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Home My WebLink About14044-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy z is 159 .~.a.n.~..ay7 5. 198.7. No .................. Date ......................... THIS CERTIFIES that the building ...O.N..E. ?.5~ I.L.Y..O~dig.khb IN.G. ..................... '. Location of Property 305 PVT. RD. //22 MATTITUCK House No. Street Hamlet. County Tax Map No. 1000 Section . l 1 .4 ........ Block ... Z ........... Lot ...2.2 .......... '. Subdivision Filed Map No Lot No . . conforms substantially to the Application for Building Permit heretofore filed in this office dated .......May..3.0.. ..... . .., 19.8.5. pursuant to which Building Permit No. , !4. .0,4,4,z. ......... . ... dated.. .J u.n.e. · ._. · · ·. · · · · · · · · · · · · · -.16 19 .8.5. , was issued, and conforms to all of the requirements of ~he applicable provisions of the law. The occupancy for which this certificate is issued is ......... The certificat~ is issued to D A.N A, P..F, 0 .X ....... .................... of the aforesaid building. Suffolk County Department of Health Approval 14- S o- g 5 N776367 UNDERWRITERS CERTIFICATE NO .................................................. PLUMBERS CERTIFICATE 12/18/86 // ~ Bfillding Inspector Rev. 1/81 F~u~ NO. ~ TO~N O~ $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 14044 Z Permission is hereby granted to: .......... ~.~..~.~ .............................. ........ ~....,,~.~. ~, ............... ~ ...... ~.....~ .................... ......... ~.~..,.~,i~.~...z~.../.~...... ,o ..~:~.~.~.~......,~..~.~...~.~(..~..~...~.- .~.../..~.~ ................................. at premises located at .................................................................... .............................................................................................. ~.~.~..,..~.~...:.-..~..~ ........... County Tax Map No. 1000 Section ..Z/..~... .......... Block ..,~...~... .......... Lot No~. ~..~.-....~ ......... pursuant to application dated ........... ~../~...~.......~.~. .............. , 19~...~...,"~nd approved by the Building Inspector. ,. Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 lib t oJg~J6 TOWN of SOUTHOLD OFFICE OF BUILDING INSPECTOR ac- ReceiptNo. 31 0 4 ? town Hail Southold. New York 11971 t ual Date ............[ ~'g /:..~.~.. Z ...................... ace red of ~._ · ~J / ..................................................................................... rig. Z....~ ,/- I/d~ ................................................................................................................................... /100 Dollars ~r ....... ~ ....................................................................................... .: ............ ...~.... ................... or Fee for Fee for -~ Yard Sale [] [] ack ?J~ ~' Fee for [] H.I.C. 4.V~ant Land C.O. 5.Updated C.O. '"~5'.00' $15.00 NewC°nstvucti°n ...... Old or Pre-existing Building Fee for rT_j.~.t i ficate [] Building Permit ~ of Occupancy [] Misc. ~a- ............. .... Building Inspector ~i~,¢~' ; Data ............. ............ Vacant Land ............. Location of Property .. Owner or Owners of Property .......... .~ .................... County Tax Map No. 1000 Section /~..'T ~.~..~ alock ............... Lot ................ Subdivision ................................. FUed Map No ........... Lot No .......... ~[... it Dat f P Perm No .... eo er . cant ................ D ~ ept. Approval .. ./~ ............. Labor Dept. Approval .................. . Unde~riters Approval .. ~//~./.4~4~7~ ..... Planning Board Approval Request for Temporar ertificate ..................... Final Certificate ... '/2L.. r~ ........ Fee Submitted $ ....... Construction on above described buildin~it,/, meets all ap~l~des and regu lations. THE NEW YORK BOARD OF FIRE UNDERWRITERS 1001272 BUREAU OF EEECTRICITY [98685 JOHN STREET, NEW YORK, NEW YORK 10038 .a,~ Octobs~ 2~,~.~,,~.o.~o.~.~.~ ~7V~7/8~N 776367 THI~ CERTIFIE~ THAT o~ly ~he el~tr~cal equipment ~ ~scrtbed below a~ introduced by t~ applicant ~med on the above application number in the prem~es of Dana ~. ~o~, 2500 R. O. W~ WestphaLia Roa~, ~ttituck,~.Y. ~s exarnined on and found to be in compliance w th the req.lrements 9f tbls Board. FIXTUR$ [ [ [ FIXTURSS ~ RANGES ~C~KING ~KS ~ OV~NS ~DtSM WASHERS ~XHAUST FANS SIRVIG DI~ONNECt ~ NO, OF J S E R V I C ~ omE~j~ Room Heaters: 1-3.0kw 2~GFI 2 Smoke Detector P. O. Box 632 $~yville,N.Yl1782 Ltc#525E ' , This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be, Sdenhf~gd bx,.,fhe~r credentJoJ$, COPY FOR BI~ILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUSLNQT BE ALTERED IN ANY MANNER. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 CERTIFICATION TEL. 765-1802 Buildin%ermit No. Owner < ~/~ ~ ~5 (please print) P 1 nmb e r ~%~/~/'~'~ ~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. ' (plumber's signature) Sworn to before me this 19 .~ · Notary Public, ~/rf~z~/(/ / Notary Public~ SUSAN S RANGHELLI County NOTARY PUBLIC, State of New York No, 4853C2C Quahfled m Suffolk County Term Expires 2/18/88 FIELD INS?E~TIO~ C'OMMENTS ~ ~ FOUNDATION (1st} FOUNDATION (2nd) ROUGH FRAME & PLUMBING iIqSULATION PER N. STATE ENERGY C~ODE FINAL ADDITIONAL ~TS: dunu p. foll P.O. Box 632 Sayvlll®, N.Y. 11782 472-3774 October 29, 1986 Town'of Southold Building Dept. Main Road Southold, NY 11971 Re: Fire Underwriters Certificate Dear Sir, Enclosed please find for Dana P. Fox. Fire Underwriters Certificate T~., N N N N TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL File No ................................ To ..~...~.. ~...~......¢..~..~ .......... .. ~.....C~.' .~....~?..~..~...~-. ............ ..... -~x ..... ~ .............. ~ '"'~ PLEASE TAKE NOTICE that your application dated . . .~..'-I ........ 19 .~. Location of Property oq~-oo ff.~,cO.....LQ .o~?.?..~..~...a,...~..~ .... .~.~.~.. ....... h~[~s'o ~]o: ............ Street Ham/et County Tax Map No. 1000 Section .... !! .~ ...... Block ..... .~. ....... Lot ...~[.'..~:'. ...... Subdivision ................. Filed Map No ................. Lot No ........... : ...... is returned herewith and disapproved on the following grounds...~...~. ,~... ~-- - .~. -~. · - /. ~..-. ~ .~.. ~.~ ~..F.~ ~... ~ 1>~ ;~.... ~.~-~r..~.~...~.. ~.~..~ .......... ........ ........... ... Building Inspector RV 1/80 SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES ?r, gper,ty ~ocaAion kL/~ ~.C)t/k.J FROM: General Engineering Services Unit Department of Health Services Division of Public Health Suffolk County Center Riverhead, New York ~19Qi H. D. REFERENCE NO.~t~ ~0.~,~ ~',~ . ' The surveys for your proposed sewage disposal and water supply systems have been reviewed, and the following will be required prior to further processing of the app- lication for approval to construct. PLEASE RETURN THIS FORM WITH ANY RESUBMISSION. ...PRELIMINARY APPROVALS-OTHER AGENCIES ~N.Y.S. Dept. of~Env. Cons. erv~tion ~ Town "Wetlands" Letter F'~IS.C.D.H.S. Vector Control III.... SURVEY DATE REQUIRED F-1Test boring and location r-l Corner elevations ~.Proposed house location '"lSurrounding property - vacant or 'improved (within radius of 100'} ~"_]Indicate any surface water within 300' of plot ~"lOther rOWNERSHIP O~ PROPERT~ r~-JProof of single & separate prior to Jan. 1, 1970 (acceptable by deed IF dated prior to Jan. 1, 1970 for specific