HomeMy WebLinkAbout18474-z
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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 8-23143 Date AIIGIIST 4, 1994
THIS CERTIFIES that the building ONS FAMILY DWELLING
Location of Property 425 SECOND AVENIIS PECONIC, NY
House No. Street Hamlet
County Tax Map No. 1000 Section 67 Block 2 Lot 14
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTStIBER 12, 1989 pursuant to which
Building Permit No. 18474-Z dated SEPTEMBER 12, 1989
was issued, and conforms to all of the requ iremente of the applicable
provisions of the law. The occupancy for which this certificate is
ieaued is FOR A ONS FAMILY DWELLING WITH ATTACBBD DECK AS APPLIHD FOR.
The certificate is ieaued to RICHARD SEYMOIIR
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 88-SO-143 APRIL 25, 1994
UNDERWRITERS CERTIFICATE NO. 8039679 MARC$ 3 1994 & 8041800 JIILY 18 1994
PLUMBERS CERTIFICATION DATED MASTER PLDlIItING JDNE 1990
Building inspector
Rev. 1/81
f'O8M NO, f
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MU5T BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N° 18474 Z Date .~f..~ 19..JS.?..
~~~~5~ ~
Permission is hereby grouted to:
....9~ .7....~.~
.................~......~~r..............
ro ...~1~..~k.. t~'"'t"
ct premises located at ....~i~.r,~......W~..~~
............................................................................~.y..................................................................................
County Tax Map No. 1000 Section ..........fem../........ Block ........`~~............9Lot No.,l~
pursuant to application dated ..........,,Y~.~~ 19.~/.., and approved by the
Building Inspector.
i~ '
Bu ng {nspector
am.~.ncl-t2c~Q ~62.' 2~-~'S'~,1 d4-CK
~ Pc~cck y ~ ~>13 ~ ~ t> ~ 4~~ ~ ~
Rev. 6/30/80
FOB3i NO. p
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILbiNG PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N° 12502 Z Date { ,~.3
.9..~s~..-3
Permission is hereby granted to:
. . . . . . . . .
/.1.
. . . ~b
~
j . . . . .
......................~~:....h.....~:~....... r~ 73~
q...... ~ p?'~.„."t~
~!t~..~,'......7550 Z-~.(......~!?.~....~.°.....~,'/"'/oil//.~..~'....~~N""K®..~iPa~~a.,da.~i...7~a3/Ps
at premises located at ............/...O~J,~.......~~o'Y'N.......` :~!:L. ~e ~ .
qq
County Tax Map No. 1000 Section Block .............5?5.... Lot No.....r!~.............
pursuant to application doted 19........, and approved by the
Building Inspector.
d
Fee
....:.:"l.:r...
Building Inspector
Rev. 6/30/80
4 Lo~ ~S / ,~/~c.~1U Y- _
/ ,
"T`Grf/~ /'z l y~ SG~'1 . Form No. 6 h,ti- L~l i
~.A ~1'~~,//~ Z ~ r'"~ TOWN OF SOUTHOLD
~•~-.-y,/a'4 D~. ~ - BUILDING DEPARTMENT
e / TOWN HALL
ctL Cw..;~~+`eR5/+Z-.~-,E~.~F-:c.~ 765-1802
l/ r-.~~~4/
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typ,:writer 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_Dent. 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.
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 dwelling $25.00, Swimming pool $25.00, Accessory building $25.00,
Additions to accessory building $2$.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
New Construction........... Old Or Pre-existing Fuilding .
Location of Property.........? L.~ ~.V.'~.-..........~~.G°.`.'::~~:.
._,•House No. / Streett Hamlet
Onwer or Owners of Property....... ~~:4:h-.~v~~....~ :..•~~~1.!"::':`.t-.'~
County Tax Map No 1000, Section ..............Block....../..........Lot..... Z
Subdivision.....(........... ...............q../....Fpilged Map...........].~Lot...\..
Permit No...~4.~.~~~...Dat S Of Permit. J~/~~~®./......Applicant.. /::C~{~ld.. ~~C1QkteOr..... .
/ ~
Health Dept. Approval....~~F ...................Underwriters Approval....... G................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate... '
Fee gS_u~~bm~i)tted: I . r'
G~~: ~3t~3 - APPLICAN
c1ELD I:• .-C~-v:J (fUnY= IIII .:UMi9E:NT~
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FOUtJDATIO:I (t st) ~
- - ~ ~
FOUtJDATIOIJ (2nd) m
2. ~
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/ 0
ROUGH FRAME !l ~
PLUMBING
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ti
3. ~
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IIJSULATIOt! PER N. Y. • •
STATE EIfERGY
CODE
F I;] A L _ ~aLti
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E
ADDITIOPSAL COMMEPJTS:
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INSPECTORS ,r ~
~~~~tiPFU(,'f
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r~~` ~ 2 SCOTT L. HARRIS, Supervisor
Thomas Fisher ` " ~ Southold Town Hall
' it ~ P.O. Box 1179, 53095 Main Road
Building Inspector c";s~-=~"' r
, t~`r Southold, New York 11971
Gary Fish '•~d Fax (516) 765-1823
Building Inspector Telephone (516) 765-1800
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
C E R T I F I C A T I O N
DATE : ~ /
Euilding Permit No. / Z"
Owner: ~1C~1/'~l' ~e-9/Yll~!!l~
(please print)
Plumber: ~~S/Z, ~G~i'~/J/ ~L''~ -
(pl ase print)
I certify that the solder used in the eater supply system
contains less than 2/IO of Ix lead.
