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Home My WebLink About13734-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 .......... Date .... .O.q .~9.b.e.R..1 ................. ,19.8.~ THIS CERTIFIES that the building .... 0. n..e..f.a..m .~ .1.y.. d..~.e.Z. 1. $ .n ~. ..................... Location ofPropert~ 1 5 Highland Road Cutchogue House No. Street Hamlet County Tax Map No. 1000 Section .... .1.0.2. .... Block .... S, .......... Lot .... .1 ............ Subdivision..H.~. ~.h.l.~.n..cl..~.s.~..a .~.e.s. .......... Filed Map No. 6.5.3. ? .... Lot No....~. ......... conforms substantially to the Application for Building Permit heretofore fried in this office dated ·.. 2./.~ ? ............. , 19 .8.5. pursuant to which Building Permit No. 1.3. ? .3.~.Z. .............. dated ... ~.a.p.c..h...7. ............... 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 ......... ... 9.no...f.~.~. ~..~ y..d.~. ?.L~.~.~. g.. ..................................................... The certificate is issued to .... g.a?.y...L .o.n.g...a p.d.. L..5 ,ri.d.a...L .o.n.~. .......................... (owner,/~e~ ~{~fO~ X X X X X X X of the aforesaid building. Suffolk County Department of Health Approval .... g..5.-.S.0.-: .1 ~..9. ./.1.8.4 ~. ~ ................... UND~WmTe}~S Cee'rIFZCAT~ ~0 ............ ~. 7.02 0. ! 2....~./. 2. .~./.~. ? ................... ?lumbers Certificate 9/26/85 · ....... Rev. 1/81 TOWN OF $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) N_° 13734 Z Date ~7 Permission is hereby granted .to:~-~O-~O~-~ ~ ...i~.~.z..L.~.). .............................................. ...~.~.~.~.....~.:.~:_.~./..~.~.~ ...... ...~..~.~.~....~..~... ' ~i ..... "......~ ............ ~o o~.~,.~,~o~o~ ......... .~.~. ........... .~~.....~.....: ......... ~.~~ .............. Co-n~v To× Uap Uo. lO00 Sec}~on ..... .~...0...~ ...... ~o~k ......... .q3. ......... Lot ~o ........ .~ ............... pumu~nt to appUcation elated ...... Building Inspector. Building Im~ector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall $outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted ia ~ 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. 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~perty showing all propertv 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 informa~ tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15.00 3. Copy of certificate of occupancy $1.00 4.Vacan~ Land C.O~. $5.00 / Date ... New Building ............. Old or Pre-exist~ng Building ............ Vacant Land : .... '~. ....... Location of PropErty ..................... ' .>' ............ ~ ...................... t ........ Owner or Owners of Property ................. : ............ ' ................. County Tax Map No. 1000 Section / C! ,~:~--.. Block .~.~ Lot Subd,v,s on / ,.. ,o... Permit No. t plicant ................ /; ............ Health Dept. ApprovaJ .... '; .....- ........... Labor . Approval ........................ ~d~ritem Approval ....................... ~la~ni~ ~ard Approval ....... ~ ............ ~aqua~ f~r Tamparar~ Cartifi~ate ..................... Final Oartificate ~.~.~te~ ..... f~.-~'. ................ Construction on above described building and permi.t/~heets all~ppplic~51e codes and regulations. ,.,.,o.,o.,.::: :>:_. zooll u THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~r['tC~ a!J.