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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 219113 Date JUNE 6, 1990
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property 675 HIAWATHA'S PATH SOUTHOLD
House No. Street Hamlet
County Tax Map No. 1000 Section 078 Block 03 Lot 51.1
MINOR
SubdivisionAPPROVED 4/9/90 Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 22, 1989 pursuant to which
Building Permit No. 184102 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 REAR WOOD DECK & STEPS.
The certificate is issued to TOWN OF SOUTHOLD
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 90-SO-33 MAY 25, 1990
UNDERWRITERS CERTIFICATE NO. N127610 MAY 9, 1990
PLUMBERS CERTIFICATION DATED HARDY PLUMBING MAY 24, 1990
J~~~~-
Building Inspector
Rev. 1/81
roaac xa s
TOWN OF SOUTHOLD
6UILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N°- 18410 Z o~te ...G.~O . .9.P.~'
Permission is hereby granted
~r...~:-n......
wlltT~:..
to ...........rlj......... ~
of premises locoted at ..........(Q...~~. ~ . . .Z!l.......!"..~all/.1.~..,.....
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County Tox Mop No. )000 Section .f%.../....l,~..... Biock ....f~...~....... Lot No. G.(....../-.~<..
pursuant to application dated .Le~!Z~.......1...~ 19.~ , and approved by the
Building Inspector.
Fee i..~v1/.7L11.~7~
Building Inspector
Rev. 6/30/80
=1ELD iGS:' C:iU:i ~~U„.E ~UMMLNi° ~
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FOUtJDATIO:J ( 1st )
FOUNDATIOtJ (2nd)
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P.OUGH FRAME & ,
PLUMBING
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IIJSULATIOf! PER N. Y.
STATE ENERGY
CODE
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11ADD I(T~,I Or~P]AL QC~OMMENTS:
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~ BOARD OF HEALTH Y...........
3 SETS ~~F PLANS
FORMNO.1 SURVEY
TOWN OF SOUTHOLD CItECK .
BUILDING DEPARTMENT SEPTIC r•oRrl .
TOWN HALL
SOUTHOLD, N.Y. 11971 NOTIFY
TEL.: 7G5.1802 CALL James. C:. (h~CldhAn.... .
MAIL T0:
C•xamincd ••/y•~ 19~ Town Hall, Main Road
,\pproved IX/.~rmit No.(.~.yl~Z Southold, New York? 11971
Disapprovedac ~ ~ ~ti it
~~i.=-9'`+,\~~
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • . . . . ~.s ~ V.i .V Ic.. ~J..~Jr ~ ~
I
f
(Building Inspector)
B:.DG. pEPT. ~
APPLICATION FOR BUILDING PERMIT TO'.NNOFSUUTfi^LC
Date .May, 8, • 1989• • • IS.. .
INSTRUCTIONS
a. Tliis 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. Ttie 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 throu~ttout the work.
e. 1o buildin; shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy
>hall hive been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
3uildin; Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
iic;ulations. Cor the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
ii:e applicant a;rees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
~dmrt 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 wlietlrer applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
OWNER
;~:ame of o~vncr of premises .TOWN. OF SOUTHOLD • •
(as on the [a:c roll or latest deed)
if applicant is a corporation, signature of duly authorized officer.
James C• McMahon, Administrator, C•D•
(Name and title of corporate officer)
Builder's Liccnsc No .
Plurnbcr's Liccnsc No. .
Electrician's License No. .
Other Trade's License No . .
1. Location of land on which proposed work will be done. .
!louse Number Strcet Hamlet ~
County Tax 11ap No. 1000 Section Q7•~• • • • • • • . Block ...Q~. • . , , , , , • , • Lot .
Subdivision Filed )\fap No. Lot .
(Name)
State cxistine use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy VACANT
b.lntendeduseandoccupancy Single-Family Residence
• ,
3. Nature of work (check which applicable): New building X,'• , •
Repair Removal • • Addition Alteration .
''ll • • • • • • • • • • . Demolition Other Work . •
4. Estimated Cost ~ ;~C.J, , , • _ , (D~scription
Fee.IJ,aiyed••- Town Project
5. IC dwelling, number of dtvclling units , (to be paid on filing this application)
• • •1 • • Number of dwelling units on each floor JV,/ A ,
If vara;c, number of cars .NlA...... .
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . N./.A . • • • • •
7. Dimensions of existing structures, if any: Front . N•/•A . ' ' ' ' ' '
1{ci~_Itt . , y/q, , , , , , , • , , Number of Stories • N/A ' ' ' ' • • Rcar .NIA.......... Depth . Jy/A, • . • •
Dimensions of same structure with alterations or additions: Front N / A • • • • • • ~ • • • • ' ' ' ' ' ' ' .
Depth ..NlA.. . Ileight , N/A Rear NIA..........
8. Dimensions of ceti*c resv ceastraction: Front . ,3p~ ~ • ~ ' ' ' ' ' • • • Number of Stotics N /A • . '
Hci;ht . aZ,3 ~~w? . Number of Stories , , Rear ~i~ Depth „od,~
j .
9. Size of lot: Front !.3 g•~7 Rear ..~.~•3/ ~ •
10. Date of Purchase • • • ' • • • • • • • • • • • . Depth ~?,9~.,,~~~,', ~ •
1 1. 7_one or use district in which ' ' • • Name of Former Owner , . , , ~ • • • • ~ • '
premises are situated , J4'R~s1.~~E- . f+-~KULIj~;~i}~ ' • ' • • • • • • • -
1''. Does proposed construction violate any zoning law, ordinance or regulation: , N 0, , , _ , ~ • • ~ • • • • ~ ~ • ' ' ' ' ' '
13. ~4'illlotbere;raded
14. Name of Owner of prcmisesT.own. At f, , $p,t{thol d • • ' 1Vrll excess (Ill be removed from premises: Yes I
Name of Architect .N(A • Address M~~n';Rd, Sout_holdplrone No.?Cr5-1892
' Address JV%A • •
Name of Contractor .TWA. .Q ears Buil.det^s•, Ia~iAress P.0,,Qgk. 2117 Amagp~~~~.329
;gg3P„•'
iS.Is this property located within 300 feet of a tidal wetland? *YES....NO.X...•
*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 dimensions fro
property tines. Give street and block number or description according to deed, and show tree[ names and indicate wheth
interior or corner lot.
SEE ATTACHED SURVEY
_
ST,\Tr OF \E1V YORK,
cou`TY or s.s .
James C• McMahon
• ~ • • ~ • • • • ~ ' ' • ' ' ' ' ' ' ' ' • ' ' • • • • • • • • • • • • • being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
~bove named.
Ifcisthe Communitty 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
•~Pphratron: that all statements contained in this application arc true to the best of his knowledge and belief; and that the
'work wrll be performed in the manner set forth in [hc application fllcd therewith.
S+vorn to before me this
.dayof.. 19~J.
Notary Public. ....Suffolk... C,~X.°n`!`?L`_...
~ County
NEtEN K DEVOE
NOTJIRY PUBIiC, State of New Ytxlt ~~l,A~.
No. 47G78'18, Suffolk Countyp ~ ' ' ' ' ' ' ' ' ' ' '
Term Expires tt:rch 3G,19__.1.t (Si;nature of applicant)
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