The URL can be used to link to this page

Home My WebLink About11432-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...Z12~3.(1 ........ Date ......... ~.y..]_.6 ................. 198.4.. THIS CERTIFIES that the building --new dwelling Location of Property . ..4.4.0 ................ .C.o.x. Neck Road Mattituck House No. ' .... County Tax Map No, I000 Section ,,. ~3.3. ..... Block . ...~ .......... Lot .... .0.07. ......... Subdivision... ~er.itag~..t~rb.q~ .......... Filed Map No..6. .8 .5.3...Lot No...9 ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... Qc..tp.b.e.r...1.5. .... , 19.8.1. pursuant to which Building Permit No. 11432 Z · dated ...... Q.c.tp.b.e..r..2.6. .......... 19.8.1., 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 p~v~te one-family dwelling. The certificate is issued to RIVERSIDE. HOMES; INC. {owtTer, of the aforesaid building, Suffolk County Department of Health Approval 3,1 r~.O.-: 33 ~. .4. /. .1.7./.8. 4. ,. ,R. qb..t :..A.:..V.i.l.1..a:. UNDERWRITERS CERTIFICATE NO ......... N. 5.7.4808 ................................ Building Inspector Rev. 1/81 BUILDING P~[ERJ~IT: : (THIS PERMIT MUST BE KEPT ON !H.EPREMIS~S UNTIL F cOMPLETiON O~ TH~ WOrK N°. ~4~ z Permission is hereby granted to: ~.~./ , -- ..........~..~.~ ~'~..¢.~. '.4.x./.~.. JLL B~Jldjng I~spector. : --/,/~./,'/.-'s / ' : ' ~ / .. at ptemise~ located ....................... -- ................ ~ ......................... ~ ....................... . ................. ,'"'""?:",~: ...... ~ ....... "?'r~ .......... ~ ....... ~ ................ ~.....~~. ....... ,....~.... ............ ..?~ ...... ~:..~..., .~.....~ ................ COU~F Ta~ Map No 1000 Sect on ..... Z/.~...,..:. ~1~ .~., i~,;..:..; ~t No ...... .~ .............. purs,ant ~a application dated ...~C7~:-..~:...:..-., '1~ F" and ~pprov~ by the 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 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 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 Date ...... . .~../'..v....~. Z..~....~.. ............... New Building ..... ~ ......Addition ................ Old or Pre-existing Building ................ Vacant Land ..~ ........... Location Of Property .~/~..~¢.~....~...~......~.~....~....~/~.~.~ _..~ /~(Q Owner Or Own~ Of Property ~'..~~...~~...~.~ ............................................... Subdivision .~..~ .~ ~. ~~ ....... Lot No....~ ..... Block No ............ Nouse No...~ Perm t No //~ Date Of Permit I0~/~/ - ' ~1 ~6~ ~X~o ~, ~, ...................... ~..:.z~ ........ ~ppucan~ ~ ~:.... ~ ....:~... ~.. F/_~. ~.. ~:. :. Health Dept. Approval ..... ~......~.....~.~. ..........Labor Dept. Approval ................................................ Underwriters Approval ~ ~ ~gO~ .............................................. Planning Board Approval ........................................ Request For Temporary Cert f cate .... ~ Fee Subm tted $ ~ '~ ................................ Final Certificate .......................................... Construction on above described buildi~ ~it m~oppl~s and regulations. ..... Sworn ,o before me this / ~ i ~.~70 ( / · ~M.~...Oayof~ ........ Z~..~_~. ~ ~e~ (sto2?~sea,~ Notary Public~~..~* ff~~ ¢~ ~ ~ , ',,. ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the eiectri~al eo~iDomnt~ descrlb~ ~lo~ an~introd~ by ~t~am~ on ~m able ~D~t.i~ ~ in~ ~ses of in the /ollowlng loc tlon; as t ~ 1st FI. ~ 2nd FI. Section Block Lot FIXTURE OUTLETS SWITCHES 15 24 DRYERS FIXTURES RANGES OVENS 16 DISH WASHERS EXHAUST FANS MULTI-OUTLET SYSTEMS NO. OF FEET OT ER APPAR ~' i-G.F.i., l-~moke De~ec~or S E R NO O~%.COND. J A WO A.W.(A NO. O~ N~UTRAL$ A WO j OF HI-I~O OF NEUTRAL O~ CC, COND. Warre~ScoCc F, leccric, Box 907, Lake.lR~, N.Y. 11779 ~c~ 498~ AGER This ceytlflcate must not be altered in any manner; return to the office of the Board if incorrect, smay be ~:gPY~:~? BUI~ING DEPARTM~ ~NT. THIS .C~pY. ,QF ~E~I~AT~E.