(,~l~[: 3~. :{,~5 8~ JOHN STREET, NEW YORK. NEW YORK1OO3S Date Application No. on file 335842/85 only the electrical equdpmnent ~ described below and introduced by t~ applicant ~d on the able application number in t~ preo~ises of in the followlng loeatio~ FIXTURE OUTLETS F~ECEPTACLES SWITCHES 20 49 27 DRYERS FURNACE MOTORS [] 2nd ~'l. Section Block Lot and found to be in compliance with the r~quirements of this Board. FIXTURES RANGES 2O FLUORESCENT OVENS DISH WASHERS EXHAUST FANS [JNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT OTHER APPARATUS: l~Sn~]ke Dc, tec~or S E R V I C NO. OF CC COND. A W,G / NO'OF Hi-LEG I A'W'G PER ~o' OF CC, COND OF HI-lEG 3 NO. OF NEUTR~$ ~3 I{OW-ard Dil.lin~ Box 574 Imurelt N.Y. 11948 lbic. 750 GENEI~AL h iR , This certificate must not be aJtered in anv manner- return to th~ ^~:~ -z &L i*~ 'J Per- !~:~d~`~e~fr~`m~re~`~erfr~`~r~`~'~:~`~`/~f~s`~/~`~ ; ~ P y d by their credent als , ~ ~'F~R ~ILDING DEPARTMENT. THIs CoPy OFO~OoIEI;~E ~ TNOTSE LTERED IN ANY MANNER. 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. Owner Plumber (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. ~orn to beforvme this ~9 ~. ~ / Notary Public,/~f County ~ .,~//~lu~b~r/' ¢ignature) Notary Public FIELD INSI~ECTION FOUNDATION (1st) COMMENTS FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY ODE FINAL ADDIT; ~L COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ,9OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined.. · x~.~.'..~. .... 19~.~-/. Approved . . .~...~..q.., 19~..g'. Permit No.{.~..~. ~ .~. Disapproved a/c ..................................... ................................ ........ (Buil~ling Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... ,19... Date..~/~. a. This application must be completely filled in by Wpewriter 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 Yor}, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or foy/emoval or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buildi~/code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspe~ (Si~ture of applicant, or name, if a corporation) ....... ............ (Mailing address ct apl~z( State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises.. ~/t~....Pg..~ ..... .~/x./.,~ . . . ?.~.. dt~.5~. ............................. (as on the tax roll or lat~t deed) If appli~~ion, signature of duly authorized officer. =d title of corporate officer) ~ilde~s License No... ~. ?.) ~.../~ ........ Plumber's License No .... (7~5.../~ffq % ....... Electrician's License No...~...Oqa. ~S~. Other Trade's License No ...................... I. Location of land on which proposed work will be done .................................................. . . . . .¢. ...... ...... ................ ................. House Number Hamlet County Tax Map NO. 1000 Section ...fO~..kfl.?~.... Block .... ...~.....~. ..... Lot .... ~... ? .......... Subdivision ./.~.0 .~' ...... ~ .~...~.' ............. Filed'Map No. kQ .~..~...~. ...... Lot · · ·k] ........... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupancy . (-~ · . .]7'..~.T: k~ .... ~. ~ .,~t../t~ .................................. o · 8. 10. Il. 12. 13. 14. property lines. Give street and blocl interior or corner lot. Nature of work (check which at plicable): New Building .......... 'Addition .......... Alteration ......... Repair .............. Rem, ~val .............. Demolition .............. Other Work ...... ,. ....... (Description) ' ~) O.o.O. Fe E ' C stnnated ost .............................. e ..................................... ; '~' (to be paid on filing this application) If dwelling number of dwellingiunits / . Number of dwelling units on each floor... [.. If garage, number of cars .... i · ./. .................................................. If business, commercial or mixea occupancy, specify qature and extent of each type of use ..../~gw,.