HomeMy WebLinkAbout19754-z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20034 Date JUNE 25, 1991
THIS CERTIFIES that the building NEW DWELLING
Location of Property 445 ORIOLE DRIVE SOUTHOLD, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 55 Block 6 Lot 15.28
Subdivision HIGHPOINT MEADOWS Filed Map No. Lot No. 25
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 25, 1991 pursuant to which
Building Permit No. 19754-Z dated APRIL 1, 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 & OPEN FRONT PORCH
The certificate is issued to MELVIN & JANICE HANSEN
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL-91-SO-15-JUNE 20, 1991
UNDERWRITERS CERTIFICATE NO. PENDING - 737191-91 - JUNE 4, 1991
PLUMBERS CERTIFICATION DATED JUNE 20, 1991 - K & K PLUMBING & HEATING
r-24 / /
wilding Inspector
Rev. 1/81
FORM N062
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°_ 19754 Z Date ~ 19f/
Permission is hereby granted to:
r.a...................................
to......
,r/
at premises located at ....alt .....G! c
.
County Tax Map No. 1000 Section ..........P- Block Lot No...... 1h!R.ta6..
pursuant to application dated 19.6/.., and approved by the
Building Inspector.
Fee $...~~:3:.
t9e
?.r
B~ll Ing I for
Rev. 6/30/80
Form No. 6 -
JJN 2 I
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
CPS y>> -a13
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 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.
i. 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.
Fees
1. Certificate 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 - $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
Date .........4..
.ew Construction ...X....... Old Or Pre-existing Building
.ovation cf Property..445...... OA,~o&.DAiv¢ SOU,tho.ZdI.....................
House No. Street Hamlet
Inwer or Owners of Property kiVyin 9 Janice Ham6en._....
;ounty Tax Map No 1000, Section..55..........Block 6........... Lot...15:2...............
;ubdivision..Y-42i'pP.iilt,Mea Mq .................Filed Map Lot
'ermit No.. 19754. . Z . . . . . . . Date Of Permit.. 411191 . . . . . Applicant D . S . M . Ca.... . . .
3118191 neb. #91-50-15
Iealth Dept. Approval ..........................Underwriters Approval.........................
'lanning Board Approval
request for: Temporary Certificate........... Final Certicate.X.........
-ee Submitted: $.,,?5.00..,
4 ao 1.
en ~aoo3~ APPLICANT
j
5~@FULA- TEL. 765-1802
TOWN OF SOUTHOLD
~~OFFICE OF BUILDING INSPECTOR
o e,
u°~ ` ?j;V.. P.O. BOX 728 •
o , -c TOWN HALL ~Ad 2 11991;'~;~
SOUTHOLD, N.Y. 11971
A
C E R T 'l F I C A T I O N
Date
Building Permit No. 19 -7,S-L(
Owner ~j (Yl Cot
(please Fri t) 1,
Plumber ' d `~m\~~ ClLo ~n
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
F
1
I I
(plumber s signature)
Sworn to before me this
D~day of
19 9 f e~~_
Notary ublic
Notary PublCounty SUSANNE I PERRICONE
NOTARY PUBLIC, State of Mew York
No. 4682799
Qualified in Suffolk County
Commission Expires Jan. 20, IDgZ
a •
ppp~
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST ( ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [INAL
ay0 a-~
REMARKS: , G rr0_ 2~
ell,
z1f
I
DATEe~~ e'~V AW INSPECTOR T
1 LD iI:SPEC:iU;J 11UATE CUMMENTS
~ m Q N
FOUtJDAT20N ( 1st ) c.,-r ~t\'~,
FOUNDATION (2nd) -
2. orlg-zl
t
to t/~-- O
ROUGH FRAME &
PLUMBING
H
J f y
3. x' \
m
y
INSULATION PER N. Y.
STATE ENERGY
CODE
a
3
~ r
z
4, m
I've 4g9*1~~
ji:
FINAL
01
/ ADDITIONAL COMMENTS: m~
41Z A~LkLul~_
. cis y
I b O
H \
H
O b
z
z
m ~
a
H
. - x
t7 O
~ r
pppp
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[FRAMING [ ] FINAL
REMARKS: 74 .
DATE Olql INSPECTOR
x
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:.
DATE INSPECTOR alL
r
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
DATE _77` INSPECTOR µ
s - ca
THE NEW YORK BOARD OF FIRE UNDERWRITERS rnf;t,
BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
Date Application No. on file '73J'1.91C41/91 191939
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
ICLt XW f rANS1:N, OI?MIA, OR., 501)11,11("f'))" f;t~j,
3.~
Basement 2nd F'/. Section Hlock Lot
in thefoilowinR location; In Ist Ft. L J G''~~ AT '4c OUT
JUIGr; 7 rr~ f1 -0--
was examined on and found to be in compliance with the requirements "f this Board.
FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS INCANDESCENT FLUORESCENT OTHER AMi K W AMT K W PMi KW AMT K W AMT H P
37 56 :aft 1 1``
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIALREC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
AMT K. W. OIL H P. GAS H. P AMT. NO. A W. G AMT. AMP AMT AMPS TRANS. AMT H. P SYSTEMS AMi WATLS
NO. OF FEET
SERVICE DISCONNECT NO. OF S E R V 1 C E
MT. AMD. TYPE METER T 1W T, lr 3W 3Ir 3W 3$ 4W NO OF CC, COND !C W G NO OF MI-lEG A W NO OF NEUTRALS A. W. G
EQUIP. PER R ,e nOFC. COND. OF HIiEG tOF NEUTRAL
1 -150 C8 Y x 1. 4clf 2E Ct
OTHER APPARATUS:
SME ),M)WIANN INC. LTC, 3635C
S011I'N!)1ail, 1dY, .1).971 GENERAL MANAGER
Per
This certificate must not be altered in any manner; 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.
IJPCPN ~ ~
MaL% i
Y t~j EL,%g.4
382.42 R,
5.82°34 20'W. C:64~0
Q~ R"-30000 0.
986.
/ \LO43 m x,30
~ O ds~ w
ti''g A ~Ol~ \ ~ q LID
/ F,~i + 70 OC 5µi 4\ \t~t\\ °
O \ \
si
Jw\~ CP~Di w\ (T1
p0.°~NOJ SC' \ 25'x!
y \ 6O Y
ti5,
4
~_OCp t1
N
Q
2
moo{ 299 s{.
p6 p c eo 12\
\~P
O
0 O_
CONS
N' ` ERV4TION E4SEMEN7.
. In
65.98' ~ 1
N.80°35 i
41 W.
(
i
Lot 31
(VACANT)
(
Lot 30 MAR 6 1"
SINGLE
S.C. IIEP9' OF
.
DWELLING QNL EXPIRE TWO YEARS , FROM DATE OF APPROVAL
~?I.n~ sr:RVicEs
SURVEY FOR
MELVIN HANSEN & JANICE HANSEN
LOT NO. 25, "HIGH POINT MEADOWS, SECTION TWO"
aUffOLK COUNTY DEPARTMENT OF HEALTH SERVICE: AT SOUTHOLD DATE. AUG. 15,1990
,
FOR APPROVAL Of CONSTRUCTION ONLY TOWN OF SOUTHOLD SCALE+ I"= 40'
'D'SO' SUFFOLK COUNTY, NEW YORK No. 90-0610
T HS REF. NO a - f *UNAUTHORIZED ALTERATION OR ADDITION TO THIS GUARANTEED T0:
SURVEY B A VIOLATION OF SECTION 7209 OF THE MELVIN HANSEN
NEW YORK STATE EDUCATION LAW JANICE
~SpA,
APPROVED *COPES OF THIS SURVEY NOT BEARING THE LAND ~f IV
SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL JUFFO U Af9O BANK
4C Q NOT BL CONS 10ERED TO BE A VALID TRUE COPY TICO TI C MPANY
C 1® -ROUARAMTEES INDICATED HEREON SHALL RUN ONLY TO
HEALTH DEPARTMENT-OATH F APP OVAL TO CONSTRUCT ^ THE PERSON FOR WHOM THE SURVEY IS PREPARED (TI LE 290-'1
A40 ON HIS BEHALF TO THE TITLE COMPANY, GOVERN-
R NEAREST WATER •AIN-MI URCE WATER PRIVATE -PUBLIC _ MENTAL AGENCY AND LENDING INSTITUTION LISTED Z
MUFF CO YAK MAP DINT 1000 SEC TI BLOCK 6_ LOT DAA15.1 HEREON, AND TO THE ASSIGNEES OF THE LENDING
MTHERE ARE NO DWELLIIMS WITHIN 100 FEET OF THIS PROPERTY INSTITUTION GUARANTEES ARE HOT TRANSFERABLE
OTHER THAN THOSE' SHOWN HEREON TO ADDITIONAL INSTITUTIONS OR SUBSEOVENT
M THE WATER SUPT AND SEWAGE DISMAL SYSTEM FOR THIS RESIDENCE OWNERS
WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT *DISTANCES SHOWN HEREON FROM PROPERTY LIMES
TO EX ISTING STRUCTURES ARE~FOR A SPECIFIC
AP WEALTH SERVICES PURPOSE AND ARE NOT TO BE UQED TO ESTABLISH ~CIY. O88
APPLICANT, p b-1_ Co PROPERTY LINES OR FOR THE ERECTION OF FENCES psf0 )4R@ $URVEy~~
ADDRESS V.0 Q 8 l3~
&feerjo0TF >J 1~14y/'EL 4177"ZZZ3 YOUNG a YOUNG R400OSTRANNEW AVENUE
, YORK
NOTE: • -MONUMENT
SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF ALDEN W. YOUNG, PROFESSIONAL ENGINEER
SUFFOLK COUNTY ON MAR.19, 1990 AS FILE NO. 8911. AND LAND SURVEYOR N Y.S.'UCENSE NO. 12845
m HOWARD W. YOUNG, LAND SURVEYOR
m M THE LOUTIDII OF WELL(W),SEPTIC TAMKISflB CESSPOOLS(CP) SHOWN HEREON
a ME FROM FIELD OW IATIONS AM ON DATA OBTAINED FROM OTHERS N. Y. S. LICENSE NO 45893
2.8.