~iM~R~Ng~ ~E~,TE~ ,~D I~1 ANY MANNER. Riverside Homes, Inc. P. O. BOX 274 1159 West Main Street Riverhead, N. Y. 11901 Phone: 516 - 727-3395 / · FIELD INSPeCTiON 1. FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY G,ODE COMMENTS FINAL COMME? FOBM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TGWIq CLERK'S OFFICE SOUTHOLD, N. Y. E×ammed , ,.~.,.~.:~..~...., ~,..,.~......~....(.~,..., 19::: ..... Approved, < , ~, - ~: t~ '~' ' Application No./..':.~'h,..:~..': ................ Disapproved o/c ............................................................................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 ofproperty must be drawn on the diagram which is part of this application. 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 issue 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 o 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 an premises and in, buildings for necessary inspectign~. "' me, if a corporation) ' (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................................. ~.~a~/~u~ ...................................................................................................................... Name of owner of premises ...... .~,~,[~.~..~g~*..~J~.~. ................................................................................................... if applicant Js a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No...2...0~...0.~.~. ................................... Electrician's License No. l.~.D..8..-.~. ................................... Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: .jj~Tt~,~l~..j~..l~9~.. ........ Lot No....~..~.. ................. Street and Number .~J..~..G~C..JJ~;..i~,~d....303~..~/.O..~$~e..~&..(g~ ...................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ,.~t~lJP, a~..J~a~]~: ..................................................................................................... b, Intended use and occupancyL}~.~..~R~..~.l.q.~.~J~.~g ........................................................................................... 3. Nature of wot~k (check wh ch applicable): New Building .................. Addition .................. Alteration ....: ............. Repair .................. Removal i ............. ~ Demolition .................... Other Work ...................................................... j' . ..~.. ~..~. ~,.. ~. (Description) 4. Estimated Cost ...................... ...................................... Fee ................................................................... J (to be paid on filing this application) 5. If dwelling, number of dwellihg units ...... ~ .................... Number of dwelling units on each floor ..... ,.~. ......... ~ .......... If garage, number of cars ..... t ............. ' ...................... ~ ................................................................................................. 6. If business, commercial or h~ixed 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 with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new coqstruction: Front ........ ~ .......................... Rear .....~.~.~. ................. Depth ........................ Height ;~t~ Number. of Stories ................. r ...................................... Rear .......................................... Depth ................................ Dote of Purchase ................. i ...................................... Name of Former Owner .' ....................................................... Zone or use district in which premises are situated ..................................................................................................... Does' proposed construction viblate any zoning Iow, ordinance or regulation: ....~..?. ................................................ Will Jot be regraded'. ............. ~ ............. WiJl excess fill be removed from premises: (~') Yes ( ) No Name of Archftect ............... : ............................................... Address ~ ..... I.'n e No ....................... PLOT DIAGRAM Locate clearly and distinctly al.I buildings, whether existing or proposed, and indicate ail set-back dimensions from property lines. Give street and bl6ck number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW~'~I~,~, S.S COUNTY OF ...