(Plumber ignature~
/'~r~ ~o~G~~
Sworn to before me this
t¢ day of 19'
Notary Public, County
Notary Public
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FOEM NO. 5
TOWN OF SOUTHOLD
BUlLDlNG DEPARTMENT
TOWN CLERK'S OFFICE ~ "
SOUTHOLD, N. Y.
ORDER TO REMEDY VIOLATION
Date ~3 +7~
19........
TO ........................................i.................................
(owner or authorized agent of owner)
I ! i-If)LL'{ ~~t/Et >=AS't 1`ro2-r~tl~'a7i-ri fit. f 173
(address of owner or authorized agent of owner)
PLEASE TAKE NOTICE there exists a violation of:
Zoning Ordinance ~bf?I ff
Other Applicable Laws, Ordinances•or Regulations
at premises hereinafter described in that ~~~r~"'"r~. 'yJ~ Z-
(state character of violation)
~i r 1 ..,-¢i uv L' r^C ~ ~ .~c~ ~ ~ r }~r~ ~ c ~ I tip.... J
a ......~?:.....~....~,.:...r..~~.........k ~~Q
,c/ ro-fY~ ty
in violation of .....frt'.Cf~~..~~~.....~Cly nfCr J4`f~'"T f
(State section or paragraph of applicable law, ordinance or regulation)
YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the law and to remedy the
sT
conditions above mentioned forthwith on or before the
f~77i~t ` ,
day of 19.ra..3
The p~~^^remises`` to/nw~hich thi RDER TO REMEDY VIOLATION refers are situated at
~fo`t.1 J1 cc;t1[~ L~ ~ cavuC-
..~y .................County of Suffolk, New York.
Failure to remedy the conditions aforesaid and to comply with the applicable provisions of law
may constitute an offense punishable by fine or imprisonment or both.
Y-r~c(r ae lr/1~-r rny~i
o~, ~ ~ I u~~eJ .7~u.ld'.~.f ~ o'~ ~*~.~1' ~
r!„ (~~lG / A.r /~'k~ SAG n,-, R- sue`. G ~ ='~~C/-r:d ~Cr,~
Building Inspector
~ cow 8 f' 7 sso z-
. .
25 Garfield Avenue
Farmingdale, N.Y. 11735
1 October 1982
George Fisher
Town of Southold
Building Dept.
Southold, N.Y.
Sir:
I am writing your office to seek help and bring to your attention a situation
which exists on the property adjoining mine at Second Avenue, off Mill Lane in
Peconic. The property in question is Lot 28 on Map 654, Map #2 of Peconic
Shores, the owner of which is Mr. R. A. Seymour.
The house and property seem to be in a state of abandonment. The house has
been vandalized several times, once to the point where a fire was started in the
house. Local police have been notified of the situation as has the owner Mr. Seymour.
To date, nothing has been done to correct this situation, and this uncompleted
structure has become an eyesore to the neighborhood as well as a danger to the
surrounding homes, since if left in a state of abandonment, it is highly likely that
it will be vandalized again.
I would appreciate it, if the building department could look into this situation
and possibly do something to remedy it.
Respectfully,
~ 07 p
Edmund Borgo
E B:lao
' t-' ~ S A.
FORM NO. 5
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
ORDER TO REMEDY VIOLATION f"~ ~~r!!tt
Date 19..tJ~
TO
(owner ar authorized agent of owner)
f 1 t-It1Ll`{ ~5~'~JEt ~AS"f r*Ihl~7-fli'nl~-rl N. Y, f 4 73/
(address of owner or authorized agent of owner)
PLEASE TAKE NOT{CE there exists a violation of:
Zoning Ordinance 70NI hi
Other Applicable Laws, Ordinances•or Regufotions
at premises hereinafter described in that ~ t 7
(s~tjate character of violation)
~~~........-~.'..k.~t''~K ~t^(ti c?( t1.Rt~~~. 1..........~.?, llei,; ~1e.,.v,~{ t;, ~y,,,,~e~.
.
oo . , . . .
in violation of .....:G2'!.9 .~'t...~L.t)......^~~.'.C(~.nle"r .A.t~......~.~~.~Tfyl
~P-
(State section or paragraph of applicoble law, ordinance or regulation)
YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the low and to remedy the
conditions above mentioned forthwith on or before the .....................................................~ST.......
r'tc r L rte ~ .
day of 19........
The p[[^^remises( to which this-O,R,,DER TO REMEDY VIOLATION refers are situated at
~fa`25 J~ cc tX~" ~.cva ~ cs~vuC
..~y .....County of Suffolk, New York.
Failure to remedy the conditions aforesaid and to comply with the applicable provisions of law
may constitute an offense punishable by fine or imprisonment or both.
t'~n[Pr,ce R,IJ7 ' Cec~t^~ .Fcr~- Fte~?~+c~ll~e
~ ~a'r~x4'r'
Building Inspector
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765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING FINAL
REMARKS: s/j1fl~°~O ,~~C~ a~/~ ~~~ar~-~-c
~G~/oay a~ ~ s~i~.lO,e~ ~.~f~x-
c.Y'/+~~z--
DATE L3 / INSPECTOR
~~~7~ _
765-1802
BUILDING DEPT.
INSPECTION
[ J FOUNDATION 1ST [ J ROUGH PLBG.
[ J FOUNDATION 2ND [ INSULATION
C J FRAMING [ ]]--FINAL
REMARKS:
C.~~
DATE l 3 ~ INSPECTOR
765-2802
BUILDING DEPT,
n
INSPECTION
[ ]FOUNDATION 1ST [ ) ROUGH PLBG.