lot) I'"lOverlay map by surveyor of total contiguous property as of Jan. 1, 1970 II II ~ Ill J I I Illl Ill U I FOR. DEPARTMENT USE ONLY: Notified By,Mail -- Person GE-35 II. INFORMATION REOUIRED ON SURVEYS Three prints of survey required Name, address, phone no. required Stat~ent signed by applicant S. C. Tax Map identification req'd. Indicate square footage of lot WATER SUPPLY Public water availability letter Distance to nearest public water main Indicate source of domestic water of adjacent.dwellings ~-----'lITest well,required on your lot VI. APPLICATION FEE $ V_I'i',. REMARKS ~ By -j danap ~on~tru~tlon ~orp. P.O. I~ox 632 Sayvllle, N.Y. 11782 (1516) 472-377'4 October 10, 1986 [town of Southold Building ])ept. Main Road Soathold, NY 11971 ~o ~om it may concern: ~nclosed please find £or Dana ~. Fox. final survey in referencetto permit Very [~ruly Yours, dunu p. foll P.O. Box 632 Sayvllle, N.Y. 11782 (516) 472-3774 Town of Southold Building Department Token Hall Southold, NY 11971 May 21, 1986 Re: Permit No. 14044Z Dear Sir: In accordance with my telephone ]conversation with the Building Department on Ma~ 20, l~6j ~ am requesting an extension of six months on the above permit. Very truly yours, Dana P. Fox DPF/pm 765-~802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION :)ND [ ] INSULATION FRAMING [ ] FINAL REMARKS; / / Examined ................ , 19... 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1802 BLDG. DEPT. TOWN OF $OUTHOLD Received ........... ,19.. Approved ................ , 19... Peimit No ............ Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS /..~./.& Date ............... , 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 ail applicable laws, ordinances,~_g, code, housing code, and regulations, and to admit authorized inspectors on pfeinises and in building for necess~ry?ts.p~'~,s. /..,r~_~_,, / .- t...A..//~./t~'k'~:'' bz(... :,,, ....... :.., .... a?pli?nt, or name, i,,a corpo,at,on, (Mailing address of appli~afit) // State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Z2; Z; ................................................... (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. /~..~.~. ff..]7. .............. Plumber's License No .............. ........... Electrician's License No..,$7~..ff.. ~.-. ............ 1. Location of land on which proposed work will be done ........ ... ............. House Number~-Z/~ff ~/_9~ Street Hamlet County Tax Map No. 1000 Section .. (/.~. · ~. Block ..... .~ ........... Lot .... .~..:.~.. ........ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ¢/~. ~lq..~..TT....Lt~./[/,t~ .......................................... / .................................. b. Intended use and occupancy ...... .~.~: · · · ff.~..~..~.. · · . 3. Nature of woik (che614~which applicable): New Building .......... 'Addition .......... Alteration .... ~..' .... R~emo~al Demolition Other Work/~.~. ~.~tY~' ~. Repair . : . ........................... 4. Estimated Co ·, ~.0. ~..~.~ .................. Fee ...................................... , . ,~..~J~ bi i '~ (to be paid on filing this application) 5. tLdw6ilin~inumbe~'i~Cl~llir~g dnits .... /. ........ 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 .................... 7 Dimensions of existing structure! if any: Front "~" · Rear Depth Height ............... Number of Stories ....................................................... Dimensions of same structure wiih alterations or additions: Front .-,~-.~..~/. ~..(~. .... Rear ................. Depth .' ................... i ' Height ...................... Number of Stories... ~ ............... ---8. Dimen,sions 9~en~ti, re new constrUction: Front .... ~".