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Home My WebLink About16032-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Bumldlng Inspector Town Hail Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-17252 Date AUGUST 3I~ 1988 THIS CERTIFIES that the buildin~ Locatmon of Property 200 HAYWATERS DRIVE House No. County Tax Map No. 1000 Section 104 Subdivision ADDITION Street Block 05 Lot 19 F~led Map No. Lot No. CUTCHOGUE, N.Y. Hamlet conforms substantially to the Applmcatmon for Building Permit heretofore fmled mn this office dated JUNE 5r ~987 pursuant to whmch Bumlding Permit No.16032-Z dated JUNE 5r 1987 was lssued, and conforms to ail of the requirements of the applicable provmsmons of the law. The occupancy for which this certmflcate ms issued is ADDITION TO EXISTING ONE FAMILY DWRLLINGASAPPLIED FOR The certmflcate ls issued to THOMAS J. & FRANCES M. SMITH (owner, of the aforesaid bumld~ng. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Bu~ldmng Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) County Tox Map No. 1000 Section .... ~...~....~'... Block ...... ~0......~... .... Lot No ..J .,~ ......... pursuant to apphcation dated .... ~ ~ ...~... Building Inspector. ....... , 19.~...1.., and approved by the Building Inspector Rev 6/30/80 I~OBM NO. B TOWN OP $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PER/vIIT (THIS PE~vUT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13042 Z Permission is hereby gr~nted,to: ~ .... ~...../.:~.~ .......... ~ .............................. ..... .~&....~,~:....~ .......................... ,~.~~~.....G.a~...~....~~.....b...~...~?.~ ........... ....L~~ ...... ~.,,....~.~,~...~:~.,: .............. .:....'. ................................................. ot p~m,~,,~,,~ot ................... ~.~~.~ ........ ~~.~ ....... ............................................................................................. County Tox /~op No 1000 Section J ...... .L~ ........ Block ........... ... ° ...... .~... ......... ~ No..I...~. pu~,ont to o~,,~ot,~ do,~ ...~E.....~.~ .......................... 19~..~.... o,d op,~ by ,~. Building Inspector. Building Inspector Rev 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Depat t,,~ent Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewmter OR ink, and submitted m~ to the Building Inspec- tor w~th the followmg; for new buddings or new use: 1. Final survey of property with accurate location of ail buildings, property lines, streets, and unusual natural or topograph m 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 buddings, Industrial buddmgs, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responmble for the buildmg. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to Aprd 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 housmg code or safety inspection of buildmgs or premises, or other perttnent reforma- tion required to prepare a certificate. C. Fees: Additions $25.00 POOLS $25.00 ALTERAT[0N $25.00 1. Cert~ficate of occupancy New Dwelling $25.0~, Accessory,St0.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of cert~flcate of occupancy $ 5.00, over 5 years $]0.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date .......................... NewConstruct~°n ...... Old or Pre-exlstlng Bu dding . V'~ Vacant Land House No. ~ Street ~ Ham/et /o¢ ¢.. County Tax Map No. 1000 Section ............... Block ............ Lot ............. Subd~wsion ................................. Filed Map No ........... Lot No .............. Permit No.../~..~.-~. ?.. Date of Perm,t ~..~; .o~.- ?.'~.Applicant.. ~.~.. ~ . .v~.~...~./~ ........... Health Dept. Approval ....................... . Labor Dept. Approval .................... ,. . . UnderwmtersApproval .................... ... . Planmng Board Approval ...................... Request for Temporary Certificate .................... · F~nal Certificate .................... o. . Fee Submitted $ ........... Construction on above described budding and pe~_all a~/?~2s and regulations. Applicant ...... '.~...' .