[ ]FOUNDATION 2ND, [ ]INSULATION
[ ~ MING [ ]FINAL
REMARKS: 1~ d~
Y"
1 <~~""~'~f'
DATE ~ INSPECTOR Nom"!.
~ ~ 765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST p--]"F~OUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING ~ ]FINAL
REMARKS:
DATE t INSPECTOR L
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FIELD INSPECTIONDATE COMMENTS
1 . . ~ B_r 7 5So z-
_ FOUNDATION , ( 1st ) ~
1
v
FOUNDATION (2nd) _
2.
c
ROUGH FRAME &
PLUMBING
H
3. ~
m
INSULATION PER N. Y.
STATE ENERGY
CODE
x
a
3
r
4. y
FINAL
ADDITIONAL COMMENTS: ~
x
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H
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H
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
ORDER TO REMEDY VIOLATION ~j
Date °~3. 19."~
S~YM OU I~ f~~cHA~D A
ro .......................................F.................................
(owner or authorized agent of owner)
H o ~.~~~....~~J~.,... F!~s.r.....~`.!oizttl i'v-re-r-I N Y. 7 3 ~
(address of owner or authorized agent of owner)
PLEASE TAKE NOTICE there exists a violation of:
Zoning Ordinance Z6 NI h( (r-
Other Applicable Laws, Ordinances•or Regulations
at premises hereinafter described in that ~~d/""~ lay~~ ,7 5Jrr7
~ 3.JG ~ ~ ~~1,\,,\), t~hara(~ct,,e~~ala~
ion)
~ ~
/ 4"""'
in violation of `""`/'.':9. ~O(~.~n(G /~2"7..~_ .....~C~O-!Y~ l~
...~~.v........
(State section or paragraph of applicable low, ordinance or regulation)
YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the law and to remedy the
conditions above mentioned forthwith on or before the ......................................................~:ST
day of pr'?( l._....., 1983
The premises to which this
ORDER TO REMEDY VIOLATION refers are situated at
~o2~J ~ County of Suffolk, New Yark.
Failure to remedy the conditions aforesaid and to comply with the applicable provisions of law
~ moy constitute an offense punishable by fine or imprisonment or both.
Y~nc%-aY Cf,L~i t«~ix~n ~ 114~`•/,.2u~1d.~.v\~ ~'l.aR-tin.,~T- ~
clv~ C~.cll / .Gn .Z`~+r~2'caT~ -x~Pcav. ,a Qom/
R.LL a~'d S~a wS Y~~cv ~ ................e........s..............................,...................
A'ty 0 ~ Building Inspector
q.d' GaT A/a Zf~ maw !Z'c. L o
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pt~d.~:~ Soo-s s= ~ ~,z~. .
1
I ~~FF~~C TEL. 765-1802
00 Opy TOWN OF SOUTHOLD
~c OFFICE OF BUILDING INSPECTOR
~ ,T P.O. BOX 728
~ ~ TOWN HALL
SOUTHOLD, N.Y. 11971
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TEL. 765.1802
O~c,~Ff~(kCpGy TOWN OF SOUTE30LD
OFFICIi OP IIUILDiNC INSPECTOR
~ P,O. BOX 728
TOWN 1{AI.L
O~~ SOUTLEOLD, N.Y, i 1971
1 ~ ~
'this is to advise you thaC the job under building
pcrrrtit no. 125022 issued to Richard Allen
on _~(_~~g~V for New Dwellin is completed and
a Final inspection ha:: ( ) has not ( X been done.
1n order t.o complete this file, it is necessary that
a Certificate of Occupancy be issued. Please fill out the
encl.nsed form, return same to [he above office with a check
for $25.00 p+ryablc [o ttie Town of Southold. Please indicate
to idhom the Certificate of Occupancy is to be mailed, and
arrange w{th Chis office fur an inspection date .
Occupancy or use is unlawful without a Certificate of
Occupancy. E'lease-help us to clear up this matter so that
legal action does not have to be taken.
Thank you Enr your prompt attention.
VerylI .~~t.ruly
y~,
~C~
Victor Lessard
Executive Administrator
Vl.:gar
encl.
TF.L. 7GS-1802
oSS~FFD(I~CpG TOWN OF SOUTHOLD
OFFICE OE BUILDING INSPECTOR
~ Y.O. BOX 728
TOWN I{ALL ,_....,.e""°,
O ® 0~ SOUTHOLD, N.Y. 11971 s 1 ~ ~s~,-;r~
~~1 ~ t; °i s
1861 g ! adV ~ i~ ,
s, g i
- . .
This is to advise you that the job under building
perrni_t no. 125022 issued to Richard Allen Seymour
on X123/83 for New Dwellin is completed and
a final inspection has ( ) has not ( X been done.
In order to complete Ctris file, it is necessary thaC
a Certificate of Occupancy be issued. Please fill out the
enclosed fo nn, return same [o [he above office with a check
for $25.00 payable to the Town of Southold. Please indicate
to Whom the Certificate of Occupancy is to be mailed, and
arrange witty this office for an inspection date .
Occupancy or use is unlawful without a Certificate of
Occupancy. Pleasehelp us to clear up this matter so thaC
legal action does not have to be taken.
Thank you for your prompt attention.
Ve~ry -{t-~r~uly your ,
. 1 .t C.~"_
Victor Lessard
Executive Administrator
VL:gar
encl.
