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23388-z
FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY - No— Z-24678 Date OCTOBER 7, 1996 THIS CERTIFIES that the building NEW DWELLING Location of Property 405 OLDFIELD COURT MATTITUCK, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 120 Block 3 Lot 8.22 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 9, 1996 pursuant to which Building Permit No. 23388-Z dated APRIL 23, 1996 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 ATTACHED GARAGE & FRONT COVERED PORCH AS APPLIED FOR. The certificate is issued to FARMVEU ASSOCIATES (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R-10-96-0021-OCT. 2, 1996 ELECTRICAL INSPECTION CERT. #12515 - OCTOBER 3, 1996 PLUMBERS CERTIFICATION DATED OCTOBER 3, 1996 - G.A.H. PLUMBING & HEAT. Bu' ding Inspector 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) Date ..................... ....�.��................. 19. .. N2 23388 Z Permission is hereby granted to; / to ......... ...... ......... .. .. ......<��- '- .... ' ,. Uj... ...., ... . .. .. ...-... . ..... ... w ......... ............................................................................................................................ ...............I.................... . . .. .... ...................................... at premises located at...........P�..�...�.... ...... c ...... ....................... .................................... ......... .... ...... ................. l 8 County Tax Map No. 1000 Section ......(... ®.... Block.......... .......... Lot No. .......1.. ✓ pursuant to application dated ... ................. 19.. �6...., and approved by the Building Inspector.. / Fee$... 421..�® . .............. . ..... . .... ? .. ilding Inspe or Rev. 6/30/80 -�J C Form No. 6 / ^ TOWN OF SOUTHOLD r BUILDING DEPARTMENT - � 0 TOWN 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. s 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 $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - t .25v,,, , 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00 Co�Aeercial $15.00 Date . . . . . . . . . 6,. .CSC. . . . . . . . . . . . . . . . . . . . . . New Construction. . V. . .60d 0 Pr - isting Building. . . . . . . . . Location of Property. . . . . . . . . . . .� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . House No. Street Hamlet Onwer or Owners of Property "`. :`:: .`:�. . . :� . . . . . . . . . . . . P y. . . . . . . / .I . . . . . . . . County Tax Map No 1000, Section. . . . . .Block. ._ U. .. . . . . . . .Lot. .g. . � . . . . . . . . . . . Subdivisio . . . . VtAj. . . . . . .rmi. . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . Permit No. . . ./°�. !.3.��.�ate Of e .° . .Applicant. . . . . . . . . . . . . . P .� Health Dept. Approval. . . . . .Underwriters Approval.. . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . FiACer4cateFee Submitted: $. . . . . . . . . . . . . . . . . . . . . . . . . A08� . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . PPLICANT TEL. 765-1802 0�4 TOWN OF SO tJTIIObD �— OFFICE OF BUILDING INSPECTOR P.O.`BOX 728 TOWN HALL . SOUTHOLD, N.Y. 11971 C E R T I F I C A T I O N Date Building Permit No. 3 Owner Y, f i t�-o (please print) Plumber II (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% . lead. (plu ber ' s signature) Sworn to before me ' s —day of thev n I ,• 19 Notary Public Votary Public , , suc-pi�LCounty . 