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HomeMy WebLinkAbout22341-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24205 Date MRCS 13, 1996 THIS CERTIFIES that the building NEW DWELLING Location of Property 1405 ACKERLY POND LANE SOUTHOLD NY House No. Street Hamlet County Tax Map No. 1000 Section 69 Block 5 Lot 7.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 31, 1994 pursuant to which Building Permit No. 22341—Z dated SEPTEMBER 21, 1994 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 A ONE FAMILY DWELLING WITH ATTACHED TWO CAR GARAGE AS APPLIED FOR. The certificate is issued to EDWIN WARD (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-94-0081 MARCH 7, 1996 UNDERWRITERS CERTIFICATE NO. N365773 OCTOBER 6, 1995 PLUMBERS CERTIFICATION DATED MARCH 11, 1996 D & G PLUMING & HEATING 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 AUTH ZED) 9 N_ ® 22341 Z Date........ ....... . ..........a........................., Permission Is hereby granted to; !�.4/e.y f ✓../.r'...../45U4./ ............... F to ............Q ,s ......�.....�' . / .. .. ..., �e.y...... ........................ .. ...... ..... . .. .. . ......a.... . ...... , ... .............. . ...... 1 �P ��.> ..... .�... o. .............................................................................................. . .................................................................................................................................................................. ................................................ �..................................../........................................................................... at premises located at.......� o ...... ./..4'. 4/f..... .�Z?pV.4K... '.'.................. ......................................................�0 w-t . . ....... .... ....................................... G� County Tax Map No. 1000 Section ......4�/../........... Block........�.......... Lot No. ...7i...�............ pursuant to application dated ............... 19....�.�., and approved by the Building Inspector. a Fee$. gd.. %.(...... ..... .. . . . Building Inspect Rev. 6/30/80 �1 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT 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. 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 "nre-existing" land uses: L." 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 - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 ZDateNew Construction. . . . . . . Old Or Pre-existing Bu•lding. . . . . . . . . . . . . . . . . • • • • • . • . . • . . . • . . • . . . Location of Property. . . . .�`J.OcS. . ... .14G(LrG-� . . . . C> . . . .�� . . . . . . . . . . . . . . . . . . . . . . . . . House No. �. Street Hamlet Onwer or Owners of Property. . . .. ... . . . . . ��. . .. . . . . . �.:J:: .J�1. . . . . . . . . . . . . . . . . . . County Tax Map No 1000, Section. .6 .7. . . . . :Block. . . .L5. . . . . . . . . .Lot. . 2n .Z. . . . . . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . Permit No. .Z3 � / . . .Date Of Permit.��p: �� . .Applicant. . . .