FORM NO. 6
TOWN OFSOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
765 - 1802
APPLICATION FOR CERTI FICATE OF OCCUPANCY
Instructions
A. Tliis application must be filled in typewriter OR ink, and submitted ®®to the Building Inspec-
tor with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal-(S-9 form or equal).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa-
tions, acertificate of Code compliance from the Architect or Engineer responsible for the building.
5. Submit Planning Board approval of completed site plan requirements where applicable.
B. For existing buildings (prior to April 1957), Nonconforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of px»perty showing aN property tines, streets, buildings and unusual naturai or
topographic features.
2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
C. Fees:
1. Certificate of occupancy New Uwellin~,$25.00, Accessory -$10.00 Business $10.00
2. Certificate of occupancy on pre-existing dwelling ~ 50.00
3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00
4.Vacant Land C.O. $ 20.00
S.Uadated C.O. $ 50.00 Date
6. Alteration $25.00
NewConstruction,,,,,,OldorPre-existing Building Vacant Land
Location of Property
House No. Street Namlet
Owner or Owners of Property .
County Tax Map No. 1000 Section Block Lot .
Subdivision .................................Filed Map No. ..........Lot No.
Permit No........... Date of Permit ..Applicant .
Health Dept. Approval ........................Labor Dept. Approval .
Underwriters Approval ........................Planning Board Approval .
Request for Temporary Certificate .....................Final Certificate .
Fee Submitted 5
Construction on above described building and permit meets all applicable codes and regulations.
Applicant
fiav. l0~tP78
TEL. 7G5-I 802
~SVFFQ~Cp TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
~ TOWN HALL
`"p~~ ~O.r SOUTHOLD, N.Y. 11971
1,X.~
April 17, 1987
Mr. Richard A. Seymour
957 Hawkins Avenue
Lake Grove, New York 11755
Ae: Building Permit (f12502Z
Richard Allen Seymour
Dear Mr. Seymour:
Since Che above building permit expired on January 23, 1985
and you have not completed construction, we are voiding the permit.
When you wish to resume construction, kindly re-apply to this
office for a new building permit. We will need all new paper work.
Very truly yours,
S thold To Build//ing Dept.
Victor Lessard,
Executive Administrator
VL:gar
z
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/~S /~34rBP7s „SP° NOTET
o t ~ ss e 7 ~ • =MONUMENT
P~? G° f+ SUBD/V/S/ONMAPF/LED/NTNEOFF/CE
p ~ p / OFTHECLERKOFSUFFOLK COUNTYDN
SEPT. /5,/930ASF/LEN0.654.
REVISIONS YOUNG & YOUNG
_ JULY 19,1974 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK
ALDEN W. YOUNG HOWARD W. YOUNG
PROFESSIONAL ENGINEER AND LAND IIURV EYDR
LAND SURVEYOR, N.Y.S. LIC. NO. 12343 N.Y.B. LIC. N0. 43893
SURVEY FOR:
UNAUTHORIZED ALTfRATIDN OR ADDITION TO HARRY SEY MOUR
THIS 9UflVEY IS A VIOL AT10N Oi SECTION
L20.W9 OF THE NEW YORK ST4TE fOUCAT10N LOT N0. 28,11 MAP NO. 2 OF PECONIC SHQ
COPIES Of THIS SURV FY MAP NOT Af 4RING ,J gyp'.. q, tiY~); ~
*MF LAND SURVE YOfl'S INNED 5E4L OR ~ ~ _ Y
•EMBOSSED SE4L SH4LL NOT BE CONSIDERED - ~ - - -
TD BE A v4uD IRUE COPY AT GUARA NT p:
PECONIC
--~t.,.yy
GUAfl ANTEES WDIL0.TED HEREON SHALL PUN ~IQ.,,, I~~.~CL
ONLY TO THE PERSON fOR WHOM THE TOWN OF SOUTHOLD ~ m ~ ~''`"*71
SURVEY IS PREP4flE0, AND ON HIS BEHALF I ' .y-t.YfL.cls~
TO THE TITUE COMPANY, GOVERNMENT4L - - - - - ~ ~ . -
4GENCY 0.ND LENDING INSTITUTION LIBTED EiY ~L" a
HEREON, 4N0 TO THE 4551GNEE$ OF THE SUFFOLK CO., N. Y. „a
LENDING INSTITUTION GUARANTEEA ARE - d.
NOi TRANSFERABLE TD ADDI TION4L SCALE: II I DATE: ti dj
INSTITUTIONS OR SUBSEQUENT owNER3. I = 30 ,DEC. 10, (973 _ I''
-
%RF1'1 SIS; S_Tl dGSflA•
. ull~~~ • 1'!~.:
~ FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
Examined ........~f?'.nJ...., 19 ~ Application No.... 7~~. U...... .
Approved 7/~7.., 19 a/Permit No...~a~.:~Q.~ ~ !u-~n~e '75`jD Z-
Disapproved a/c .
. a,0
~
dM .
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date ..............c...., 19
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, 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 stze
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this app
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 pern
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 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, additions or alterations, or for removal or demolition, as herein describ:
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and
admit authorized inspectors on premises and in building for necessary inspect' }ts.
(Signature of applicant, o ame, if a co/rporation)
r (Mailing address of applicant]
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build:
wt~.. ~v-
.....~gt ..................nn...............................................
Name of owner of premises P?. J ~ ~1 ~ < ....S.L Y`'- °
(as on the tax roll o latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer) '7 J _ r,-/ i/~ / SD^ / D/
T.ceitG(//I .UQ L _
Builder's License No . .