BRANDIS 6 SONS INC.
/ 1 G 382 42 R,.
V 1~ 5.82034 20 W. ~=S~00
/ ~ 300.00 9
/ ~ \yo ~~N L=31.42
NN
4y~ 'N. 2B G. (n
10
o, V)NOP J O
~ ~°5 f D 9 1yFl' ~
CP ~e~• e' Q'
o N
LOt 24
1
kf)
vl
NI
I
~.°t 2399 SF.
~O~FL6 PCeO , 2!
I
I
I
1 m
N~a 1 0
1 SERV4T(ON E4SEMENT
1
65.98' I
N"'00-3541 W. 1
1.
Lot 31 ;
Lot 30
SURVEY FOR
_ MELVIN HANSEN a JANICE HANSEN
f1 ~\LOT N0.25,"HIGHPOINT MEADOWS, SECTION TWO" AP R.9; 1991
APR
91
U ~J L~ AT SOUTHOLD DATE'. AUG. 15, 1990
rAffi - 9 TOWN OF SOUTHOLD SCALE 1"= 40'
SUFFOLK COUNTY, NEW YORK No. 90-0610
K UNAUTHORIZED ALiCRAT10N OR ADDITION TO THIS GUAR ANT TOF Mph,
BLDG. DEPT. SURVEY IS A VIOLATION OF SECTION 7209 OF THE
TOWN OFSOUTHOLD NEW YORK STATE EDUCATIONLAw MgNVENStAN W. `09
M COPIES OF THIS SURVEY NOT BEARING THE LAND
SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL SU 0 UNTY NASU AL. ANK
NOT BE CONSIDERED TO BE A VALID TRUE COPY TI LE AN CO PANY
NGUARANTEES INDICATED HEREON SHALL RUN ONLY TO I
HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT THE PERSON FOR WHOM THE SURVEY IS PREPARED - \ 1 N0. 51$?
AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERN-
0 NEAREST WATER ISAIN-MI _ If SOURCE OF WATER PRIMATE _PUBLIC_ MENTAL AGENCY AND LENDING INSTITUTION LISTED
R SUfF CO. TAX NAP OIST -9=SECTION 3,5 _ BLOCK _S_ LOT a" 'I HEREON, AND TO THE ASSIGNEES OF THE LENDING
NTHERE ARE NO DWELLINGS WITHIN 100 FEET OF THIS PROPERTY INSTITUTION GUARANTEES ARE NOT TRANSFERABLE -
OTHER THAN THOSE SHOWN HEREON TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT NO, 45g93
N THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FOR THIS RESIDING[ *DISTANCES HERSS SHOWN HEREON FROM PROPERTY LIMES 'NT
WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT TO EXISTING STRUCTURES ARE FOR A SPECIFIC
OF HEAL SERVICES PURPOSE AND ARE NOT TO BE USED TO ESTABLISH ~SND
APPLICANT, PROPERTY LINES OR FOR THE ERECTION OF FENCES
ADDRESS
YOUNG a YOUNG RRIIVOERRHEAD,NEW iORKKE
NOTE% 8- MONUMENT
SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF ALDEN W YOUNG, PROFESSIONAL ENGINEER
SUFFOLK COUNTY ON MAR.19, 1990 AS FILE NO. 8911. AND LAND SURVEYOR N Y.S. LICENSE NO 12845
m HOWARD W. YOUNG, LAND SURVEYOR
m III THE LOCATIONOF W4LL(W),SEPTIC TANK(ST)IS CESSPOOLS(CP)SHOWN HEREON N.YS.LICENSE NO.45893
ARE PROM FIELD OBSERVATIONS AHD OR DATA 08TAINEO FROM OTHERS
Z.
B
BRAN015 A SONS INC.
S.8203420`N. 382.42 < S90oo
/ 8,300• '66,
3\.42
Iry
N
N
N6` N 2e%G' ~ ~ ~~I?
