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Home My WebLink About18785-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19865 Date APRIL 24~ 1991 THIS CERTIFIES that the buildin~ NEW DWELLING Location of Property 450 BAY H~EN LANE House No. Street County Tax Map No. 1000 Section 88 Block 4 Lot 23 Subdivision Filed Map No. Lot No. SOUT~OLD~ N.Y. Hamlet conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 9, 1990 pursuant to which Building Permit No. I8785-Z dated FEBRUARY 9r 1990 was issued, and conforms to all of the requiraments of the applicable provisions of the law. The occupancy for ~]ich this certificate is issued is ONE FAMILY DWELLING WITH ATTACHED GARAGE & DECK AS APPLIED FOR The certificate is issued to STEPHEN & ELLA SCHMIDT <owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 90-SO-03-APRIL 15~ 1991 UNDERWRITERS CERTIFICATE NO. N-143402 - JULY 31~ 1990 PLUMBERS CERTIFICATION DATED APRIL 22~ 1991 - HARDY PLUMB. & HEATING Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT CrHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF TIlE WORK AUTHORIZED) N9 18785 Z Permission is hereby granted to: ..Z..,e...~.~.....~.~...~ .................................... .~.~~....~.:....%...!..L,..~../ ........ ,o at r~,,,~,e, ~ocot~ at ....~..~...~...~......~ ................ , ...................... .... .............................................................................................. County Tax Mop No. 1000 Section ....... .~.. ,~..,'~., ...... Block ........ .,0,,..~ ...... Lot No ...... .~.,~ .......... pursuant to application doted ........................ ~~ .~. ................ , 19.~...0..,, and opproYed by the Building Inspector. Rev. 6/30/80 Form No. 6 TOWN OF SOUTIIOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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. 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. 0. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $Z5.00, Accessory building $25.00, Additions to accessory building $25.00. Busimesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $i0.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 few Construction ........... Old Or Pre-existing Building Locagion of Property ........... ..... /__~¢~ ~.~; .... ~ , . House No. Street Hamlet )nwer or Owners of Property ............................... ... ... .. . . .. ... ... . .. . ~ealth Dept. Approval ........................... Underwriters Approval ...................... .. . 'lanning Board Approval .................... .... Final Certicate ........... ~- ~ ~- "4 lequest for: Temporary Certificate ....... ~i~ 'ee Submitted: $ ................... i..'''' ,i -///~//~/~~ ............................................... OI~F~CE OF B:~d'I~LD~G TO~¥N I-LLLL £OUTH. O: D, ~.y~ 1: 1.971. T-EL. 765-I 802 CERTIFICATION DaSD APRIL 22, 1991 Building Permit No. 18785 Owner WINDS WAY/SCHMIDT-BAY HAVEN (please print) Plum~er HARDY PL. & HTG. NORTH, INC. (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (pluraber's signature) SwOrn to before me this '" Notary Pu'b i ~cd Nota:7 Public, ~-~,_ .~!~/'~ .County ?OU~D~T~ 0.~ ~ ~ .st ) II ?OUNDATI0,'~ f 2nd ) 2. EOUGH FRAME & .FLUMBING iNSULATION FER.N. Y. STATE EHEEGY CODE FILIAL ADDITIONAL COMME~ITS: /W/q ~ o,'-- ,& o ~ ,Wo. Z 8 765-1802 BUILDING DEPT. INSPECTION [ F~OUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL REMARKS: ,~~,~,~ DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND ~j~SUILATION DATE 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDA~TION IST [ OU~~GH PLBG. [~~A~i'ION ZNO [ ] INSULATION [ ~FRAMING [ ] FINAL 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FO.UNDAT~ON 1ST [ ] ROUGH PLBG. [~OUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: DATE INSPECTOR FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N,Y. 11971 TEL.: 765-1802 isapproved a/c ..................................... (Building Inspector) AP?LICATION FOR BUILDING PERMIT BOARD OF HEALTH ,~;~"~ ~' .... SURVEY .,. ..... ~:~.' .... .:¢-:....qKq> ..... SEPTIC FORM .... ~'.~ ....... NOTIFYI CALL MAIL TO: Date ................... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the BuLiding Inspector, witl sets of plans, accurate plot plan to scale. Fee according to schedule. h. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stre or areas, and giving a detaiIed description of layout of property must be drawn on the diagram which is part of this apl 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 pen 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 a.ny purpose whatever untiI a Certificate of Occupan 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 t Building Zone Ordinance of the Town of Southold, Suffolk County,. New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, ad. ditions or alterations, or for ~;cmoval or demolition, as herein describ( The applicant agrees to comply with all applicable laws, ordinances, building code, housin~ code, and regulations, and admit authorized inspectors on premises and in building for necessary ins?~s,~t~...~. ~_,./~ <~.~,~- ~, . . '(§~natur~-' "~'oi' hpplic~nt,jS; ..... ' (Mailing address of applicant) State whether, applicant is owner, lessee,o agent, architect, engineer, general contractor, electrician, plumber or.build<___ ........ .................................................... Name Of owner of premises... Zf/k"7.?~'tJ~... jt~. )'~ :~ .~.~. ..................................... (as on the tax roil or latest deed) Ir applicant is a.