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Home My WebLink About14126-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13905 Date October 7, 1985 THIS CERTIFIES that the building .... O. n..e..f.a.m. ~ .1 y.. cl..~.e.l.1. $ .ng ...................... Location of Property lT. 0..0.F.a.i..ry.a.y. Drive Cutchogue House/Vo. Street HamlEt County Tax Map No. 1000 Section 109 ...Block 05 .Lot 014.9 Subdivision..Ffl. I. ~.¢/.~.Y...F.g.R?.S. ..............Filed Map No. 6.0.6.6. ....Lot No. 9 conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... J.u.r~..7~ ......... 19.8.5. pursuant to which Building Permit No. 1.4. .~ ,a.6.Z. .............. dated J.q 1. y..~.0. .................... 19 .8.5,, 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 ......... ..... O.ne. £.am$iL7. .d~eZ.L£ug ..................................................... The certificate is issued to .... .R .O.B.E. ~ .T. ?.0. H. ~ .S.Eft. [o~,'~;-, '~,~1~2~'~t'~'~ '2 ~ .................. of the aforesaid building. Suffolk County Department of Health Approval 85-$0- ~ 06 OCT. 4, ~ 985 UNDERWRITERS CERTIFICATE NO. P e n d ± n g PLUMBERS CERT. '~0/5/85 Rev. 1/81 Building Inspector 'TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT ~'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ,/~ ~ · . ......... ~~... ....... ~.~.H~..~..~ .......... .... ......... ...... .,~-~,~....=~..:.~..../~.~.~/.. to ...... ~..~.~.~c~........~.~......~.~.r.~.....L~¥~.~/~ ............................. County Tax Map No. 1000 Section ...... /...~....~.. ..... Block ...~.....~.... ....... Lot No...~.../...~..'...~.. ....... ~drsuant to application dated .......... ..~...~... .................... 19 .~....., and approved by the Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall 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 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 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. Su bm it Plan n in g Board approval of comp leted site p lan requ irements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~Coperty 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 condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion requ ired to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $ :[5.00 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 Date ..... /.~..--. ~'. :: .~..J~-. ........ New Building . ...Jf~... ..... Old or Pre-existing Building ............ Vacant Land ............. Location of Property.../?..~..~....~,o. ? .~..~..~.~ .... '.~:~ ................ ~. ~'~.~q .~.~...~. ~..,~..... Houae No. Street M Ham/et Owner or Owners of Property ......... ~.~..~. ~. ! ............................. County Tax Map No. 1000 Section ..... ~..~. ~. .... B~ock ..... .O..~. ...... lot .... .~. ~.'.,. ~. .... Subdivision .... .~. ,~..~..~..~"~.... '../~,x.~.~.~. ...... Filed Map No...t~.~..~.~...Lot No...~. ......... Permit No. ,/.~./. 2 .~.~,.. Date of Permit ...~.~?g.'7.~..~pplicant ........ ee .77... ........ Health Dept, Approval ..... ~ ............... t. abor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .... ~ ............. Fee Submitted $ ..... ............ Applicant Rev. 10-10-78 FIELD INSPRCTI@~ COMMENTS FOUNDRTIO~ (~st) FOUNDATION 2. ROUGU FRAME & PLUMBING (2nd) iNSULATION PER N. Y. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765o1802 CERTIFICATION Building Permit No. Owner Plumber (~ease print) (please pri~{ ) certify that the solder used in the ~?~ supply system contains less than 2/10 of 1% lead. (plumber ' ~signature ) Sworn to before me this day of Notary Public, County Notary Public 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL,: 765-1803 Examined Approved .7/..~.~.~..C..., 19 mermitNo./.~./J.~..Z Disapproved a/c ...................... .H(~ .......... (Build'ing Inspector) APPLICATION FOR BUILDING PERMIT TOWN OF 8OUT~ OLP Received ........... ,19.. · 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 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 pumuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New yo,~, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, orfi~r I~emoval or~emolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, built. !n.~,~ode, housing code, and regulations, and to admit authoriz ed inspectorson premises and in building for necessary (Mailing address of applicant) ,Afy State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .. ~e2.[ ¢~ . .T~.. ~ h .~ .s.c..m ..... :.. ................................ (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..e?~.~.~.~. ................. Plum bet's License No. ~ I..t..OX,¥. ~.x~. ........... Electrician's License No. ~...~. ............... Other Trade's License No ...................... 1. Location of land on which proposed work will be done. t ., ,' ..................... House Number Street Hamlet County Tax Map No. 1000 Section .... ~..O.? ......... Block . .