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HomeMy WebLinkAbout20203-z FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Ha11 Southold, N. Y. CERTIFICATE OF OCGUPANCY No Z-20972 Date AUGUST 25, 1992 THIS CERTIFIES that the building NEW DWELLING Location of Property 215 HARBOR LIGHTS DRIVE SOUTHOLD NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 71 Block 2 Lot 6 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore ' filed in this office dated octo6er I1 1991 Pursuant to which Building Permit No. 20203-Z dated OCTOBER 11, 1991 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 ONE FAMILY DWELLING WITH ATTACHED GARAGE AS APPLIED FOR. The certificate is issued to JOHN & VIRGINIA CAMPBELL (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 88-SO-36 - JUNE 19, 1942 UNDERWRITERS CERTIFICATE N0. N-227257 - MARCH 6 1942 PLUMBERS CERTIFICATION DATED APR. 6 1942 - PECONIC PLUMB & HEATING ldi g Inspector Rev. 1f 81 t'OBlt NO. A TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CfH15 PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPL~'tON OF THE WORK AUTHORIZED) Na 20203 Z Date .....~Q~.~ >9.~~ Permission is hereby granted tp: t...r... ~ .....~a'.~..,f9 to .~!~s~:~:'.~:~'.-~..~~:. of premises located nt .........r:~.'.:~......../,~'...~... .G$~:......~.1.1k~df.~ County Tox Map No. 1000 Section ........7~.......... Block ......s~"1 Lot No.......~P............... pursuant to applicption doted .......1/~,L1...5 )9..~~, and approved by the 8utldingyl/nspectpr. ~ LU! ~~/gj Fee S..tt..f..°~...:..~~ ..1~ O~'J"lo 0 2 ~.-`..'~~F .ate Bui 1 for Rev. 6/30/80 ~~~1 l~' ~ ~.0 1.: •,~s` Form No. 6 3:i 4 };i TOWN OF SOUTHOLD ~{'9~5~ BUILDING DEPARTMENT Pi ~ ,JI ~li`R, ~,W-~._.,~ TOWN HALL Yr;w,.'•;:t",:~ p:,~ti.u`,'~~..,w.~„k, 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. ~j 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 1. Certificate of Occupancy - New dwelling 25.00, Additions to dwelling $25.00, Alterations to dwellin $25.00, Swimmin g g 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 - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 i G ' / Date ~.1..~ : . New Construction....Y...., Old Or Pre-ex~is/ting Building.....~.+..7.~...~./y. 'Location of Property...~l~...........17~~~Q~.:~/~a'J~.r~t.l~/~fY.4:.. ~Y~//7~a~~.... House No. n Street Hamlet Onwer or Owners of Property..~~.'l.~~N..u. 1?~k`'. ~?~~~,~?,,,,~~f.°;,~~f,G';~„ County Tax Map No 1000, Section.. ~ l~......B1ock.....~.'~.-. ...p......Lot „ ~ ubdivision..!~~`RA~~,' .C/(~Sff7~~S/~~~~'Filed Map.7.'.~~fi.j....Lot.;~?f-T permit No..~~ ~ z ,Date Of Permit. /D~y~9/ , , , , , ,Applicant~~?/u~.C: u/.'~>9!%P~~.G~ . . [ealth Dept. Approval ..........................Underwriters Approval......................... Manning Board Approval equest for: Temporary Certificate........... Final Certicate. Y,..,,,,, D~ ~e Submitted: ,°r,~14'?? . C O ~ ~ 2 APPLICANT ` _ TEL. 765-i 802 5~ti~~tj ~o ~ro~rrr o~ so*r_rr~oan ~`a' he OFFICE OF BL'ILDIPIG INSPECTOR ' ~ . P.O: BOX 728 -c TOWN HALL , Old ~0'T SOUTHULD, N.Y. 11971 Ol~~ C E R T I F I C A T I O N Date Gf// Building Permit No. o(~`~d~3-Z owner Jo/~.y w' ~1.~ ~ 1~11i~ •~~~i~l~i~~~ L please pri ) 44// ~ Plumber~~/ ~U~ Y~~~~~~~ please print) I certify that the solder used in the water supply system contains less than 2/10 of to lead. lu tier's ignature) Swo n ..o beforo me th • s mil ' day of i 19~, ~ J P / ~ Notary ubli tlotary Public, .JiJ~.