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I . I 76S.1SOZ BUILDING DEFT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSU ON [ j FRAMING [ INAL [ ] FIREPLACE 8 CHIMNEY REMARKS: 417 DATE INSPECTOR 765-1802 BUILDING DEFT. INSPECTION [ ] F UNDATION 1ST [ ] ROUGH PLBG. [ FOUNDATION 2ND [ ] INSULATION [ ] FRAMING FINAL [ ] FIREPLACE & CHIMNEY REMARKS: L G DATE INSPECT 70-1802 BUILDING DE". INSPECTION [ FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE INSPECTOR '65.1802 BUILDING DEFT. INSPECTION [ ] FOUNDATION 1ST [ ] RO PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE INSPECTOR 765.1Soz BUILDING DEFT. INSPECTIO�N [ ] FOUNDATION 1ST [ ROUGH PLBG. [ ] UNDATION 2ND [ ] INSULATION [ FykMING [ ] FINAL [ P�j FIREPLACE & CHIMNEY REMARKS: ilk DATE INSPECTOR -[ I mu m". DATE C,ut It I V I I Eli 1:M I III IAT 1011 In --._.__ .......... '- ...- _ ..._ .._ . _______..__ _._. ----------- 7Z!.......... , II)A,I*I ol I ----------- -------- --------- -------------------- ---------- - --------- FRAIII," A. ............ lv� ------------------ - -- - --------------- IIINIII.ATIO11 111;It Y . STATE CODE ----------------- 1; 1 IIAI, --------------- --------- --------------- --------,,------- ------------------ m �,�� --------------------- ADDUIAOIIAL ------------------- 2N_ +' BOARD OF HEALTH . . _ . . . . . . . _ . y FORM NO. 1 3 SETS OF PLANS L . . . . . . . . . . . . . . TOWN OF SOUTHOLD SURVEY . . . � . . . . . . . _ . . . . BUILDING DEPARTMENT CHECK ZU..0i- �: . 9 TOWN HALL SEPTIC FORM . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 BLDG.DEPT TEL: 765-1802 NOTIFY: TOWN OF SOUTHOLD CALL Examined._ Z 19 L r MAIL TO: .a�°�P . . . . . . Approved.... 19�Sr✓. Permit No3W, .. ��,-A f.:�>.....71d,.. Disapproved /c .......................... .... .................................... - �&yilding Inspector. .... .........)2_� AP L CATION FOR BUILDING PERMIT - Date. . . .�. . . . , 19 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 mist be drawn on the diagram which is part of this application. 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 issue a Building Permit to the applicant. Such pgrmit 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 have been granted by the Building Inspector. t APPLICATION IS HEWHY 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, ']ding ing code, and regulations, and to admit authorized inspectors on premises and in building for sary ions a . .(Signature ofapplicant, or name, if•a..orporation). .•.. .(Mailing address of. . '....'••...•.applicant) State whetter app11'. is. . . .owner, lessee, architect, engineer: general contractor, electrician, plumber or .......; .... ilder. Name of owner of premises .. � ... .. .` v:' ...0 ................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ......................................................... (Name and title of corporate officer) Builders License No. ......................... Plumbers License No. ......................... Electricians ]License No. ..................... Other Trade's License No. .................... 1. Ivcation of land on which proposed work will be dame.. ........................ ..... ................... ....................................................................................................................... House Number Streets� Hamlet sn County Tax Map No. 1000 Section ...� ....... Block ...V 3....... Lot .. i .... Subdivision ... �!{!1��, ..�tr�.5............. Filed Map No. ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......................... ...... ....................................... I b_ Intended use and occupancy ......I...5. .................................... .1. Nature of wuck (d►eck wl►ic:l► applicable): New Ik►ildtnl; . ........ Acklicicxn .......... Alteration .......... Repair ............ Renioval ............. DemnliLion ............ Other Work .................................. (Description) 4. Estim►►►tecl Cost ... �� ................ fee .............................................. (to lie paid cx► filing this application) S. IF cicaellinl;, rxnl►er of cltaellicu., units ............ Lumber of ch,relling units on each floor ................ If garage, ►xnl)er of cars .......�..........0..................... G. If Ixisi►►ess, caniercial or mixed occupancy, specify nature and extent of each type of use...................... 7. Dimensions of existing structures, if any: Front................ Rear ............... Depth ................. lk:iglit ......................... Unber of Stories ............... Dimension of sere structure With alterations or additions: Front ............... Rear ............... De1►tl► .................... neig t ....._.............. tanl)er of Stories ..//.��............ QQ a. Dimensions of entire new cons Lruct:ion; Front ..(,f .... Rear Depth ..d. ... Ik.-igl►t NYiber of Stories ......t.............. 9. Size of lot: Front ...4.1:IP-(l........ Rear ? '............. Depth ....)....... 10. Dare of hirchase. ..................... NM•me of Former (User ........................................ H. Z xie or use district in wtiid► premises are situated ........................... ................................. 12. Does proposed cc-instruction violate any zoning law, ordinance or regulation: ........................ 13. Will lot he regraded ..... ---------- Will excess fill lie removed From prenises: YES NO M. Naues of Omer of prenises .1►.! .. .... Acklress .............................. Plxx�e No. ........... N:nie of Ard►itect �.... .j..,,-.................... Address PI►one No. ........... N►�cre of Ccx►tractor1t! .. �!:`:". " ............... Address ...... ....Phone No. ........... 15. Is this property within 300 feet of a tidal caet]and? * YES .......... NO ....(/.. *IF YES, Saunun 1CIm ims :.S PERMIT MAY mi REQIIIRr.D. PLOT DIAGRAM Locate clearly and distinctly all Imildings, whether existing or proposed, and indicate all set-back dimensions lien properry.1ines. Give street and block nud)er or description according to deed, and show street names and indicate iAiether interior or corner lot. i SI'A lE M DREW YMK, S� /�m—b ................. . ... ...................being only swan►, detx►ses aixl says that he is the appl is n►t (Name of individ►ial. signing contract) above ►umed, Ikeis the .... .......`.... ....................................... ............................... (Ccn►tractor,.; gent, c:orporate officer, etc.) of: ;;aid omier or owix-rs, and is duty eu►Lhorized to per.fonn or have performed Lie said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and be'Hef; and that Lhe work will be performed in the nti►nner set fordilin the application failed therewith. 'worn Lo I ore im- t.his . C t ''.;':` - .clay ,. 19.. �J ? ;Notary Ad►1 c .. ....... .. ..►IRE1=Gk� York (Sigrk, a of ApplicanC) Notary Public.State of dew Suffolk.County _. :, ocpires December 8,19 70 - 19 - 30�•/ -So. 00 too too d� 0 0 Q WATER 81 JPPLY AND SEWAGE DISppg CONFORM NEW STANDARDS STEMS MUST DATE wEw c 1� yVEMI3ER 13,1"S. eAn 'c'� � nor o N cn -ZSr - Ff, &Aie- I oil,So 0 _ � � ►000GA1� a SU"O COUNTY DEPARTMENT OF HEALTH SERVICES ° s Iso.o 0. A _ FG $APPROVAL OF CONSTRUCTION FOR A SINGLE FAMILY RLSEDENCE ONLY Tip 4Sa.o loq.c� 26 1996 Hs W. a! Io3.