��'.'.��:1� .: t".'�V . . . . . . r Health Dept. Approval. . . .. . . . . . . . . . . . . . . .. . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . .. . . . Final Certicate. . . . . . . . . . . Fee Submitted: $. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . APPLICANT DA-1wS 1145069 THE NEW, PORK BOARD OF FIRE UNDERWRITERS PAGE I BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK, NEW YORK 10038 Date OCTOBER 06,1995 Application No.on file 88933195/95 N 365773 THIS CERTIFIES THAT only the el tr'Cal,equipment as described below and introduced by the applicant named on the above application number in the premises of EDUVIN WARD, 1405 ACKERLY POND LANE, SOUTHOLD, N.Y. in thefollowing location; IN Basement ® lst FL E 2nd Fl. GAR/OUT Section Block Lot uws examined on SEPTE BER 29 r 1995 and found to be in compliance with the National Electrical Code. FIXTURE RECEPTACLES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS SWITCHES OUTLETS INCANDESCENT1 FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P. 29 40 23 29 1 1.4 1 F DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. NO.OF FEET AMT. WATTS 1 E" 3 — 1 SERVICE DISCONNECT NO.OF S E R V I C E AMT. AMP. TYPE METER �,4W 3W 3 0 3W 3.0 4W NO.OF CC.COND. A.W.G. NO.OF HI-LEG A.W.G. NO.OF NEUTRALS A.W G. EQUIP. PER Ar OF CC.COND. OF HI-LEG OF NEUTRAL 1. 200 CB I X 1 2/0 1 2/0 OTHER APPARATUS: 111ELL PUMP-1 FIRE PLACE BLOVTER-2 WHIRLPOOL BATH-I MOTORS.I-I H.P. ,2-E H.P. ,I-F H.P. G.F.C.I:-4 SMOKE DETECTOR:-2 RICI ARD NAPOL'ITANO LIC.#3922-E III ROSEMARY LANE GENERAL MANAGER CENTEREACH, NY, 11720 Per `11 ' This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT: THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. j • :iG: .:ram�, Town Hall, 53095 Main Road Fax (516) 765-1823 P. 0. Box 1179 Telephone(516) 765-1802 Southold, New York 11971 - OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD C E R T I F I C A T I O N DATE: M,arcil �s Building Permit No . Owner: W L IJ � f (please print) Plumber: 6 le,�� (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (Plumbers Signature) Sworn to before me this day of /`�l G��/ U I 19q� I HOPE HILLYER Notary Pub c, 4 County NOTARY PUBLIC.State of New York r No.011-115022674,Suffolk County Term Expires January 18, 1998 o� Gyc y 2 Town Hall,53095 Main Road p • Fax (516)765-1823 P. 0. Box 1179 �'� �� Telephone (516)765-1802 Southold, New York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD October 161 1995 Senate Homes, Inc. 1098 William Floyd Parkway Shirley, NY 11967 Re: Pamela Hunt (Edward Ward) - SCTM#1000-69-5-7 .2 Prem: 1405 Ackerly Pond Lane, Southold To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons,: xx An application for Certificate of Occupancy is. ,-"' not on file. (Enclosed) xx No Underwriters Certificate on file./ xx The check is not , on file. $25.00 xx No Health Department Approval on 'file No final inspection has been made. xx ' No Plumber Solder Certificate on file. . (All permits involving plumbing being , issued after April 1, 1984) . BUILDING PERMIT # 