~n~/~ County BARBARASTEPNOWSKi ~ Notary Pu6Ao. date of New York duaGffedin Sutlolk County Exp6es Sept. 30, 19 r THE NEW YORK BOARD OF FIRE UNDERWRITERS rArF ~ ' L18L.i07`/ BUREAU OF ELECTRIGTY 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date 1'IARCIi Mflr1'?.r32 Applioation No, on file X14`7 ~aa ~1 u~7.~tU) r i THIS CERTIFIEi3 THAT ~ only the elec[rlca! equipment as described below and introduced by the opplicant named on the above application number in the premises of pP.,lYOHN CAMk131;irUt 2~L,i HAR1i0ii T.IS.GhI~`5 f~RZVF, is~,$+CV~IT+Y'G ~Jr ;fb0`CISOGbt N.C'. in thefollowinq location; ®Rasement ® lac F'1. ©2nd F'l. rAltrA.TT1.C BOUT Section Block Lot was exmnined on ~F~~ZUAfl"T ? U r Y ~ and found to be in contplianec with thv reyuirementa of Ckls Fionrd. § FIXTURE ECEPTAClES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT FLUORESCENT OTHER AMT K W AMT K,W qMi. KW. AMT. K. W. AMT. N.P b' 1~2 9G a6 .l3 1. 11.7 1.2 ~ P DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIALREC'PT TIME CLOCKS gELL UNIT HEATERS MULTI.OUTLET DIMMERS AMl N. W Oll H. P. GAS H P. AMi, NO. A W, G AMi. AMP. AMT. AMPS. TRANS. AMT ry p SYSTEMS pMT. WATiS NO.Of FEET 7 F 1 3tl 7. fl GF?z3 SERVICE DISCONNECT NO.OF 5 E R V 1 C E METER NO. OF CC. COND A W G ~ A W. G A. W G. AMi AMP 1YPE EQUIP 1,e' 1W 1 ,e' 3W 5 b' 3W ~,e" 4W pER .e" Of CC COND. NO OF HI-LEG OF HI~LEG NO OF NEUTRALS OF NEUtRAL 2 1541 GH ~ ff 1 1.1~ 2 t.JN OTHER APPARATUS: fittr.c~, Ixo1~M ft~Arr~e.sta-a,.~ x.w. Gi1~PlJ~3ALe k~•~l9 1t.'tF. G.F'.C.'.f.:-b slx~xr; u~~lnrroza:-s Rf3rLA[t ~IraCTdi.T.C S,tiC,~3G17-G C/~~~ B.O,Tit9X lG9 CIIPCHCI~UF t IaY t 119_~,r5 GENERAL MANAGER _ Per~.1 tr~~ This certificate must not be altered in any monner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. _ COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. lELD I::SP'C:IU:J ~~Unir. ~ %OtKMENT° d 1 . ' ~ ~ Y ~ FOUNDATION ~ (1st) ~C.~ FOUNDATION (2nd) _ m 2. 0 9C~q ROUGH FRAME & -1 PLUMBING ~ A ,..-~......~i ~n 3. m ca IIJSULATIOPI PER N. Y. - • STATE ENERGY CODE ~ x 4 . ~ ~`-`1-~ ~ _ u FI;JAL it/ ~J~ O \ y ~ R AD ITIONAL COMMENT ~ ~ UUU ,ay~n_~o~,~,~/ ~i cue O _ _ ~ ® ~ ~ /U~~i/ /7 Y -'!il tG ~CBvrq ~ > °c1 ~ ~ x ~ v U~,,'.l ~ m ~ FOBM NO. D TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UN71L FULL COMPLETION OF THE WORK AUTHORIZED) s ~r No ~~76Q2 ~ Date .....1~.....~:~ 19.C~G,t Permission is hereby r nted to• c~' ' . . to L~i~.?. (..~..~'~ili~r~.~....~......~/... . . .~1~.....~u/~1..'t°~...~irt~s.!1,~-..L~'/..`. ct premises located at .~~.a"~......fnd!l.~,l~!°L......~ . . . . ~i y' ~ ' : Gt. ~ . . . . . . . . . . . . . . . . . . . County Tox Map No. 1000 Section Block .............iZ....... Lot No..........~.......... pursuant to applicotion doted .........If/~ i4.~„~{ and approved by the building Inspector. ~ 7 ~`f'0 Fee $..,~'.l.~.t.. T'~:~rP.G,G ,~3 ~ C~'--~~.•~• , Buildi 1 actor Rev. 6/30/80 &'OEdM N0, 11 TOWt~t OS' SOU'I'HOLD HUILDINO DEPAHTMk.NT TOWN HA1,L SOU'1'HOLD, NY DE:Vi,T.OPMF:~T9' 1'ERMI'P C Ito N' Dato ~S 1`) O g I'ex.nlsaion 1e kaarobq Y;ranted to: at premiooa locstod at ~/..5~ ~ f7,~j~ County Tax Map kdo. 1000 Oootiora ~ Bloclc ~ I,ab .Y~ puraiaunt to a~plioation dat~+d ~~p// 19~~, and approved by the Building Inapector< ;~uildint; Pexanit klo. ~ ._z Bui__~ apoctor Lt /fS0 t .-.a'` ~oS~FF~LK~oG HENRY P. SMITH, President 0 ~ TELErHONn JOHN M. BREDEMEYER, Vice-Pres. rr° ~ (516) J66.1692 PHILLIP J. GOUBEAUD v® ~ ~ ELLEN MKLARSEN JR. ~~~1 l~i ~~0~ BOARD OF TORN TRUSTEES TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 728 Southold, New York 11971 July 28, 1987 Mr. John C. W. Campbell 52550 iJlain Road Southold, 1Vew York 11971 RE: Application Tdo. 536 Dear Mr. Campbell: The following action was taken by the Board of Town Trustees during their regular meeting held on July 27, 1987 regarding the above matter. WHEREAS, John C. W. Campbell applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated May 5, 1987, and WHEREAS said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and WHEREAS, a public hearing was held by the Town Trustees with respect to said application on July 27, 1987 at which time all interested persons were given an opportunity to be heard, and no objections were raised, and ~^]i'_Es2EAS, the 3oard members have perscaally vieweu and are familiar with the premises in question and the surrounding area, and VdHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and 4JHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, Yd04`d, THEREFORE, BE IT RESOLVED that John C. W. Campbell BE AND HEREBY IS GRANTED PERIyIISSI011 UNDER THE PROVISIOIQS OF THE 4'JETLATQD ORDIIIANCE OF THE TO`vViQ OF SOUTHOLD TO: Construct a single family residence on property located on Harbor Lights llrive, Southold. This permit is approved with the provision that dry wells are installed to contain run off and there is to be no fertilization used on the lawn. Board of Town Trustees -John C. W. Campbell Page 2. This permit will expire on July 27, 1989 if work has not commenced by said date. There are two inspections required and the Trustees are to be notified upon the completion of the work. Prior to the issuance of said permit by the Clerk, the applicant shall file with the Clerk a certificate that he has public liability insurance policies insuring against any liability which may arise in the performance of the operations pursuant to such permit in such amount as shall be fixed by the Trustees, which said policies shall name the Town as a name insured. Please take further notice that this declaration should not be considered a determination made for any other department or agency which may also have an application pending for the same or similar project. Please remit $10.00 for Wetland Inspection Fees at this time. Very truly yours, ~ ~ ~ Henry P. Smith, President Board of Town Trustees HPS:ip cc: Robert A. Greene, D.E.G., Stony Brook Commissioner Henry G. Williams, D.E.C., Albany Stephen Mars, Army Corps of Engineers Thomas Hart, Coastal Management Conservation Advisory Council Bldg. Dept. Board of Appeals File PLEASE RETURN TO THE BUILDING DEPT. FOR A DETERMINATION ON THE NEED OF ANY OTHER TOWN PERMITS THAT MAY BE REQUIRED FOR THIS PROJECT. - r~ 1 ci T6S-1802 'ze BUILDING DEPT. INSPECTION . [ ]FOUNDATION iST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ NAL REMARKS: C_.C1wu~_.P~..~`t, " & r ~ ~ ~ ~e" I DATE Y" INSPECTOR j 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ }ROUGH PLBG. [)FOUNDATION 2ND [ INSULATION [ ]FRAMING ~~JJ [ ] FBI-NAL RE~M~AR~KS: °~2~. .G.r 9-a%t - - DATE INSPECTOR C~ 765-1802 BUILDING DEPT. 1 NSPECTION [ ]FOUNDATION 1ST [ ROUGH PLBG. ()FOUNDATION 2ND [)INSULATION [~RAMING [)FINAL REMARKS: ~ r DATE 0 INSPECTOR 765-1802 T p O BUILDING DEPT. NSPECTION ~ ' [ ]FOUNDATION 1ST [ ~OUGH PLBG. ~ - [ ]FOUNDATION 2ND [ ]INSULATION n G~~ [ ~RAMING [ ]FINAL ~ . 2t~ V REMARKS: ~ ~i?~~ i ' ~ s ~ DATE ~lJ INSPECTOR i 7~,0~ T65-1802 BUILDING DEPT. .INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: ~ DATE ~ ~ ? INSPECTOR r` ~ 765-1862 BUILDING DEPT. INSPECTI®N [ ] F UNDATION 1ST ( ] ROUGH PLBG. [ FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARK ~ C,g / X 1 ` -s DATE ~ ~ . INSPECTOR 9`-^t20-6 (9f86)-25c NEV.' YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION ` DEC PERh11T NUMBER - EFFECTIVE DATE 10-87-1406 ~ 1/6/88 fACILITYIPROGRAM NUMBERIs) PERMIT EXPIRATION DATE(s) Under the Environmental Conservation Law N/A 12/31/92 328e1329: Aquat c Pestic des 27 ~ W terROua~y~ Certification ~ Tidal W tlands prdtecTi n~ tltWat r ~ SPDES 17, Tities 7, 8: ~ Solidi Waste IMa ageme tRR 360: WatelrSupp~Ytle 15: ~ AirlPol{uton Control* ~ Hazardous Walste~Management3~ Article 15, Title 15: ~ Article 23, Title 27: ~ Article 34: Water Transport Mined Land Reclamation Coastal Erosion Management LonglslandTlWellsS~ ~ Frelshwat r Wetlands ~ Floodplaio Management Article 15, Title 27: N-New, R-Renewal, M-Modification, ~ Articles 1, 3, 17, 19, 27, 37; Wild, Scenic and Recreational C-Construct (*only), 0-Operate (*only) 6NYCRR 380: Radiation Control Rivers PERMIT ISSUED TO John C. W. Campbell ADDRESS OF PERMITTEE 52550 Main Rd „ Southold, NY 11971 AG EN ~FQAR PERMITTE EICONTACT PERSON TELEPHONE NUMBER r~t~ //itf3kty~~F+~gH{y{3tv2f4EX~~~f£R'~k9g1 LOCATION OF PROJECT: Harbor Lights Drive, 100' east of canal, Ba iew Southold SCTM ~F1000- 1- - LOCAUa~1Pe1R,OlECTfFACILITV couN Suffolk TOWSOllthOldE UTM COORDINATES DESCP,.IIlTleaNrO°Fl~jHOSOUtfiern yportion of lot and construct single family dwelling, garage, ldriveway, sanitary system and well in accordance with NYSDEC approved plan attached, GENERAL CONDITIONS ey acceptance of this permit, the permittee agrees that the permit is contingent upon strict compli- once with the ECL, all applicable regulations and the conditions specified herein or attached hereto. 1 The permittee shall file inthe offica of the appropriate regional permit administrator, or other office designated in the special condmons,anotice of inten[ronto commence work at least 48 hours m advance of the Ume of commencement and shall also notify himlher promptly m writing of the completion of the work. 2. The permitted work shall be sublet[ [o inspection by an authored representative of the Department of Environmental Conservation which may order the work suspended if the pubbc interest so regwres pursuant to ECL §71-0301 and SAPA §401(3) 3 the permittee has accepted expressly, by the execution of the application, the full legal respons,bility for all damages, direct or indirect of whatever nature, and by whomever suffered, arising out of the project descr,bed herein and has agreed to ,ndemn,fy and save harmless the State from su,ts, actions, damages and costs of every name and descrip- tion resulting from the sa,d protect. 4 The Department reserves the right to modify, suspend or revoke this perm,[ at any time after due notice, and, if requested, hold a hear,ng when: a) the scope of the project s exceeded or a violation of any condition of the permit or provisions of the ECL and pertinent regulations are found; or b) the permit was obtained by msrepresentabon or fadure to du<lose relevent facts, or c) newly discovered information or s,gmfi<ant physical changes are dscovered since the permit was issued. 5 The permittee is responsible for keeping the permit active by submitting a renewal application, including any forms, fees or supplemental information which may be requited by the Department, no later than 30 days (t80 days for SPDES or Sohd or Hazarduous Waste Management permits) poor to the expnation date. b This permit shall not be construed as conveying to the applicant any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work or as authoriz trig the impaitment of any rights, title or interest in real or personal property held or vested in a person not a party to the permit 7 The permittee is responsible for obtaining any other permits, approvals, lands, easements and rightsrof~way which may be required for this protect 8 Issuance of this permit by the Department does not, unless expressly provided for, modify, supersede or rescind an order on consent or determination by the Commissioner issued heretofore 6y the Department or any of the terms, condi0ons, or requitements contained in such order or determination. 9 Any modification of thrs permit grant by the Department must be in writing and attached hereto: PERMIT ISSUANCE DATE PERM T ADMINIS ATOR ADDRESS $ldg.4O,SUNY,Rm. 219 1/6/88 Alfred T, Kellar Ston Brook NY 11794 AUTHORIZED SIGNATURE j~ Page 1 of 3 cc: BMHP 95-7~ a (7:86)-15c A[)U'T(ONAL GENERAL CONDITIONS FOR ARTICLES 15 (Title 5), 24, 25, 34, 36 and 6 NYCRR Part 608 ( J 10. That if future operations by the State of New York require an al- other environmentally deleterious materials associated with the terauon in the position of the structure or work herein authorized, or protect if, in the opinion of the Department of Environmental Conservation 14 Any material dredged in the prosecution of the work herein permitted it shall cause unreasonable obstruction to [he free navigation of said shall be removed evenly, without leaving large refuse piles, ridges across waters or flood flows or endanger the health, safety or welfare of the bed of a waterway or floodplain or deep holes that may have a the people of the State, or cause loss or destruction of the natural tendency to cause damage to navigable channels or to the banks of resources of the State, the owner may be ordered by the Department to a waterway remove or alter the structural work, obstructions, or hazards caused 1i. There shall be no unreasonable interference wrth navigation by the work thereby without expense to the State, and if, upon the expiration or herein authorized. revocation of this permit, the structure, fill, excavation, or other 16. if upon the expiration or revocation of this permit, the project hereby moddication of the watercourse hereby authorized shall not be com- authorized has not been completed, the applicant shall, without expense pleted, the owners, shall, without expense to the State, and to such to the State, and to such extent and in such time and manner as the extent and in such time and manner as the Department of Environmental Department of Environmental Conservation may requne, remove all or Conservation may require, remove all or any portion of the uncompleted any por[~on of the uncompleted structure or fill and restore the site structure or fill and restore to its former condition the navigable to its former condition. No claim shall be made against the State of and flood capacity of the watercourse. No claim shall be made against New York on account of any such removal or alteration. the State of New York on account of any such removal or alteration. 17. If granted under Article 36, this permit does not signify in any way 71 . That the Slate of New York shall in no case be liable for any damage that the project will be free from flooding. ~ - or injury to the structure or work herein authorized which may be caused 1g If granted under b NYCRR f art 608, the NYS Department of Envuon- by or result from future operations undertaken by the Scare for the menial Conservation hereby certifies that the subject project will not conservation or improvement of navigation, or for other purposes, and contravene effluent limitations or other limitations or standards under no claim or right to compensation shall accrue from any such damage. Sections 301, 302, 303, 306 and 307 of [he Clean Water Ac[ of 1977 72. Granting of this permit does not relieve [he applicant of the responsi- (PL 95-217J provided that all of [he conditions listed herein are met. bili:y of obtaining any other permission, consent or approval from 19. All activities authorized by this permit must be in strict conformance the U.S. Army Corps of Engineers, ILS. Coast Guard, New York Slate wrth the approved plans submitted 6Y the applicant or his agent as part Office of General Services or local government which maybe regmred. of the permit application. 13. All necessary precautions shall be taken to preclude contamination Such approved plans were prepared by of any wetland or waterway by suspended solids, sediments, fuels, solvents, lubritan[s, epoxy coatings, paints, concrete, leachate or any on SPECIAL CONDITIONS 1. Parking area and driveway to be constructed of permeable materials. 2. Roof runoff to be directed to drywells. Supplementary Special Conditions (A) through .(J) attached. DEC PERMIT N MOER YO-87-1406 PROGRAM/FACN/A t.'UMBER Pd e OP ~_G. i~-9•~7 NYSQEC l~-7:.~oR .C/C/,~TS ~o~,~j /`~~i i2C>VCJ roo'•~ T ~ WALL • m tDD~ ~ ~ ~ 7a ' ~xsr57-rur Z r4`O6'S~ 40 ~ is ~ ~ ~ ~ c ~ 1c9~ ~ ~ r/kr,~A- ro xt~ ~ S --------,D---- ~ ~ C ~.EA-Z RRr-p ELEU- ~i~~V. 5~ ~ ~ Lev, M' .f-~ ~ iJl..l7•'~C.~,v •7~ r;."~. f, iii •I ' iii rC , r ti~~7 pL ~!-F:r=~ ro ter. c~;~2~~ lass Sov~-X<<A~AI rv>`T ~o~ oi= k i,OT,~tf~f r /VU FILL r?E'QU/R~',~ 'J ~ r1-G..~1-• P E1,'rU, 5 ~ ~ f/ w Ttf ~ y ~ ~ ~r c~0 L' i t-}- rJ l.-Tj ~t ~ ~ I- c- McDONAZD GEOSCIENCE - Box 1000 • Southold, New York 11971 • (516) 765-3677 TEST HOLE DATA SHEET Name: John CampYrll SUn7eyOr: Van Tuyl Location: Southold Harbor Lights Tax Map Number: ~7/- .Z-,la Project Description: Lot .~-cj-~-~-- Date: 11/7/87 Humis 1.. Dark brol,m sandy loam 6.. Brown loamy sand 3.2' Brown coarse sand 8.8' Water in brown coarse sand 15' Comments: Test hole located 75' east of western line and ~0' north of southern line This is a cotip of your test hole data and a bill......$100.00 _ ~ o ' 8 r. _ , _ _ _ -.z l I a i . r ~ ti S- y~ N M.,. ~ \ ~ i (MM„1 ~ f{, (A~ "1 t~ l: i t1. \ v ~ ..n ~ ~ ~ _ F E' L` "I I ~r LI ~ ~ ~ Vl ~ R ~ `~J i ~ w r,~t ~ ~ ` ~ ion' fca f+c~'ive ~ •j . ~ ~ ab j~ ~ 14 ~ 2 4 l1 o ~v.9~r7,~r~ ~ ~'v ' ~ ~ t0 ~ ~~1. 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'Fl r ? . ~y1[ } o- r l§ lhn ~ ~ ~ < ~ F ~ FFF'' - '3~ y y ~ ~ ~t "'~~Y 'f,b~ ~ ~ ~ sr t ~ ti , ~ ~ t - ' , A ~ s t~ r ~ g~ ~r~_ . 3_ ~ ~ t , , . , s z„ ~ .:r " ~ ~~~z,~;~,~r~~i~~~'t;~ 17~t~rfiiiii~~ ~ o ~r i~iiran INi i~i i i1 `f' ICI I Illf I~ lll~ 11 f'lll l~ I~ ~I 7t ~ I ~ FiP~ gy d" / BOARD OF HEALTH Y 3 SETS OF PLANS FORM N0.1 SURVEX TOWN OFSOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORM TOWN HALL NOTIFY SOUTHOLD, N.Y. 11971 CALLJohp_ C; W_.. Cam~k~e11 TEL.: 765-1802 MAIL TO:Box 1147, thold, N, 765-2887 Sou Examined 19fp~~ Approved . l1.//.~......, 199.~PermitNo.~~6pa~ ~ l~ Disapproved a/c ~ ~ov i BLDG. DEPT. TOWN OF SOUTHOLD uil ing Inspector) APPLICATION FOR BUILDING PERPAIT Date . U e•t 193.(3 . 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 pazt for any purpose whatever until a Certificate of Occupancy shal)~ have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Depaztment 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 necessa insp tions. gnature of applicant, or me, if a orp"oration) Box 2887,Southold, N. Y. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Owner Name of owner of remises John C.W, .Campbell:, Virginia W, • Campbell • • • • • • • • • • • • • • • • • • • • • • p (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No.Geo•,•Ponti•no~Cuteho~ue,N.Y. #12997 Plumber's LicenseNo.C~@4,•Berry,,•~outhold,N.Y.. #56~ Electrician's LicenseNo.Ga>^y..AOY'oSk~,. C•utehogue,N..Y. #29111 Other Trade's License No . ~ ~ 1. Location of land on which proposed work will be done. .Lot 111b Harbor Lights Drive Southold,N.Y. House Number Street Hamlet County Tax Map No. 1000 Section 07.) Block 2................. Lot YLC• •6 • • • • • , • • • • Subdivision Harbor. Lights,Estai<QS............ Filed Map No. ta.6,g1.......... Lot ....~?b........ . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed constn~ction: a. Existing use and occupancy ,Vacant band ~nt?}.p~s.„tH!?~~+.15 b. Intended use and occupancy SJ;ngle• Fami-,ly ,1]~'e•11in~ , • • • .~~„~[,3+„p±~~. ~±~~Pti?:r=.,zt of work (check which applicable): New Building . , .X...... Addition Alteration . ar Removal , Demolition Other Work , , . ?80000 (GesaripSion) 4. Estimated Cost Fee ` (to be paid on filing this application) 5 Tf garallen number of adwellin TW its gne....... Number of dwelling units on each floor . g g ~ 6. If business, commercial or mixed 'occupancy, specify nature and extent of each type of use . 7. Dimens(on~,of existing structures,i if any: Front Rear Depth . Height >.k.;.:........... Numb,'er of Stories . . Dimension of same structure wit alterations or additions: Front Rear . S- Depth 5 Height , . , Number of Stories . 8. Dimensions of entire new construction: Front . 7.3£t• 6in• • • • Rear .73ft• •6in• • • • • Depth 52.ft • . • • . Height `s..30ft'.,........ Number of Stories ....Two . 9. Size of lot: Front ].OA£t. • •I • • • • • • • Rear 1.QOft Depth .?Op.£t.............. . 10. Date of Purchase Zl•-lk.-b6 • . • • • • • • . • .......Name of Former Owner Ered....and..]i~,~~ c.l.d . Reese . 11. Zone or use district in which prerises are situated ..F.t~S.i,d Srit1~•1 . 12. Does proposed construction violate any zoning law, ordinance or regulation: ,No, , 13. Will lot be regraded . NP ..................Will excess fill be removed from premises: Y s No 14. Name of Owner of premises,~9h,~yir~., ,Campbe,~~dress Southold IN,.Y, , , ,Phone No. 7b5'?~87...... Name of Architect J. J ame ~ RSCh , , , ,Address .Phone No. . Name of Contractor Geo,., •Pon~tino• • • , , ,Address Cutch'ogus:,* ._Y.X_ phone No. ~3~.'~~~.B..... . 15. Is this property located within 300 Eeet of a tidal wetland Yes X_ pp~~ *If yes, Southold Town Trustees Permit ma be reggu~ired•Permit Issued•7/~S%8`J~~App.~ 536 i PLO DIAGKAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property fines. Give street and block r{umber or description according to deed, and show street names and indicate whether interior or corner lot. See Survey attached, ~I . I' i i STATE OF NEW YORK, S.S COliNTY OF . Slil:fOlk ~ John C . W ,Cam be 11 & V it inia W , C ampbe 11 being duly sworn, deposes and says that he is the applicant (Name of individual si n Ong contract) above named. p...... ....g 1 . Owners • _ • . • .I'i He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dull authorized to perform or have performed the said work and to make and file this application; that all statements conti}ined in this application are true to the best of his knowledge and belief; and that the work wIIl be performed in the mannei set forth in the application filed therewith. Sworn to before m~ i .day of,. 19 . ~ . Notary Public, I.-.... .County ~ 4 QLIW cam....... . U:i.~ . Ye1h (Signet re of applicant) QommMlat Exphes Decenibe~r B~tA.~ ~