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FORM NO. 4 TOWN OF SOUTHOI~D BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N~Y, Certificate Of Occupancy No...~.17.2..3.6 ......... Date Yebpuary 1 198..4. THIS CERTIFIES that the building 7:'.n.e..w. .d?,e..1 .~).n.~ ............................... Location of Property ... ] .5.6.q .... Bridge Lane Cu tchogue tqouse No. ' ................. ~'t/e3i ....................... pN County Tax Ma o. 1000 Section 085 .Block 02 ..... Lot 030 Subdivision..5.s.m.a..p. fi.q~..e? ................. Filed Map No..5.8..7.2...Lot No. I . conforms substantially to the Application for Building Permit heretofore Fried in this office dated .... .d.a.n.u..a?.y..2.9 ......19 .8.3. pursuant to which Building Permit No....q .2.1.4. J..Z. .......... dated ..... .F.e.b.p..u.~.r..y...6 ........... 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 ~rivate one-family dwelling The certificate is issued to KEVIN & CHERYL LYNCH fowner, I~'~s'~ of the aforesaid building. Suffolk County Department of Health Approval 13-S0-16~ 1/30/86, Robt. A. Villa., P.E. 627358 UNDERWRITERS CERTIFICATE NO ........ ~ ......................................... Building Inspector Rev. 1/81 crH~s ~£RMI~ MUST B£ C~PL~IONOF THE WO~K :' ' Z Pe~issi0n s hereby gmnted m~ ~ tO j ...................... ~ ~ premiss located ~nty Tax Map No. qu~uant ~to application da~ ~i ding nspector. ~e~ $~,,.... ................ NO~ ............... and ~ approved by the zooo771 THE NEW YORK BOARD OF FiRE UNDERWRITERS BUREAU OF ~LEGTRIC~rr~ ~ B5 JOHN STREET, NEW YORK, NE~V ~ORK 1003~ ,,.,~ ~ ~, ~.~ ~,,~..o. ~o. o.~,,~ ~ ~ N 6 2 7 3 5 8 THI~ CERTIFIE~ THAT only the electrlc~l equipment ~s ~scribed belo~ a~d introduced by the applicant ha~d on ~he able application number in the premises of ~ J. ~ ElS ~ri~e FIXTURE OUTLETS DRYERS FIXTURES ~2nd FI. Section Block Lot and found to be ~n co.~phance w~th the re~/u~rements of thts Board. RANGES DISH WASHERS EXHAUST FANS FURNACEMOTORS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT S E R i, OTHER APPARATUS: ~otoz'~: l-f, 1-Pos~ Li~e., I~G.F.C.I., 1-Mmoke De~c~v ~ C NO OF HI-LEG NO. OF NEUTRAL5 Ruland l~le~t ~-1~ ~at~ituck, N.Y. 1195~ This certificate mbst not be altered ' , manner~ return to the office of the Board if i GENERAL MANAGER ma)' be identified by their FORM NO. 6 TOWN OF SOUTHO~D Building Department Town Hall $outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and s0b~itted 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 seWer"age 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 buildihgs or premises, or other pertinent informa- tion required to pr?pare 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 certiffcate of occupancy $1.00 Date ..... , .. New Building ........... Old or Pre-existing Building(Z) ........... =/Vacant Land Location of Property ........... .~. ~(~... J~(~.~ ........ -,~-,.. Hou~ No. Street Hamlet Owner or Owners of Property .~%~ +..~_~.[.~...~.~.~ ..................... County Tax Map No. 1000 Section . ~.~ ~. .... Block . .~.~ ...... Lot ,~.3.~O Subdivision ~.~.~.. ~.~.~GC '. .......... Filed Map No..~.~, .Lot No,., t .......... P,,mitNo. i. .[ J. D teofP, mit ...... Ap¢ic t Health Oep[. Approval .... Labo¢ Dept. Approval ...................... ,.. Request for Temporary Certificate ..................... Final Certificat~ .... ~.