22341-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. Ayj� BUILDING DE INSPECTION [ ] FOUNDATION 7ST [ ] ROU PLBG. [ ] FOU DATION 2ND 14, NSULATION [ FRyMfNG 140-- [ 1 FINAL FIREPLACE & CHIMNEY REMARKS: xon llaen All� J��, c u DATE INSPECTO 765-1802 BUILDING DEPT. ` `�� INSPECTION [ ] FOUNDATION 1ST [ ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ A -FRAMING [ ] FINAL [ FIREPLACE & CHIMNEY REMARKS: A 0--goy /��Q��,�-���ivy � (���1�� z��,��' �i��.C-�'f•��� � d�v z � ��- DATE INSPECTOR � J M.1802 BUILDING DEFT. INSPECTIO�" [ ] FOUNDATION 1ST [ ROUGN PLBG. [ ] FOUNDATION 2ND [ ] INSULATION �RAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: g, Ir "'- -WW - r Apo 41P-0_ 54p �9ezaa__zimoo� � 9 DATE INSPECTO Ace- m- 802 BUILDING DEPT. �7 k� INSPECTION 1 1 1N 1ST ROUGH OUNDATION 1 INSULATION FRAMING FINAL REMARKS: 01 ei4 64 s 44o( DATE- r INSPECTOR ./� /i �r - 765-1802 BUILDING DEPT. 1 r INSPECTION [ ) FOUNDATION 1ST [ ] ROUGH PLBG. Jp [�)ool"ATION 2ND [ ) INSULATION [ ] FRAMING [ ) FINAL REMARKS: 61 INSPECTOR DATE �l%f�� S__-,-% t fJ) %JJ i i/ BUILDING DEFT. 6PECTION [ FOUNDATION 1ST [ ] ROUGH PLBG. � FOUNDATION 2ND [ ] INSULATION ( ] FRAMING [ ] FINAL REMARKS: 0e) all DATE INSPECTOR 765-1802 BUILDING DEPT. NSPECTION _.FOUNDATION 1ST [ ] ROUGH PLBG. ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ) FINAL REMARKS: i DATE � IN8PECT0 765-1802 BUILDING DEFT. INSPECTION [ ] FOUNDATION iST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 ULATION [ ] FRAMING [ FINAL [ ] FIREPLACE 8 CHIMNEY REMARKS:rAiBl��.ds. .9.�.0�� A�� rL� Ae DATE / INSPECTOR Fri a- L/ / � � . � ice, i • 'COP r �IAsMill a / J �•� ado J13L1) INSPECTION REPORT DATE COMMENTS --------------- FOUNDATION ( IS'r) FOUNDATION----(2ND)______ _—_—��� --_— r'-�' :�c'�c,_ --- ---___ — �r%----- ROUGH FRAME & � PLUMBING if s op ----- --------------- -------- INSULATION PER N. Y. STATE ENERGY I II CODE a -c C ii--- = II-- ----ii- � 10 �, -- if FINAL _________________________- ADDITIONAL COMMENTS: H _ H ' O ` a — r r� b -- y Sep. 19 '95 11:05 SENATE CONST/PREMIER SER FAX 5164755154 P. 1 P. 01 $EP-'-i M-95 FR I 04 :42 PM j I PICONE BUILDING PRODUCTS DIV. OF PiCONE ENERGY SYSTEMS INC. J©I� � � August 30. 19.95 Senate Homes Conatruction aOB: AckerlY Lane Southold, 11971 nuilding Code Added bracing done at the top of Flue was Properly Installed in accordance to NeW York State and Local Building Codes. Thank You, Diane Cooper I'' fi it 1 cc: D. Damao �i SLDG.DEPT. z TOWN OF SOUTHOLD LONG ISLAND AVENUE HOL7SVILL• E. NEW YORK 11742 • PHONI: (516) 289.5490 • PAX: (516) 289-5416 J . 1$0 March 27, 1995 Southold Building Department Tours. Hall 53095 Maui road Southold, N.Y. 11971 RE; Building Permit 22341 Z Ackerly Pond Marie Sec 69 Block 5 Lot P/O 07 Request for seal of stability of footings for garage Upon my review, the stability of footings at the garage area are acceptable MAR 3 1 R05 OF NEB 1 "am lomlllar with the STANDARDS FOR APPROVAL �• S I.9 O SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Y {, AND CONSTRUCTION OF SUBSURFACE SEWAGE P FOR APPROVAL OF CONSTRUCTION ONLY DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES and will abide by the conditions se/ lorlh !herein and on the r�rI permit to construe! DATE- WS. REF. N0. fi. Y ` .ICE 6oii�y ��''�xtr��.in�� :,,�',r. •� 1 �' - �� D�j\6 °ji APPROVED ? s sdy Iva�7 .: CO \�h \ �0 �Q AV 5'. -R, A o)' •�,^ jam' Y��.: , � � •,' �ZA9 , p, u `sit• 4c Q '� r 1 HEREBY CERTIFY TO CENTERBANK MORTGAGE COMPANY AND FIRST AMERICAN TITLE WSURANCE b• COMPANY OF NEW YOR" THAT AS OF THE DATE HEREOF fAJ THIS SURVEY AND THE BOUNDS AND G r,46 A 4SU BENTS SHOWN hEREON ARE SUBSTANTIALLY / v r P�\O tia O n E. G G SURVEY FOR MAR 3 I �. ED WIN WARD i99� O° A T SOUTHOLD f i oti5i`~ x2 TOWN OF SOUTHOLD — { SUFFOL ss O5 NTP10 0' N.Y. Scale: 1"= 60' 4. g o co. ti ° �, June 15, 1994 \ IN, Aug. 8, 1994(B.O.H.) 0�'�`✓ �o '° �`�\ •( QP� Aug. 30, 1994 (Certification ) I Vo IF Dec. 16, 1994 (foundation) 10 r AREA = 2.5386 Acres AND SUR` 9_Q f\ CERTIFIED TO• !c�' '� y�3� ' •�, a v" EDWIN WARD G ' ��o V' •\° �. . -,S. LIC. NO. 4961 Prepared In accordance W th_the minimum ___ - L'OT=NUMBERS-ARE REF> CED TO standards for lillel;urveys as established 'SUBDIVISION MAR OF PURITAN FARMS' by the L.1A.L.,S 127d approved and adopted (516) 7/65 - 5020 ORS, P.C. ' �02 FILED JUL Y 19, 1994 FILE NOi 9538 for such use by The New York Stale Land P. O. BOX 909 i Tille Assoclalioz ELEVATIONS ARE REFERENCED TO N.G.KD. The locations of Wells and cesspools MAIN ROAD shown hereon are from field observations SOUTHOLD, N.Y. 11971 and or from data obtained from others- '/��r'�� ����o�•r� »+ems• r x ,,r't - .�' � lx>• �' '4 ki•�w.�.t�:'C7;T t�w�thi.i� � +.�i� R 4 ,MFD.,��.'. t,���:� � � .i���r .a.'. � 1r, i .• Fes -. - { • ' r c !am lam//!ar with the STANDARDS FOR APPROVAL G�• s�9 ANO'CONSTRUCTION OF SUBSURFACE SEWAGE y O� OLK COUNTY DEPARTMENT OF HEALTH SERVICES , > { < 'DISPOSAL SYSTEMS FOR SINGLE FAMILY R$S/DENCES' `FOR APPROVAL OF CONSTRUCTION ONLY �`- z, � t°*•r - "and will abide by the dondillons set.forth,therein and on the; ; - iS.P � v ,•sg� t., x a O. E` S.REF.NO. ,�,� �'�' ',�+�'� �T�, R permll to conrlroel � v ,��,' s. ��/► • W tti^ �11 l:bo/1�9. VEO r2 p i a�r,;pr ' '� � ceo.ra•���i � $+"3"9"�gr$,,,,, a�:�� + �Q �. ,K i 4,sK 05"', S¢ri d •�+ sr t f aL � PQvrr l • iA -.' f� ;{4•S fit �;{j{ 9 �G 7 �r i ytii k ab\ r Oc, I HEREBY CERTIFY TO CENTERRAW MORTGAGE k `C�p / O y tGr COMPANY AND FIRST AMER/CAN TITLE WSURANCE (1` _7 -i_ COWANY OF NEW YO?" THAT AS OF THE nA TE i¢ r HEREOF !AJ THIS SURVEY AND THE BOUNDS AND ,t,G` I �S• /�^\�\,\ '/' �'� MEASUREMENTS SHOWN hl�R£ON ARE SUBSTANTLALLY t .'/ !. t _ .. •fir' _ . CORRECT re 0 SURVEY FOR �— E�. i ED WIN WARD F, _ � oO°� �� AT SOUTHOLD Y TOWN OF SOUTHOLD ) r�a' SUFFOLK COUNTY, N.Y. MAR 3 1000-69-05 P/O 07 _ Scale: 1"= 60' June 15, 1994 ti� `. �a.•.dr js p. .o d' ° • ..}. �(�Y � Aug. 8, 1994(B.O.H.) ,.-- �.n •� I e° �( QP ' • Aug. 30, 1994 (Certification 1 ✓ �\ 0 t Dec. 16, 1994 (foundation) V • � ,\49 tt�sir ��\c`, �' � a 1. , _ � , AREA =2.5386 Acres. ���M 2 q 09 CERTIFIED TO EDWIN WARD i Y.S. L/C. NO. 49618 62. Prepared h accordance Nlh the m/n/mwn y y, LOT'NUMBERS'ARE ED TO alondoida for 1///e surveys as eslabOshed ' , ECONIC YORS, P.C. �� r'• 'SUBDIVISION MAP OF PURITAN FARMS' by the UA.L.S and a proved and ado0led (5/61 765 - 5020 :-1 rll 11 It lt'V IO tOOA r1I r, Air) OS7A /__ ....t __ l,. rt„ .