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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 Z-23357 Date NOVEMBER 17, 1994
THIS CERTIFIES that the building ALTERATION & ADDITION
Location of Property 825 OAK DRIVE SOUTHOLD, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section s0 Block 1 Lot 35
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated DECEMBER 6, 1993 pursuant to which
Building Permit No. 21841-Z dated DECEMBER 17, 1993
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 ADDITION & RECONSTRUCTION OF EXISTING ONE FAMILY DWELLING
AS APPLIED FOR
The certificate is issued to THOMAS & ANN BRADY
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-332069 - NOVEMBER 1, 1994
PLUMBERS CERTIFICATION DATED NOV. 15, 1994 - H. SMITH PLUMB. & HEATING
Q.1'. ~4'
Building Inspe or
Rev. 1/81
FORM NO.3
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° 21841 Z Date 19...
Permission Is hereby granted to:
15 ex"4b
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.......r.~..
f........ ~.Y.:...., s7...9....
.
~~/,?~..........5....... /1i°~°Li~
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at premises located at......... 6..1 ...............~J.... G/'r
i?`r!..~.}.......................................................................
County Tax Map No. 1000 Section Block Lot No. 3.'S
pursuant to application dated .......4, 19.../..~~..., and approved by the
Bullding Inspector.
Fee 53:.. ydt~
...:..J"
J~ Building Inspector
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
T014N HALL
765-1802
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 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 dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelli 25.Rng , wimming pool $25.00, Accessory building $25.00,
Additions to accessor $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building - $100.00
3. Copy of Certificate of Occupancy - $20.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
(Jt~7k4 02///ON OFOt/,HAVse Date
New Construction. A kR%)(F'ifr ld Or Pre-existing Building ...7.. 1~t
Location of Property.....4 P J~ 0/~. :............s~.4:17
House No.. Streetp ~ Hamlet
Onwer or Owners of Property... tax
County Tax Map No 1000, section.... V e......Block....~...........Lot. 3
Subdivision.... b O................... Filed Map............ Lot . .
p"
Permit Z....Date Of Permit 2•/"~1/Y."3....Applicant.~f` tf~ ?.?/N,Oy
,{fS E~ NL e/ gs~ OLS WIZ L
Health Dept. Approval. .....`il~ ...........Underwriters Approval. .X....................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate.. x.......
Fee Submitted:
• yg g /r? / X .
~0-?.-2335 APnTrr
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1001071 BUREAU OF ELECTRICITY
F 85 JOHN STREET, NEW YORK, NEW YORK 10038
Date NOVEMBER 01,1994 Application No. on file 84901294/94 N 332069
THIS CERTIFIES THAT
only the electrical equipment w described below and introduced by the applicant named on the above application number in the premises, of
BRADY, OAK DRIVE, (REYDON SHORES), SOUTHOLD, N.Y.
in the following location; ® Basement ® /at FL ® 2nd Fl. ATTIC/OUT Section Block Lot
was examined on OCTOBER 28,1994 and found to be in compliance with the National Electrical Code.
FIXTURE ECEPTAClES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCANDESCENT EIVORESCENT OTHER LMT. K.W. AMT, K.W. AMC K.W. AMT. K. W, AMC H. P.
39 43 44 39 1 1.2 1 F
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS FEII UNI7 HEATERS MULTI-OUTLET DIMMERS
AMT. K. W. Oll N. F. GAS N. v. AMT. NO. A. W. G. 11 AMT. AMP. AMT. AMPS. TRANS. AMT. N P SYSTEMS NO. OF FEET AMT. WATTS
1 F 1 2/1 H 1 30 1
SERVICE DISCONNECT NO. OF S E R V I C E
"T. AMP, ttff METFR I F 3w I R 3W 3 tl 3W 3 / AW NO. Of CC. COND. A w. G.
iCUI?. PER / OF CC. COND. NO OP NI I Of M LEG NO.OF NEVTRA6 OA NfUTRAI
1 200 CB 1 X 1 2/0 1 2/0
OTHER APPARATUS:
MOTORS:8-F H.P.
G.F.C.I:-10
SMOKE DETECTOR:-2
G S CONTRACTOR LIC.4578-E
BOX X 215
SOUTHOLD, NY, 11971 GENERAL MANAGER
11
Per A AZ
This certificote must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be ident fii~by their credentials.