~ao~gI~t~e 9~duly authoriCd officer. .... Builder's License No ........................... Other.Trade's License No .................. .. .. I. Location of land on which proposed work will be done: tlouse Number Street County Tax Map No. I000 Section ...... 0.~..~.':'-- .... ' Bl'ock....~.. (Name) Hamlet Lot °. .2 ' ........ Lot .......... 2. State existing use and occupancy of premises and intended usc and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy . · · ~- ' .... . ...................... 3. Nature of work (check which applicable): New Building .......... Addition .......... AJteration ...... Repair ........... .... R~moval .............. Demolition .............. Swirmitv~l:~3..~,~,~r~r~ a-~, .... Tennis Court ........ Accessory Building .......... Fence ....... Other Work; ....... 4. Estimated Cost ....... ! .~...,..~.,~ .................. Fee ................................... . (to be paid on filing this application} 5. If dwelling, number of dwelling units .Ffly:%~. Nnmber of dwellhlg units on each floor .... If parsee number of cars ,~. ......................... 6. If business, commercial or mixed occupancy, specify nature and extent o f each type of use .. ?. Dimensions of existing structures, if any: Front..,............ Roar ............... Depth .......... . .. Height ........... Number of Stories ........................ Dimensions of same structure with alterations or additions: Front Rear ............ Depth ...................... Height ................... '. Number of Stories. 8. Dimensions of entire new construction: Front .... ~/'~,g.~ ~ '~ -- ' '/ ......... ": '~ ~' ' -e,' · ...... Rear ...J.4' ........ Depth .. ,c./.~:.o. .... Height ..... /{<,' ! ...... ,Number of Stories ....... . .~'*~"9:'...; ....................................... 9. Size of lot: Front ............ ear ...... ' ....... De ..... 10. Date of Purchase .... . ......................... Name of Former Owner .......................... 1 I. Zone or use district in which premises are situated ......................... t .......................... 12. Does proposed constructiq>~ violateeany zoning law, ordinance or regulation: ...~..o, ........................ 13. Will lot be regraded ... ~../i~/'t'.~. . . ./~o. g..~ ........... Wiil excess fill be removed from premises: Yes .... N 14. Name of Owner ofpremises . ~'~..~t-a4 ~[~. t.~. ~:~.~"TAddress ....... .~.-.~ L~'. Phone No ............. Name of Architect .... L' ..................... Address ..................... one ............ LL ': ame Contracto .L-(.. 5 .%... ^da e ........... ..... ,,-.. '. 15.Is this property located wlthzn f'00 feet of a tidal wetland? *YES .... NO.-~.- · If yes, Southold Tox;n Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, and, indicate all set-back dimensions fro~ property lines. Give street and block number or description according to deed, and show street names and indicate wheth( interior or corner lot. STAT OF SeW ¥ORr, S.S COUNTY OF/ .............. · t. ..................................... being duly sworn, deposes and says that he is the applicar (Name of individual signing contract) above naa'ed. · lie is thc ..... . ~ ...................... : ............................... - (Contractor, agent, corporate officer, etc.) -' of said owner or owners, and is duly authorized to pe,fform or have performed the said work and to make and file th application; that all statements contained in this application are true to tile best of his knowledge and belief; and that th Work ~vill he performed in the manner sci forth in the application filed therewith. Swum to before me this Notary Public ................ M-¢~ ...... Countr LINDA J. COOPER N~tary Public, Stere of New No. 4822563, Suffolk County3 ~c2 Term Expires December 31, 19 / · (Signature of applican' '"'" SUFFOLK CO. HEALTH DEPT. APPROVAL STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DIS~AL ~ SYSTEMS FOR THIS RESIDENCE WILL ~ CONFORM TO THE STANDARDS OF THE '~ SUFFOLK CO DEPT. OF HEALTH SERVICES. APPLICANT ~ ' SUFFOLK COUNTY DEPT. OF HEALTH SERVICES -- FOr APPROVAL OF CONSTRUCTION ONLY DATE: ~/ APPROVED: , , , SUFFOLK COUN]Y DEPARTMENT 0F HEALTH SERVIC~ . ~NGL~LY DWELLING ONLY SUFFOLK CO TAX "AP DESIGNATION: BLOCK ~AT~ [ S Igg~.S. REF. ~0. ~ O!ST. SECT. PCb Tile sewage disposal and water suppiy facilihes Jar this location have been inspected byffis Oepa~ment 8nd/or OWNERS ADDRESS: other age~ a~d foun~to be ~tisfactory. ,. Chief of bureau of Waste~ter I 'TEST HOLE STAMP ...... ~ab.~. 1~90 RODERICK VAN T_UYL, PmC, - 8?990 LICENSED LAND ~RVEYORS t~ :, _- . .,)>' RODERICK VAN TUYL, P.C. LICENSED LAND SURVEYORS GREENPORT NEW YORK STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT OF HEALTh SERVICES. SUFFOLK COUNTY DEPT. OF HEALTH SERVICES -- FOR APPROVAL CONSTRUCTION ONLY DATE .... APPROVED: ,, , SUFFOLK CO TAX MAP DESIGNATI'oN:' DIST. SECT BLOCK PCL. OWNERS ADDRESS: DEED: L. P ~ ~E~T HOLE STAMP ,.~TEF'H£b.I 5CHWi/L')7' RODERICK VAN TUYL, P.C. LICENSED LAND SURVEYORS GREENPORT NEW YORK It !~l~'he applicant"~'responsibility to malntaj, n~.acJ,equ.a_te sanitary distance betwee-r~ll 'w~r supply and sewage _disposal facilities. THE ~[I~L3~AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONSTRUCTION ONLY O~T~. FE~ 08 SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT BLOCK PCL. ~WNERS ADDRESS: DEE~.L. P. HOLE' .... S'TA~IP ' SEAL Iv; PLUMBER CER ON LEAD CONTEt',', SOLDER uSED IN SUPPLY SYSTEM EXCEED 2/10 o~ OCCUPANCY OR USEIS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY PLUMBING FU,,IMBING WASTE & ~.TER UNE'8 NEED 1E6'nNG BEFORE COVERINQ l