Plumber's License No . .
Electrician's License No . .
Other Trade's License No . .
1. Location of land on which proposed work will be done. y Z:~...5~. c ° ~,e c , ..:G
~ a ~'Z.
House Number Street Hamlet
County Tax Map No. 1000 Section .....G.7 Block Lot
Subdivision . °-^c°:`f'.`.. Filed Map No. ~`~~.•Y. Lot
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ......N".':` ~
b. Intended use and occupancy F'~`:5.4...... Ft!4G.... ~ U.gc.. d:~P.-r .
Scf, .-....-....^,i ~u...S yL . .
_ l
Nature of work (check which applicable): New Building Addition ~ Alteration .
Repair x.......... Removal Demolition ..............Other Work .
(Description)
4. Estimated Cost ...~i:: J- Fee ~.~r'.. .
(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 .........................................................~v........... .
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 .......Zr.............................................. .
Dimensions of same structure with alterations or additions: Front S`.""~...... Rear .
Depth ......................Height ......................Number of Stories .
~8. Dimensions of entire new construction: Front Rear ...............Depth .
Height Number of Stories .
9. Size of lot: Front ,~i? ..~!!.`.S`.?? . Rear o.... Depth . a
10. Date of Purchase .............................Name of Former Owner .
11. Zone or use district in which premises are situated .
12. Does proposed construction violate any zoning law, ordinance or regulation: ....y.~° .
13. Will lot be regraded ~ .S ...........Will excess fill be removed from premises: Yes Nc
14. Name of Owner ofpremies..!<«~`.'~:d:•.54~~~rddress./.'~°flr.,A';t<~~.~j,PhoneNo...~Eft..3l~~.
Name of Architect ...........................Address •.r.I. Phone No.............. .
Name of Contractor ..........................Address ...................Phone No.............. .
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fron
property lines. Give street and block number or description according to deed, and show street names and indicate whethe
interior or corner lot.
C" ~
STATE OF NEW YORK, S.S
COUNTY OF Sk c`~.~1 k, . ,
~ " ` being duly sworn, deposes and says that he is the applica
(Name of individual signing contract)
above named.
w'^-~'-
Heisthe
(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 ti
application; that all statements contained in this application are true to the best of his knowledge and belief; and that t
work will be performed in the manner set forth in the application filed therewith.
Swom to before me this
zS L?~...........day of i'!1."<'.' 19 a3
Notary Public . County
(Si ture of applica
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~AO7s ~ J.;.Y` NOTE
o I ~ I • =MONUMENT
~c~ LQ?+° SUBD/V/S/ONMAPF/LED/NTH£OFF/CE
o#o / OFTHECLERKOFSUFFOLK COUNTYON
SEPT !5,1930 ASf7LE N0.654.
REVISIONS YOUNG & YOUNG
JULY 19,1974 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK
A LD EN W. YOUNG IiOWARD W, YOUNG
PROFES610NAL ENGINEER AND LANG eURV[YOR
LAND SURVEYOR. N.Y.S. LIG. NO. 12843 N.Y.S. LIC. NO. 488D3
SURVEY FOR:
UNAUTNORIZEO 4LTERATION OR ADDITION TD HARRY SEYMOUR
THIS SUfl VEY IS 4 VIOLPTION OF SECTION
L2AW9 DF THE NEW YORK STATE EDUCATION LOT N0. 28," MAP N0. 2 OF PECONIC S
~ of NF/V
COPIES OF THIS SURVEY MAP NOt GEARING
THE LAND SURVE YOR~S INkED SEAL OR ~ S~,~Yp ~w\ " ~
•EMGOSSED $EPL SHALL NOT GE CONSIDERED _
TO GE A Vq UD TRUE COPY AT PECONIC GUAR T ~ ffE)i 1 ~ }
irv y": .Js
GUARANTEES INDIC0.tED HEREON GNdLL RUN
ONLY TO THE PERSON iOR WHOM THE TOWN OF SOUTHOL~ I-tt I b
SURVEY 19 PREPARED, AND DN HIS GEHAIF O V 1 •
Tf THE TITLE COMP0.NY, GOVERNMENTAL Y~
AGENCY AND LENDING INSTITUTION LISTED BY x~~:.!•~•~""•' _
HEREON, AND TC THE ASSIGNEES OF THE SUFFOLK CO., N. Y. h.
LENDING INSTITUTION GUARANTEES ARE
NOT TR0.NSFERPBIE TO ADDITIONAL SCALE 11++ + DATE:
INSTITUTIONS OH $UBSEOUENT OWNERS, 1 = 3O DEC. 10, 1973 " !.3(:^"'Y-~ .
K&E 17 5153 5_>3 d05BG•
8 ~ Sa ! 43
LL _ q0' _ _ WELL 2>' IIE' ~f CP.
( DWELLIN01 I ( DWEL'_IND, ( DW ELLIHO)
C P. LOCATION UNN NOWN) CP, LOL~UHKNOWNI
W E'_L
S UBDIVI SION - IN BASEMENT
PECONIC SHORES"
~ LOT 19 SUFF. CO. FILE N0. 117 LOT 21
Lor zo f~
.t_ I N.54°32~3011E.~ 50.00` ~ ° .I, 3_9 _ 135'
tr I C M. {jw P/ L ° FllcP / PI PE
be {i//cd ~ /O ~ 'j 6,3 ~
c t' <t'
O ( DWELLING I
W/7`~7 C I' , C 1' t t' c/ O
OW~lCrs ~ _ u1Ge,,~ f WELL OVER 150'1
rQCrMIb}/UTI O P/G~ I O
~ °y3 .1 a' LOT 25
~ ~/0 S E% TING
E%IST. ~ 2 3T y. 80'
CP. Q.1'/ ~/Y~ .°%G3 F AME r'I CP.