- ......... ,.. ..................... Construct[on on above described bu~[ding and permlCmeets al~pP~cabJ~odes and regulations. A~Olicant ...... . .......................... DN ~DATE COMMENTS (1st) (2nd) ~/~_ ? /ADDITIONAL COMMENTS: FIELD ~NSPECTION FOUNDATION FOUNDATION 2. ROUGH FRAME & FLUMBtNG 3. INSULATION FER STATE ENERGY C,ODE 4. FINAL FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined~...4 .... ,19 .~. Approved .?, .~.....~. ...... 19~..~. Permit No. d.~../. · .~.~. ·~ Disapproved a/c .................. ~ ......... .(/~. ..... / APPLICATION FOR BUILDING PERMIT Date~.. INSTRUCTIONS Application No.. ~.~../'..~.4 ....... 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 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, i~s.~4Z4j( (~gnature of ~]Pplicant, or name, if a corporation) · _ ....... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or~ Name of owner of premises ..~..~..~..~: ...................................... (as o~t 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 .... .~../.~ ................. Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. .... ................ ............................................ House Number Stff~et Hamlet County Tax Map No. 1000 Section ..~..~..G.~.d4..c). ....... Block . ~.~ .O. ¢. ......... Lot .~.~. ~..C_). ~..cb. ...... Subdivision .~.....~...¥~e~o.. ................ Filed Map No. ~.~.7~ ....... Lot .... /.' .......... (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 ........ 3;~E~ ........ ~ ........................................ 3. Nature of work (check which applicable): New Building ......... Addition .......... Alteration .......... Repair Removal Demolition · Other Work 4. Estimated Cost. .O...o...., ....................... Fee ........................... .! (to be paid on filing this application) 5. If dwelling, number of dwelling Units ..... / ........ Number of dwelling units on each floor .... /. ........... If garage, number of cars 6. If business, commercial or mixe~ occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure wi~h alterations or additions: Front ................. Rear .................. Depth : Height Number of Stories 8. Dimensions of entire new construction: Front ....q(.~.. ....... Rear . .5/. ~Z.. ......... Depth .4.~.. ........... t' Height . ~/.~ ........... Number of Stories ./~z2~. . . . 9. Size of lot: Front /~.~ .~ ~.~+ Rear /~2/'~ .~."'¢:5~ ....... ~);;;h ' ' ~ '~ :~: ~ .~.' i ......... 10. Date of Purchase /~/~.~/.. ~..27 ................. Name of Former Owner .~.. ~ ...... i 1. Zone or use district in winch premises are situated ............................. 12. Does proposed construction violfite any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ..... ~ .................. Will excess fill be removed from premises: Yes No/-'"' 14. Name of Owner of premises ................... Address ................... Phone No ................ Name of Architect .......... Address .................. Name of Contractor ~. ~ [~L~,~ i i i i i i i ii i J Address ~ff-F/-c~. ~'~. Phone No. Phone No. 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 ~ mmbar or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NE.W Y~JRJ,K,,/. COUNTY OF .~~. .............................. ~ ................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ....................... .................