P
o PSVO 8°0 /~/1
Z a4OVN0 y
l Na 5
`u1~ N 95 i
Lot 24 m
I
PI N
NI ~
I
Zg99 SE•
~°y26 PCgo "Oil \
I
'm
' o
C SERVATION EASEMENT
,Uf 65.98'
800-3541 W.
I
Lot
LOt30
SURVEY FOR
MELVIN HANSEN a JANICE HANSEN
'y.ra e....rm. I, N
LOT NO.25I HIGHPOINT MEADOWS, SECTION TWO APR 9 , 1991 APR. 1 1991
AT SOUTHOLD DATE AUG. 15~I1990
9 TOWN OF SOUTHOLD SCALE I"= 40'
SUFFOLK COUNTY, NEW YORK NO 90-0610
R UNAUTHORIZED ALTERATION OR ADDITION TO THIS GUARANT TOF W~' ,
BLCG. DEPT. SURVEY IS A VIOLATION OF SECTION 7209 OF THE
TOWN OF SOUTHOLD NEW YORK STATE EDUCATION LAW J(gNV E N
W, X09'
RCOPIES OF THIS SURVEY NOT BEARING THE LAND JAN W.
INKED SEAL OR EMBOSSED SEAL SMALL SU 0 UNTY Nlr1 AL., ANK
NOT BE CONSIDERED TO BE A VALID TRUE COPY TI LE N{>~, COQ PANY
THE PERSON .GUARANTEES INDICATED HEREON SHALL RUN ONLY TO
HEALTH DEPARTMENT-DATA FOR 4PPROM4L. TO CONSTRUCT THE PERSON FOR WHOM THE SURVEY 15 PREPARED ( I NO. 514•
ASO ON HIS BEHALF TO THE TITLE COMPANY, GOVERN- Yi
M NEAREST WATER INAIN_MI ! MSOURCE OF WATER PRIMTE - PUBLIC _ MENTAL AGENCY AND LENDING INSTITUTION LISTED
R BUFF CO. TAX MAP DIST IOOO SECTION x55 BLACK 6 LOT O/n 15.1 HEREON, AND TO THE ASSIGNEES OF THE LENDING
MTHERE ARE NO DWELLINGS WITHIN 100 FEET OF THIS PROPERTY INSTITUTION GUARANTEES ARE NOT TRANSFERABLE
OTHER THAN THOSE SHOWN HEREON TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT G~ M1'o, 45893
`F
M THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FOR THIS RESIDENCE OWNERS
M DISTANCES SHOWN HEREON FROM PROPERTY LINES
! 'yS
WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT TO EXISTING STRUCTURES ARE FOR A SPECIFIC f1 n'~ 'LAND
OF WEALTH SERVICES PURPOSE AND ARE NOT TO BE USED TO ESTABLISH
APPLICANT' PROPERTY LINES OR FOR THE ERECTION OF FENCES
ADDRESS
"L E~~" AVENUE
YOUNG a YOUNG RI NEW YORK
NOTES MONUMENT ALDEN W YOUNG, PROFESSIONAL ENGINEER
SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF
SUFFOLK COUNTY ON MAR.19, 1990 AS FILE NO. 8911. AND LAND SURVEYOR N YS LICENSE NO 12845
HOWARD W. YOUNG, LAND SURVEYOR
u NM LOCATION OF WELL(W),SEPTIC TANK(ST)OCESSPOOLS(CP) SHOWN HEREON NY S LICENSE NO 45893
a ARE FROM FIELD OSSERWLTIONS AND OR DATA OBTAINED FROM OTHERS 2 B
BRANDIS 6 SONS INC.
R•
A ny~
~J
,XJPI 2 11991 1 [ , ~I
U r
TOWN OF SDEPT,
TU
S.8203420'•W. 38242 <R`400
Sg O•
/ / O R=300A0 •e6`
/ \ \2O L\3 L=31.42
/ / S°oo N 1
op a, G
NI IH oA 55 Fo ,2 G~
N.1\ II 2 205 FPp~4°a
y ~I~ o. ~SOPi 0 a O
CAO ~6~~ Y.GpPP N Yoe
#p5
2
y '
O
~ov23ggs4.
Vov26 PCeA ' 2\
0
NSE
I RVgT10N EgSEMENT
NI
65.98, I
"10035 1
41 W.
1
Lot 3f ;
I Lot 30
SURVEY FOR
SUFFOLK COUNTY uEPARTMENT F HEALTH SERVICES MELVIN HANSEN 81 JANICE HANSEN
JUN 4,1991
4UN Imrt. LY DWELLING ONLY LOT NO.25,°HIGHPOINT MEADOWS, SECTION TWO" APR. 9, 1991
yy S APR. I, 1991
DAT H.S. REF. NO. ~Ls AT SOUTHOLD DATE' AUG. 15,1990
I The sewage disposal and water supply facilities for this TOWN OF SOUTHOLD SCALE I"= 40'
location have been inspected by this Department and/or SUFFOLK COUNTY, NEW YORK No 90-0610
other' i aa'd fA~nd baspory.