H U6E. ,n PROPOSED CONCRETE
r~~ ~'~~I ~ F. e_04 ,ri
RETAINING WALL
. ~
lN0 ASENENTI _ _ FIMIBHED GRADE DETAILS
I IRON
I PIPE 1, n 1 rc',
u ;
~ 20. ' I ~ 'c ,9
LOT ,29 n~^/ '
~J 1 / v4
^ I znG.g y I ~
Z I WIN00~ I LOT ZB ~A~REBAR ' ~r. eY OCR S'MAX
I I e a" O.C. 1 • ~ (VARIES
J
~ I t ~ 'I I h'
° I ) t I = i.
v
a ; n
I t I i ~,v fWSFIEP GRADE
I LOT 2 8 ! I ? MEMBRANE ~ ~ ~
I I I ~ WATERPROOFING t<.~
AREA .7,500 $q. ft. I, x ~ 3Efl7E IC SYSTEM e
~k ~ ~ I ° W M
J J
el 6.0:proposed ~ \~1 - - g" , ~ ; e^ E• MIN.
el 6.0 = exailrrg I y s ~ - I ' W't`
N3 REBAR • ta" '
I ° m O.C. f.,
v~ I m~ ~'3.c
~ 9 REBAR a le"O.C.
I I ~ ~ L S' ' D" . I
N I N ~~T 27 I
h ( '`€a j n
lV, I d. EyO I M Q
Z ~ Q J V7 OQ The water supp/y and sewage disposal
I , to sthe slanda~As ol5lThe~ Su/IolAc Caunfy
~t I i ~ Depar/menf of Heallh Services.
_9 I !29.92'
I el, 3,
CM. CM
O.L/N/S S.54°3213011W. 50.00 o. L./N{s.
q E'E. 0. 3'E.
Prepared in occordonce wllh the m/nlmum
f_a _ slondards for Nlk surveys as established
SEC 0 N D A V E . y by the L.I. A.L.S. and approved and adopted
(50 ' WIDE ; for such use by The New Yor4 Stale Land
1111e Assoclollon.
( b I RT ROAD ; The /ocaNons o/ wells and cesspools shown hereon are /rom i(•!d
rawEttmrc/ abservatlans and or /rom daJo obtaln!d Isom ofhars.
(OWEL LIMG/ r'OUSE
WELi6 CESSPOOL LOCATION CESSPOOL OVER FsI. yF lr,
~9 ! °RADF. TD BE kEl,D TO R£TAlNG WALL J
fSe' r G.6 !.;ISbG'L rirAPE
- ~ r - - - _ _ EL. 6,J.
•e1 I ein J/9" per q.
~ 4' Frrved piN~ EC min I/N'/{/i T
t4 :p •f~F r::...v ~ ~`u 1 d~ ~ OL EAN
SS2 _ _ ~ SANo
ErIH ~ !c ¢B'
TEST ~ ~:F.NTER C.P. OF S
NOLE POOL LL LISTER
DATA el. 3.0 aRCPCSEE SE Wt GE LISPC.'.'AL SYS TEM POOP:
BROWN LOAMY SAND ~ wl TN CL' 6h ; AI'1 S GRAVE!. COLLAr
fa' ~ "CG ' A".PM1' F,.~-.A -LNLRE TE 5El"I'lr
GhCY COARSE SAND 22' I} ~ O 'PNE H~ 7TOiu vF 1,. ..1 to BC Y ABCVE
HO. "L ~RC~.N'f •A rER.
WATER IN GREY Z ~ ~ SURVEY OF
COARS£ SANG 6' ,{r¢2V
WA TfR IN PARK BROWN ~
`LAY G.E' ` ° LOT 28
WA TfR /N GRCY ~
COARSE SAND ~ 1` MAP N0. 2 OF PECONIC SHORES 11
~ FILED SEPT. 15 , 19 30 FILE N0. 654
~ ~ AT PECONIC
,~~`p'l,,DS~9 o TOWN OF SOUTHOLD
~ ~ ~ SUFFOLK COUNTY N.Y.
~ 1000 - 067 - 02 - 14
N.Y.S. LIC. NO. 49818
SCALE l° = 201
DRS, P.C. AUG. 26 , 1988
Dec. 29, 1988 (revise)
~l ,/Art 25 /FS r~v/~e~
SOU N. Y. 1T97f ELEVATIONS ARE REFERENCED TONQV.D.DATUA[ Aug. 25, 1 ~9 (rews/an
88 - 5 ~r
8 S Sa 143
LL._. 40' ELL PS' f 115' ; jCP.
i DW ELL IND ) ( DWELLIN~-`I~- I °WELLIN6)
CP. LOCATION UNKNOWN) I CP. LOC ~ UNKNOWN) WELL
IN BABEMlNT
n SUBDIVISION - ~"PECONIC SHORES°
M LOT 19 SUFF. CO. FlLE N0. 117 LOT Z 1
0
- - LOT 20 ~ ~
.L2_•Y I N.54°3230°E. 60.OOY"""°~«.s.g 15s~
I Q 3•,E fW f/G~•a ~ ~/°P f PIPE •1
p Wa/% 0.5~E.
