HomeMy WebLinkAbout19989-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20267 Date OCTOBER 7, 1991
THIS CERTIFIES that the building NEW DWELLING
Location of Property 470 MOCKINGBIRD LANE SOUTHOLD N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 55 Block 6 Lot 15.55
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 26, 1991 pursuant to which
Building Permit No. 19989-'L dated JUNE 27, 1991
was issued, and conforms to all of the requirements of the agplicahle
provisions of the iaw. The occupancy for which this certificate is
issued is ONE FAMILY DWELLING WITH ATTACHED GARAGE & WOOD DECK
The certificate is issued to DBM CO
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 90-SO-120 - SEPT. 30, 1991
UNDERWRITERS CERTIFICATE NO. PENDING - SEPT. 22 1991
PLUMBERS CERTIFICATION DATED AUGUST 21 1991 - K & K PLUMBING & HEAT.
/
Building Inspector
Rev. 1/81
10HBE[ NO. A
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~ 1 9 9 8 9 Z Date ..........~.,t~m.a.......a.7 19..9..1.
' Permission is hereby granted to:
......~.,...1,~...~..:....... ~.1.
Q
.
...................................l.J....................\.....
' of premises located at ....~.7 ~:".^.?4:...... ..fJF..4~i*.:t.
i
County Tax Map No. 1000 Section .....~.S.S...... Block Lot No....~.5~.'.~~.Sr..
pursuant to oppiicatlon dated ......~...~~~'....z..~ 199..x.., and approved by the
' Building Inspector.
Fee s.."~.~.~:...7 S/
- Buildin nspectar
Rev. 6/30/80
e I~~ ~,r ~ ,~p ~ Form No. 6
~ C., I
TOWN OF SOUTIIOLD ~f°•,~~~d.Y.,..a..
'
_ .~,~.m:.~„ d
!7l'7~- BUILDING DEIiARTMENT I' S ~ ~ ~ ' ' (j
TowN 11ALL !t f` 4 ~j
¢r ZZ3
z 765-1802 ocr - z ~ssi '
APPLICATION POR CLRTIPLCATIi OF OCCUPA CY 63:.r~. Lsi`F'T.
~,,..~.701ftJfU f)F
SC1U(~(Bf.Xa';
<1. Tlri.s 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 pealth Dept. of water supply and sewerage-disposal(5-O, 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 f.or the building,
6. Submit Planning Board Approval of completed site plan requirements.
S. For existing buildings (prior to April 9, 1957) »on-conforming uses, or buildings and
"pre-exi.sttng" .land uses: ,
1. Accurate survey of. property showing a.ll. 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
masons therefor in writing to the applicant.
Fees
1. Certi.Licate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling $1.5.00, Swimming pool. $2.5.00, 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 G'ertificate o.C Occupancy - $SO.OO
5. 'temporary Certificate of Occupancy - Residential $15.00, Comm~Jercial $15.00
Date ~ ~ ~ ~ , ;1
~ew Construction..... Old Or. Pre-existing Bu ilding...........•
.ocation cf Property....:"#,~~?,,,,,,,MoCKIiJC~,~.3,IP,~ LN .SOv~T7-lp~~
Clouse No. Street }iamlet
lower or Owners of Property.....~.n'J.. M....~o.o
;ounty Tax Map No 1000, Section...S-? ;5.......Block......~.........Lot....~q?t~:5^.....
;ubdivi.sion..~+i Cn,F? pOin~T f-lt=f1~0~S
q / .Filed hiap............Lot... ~
'ermi.t No. ~ q. J. z ...Date Of Permit.b?.`~,~/9I.......A ,i~,(J,, M C~ ~ •
REF F 90°Sa-) Pplicant.
2.0
lealth Dept. Approval
......Underwriters Approval
'lnnning Board Approval....
:e quest for: Temporary Certificate........... Final Certicate... ?
be Submitted: $,c~~,•,Qa,,,...
