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FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
• Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 219192 Date JULY 9, 1990
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property 290 PRIVATE ROAD #32 SOUTHOLD
House No. Street Hamlet
County Tax Map No. 1000 Section 59 Block 09 Lot 10.3
MINOR SUB
Subdivision COMM DEV. AGENCY Filed Map No. Lot No. 3
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 22, 1989 pursuant to which
Building Permit No. 184042 dated AUG. 25, 1989
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 WOOD DECK 5 STEPS
The certificate is issued to TOWN OF SOUTHOLD
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 89-SO-36 MAY 22, 1990
UNDERWRITERS CERTIFICATE N0. N132805 JUNE 12, 1990
PLUMBERS CERTIFICATION DATED_ HARDY PLUMBING & HEATING MAY 24, 1990
Building Inspector ~
Rev. 1/81
ro;nc xa ~
TowN oP souTHOLD
BUILDING DEPARTMENT
TOWN HALL
sOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
CQMPLETION OF THE WORK AUTHORIZED)
N°- 18 4 0 4 Z Date G......~.~.-..........., 19.F.~... `l
Permission is hereby granted
~..t-~....~
to..........~......... `
at premises located ot ................er:`..~~..~..!~T/a......1.~.~........~.~...............
.
County Tax Mop No. 1000 Section ...a.•..•~f...•..•.... Block ...~.1.....~/......... Lot No...l.l.^..:~....
pursuant to application doted .....L~~ 19.~~and approved by the
Building Inspector. 4`--
Fee $...~1?!.`~?.!!.`~
Building Inspector
Rev. 6/30/80
Y
THE NEW YORK BOARD QF FIRE UNDERWRITERS PAGE ]
J.0009b8 BUREAU' OF ELECTRICITY
85 JOHN STREET, NEW YORI~tlEi1N.YORK 10038
Date JUNE 1.2, 7910 gpplicotion Nm on file 65009789/89 N ] 32805
THIS CERTIFIES THAT
only the electrical equipment oe deurihed below and introduced by the opplicant Homed on the o&oue application numher in the premises of
T7JO BEARS AUIL7)ERS, PRIVATE ROAD, SOtITNt7LD, N.Y. ~L1
in thefollowinq location; ®8aeernent ® let Fl. ®Pnd E7. .OUT Ser[ion59 BIocIC~ Lot 70]0
uws examined on MAY 74 , 7.990 and found to he in cornplianre uilh [he reyuirementA of this Buard.
FXTUlE EPTACLES SWITCNES pXTURES RANOES COOKING DECKS OVENS DISH WASNlRS EXXAUST FANS
OUTLETS INCANDESCENT FIIIORESCENT OTHER NAT. K.W. AMi. K.W. AMT. K.W. AMT. K.W. AMT. H. P:
]4 33 75 74 ] 1.2 1 F
DRYERS FURNACE MOTORS FUTURE ANMIANCE FEEDERS SF[CIAI REC'?T TIME CLOCKS MLL UNIT NEATFRS AUILTMOUTIlT DIMMlRS
AMi. K. W. Oll H. P. GAS H. P. AMi. NO. A. W. G. AMT. AMP. AMT. AMPS. TRANS. AMT. H. P. ~
~T AMT. WATTS
3 F ] 30 1
5lRVICE DISCONNECT : NO.OF S E R V 1 C E
AMT. AMP. TYPE METER 1 F TV 1 a JW 3 / SW 3 F AW NO. OP [C COND. A. W. G. NO. Of M4LEG A' W' G' NO.OF NEUnAlS A. W.G.
LOUIE. PER O Or CC. COND. OF HI-LEG OF NEUTRAL
] 200 CB 7 X 7 2/0 1 2/0
OTNEE APPARATUS:
MOTORS:].°3/4 N.P.
G,F.C.I:-3
SMOI:E DETECTOR:-2
NI7rI,IAk T.STOCR LIC.~889F. G/~~~
7250 SMITNTOWN AY$NUE
BOHEMIA, NY, 77.77.6 epEEeu EAAwAOIR
c 11
Ptr `
This certificate must not be altered in any monnsr; return to 1M office of the Hoard if incorratl. Inspectors may be identified by their credentials.
COPY FOR BUILDING ~ A S E ALTERED IN ANY R.
l J _ "r=L• L. 7b_ -1802 .