-7 , aa- - - - APPROVE _ R MAX MUM OF�BEDROdMS EXP THREE YEARS FROM DATE OF APPROVAL 0 NEW I I DESTIN G.GRAF � ;+TAR of LICENSE I#0500 OSN ICES ® hEAI-T� ION �> AAAg f> Unouthorl"d alteration or addition to this document is a violation of Section 7209 SURVEY OF. I �T ^ of the New Yak State Education Low. �r (,/l..I CerUncotlons indicated hereon shall non only to the person for whom It Is prepared and on his behalf to the Title Company, Cevwmmentel Agency end Larding Inetltuiidn W` !�T noted hereon, and to the oesigness of the lending Institutions or subsequent owners. Q A%oc-4�2 Copies of this document not bearing the professional's Inked tool or embossed sea shall not be considered eel valid true copy.. The offset*(or dimensions) shorn hereon from structures to the property IMn are for a specific purpose and use and therefore are not Intended to guide the erection of fence,retaining wells, pods, patios,planting areas, addition to buildings or any other construction. The existence of right of ways and/or easementse of record, If any, not shown are r not guaranteed. SURVEY DATE: S 1s �� SCALE: ( = CERTIFIED ONLY TO:/,.4A� i ��� DESTIN G. GRAF '/ LAND SURVEYOR By . 73 WOODLAWN ROAD DESTIN G. GRAF N.Y. LI No. 50067 ROCKY POINT, NEW YORK 11778 TAX I.D. No. `ncac PHONE (516) 821-3442, N.Y.S. LICENSE No. 50067 � - 2 0 - 03 - 63.2v LET In L�T�I 2S0. 0o I 0 0 ' c�1 la W , Q �' � -��✓Nt�-f oa ; r 0 Z3.e tT. q 2.1.0 A()� O N � I 1 1 r U, MAY 2 9 IPP6 :q 61 G. DEPT. TOWN OF SOUTHOLD Unauthorized alteration or addition to this document Is a dolatlan of Section 7209 SURVEY OF. of the New York State Education Law. Certifications indicated hereon @hall run only to the person for whom It Is prepared and an his behalf to the assigns" ns"Compony6of Governmental /penny and Lending Institution Ae f �� _' ` , � AT Noted hereon, and to the u@Iprsu of fine lending tntlltullon@ a subsequent owners. D •f'�ja�/�tL%j Copies of this document not bearing the professional's Inked seal or embossed seal @hail not be considered a valid true copy. AAA_-'`'1^ W-14 T�� O� �L The offset*(or dimensions) shown hereon &am structures to the property Nnss are /`� Ar 1� 1 for a specific purpose and use and therefore are not Intended to guide the erection of / fenee@,retaining wdle, poole,pollee, planting areas, addition to buildings or any oth �., �31J►-�'r�, ,�. construction The existence of right of ways and/or easementse of record,if any, n �� not guarrteed. � VEY DATE: SCALE: CERTIFIED ONLY TO: DESTIN G. GRAF LAND SURVEYOR By 73 WOODLAWN ROAD DESTIN G. GRAF N.Y.S. LIC No. 50061 S, (>, ROCKY POINT, NEW YORK 11778 TAX I.D. No. ovp — 1 ZO PHONE (516) 821-3442, N.Y.S. LICENSE No. 50067 — ��✓ S.ZZ wF�w- �o U U WATi S I"PI,Y � COIVFOI`.M AND SEWAGE DISFOSA SYSTEMS�' UST n'II NEW STANDARDS DATE wEw C DER 13, t99S> s /44 �- I� CDO, w \ 6rAe.. I o4.So 0 �orMr� rN s O r a SUFFO OOTJPJTY DEPARTMENT OF HEALTH SERVIC0 (a�. 8 A ri G P • R APPROVAL OF CONSTRUCTION FOR A n - SINGLE FAMILY RESEDENC)E ONLY 96 1 t Win- cKIP CD ,c1 00 1 ��I�,.A xsr -r,d, 10` -61 R MAXEMUM OF-L�-BWROJMS EXPI .S T M YEARS FROM DATE OF APPROVAL F E y DESTIN G.GRAF t, mAR no Of LICENSE InM500 O 14E.ALlII S�RVICF �pFF lON 4�P� tAW 69)00 Unauthorized alteration or addllion to this document Is a vIolatton of Ssetlen 7200 SURVEY 0F: of the New York Stale Education Low. (�J CsrUfleotions Indicated hsrson shell nm anty to the person for whom it Is prepared ve and on his behalf to the Title Company, Qonmental Agency and Lendlrng Inslltulldn W` �T meted hereon, and to the