t/" % UNAUTHORIZED ALTERATION OR ADDITION TO THIS GUARANTE
SURVEY O A VIOLATION OF SECTION 7209 OF THE MELVI tyl Nf
-_ChiRf 4 Bureau,of Wastewater Management NEW YORK STATE EDUCATION LAW JAN r
N COPIES OF THIS SURVEY NOT BEARWG THE LAND
SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL SU OL C~VtRJTW.N .BANK
MOT Of CONSIDERED TO BE A VALID TRUE COPY T OR ~LE AR
, GUARANTEES C MPANY
,"GUARANTEES INDICATED HEREON SHALL RUN ONLY M
HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT THE PERSON FOR WHOM THE SURVEY IS PREPARED 10
AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERN- Wl
R NEAREST WATER BAIN_MI T 14 SOURCE OF WATER PRIATE _PUBLIC_ MENTAL AGENCY AND LENDING INSTITUTION LISTED
R PUFF Co. TAX MAP MY IQOOSECTION _55_ BLOCK 6 LOT A".[ HEREON, AND TO THE ASSIGNEES OF THE LENDING
,"THERE ARE NO DWELLINGS WITHIN 100 FEET OF THIS PROPERTY INSTITUTION GUARANTEES ARE NOT TRANSFERABLE
OTHER THAN THOSE SHOWN HEREON TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT
R THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FUR THIS RDIDENCE OWNERS NM
WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT *DISTANCES SHOWN HEREON FROM PROPERTY LINES Q
Of HEALTH SERVICES. TO EXISTING STRUCTURES ARE FOR A SPECIFIC 51~. a
PURPOSE AND ARE NOT TO BE USED TO ESTABLISH FA LAND S
APPLICANT' PROPERTY LINES OR FOR THE ERiCTION OF FENCES
ADDRESS
TEL YOUNG a YOUNG R400 OSTRANDER RHEAD,NEWAYORK
E
NOTE• •=MONUMENT
SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF ALDEN W YOUNG, PROFESSIONAL ENGINEER
SUFFOLK COUNTY ON MAR. 19, 1990 AS FILE NO. 8911. AND LAND SURVEYOR N YS LICENSE NO 12845
HOWARD W. YOUNG, LAND SURVEYOR
ro *THE LOCATRIN OF Wf1.L(WI, SEPTIC TANK(ST)11 CESSPOOLS(CP) SHOWN HEREON N.YS LICENSE NO 45893
a ARE FROM FIELD OPERATIONS AID OR DATA OBTAINED FROM OTHERS
Z.B.
BRANDIS 6 SONS INC.
~G o ~~~od
BOARD OF HEALTH K„
FORMN0.1 3 SETS OF PLANS
SURVEY QSIl,
TOWN OF SOUTHOLD C11ECK
BUILDING DEPARTMENT SEPTIC 'FORM "
BLDG. DEPT. TOWN HALL
' TOWN OF SOUTHOLD SOUTHQL.Q,. L\Ly. 1101
t.pTiFfi
L/ TEL.: 765-1802 CALL
" Examined :C 19 MAIL TO:
Approved / 19?/. Permit No..~~~
Disapproved a/c
(Bui ing Spector)
APPLICATION FOR BUILDING PERMIT
Date Mcviceh 25. Ty91
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building lnspector, with
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 street
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appL
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 permi
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 Occupant}
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 applic le Laws, Ordinances o:
Regulations, for the construction of buildings, additions or alterations, or for removal or demo ton, as herein described
The applicant agrees to comply with all applicable laws, ordinances, buildin ode, housin~'c
admit authorized inspectors on premises and in building for necessary inspec ns and regulations, and tc
*(Signa ur Ilea t, r name, J orporarton)
.v.....7...x,2.30',. Gn.. yea , Al, y, 1944
.
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
buitdeA
Name of owner of premises VfZYtitj. NGC" 2tt...........................................................
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No... . . . . .
Plumber's License No. ,h~ r,IG„~~urlg;,~c~t H7~7 35-1
Electrician's License No. S fl C->e:- tL.l~ jjc~1~70I 3 3 1 :
Other Trade's License No .
I • Location of land on which proposed work will be done:
Lot X25 ftcote D& ve, Southad
House Number Street, Hamlet
County Tax Map No. 1000 Section Block , , , • • , , , , • , Lot.. 15.28
Subdivision . H.cghpoint Meadom
• Filed Alap No.
(Name) Lot..?~...........
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
A. Existing use and occupancy..... .
B. Intended use and occupancy
3. Nature of work (check which applicable): New Buildin........ Additicn .Utera
Repair Removal Demolition ..............SWT........