~ ............ Dimensions of existing structures, if any: Front... ~ ....... Rear .............. Depth ............... . Height ............... Number of Stories ........................................................ Dimensions of same structure ~Vith alterations or additions: Front ...~,~-(~ ......... Rear ................. Depth ................... i · · Height ...................... Number of Stones ...................... Dimensions of entire new construction Front ....... 0 ...... Rear . . . O ...... Depth ......... Height ....I.q/ ......... Number of Stories ....... t' ................................................ Size of lot: Front ..... 1 ~.~., ........... Rear .... 4. q~ ............. Depth ... :,~ .~. [ .............. Date of Purchase ...... ~ ~./.2.] ................ Name of Former Owner ... ,,'~.~..~.t,~; ~..~% ........... Zone or use district in which pr~mises are situated ........................... ;I/~ ....................... Does proposed construction violate any zoning law, ordinance or regulation: ...... ~.t.~'. ....................... Will lot be regraded ... It~ .O~. ! .................... Will excess fill be removed from preinises: Name of Owner of premises . ~O~ .............. Address .. ~"o~q~..~q}~-,%. Phone No. ? ~V~t ~1 ?.,No Name of Architect Name;of PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from : number or description acc, ording to deed, and show street names and indicate whether STATE OF NEW 7ORIt[,,e ~ ~ o . ........ . ./. .... ~t::~..-- ..... ~4~td¢~ ............... being duly (Name of individual signing contract) above named, i sworn, deposes and says that he is the applicant He is the ............................................................................ (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 application; that all statements contained in this application are true to thc 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 ~ ., --// , ~ . 19 .~..~ .......... ~./. ........ day oiN/~.-'f~. · .....~.., · /ff Notary ~i1.' .~..~'t--~... { NOTARy PUBLC, Sldl~ o~ Nsw Ye,~ ...... ,/[)/,.~ ............... ''''' ................. I DIO. ,1}2~:~13~462~ . ;~{{olk Count't., ~ ' // · - ~mrn[s~n.~/~i,,~ ~ar¢h aO, 19..~ (Signature of applicant) but 5 bot ~: HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT -~ NEAREST WATER MAIN__ML- 'X- SOURSE OF W~TER PRIVATE__ puB~*IC__ 'K- SUFF. CO, TAX MAP DIST. 'SECTION BLOCK ~LOT ~r *,%~THERE ARE NO DWELLINGS WITHIN IOO FEET OF THIS PROPERTY OTHER THAN THOSE SHOWN HEREON, ~'THE WATER SUPPLY'AND SEWAGE DISPOSAL SYSTEM FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES. APPLiCANT: ADDRESS= , -X-THE LOCATION 0¢ WELL(W)~EPTIC TANK(ST)& CESSPOOLS (CP)SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS. SURVE? FOR GARY M. LONG [~ LINDA M. LONG LOT 4 "HIGHLAND ESTATES" A,T C~TCHOGUE TOWN OF SOUTHOLD SUFF~O~K COUNT~', NEW YORK ~. · ~UNAUTHORIZED .~LfERATION OR'ADDITJON TO '['HIS DATE : FEB. ~0,1985 SCALE: I": §0' NO. : 85-154 GUARANTEED TO: TICOR TITLE SURVE~ S,A VJOLATJON OF SECTION'7209 OF THE ~'COPES OF TH S SURVE:Y NOT,BEAR NG THE LAND , SURVE~OR'~ INKED'SEAl. OR E~SOSSED SEAL SHALL I~/OT ~ CO,NSIDER/D TO SE A VALID TRUE COPY ~GUA~NTEES INDICATEd HEREON SHALL RUN ONLY TO ANb O~iHI~' BEHALF TO T~HE TITLE COMPANY. GOVERN- MEN,TAL AGENCYAND LE. NDIN'G ~NSTITUTiON LISTED OWNER~. -X-OI~T,~N~ES SHOWN HE~EON FROM PROPERTY LINES TO E×~STI.