,~~C ~ -O. TO~'t3r•I~I OiL? SI~~J:T~~:
J /
~ .c OFFICE OP B,U3LD13~G IVSPfiCT;OR
~a ~ P.Q. I30;'.' ; 28:
y~~ SOUTHU~D, .I.Y. 1:197'1
21
C E R T I F I C& T I. O. tJ:
Date MAY 24, 1990
Building Permit No. 18404
Owner TWO BEARS
(please print)
Plursb-er HARDY PL. & HTG. NORTH, INC.
(please print)
I certify that th^_ solder used .a the water supply syst.m
contains less than 2!10 of 1$ lead.
" (plumber's signatur
Sworn to before a this - -
a 5 day of~
19 mil)
Rotary ublic
Nota_° Y~~~_ic, SU~~04~ County ~ 1AEIIWIEV.BROVM
Notory Pubk, SgAO d Now Yak
No. 4908712
m~oa.t~9~t9gl
r1ELD iI:S:'cC:iUt1 ~~UA;a ~OMMGNT~ ~
'o
1 . a, - a
H
FOUtJDATION (1st) 9 ~ y
-N
FOUNDATIOtJ (2nd) m
2. _
o~
P,OUGH FRAME & . Q
PLUMBING ~ _
cn
3. /Jy !~O ~ y~
x
~ m
m
H
ZIJSULATION PER N. Y. ti
STATE ENERGY ~ p~N.
~
CODE
i~1 ~ a~
3
m
r
4 . .3
FZiJAL
ADDITIOtIAL COMMENTS:
M~
9
2
S~
A
r( _
H ~'1
x~
v
mC-
-e "~i0
yv\
! ~ BOnRD OF iE.\LTN U...........
• ~ ~ 3 SETS ~ PL.1NS .
FORM N0.1 SURVEY
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC r•oarl
' TOWN HALL
SOUTHOLD,N.Y.11971 NOTIFY
TEL.: 765.1802 CnLL James. C:. fl~flahPM.... .
MAIL T0:
Examined . . , 1. ~ 19 ~ '
Town Hall, Main Road
,approved 19~~ermitNo..~g.~t~yZ SoutholdRR, NewR YorMk 811971
Disapproveda D LS ~ L5 ~ U t5 ~
ilil
J shN ? ~ i989 .I ,
~.:~~~~1!~..
(Building Inspector BLDG. D~aT. ~
TOWN OF SOU7HOL0 ~
APPLICATION FOR BUILDING PERMIT
' Date ,May, 8,,1989.,,, 15...
INSTRUCTIONS
a. Tltis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
cation.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit
shall be kept on the premises available for inspection throughout the work.
e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy
shall !rave 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 applicable Laws, Ordinances or
Re=ulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections.
Town of Southold - Community Develop.
.
(Signature of applicant, or name, if a corporation)
Town Ha11, Southold, NY 11971
• (Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
OWNER
NameoCownerofpremises ,TOWN OF SOUTHOLD •
(as on the tax roll or latest deed)
If applicant is a corporation, signature oC duly authorized officer.
James C• McMahon, Administrator, C-D•
(Name and title of corporate officer)
Builder's License No... .
Plumber's License No. . ~:•1 / .
Electrician's License No. .~C/,!lr............
Outer Trade's License No . .
1, Location of land on which proposed work will be done. ......bl~~' , , , ~l`',LV.I~T~, , , ~U. , ,~,~c~,
HouseNumbcr.•.......••,.• Strepet cy Hamlet ~
County Tax hlap No. 1000 Section .......4~J Block . , , , , . , , , , . Lot f~.-r3
Subdivision Filed Alap No. Lot .
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy VA C A N,T . . . . . .
b.IntendGduseandoGtupaney Single-Family Residence
D~.c/E~- ~1/~/
_ ` _
.
3. Nature oC work (check which applicable): New [iuilding , X ' ~
Addition ~ Icration .
Repair Removal Demolition Other 1Vork .
--~-~7~ (Description
4. EstimatcdCost .~jC.tl/. Fee . WaiYed,.- Town Project
1
(to be paid on filing this application)
5. If dwelling, number of dwelling units ..........1 , , , . Number of dwelling units on each floor j`l,/ A ; • , • . _ .