Tennis Court Accessory Building . . . . . . . . . . Fence .......Other Work...........
4. Estimated Cost ..Y', Fee
(to be paid on [;ling 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
Hei_lit Number of Stories
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stori es
8. Dimensions of entire new construction: Front `~Q Rear ?.0, Depth 3D........ .
Height Number of Stories
9. Size of let: Front ...:120 Pear A.................... Depth 290, ,
10. Date of Purchase 9 10 90
~ ........................NameofFormcr Owner
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation: .
13. Will lot be regraded Will excess {ill be r moved from premises: Yes
14. Name of Owner of premises -h1eevin Halweii Addresl025 Cedah ~n. Phone No. I~rZ:?$$$......
Name of Architect Address Phone No........ .
Name of Contractor ~ Fi.. Address Phone No.`.7-. ZA?3 .
IS-L& this property located within 300 feet of a tidal wetland? =YES....NO....
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimers:c:.-
property lines. Give street and block number or description according to deed, and show street names and indicate w:.::
interior or corner lot.
STATE OF NEIV,YORF L S.S
COUNTY OF...........k.....
{ C-12 i3 & l2 1 1.,1 ti 'b E L being duly sworn, deposes and says that he is the applicar
(Name of individual signuie contract)
above named.
He is the. ....4~ U I ~.t~.C~
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file th•
application: that all statements contained in this application are true to the best of his knowledge and belief; and that V:
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me (Iris
z.~........... dayo(.....N.?.R~ H......... I9'(
Notary Public, 7............ County
P, N~
PI"i''P, FU3LIC, Slate cf t0ew York 4'(Signaru a of applicant
Nc.
C~•_.i9ed in Suffolk C.unty
Ccmi)kdo.i Expire; Ian, d, 19 9
Z
I
Issues/revision.
35' - u • •
ION- fin Ci'_b•. 14~_ 1„ 4'
I
Ln
0
X7,.41 C. P
ice"" -l C/ - _Ju k ca,l2rbr~ut, p -fit2uOU11w~> J8
`N ~ n..wcMOrn,. k `o
_o ~J1p.AlegJlvl 4J m. NaTEf'J, g` -'p -~P_2.~Myr~F ~i
'~-~O\•~ ~ Mk~ bL4~,42
2 ac
rr _ Ca ~ su~eee ~
r -Ah
8 ~ "t
N O°K ~BFe. ~.wz~ 9 CC
l
=N O
~ P
4 `E z
cvccw-c~~ b •
N 8rcorLOoM'~I ~1Ct+12aM- .a acK71~;0oM ~2
A -~1~
A 21 =399 s,e
' UNq.b~•t ~ ,
i U
S -2WR w L
n l ac
LION ~JR4'!~( P~(• " 120919 ~ I •¢bb~0 ~fL0.~2 '19 f - „~/~1q~ I4 ~ 4~ry1 c.9
GCa.GDM+SR?~nR' ~(aUNG b Y'~~JNG, LIG,$URYY.YOla4 ~nl
KIVeKAelllv, N ! a ~s 3-to-~., 4, 3. z ~
' PdJG19, 1990
SG'LH, NeIDD0-5~-(o-I~J -N. ~yy
~IT~. pLAI`I / X96 - ~ II
cs
I
/ (vaco.N~ 1 (vACO.NZ) ~i'~GONY7 , 1~1.-OGI 7 ~ !5S,- Is- Uj
w
a-ttsFS zo s~-1~==
- - G~xl.~7H.IfP~iJrti"4, t L OK as ve~m~~esn
.o _a z
% b" w 4" x -I , m.. fl„rr~. 0" R[ ramyw=-?-(2.)g i2" °.4~1fl,46N .Q44- C7~CR~LN1 5a44 N 0 dyl,~ N
y Natlast -N
W
d0 puZ'1 A ~I"~~ 2ND F1-Dab ~oi5'R d
N.400 d 3 tfd 3.1 r~ / _jl I U U a5ecn ~e w r p 3
$u ep W
• client/pwnOr, i
09-1 1 S RVEn ~ON o -VC.ITG1-111 ~IIJ 1CT• l{7c T
U4111-ON 1.uv ' ED y o ca 014
FHps BEEN PPpRO .u
3. I_//rNOt/.rax~ wu Amy ~ ~
m ynlXmc~' % - u) •y~ ~ P ~ 1-1\?I.IJCi k'~l7{?M
'•,T/ X
66 ~
- _ I G~ 2., ~ .i d_`h. 6•.4i, pu'g4D,~ 4n r4•~-2u
i
4
4[trvioaM ~Ev~..cP~ X'p.:c1x~+~cc.N ,
atMLtig-va' M4u6iC, 2-4 .3-G P7 ~ N F
o~ q 1 ,o HMW~./DOD }{,ppp1.IL~ ^ `Q -4o•?G. 21 Gd prpject title: .
NOTI,~j ALL WOKK e/ -ViLL PZ 0,0Wt 1N ACCz I19V ,NCe WITH p~yL~ ~iPVUC ~fA'~~ANI'~ LLCALCOL7~
AL 4`(
W
To TNLY IJlw or~1YM_" KhjowVlpYvl PliolwE `At'o pwi*o SoNKL - - low
N`/2N JI~O~~Dy4W004Ti Trtf+..6 FAW.2 4UJH COMP(,A" W N sop
0v46~~9c;y C~~O/NSKVATof4 coots ?W~ ~oN -7814 PAD, S drawing title.
X4 E-~A .i2G~-'G--• ortirN~ izGOM :Q W44o '_04(a V
r O
67- 4 m6 i
SITS I~l-a~,l -
i--
.484to -2Wifv z
:o I_ ~K1u~1PJ7PAY~ (oIMC~-KItXV`~ ra C date. scale.
1 x0
a' 2Co-2' issue. CC
MAR 28 1991
d
thawing no.
2b3io GS ECAVI ~ P
tgpED bac i '
@~G~pt'at 1. eq ~rFC.~
f iY Y
6941 p'N Q
6 OF NFa iO
NASSAU SUFFOLK B W F,PRINTINO
.71 1
' ~ =18A Fiq`~sieioligl '1 r
. ~ ; t S'l 91 I~.^If19~, ~`F*J tR.,+aarT ~ `21
L ,
Ire"
fn~.l I 91' 'D1 M,enV~'I67F.1'Y„FF„TL ~
UGZ
J
I ~'?~24R'JI 1AG~4rf IsEL•'. r,
I
10
KICGb 6q~1m -
Svt~ 1
~o6 ~cY~P SFFIIaGLCa4 CN i PEVr b~nL~NG' parx~c ow
~e' ~nfrulyc,gwnnrEir-rn1lcu~enaeo 12
- _ ~7
2'1%4" callLntc TIC
A n%O'Fro~ to ~t EO°@ IGII O. C,
j Lh
- ~ 12'L2 Y.?~ITIN rUL_ ~ _ _ ~ Vol,
. -P%r~I-Al-t)M•G4O - E~Of tOV 1 ZSR'1'TOM, tl~' ..IOI'I~'1":S, pir3T - PWMBIN13
' kKsC%W poM~n , ~.yy~ 2~*Cd!aBIL161C .bW7.~ ~ 'i ~ 2'x V'G, JOIS75 L 14 Q.G. ALL
41N4 l- tomf W/WW(V$Mf tU'o.O.+ppAf,LiWG/y D KATER UAU NEED
I~ TESTING SEFME COVERING
a-0
aI ~G Gicp+Z) W/ I
I
- VINti'i- rt. W/CONT..VC-NTH', - ~ I^~ I
I
' ~.~q enyC INSUL, I
it _ I i(GP~"?ue - crap ap'~n4u~v~acap. - ~ _ ~ ~ I - - ?,cam- a!r' :suo~.xn.+~ PLUMBER.CERTIFICATION
r I V'r, Z, - Kaf•,1.14R~M'(§~ 1 I - E'Li"C`1'4N1 "~"JOf?'7'b Fer~cr-r_s -.,QN,LEAD CONTENT BEFORE
,2"re"1"..uKJolyfe FN I VINYL ~iloir~G - 2''x d'~.b ls-Ise14e'oc. CERTIFICATE OF OCCUPANCY
' HEAb&C O5 KPR,b, QG:'I'dLR1Y.Ib R~t~q - I
' 'III yrG'R' ~rn cel~wa SOLDER USED IN'WATER
041 rMTWWr--,jWWALI, i W/VL~~GP(Y9fJ, voM SUPPLY SYSTEM CANNOT
m EXCEED 2110 of 1 % LEAD.