oesignese of the lending Instllutlans or subsequent owners. of— ��7 Copies of this document not bearing the professional's Imhod seat or embossed seal shah not be considered a valid live copy. The offsets (or dlm*hnsnsians) shown hereon from structures to the property IMa are ,v,,T 1 1 � •�`^1'�"' l0 � I_ for a specific purpose and use and therefor am not Intended to qulde the orecllon of fenees, retsining wells, pools, pallor, planting areas, addition to buAdFngs or any other construction. The osletence of right of ways and/or seseentse of ed. If an not shown are - r ' not guaranteed, m record. y, SURVEY DATE: 31S `�lo SCALE: I = CERTIFIED ONLY TO:' +, LewVAe-i 4�6, DESTIN Go GRAF LAND SURVEYOR BY 73 WOOOLAWN ROAD DESTIN G. GRAF"N.Y.t`:'V No. 50067 ROCKY POINT, NEW YORK 11778 TAX I.D. No. I �O - 03 � 3.Z?-� PHONE (516) 821-3442, N.Y.S. LICENSE No. 50067 ��� - -70 - 'I =:3 `V./ 2SOr 00 4�t,g4�hr� Q wEw 0 OL 1 z4' m� (Z" I l51 1fn� W V 1 �i�7-JC O N • t k f Q O 4.o�" N I woo3dnck 1 ass 3a' cl .r ,:z; , -T"'t�4e o s — j 6 ;, Cr pp� ,vaJt� °iq t • � � y=y (9a � ,� Sl peer'-_+If:� `°i .I �� •.-.i `�� .e .apt;,j i HE LOCATION OF WELLS, SEPTIC AIR rf TANKS AND CESSPOOLS SHOWN HEREON ARE _HELD: OBSERVATIONS SC D L AND OR DATA OBTAINED FROM OTKRS. llFALT EPT. OF. H SFRVi 4Nkv �►,���hP Y�BoP� Unauthorized alteration or addition to this document to a Nalatlon of Section 7209 SURVEY OF: j _d�• of tA•Ner Yrk Stork[ducall•n I— Usti.Carl Usti. lndL harem shall run only to the person for whom It Is prepared and an his behalf to the Title Corrlpanyr,Governmental Agency and Lending Institution listed hereon,and to the sealpless of the lending Institutions or sub"Went omen. MAC 0 4— f ^�/ ' �� Copies of We document not bwhp the protenlonal's Inked eed or embossed seal .hall not to considered a valid hoer. here /V1�-R"tTi�l TatfJt� o� �. Th•albet.(cur dmensians)shown hereon from struabn.s to the property Ilnse ors I l far a specific purpose and use and therefore we not Intended to quWe the erection of fences.retaining-11%fade,patios,pl-Unp areas, eddtlon to buildings or any other cornbuoUvL The•rlstsnce of riot of ways and/or sawnentse of record. N any; �i QF E y r f not gurq,tnd. ,gyp O RVEY DATE: g I Zl. SCALE: = CERTIFIED RTIFIED ONLY T0: 1 DESTIN G. GRAF cs Y& 46& A T' t LAND SURVEYOR Op L ENSE N05 67 By AD DESTIN G. GRAF N.Y.S. LIC No. 50067 S L P� ROCKY POINT,73 NEW�YOO RK 11778 TAX I.D. No. 27, PHONE (516) 621-3442. N.Y.S. LICENSE Na 50067 4 `� � � ' i LIPAP fill 4 x 4 C.c P A!� AS NOTED l r. 3 ,Z,'1 xK !2" G. .___``Y (� r4 'X r 4 'c C.A . -c� °, Q (�b . „ � : c,' ?, 4t���� " - �� . ICATE F'' BY: �t1.0W FtriAL'Crtc+�7?E �; �Y ��� NOTIFY 'BUILDING OE ENT � " v € rn s� 765-1802 9 AM TO 4 THE FOL.LOWIMG INSPECTIONS: t — .�V 1. FOUNDATION - TWO REQUIRED r C ,p Sno T FOR POURED CONCRETE , 2. ROUGH _ FRAMING & PLUMBING FRAMING UNTIL SURVP 3. INSULATION _ ., ON T _ C.O., 4 FINAL CONSTRUCTION MUST o�-FouNo�rloN LOCATION BE COMPLETE FOR _ x I ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. 1 2. to (f 4 4, y��r�.r Cam" STATE CONSTRUCTION & ENERGY r_ rr rr, CODES.- NOT RESPONSIBLE •FOR I . {. DESIGN OR CONSTRUCTION ERRORS 7 'o tr" v E t,2 G f i l: ! rF P4 ! rJ , 1- /� , 'nr D G r!1 1 U 7V Y J.:-f is 'S� d �% T - i i t ` :/ J 'V- 1 � C,l A 'A wl �. t, 1 'A i�=" T J y t � I s'• I r 1 _1 G ,. r � P. „ „ , Q � J _ N J - _ p , i Q - L - F , � G a IZ J a. t:: EL �• i r � rJ i � 1 G � � 'ram:. mot) F R a; A D� a G A rJ - 1;�E� F ,A _I E r , F , i' �: WD. .vJA��:" � 4.. 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