Q feca. 1l o.a'a '
Y~i c/ G•~ / E 0 t DWELLING) l
/
W/fh .C/ ~ ( WELL OVER 170'1
otviJC~s 0 ~ ~~'3 O ,
,ot~Miy3/orJ I 0 Q~a fl_5_ ~
Jfl ~ ~,~3 S el.o' LOT 25
h /Or T E% TD7G
_ E%IST. ~ 2 STY. 60s '
i^) CP. e~ / ~/W 6 0.} F AME - ~ ICI. .
N U7F. ~ PROPOSED CONCRETE
~ F• • e'04 RETAINING WALL
p
^'I a (NO ABEMENrf FREBHED oRAOE DETAILS
IRON
~ PIPE I / _ I)
.f,%i
\ ~ ` 'b
1 LOT'~29 z
e I Ena.7 Y I ~"`r
WIND Nt REEAR
i I I LOT 2 6 ,Pt REEAR / •N„ 14' O.C. T MAX
I I • s° o.c. ~ . / tvAR1EE
TEST MOLE ° I ul I ~ U.
_ 'r
i ,F'~ fNitt(Lp ~ ORADI
GROWN LOAMY I LOT 28 I i }MpIMRANE ~~,j'
SAND IOC ~ I p ? ~ V3RTTEICRPSYB EM
BROWNI7N YN\C~, I I ? o .t!!E)E)E)EEE rq .M
GREY COARSE 1 ~ J 1' - E" ~Y 5~ 7'•MM.
SANG 2,2` I I v w d - rt ~,I
'j ° IP7 RERAR ~ 1E" 1
WATER IN =n I I ° e O.C. ^).i
PREY COARlE 6 0°IOI $ W m SsL'y Y',o~ `d„ ss J, e•",n.~
EAND t~
WATER IN - }
DARN EROWN O ~ M' i REMR • Ki"O.C.
EOEOY CLAY M I
WATER IN N I ,I N LOT 27 r
9 R E Y 1 _ _ ti._...a...._..-
OAR7E o t ..Y
z I ®j ~ ~~Q
WELL
I I , V
°I~_a I a_ MIFF 129.92'
CM. CM.
as S.54°32~30~iW. 50:00 u: y; EN/s.
€._a L a.• 'the 'water supply 8 tw°ge dispoi°l t7,ro~
SECOND A V E - ~m, for this residence will conform to )h.
C 50 ' w I D E ~ st°ml°rds of )I» sDRoBc Count' Dep°rt-
mW °f HsoEh Swvicw.
( DIRT ROAD I
(DWELLElO) (OWET,LMJOJ HOUSE
WELLa C[lBPOOL 10CArK1N Fsl. fh.
CFBA~OOL OV6r 8.~ f GRADE TO BE HELD TO RETAW6 WALL !
gs , 6.6- F'7NfSHEO GRADE
EL. ~•l•
prv m!rt I/4' per 11.
~ . EL 4. _ .tom _ ,*OP EL 3.3'
e / Gr0 = OP a/CVG%T/O /7 f" prove py~ Nv. EL 9.5 mM !/6-'(r~." ?-~f•:
~j .SEPTIC - W CLEAN
Q( ~ s ex~sf~ e%vG-~/On ~svM ~~'Y .Racwo N ~ SA/~U
MA rfR 0.9•
:LE'AI~ CENTER C.P, OF 3
/ u. s x , ~.,1 i°n• ~ , I w~r,lgi4,~ 'ice POOL CLUSTER
O exPa-ns/o~ ~oa ~u ::.3. ttw` ,d4 6i .k,~_Y i~~va`µa~ 1i411Q~EWAGE DKPOSAL SYSTEMS PDOLS
AN SAND 6 6RA VEL COLLAR
1900 GALLON PRECAST CONCRETE SEPT/C
TANK 80TTOM OF POOCS TO BE C MOVf
S(iFF:iY Cl'~L^k~lY Di'P,~.F;T..a_~T OF HE,""LTH 5Y'4YlCf:S GROUND WATER.
tc'.t. o.;~:_v~L c..P ccrasT~uct:~e~ ctatY SURVEY OF
DATc S• it• fiS r,s ~E~. rao. L~ 1 28
APPROVED Q-~-- 'I MAP N0. 2 OF PECONIC SHORES °
FILED SEPT. 15 , 19 30 FILE N0. 654
~~y~0 ~ AM~`S[F :Ippmved in accordance with $oard of REVIrW AT PECON IC
~o ~ determination dated 8 • ? ~ •fig ~ TOWN OF SOUTHOL D
A SUFFOLK COUNTY ~N.Y.
rs, ?r" , ` ~ 1000 - 067 - 02 - 14
q ° °rN.Y.S. LIC. NO. 49888 II I
i" Htl SC A LE I = 20
tC URVEYORS, P.C. ~'"}B AIUG. 26 19$8
618) 786 - 5020 a ~•L~8 Dec. 29, 1988 (evraeJ
P. O. SOX 909 TPiMilfYI~~VATKWd~ m '~~'RO"frFARl~vornERa.,fA~t 25~ t98~ t'e'v~se~
MAIN ROAD EIEVATADAlSARETOKCt'Y.tltDA7G1[~
SOUTHOLD, N.Y. 11971
AREA= 7>600~¢ft
P.K. 8$ - .~1~~
H.S Ref. # 88~'`•SO 143
%
t-L. 40' _ WELL 2 s _ v IIS ~ \I CP.