~-.. ~~ ......................... Rev. 10-10-78 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No.~/.~O3~-Z (please 'prxnt) ' (please print)' I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (p~u~er s sl~ature) Sworn to before me this ~-day of ~C/./~o~ · Notary Public,~/~_W/~ County Not~ry 'Public BARBARA STEPNOWSKt Notmy Pubhc, State of New York No 4844752 QuNJfl04 In Suffolk t~)u~iy JND~T!ON s JNDATION (2nd) UGH FRAME & ?LUMBING 7 SULAT!ON PER N. ~. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: ,/ BENECKE SCALE: e= IRON PIPE ,9~FFD~K COUA/IY'FAX HAP DE$1~IVATIOi~: DIST. IDOO, SECT. IOq, 81.OCK ~ LOT HAP OF LAND ~ URYEY1FI) ~ THOMAS :F. SMITH CUTCHOGUE TOWN Of: ~DU'FHOLD SU FF.. CO., 45 SURViVe, ~UG. D, ~g87 P, ODER ICK VAN TUYL, RC LIe. ~0 FORM TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTIfOLD, N Y NOTICE OF DISAPPROVAL File No . . PLEASE TAKE NOTICE that your apphcahon dated /'~', J /~ ~ -- ~- ., 19 forpemuttoconst~ct ~~ ~ / ~~~ at L°cat'°n°fPr°pertYHo~eo~ ~~ ~ g~ County Tax Map No I000 Sectton [ ~ Z Block . . ~ Lot / ~ Subdivision Fded Map No Lot No Braiding Inspector RV THE NEW YORK BOARD OF FIRE UNDERWRITERS ~A~;s ~ ]001071 BUREAU OF ELECTRICITY /~ .~F~I~IL 05~ ~ 9~8E5 JOHN STREET. NEW YORK. NEW YORK IOO3B 5268528~/88 N 008?30 ~te ~pplica~ion No. o. file THI~ GE~I~I~ THAT o~ t~ e~t~ ~uipme~t ~ ~ ~ a~ int~c~ by t~ ~t ~ on the a~ ~t~ numar in t~ p~m~ of ~ e~amin~ on and found to be in compllan~ wi~h the r~ulremen~ o~ ~h~ B~, RXTUm~ RXTUImS RANGF. S OUTleTS FLUORESCENT 1] 16 13 OVENS ~SH WASHERS EXHAUST FANS mMMERS OTH~I APPARATUS: G.F.C.I: -1 ~MOKE DETE~TOR:-i G & S CONTRACTOR BOX 215 SOOTHOhD, NY, 11971 This certifkate must not · a~tered ia Per manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY F0~ BUILDING DEPARTMENT. THIS COPY 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION 2ND FRAMING REMARKS: iiNs UGH PLBG. ULATION [ ] FINAL 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [~MING £ ] FINAL DATE ~~/~r~'~ , NSPECTOR~*"~~~~ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION REMARKS: [ ] FRAMING [ F~INAL DATE ~'///~,'/,~,// INSPECTORA~/~/ // TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N,Y. 11971 TEL.: 765-1803 Approved Disapproved a/c ...................... Received ........... ,19.C. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .. . ,19.. INSTRUCTIONS a. Tlus apphcatlon must be completely filled m by typewriter or in ink and submitted to the Budding Inspector, w~th sets of plans, accurate plot plan to scale. Fee according to schedule b. Plot plan showing locatmn of lot and of buddings on premises, relahonshlp to adjoining premmes or pubhc stree or areas, and gtvmg a detmled description of layout of prope~ must be drawn on the diag~m whmh m pa~ of thru appt ca~o~. ~. The work covered by t~s applic~hon may not b~ commenced before ~ssu~c~ of Building P~rmit d. Upon approval of thru apphcahon, th~ Building Inspector will tssued a Building Pe~t to ~he apphc~t Such pe~ sh~ be kept on the premises av~able for mspechon ~rou~out the work~ ~. No budding shaI1 be occupied or used m whole oran pa~ for any pu~ose what,vet unhl a C~ifi~ate of Occup~ shah haw been granted by ~ Building Inspector. ~PLICATION IS HEREBY MADE to ~e Budding Dep~m~nt for the iss~ce of a Bmld~ng Pe~tt pursuant to tb Building Zone Ordinance of the Town of Southold, Suffolk County, New York, ~d other apphcable Laws~ Ordm~ces · Regulahons, for the ~onst~ct~on of budd~, add~hons or al~erahons, or for removal or demohhon, as hereto des~nbe~ Th~ applicant a~ees to comply ~th a~ apphcable laws, ordinances, building code, housing code, and reg~hons, ~d~ admit authorized mspectom on premises and m bmldmg for necessa~.~ns~ec~~-- ~ ... ...... (Marling address of apphcantY State whether apphcant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or budde~ Name of owner ofpremmes (as on the tax roll or latest deed) If apphcant is a corporation, mgnature of duly authorized officer. (Name and title of corporate officer) Builder's License No Plumber's L~cense No Electnman's License No ............... Other~rrade's License No ....... Location of land on which proposed work will be done ................... House Nmnber Hamlet County Tax Map No I000Sectlon .... ].