENGINEERS, ENVIRONMENTAL SCIENTISTS and PLANNERS 575 BROAD HOLLOW ROAD, MELVILLE, N.Y. 11747 · 516-694-3040 CLIEN~ NAME AND ADDRESS Har~y Goldman Water Analysis Main Road Mattituck, NY 11922 Lab No. 460143 Date Collected 7/26/84 Add~{ional San~ple Info. See LabReport # 411955 PARAM~£~ ug/1 vinyl chloride .................... methylene chloride ............. .. .. 1,1 dichloroethane ................. chloroform ......................... t, 1,1 trichloroethane .............. 1,2 dich~oropropane ................ trichloroethylene .............................. tetrachloroethylene ............................ chlorobenzene .............................· .. .. toluene ........................................ m-xylene..o... ................................ . o-xylene ....................................... p-xylene ....................................... o-dichlorobenzene . temik ............................. · ....... · .... Results reported meet N.Y.S. Drinking Water Standards. < 1 < 1 13 < 1 20 < 1 < 1 3 < 1 < 1 < 1 < 1 < 1 < 1 < 1 < 1 Date Repo~rted 8/6/84 Director Me}','ille, New York · Fa~mlngdale, New York ° R[¥erhead, New York Environmental Engineers & Scientists HOLZMACHER, McLENDON and MURRELL, P,C. 575 BROAD HOLLOW ROAD, MELVILLE, NEW YORK 11747 (516) 694-3040 WATI~R RESOURCES · WATER SUPPLY & TREATMENT · SEWERAGE & TREATMENT · AQUATIC & MARINE ECOLOGY MODEL STUDIES · P~LOT PLANT STUDIES · WATER/WASTE WATER LABORATORY AND ANALYTICAL ~ERVICES CLIENT'S NAME AND ADDRESS LAB. No. FIELD, OTHER (SPECIFY) REC. CODE DATE TEST DATES: TIME COL. SY GOL~-ECTED RECEIVED 07126/R4 ANALYSIS PREMISES OF sAMPLING POINT BOB NA;U~t'I NHT(~N POINT OF COLLECTION: , ¢ DISTRIBUTION WELL ROUTINE RE-SAMPLE SPECIAL COMPLAINT POINT OR 07,:>,61~4 WELL RAW (1) REATED (2) OTHER (3) LAB. WELL NO. ~' ' ~ ONLY ID. 03 TEST RESULT Bacteria APC/ml Coliform Bacteria MPN/100ml Color (units) Turbidity (units)' Odor: Cold Odor: Hot RESULT Nitrates (mg/I N) Chemical Oxygen Demand (mg/I) Chlorides (mg/I) Total Hardness (mg/I as CaCO~) Total Alkahmty (mg/l as CaCO~) pH Total Solids (rog/I) Specd~c Cond (pmhos) Detergents (mg/I as MBAS) -:~ D~ssolved Oxygen (mg/I) Hexavalent Chromium (mg/I Cr +~) Calmum Hardness (mg/I as CaCO3) Temp (Field) °F Total iron (mgA) Manganese (mg/I) ';*i Free CO~ (rog/I) Nomograph -- TJtration Fluoride (mg/I) Free Ammoh!a (mg/I N) Ammonia (mg/I N) N~trites (mg/I N) COPIESTO: WA'¥E:R RUNN1Nr; TEST RESULT I~hosphate (mg/I P) Phosphate (n~g/I P) MISCELLANEOUS Test Code Copper (mg/!) Sodium (rog/I) (r~g/~) REMARKS: 7,-,27-8'~: B0B I,¢A 0D [ N!3TON I 'i'E.~S I'l¢4;~Kb.~ ~( E,,,L,E_~I""" E' N.Y,S', L,]:MZT$ FOR SIGNATURE TITLE LASORATOR,Yi, DihECTOR S.C. McLENDON Result !DATE ' :REPORTED FI~ECD~NSPECTION COMMENTS FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL ADDITIONAL COMR FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180;~ Approved...~.~¢...~., 19~'.~. Permit No.]. .~'.'~ :-I."~.. Disapproved a/c ... .................................. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No.. ! .~..~.: .~..~ ...... Date ...... 