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1001071 BUREAU OF ELECTRICITY
F 85 JOHN STREET. NEW YORK. NEW YORK 10038
Date NOVEMBER 01,1994 Application No. on file 84901294/94 N 332069
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
BRADY, OAK DRIVE, (REYDON SHORES), SOUTHOLD, N.Y.
in thefollowinp location: IN Basement ® Ist F1. ® 2nd Fl. ATTIC/OUT Section Block Lot
uns esorrsined ors OCTOBER 28,1994 and found to be in compliance with the National Electrical Code.
FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCANDESCENT iIUCRESCENt OTHER iJAI N W. AML l W NAL IM .1 I(.W AMT. H P
39 43 44 39 1 1.2 1 LF
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'Pi TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
-T . A. W0. AMt. AMP AMT. AMps TRANS. AMT. H P SYSTEMS WATTS
AMT. K. W. OIL H. P. GAS H. P. AMT.
NO.OF FEET
T N
1 F 1 2/1 HO 1 30 1
SERVICE DISCONNECT NO.OF S E R V I C E
METER NO OF CC COND A w c. A. w. G. A. W G.
.T AMP TYPE EOUIP. 1-e ]W 1 R JW 3 H 3W 3 F IW PER a OF CC. COND NO OF HI LEG OF HLLEG Of NEUTRALS OF NEUTRAL NO. 1 200 CB 1 X 1 2/0 1 2/0
OTHER APPARATUS:
MOTORS:8-F H.P.
G.F.C.I:-10
SMOKE DETECTOR:-2
G & S CONTRACTOR LIC.#578-E
BOX 215
SOUTHOLD, NY, 11971 GENERAL MANAGER
11 ~i
Pe
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be Went f'1 by their credentials.
INSPECTORS
o~~cpfFO(,~co I
=y' 1 G?` SCOTT I- FIARRIS, Supervisor
o i.
ua i. Southold Town Hall
Thomas Fisher v- ^2r P.O. Box 1179, 53095 Main Road
Building Inspector
Gary Fish ~'x0( Jt Southold, Fax 971
(516) 765-1823
Building Inspector Telephone (516) 765-1800
I
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: November 15, 1994
Building Permit No. 21841Z
owner: Thomas and Ann Brady
(please print)
Plumber: H. Smith Plumbing & Heating, Inc.
(please print)
I certify that the solder used in the water supply system
contains-less than 2/10 of 12 lead.
WumKers Si nature)
ifenry P. Smith, !'res.
Sworn to before me this
15th day of Nov. 1994
Notary Public, Suffolk County
'L Notary P?bl ?sE
BERNADETTE L. TAPLIN Notary Public
NOTARY PUBLIC X4814893
state of New York
RetidinBin Stiff olk 3nll
:ommisaion Expires
.--VOL Sept.
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ FINAL
REMARKS:
s
P4 o
DATE l INSPECTOR
D i ?C:IUN 11D; TE i~ COMMENTS
- H ~
rOUNDATION (1st / stOt -
v y ~
FOUNDATION (2nd)
2. v' vt
ROUGH FRAME & L - y
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INSULATION PER 11. Y. Ji _x~ Qr~ 1
STATE ENERGY r1
CODE
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FINAL
o ~
ADDITIONAL COMPIEIITS: x
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M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST ( ] ROUGH PLBG.
[ ] FOUNDATION 2ND ( ] INSULATION
[ ] FRAMING ( ] FINAL
REMARKS:
r
DATE INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROU PLBG.
FOUNDATION 2ND NSULATION
[ ] FRAMING [ ] FINAL /
REMARKS: ~L
DATE (~O// 19 INSPECTO
X7T' I
765.1802
BUILDING DEPT.
1 NSPECTION
[ I FOUNDATION 1ST [ OUCH PLBG.
( ] FO NDATION 2ND [ ] INSULATION
[ MING [ ] FINAL
REMARKS:/~/%~/ ?/%~~-l
_y
DATE INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
F NDATION 1ST [ ] ROUGH PLBG.
] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
7
a
DATE ~3 / INSPECTO
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] IN TION
[ ] FRAMING [ FINAL
REMARKS%
DATE aw/w INSPECTO
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r/lLE APO. 8208-273014
CHICAGO TITLE INSUMNC! COUPW
CbIG) 717.441
FS~ TITLE i d way-~ I
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EDWARD J. SMITH O JOAN SMITH
LOTS 27,26 B 29, BLOCK C 1
"MAP OF REYDON SHORES' DATE MAY 3.1*02
AT SOUTHOLD SCALE. I'•I(O• '
TOWN OF SOUTHOLO
SUFFOLK COUNTY, NEW YORK NO. 1 41-194
N UNAUTROMIUm ALTENAlmN ON Amp riot to rnu GUARANTEED TO, ~
/uAY" I/ A VWLATIOM or SECTION Tim Off"
YORR /rAtT EDUCATION I AN CHICAGO TITLE N16URANCE COMPANY
wEY
• CORE/ OF TNIS SURVEY NOT %Ehft 1M( LIMO 'NO fURVf VON'I 1wN[0 /pl 011 TYrOr/C0 SVL SNALI
NOr CC CON910Ee10 TO.a. WILIO TRUE COPY
RD0 ..MTEa( IMDICAT(O 111CO. (M....VM t"rD
rM[ I(IrON OR MOY rN[ SURVEY lE PREPARED.
AND ON NIf 8f%ALr TO fM( TITLE SVVFM%.
I(NTAL AQMCT AND L[NDIM( INEr'fYTIOw LI[T(O
[9401'0 I
Nf -00'r ND TN(.SSNME[S D.r THE rNAN!/I
OOI1rUYION. oOAR t[E
AN AA{ NOTRAILI j)^fj/fI~/]•.•f_~,./jl/
N A001 t1DNAL INIRRUO/ONS DI /INaIOULIt 1
N 111"ANCES SMOYN M(NCON'NON PROPERTY LINES P/y
EI To EEO/TAI OT roeA SPECIFIC
Er MONUMENT PURPORT A ARE
LINES NOT TO 69 E[ TO (OrNU/N UIED J• STAKE PROPERTY LINES as row as uREClacnaN or nNCas.
SUBDIVISION MAP FILED IN THE OFFICE OFI hi CLERK OF
SUFFOLI. COUNTY ON JULY :,1971 AS FILE IKL 431 YOUNG e00 OSTRANDER AVENUE
IUfR CO. TAX MAP 013T. SECT. BLK LOT LL .1 BI YOUNG RIVERHEAD. NEW YORK
1000 OSHA 01 S!
ALDEN W YOUNG,PROFESSIONAL ENGINEER '
AND LAND SURVEYOR N.Y.S.LICLMSE 940.12141
HOWARD W YOUNG, LAND SURVEYOR
N.Y.S. LICENSE NO. 45893
I
(v ,-'1 7T ' ~ BOARD OF HEALTH
FORM NO. 1
3 SETS OF PLANS . . . .
TOWN OF SOUTHOLD SURVEY
OECD BUILDING DEPARTMENT CHECK
TOWN HALL SEPTIC FORM
" SOUTHOLD, N.Y. 11971
TEL.: 765-1802 NOT I FY ;
CALL
Examined ...%L./.f 119(~/.~ L MAIL TO-...,.............
19 Permit No. dI ° . .
Approved
p
Disapproved a/c Or nA K! '~~i
,rq~r
7 Bing ing Inspector)
APPLICATION FOR BUILDING PERMIT
Date 0 4AZ..4 19 p
INSTRUCTIONS
a. This 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.
I e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy
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 applicable Laws, Ordinances or
Regulations, 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 inspectio
(Signature of applicant-, or name, if a corporation)
/?O.>r.9./, oAK. dR. :fov
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
CTf1VFiPR~ . LOn/7fICjTI~ .~rN?r~113'An/F
Name of owner of premises . 7!r!r'J.:q!Ui~+E'A~1
(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. <~.47/.:!`iz
Cr
Plumber's License No.
Electrician's License No. A.S.. [.LFrlC/~
Other Trade's License No .
1. Location of land on which proposed work will be done .
OAK 0%P fa' .
.1`.......... uryot 4.. -
House Number Street Hamlet
County Tax Map No. 1000 Section ...:.9.Q Block 1 Lot-15 .
Subdivision . !~~/AOnJ S'A'V445, , , , , , , , , , , , , Filed Map No. Lot .
