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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-23911 Date SEPTEMBER 25, 1995
THIS CERTIFIES that the building ACCESSORY
Location of Property 2895 ALDRICH LANE LAUREL, NEW YORK
House No. Street Hamlet
County Tax Map No. 1000 Section 125 Block 02 Lot 1.5
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 24, 1995 pursuant to which
Building Permit No. 22707-9 dated APRIL 27, 1995
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 ACCESSORY AGRICULTURAL STORAGE BARN IN REAR YARD AS APPLIED FOR
The certificate is issued to RICHARD A. MILLER
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
-.,4 ~ Z""4
Bui ding Inspector
Rev. 1/81
FORM NO.3
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)
NP 22707 Z Date ............9/.............9...199j....
Permission Is hereby granted tg:,
/(~j?
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/ 7..............tr
.
to . .
, tl..l.., . ..m%
at premises located at ..............<X..../..../..........-................~../...........
~.'//f`d'...~
County Tax Map No. 1000 Section Block Lot N .4.
pursuant to application dated 19... CY and approved by the
Building Inspector,
;
Fee S.Sr?..D
Buildin Inspect
Rev. 6/30/80
Norm No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT 'y q
TOWN HALL ,,1.. ~ 22M
755-!802
BLDG. DEPT.
TOWN OF SOUTHOLD
APPLICATION FOR CERTIFICATE OF OCCUPANCY 'r_.,._.~_---
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 Appr•)val 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 17 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
Certificate of Occupancy - New dwelling $25.00, Additions to dwelling S25.00,
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 Buildin¢ - $1,00.00
3. Copy of Certificate of Occupancy - $20.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential G$15.00, Commercial ;15.00
Date y.r
New Construction........... Old Or Pre-existing Building
Location of Property..gaFvr ./1gve*of /,11 * * -AAv/L6L
Douse No. Street Hamlet
Onwer or Owners of Property.!'1!Gl~IA~?o Ff....../ IGG
louncy Tax Map No 1000, Section...~~ .....BIock.... 0.77......... Lot...I! r
7ubdivisi.on F'iIcd Mnp............ Lot......................
Permit No. .•..Date Of Permit. ......Applicant
ilenlLh Depc. Approval ..........................Underwriters Approval.........................
'lanning Board Approval
Request for: Temporary Certificnte....... Final Certicate...........
-ee Submitted: $.....a.s,`
CO9' o
o~Og~FFO(,~cG
Gyp
N 2
Town Hall, 53095 Main Road p • Fax (516) 765-1823
y11Q~. Telephone (516) 765-1802
P. 0. New York 9 11971
Southold
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
September 14, 1995
Mr. Richard Miller
2895 Aldrich Lane
Laurel, NY 11948
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
xx An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
xx The check is not on file. $25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 22707-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
FfELD INSPECTION REPORT NDATE n
COMMENTS
N % ~c~v9<< Qs2S ~ ~
FOUNDATION (I ST) II II
FOUNDATION (2ND) N u ~
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ROUGH FRAME tk p p
PLUMBING
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------~-====I~---------=x=====xx--xxaxxxxxx==axaxxxx=x=x
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INSULATION PER N. Y.
to
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STATE ENERGY u H
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ADDITIONAL COMMENTS:
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1
HERITAGE
BUILDING SYSTEMS, INC.
DATE: 03-20-95
800-643-5555 QUOTE # MILLER 4
FAX 501-945-2255
P.O. Box 470
N. Little Rock, AR 721 15
PURCHASE ORDER
BUYER: RICHARD MILLER SHIP TO:
COMPANY: ADDRESS:
ADDRESS: 1181 E. MAIN ST. CITY, STATE, ZIP: RIVERHEAD NY
CITY, STATE, ZIP: RIVERHEAD , NY JOBSITE PHONE:
PHONE: 516 727-2792 11901 COUNTY: SUFFOLK
FAX: 516 ATTENTIONQUOTE GOO,.) rn-P 30 GAYS
BUILDING •
WIDTH 34 TH 6 HEIGHTI4' 2" ROOF SLOPE 1:12 FRAME TYPE CLEARSPAN L_R
GROUND OW 30 LIVE LOAD 21/21 WIND LOAD 82 CODE NY BC --,-----YEAR 1991
EXPOSURE. B SEISMIC ZONE 1 BAY SPACING 2 BAYS AT 30'
ROOF PANEL GALVALUME WALL PANEL COLOR_ PANEL TYPE STD HERITAGE -----GAUGE 26 _
U FABRICATE & SHIP M ENGINEERED STAMPED DRAWINGS ? APPROVAL DRAWINGS X-LETTER OF CERTIFICATION
DOORS 3070 STEEL WALKDOOR WITH-HARDWARE AND TRIM
DOORS . . . . . . . . . PACKAGE. _ - -
WINDOWS . . . . . . .