19 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 fqr any purpose whatey~ u~il a Certificate of Occupancy shall have been granted by the Building Inspector. //// APPLICATION IS HEREBY MADE to the Building Department for the issua~6e 9if a~uilding Permit pursuant to the Building Zone Ordinance of the Tgwn of Southold, Suffolk County, New Yorkj/gmd/ott~r applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for ]~{mg~al/d] demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, bufldin /)tod~t, ~Su~ing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspecti (Sig~ ~cant, or name, if a corporation) '(Mailing addYess of'applicarit) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. ................................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No .... ............ Electrician's License No ....................... Other Trade's'Licenge ..... : ............ tX2 1 ~ ~ ~ rv~ t~ [' Location of land on which proposed work will be dorm .................................................. House Number Street Hamlet County Tax Map No. 1000 Secti~_~ .... .~.i~.7 ....... Block ...6 ............. Lot..../..~... ......... Subdivision .... ~.?~..(/~.iq.a~..?~..~.~. ......... FiledMapNo..l.O.(~,~. ..... Lot ~ ( ) State existing use and occupancy of premises an~d intended use and occupancy of proposed construction: a. Existing use and occupancy., .~./~'.~.~ . .; ~ b. Intended use and Occupancy .......................................... :...,. ; .................. 3. Nature ~fwork (check which applicable): New Building .. ~ .... Addition .......... Alteration .......... Repair ............... Removal .............. Demolition .............. Other Work ............... : (Description) 4. Estimated Cost ~. ~ (21~), ~ Fee : i [ (to be paid on filing this application) 5. If dwelling number of dwelling u~t~ ~ .A ............ Number of dwelling units on each floor . If garage, number of cars ...... i ]~//f4~. ............. i ............................... 6. If busm.ess, commercml or m~xed loccupancy, spemfy na[ure and extent of each type of use .... '7 ............... 7. Dimensibns of existing structures, if any: Front ...... t~../4.'1~¢... Rear .............. Depth .............. Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear ................. Depth ./ ..................... '. Height ...................... Nmn~b~r,o4' Stories ..................... 8. Dimensions of~e~nti[e new construlction: Front ...... ..~.~. ..... Rear ... ~.~.O~.. ...... -. Depth ...~..&'~. ..... Height ..... ]./,z ........ Number of Stories ..... ] ............................... · .,~. w ~ ........ Sizeoflot Front . .10.~ .. .......... Rear ...... /~.C). ........... D~th ..1~ ,.q.~ ..... Date of Purchase .... I.q~ l; ........... ~ame of Former Owner .~l~J.~.~..~.,.~:. ] ]. ]...: ] Zone or use district in which premises are situated '[~,~.~ . ' ' ' Does proposed construction v[q!a, te any zoning law, ordinance or regulation: .... .~..O. ..................... Will lot be regraded ....... [,NLJ_., ..... ~,,...! ......... Will excess fill be removed from premises: _ Yes, Name of Owner of premises 3~.t.(./.~d~.~...la.~... Address ................. '.. Phone No, . Name of Architect ~ .