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Home My WebLink About12977-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..z. 1..3.2.2.0. ......... Date ...F...e .b.r.u.a..r y..1.9. ................. 19 .8.5. THIS CERTIFIES that the building .......... .O.n.e...f.a.m.i..ly..d.w. 9.1.1. i. 8g ............... Location of Property .. 7 10 Shepard Dr. & q 095 Glenn Rd. Southold House No. Street Hem/et County Tax Map No. 1000 Section 0 78 .... Block 02 .Lot Subdivision ... ?.e.s.~...C.p.e.e..k..E.s. ~..a.t.e.s. ...... Filed Map No...3.8.4.8...Lot No .... .4.8 ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated March 27 198.6. gp ..................... , . pursuant to which Bu/ldin ermit No ................ dated . .k p.r.J~ ]_. 5 ................... 19~ q., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which tiffs certificate is issued is ......... One family .d.w.e..1.1i.n.g The certificate is issued to ..... C.H.~ .5.S.T.Q .~U.E.R of the aforesaid building. Suffolk County Department of Health Approval 5/4 1/4 sc. ...... UNDERWRITERS CERTIFICATE NO .... N 6 7 6 3/4 3 PLUMBERS CERTIFICATION 2/1/4/85 Rev. 1/81 Building Inspector 1~o~ NO. ~ TO~N OF $OUTHOLD BUILDING DEPARTMI:NT TOWN HALL $OUTHOLD, N. ¥. BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12977 Z Dote ...................................... , 19.?.. Permission is hereby granted tq¢ ~ ~ ...~ ~ ~...~ ~ ~ ........ ~ ~.....2.~ :~.. . C~~. ~.....~ ~.~ ...... ~.~~.....~;~ .................... ...........~'..3. ..... ~., ......................................................................................................................... at premises I~ated at County Tax Map No. 1000 Section ...... ..o...~..~ ....... Block ..... ..~.....~.. ........ Lot No ....... ..~..~.. ............ pursuant to application dated ........................................................ , 19 ........ , and approved by the Building Inspector. Fee $...l,~.].!..~... ...... Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Bouthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY InstruGtions 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 alt 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 p~operty showing all property lines, streets, buildings and unusual natural or topographic featu res. 2. Sworn statement of owner or previous owner as to use, occupancy and cohdition 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 3. Copy of certificate of occupancy $1.00 $15.00 4.Vacant Land C.O. $5.00 .'/': ~/~ Date ............... New Budding .z~..."~.'. ..... Old or Pre-existing Building ............ Vacant ~and ............. Location of Property ................... "' '~' '~ County Tax Map No. 100,¢ Section .,?..~......~...'~.. Block ............... Lot .............. Subdivision.....~.-.~~ ,~.Filed Map No. ?..~. ?..~...Lot No ....... Permit No. J.~.~. 7.7. Date of Permit .......... Applicant .................................. Health Dept. Approval ...................... Labor Dept. Approval ........................ Underwriters Approva~ . .~..~. ........... P~anning 8oard Approva; ................. Request for Temporary Certificate ..................... Final Certificate ....................... Construction on above described building and perm~.~meets, all a~Pp~able co~$ and.~'e~qulations. Applicant .~~~ ....... Rev. ,0-,o-~8 ~.~ ~ ~ '7~ ~F I ~D INS?ECTION COMMENTS FOUNDATION {1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING Se INSULATION PER N, Y. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: p~a THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY SS JOHN STREET, NEW YORK, NEW YORK 1OO:3~ i,~thefottowingloca,ion; ~ Basement ~ Is, FL :~ 2nd FL Section Block Lot48 wasexa,tinedon ~al~tzs~y 2]. ]~q~5 andfoundtobelncompllancewlththerequirementsofthisBoard. FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS FIXTURE OUTLETS SWITCHES FLUORESCENT 23 P9 DRYERS DIMMERS SYSTEMS NO. OF FEET OTHER APPARATUS: Mortar/s: l-.'F 2 Smok.',~ Detector E R V I C NO' 0~ COND OF ~C. COND, NO OF NO, OFNEUTRALS Oua li~:y Elec. East Hain St Smi. thtown N.Y. ].17~t7 Lic 717 E This certificate must not be abe(ecl ia aay m~ner; return to the office o~ the Board J~: into?reef. Inspectors may be COPY~FOR B~ILDING DEPARTMENT. THIS, COPY, OF CERTIFICATE i' their , 5 -TERED,? A." MA..E. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. Owner (please print) Plumber ~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this [~ 4~ day of ~, 19 3g · Notary Public, County (plumber,s signat~u~e) Notary Public ARLENE C, BAKER Notary Public, ~ot~ al l~ew York 47~60'31, Camm, Expires 765-X802 BUILDING DEPT~ INSPECTION, FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION FRAMING [ ] FINAL REMARKS DATE ~/-//~//2~/~ I N S PECTOR FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved ., 19 .. Permit No ............ Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERi¥]IT INSTRUCTIONS 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 t~e work. e. No buildhig shall be occupied or used in whole or in parr 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 issuagce-o,( a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York//'and otl~er applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for~emoval o~r demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, build?)~ codaS'houSing c~ode, and regulations, and to admit autliorized inspecto rs on premises and hi building for necessary,~/J~fl~ ,,?~,F~p (Signatu~e'-6t applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. ...... .rff. ................................................................................ Name of owner of premises .~/f..~i-.5TO~.8'*"~ .~ .~3J77.~,5'... ~... 3T.U/.,/. ,0...-ff..Z/dP.j-. 7--.. ,t.~,O./U;ZE,~..(./~.iE'..~). .... (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. MEM. Plumber's License No..~.-~.~...t~. Electrician's License No..~.]..~..~. .... .~..~Zt'T.t/. Other Trade's License No ...................... "7 / 1~ 1. Location of land on which proposed work will be done ...... ~. O~. ~..*~. ....I~..~.... ~5/~,'~.O~..-~... l~.F~} ~/~..,~, lO't5 ?. . ................................... .5.o. .......................... House Number Street Hamlet County Tax Map No. 1000 Section ...... ~. ~. ........ Block ....... Oe. ......... Lot ..... ~ ............ Subdivision . ./~. C.~'.77... G~gE~... ~'.~7-/07'7. e'~. .... Filed Map No. . .~. E'.~/.~ ..... Lot . . . .~. ?. ........ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... .VJ~c~.,5/MTT'.... ~, o.-77~.. .........................' .................... b. Intended use and occupancy .... .,5½..a4o. &~'....~'rqo?~i/~ .~/...~./M.-K..~j.;/.' .x./~. ........................... 3. Nature of work (check which a .plicable): New Building .......... Addition .......... Alteration .......... Repair .............. Rem )val .............. Demolition .............. Other Work ............. (Description) 4 Estimated Cost .~'~..~ ~.q~ ] [ [, .... ~ .......................... Fee ................................... . i (to be paid on filing this application) 5. If dwelling, number of dwellingiunits ....~. I .~. r_&..4~. Number of dwelling units on each floor ............... If garage number of cars 6. if business, ' ' ' ' ................... commercial or mixed occupancy, specify nature and extent of each type of use .-1'. 7 l)imensions of existing structures if any: Front ~ Rear - Depth Height .~ Number of Stories~ Dimensions of same structure with alterations or additions: Front . -- Rear .~. Depth .'7 ...... ~ Height ... '- ...... Number of Stories . -' .......... 8. Dimensions of entire new construction: Front ....~t.O. t Rear ,...~.Of. . Depth . .~?-.e~ r... Height .,¢, ~,. t. ,6~" .... Number of Stories, , 9. Slzeoflot' Front 17~ . ~,,~, I.-q'.~ Do,,*h ........ j/.] ..................................... v .......................... 10. Date of Purchase ...... ,:,,%jty,,.-~.~. ............ 1 1. Zone or use district in which premises are situated A¢~.~.b.¢~ .~, ..... 12. Does proposed construction violate any zoning law, ordinance or regulation: . dido .......................... 13. Will lot be regraded ....... .~ I~'~ ................ Will excess .ti, Il be removed from premises: Yes 14. Name of Owner of premises Gt/~J.~.'rP.~?/~5~..~qM .T~.. Address ~'./,~,&~J7. g,O./d/'t~ie~4,-Phone No. ,~'~q ff.'. / 7~.~',',',',',',',',',~o.. Name of Architect " ~ ................. Address ................... Phone No ................ Name of Contractor ~0'!.¢.. iO~. · O. tOMl~ff-.,. .... Address ................... Phone No ................ PLOT DIAGRAM Locate .clearly and distinctly ali buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block~Lnumber or description according to deed, and show street names and indicate whether interior or 6orner lot. STATE OF NEW YORK, i COUNTY OF S.S .......................... ' ....................... being duly sworn, deposes and says that he is the applicant (Name of individual si ning contract) above named. He is the (Contractor, agent, corporate officer, etc.) of said owher 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. Sworn to before me this .......... · ~..~...?'~' ...... day of .... .~..~ ........ 19 $ota, eu lic ....... County NOTARY UBl~C,$lateo NewY0k ..... ~----.,.,,,.,o-~ .................... No. 4707878, 3tffFotk Comity (Signature of applicant) Tcrc~ E×p~res M.~rch 30. 19 ~,~ '; DWELLIN LL DRIVF (15.0) k,~O0'~ S. 50o16,40-, E. 92.67 .rd. :cA, '",,%",.. '-, ,' '- TAX' '~A,P DISTRICT., 100' - 78- 2- 5 ~ ~ I ~ ~ ' SUFFOLK'COUNTY DEP' OF THE WATER SUPPLY ~%sEwAGE I NAME "~"'AG"ova'" ~ c~ w,~ co.[o.M TO i.~-- --SX~.~ ........ , ~ ~F ~'~"~'~ ~'~"T~"[~,E~ JOB NO. 84-' ~6 --I ~ILE NO. WEST CREEK ESTATES '~EA~, ¢, ...... {rl}lOl"~S J~S~IH'Trn ....... ~S *E~ MAP OF WEST CREEK ESTATES ~ITIO. rO THiS ~U~VEy IS A SITUATED AT SOU%HOLD THE N~ ~ ~A~ EOUCATIOfl BEARINQ mr t*.~ SU.VE~.'S TOWN OF SOUTHOLO- SUFFOLK COUNTY N Y A VAUD ~ ~pv SCALE 1" = ~' DATE 3- 20- 1984 GUARANTEED ONLY TO FILED ~AP NO, 38~8 DATE 8-19-1963 BOOK NO. L.L PAGE The existence o( right of way~'0m~ or easements ' : HAROLD ¢. TRANCHON JR. P.C. of record, if any, not shown ~e ~ot guaranteed. LAND SURVEYOR SUCESSOR TO WILLIAM G. MEIER ¢,,. //u~ ~ NEW YORK ~ 1792 ~.Y, LIC. NO. 048992 (516) 929;~695 ALT. 473-3626 tAROLD F TRANCHON JR. PENN. LIC. NO. 21115-E { ~ ~: i` : ~ SEPTIC TANK, CESSPOOL & WELL LOCATION S DWELLING- WELL set stk, O< 8,0) ~stk,Set N 48°20'00"W LOT NO, FINAL SURVEY 12-18-84 DWELLING LOT AREA 19,689 SO,. FT TAX MAP DISTRICT 1000~ 78- 2-5 S.50"16'40' E 92 67 '~on ~ (12 O) ~ :- I / 20.2' ~ ; 2 sty. ~ ~e . dwell, mr. 32.3' cesspool s LU 49 WELL (8,0) ¢ 112 62 Ss~k,t (100) 5O 0 Z Z SUFFOLK COUNTY DEPT. OF HEALTH SERVICES FOR APPROVAL OF CONST, ONLY DATE H,S. REF. NO. APPROVED BY THE WATER SUPPLY & SEWAGE DISPOSAL FOR THIS RESIDENCE WILL CONFORM TO THE STAND- ARDS OF THE SUFFOLK COUNTY DEPT, OF HEALTH SERVICES. NAME ADDRESS TELEPHONE GUARANTEED ONLY TO DIME SAVINGS BANK FIRST AMERICAN TITLE INSURANCE CO OF N Y N,Y, LIC. NO, 048992 HAIl'OLD F, TRANCHON JR, PENN. LIC. NO. 21115-E JOB NO, 84-106 84-690 SURVEYED FOR LOT NO 48 MAP OF WEST CREEK ESTATES SITUATED AT SOU THOLD TOWN OF SOUTHOLD -SUFFOLK SCALE I" = 30' DATE FILED MAP NO, 3848 DATE BOOK NO. L L PAGE FILE NO. WEST CREEK ESTATES COUNTY N Y. 3- 20- 1984 8 ~ 19- 1963 HAROLD F. TRANCHON JR. P.C. LAND SURVEYOR SUCESSOR TO WILLIA~ G. MEIER NORTH COUNTRY ROAD - WADING RIVER NEW YORK 11792 (516) 929-4695