(Name) ,
1 State existing use and occupancy of premises and intended use and occupancy of proposed construction:
p i
a. Existing use and occupancy 2!Ne~~. /cry, 1.4W,e44/Az-
b. Intended use and occupancy r<~?!G(E,r!1ANi4y. Dkc%!?4~!YC...................
3. Nature of work (check which applicable): New Building X Addition Alteration
Repair Removal Demolition............ Other 1V
(Description)
4. Estimated Cost Fee
(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
.6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .
7. Dimensions of existing structures, if any: Front ....Yk Rear ...e..4......... Depth . , 30
Height ...?.Z......... Number of Stories ? .
Dimensions of same structure with alterations or additions: Front `Ky....... ! >
`
. Rear ~z~ .
Depth.... Sr............... Height...................:.. Number of Stories...........:..........
8. Dimensions of entire new construction: Front `?Y Rear ...IrY.......... Depth ..Y9
Height ..4ikl Number of Stories - .
9. Size of lot: Front Rear...................... Depth
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: .111cO .
13. Will lot be regraded 41VO Will excess fill be removed from premises: Yes 6
14. Name of Owner of premises T4 jl....... Address . 437.4 9144e Phone No. l'.r:s4Y7 .
Name of Architect ~ 1. 4Cf! Address . 44r!+eer Phone No..5 Y.e
Name of Contractor `4? '1~!!^+?~P!!~~.......... Address /q,, AY(P447e, Phone No. 7Gf.l~eq
15. Is this property 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 dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF NEW~1'-ORI~~ k COU F 0 l o S.S
C',dl.r1,5~7JY~ being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
Heisthe
Contractor,' gent, corporate officer, etc.)
if said owner or owners, and is duly authorize o perform or have performed the said work and to make and file this
Ipplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the
.vork will be performed in the manner set forth in the application filed therewith.
worn to before me t 's
.day of 19 .C3
lotary Public, J Gt County
CLAIRE L GLEW.
Notety Public, State of New York .
No.4879505 (Signature of applicant)
Qualified in Suffolk County
Commission Expires December 8, 11 9
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IIMDERWRITERS CERTIFICATE
REQUIRED
~AP/PI APPROYEDS NOTED
DATE; LL' DATE; L fi? _ R
PLUMBER CERTIFICATION FEE: y-. a -~/r(o~% BY:
01 is gg A~(+~/ FEE: 'B . NOTIFY BUIL NG DEPART NT AT RF NEW y
ON LEAD CONTENT BEFORE 4dC LP PAi gC it OR 765-I 802 9 DO NOT PROCEED If copper tubing Is used PLUMBING CERTIFICATE OF OCCUPANCY 9 FOLLOWING 765-1802 9 AM TO 4 PM FOR THE 5a~t:~ce T, ~9r FOLLOWING INSPECTIONS:
UNTIL 2nd OUNDATION LOCATION E IS UNLAWFUL 1. FOi1NDAT 1. FOR PO - TWORCQUIRED (~~~C~l~rK~ /t `lL/
F FOUNDATION LOCATION for water distributing ALL PWATER LINES NEED LUMBING WASTE SOLDER USED IN WATER FOR Pout FOR POURED URED CONCRETE r o ; ; IiI//fJL W s Sys '
HAS BEEN APPROVED system; PIPI^9 shall be TESTING SEFOIIE COVERING SUPPLY SYSTEM CANNOT WITHOUT CERTIFICATE 2. ROUGH - 2. RDUCIi -FRAMING R, PL119A61NG ~/1R! ~ +1"
of types K or L onl 8. INSULATIs 1 INSULATION sG } l` r
EXCEED 2110 of 1% LEAD. OCCUPANCY 4. FINAL 9E COMP, 4. FINAL - CONSTRUCTION MUS Phone 477-0400 Main Road BE COMPLETE FOR C.Q. ~~FESS;UNF
ALL CONST ALL CONSTRUCTION SHALL ME GREENPORT. NY 11944
THE REOUIF THE REQUIREMENTS OF THE q7
STATE CON! STATE CONSTRUCTION & ENERGY EL/T'
COOES. NC DESIGN OR CODES. NOT RESPONSIBLE FOR I' 'B' AD.Y 'PRELIMINARY 15 9 DESIGN OR CONSTRUCTION ERRORS I I 93
DWG L`LEVATIan15
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