*q.~.. !,._.5~.,!,16..g',~'~? .... Address .... Phone No ................ Name of Contractor .~o[...~..;t!¢[l~'.tt~Ml~..~... i ] i Address ]]]]]]]]]]]]]]] .... Phone No.. 10. 11. 12. 14. PLOT DIAGRAM Locate clearly and distinctly all buildings whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block npmber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW_YORK ...... i~ ..... ;.~..d. d .~.~ .'~..7~.., ~ ~4 ~. ~.~ ..... being duly sworn, deposes and says that he is the applicant (Name of individual signin~ C~atract) - above named. ~e is the ....................... .................................................................. (Contractor, agent, corporate officer, etc.) )f said owner or ownen, ~d is duly ~authorized to perform or have perfomed the said work and to m~e and file ~is ~pplication; that all statements contaified ~ this application are true to the best of his knowledge and belief; and that the vork will be perfomed in the m~ner ~et forth in the application filed ~emwith. :~womtobeforemethis ~ ~ ~ qota~ Public, .¢'.~ ............... ~ ............... County NOTARY PUgLIC, State ~fl New York ~ Commission E~pire* March 30, 1~ (Signature of applicant) SUFFOLK CO. HEALTH DEPT. APPROVAL H.s. NO. STATE~NT OF 'INTENT - SYSTEMS F~/~HIS RESIDENCE WILL CONFORM T~E STANDARDS OF THE suFFOLK'~PT. OF HEALTH SERV ces II' 71/ SERVICES-~ FOR APPROVAL OF W RS A R N.&Z*.gS'E. - ;o0.o ? v SUFFOLK CO. HEALTH DEPT. APPROVAL H.S. NO. I~-~'~,.'~-~10 STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS Of THE SUFFOLk CO. DEPT. OF HEALTH SERVICES. (s) APPLICANT SUFFOLK COUNTY SERVICES FOR CONSTRUCTION ONLY DATE: DEPT. OF HEALTH APPrOVAl Of H. S. REF. NO., APPROVED: SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT BLOCK PEL OWNERS ADDRESS: % C, vv'moc~N~-r'o~ T'.JT~4tLk L~, DEED: L..~?~ P. Z~ (~:;.) TEST HOLE [ ' ~TAMP SEAL i SUFFOLK CO. HEALTH DEPT./~ROvAL,''~ H.S. NO. ~ENTSTATE OF ~NTENT TME WATER SU/~Y ANO SEWAGE DISPOSAL SYSTemS F~/TmS ~S~O~NCE SUFFO DEPT. OF HEALTH SERVICE FOR APPROVAL OF CONSTRUCTION ONLY DATE: ~, ~--~ SUFFOLK CO TAX mAP DESIGNATION · ~ST ~Ob~ STAMP SEAL - - ALL WORK SHALL COMPLY ~tJTH THE ~,q YORK sTATE-CONS~RUCTI~',cO~I~? 2, 'THE HE~ YORK STATE ENERGY CO~E :SHALL OF PART S (ACCEPTE~ PRACTICE),AN9 PROVIt)E SEPARATE HEATI~ ZONES FOR ~CH FLOOR, ALt: EQUiP~NT SHALL COHPLY WITH THE ENERGY CODE', 5,FIREPLACE DAHPER SHALL HAVE A LEAK RAEE OF FITTI~ WITH A 6.THE #ITCHEN EXHAUST FAN VENT. SHALL BE FITTE~ NJTH A':~AHPER 7,HOT ~IATER AND HEATING 'PIPES SWALL-BE ,iNSULATED TO R = 8;HENALL HEATiNG~ HOT wATER A~ ELECTRICAL EOIJIPHENTSttALL YORK STATE 9,iNSULATE PER SCHI3)ULE, SL.,~ ~GE -' P--- ~' TOTAL Zp ............... I ........ -.-3. L ~pPROVEP AS 7851802 9 AM TO 4 PM FOR THE NG iNSP£CTIONS . ~ ~oURED Z ROUGH - FRAMIN~ & I~LUMBING 4. BE ~up ~r~ FOR C O ALL C , ~,J~ OR CoNSTRUCTIO Unauthorized aJfer¢i6n addition to this document is vioWion of section 7209 of the New York State EducBtJon Copies of this document not beal'ing the englneer's inked 's Ose~sea ~r embossed seal copper tu~i~g ~ b~ considered valid copies, tystem~ p~p~ng L only ~ o~peSK°r 1