�.., V,.f. ry_._ P__l OF REALTH I U" FORM NO. 1 -3 SETS OF PLANS . . . . . . . - j TOWN OF SOUTHOLD s----SURVEY . . . �_ _ . . . . . . . . i t 11994 BUILDING DEPARTMENT ---C11ECK . . . . . . _ . _ . . . . . . . TOWN HALL —SEPTIC FORK _ . . . . . . . . . . . SOUTHOLD, N.Y. 11971 BLDG. TEL.: 765 1802 t:aT I p�Y_ �, f , - TOWi�OF S_ THOL `J ct7 J Examined . / 1 C A L L j . . . • 22 C� SAI L TO : Approved . . . . . °�. ., 19 Permit No .`�. !.� . . . . . . . . . . . . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . - . . . . . _ . . . . . . . . . . . (Building Inspecto A LICATION FOR BUILDING PERMIT Lu • Date . .V . ..... . . . .. 19?7l. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink arid 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 street: 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 permi; 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 Occupane-., 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 ins ections ... . . . . . .. . . . . .��l o�r;t. . . . . ."(. . . . . . . . . . . . . . (Signature o/f�applicant, or name, if a corporation) . . . . . �d .1ti,;lG(.it (�Loy� .t"!q(�{liwc . . . . ,(M illiing a re s f ap licant) St e whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . . . . . . . . . . . . . . .-. . .��. . . . . . . . . . . . . . . . . . . . . .. . ... . . . . . ... . . . . . . . . . . . . .... ... . . . . . . . . . . Name of owner of premises . . !. lLfe ( �a . . .`�t+c".. . . . . . . . . . . . . . . . . . (as on the tax roll or latest deed) If appl• is a rpo i n, s"g at re f duly authorized officer.' . . (Name and title of corporate officer) A Builder's License No. . . . . . .�. . . . . . • . • . , . • • , , Plumber's License No. 1 �21i {��le • �vz�Q iN a��• l - Electrician's License No. � . Other Trade's License No. . AJ. A• 1 Location of]and on which proposed work will be done. e-465' Porgy ✓ . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . ... . . . . . . . . . . . . . House Number Street Hamlet • . County Tax Map No. 1000 Scction . . . . . , . . , . . . • . Block . . . . . . . . . . . . . . . . . . . . . . . . . . . . Lot . . . . Subdivision . . . .Q A. t.1 . i • A W S . . . . . . . . . . . . riled Map No. LotQ(Q•a 1 (Name) ; . . . . . . . . State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . :U ITC„ ! ,V`�► �nt ! llq . • •� !.r/. . . . . . . . . . . . . . . . . . . . b. Intended use and occupancy . ,C.( . . .L�l S 1, `_ �? . . . . . . . . . . . . . . ,o...ei::'a 11: 1:i.S i••.,f, 1?3L: .. i'u. c.<.Itl:�iii.i.J -3. Nature of work (check which applicable): New Building Repair . . . . . . . . . . . . . . Re ' • . . . . . . . • :addition . . . . . . . . . . Alteration . . . . . . . .Removal Demolition . . . . . . . . . . . . . . Other tiVork 4. Estimated Cost . . ppr,Q�,�? (Description) . . . . . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing,this application) S. If dwelling,number of dwelling units . , , , , . , , , , , , , , . Number of dwelling-units on each floor . . . , _ If garage, number of cars . . . . .1, • • • • • • • . . . 6. If business, commercial or mixed occupancy, specify • • • • • • • . •.. • • • . • • ' • ' ' ' ' • ' • ' 7. Dimensions of existing p Y, p. Y.naturc and extcrit of:cach'type of'use,. , • • • • • • • • b structures, if any: Front . '� - Rear De. Height . . . . . . . . . . . . Number of Stories % . . . . . . . . th . . . . . . . . . . . . . Dimensions ame structure wit • • " ' " " " " " " ' • • • • • • • • • • • .S� h alterations or.additions: Front: ,�, , • , • • • , • Rear . . . .�• Depth . . . .a�'. . . . . . . . . . . . . . . . Height . .a( ' ; ' • . . . . . . . . . . . . 8. Dimensions of entire new construction: ' ' ' • • I. • • Number`of Stories . .(Y4. Front .. . ,Rear . S¢, • , • , , , • • Depth .� Height . . .ca�D�. . . . . . . Number of Stories . . ..l !/� • . . . . . . . . . . . . . . 9. Size of lot: Front 7© t _ Rear . �y}.`!�? • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10. Date of Purchase . ��t�? 7 . . . . . • • • • Depth / . . . . • • . . . . . . . . . A L Zone or use district in which premises are situated , • ' Name of Former Owner f4�jt�1 c� • (��� 12. Does proposed construction viglate any,zoning law, ordinance or regulation: • • • • • 13. Will lotbe-regraded 1442:�.1 • • . • • • • • • • • • • • • • • • . . . . . . 1a.• Nr�.n • • • Will excess fill be removed frorn premises: Yes • No i e o. Gwritr cif premises �pr42ctFrr! ; (f��c.7t • ,Address Name of Architect �''. owq � •' S D C :���e •� • • • • • • • • • Phone No. . . Name of Contractor . .S.�a�r� • •Address one No.3.. (�S/I Itm 15. Is this property within 300 feet of a• tidaladress wetland �•*Y ° �`1�es. . . . . .({�r�. . No.ArIoX'No. a' f 02S-00• .� . . . . • *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. . J STATE OF N �OUNTY OF S.S . . . . . . . . 1� '��.a e �• /gild �� . . . . . . . . being duly sworn, deposes and says that-he is the applicant .bove nlmcd.(Name of individual signing contract) . feisthe `!07r. e . . . .r. : . . . . . . _ . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) • • ' • ' ' ' f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this 'plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ork will be,performe'd in the manner set forth in tine application filed therewith. :•orn to before me this . . . . . . . . � . . . . . .day of. . Y , 1999 r Mary Public, . . . . . . . `�'� ' . . .,. County CI��G Gf Note DANA TRIPODI . . . . . . . . . . . Notary Public,.State of New • ' ' ' ' ' No.01TR5015916• (Signature of applicant) aified inComm slsion Expir soAug 2 199'_� N l am familiar with the STANDARDS FOR APPROVAL G>• �� SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES AND CONSTRUCTION OF SUBSURFACE SEWAGE FOR-APPROVAL OF CONSTRUCTION ONLY DISPOSAL SYSTEMS FOR SI LE FAMILY RESIDENCES � 8 and will abide by the con di ns s forTin and on the isSiYYY�. �� permit to construct. �0. A DATE S. REF. NO APPROVED �'� 3 1 1994 scarily/oct,., �`O \�h• ei Sim= PMILY ONLY � ec J: o 2 � .Sins AWN E�'T, c' fr EXPIRES THREE YEARS FRO ' OF APPROVAL of SO(/�HpLD co a rs Q 0 ds (/ r"�D .0��° °`�• r-a v e lt2- tel O�Q' 2Z � tiro � ,S ka� �• :!G�� � ti ASS0. 