VENTS . . . . . . . .
FRAMED OPENINGS 2
FRAMED OPENINGS 12'X 12' FRAMED OPENINGS WITH TRIM PACKAGE.
_ - - -
FRAMED OPENINGS - ^ -
- - -
OVERHEAD DOORS
- -
OVERHEAD DOORS ALT- *TWENTY YEAR ROOF SCREWS AR_E,-INCLUDED EAVE SKYLIGHTS _ 8 ? ROOF-__ X WALL LENGTH_3'X 4_'
TRIM INCL_ K STANDARD TRIM F- DELUXE TRIM ? GUTTER & DOWNSPOUTS
INSULATION
NSULATION _ ALT ? ROOF ? WALL TYPE-.-,- ALTERNATE
_
BASE OPTION INCL- , M BASE ANGLE ? BASE GIRT E) BASE TRIM ? BASE MEMBER TRIM
WARRANTY _INCL , . 9 20 YEAR ROOF ? 10 YEAR ROOF K' 20 YEAR WALLS ? 5 YEAR WALLS
NOTES:_ ALTERNATE #1 3" WHITE VINYL BACK FIBERGLASS INSULATION FOR
ROOF AND WALLS. ADD $1400.00 X
ALTEkNATE #2 2-12'X 12' ST_E_EL CANISTER ROLL-UP DOORS WITH -
HARDWARE, ADD $1275.00 X i. -
BUILDING IS AISC CERTIFIED AND BUILT TO MBMA SPECIF::CATIpNS -
FREIGHT TO JOBSITE IS A C6MBINEDLO_AD.(CONS-0 IDATED:
WE APPRECIATE_YOUR BUSINESS!t! _ SCOTT YARBROUGH
We propose to furnish materials complete in accordance oth the above specifications for the sum of:
CUSTOMER ACCEPTANCE OF CONTRACT BUILDING: $ 9 , 6_0_3. 00
PLEASE CAREFULLY CHECK AND VERIFY THIS PURCHASE ORDER FOR FREIGHT: $ INC_L_UD_ED
COMPLETENESS AND ACCURACY. CONTRACT PRICE: $ 9,603. 00
THE PRICES, SPECIFICATIONS, TERMS, AND CONDITIONS AS STATED ON THE ENGINEERING DEPOSIT $ ___l , 9_2 0_._00
FACE AND REVERSE SIDE OF THIS CONTRACT ARE HEREBY ACCEPTED. YOU BALANCE OWED: $ 7 , 6 83.00_
ARE AUTHORIZED TO DO THE WORK AS SPECIFIED. THIS CONTRA ' IS vFy,Jp~NHEN slc D D ACCEPTED BY AN
BALANCE OF PAYMENT WILL BE C.O.D. PAID BY CASHIER'S CHECK ON OFFICER OGtI~'
DELIVERY. ANY APPLICABLE SALES OR USE TAX WILL BE ADDED PRIOR TO REPR ,N1ttf0E
DELIVERY,
CON p
ACCEPTED ON THIS ' N. LITTLE ROCK, AR DA E
DAY OF ,19-.. BY
BY: X . _
,1-- - HBS COMPANY OFFICER TITLE
PLEASE COMPI FTF r1RrlFri ING/10./ATIAY r...........
12iii9k ow
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION iST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE ~1 INSPECTOR la"~
BOARD OF HEALTH
OF PLANS
ry n~~ ~ Tnn ~ -~I„ FORM N0.1 3 SETS
LS IL9 V- Lrs t; TOWN OF SOUTHOLD SURVEY BUILDING DEPARTMENT CHECK . . .
ld--~- MAR24 1995 TOWN HALL SEPTIC FORM
SOUTHOLD, N.Y. 11971
TEL.: 765.1802 N0`71FY
" MCALL
Examin "~L T0:
Approved . ° 19 ' .Permit Nopr1r~ CAL .7z?
~ _ .
Disapproved ac
(Building Inspector
A LICATION FOR BUILDING PERMIT
t
Date 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 stieets
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.
d1'Upon approval of this application, the Building Inspector will issued a-Building-Permit to the applicarit: uch 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 all applicable laws, ordinances, building code, housing code, and regulations, and to
_ admit authorized inspectors on premises and in building for necessary i/nsper..tio
C
4I/
- (Signature of applicant, or name, if*
f a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, 'agent, architect, engineer, general contractor, electrician, plumber or builder.
.........y
Name of owner of premises.. .