~..-~'. ............ Lot.. Z.~.{ ~. ...... .... Subdivision .... . .~..2~..t~. ~.Sr../~. ~7!$' ............ Filed Map No .... .~. ?..~...~:.. Lot .... .~. ......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... .~.~. ~.~ .~. ~ ..................................................... b. Intended use and occupancy ........ .~...~.... .~. ~ ..... .z~..~ ............................... 3; Nature ofwork (check which ap~licable): New Building ..~..~.~ .... 'Ad Repair .............. Removal ........... Demolition . . dCost . . . ~ .,~oo ,~- ~ 4. Es ............. .~.. ~....~ .............. ~ee . 5 fd ' fd 11' ' ' /. N mb old · I. welhng, numbero we mgunlts ............ u er w If garage, number of cars ..... ~. ............... .. . . ... .. . . 6. '~l~uS'i'ness, commercial or mixed occupancy, specify nature and extent o 7. [aim~sion~ of existing structtrr~s, if any: Front ............. Rear iition .......... Alteration .......... .......... Other Work ............... ?'./~V'- C~7 (Description) ..................... (to be paid on filing this application) ~lling units on each floor..'"7..: .......... each type of use ..................... .............. Depth ............... Number of Stories l:~ons of same structure with alterations or additions: Front ................. Rear .................. [~pt-l~ .................... :.. Height ...................... N ~mber of Stories ...................... Dimensions of entire new constrUction: Front ..... ~..~- ...... Rear .... .~..,~. ...... Depth ............... Height ..../. ~.. ........ Nun~b,r of Ston ......... /. ...... 9. Size of lot: Front ........ .~?~ ......... Rear. ]~2$.w... 10. Date of Purchase .... g[ .~ i~."/ .................. Name of Forme 11. Zone or use district in which pr~mises are situated ...... ~.~,a' ...... 12. Does proposed construction~olate any zoning law, ordinance or regular 13. Will lot be regraded ..... ~..~?. .................. Will excess fil 14. Name of Owner of premises .~.$~,~..7~..~oAn~eo... Address Name of Architect ......... ', . .I.I .............. Address Name of Contractor ........ i 3. ~ .............. Address · ..... Depth .... ~ ................ 3wner ... ~ {~.4-~ ot~ ............... &" '.d .......................... e remqved from premises: Yes ~ LoC. .~.d. qt:¢q4 Phone No...~ ~-_/4K ~' .... :,{,~-t{~.i.~.[]Phone No ................ t,~, q,./ ....... Phone No ................ : i PLOT DIAGRAM Locate, clearly and distinctly ali buildings, whether existing or propot property lihes. Give street and block number or description according to dee~ interior or corner lot. STATE OF NEW YO]~ ~ , COUNTY,~OF .~ .14F.~-O ~g- S.S ....... ~.D~..~. :~2 "~ ~ 2 '~.~ ................. being duly (Name of individual si~ing contract) above named. He is the ...... ~ ~ .~.~,....i .~. 9.~ ~ ~q ~ ......... (Contractor, agent, corporate ( of said owner or ownars, ~d is dly authorized to perform or have peril application; that all statements contained ~ this application are tree to th work will be perfomed in the m~per set forth in the application filed then Sworn to before me this ~ .. ................... d y.o ..... ~.~ ........... ,19 ... Nota~ Public~~ :~. ...... County u. a /. / //( ~o. 52.45247171/I/ / ~ ~ ' V J, and, indicate all set-back dimensions from and show street names and indicate whether ~orn, deposes and says that he is the applicant rficer, etc.) .rmed the said work and to make and file this ,~ best of his knowledge and belief; and that the with. NOW or Dads Lot I0 Formerly Ketcham Lot $. 88°59'20' E. Lot 9 Area: 4095;5 s,f. I N.88°3~'20' W. 112.16' LOT 9 '~FAIRWAY FARMS" AT CUTCHOGUE '11:)WN OF SOUTHOLD SUFFOLK 'COUNTY, NEW YORK SURVEY FOR 'ROBERT JOHNSON SUFFOLK COUN~ DEPARTMENT QF HE~AUH SERVICES FOR APPROVAL OF CONSTRUCTION OF . ~i~le Family Residence Only -DATA F~ APPRO~ TO C~TR~CrT, .~ [OT~ YOUNG s YOUNG N~OTE :,t, = :' SUBJ~I¥1$10N MAP ¢iLED IN'THE ,oFFIcE OF THE OF SUFFOLK 'COUNTY iON FEB. 15,19?4 AS FILE' NO. 6066 ~t~ ~ O~OATA OITN~D F~ OTfl~n~ ALDE~ W YOUNG, PEOFESSIONAL ENGINEER ~ND LAND SURVEYOR N.Y.$. UCENSE NO; 12845 HOW4RO ~, YOunG, La~O SU~VEYO~ N.Y.S. LICENSE N0.45893 DATE: MAY 22, 198§ t" 50' SCALE: : NO. 85- 584 400 OSTRANDER AVENUE RIVERHEAD~ NEW YORK Now or Doris Formerly Ketcham Lot I0 Lot S. BB'~59'20'' E. Lot 9 Area= 40955s.f. N.88°38'20"W. 220.00' DRIVE WOOD WAY NOT~: I ' MONUMENT SUBDiViSION MAP FILED tN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON FEB. 15,1974 AS FILE NO. 6066 SURVEY FOR LOT 9 FAIRWAY FARMS" AT CUTCHOGUE TOWN Of' SOUTHOLD SUFFOLK COUNTY, NEW YORK PATE MAY 22, 1985 SCALE I"= 50' NO 85 - 584 Ik,/gl"tg gl /L/L./Iqk7 RIVERH~AD, NEW YORK III I/ ALOI[N W, YOUNG, PROFE$SIONAL ENOIN[[R j~J'~j~J AND LAND SURVEYOR N,Y.S. UCENSE NO, IZS~.~. i [] J HOWARD W, YOUNG, LANO SURVEYOR '~ . IlJ NY.S, LICENSE N0.45893