APPLIL'ANT
en~,aoa~~
,....,~.w . . ~ ~ ~_w__
i ` ~ TEL. 7GSd 802 ~x
~~FO[k
~4~ ~ boy To~vN Ur soYJrIIOLD
~r~,. t•:ytt!!i.;p ~ OFFICE OF DUILDItdG INSPECTOR j j ~
~ t°r~ rn p.O.DOR,728 ~ ~~~~C~~~,eS'~I~I~E~f(~~~ t `~i~''
"O cA -e TOWN HALL l~`
Off" SOUTHOLD, N.Y. 11971 ~ ~ g ~
~ ~ • k ? 5 YtN' 1
- ~a1 r ~ , OCT - 2 ?991
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C E R T I F I CAT I O N - y ,a~,'`?F
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Date 0,~~,~~ g~"
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Building permit No._f ~f
Owner ~~j'('(~ Cot'Q ~ ,..`F`
(please print) ;,~~a`
*
plut:.ber ~ ~um~n~~ ~ ~o.~\n~
Ipleas:e print) ~ ~ ~
~~a~~ a.3S ~ .
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~ ER}
I certif that the solder used in the water su 1 s stem
Y PP Y Y
~^"contains less than 2/10 of 1~ lead,
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(pli.unber's signature)
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' Sworn to beforo me t}his
i=- ~3 day of ~ tJ ~ ~ .
n NO t3 ry~liC
' , tlo to r;; pub],lc 1 County SUSAMNE J. PERRICtJNE r,?,;t~
NOTARY PUBLIC, Stele of New VOfk
• No. 4bII2749 ti ~~i, .r.,F.y
6 ,~.q
I qualified in Suffolk Counfy .,°,~Cj
Cornmiuion Explren Jan. iD 9 Z _,;„f.-.
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ADDITIOPIAL COMMENTS: ~
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T6S-1802
BUILDING DEPT.
INSPECTION
[ FOUNDATION 1ST [ ] ROUGH PLBG.
[)FOUNDATION 2ND [)INSULATION
[ ]FRAMING [)FINAL
REMARKS:
DATE INSPECT
J~~~~
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ROUGH PLBG.
[ ] F UHDAT{ON 2ND [ ]INSULATION
[ FRAMING F{NAL
REMARKS: _
s ~
p ~•c.rr~,_
z
DATE ~ INSPECTOR
4
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOU DATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [)INSULATION
L
[ ]FRAMING [ ]FINAL
REMARKS: _
t DATE ~ INSPECTOR
L 1 765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ INAL
REMA KS: ~v
4
~
.use'
DATE ~ INSPECTOR G
ll~
1
765.1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH BG.
[ ]FOUNDATION 2ND SULATION
[ ]FRAMING [ ]FINAL
REMARKS: G~~
-Crrd~`-eZ-~..
-,P
s
~ INSPECTOR
DATE
LI
-°~'~"-°'(~(~~~~C`~~~rr "{N' t 60,11;0 OF HE.\LTFI
L~~ V ~fI ~1 FOF2M NO. 1 3 SETS OF. PL,121S.::::::::: .
II _ TOWN OFSOUTHOLD SURVEY .
~ fl~ BUILDING DEPARTMENT ~CIIECI: _
TOWN HALL SEPTIC roR:t _
SOUTHOLD, N. Y. 11~J71 ~
BLDO.DEi='1. TEL.: 765-1002 t:o"'r' ~ _
_TOWN_OF SCIUTNOLD _ ~J ~/,.~~~~JJ
xamincd . . 19 CALL D.~s'GX;~... .
P1A T0:
PProved , 19 9). Permit No. ).99.~~ / .
~isapprovcd a/c .
(Bur mg Inspector)
APPLICATION FOR BUILD{NG PERPAIT
Date .......6:.~ 19~ ~ .
INSTRUCTIONS
T}tis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
s 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
areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of t}tis appli-
ion.
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
11 be kept on the premises available for inspection throughout the work.
e. No building shall be occupied or used in w}tole or in part For any purpose whatever until a Certificate of Occupancy
Il 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
(ding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
:ulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
applicant agrees. to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
lit authorized inspectors on premises and in building for necessary inspections.
(Signature of applicant, or name, if a corporation)
®:.3.4.x...2; i3o,.~.REt;.c)~o2.T, /i9~y
(Mailing address of applicant)
to whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
!~?.cJ a~?E2
ae of owner of premises h1 C c~ .
_ (as on the tart roll or latest deed)
tplicant is a corporation, signah~re of duly authorized officer. •
j
(Name and title of corporate officer)
Builder'sl.iccnse No . . .
Plumber's License No. ..a 3 S
Electrician's License N,o . . .
Outer Trade's License No . . .
,.ocation of land on which proposed work will be done. - ~~C7 PO i ~J _r Eq'~ d l~t%. , . , , ti- O T ~ ~9
ousc Nuinbcr ..............~.~.C?.c?.?7/-4
Street I-Iatttlct
nutty Tax ,1fap No. 1000 Section ~?v~.~........ Block , J.S
Lot...
LL''~ _
~bdivision.F~)GtrI~PU.iiJ.r...M,~;g,~.~.~s. Pilcd~1apNo .
Lat
(Name)
ate existing use and occupancy of premises and intended use and occupancy of proposed construction:
Existing use and occupancy .
Intended use and occupancy ......:'U c /~Y6.~?~
3. Nature of work (check which ap ~ u/~
Phcablc): Ncw QuiWing Addition '
cpair ......~.,......~f~l.al Vtcration
Remol Demolition Other Work .
4. Estimated Cost , , (~ription)
Fcc
5. If dwelling . , • • li (to be paid on filing this applj5a~,i~an)
riumbcr of dweltin^ Knits , , , , ,
b u'
If garage, number of cars • • • • • • • • Number of dwelling units on each floor ~ '
6. If business, commercial or mixed'ioccupancy, specify nature a td extent of each type of use ~ • ~ ~ • • •
7, Dimensions of existing structuresj if any: Front , Rear • ~ ~ • • ~ • ~ ' ' ' ' ' '
Height Depth...............
Numdcr of Stories .
h alterations or additions; Pront • ~ ~ ~ ~ ~ ' ' '
imcnsrons of same structure wit • Height , , , ' ' ' ' ' • • • • • Rear •
t It
Number of Stories .
8. Dim h~sions of entire new c NUt~ption: Front , , , , Sz> ; , , , , Rcar , ; , , , , , De th 3 d
Hci~ erofStories......, P
9. Sizcoflot:Front....
0. Date of Purchase Rear' Depth iP............. .
p .Name of Former Owner .
I. Zone or use district in which rcn%ises are situated . .
ocs ro oscd construction violet,
3• P P j e any Toning law, ordinance or regulation:
3, Will lot be rc~raded • • • .o ,
. k'r • • • • • • • • • • • • ....Will excess t711 be removed from premises; Yes
3. Name of Owner of premises . ,a7,d•!ti-t C~ . Address !-{cl3 F'lst r.~ c
Name of Architect PH121.v[ e-n-• (3,2aw~j'' r • vT; • • • Phone No..;~~ 7 ;z~%~-3
• • Addtess . . . . . ......Phone No.. ,x(77;
,y'752.
Is tthis on~actor ~ . .Address Phone No. '
pro ert within 30
P y 0 feet of a tidal wetland. >r ~ "
t ° Yes........ No.......
•If es Southold Town Trustees Permit may be required.
~ PLOT DIAGRAM
Locate clearly and distinctly all btYildings, whether existing or proposed, and, indicate all set-back dimensions from
roperty lines. Give street and block number or description according to deed, and show street names and indicate whether
rterior or corner lot.
'i
~ .
,
TC OP NG~V YORK,' •
JN ~ 0 wi+,RD, , ? s • , • . i_ , , , • . • . • • • , , , , , , being drily sworn, deposes and says that he is the a : lican
(Narnc of indrvrdual srgnmg contract) 1 P t
'c named. '
:thc......(7W~E~....., I
(Contractor, agent, corporate officer, etc.)
Id owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
cation; that all statements contained in this application arc true to the best of Itis knowledge and belief; and that the
will be perforntcd in the rnanncr set forth in the application Glcd therewith.
n to before me this
G~,!~~ .......day of I ~t I
Y
Publi/~~'i'~~~%~~ • • • • • • . Count
C_~cQ_s
SUSANNE J. P~CONE ~
NOTARY PUBLIC, Stara of Mew Yark ' ' ' ' ' ' ' ' ' ' ' ' • • .
Mo, naoz~sv (Signature of applicant)
Qualified In Suffolk County ~'i '
Cornmisaion Ezpirea Jan. 20, ty~Z
~
MQCk/ ~ ~ c4Hri
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SURVEY FOR ~>f~,.
°•3S
D.B.M. COMPANY
BUPPOLK COUNTY DEPARTMENT of HEAITM sERVtces LOT N0.49, IIHIGHOINT MEADOWS, SECTION THREEII
AT SOUTHOLD DATE'. OCT. 15,1990
FOR APPROVAL OF CONSTRUCTION ONLY TOWN OF SOUTHOID SCALE I"=40
SUFFOLK COUNTY, NEW YQRK No. 9o-osoz
. DATE OCT 191990 NO, 96 - Ia ° K UINUiXOR12 CD Al7ERA T10N OR 4D DI TION TO MIS
SURV[Y 6 A vld. ATION dF SECTION 7209 OF THE E OF Ned"'-.,,~
~ NEV YORK STAT[ EDUGTI W1 lAYI p'1 ~
4PPROVED w COMES OF MIS SWiVEY NOT fEARWG THE lANO S~ '{y
/ \ R'S MKED SEAL OR ENSOSSED SEAL SNALI ~p,EIO W, ` Mr
3d~(O ~ ~ -~1 NOT LECONSIDEREOTObEAV11110TRUECOPY ®G
RGtl ARANT,EES iN01UTED NE REDN SHALL RUN ONLY TO Q
HEALTH DEPARTMENT-DATA FOR APPR TO CONSTRUCT M[ PERSON FOR WHOM THE SURVEY IS PREPARED SE Z'
AMO 011 NIA bENALF TO THE TlTlf COMPANY, GOVERN- T Q ,
R MEAR[ST WATER ~AIN_MI 2 wSOURCE Oi WAT R PLIIMTE _,.PUbLIC _ NENTAI AGENCY ANO LENDING WSTiTUTI ON LISTED
k fllFF CO. TA1t AlAP DIfT 108D S[C TION !LOCK lOTf(,p.l$•1 HEREON, AND TO ME AlE IONEES Of THE LENDING
M MLRL ARL NO DWELLIINf WITHIN 100 FEET Of TILS PRO P[RTY INS TITUT1011 GUARANTEES ARE NOT TRANfFERAbLE
MNLR TNAM THOSE bNOWM N[REOM TO ADDITIONAL INS,i1TUTIpIf OR SUSSEOUENT
R THE WATLR SLIMLY AND fEW1bE OIfFWAI SYfiEM Fdl Mif RLf IDENOE OWNERS
WILL COMIOMf TO TN[ fTAMDAROf OF THE SUF/OlK COWRY DEF'ARTMCNT w DI }iANCE3 SN01YN HEREON FROM .PRDPEMY UNEf ~,4
TO EKIf 71NG fTRDC TUREf ARf ?0R A SPECIFIC ,y.,~
OI MLALTN fO1VlGLf. PURYDSE AMb ARE NOT i0 bE USED TO ESTAbII}N `[fl WEyO
APPLICMIT.^~~,~ /i ?110VERTY uNES OR FOR THE ERECTION 0/ FENCES 'W ~R
ADOREff (~J? ri~1~~K~ S7' ~rY~eP~,~~por'~~ 1 a.9~ y -
77 T[L z22~ YOUNG ~ YOUNG ~ ~~NDER AVENUE
RIVERHEAD, NEW YORK
NOTE' ~ ALDEN W.YOUNG, PROFESSION4l ENGINEER
SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF
SUFFOLK COUNTY ON MARCH 19,1990 AS FILE N0. 8912. ANO LAND SURVEYOR N.Y.S. LICENSE NO 12845
a HOWARD W YOUNG, LAND SVRVEYOR
ro MTNE LDCATLW OI WLLI.M1,fE?TIC TAMKlfflb CEffP00lf(C?) !MOWN NLRLDM N.Y. S. LICENSE N0.43893
e ARE Pwdl fl[1D OMEIIWTiONS MID OR OAM ObTMM[D PNOM OTNERf L f
SRANDIS ~A SON9 INC.
~
R' \80.00' L:171,gs• OC' 1 /~Ge~ \
O ~O \
\a~O `gip p~ ~/~n' ~'FT
0~ ~ p $ ~~Y'YL\ FqM\
pX. C.
2
ay
hDyb
~p ~
'sD, °o.
o° mY'
a° ~ R.~60. ~ 74.25
1. o~~ \\op~ Op L= ~
K J
v. ~ O
v °
~ 1 3s, to ~t~. ~o~l~
O \3 ti /
9/ 9 ^ mss' I g~//
\ 1
\ Q 20.5'
V ~
so.5'
«
1 STORY FRAME ~
l \ y HOUSE 8 GARAGE 121'
A o a
9 0
O sz.
9 y~` 315' DECK" \
y \ Y \
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SEP. 26 199;
• ,~I~PT.OF
. •~RYICES
_ SURVEY FOR
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES JOHN S. ROSS & MARGUERITE ROSS
- - ` -SI_N~LEFAMILY DWELLING ONLY LOT N0.49, DHIGHPOINT MEADOWS, SECTION THREE"
DA1g~'(~.~. H.S. REF. N0. 9D-SD-Oa0 AT SOUTHOLO DATE'. SEPT 24, 1991
The sewage disposal and water supply facilities for this TOWN OF SOUTHOLD SCALE I"= 4D'
tocationhavebeeninspectcdbythlsDepartmentand/or SUFFOLK COUNTY, NEW YORK No. 9I-OBIs
other agent s an fow~d io be satisfactory
,~]g/~ KUYMUTNOR12E0 ALTCIIATIOM OR AODir1oN TO TNIS CERTIFIED T0~
SURYEY b A VIOLATION OF SECTION 1209 OF THE JOHN S R
Chief of f3 reau of Wastewater M nagement NEW YORK STAiC FwcAnoN LAW MARGU ~p
KCO?1 E3 OF THIS SVItV EY Nor {EARW6 THE LAND TIDD ~
SVR VE YOR'S INKED SEAL OR EM{OSSED SEAL SMALL ~
MOT CONSIDERED TO {E A VAL10 TRUE COPT ~~,pD w }
MGtl ARANTEES INDICTED NEREON SMALL RUN ONLY 10
' THE PERSON FOR wNOM THE SVRVEY IS PREPARED Q
HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT ANO a ws {ENALF TO 7NE TITL[ COMPANY, GOVERN-
i ? MENTAL AOE MCY AND LEN DIME IM3TITU 710M LISTED
M M(MCST WATtR ~AIM~MI _ NSOURCE OF WATER MIMTE _PU{LIC. NEIIEON, AND TO T11E ASSIGNEES OF iNE LENDING
RMIFF CO. TAK MAP M{T 1409. SLCTION ~';L KOCK _8-LOT 1535
R 1NLIt ARE IID OWELLIW{ WITMIM 100 FEET Of TWS PROP[RTY INSTITUTION GUARANTEES ARE NOT TRANSFERA{LE
OTNLR TNAM TNOSE !MOWN NLREON TO ADDITIONAL INSTITUTIONS OR SU{SEOUENT
N TM[ WAT[R SUMLY AND SCMM{t W{?O{AL SY{TLM FO11 7M1f Rtf IOENCt OWNERS
WILL CONFOM/ TO TNL STANOAROf OF Mt SUFFOLK COUNTY OCPARTNENT R DISTANCES SNOWM HEREON FROM PROPERTY UNCS
i TO Ex 13TING STRUCTURES ARE FOR ASPCCiFit
f OF NLALTN {LM ICL{ PVR POSE ANO ARE NOT 70 {E VSFD i0 ES TASLISN Off,
` ARLICANT. VJ Y~ P ?IN)PERTY LINES OR FOR THE ERECTION OF FENCES G*0 4N4~T^I
I 1-~ 'tS ~-CJa f 3a
I_ ADDRLS{ 100 OSTRANDER AVENUE
6-r uv' vt1 ~ tl9~L - ~~-z~.~ YOUNG 8' YOUNG RIVERHEAD, NEW YORK
I NOTE~~=MONUMENT ALOEN W YOUNG, PROFESSIONAL ENGINEER
I SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF
SUFFOLK COUNTY ON MARCH 19, 1990 AS FILE N0. 8912, AND LAND SURVEYOR N Y_S. UCENSE N0. 12845
m HOWARD W. YOUNG, LAND SURVEYOR
NTK LOCATION OF WEI.L(W), SEPTIC TAMKI{T)•C[SSPOOLS(C?1 {MOWN NLRtOM N.YS LICENSE N0.45893
a ARE HIOY FI[LD OpERWT10N3 MID OR DATA 0{TMNtO FROM OWNERS Z,{,
GRANDIS 6 SONS INC.