~ STRUCTURES ABE EO. A sP~c,P,c PURPOSE AND ARE NOT TO BE USED TO ESTABLISH / ~ PRO.bEtTY;LINES OR EOR THE ERECTION OF FENCES. ' :' Y'UNO " rl l: 1 G e, YOUN ALDEN W. YOUNG, 'ROFESSIONAL EN~ AND LAND SURVE OR N.Y.S. LICENSE N~ HOWARD W, YOUNG, LAND SURVEYOR · N.Y.S: LICENSE NO. 45893, 400 OSTRANDER AVENUE RIVERHEAD, NEW YORK ,ALDEN W. YOUNG, PROFESS ONAL END NEER AND LAND SURVEYOR N.Y.S. LICENSE N0.12845 SINGLE FAM4LY DWELLING ONLY SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION OF Single Family Residence Only DA~E . ,~/~.)'/¢,e'-'HS REF. NO. ff'-~'--~<~-/~'~' APPROVED .... ~ _ HEALTH DEPARTMENT- DATA FOR APPROVAL TO CONS,TRUST ~ NEAREST WATER MAIN~MI.-+ ~-SOURSE OF WATER, R VATE~/~ ~PUBLIC ~ ~SUFF. CO. TAX MAP DIST./~ S ~CTION ~BLOCK ~,, LOT ~ ~THERE ARENO DW~LL3NG5 WITHIN I~0 FEET OF THIS PROPERTY OTHER THAN THOSE SHOWN HEREON. ~THE WATER SUPPLY ~ND SEWAGE DISPOSAL SYSTEM FORTHIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT OF HEALTH 9~RVICES. · = MONUMENT 0 =PIPE SUBDIVISION MAP fiLED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON APRIL 26t 19TT AS FILE NO, 6SS?. ~ THE LOCATION OF WE LL (W),$EPTIC TAN K (ST) & CESSPOOLS (CP) SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS. MAIN OAD (~S. Rte. 25) SURVEY FOR FREDERICK, W. KAELIN,dR. ~ MARGARET E. KAELIN LOT 4 , HIGHLAND ESTATES AT CUTCHOGUE DATE : FEB. 3, 1978 TOWN OF SOUTHOLD SCALE: 1"=50' SUFFOLK COUNTY,, NEW YORK NO : 78-47 · N-UNAUTHORIZED ALTERA~TION OR ADDITION TO THIS SURVEY IS A VIOLATION O,F SECTION 7209 OF THE NEW yORK STATE EDUCATION LAW 400 OSTR~NDER ~VE~U~ YOUNG YOUNG ALDEN W, YOUNG, PROFESSIONAL ENGINEER AND ~AND SURVEYOR N~S. LICENSE NO 12845 HOWARD W. YOUNG, LAND SURVEYOR N.~S.~LiCENSENO. 45893 SURVEY FOR GARY M. LONG ~ LINDA M. L~G AUS. 29, 1985 oA~z I~ a.D. ~F. ~~~ LOT 4 "HIGHLAND ESTATES" MAR 13,1985 AT CUTCHOGUE DATE . FEB. 20 ~1985 ~ sewage ~lsposa3. ~ ~te~ s~ppZ~ TOWN OF SOUTHOLD SCALE: 1":50' ~aotllties fo~ t~ls lueattea h~e bee~ SUFFOLK COUNTY, NEW YORK~[ O~ f;~NO~'l'54 taspeot~ by this de~n~ ~d fo~d ~ NEW YORK STATE EOUCATI~N LAW, SURV[YOR'~ INKED'SEAL OR EMBOSSED SEAL SHALL ~ARY M ~ NOT BE CONSIDERED TO BRA VALIO TRUE COPY ~GUARANTEES INDICATED HEREON SHALL RUN ONLYTO H~LTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT THE PERSON FOR WHOM TH[ SURVEY IS PR[PA~ED, ANO ON HmS BEHALF TO T"E T'TLE COMPANY' GOVERN- ~NEAREST WATERMAIN Mt.~ ~SOURS~OFWATER~ PRIVATE ~PUBLIC MENTAL AGENCYANO LENOING ~NSTITUTION L~STEO ~SUFF, CO. TAX MAP DIST I~OOSECT ON 102 BLOCK Q~ LOT~I ~ HEREON,AND TO THE ASSIGNEES OF TH~ LENO~NG - ~THERE ARE NO DWELLINGS WITNIN I~0 FEET OF THIS PROPERTY INSTITUTION. GUARANTEES ARE NOT TRANSFERABLE ~THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FORTHIS RESIDENCE OWNERS WILL CONFORM TOTHESTANDARDSOFTHE SUFFOLK COUNTY DEPARTMENT ~ DISTANCES SHOWN HEREON FROM PROPERTY LINES TO EX~STING STRUCTURES ARE FOR A SPECIFIC OF HEALTH ~ERVICE~. PURPOSE AND ARE NOT ~0 ~E USEO TO ESTABLISH TEL., ~ ~ 400 OSTRANDER AVENUE YOUNG YOUNG · = MONUMENT o ,P~PE ALDEN W. YOUNG,PROFESSIONAL ENGINEER SUBDIVISION MAP FILED IN THE O~ICE OFTHE CLERK OF SUFFOLK COUNTY AND LAND SURVEYOR NXS. LICENSE NO, 12845 ON APRIL 26~ 1977 AS FILE NO. 65S7. : HOWARD W. YouNG, LAND SURVEYOR .. ~ THE LOCATION ~ WELL (W),GE~IC TANK(S T) ~ C~SP~LS (CPI SHOWN H ER EON N,~ S. g I C E N S E NO. 45893 ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS,