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Home My WebLink About12692-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z.~.3.2. g. ,8 .......... Date APRIL 1 ., 198.5.. THIS CERTIFIES that the build[tag . NE.~ · · DW-I~ E L .I.N.G ............................... Location of Property 105 FLEETWOOD ROAD CUTCHOGUE House No. Street Hamlet County Tax Map No. 1000 Section ... q. 3. .7 ...... Block 04 .Lot 8 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 1 I 19 83 pursuant to which Building Permit No. 12692Z dated . .O..C .TQ.E.E..R..1.3. .............. 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 ......... FOR A NEW ONE FAMILY DWELLING The certificate is issued to PAULINE W. KETCHAM ..................... gr 't34&'o ...................... of the aforesaid building. Suffolk County Department of Health Approval 1 3 -$ O- 1 3 5 UNDERWRITERS CERTIFICATE NO...N.6.5. 6.. ? .3.9 ........................................ Rev. 1/81 Building Inspector FOuwe NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON TIlE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12692 Z Permission is hereby granted to: ................ at premises located at ..]...O....~........~.~.,~.~j~.~........~T~..,......C~.&~..~__L~) _J~ OI 'D ,~ ............. County Tax Map No. 1000 Sec,ion ...Z..'.~......']/.. ....... Block ....... ~ ........... Lot No ......... ~ ............. pursuant to application dated ....~..~.....L) ..................... , 19.~.~1~, and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY BLDG, DEPT. 1'OWN OF ,SOUTHOLD Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate 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 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 p~-*operty showing a~l property lines, streets, buildings and unusuat naturat 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 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 New Building ..... ~, ...... Old or Pre-existing Building $15..00 ............ Vacant Land ............. £ P. .//.0. Location of Property .Z/..~.~.~...,~..~.~../%~.~.~..~.~..~. .......... , .............. Hou~ No. Street Hamlet Owner or Owners of Property ~/~ ........................................... County Tax Map No. 1000 Section ../7.~ ....... Block ....... ~ ...... Lot..~ ........... Subdivision .~Z~¢~.` ¢¢¢~ .............. Filed Map No. L~¢.~...'..Lot No. l~ .......... Permit No./~.. Date of Permit /¢~...Applican~~.'.~~ ........ App Y.¢ 7~-./ .J~ ......... App ........................ Health Dept. royal :, .Labor Dept, royal Un . rit. rs ...... . ,o,,d .................. .... Request for Temporary Certificate ..................... Final Certificate ..................... Fee Submitted $ .~.. :~.'~. ........................ Construction on above described building and permit meets all applicable codes and regulations. Applicant ~.~..~~.. ...................... Rev. 10-10-78 THE NEW YORK BOARD OF FIRE uNDERWRITERS · '].0003]{.'/~ BUREAU OF ELECTRICITY ~ e5 JOHN STREET, NEW YORK, NEW yORK 1003~ THIS CERTIFIES THAT ~n the followlng location; ~ Basen~e,tt ~ 1st Fl. ~ 2nd FI. Section Block Lot FIXTURE OUTLETS~ RECi2ACLES, DRYERS SWITCHES FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS MULTt~OUTLE'~ SYSTEMS NO. OF FEET OTHER APPARATUS: 1-G.F.I. 1-~ke detector E R V I C NO. OF NEUTRALS 310 ~illwa~er Av~Aue G~NEaA~ MANAGER/ ~cho~e, ~.Y. 11~3~ Lio~'~ 1~ This certificote must not be aJtered in any manner; return fo the office of the Board ff incorrect. Inspectors may be'identified by their credgfifials. 76S-1802 BUILDING DEPT INSPECTI ON FOUNDATION 1ST [~]///ROUGN PLBG. FOUNDATION ZND [ ] INSULATION ~']/FI~MING [ ] FINAL DATE iNSpECTOR 76s-18o2 BUILDING DEPT~...~ IN SPECTI,,~0 N FOUNDATION 1ST [~ ROU'~H PLBG. FOUNDATION 2ND [ ] INS.,ULATION [-~,FRAMING [ ] FINiaL REMARK/S: / FIELD INSPECTION FOUNDATION (1st} FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING 3. INSULATION PER N. Y. STATE ENERGY qODE 4. FINAL FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1803 Examined . .~.~..I.~..., 19~..~. Approved . .~. ~. ) .~...., 19~.~. Permit No. ). ~ .G.(~ .~..~.. Received .......... ,19... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tkis 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 Regulations, 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. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . .~,.,.~,V. ~T... ~.,~.../~.. .................................. (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 ......................... Electnczan s License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. .... ....... ............. ........................ House Number Street County Tax Map No. 1000 Section ..... ./,~. ........ Block...~.. .............. Lot ....0. .............. Subdivision...~.~. r~../t~..~..]~.'.~.ff. ~. .... C~. ~..~.-. ....... Filed Map No..ff.'./.,~. ,~.~.... Lot...,] ~Q ......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~ b. Intended use and occupancy ..... /'~.