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly iauthorized to perform or have performed the said work and to make and file this application; that all statements contaified in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner ~et forth in the application filed therewith. Sworn to before me this ........................ day of.;...~...~..,19... Notary Public, : · -.County Notary Public, State of NeW York "~ ..... "'"'~7 .................. Ho. 5,20-0344963 Suffolk Coun~j.~,~-k /~/ (Signature of applicant) I Coramis~ion Expires March ~0, 19~:~.-~ SUFFOLK CO. HEALTH DEPT. AFF~OVAL H.S NO, ( ~TAT~ME~ OF INTINT ..... THE WATER ~Y AND SEWA~ DI~AL C~ TO THE STAND~ OF T~ ~FF~K CO. ~. ~ H~LTH ~RVI~. S[NV~C[S - FOR APPROVAL ~. ~. ~. ~.: ~FF~K CO. TAX ~P ~ ~ROLD, N.Y, ~ ~[" , ~M ' ,,, F~L~D NOTE : SUFFOLK CO. HEALTH DEPT. APPROVAL LCJ r NO'S REFER Tr', t`fR�'S-, OF �� ' � �� SUFFOLK COUNTY HEALTH DEPARTME T H. S. N i��r. x .t:.` W �N ee{<•" � 'r=.._` � J.. �+i=.� r7.M. __ ._._ _. E L DAT H. D, REF. The � ,ale ci:.. -�"�ci5t_. . .. . �.. ? ., supply 49' ' . ,_5 ies . . * :' .. .'• . ; ;n ;-ave beer insp :o.ed b and f Tan ! . S Lob satisfa•�rtbr I r n STATEMENT OF INTENT Chief of General Enginge i THE WATER SUPPLY AND SEWAGE DISPOSAL 361.7.�;i E'-� ..... 32�.53 service _..._. —•- .��__._�__ � SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. OF HEALTH SERVICES. L` (S) .r APPLICANT ,. ^ SUFFOLK COUNTY DEPT. OF HEALTH = '• � �•h4f' SERVICES — FOR APPROVAL OF CONSTRUCTION ONLY t • 3 ,x.: f.. t; F 3'1 0 .. U DATE: H. S. REF. NO..-Of - ► 3 S sJ ! �r ,< APPROVED: cQ f�a I J-,4,7. : lSUFFOLK CO. TAX MAP DESIGNATION: 0 _IL DIST. SECT. BLOCK PCL. 7" f ,�;� 4 OWNERS ADDRESS: 6,0 t L".)6 F: L, .V1 E' . 1 ` 322.05 R / -rE:i _ `73,1 - s c,6 P' Cs M fie t-,J DEED:� L. IN(A P. , TEST HOLE STAMPRTA , 7Hl5 ORIZED L SURVEY A VIOLATION OF+„o� �S f MON 7209 OF THE NEW YORK STATE 1DUcAT10N LAW. ! COPIES OF THIS SURVEY MAP NOT BEARING S,C A L 1 THE LAND SURVEYOR'S INKED SEAL 01 E-ABOSSED SEAL SHALL NOT BE CONSIDERED 01^4- �0 ;e+-s- 1Q 13E A VALID TRUE COPY. 1_.._'____.___'__"..7 � ^(' ,rUARANTEES INDICATED HEREON SHALL RUN. �•-,, f-•-„ i ,/ y=;:,t,,,,,I-^, `,) a ;,5,, , _ PMLY TO THE PERSON FOR WHOM THE SUP-, I , ,...>> �m IS PREPARED, AND ON HIS BEHALF TO THF 7 €f »� rv ✓Yy b' 1�-.�. .L , !ate. { 1,' TITLE COMPANY,GOVERdh1ENTAl iGENCN 4:ENDING INSTITUTION LISTED HERON, AN, (.07HE ASSIGNEES Of THE LENDING INS:' .? .f ,..� 2 .._¢ ..e_--_- -! I (-.�.,,,~-��r._-•t'�'.._e_r .t 1. A i> �`` k i ! 1.7'�e�..�� Q�IOkdj ADDITICINAAh�ES..A°L,,.NOT TRAMSF,� ? r' 2 �6.I Y<y vy 1'•^Y it-�.a-. i�,.,. 1�:- 'yr i �'/fF. rM ; (,.• e ¢ I `'�:�: �waSS°'2�54 a SEAL --M '1_14tE 71"t`U (.-5UAQ> ltJ'F'_t=E_ t ..•�a%! tL Cr)MPYNt'T'.(AHD Ti r,0 U i 4 ,} 'L D ' 1963 RODERICK VAN TUVL, P.C. LICENSED LAND SUR EYORS •U[--f G. f `'.`7�.1. r�, "4 ,x��4._ �! )f< fie' `t`. = GRE N ORT NEW YORK TELEDYNE POST N22035 � -__ . � 11 I I I . 1�_ � - . � � I ,t � � . � I � I � eM. 0,,1'1�,I � - , �,I I . W1 ,, :1, S1 1, 11%,�, .1 �, ... � . , 1,�,,� , _;�' l', '� ", 1 , I � � � ,� I�A I , _1 'a � , I 1�_ ,�, " �A �N"I, "1� - ,',- I c to' ,, '' a- � A W 1. ,� a�, aw AQ ,f� � 11 > 110 .., . . r�,, I w Wi� - � _.�,o I � " � , I I ,�_ , � I . , 1� .1, , 11 ` I lrc�".I%�,!'t` --,� ,-, ,. 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