4 aJ c t, e 0, ti0 Lo�r� leo SURVEY FOR � r ' e. 0�0 �� ED WIN WARD 'r F/Fi '°° A T SOUTHOLD TOWN OF SOUTHOLD ? SUFFOLK COUNTY N. Y. 1000 - 69 - 05 P/0 07 Scale: 1"= 60' June 15, 1994 O�� z�rQ A e�' ( P . 8, 1994 (B.O.H. ) ✓� `,O o IG ` v s °� P��Q'� o v �9 0 A �� 5 s�' d AREA = 2.5386 Acres CERTIFIED TO 4s06 o a EDWIN WARD NEW tSs l Z Prepared In accordance with the minimum / N.Y.S. LIC. NO. 49618 •Q 5• L 0 T NUMBERS ARE REFERENCED TO standards for title surveys as estabrahed PECONICk SURVEYORSt P.C. "SUBDIVISION MAP.OF PURITAN FARMS' by The UA.L.S and approved and adopted (516) 765 - 5020 for such use by The New York State Land P. 0. BOX 909 ELEVATIONS ARE REFERENCED TO N.G.V.D. ? { The locations of wells and cesspools Title Assocfafion. MAIN ROAD ,\ shown hereon are from field observations SOUTHOLD, N.Y. 11971 and or from data-obtained from o&rs- • 94-201 I am familiar with the STANDARDS FOR APPROVAL Go. `S �Ceo AND CONSTRUCTION OF SUBSURFACE SEWAGE ' SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES and will abide by the conditions set forth therein and on the 0& permit to construct. DATE HS. REF. NO. G��� V i APPROVED sa�dy /oQ �N co ci.rs e ,�� ♦�• -5 LZ 9r-aver ® 5• k hole 0�� 0� �9 PXX �t,' 2S- 4 aJ L �y HEREBY CERTIFY TO CENTERBANK MORTGAGE COMPANY AND NCO / O F �� ��/ COMPANY OF NEWS Y ARMERHA T ASICANI TLE OF INSURANCE DA TE ,_, ��► a HEREOF (A) THIS SURVEY AND THE BOUNDS AND e MEASUREMENTS SHOWN HEREON ARE SUBSTANTIALLY CORRECT - 0 ® 3 _ �.ke0 , ` SURVEY FOR / ' �: - ED WIN WARD °° -; A T SOUTHOLD ' 2 TOWN OF SOUTHOLD ? SUFFOLK COUNTY, N. Y. 1000 — 69 — 05 P/O 07 Scale: 1 = 60 0 titi fl ,� P _ R June 15, 1994 �p 3or����0 0 g� _ - ! ( Aug. 8, 1994 (B.O.H. QP` h Aug. 30, 1994 (Certification ) ✓� �� �'� �,® lj Dec. 16, 1994 (foundation) I, �. 31Pei' s>� 0 AREA = 2.5386 Ac es . _=--- - .' CERTIFIED TO , a EDWIN WARD E t °° 0- �2'� Prepared in accordance with the minimum '; - Y.S. LIC. NO. 496/8 �� •Q� 5 L O T NUMBERS ARE REFERENCED TO standards for lille surveys as established PECON/C z YORS, P.C. " SUBDIVISION MAP OF PURITAN FARMS by the L.I.A.L.S and approved and adopted (5I6) 765 5020 O FILED JUL Y 19, 1994 FILE NO. 9538 for such use by The New York Stale Land ti Title Associalion P. 0. BOX 909 ELEVATIONS ARE REFERENCED TO N.G.V.D. The locations of wells and cesspools MAIN ROAD shown hereon are from field observations 1/ 7 1 9 4- SOUTHOLD, N.Y. 11971 �RdLor_from data obtained from oP, �o 37A�c� 94-201 y I am famillar with the STANDARDS FOR APPROVAL GJ• SUFFOLK COUNTY, DEPARTMENT OF HEALTH SERVICES AND CONSTRUCTION OF SUBSURFACE SEWAGE S�c"+NO FOR APPROVAL OF CONSTRUCTION ONLY -DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES and will abide by the conditions set forth therein and on the '?- permit to construct. 'O�0. 