~.5/~. ~..~/. ~.. ............. " .................. 3. Nature of work (check which appticable): New Building ... Addition .......... Alteration .......... Repair .............. Rembval .............. Demolition .............. Other Work ............... i ~..~.~ ~2~d552 ~ ] 0 '~ ,.~ (Description) 4. Estimated Cost.. , ..... Fee r ~ (to be paid on filing this application) u / 5. If dwelling, n tuber of dwellingI units .............. Number of dwelling units on each floor ............... If garage number of cars ' . 6. If business, commercial or mix{d occupancy, specify nature and extent of each type of use ....... . ............. 7 Dimensions of exIst~ng structurgs, if any: Front .~ Rear ...--ry.... Depth Height ~ Number of Stories Dimensions of same structure With alterations or additions: Front " Rear Depth ...... .-'7: .......... !... Height ........ ~ ............ Number of Stories... ~ ..... ,v ......... 8. Dimensions of entire new constrUction: Front ~ ... ,~./.2.., ..... Rear ...Z~. ........ Depth . ~../~. g'. ...... Height ~ [t/. Number of Stories ~ ~ 9. Size of lot: Front ... ~5-~../. i..., ......... Rear .... ~. ............... D. epth .c~ ~ ~...~p,~..,(~ ..... 10. Date of Purchase ...... ~ *qC--~dfl ............. Name of Former Owner /~J(.,4~.. ,t~9~Z/,. C.g?/~IS/., ...... I 1. Zone or use district in which pr~mises are situated d~9~'~.., ............... 12. Does proposed construc, t~on violate any zoning law, ordinance or regulation: .. ~.'~. ........................ ._2._ 13. Will lo.t be regraded /~:~..,~ i ..................... Will excess fill be removed from premises:¢,~rg Yes Name of Contractor (3 PO.,./¢.~ ~.//)k)~. ......... Address 5;r/~4 .t,V.~.T~,./F..)~.t4.. Phone No~ g'~/J-kS'9'g[~O '" PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from l property liOes. Give street and boek number or description accordin~ to deed, and show street names and indicate wheth-' er,interior ~r corner lot. : i STATE: OF NEW YORK, ) CO,U N~Y O~ ...................................................... ) STATEOFNE,WX/~K,/ ./ ,,, ~ ' couN:ry OF · _' M~. ~'..~ ~ .......... being duly sworn, deposes and (Name of individu~ sign'ng contract) above named. e is the.. ~~. . (Contractor , agent, corporate officer, etc.) of said owner or ownem, ~d is dul? authorized to perform or have perfomed the said work and to m~e and file this application;that all statements contained ~ this application are true to the best o~ledge and belief; and that the work will be. performed in the m~net set forth in the application filed therewith. Sworn to before me this .......... ..... day of: ....~~7.': 19 ~ N~ e~bl~c .............. '"~.. ~County ~, ................. ~ ,~~?~ ~ (Signature of applicant) . "' Is[m Expires March 30, 19~ says tha:e is the applicant COUNTY OF SUFFOLK DEPARTMENT OF HEALTH SERVICES November 12, 1980 Mrs. Pauline Ketcham 38 Shebar Drive Islip, New York 11751 Dear Mrs. Ketcham: Re: Board of Review Hearing Application to Construct with Private Well and Sewage Disposal Facilities on Property Located on the N/S Fleetwood Road, 40' E/O Pequash Avenue, Cutchogue, Town of Southold At the hearing held on September 24, 1980, you had an opportunity to present your appeal of the department's ruling on the subject application. In accordance with the provisions of Section 220 of Article 2 of the Suffolk County Sanitary Code, the determination of the Board of Review is as follows: Based on the information submitted, that the application be approved provided the sewage system is located maximum distance from Mrs. Cromwell's well and Eugene's Creek, as per final approval of the General Engineering Unit. Since the determination of 'the Board of Review submitted to the commissioner's office on November 8, 1980 has not been reversed or modified by him, it is therefore deemed to be the determination of the commissioner. Very truly yours, H. W. Davids, P.E. Chief Engineer Bureau of Environmental Health HWD/lst CC Robert A. Villa, P.E. Richard Lark, Esq. Mrs. Florence C. Crowell Town of Southold Building Department 225 RABRO DRIVE EAST · HAUPPAUGE, N.Y. I 1787 · NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Building 40, SUNY--Room 219 Stony Brook, NY 11794 (516) 751-7900 AMENDMENT TO PERMIT EXTENSION OF EXPIRATION DATE RE: Permit No. '~OOf~l-- 1~76-O7.'~ Your recent request to extend the above permit has been reviewed pursuant to 6NYCRR, Part 621. It has been determined that there has not been a material change in environmental conditions, relevant technology or applicable law or regul- ations since the issuance of the existing permit, therefore, the expiration date is extended to ~-]?~ )~ This letter is an amendment to the original permit and as such, shall be attached thereto, and a copy posted at ~e Job site. All other terms and conditions remain as written in the original permit. Very truly yours, I ~ Daniel J. Larkin Regional Pe~tt Administrator DJL:cz kJ t