(as,on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer) - t
Builder's License No .
Plumber's License No.
Electrician's License No .
Other Trade's License No.
I . Location of land on which proposed work will be done .
1) ??-r .......Ala!lwa?...L4.ve............Z,Au~ee1, ~.~y...AP.......
House Number Street Hamlet
County Tax Map No. 1000 Section 4O Block . 4~ ~ 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 ...................................4rry s. , {.y.,?ii.......... .
o,Q
b. Intended use and occupancy . Pr. i! f ..OA?4.d
3. Nature of work (
check which applicable): New Building , , Addition Alteration '
Repair Removal Demolition Other Work
1Kp (Description)
4. Estimated Cost Fee , .
(to be paid on filing this application)
5. If dwelling, number of dwelling units , 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 structures, if any: Front • , Rear, Depth .
Height . Number of Stories .
Dimensions of same structure w4h alterations or additions: Front Rear .
Depth : . Height , Number of Stories . .
8. Dimensions of entire new construction: Front ....(P0.... , . • , , Rear /wO.......... Depth
Height . , . , . Number of Stories . ! •
9. Size of lot: Front ..~!(?-Aor . . Rear• ~1 *1.9'7............ Depth 46r..>ro.p .
10• Date of Purchase ...7k Name of Former Owner , .
11. Zone or use district in which premises are situated goA
Does
to any zoning law, ordinance or regulation: . o . , .
13. Will proposed
Name of ro osed Owner of remises construction viol '
. ,
lot be p regraded p . . .,A/o • • • • • • • • ..........Will excess fill be removed from from premises: Yes No
14.
• • • • Address Phone No. .
Name of Architect . . . . • Address . Phone No. .
Name of Contractor . . Address . Phone No. .
15. Is this property within 300 feet of a tidal wetland? *Yes.. . No.)d .
*If yes, Southold Town Trustees Permit maybe required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or scorner lot. _ Li -
r ,a6
iq~
Ob 33t. 66
f3~nN
t5~
0
Sjo s
h N
r
STATE OF N RK 4 S m
COUNTY F f~
am of individual signing • • ' ' ' : being duly sworn, deposes and says that he is the applicant
(N contract)
above named.
3e is the....
(Contractor, agent, corporate officer, etc.)
if said owner or owners, and is duly 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 the best of his knowledge and belief; and that the
,vork will be performed in the manner set forth in the application filed therewith.
)worn to before me t is
. day of 19qr
4otary Pub o
County
Y/
CLAIRE L. GLEW
NOTARY PUBLIC, State of New York
No.4879505 (Signature of applicant)
Qualified in Suffolk Countyy.
Commission Expires December
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- SUFFOLK` COUNTY DEPARTMENT OF " WMTH 5ERYICES '
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f s-fz fo% REVISIONS YOUNG YOU SE °F vEh
DEC, 25, 1976- -400'0 ST RANDER 'AVENUE, RIVER EA ,~f (2~N k7~ yO~
- e
ALDEN W YOUNG NG
~l - - - PRQMBB 0NAL ENGINEER AND 1 RVL
~OC1/7t , , - LANG "WRY¢YON. N.Y.SFLIC,. NO. 12845; _ - • Nm. E8 3
SURVEY FOR:..
UNAUTHOR12E0 ALTERATION OR ADDITION % SECTION
' THIS SURVEY ISA VIOLATION 4FF SECTION RICHA A. NILLER
fi
7205 OF THE NEW -YORKSTATE EDUCATION 45893
E _ e,-LAW
.
COPIES OF THIS'S_U[NEY ASAP N07 BEARING,-` ANA 38R~~'v
-
THE LAND SURVEYOWS INKED SEAL,OR
V7q - EM809SED SEAL SgAL4 NOT BE CONSIDERED
TO HE A VALID TRUE Copt GUARANI'EEp
~LAUR4L ~ ,
T- GUARANTEES INDICATED HEREON 6HALL RUN - '
-0N{~ TO THE PERSOWFOO WHOM YHE } - TOWN OF'
{ - _ SURVEY 19 RREPARCDjAND ON HIS OKHALF
TO TIIE TALE COMPANY 00VFReIMENTAI _
AGEKCY AND L NQEN~'c+N to UTtOIV iJ;STFB 8 -
HE EONy AND TO YHEIAS,,iDN BED OF THE Q _ ~ ~~G('QC,r\ CV I
IE.NDINU INST ITOTIOTIA, COAFANTEES ARE
%
NOT eY RANSFERABLE'TO A0.OITIONAL $t({~„ q pA'K
ZT61 U,TIONS 0R $VBSEQQ9Nl' OWNERS, c
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