'fin RIO-94-0081 61, t r DATE _ HS. REF. N0. cli;lt�fi. . °Oli G- `rw�V � o �� APPROVED g� JAN 18 A :52 sci oocy ioa�, O CP sand �a° {�.® r_ `'l G� hde cc��iJtia�/y y, �i- O�Q� _ / tiro ,s Aga V Q� tt�. ti ems- Qc �`` �° '♦ SO. Q I HEREBY CERTIFY TO CENTE•RSANK MORTGAGE �) / �,., y� COMPANY AND FIRST AMERICAN TITLE INSURANCE �" COMPANY OF NEW YORK THAT AS OF THE DATE ' G� HEREOF (A) THIS SURVEY AND THE BOUNDS AND CEA MEASUREMENTS SHOWN HEREON ARE SUBSTANTIALLY o 0 ^^0 A 4 eo 'k. _— & ? = �Ifit -,f � �� �u ��ol SURVEY FOR IIdV U IJ GtJ W i)4..:.'o.�l� d l/-LL L U ea'-! , 11 `' ///1/ \ !'I 'az•a0� �1`c�7 q' !, FL 6 ^ r.�P2, ED W/N WARD ° t�� � -_N-"l A T SOUTHOLD �� TOWN WN OF SOUTHOLD 10�� ? �l3<:.1Vv �'✓,_,.yy�s.S i., n' ru J2 1:4��:1rf'-�iA lJ•- P"._�°� Ir s c •,,L 'Ly =u�La.. L-�-- SUFFOLK COUNTY N. Y a� 77A• ' � ��m-gJ tia� "' "r" a p?;mJu C�Diu:"..d�,�,,•. f _ _ � utTrj`:�uiW to -� q 11000 69 05 P10 07 I _c0 ��J/ ��----� � SV cWe• 1„= 60' 1 ----- -- June 15 1994 Sap • � � �--� . : � �P c--�%r,�..� � ���-�_,�.�_„�s�:�� _ _ O� �9��. 2 O ` lj; VVgi.eT 9;L�Z_.j�:l:'•u�i,.iJ L�rt1Z�,r -L� �� Aug. 8, 1994 (B.O.H. ) .-v-� A AJJL..J • Q Q►, �?'�° _ ---- ----- Aug. 30, 1994 (Certification ) ✓O 0w�� �,� it Dec. 16, 1994 (foundation) �fi 3a c v �� 9 10. Oct. 12, /995 (final) oa AREA = 2.5386 Acres Q��o� �Elv yo T. ME f _ F CERTIFIED TO EDWIN WARD Prepared In accordance wllh the minimum J o .Y.S. LIC. NO. 496/8 •y� 5, L O T NUMBERS ARE REFERENCED TO standards for Lille.surveys as estabrshed P k9 ORS P.C. SUBDIVISION MAP OF PURITAN FARMS by the L.I.A.L.S and approved and adopted (5/6 A O ' 0� FILED JUL Y 19, 1994 FILE NO. 9538 for such use by The New York Slate Land P. O. B 909 ELEVATIONS ARE REFERENCED TO N.G.V.D. a The locations of wells and cesspools Title ASSoclolion. MAIN ROAD shown hereon are from field observations 7/9t SOUTHOLD, N.Y. 11971 and or from ,data obtaked from p ars, Co��oGrJw. S7ni4y 94-201 '. '", i ~,~ . ,~ ~ ' - ' . - .'.'~ ' . -';. ..I, 'E' ..,~J,~I'~' I~ ~.~,', - ,- .,,.,... 't~r,L~ ., ~1~ ~ .. ' I~ '[~ ' ~11~'i, 1:~1~ ~I~ .~ // ' m ~'l.~: ~ ' ~- ~11 ,~--~,-- , /l m~-~q~~,~.~ -r I ~,~' ,, , . . ~I .~ ~ . 1~ ~" ~' '*'~" ~ld ~, '~ ~ ,I~ '~1 ~-~-.~ :", ~I "//, / ~ .~~.~ II I~'· ~' ,1~ ~,k; ~/c /W ~ ~J~Z]ll**~ ~ -¢I// I ~1 ~1 I ~' ~ '..-. ,, ,, · ' "- , · ' '*, - , .,, ,, , .,, . ~ ~ ~ ......... , ~ ~'~, :,,' . ~,'_/z~ ,, .GENERAL NOTES N~I~ BUILDING DEPOT AT ~b~ ~ ~ ~ ~ ~ ~ ~ ,~ j~ ,._ ~: . ~.~,., , ,,~,o,~ ,.,.,s~ ~flT~l ~ ~,~,~._ i __~ ~ ,,~.~. I~' z.~.. · ;47 l/ '~-I ~.~,,.o,. ~o.~,~ ,,~ ........ t ~'~ ~IF~ ~* ~ ~ Em - ~ ~ ..... / ' ~ P.C. BOLTS SHALL BE 8'0" O.C. ~X.. l'O" FR~ EACH END OR CORNER REQUIRED .~ r~;[,~'~'g~c~',,~'~L~m ~ v~ ~;~ m?~ j [ ~~ ?,~ 10. CONC. SLABS TO ~EST ON MXN. 6' FINE~AVELORSANDWITHHIN.~M[L J - ~,.I. [ ~/~.- / I ~~ Ii [ [ , ~ .... . .... POLYETHELENE VAPOR BARRIER ~HDE* OCCUPIED ~ ,. UNTIL 2nd SURVEY 0F ~. - ~ ~ · ,' CERT/FICATE OF OCCUPANCY F ~- ~ , ~~ ~ - TYP, EXTERIOR WALL ~ PlCAL FLAT RC i~ A~ PLUMBING ~ &~RUN~' J j~ I~ ~ ~- I / ~ ~ ~ Ii f~ ~t~ diatnbuti~ I~. ~: ~E~?g~R~[~E~.CODE' DATE .'! X I I I ~ 0 I I 3G~;o .JUN $1995 3 (~E, o , ]