I~ II !4 71
' 1 ~ Iz-'L'lp~cfr INSJL•. 'i _ I t
pY !'~R.ON PY" GQ~c PLYy~N f-LroR
' * 16 0!I NTGO $rn~NCgct~an Gl n - pp TopaFSN/Fw=K aF su~F+'>..cx71e.. f If copper tubing is used
27 for Water distributing
- o?JO' 2^+6'1 cc>10, W4ILL 4Mt,aKx -A 44 It PI~7M'f6KMll1><' -9446" ~ o?JOYdI'6 - O - TS~M Jof Jj•_•t, systems piping shall be
u 1 a0 2 No p,,,Kjl¢ _ gn-soc G0.AOC' ''T ~ K 1 o pp~ jpI'9'(5 a Po euoq~iwq aS uliaaO. of types K or L only k
IU"Odi`.-urYY.I6 77 tP/'Pt-wx,1e~G'o"7,al~ll
_ 1i1 WA+yl6 (if~QlKaWa
sI
COL- A
Y~VPJfiR1 RIEKMILI W~'rI, Z. I~ ROOM M1 W =V=WMM
~Mu 6'~O" H C". MbUWQ WNW, 'L T
OM OHIL
VA1fM'Ia'kR1BR &J 4u NYwYp
',A,ur lUU CoNC_4'pOfING $ ' 'w1MNvfi9'x t'ai'l. r!"k'Iai7PEa' ' i <r l y _ ~i P'b,
Il
_UjLC jN(l ~ 5'BC7"IC N
3 "t l ` G' (t,4, -r, e.) 6L "Al
24' a"
~'-15-
IaIaRLAIRDI'KDnnMTr' <
REQUIRED
ct_marlL.r~~gr6Kt~G ~F I i ,
1 i
~ AAA ~ "fw:t~ a -1=#~+~?~~.1 t
OCCUPANCY OR
WitJOa..I wmr
J4.,5p F-- 1- R CC ~ A _ USE IS UNLAWFUL
` - 'g LOGOT ON'S _ e., -a 00
WITHOUT CERTIFICATE ~
I
OF OCCUPANCY
' oe GJM ~ I I
II II I F¢fivlOE. ~(PE~X~ GyFTJM N~"T'~ . ° I ~ Onls~ OESIDE Au.. i eF - ~ I N I
Tv F le UILT MIRr-op_ I M-AAgj= IC'K G-nl we, F7ft " ~UFI.J6G.G.. .may, project title.
p~~( VJb rl8'
I I' P; Y + ~P flliEt? AS KdDICD
AO _9 I G I
Izz [,~zrE~i 9i B.PU-
FEE 3.% BY: _ Cawing It]@ - _ NOTIFY BUILD NG DEPART 76 T SI
I' Q 765-1802 S AM TO 4 PM FOR. THE
I I I I I 'o I FOLLOWING INSPECTIONS.
W~y~QJ, srEeL CrIR~ LY 31 L''~sTra, \C.r, ~L. I "h I~1'` . 1. FOUNDATION - TWO REQUIRED ^w {'1=pj4 ;:;~t'I,-,
CG WMN \YR1~ k' FOB POURED CONCRETE FCp-y},C4,,t,1 1'~ihutr}f
"hex Q ~YV S7L~ I I 'JD 1~`~1 UUU 2. ROUGH - FRAMING & PLUMBING 1
- I --11UU 3. INSULATION ~Yw ' 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. - - -
ALL CONSTRUCTION SHALL MEET
U)a "II THE. REQUIREMENTS OF THE N.Y..,'d . epilp 3 12. ql r tar ~<e -
STATE CONSTRUCTION 6 ENERGY a: m CODES. NOT RESPONSIBLE FOR wwfi.
DESIGN OR CONSTRUCTION ERRORS -"MAR 281991
I W diewing.no.
I
`5tERED Apc,
- F!,) U r 11 1 1 O h-1 L df~ l P4,~gERt I. agD~~~ncA A Amw
i. I y:
N r °R -ref, n0'. a
X 12'~ Pou2.E'P GONG. - Fx-rlwl u 3=n'~w
'[jt~' L7E CMIA1)lN~i/J.I'~ _0` 341 DQ'I'
FNO
NASSAU SNFFOLK BLUEPRINIING
I r'~~ 1 J
R•`I
~ I f I
~t
4 t
ti
ri
t I
I'oq!!
L[i [H
l 1
1
I
t } ~~a I I
\ 1:
of
IfiN
. ~ m a fl t -
7==F
I
! ~ t M 1M1 y 1
y~y . ~ ~T I r" r 1 1 !
\u;
1S
F.ly
W, Y..
lit
~I
I'
7~ _ _ ai . -
1
-~P ~ ~
_~JL Y,jyT^\j 1 OWM
--T.T__
1 Pi II4 ii
o\
7WJ t_t1t10:
P~
I
IBrYa
I~lAR 28 1991
!.Wins Fp,
g~EpED ARCyT
~v~ apt 1. SRO FCC ' 'Y
TF OF N00*0
I
I
I
AM-2
1P1p
<ICUV WALL C 74°D.C.
l/-W/ rzloj
II
I
~ 2~°8~1Co"oc
yrb" Iaoa. - _ -
_ 2xG@ I _~o~ I
~ _ MC~[hL JGl~If Pic j
f-G^ i
-tom' ' \ I 2xG ,
SK5 W/V3"PLY !
i
GJI~W
I \ i
rr pI tl''Q~i1~`'8s d:;e C$,ASG,"_i" _r~'!"Y`~I P,?uv ~;t I
:~EnED AI2~y~A,
G•OI 16341 DQ.f 1
OF NEW