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Home My WebLink About23947-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No E-25173 Date JULY 31, 1997 THIS CERTIFIES that the building ADDITION Location of Property 1050 LONG CREEK DR. SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 55 Block 4 Lot 10 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 51 1997 pursuant to which Building Permit No. 23947-Z dated FEBRUARY 28, 1997 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued ie ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to ROBERT F. & JOAN P. SHEPARD (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-423476 - JUNE 20, 1997 PLUMBERS CERTIFICATION DATED JUNE 11, 1997-VAN ETTEN PLUMBING T Building Inspec Rev. 1/81 FORM NO. $ 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) N° 23947 Z Date F; . � ................................ 19 ;7/ � Permission is hereby granted to: � .. i4 rrTP.. c ............................. /.d. ... �.G4( .......................... /� ��urr4?........ .x.�...... ll..P7..0................. to ..... :....... ... . ll�. ...... ...... .. ............ ....z�rl ......:�r.. //�.... �9s......4...-�1. . -C:✓.................. atpremises located at ..........F� ...... .... ... .. ......4�,�`.e ..... .................................. .............................................................. /.7mva.............................................................. ................................................................................................................................................................. County Tax Map No. 1000 Section ...... ,J ..........cBBllock .........QIK... Lot No. ..... o.......... pursuant to application dated ........... D?..... ........................... 19✓...?, and approved by the Building Inspector. ✓1L Fee ;....................... a!^ .. ....... . ........................... �8 din Inspector Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form) 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1-- lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1 . Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certiiicate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. �2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - .25c. 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential ,� $��15.--000//, Commercial $15.00 Date . . . . . . . ._. R.�}! ....y. .!. `. J.',. . . . . . . . . . . . New Construction. . . . . . . . . . . Old Or Pre-existinngBuilding.ly. . . . . . . . . . . . . Location of Property �'. . . . .��!�!r. . . ... 4�.�EE G _ ,G!V e r,�,O,u rel Goo , ti _ _ �`�.7/ House No. Street Hamlet Onwer or Owners of Propert. . 1 ./S�C�T. . � .T! '. �.. �!.EPl 2At. . . . . . . . . . . . . . . . . . . . County Tax Map No 1000, Section. . . . .`. Block. . . q. 1. . . . . . . . .Lot. . . l .. . . . . . . . . . . . . . . Subdivision..�.J. . . ... . . . .. . . . . . . . . . . . . . . . . . . .... . Filed Map. . ��Lot. . . . ✓J. . . . . . . . . . .... .... Permit No. . e.K-: ./�74 .Date Of Permit. zJ. . . . .Applicant. .�. .`55e. . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. ./,-� . . . . . . Fee Sind: $ .&76? � S �: . . . . . . . . . . . . . . . . . . . Q3 APPLICANT - �t�11 f •'�.� Town Hall, 53095 Main Road : -Z .v Fax (516)765.1823 P. O. Box 1779 Telephone(516) 765-1802 Southold,New York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD C E R T I F I C A T I O N DATE: Building Permit No. 3 q J Z po Owner: foAe(/ 5AeM9D (please print) n Plumber: (/AAV E*rni't/ 4oLe.'I (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sel� -ya cit/ - (Plumbers Signature) Sworn to before me this 11.e day of 19 Q 7 Notary Public, _ County LINDA J.COOPER Notary Public,State of Now York No.4 822563,Suffolk County F I f•;!.0 ( 'I;i i'!•;C I'I Of; R@:'UR C -_-PA I H _ (:UtINf..,N i ,'; o . r-nnNnnrrnN ( Ir;r) �i /.f✓. sl��ls✓s _ ''Gf � - a I I -n �� f --- It I*Ull rll)nl'7(]ri (2rl )) q N '+ ;rr . it TMI)CII FRANF. F a 111.11"n I Nt: I',�I� ./�i� til�� _�s�././'�`°`.� ��r ✓_"— /'y(r.R.+.L. .. If I - t I II 6i I� h; i Ih+sur.nTloN PF.rt N . Y . Gl'n'TF FNFRCY J ------------- if..tl /7 ' ` it M II l itit .I _ . ... FINAI. - �I AUb I"I MUM. CUFMF.NT3: z C M-1802 BUILDING DEPT. INSPECTION [ NDATION 1ST [ ] ROUGH PLBG. [ } FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS.: DATE T 74a 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ 7INSU GH PLBG. FOUNDATION 2ND [ LATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNE{�Y REMARKS-. ✓�" i A C� DATE �5- I-Y7 INSPECTOR �� M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ROUGH PLBG. [ ) F"NDATION 2ND [ ] INSULATION [ V]/FRAMING [ ] FINAL [ ] FIREPLACES CHIMNEY REMARKS: yyr.GelZL-iy (r►r1'LGLi�CB.�a / c DATE -�"/2� / � INSPECTOR M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND ( ] 1 LATION [ ] FRAMING [ FINAL [ ] FIREPLACE & CH/IIMNEY/� REMARKS: ( c /� DATE INSPECTOR THE NEW YORK BOARD OF FIRE UNDERWRITERS fD�r 1 BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NY 10038 Date ,jUM!, �f,A. i'.Ay) Application No.on file 1 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of PL(VPRT SHEEI'FAY.D, 1050 :WNG CREFY DRV-� SOUTH?LD, N.Y. in thefollowing location: ❑ Basement 0 set Fl. ff 2nd Fl. .Section Block Lot was examined on 11"UNE i 7 14 a", and found to be in compliance with the National Electrical Code. FIXTURE FIXTURES I RANGES ICOOKING DECKS I OVENS I DISH WASHERS EXHAUST FANS OUTLETS ECEPTACLES SWITCHES 'NCANDESCENL RUMESCENi I OTHER MST. K W. AMT. K.W, AMT. K.W. AML K.W. AMT. H.P. 1 }+ DRYERS FURNACE MOTORS I FUTURE APPLIANC! HEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI.OUTLET DIMMERS__ SYSTEMS AMT. K.W. On H.P. GAS H.P AMT NO. A.W.G. AMT. AMP. AMT. Mtn. TRANS. AMT. H.P. NO.OF FEET AMT, I WATFs SERVICE DISCONNECT OF S E R V 1 C E AMi. P. TYPE METER 1,9 IW 1/3W 3 F 3W 3 X 4W NO.OF CC.COND. A.W 4 NO.Of HLUG A.W.G' NO.Of NFUTRAIs A.W G. EOUP. n'.R.e F CC.COND. aF Hb LEG Of NEUTRAL OTHER APPARATUS: :ttOf(F; l.iIlTErrpnu. _^ -T-Qf SACSp T,rr, TNr'. I,T! sgt6nsp:>:1SapuyalaaEtraier snpplycF TW ra�aLt'kYa=•T3�crtk�d xoDa�ian,ha.s a/ip - ... 11 S'j �YDSPeotedibf Wls d rtme i �� r\ - ¢¢�i.�tt'BdnerBL.Ea81a'eI1'sa/'- a _�- ' riEtS'iH pEPARTMEH4•pATA FOR APPROVAL TO DOHSiR17C�'L,#�-' wN/AR[[FMARw M4M_1{t! 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IVE' F��r �`��s'-Y:yH9.�-).:sl�•74inW,�"'�ti+' .�. 6d. � eiygE1 �y,3•��+[rD�wtroro�K•is`Tfi BWRaM4fEQ TGs.T . ; J •`ry.`•:n�i,.�''-' 1 145 j�}pl, 'riiit]]�t4'9fs 5+t SEEURtT'F T7TLER aUEMNiSYI {.`s k 'W 'a[.q Iu •Qrrat, iwr� '-�,. •yp' row Gly[oasts. `"'yiie' Ito Ntxy. - ,wxNmTltmislKww� sy1` +uyEM'�i u.Fe�t '*N�.wwv�°art[r..toc.. ; .�k'. yEtS`:f.Nra. tt,. •_E z. �� j5 'wewwwcailsLlaqriint a.�rw_rlw.`t - oy° '- I K' aMF/a' F l.l[lb{i•- � - ., ot tM[1 w ,tri` �s A:a�-••Y aY� 'c. . • I aMEiJN4 _ J. 1 .. . .-_ NOTE■:MONUMENT FOUND }''�r -OSTRA'NO�RAVE 0=STAKE { n p i f ELEVATIONS SHOW THUS-EL•Iso ARE I REFERENCED TO AN ASSUMED DATUM. SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON / � e-Y-,�/, OCT L RK AS FILE K OUT. ( yu^ # I I � i I I II 1fl III 1111111 I'I' IlUllllill I VIII IIIII111111�l�IIIIIII��I I�II�I f�l��I11 BOARD OF HEALTH . . . . . . . . . . . . . . . FORM NO. 1 3 SETS OF PLANS . . . . . . . . . . . . . . . TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . .. . . . . . . FM ----5 - BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . . . . . .. TOWN HALL SEPTIC FORM . . .. . . . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 TEL: 765-1802 NOTIFY: // CALL 7)(05:-.1.55.1. .. . . . . Fx ined........,ggql.ffJ...... 19.�<.. MAIL TO: . . . . . . . . . . . . . . . . . . . . Approved...... // .E/..... 19�. Permit No. - '. .................................. Disapprovedarc .......... /. ..........•••••.... .................................. ...................................................... (Build' tor) APPLICATIO OR BUILDING PERMIT Date.. . . . . . . . . . . . . . . 119. . . . INSTRUCTIONS a. This application mist be completely filled in by typewriter or in ink and submitted to the Building Inspector 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan slowing 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 application. c. The work covered by this application may not be camoenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue 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 MALE 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, Ordinancesor Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buil r ssary inspections. . . h (Signature of applicant, or name, if accorporation) (Mai ing address of 1pplicant) //97� State c.bether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build ..••••••......•••••.........Q ° .............................`....•••••.................................... None of canner of promises � f?:7... ..¢. aq ...cJ'° '�� .................................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ......................................................... (Name and title of corporate officer) Builders License No. .. .1.... vej C +r ter" ^ vE " Q ✓` Plumbers License No. .......................... Electricians License No. ..................... Other Trade's License No. .................... 1. Location of land on which proposed work will be done......�.................................................:..... ...... �> O...10A.,6: t� , ,�.. 'ff�Z) A ,X........................s . ........ House Nmuber Street r�3 _ ,f Hamlet plet County Tax Map No. 1000 Sect-ion 5� Block' .............. Lot ....!.P .............. // ......... Subdivision ...................................... Filed Map No. .�!5/4.f.7.... I.ot ............... (Name) 2. State existing use and occupancy 'off premises and intended use and occupancy of proposed construction: a. Existing use and occnnpancy .T//•D/`1t................................................................... b. Intended use and occupancy .Cl.OSE ......................................................................... 3. Rhlure of work (check which applicable): New Ihtildiry; .......... Addition ..?�.... Alteration .......... Repair ............ Removal ............. Darc9l iLion ............ Other Work ............._... ................ 4. EsLinmted Cost ..!!..�/ �l......., fee ....,. ..... ........................................... (to be paid rn filing this application) 5. 11 (lolling, milber of dulling units .... ..... timber of dwlIIng units on each floor ................ Ifgarage, ormber of cars ........./........................... G. If ixrsiness, caarercial or mixed occupancy, specify mturee and extent of each type of use...... /............. 7. Dimensions of existing structures, if arry: Front.....-SF....... Rear --5 ......... Depth . ........... height ......................... Number of Stories .................. Dimensions of wane structure with alterations or additions: Front ............... Rear ............... Depth .................... Neigbt ...................pNntrer of Stories ............... � 6. Dimensions of entire new construction: Front ....`(...J..-. Rear ............... Depth .,7J.......... Ileiflht ........1.5............ Nmber of Stories ....r............... 9. Size of lot: Front ...... y3....... Rear ....�Y.5 Depth ...1.'769.......... 10. hate of Pthrcuase ;:�' .'? r.��4.I. Nome of Former Owner 11. Bone or use district in which premises are situated ...........................................................— 12. Does proposed construction violate any mining law, ordinance or rel,Mhlation: ........................ 13. Will lot be regraded -. N 0 Will excess fill the removed from promises: YGS NO ... I .....__.... /O.Sa LQN G.rN&ex /)I M. Nares of Owner of premises °Tf TYs.t . JTZ l��dt4kiress ...... ou [jFG�! f.....-. Phrnhe No7j6F- Af;- Narp of Architect .�.I �. NT.�I4r�._........_ Address / ..(o .$i.9J.1-.,.�.,t?/.+? `... Phone No. Name of Contractor ..�4.4f.�.�!1'1.1�A� .. fir!'! .__ fuklress No. r,77'Qr� SMP/IGrJc�irr9w r 15. is Lhis property within 300 feet of a tidal wetlawl? * YRS .......... NO . *IF YGS, s(1NI m) 7u4N Tmmix,5 PM- rr MAY tui m,7jtRRD. Pt.o-r DIAGRAM locate clearly and distinctly all buildings, whether existing or proposed, aril indicate all set-back dimensions fr m property lines. Give street and block naber or description according to deed, and allow street rimes and imlicate cdhether interior or corner lot. SFAIIi u.- NiW rm' SS MINTY (A' ....................... ..........................................................being duly sworn, deposes and ways that lie is the applicant (N.-me of individual, signing contract) above nnlred, Ikis Lbe .............. ..................................................................................... (Crnhtractur, agent, corporate. officer, eLc.) of said owner or owners, and is duly mrthoriml to perform or have d>Prfonu d the said work my] to make aril file this application; that all. sLateurents contained in This ippl icition are true to the best of his kmmledge and belief; mid that the work will be perfonmd in the rmm)vr set rortlr in the application filed therewith. ,,worn to before nr this ....... .day of j?iC 422 -.... d9.4?7... _ Notary Pl11C •••••NOTARY(hftoC"-' d- Ne. 30-4916018 tbN-YOfk'••••--••••- ....... ............... o,,,m;ed in Nevauyyrgrvy (Sigrwallhre of Applicmnt) Commission n+nirot_F //a-..;cTJ F Ji. Z I , ,, " F; o 1_,,�I it TA f F v Tt, li, T 441r, F6 _ >• - ,, ; ;z_ "T 7- �k-T, 4v%& 'F 4�FF. 1iF .2 T lip 3 11 1 r i;FT -E T F. TF 1, IF Fii_4 - "as f: Ti TF F4,' I -'o F T o F, Ff� F, T t j I F� F 4 jll ppt t if 4 -F 7 T FF 4- VAO YW w # 7 T 47 co 7 'lot* F T IF - oil opw„ law *4 T.W 44 r T,I F1 IOU TF�r tit -T., 4j:i;!, IT lei T v t 10 Z L let F- v Ear 1 �4 f Ft, Ti2,,t TA7 "Fle VL It—j- z j'nl LlOCCUPANV T, UNLAWFUL '` IF, -IF If WITROUVCERTIFICATE OF OCCRANCT4 I k IT :0DOWRIEQUIRED TERS CEOFICAW Vvv R F5ATF. F5AT Fir!, 4X,F, f VME OPENINGS FOR 7 'BUILDING DEPART FNi I- pid 7= r NOTIFY 0 -AM TO A Z r EMERGENCY ESCAPE AS- PM FO9,THE JIM FOLLPWII, INSPECTIONS"-REQUIRED WP4RI.71 RFDT'- FOUNDATIONi -•JWO REQUIRED FOR POUREDFCON N.Y. STATE NO[ OINGOOPE.- - CAM 2::ROUGH- -'FRAMING' _P WRING F L 11 INSVWI )JUOTION M $Ti"r� 4.,�41NALI -z,C MSl a I ECOMOLETE FOR .0. i r I .CONSTRUCT tEHA�L..-MEET, AL'i 7 17, I-THR REQUIRE TSL'QF,THI5_ NY.�� r MEN L RGY WISER ISIQf 1§0 tc ItITATIR 'MiMUCTION, EN 3p0*0 bESIGN WCONSTIRL TI F- F. T, f r "I IF- It, '4 f' T -L 'rit, , ` , Ft �Tf f