~.4.. Block . ~ .... Lot...!.~ ....... 2 Subdivis~on ............. Fried Map No ' Lot .......... (Name) State ex~shng use and occupancy of premises and ~ntended usc and occupancy of proposed construction a. Existing use and occupancy . ~? ~].~. / b. Intended use and occupancy .. .t/ .......... ~. ......... .~. .............................. 3 Nature of work (check which applicable) New Budding .. Addition .. P~. ·.. Alteration ........ Repair . .. Removal ........ Demolition ....... Other Work .......... .~,. ~',~ ~. (Descnptign) 4. Est~raated Cost .................... Fee ....................... " (to be paid on fihng this application) 5. If dwelling, number of dwelling umts... /. ........ Number of dwelling units on each floor... ! .......... If garage, number of cars .. t.... 6. If business, commercml or mixed occupancy, specify nature and extent of each type of use ............. 7 Dtmensmnsofex~stlngstructures, lfany. Front ..... .~.6~( .... Rear .. ~F-2..t ...... Depth . . ~..~t, ...... Height g~. ' . Number of Stones Dunensmns of same structure w~th alterations or additions Front . ~ ....... Rear . ...,*~. ......... Depth . ~- ~ ....... Height ,/.X~'. t ........ Number of Stones .. / ............. 8 D~menslons of entxre new constructmn Front ., .~'~. .... Rear ... ~ .~. ....... Depth .. Z,J'. ....... Height t'.f' . Number of Stones S~zeoflot Front .... ~.$ ,$../.e..... . Rear ... .. .~.~..r.~. ..... Depth ... ..~..~s.~ ...... Date of Purchase ................... Name of Former O.w,r)e.~r ................ Zone or use d~stnct in which premxses are situated ..... ~: ~...~4"~.d;~'/l/7:t'..~g- .................. Does proposed construction violate any zoning law, ordinance or regulation ................... Will lot be regraded .... ,~. .............. Will excess ~l be removed from premises Yes N, Name of Owner of premises .'l~g4~4~[~..,,,f",~9tl'g4. Address/..7.~'~'~6/~' ~'~: P.h~.~ No..a ........... Name of Architect . .~[~ .s~'~e~&;~. ..... Address'~,~.~,a~/~.~.l~.~l~n~'i~'~ No(~t ~,.~. Name of Contractor --= .................. Address ................ Phone No ............ 9 10 1I. 12 13 14. PLOT DIAGRAM Locate clearly and distinctly all buddings, whether existing or proposed, and indicate all set-back dnuenslons fros property hnes Give street and block number or description according to deed, and show street names and ~ndicate wheth¢ interior or corner lot STATE OF NEW YORK, S.S COUNTY OF ........ ' (Name of ~ndzvldual signing contract) above named being duly sworn, deposes and says that he is the apphca He ~s the .... (Contractor, agent, corporate officer, etc ) of sa,d owner or owners, and ~s duly authorized to perform or have performed the said work and to make and file tl apphcat~on, that all statements contained m this apphcatmn are true to the best of his knowledge and belief, and that tl work wdl be performed :n the manner set forth m the apphcation filed therewith. Sworn to before me this ....... 7 ... dayof Notary eubhc, .. K...~.Z.. . County Hrl r~K PE\LE No 4/07878, $,~fl?, ~' 6. ~er~or ~O~d~g~ Wa~s ;~ '~ade ~ ~ ~r~fed wi~ ~W~ coa~ o f. 'appr~d 2~Co~'r~e footings %s~l ~e~, ae~e'lo~a S=~e~h 0f 2500 ~- dowels 4'-0" ma~ ,: 4~,ao~ Se~r shall co~nec~ t9 ~is~ng ,sept~ syst~. l.~&~n-o~ ~i 6ut-I~ts, ,wit~eS, feoepta~les, 6e~Li~g ~ght, as d~eeted by the o~er. ~.D~ t~ .be uo~ed to ~s~i~g h~ting e]~ogt ~d s~e~ ~ accord~e ~ith accepted prac~e. [ f:.,. '_% APpRO¥~D AS FEE ~' I~ ~EPARTME BE C ~t~,~,ON SHALL MEET ' n is used ifcepper tuoi g~ water ~.istrl ,bu~i~n~g. o} ~peS ~ i Iz IFFC IDININ~ I~OOM LIVINC I~O©M IB[ HAYD EN ARC H ~TiEC'T '3a4 BU_ RNS. STREE' ~OUTt4 F_LF~VATION f~ JOHN B..~HAYD E N~.,,A: '~ARCHITECT','. "'~' '334BURNS STREET FOREST H!,LLS, N.¥L q r ON; II 'Il II , L'] V'I N C ~IDE~OOM P~tD )7,00 M OHN B. HAYDEN NC, I~OOM JOHN B. HAYDEN A.I.A. ARCHITECT 334BURNS STREET scALE1DATE EOREST .,,~s, ,.¥. i ,x.~-,~x l.~x,~x~I .x ./