~. ....... Rear . .,,~. ,~.~. .... Depth . ,-~ .......... · Height ~... :~=J~ .~. '. ...... Number of Stories ..... ~ ................................................ 9. Size of lot: Front .. Z 3/-?... i .......... Rear .... /.~/..~. ............. Depth .//~.. ~.. ~..~..O..o. ...... 10. Date of Purchase ../.°/. ~ ~0. i ................. Name of Former Owner ."~. ~/t]:~4~;;~C~ ................ 1 I. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction viol~te any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ....... c~.. .................... Will excess fill be removed from premises: Yes 14. Name of Owner of premises . .~)/~..~....~-~/.. ~. O~.. Address . .~.~o~ .~W~/,~ . Phone No. ?~.. ~.~. Name 6f Architect.. ~...~./~/.~./3. r ........... Address"~.~,~:rW/'/J~/~.~ :~ Phone No../ Name qf Contractor . .~,~'~. ~.. .............. Address .~z:~44 ~ )-. ~../~¢K./I-l.~.lv~/r~ Phone No.. ~7~ ;?.-/.~. ~... PLOT DIAGRAM Locate clearly and distinctly all ibuildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block rmmber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY J~F . ........ ,n ....... ..... ~-~...t~..~..~ .................. beingdulysworn, deposesandsaysthatheistheapplicant ' ' ,(Name of individu~l signing contract) above named. He is the ..... ~ ..... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul'9 authorized to perform or have performed the said work and to make and file this application; that all statements contilined~ in this application are true to the best of his knowledge and belief; and that the work will bo performed in the manne', set forth in the application filed therewith. Sworn to before me this ' ....... /.../. ............. day of'~~ ..... , 19 Y.':/ N9. 52-4688932 Suffolk Coullty..~ (Signature of applicant) ~ Term Expires. March &O., 1.9~ ' FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 ,Examined... ~../..~.., 19~. .5'~ ~ Approved l rmit Disapproved ~ c ...... '7 iVY. .... [ ........... ./)- ....... APPLICATION FOR BUILDING PERMIT Received ........... ,19... Date . ?AY....3.0., .......... 19 .~.5. 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. e. The work covered by this application may not be commenced before issuance of Building Permit. c7 d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicaflt. 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 .Reeulations, for the construction of buildings, additions or alterations, or~Zo~r, emoval or demolition, as herein described. Th~ applicant agrees to comply with all applicable laws, ordinances, bja'[l~ding coXde} hoc'~tng code, and regulations, and tO (~'~icant, or name[if a corporation) P.O. BOX 652, Sayville, NY 11782 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Owner & General Contractor Name of owner of premises ,..D?:.n..~.. 5*. Pox .................................... (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 ....... ! .9.4.5. .H ~.--Su..g .g.o.~.k... C ~ny Plumber's License No ......................... Electrician's License No. 52.5.~ ........ j Other Trade's License No ...................... 1. Location of land on which proposed work will be done ........................ : ......................... 2500 R tph .R.d Mattituck .O.W. Wes alia . . .......................................... ~ ..... House Number Street Hamlet County Tax Map No. I000 Section ...1.~..4 ............ Block ..... .7 ............ Lot. 2 Subdivision ................................ Filed Map No ............... Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: lq'on e a. Existing use and occupancy ..................................................................... b. Intended use and occupancy .. OB.e. family. ~L~elli.ng ........ ' ........... 3. Nature of work (check which applicable): New Building .... .X. ....Addition .......... Alteration .......... Repair . ~ ~ .-.1~1~ · Removal .............. Demolition .............. Other Work ............... (to be paid on filing this application) on each floor .............. 5. If dwelling, number of dwelling Units ...... .~ ........ Number of dwelling units '~ ' ~ ' ~.. If garage, number of cars ..... ~. ~. .............................................................. 6. If business, commercial or mixed 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 wlth alterations or additions: Front ................. Rear .................. Depth: .................... !.. Height ............... Numbjr 9f Stories ...................... 8. Dimensions of entire new construction: Front .... i,~ ~ i i .... Rear.. ~.~(,~ ........ Depth ,~.~,~ ......... t!eight .............. : _Number of Stories ........................................................ 9. Size of lot: Front . ~..../.~. ~ ........... Rear .... /..~2. ~...,. ~..~. Depth /~..~..~ .... .,~..d?~..~.. Pur h se ])eoembeT 2, 1980 Name of Former Owner 10. Date of c a .......... . ................. . . : .................. 11. Zone or use district in which pr~mises are situated....A..R.e. ~.~.d.~.n.. ~.~.~.1./..~ ................... No 12. I)oes proposed construction vic!ate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........ } ................... Will exf~ess~ f. ill b.e removed from premises: No 14. Name of Owner of pLewi~es .~,a~ .~:...F. qx. ...... Address .~c~te.. ~.~..~ ~ ~c~one No.. 472-Y~s774 · · ~cnar~ wright ~ ¢~ct afl H 1 h eNo . Name of Architect .~. ...... ~i ................... Address .~ll~,~o~.. 'I~½' fl~h°n . ~]912.'-~ .~.~0.' [ [ [ . ~anap vonst.(~. ~ox) ~ 2 h o 47.2-3.7.7.4... Name of Contractor ........ ~ ................. Address ~.~,. ~Z.. ~. ..... P one N . . . Sayville, NY PLOT DIAGRAM Locate clearly and distinctly ali buildings, whe~er existing or proposed, an& indicate all set-baak dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK. COUNTY OF...S.u..f.fp.~,k. ..... S.S ........ .]).~.n...a..2.,...I~9.x' ......................... being duly sworn, deposes and says that he is the applicant mgmng contract) (Name of individual ' ' ' above named. He is the ............... 0. o..n]b?,a.c..~.o.r..&...O?.n.e..~ ..................................................... J (Contractor, agent, corporate officer, etc.) : of said owner or owners, and is d¢ly authorized to perform or have performed the said work and to make and file this applicatioTt; 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 man ,ncr set forth in the application filed therewith. Sworn to befor.~me this ! /.3 · ............. 2"~";',"~'day°f"~' ~¥'~' , · Notary Public, f~~...~...~ · .F~. ~2ounty ~ '~e qualified In Suffolk COun~ Commission Expires March 30, 19 ~ , SUFFOLK CO. HEALTH DEPT. APPRovAL " PLEASE NOTE ! H.S. NO. It iS the applicant's res. ponsi.b, tli. ty to ~,~4~;3 ~-m maintain adequate sanna~ ais[ance ,~w~ ~: r~ · ' between alt. water s~pply..end sewage. disposal facilities. 7 ~VE~E~ FOCi.:: . . ~ ~ ~T~'~T~~ ~T' SY~EMS FOR THIS RESIDENCE WILL ~ ~ : SUFFOLK CO. DE~. ~ HEALTH SERVICES. ~V-5.~C ~ATT[~, . CONFORM TO THE STANDAR~ OF THE ~5~X~¢~'' ;~ ' SERVICES -- FOR APPROVAL OF --~ 'r' ~T~ /~'I CONSTR~T~N ONLY , ~FOLK CO. T~ Mm E~[GN~TION: ~..LEV 5.~EF~ ~ 0~D, HtGH ~ATEFd,ADD 2,6' PO~ ~EAf-4 ~EA ~EVE~. ~: ~' R~RtCK VAN TUyrL. · ' "' SUFFOLK CO, HEALTH DEPT. APPROVAL C~E.E~' ,' J, ' · ' THE WATER SU~LY AND SEWAGE: DISPOSAL O~.~'~Z S ·" : '" m '.~ L ~ = SUFFOLK CO. DEPT. OF HEALTH SERVICES. 5~ ; DI~. ~CT. BL~K ~L. L ICEN.D LAND SURVE ~"S ~ GR;EN~RT NEW YORK