~E~?.?..~ .............. i ................. t ....................................... ....................................... bei,ng duly sworn, deposes and says that he is the applicant (Name of individual sighing contract0 above named. He is the !.....~.~..I~..~..~..V~....~ ....................................................................................................................................... ; (Gbntractor, agent, corporate officer, etc.) 6f said owner or owners, and is dqly authorized to perform or have performed the said work and to make and fife this application; that ali statements contained in this application are true to the best of his knowledge and belief; and thai'the work'will be performed in ~he manner set forth in the application file( Sworn to before me Notary Pu'bl pUBLiC, of New York ir k County No, 52-460~884 Expire~ i~ar~h 30, ~.9~ (Signature of applicant) z ' NOW OR FORMERLY ROBERT end DIANE ADAMSON DWELLING (WELL) s.21 25 E. -~'IS'EA~E. MENT TO PARK AREA~ N. 22o13'30"W,' FOLK COUNTY DEPT. OF \LTH SERVICES FOR "ROVAL' OF CONST. ONLY REE. NO, gANTEED ON"LY TO NECK 190,00 VACANT) THE WATER SUPPLY,&, SEWAGE DISPOSAL, FOR THIS RESIDENCE WiLL CONFORM TO THE STAND- ARDS OF THE sufFoLK COUNTY DEPT, OF HEALTH'~ SERVICES, ]MAT ,' ~EARES,! WA,E~ ~A ~ TAX MAP ', "D~ST 1OO0 SECT. 113 N.Y. LIC. LD F. TRANCHON JR. PENN. ~626'"" ' ~?:, DATUM APPROXIMATE ~ LOT AREA = 46,600 sq NEAREST WATER MAIN ROBERT ond DIANE ADAMSON ~ TAX MAP 3 DWELLING(WELL)~ ~.~ ~LOCK 14 ~OT9 S' 21°25'[0"E. 190.OI g / N.22*I3'50"W. I~.00 (~o.~) COX NECK ROAD (4o,~) (VACANT) IH ECTI0 REQU ED SU~FOL~ COUNT~ DEPT. O~ THE W~T[R SUPPLY ~ S~WA~E NA~[ HEALTH SERVICES FOR DISPOSAL ~OR THIS RESiDEnCE ,~"~.;~: H.S. REF. NO. //~-~--~ DEPT~ ~EAL%E SERVICES. /' .81-94 FILE NO. HERITAGE HARBOR "It sh~ld ~ s~e ~i$ -~D ~R RIVERSID HOMES pro~ is I~ot~ in on ogriculturol LOT NO. 9 oreo, the possibility exists ~ot t~ MAP OF HERITAG~ HARBOR woter supply moy contoin troce ore,nfs of ~stic~es ofld~or nitrotes. SITUATED AT MATTIUCK S~ml onolysis (~Nt~) rquir~, Co~ th~ ~nt ~ to TOWN OF SOUTHOL.D,-SUFFOLKCOUNTY, N,Y, ~", SCALE 1" = 50' DATE APRIL 3,1981 GUARANTEED ONLY TO FILED MAP NO. 6853 DATE SEPT, 18,1979 ~OOK N~.'L L ; PAGE HAROLD F. TRANCHON JR. LAN~D SURVEYOR SUqESSOR ~.0 WILLIAM G. MEIER /'/~-/'~'~'~% _~, ~ .... /~' -- ~. NORTH COUNTRY ROAD WADING RIVERNEw:~ YORK 11792' N.Y. LIC. NO, 048992 (516) 929-4B95 ALT, 473-3626 HAROLD F. TRANCHON JR. PENN. LIC. NO. 21115-E DATUM APPROXIMATE + ' LOT AREA = 46,e6o sq.ft. The existence of right of ways and or easements of' record, if any, not shown are not guaranteed, { NEAREST WATER MA N '~ IN EXCESS OF lpOOFEET ROSERTo.d DIA.E AOA.SON NOW OR FOR.ERLY ~'~"~ ' IS TAX MAP ~ ~....~-~...~ , D T. IO00 SECT, 113 DWELLING (WELL) ~------~ E~LOCK 14 LOTg {V~A~T} NOTE. SEPTIC ~ANK, CESS~OL A~D WELL LOCA~IONS BY ~THERS SUFFOLK COUNTY DEPT. OF THE WATER SUPPLY & SEWAGE NAME HEALTH'SERVICES FOR .DISPOSAL FOR THiS RESIOE~CE APPROVAL OF CONST. ONLY WILL CONFORM TO THE S~AND- ~DDRESS DATE ARDS OF THE SUFFOLK COU'NTY APPROVED BY ~ , r i ,, STRU~URES TO ~E PROPE~Y FOR WH~ rile SURVEY IS PRE- SURVEY D FOR RIVERSIDE HO~ES ~NSTITIITIOP~S O" S/IBSEQ~ SITUATED AT vi~Bm ~ ~lON 7~ O~BEARINGCOPTES OFTHE~IS ~.D~"VEYsu. VEY~'s~AP NOT TOWN OF SOUTHOLD~ "~UFFOEK COUNTY, N,Y, ~. S.~LL .0~ ~E m.sm~ ~e as SCALE ~ ? = 50' ~ D~TE APRIL 13~ 198 1 GUARANTEED ONLY TO FILED ~AP NO. ~853~~ D~,~E SEPT. 18,1979 ,S~CES'SOR ~O WILEIAM G. MEIER . . LIC. NO. 048992 , (~16),g29-~95 ALT. 473-3626 ~:~.ZL]NG, VENTED AT] IIi ABOVE WI~FI R-'S8 OCCU~AHC¥ OR IE~ IS I~HL,~VFUL NOTIFY BUILDING DEPARTMENT Am 755-1802 9 A~ TO 4 PM FOR TH~ STATE CONSTRUCTION & EHERrm~ , -- __. It t -F-¢~ A-F:?- J JI II DRAWING NUMBER DRAWING NUMBER DRAWING NUMBER 1¸,