• _
( DWELIL INO ) ( DWELL INa~ F OWELUNO I
CP, LOCATION UNN NOWN) I CP LOC 1 UNKNOWN )
WELL
SUBOIVI SIGN - ~°P ECONIC SHOR ES~~ IN BASEMENT
n
m LOT 19 SUFF CO. FILE N0. 117
o LOT 2.1
LOT 20 m o
I •Lt_~ ~ N .54°32 ~ 30"E.~ SG.OO, e.. 3y9 135' P
Ilrr "M. PIPE G~~~¢~~y/~/y ~~y ~p
't. 0.3'5 Vw •'~Ai\~IVV~1 • YGi'
~P /o _ SMit~LE~F~
Y Ot~.Y
at wlodr
/ O ( OW, yEL~Y~~J{,7~{j~~')(tt~~~ q
( lP. /P' ?aoc s{y O ( E LY~lRIil~~ • ~4.rGl~ 3
~ -t rr~ ~eeb~K. O
O 9. E, IA ~~itMQ,b0~011 WNMt
~ LOT
ST ~ Lj, .I. Mid baM~OlCf~b
EXISTING /~r.~r~r
EXIST. ~ 2 STY. i/•+• /K`•B A/'a_?
%~~)~'~I CP, 1 Fk AME J
' HD'J SE. n ~B~~e E
),..t ~ F.F. e_04 V11iG~{I•
~ -f Nis, n
lN0 BASEMENT) FINISHED ORA DE
PIPE 1
4/ ) .:.y .
d.i
IRON ,e^~
~ 2D,3' ~'e
`,1.9
I ~
2^~ ST t ~ M4 REBAR
~ I WINDOW ~ e'MAX
z LOT 2 6 M4 REBAR I ~r„ { Z' O.C.
~ \ I { Z" O.C. I r (VARIES
J
W
~ ~ h
° I ~
I ~ ; ' f' d
I C ° e,,, v fINSHEO GRADE
I LOT\2F I I' i
I I L ^ ° WATERP OOFINO
~ SEPTIC SYSTEM
AREA = 7,500 sq. fe. ~ I ~ o BIDE. `.a ,w
J
el. 60. f8opoasd ~ W ~ ~ Br' 4rjw e^ ~'MAi.
° :K3 REBAR ~ 7R" ~
° m O,C, i,
u. I V' .`J ~ N:
~ ' yl 1_ x
M M 3 REBAR ~ 10°O.C,
N I I I N I.JT 27. 1
o ~ o
~ : II 11 p Q
ro 1 .1.3.0
Z ~ e I m OQ The wafer suppty and sewage disposal
I ~ W ~ systems /or lhls residen.'e wt!! canlorm
` to /he standards al The Suffolk County
~t I ~ Deparh'nen7 Health Services.
I wc71 129.92'
"-H I ei ~
CM. CM.
0. 3~E~S S.54°321301`W. 50.00` a. 3; EN/s.
prepared in accordance with the minfmum
f ..3 _ slartdards for /inB surveys os established
SEC 0 N D f'~ Y E , V( 50 ' WIDE ; try the L.LA.L.S. and approved and adopted
tar such use by The New Ya•F Stale Lvnd
T'i11e d ssocivllon.
( GIRT ROAD I The locvllans al wells vnd cesspools shown hereon are Isom /ford
rowettwtt! observations and m /ram dafv obtained lrvm others.
(OWEL!!NG) r'JL/SE
WELL{ CFSSPOOC COCA r/ON CESSPOOL OVER f rl. ~.Crq
IMCNOWN ua, ~ °RAGE .'O BE HELi r0 RE PAlNG WALL i
~ u E.6 „n r ~n Ai%F
- EL. 6.3
!/9 per 'r. -
t4 .r t ` =i EAN
L_-_ _ _ J ,ROONU ~ SA NO
wA r[R
N > tam . ~ o.®.
TES ~ '.6'N PER C.P. OF 5
POOL cLUSTEA
DATA •l. 3.0 ~ '^n CFCSEG .SE RA S[ i(uFCSA !.5YS!'EM s YfOL'
BROWN ! GAMY SA Nf ~ ~'PN " c! ~ , l r.RAV,:' cL'f.LAn
IO' ~I '.v -n .N4ea TE ~Gr In
GhCv f fANF rviiM i r IV bE 2' ABC'VE
OARSE SANn 2.2• ~ ~ r~RC%iN~ ,+rL r.
WA irR (N GREY
`OARSF SA"" R• SURVEY OF
WA TCR !N pARX RROWN T
CI AY G.5' ~ V LO 1 ~ V
WATFA rN GREY ~ < " MAP N0. 2 OF PECONIC SHORES 11
COARSC SAND
r3' ~ FILED SEPT. 15, 1930 FILE N0. 654
~ AT PECONIC
U~~~~N~oZ~`~~ ~ ~ ~~'"`;~~y~+ TOWN OF SOUTHOLD
A ~ ~ `~UFFOL K COUNTY N.Y.
( ~ ~yg~ooo - 067 - 02 - 14
. LlC. NO. 49618 J!`PR 22
SCALE 111 = 201
P.C.
(516)7 AUG. 26 1988
P. O. BO F S.1~1jµ
$ER OFt~ Dec. 29, 1'988 (revise)
MAIN ROAD r' M~~`e, . ,IAN 25 /98 r~vr~e~~
SOUTHOLD, N. Y. 11971 ELEVATIONS ARE REFERENCED TO MQ Y.D. DA T(Att Apn1 19, 19
994 (C esapsools) )
88 - 511