ICgaragc,numbcrofcars .NlA
6. IC business, commercial or mixed occupancy, specify nature and extent of each type of use . N?.A , , , , , , , , ,
7. Dimensions of existing structures, iC any: Front N•/.A Rear . N(A. , , , , , , , , , De th . Jy/ A
I{ci=ltt N/A.......... Number of Stories ..N/A P • • • • • • • • • ,
Dimensions of same structure with alterations or additions: Front . lV.~? . • , . , . , •Rcar .NIA............
ept • .NlA height Number of Stories N/A,
3. Dimensions of cntiie new construction: Front , , , , , , Rear ~C , , , , , , • Depth . v~',-tom.', , , , , ,
Ilcigltt .~j~ S%? Number of Stories . sn ,
9. Size of lot: Front .....lBi?.~ Rear ....e'l~.-O ~ ~ .
Depth ..~~O.O
10. Date o urchase .............................Name of Former Own r .
1 1. Zone or use district in which premises are situated ...t~.CQ~;S,J,j)~jt/~~ , • ,1~(.~.~JkPl4L.
.
1'_. ocs proposed construction violate any zoning law, ordinance or regulation: , N 0, , , , , , , , , , , , • . , _ . • .
l3. R'ill lot be regraded ...will excess fill be removed from premises: Yes 1
l4. N.vneoCOwnerofprcmisesT.own.~Itf,,$putho~d.AddressMd}n';Rd• SoutholdPlioneNo.7a5-1892..•.
Name of Architect ..NSA Address A(i9.. , /A
Pttts'hd~}' .N
Name of Contractor.TWP..Qears,t3uil.ders, ~~t~ltlress P.O,,Qpx, 2117, Amagp o. 329-.Qg3P..:
15.Is this property located within 300 feet of a tidal wetland? *YES....NO X
kIf 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 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.
SEE ATTACHED SURVEY
r J
~ `S~s~PZ~~.
ST,\"rf OF NE~V YORK, S.S
couvrY of
• .James C • MeM ahon , , , , , , , , , , being duly sworn, deposes and says that Ite is the applicant
(Name of individual signing contract)
~bovc Wanted.
Ilcisthc „Community Development Administrator.' '
(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 this
'Pplicahon: that all statements contained in this application arc true to the best of his knowledge and belief; and that the
'•vork wdl be performed in the manner set forth in the application Glcd thcrcwitlt.
Swom to belorc me this '
(........day of 19 `.F~
Notary•Public, •,,,Suffolk•..~„~,t.U~County , _ `
NELEN K DE YOE .~~\~Fl U 0 l~ .
NOTARY PUHUC, State M h12ntY~ork~ ~~""::"aa^^-- ::UU . . .
_[1 (Si, nature of a
Term
Ex~eiTAa4trch
30 19 a pp r fit)
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BROWN CLAYEY
a 1N0 MITN
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9~' ti,, 10 ~ sinoncoARSE
5 A P/ c 15.8'
F'~~Q~A~/ .I ~=1 CP. ;~mF Od• a ``qn/~ MATER INBROwR
IT q~S1~TC~
~ ry\, /T~~u/t~1s. SU~~` ~0~~ coAREE sAno 22
AREA 30, 019 SQ:~ ~9q MELL \ ver t° grad tank
~ fQG 9q e
/q ,
THE LOCATIONS OF WELLS AND CESSPOOLS SHOWN !#REdI ARE T~ SURVEY 0 F E RTY
FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OT
FOR
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES ~ M U N I T Y DEVELOPMENT AGENCY
FOR AP RO L OF CONSTRUCTION ONL,Y11 ~ I
DATE ~~~H/R~EF.NO. /~V AT SOUTHOLD
APPROVED - ~C~~- r FEB s ~ TOWN OF SO,UTHOL D
s;c.oEr~t.oF SUFFOLK COUNTY, N Y.
I~ ^n.i a HEN.T1i SERVICES 1000 - 59 11 091 - P/0 10
r g~~ DWEL.I_?~ i Lt SCALE I = 30
1-~ TW9 YEARS FROM qA"r E ~7r ra~~'~~ ~ Nov. 22 , I9ee
JAMES C. McMAHON
COMMUNITY DEVELOPMENT OFFIC!
TOWN HALL .fi
g ANa~(rh,',. SOUTHOLp, NE1NN YOYK 11911 PrelparAd SF aecoedaner wNR Ihs miRrMlom
9 GF 'M 7~5-( 7~ atandarda for tBki surw a as aatabli~hsd b
~ ~O ~ THE WATER SUPPLY AND SEWAGE DISPOSAL Y 7'
o O SYSTEMS FOR THIS RESIDENCE WILL CONFORM the L.LA.LS. and. approved and odopbo
4'. L1C. N0. 49668 TO THE STANDARDS OF THE .SUFFOLK COUNTY For such uae by Ths New York StaN land
* DEPARTMENT OF tfEALTH SERVICES. Tins AsaxiaHon.
P C ~a~~a~,' , P C.
516 ~ ~F~_Q20
.O. BO 9 LOT NUMBERS REFER TO ~ MINOR SUBDIVISION ELEVATIONS ARE REFERENCED
MAIN ROAD MADE FOR COMMUNITY DEVELOPMENT AGENCY. TO AN ASSUMED DATUM.
SOUTHOLD , N.Y.11971
_ _ D.K. 88 - 143 (3 )
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AREA .31+765 sq. ft *~i,~M~. ~
o
~1 • *~C' MILL ,
SURVEY 4F PROPERTY
FOR
cam ro, C4IMAYItiNITY D'EVELQPl~AENT AQENCY
r+~carw~c ~u~srlucr ~rav
~voRrri Aor~r e,~s>r s rlartitr
AT SOUTHOL.O
TOWN OF SO,~UTHOt. D
SUFFOLK COUNTY, N Y.
looo - as, - os, - Pfo w
SCALE I" 30'
NOV.,,22 ,1988
y~C 6ANOSG ~t . g, f'~fOfM/d /OC.J
CFCyp.C~O
+ A
r.s. uc. No.4ssss
0 6e P
roRS, Pc_
alsl - ao2o
.O. SOX 8011 LOT NUMO$RS REFER TO : " MIRDR 9UlDIYt310N " ElEVA710M{ A# R[fEREMCEO
MAIN ROAD MADE FOR COMMURITV DEVEtOPMElR AsM/CY. TO AN AgINAEp DATUM.
90UTNOI.D , N.Y.IID71 ~.rr
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AREA =31,785 sq. fi. ' is ? o
Fti q
c .
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9,p
v9~T
~s # ae-so-3s ~ S U R i/ E Y O F Pt~OP'E RTY
FOR
CERT1~0 TO
e,,~wt of new raRK COM~AUNITY DEVELOPMENT ~EAtCY
g~i
~ORra~~ inlcoRPOR~ riv
oMNE n~nf~K AT SOUTHOLD
TOWN OF ~Q,UTH4i. D .
SUFFOLK COUNTY DtPnRTfr`.EPif 0` I~Er.LT;i SERVICES SUFFOLK COUNTY, N Y.
pI-~_ ',5~p1h'e~~:E~~-n~EAM~NILY DJ~'ELLING ONLY 1000 - 59 - Os - PfO 10
. DAT~tLI_b..4_J~ZiGI+H.S. f?EF. No. $4 5o-t36 SCALE I " • 30
the sewage disposal and wafer sv~ply faci!iti:~s for ff~is
16CafiaO hd4? heen inspected bY';.i« r:~spa rnentano/or NpV. 22 ~ 14ia
other a ncia and fo/unYd to~@-e~s-a.i~factorq. .S ~ ~ 8, 1~~fOUI1d /OC.J
~rcCJ LAtUDS~\ Chief f Bureaueau
of~l"last~ewat Ma~~agement FIb. 19, f~YO (1~MISt)
Nt. ME c 'fG~ - -
~y c`" (JAN 0 s t991 - fie,-Rx~.~'y°~°~-~
.
i r fa,~. ~ ~ ~?a .
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1 - Flo
~~<.w..s uc. No. ~~~e .MM ! t~
c oRS. ac.
(stet ns - so4o e~• ~
P, V. ~X 8OB LOR NWAQfRS REFER TO : " M{NOH SUBDIVISION " TOWN OF
MAJN ROAD hIkDE FOR ODMMUNITY DEYELDPMENT AiNICY.
4R rwai» it -!6.l0
saurrroty, M r. tt:rt -
..,143 (3 ~