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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-22519 Date AUGUST 11, 1993
THIS CERTIFIES that the building ADDITION & ALTERATIONS
Location of Property 500 HIPPODROME DRIVE SOUTHOLD, NEW YORK
House No. Street Hamlet
County Tax Map No. 1000 Section 066 Block 02 Lot 13
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated FEBRUARY 23, 1993 pursuant to which
Building Permit No. 21245-Z dated MARCH 25, 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, DECKS & ALTERATIONS TO EXISTING ONE FAMILY
DWELLING AS APPLIED FOR
The certificate is issued to ELLIOT B. & ORA HEATH
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL NIA
ELECTRICAL INSPECTION CERT. NO. 2538 - JUNE 30, 1993
PLUMBERS CERTIFICATION DATED JULY 18, 1993 - FRANK MCINTOSH
i
Bui ding Inspector
Rev. 1/81
FORK NO. a
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)
NON° 21245 Z Date qa. l9.~3
Permission is hereby granted to:
to,. OX.
at premises located at ..tl~~C?../l ..2lR::=.... lr~c
..i.............................................................................
,~...."r...........1^
County Tax Map No. 1000 Section ...........!!°A Block ..........2 Lot No.......... ~
pursuant to application dated .........r°w? / 19~/ 1 and approved by the
Building Inspector.
Fee
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f.....c..... P~
/ Bui mg Inspector
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Rev. 6/30/80
f
J4 /11
Form No. 6
TOWN BUILDING OF SOUTHOLD
DEPARTMENT
TOWN HALL
/ 765-1802 } JUL 2 6 M
J'u
APPLICATION FOR CERTIFICATE OF OCCUPANCY BL~FSOU `H
TOWN OF S6U fi~S;t.++
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.
s
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 - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15/,00 Commercial $15.00
Date ...f
New Construction....... Old 0 Pre-existin Builds
Location of Property...
House No. Street / Hamlet
Onwer or Owners of Property... ..1 *59
7
County Tax Map No 1000, Section Block C:": LoC.... 4Jl X
Subdivision .~.j:4~:~!/r/ 4r ..Rrl-xr~......... ~i/le 2Map. .l ! Lot..... ~
Permit No.. lDa''te Of Permit .....~~J/I.Applicant...
Health Dept. Approval .....(!fiK . Y9 Underwriters Ap val....
Planning Board Approval....... y' /
Request for: Temporary CertiffQiiccate........... Final er at
Fee Submitted: P4_49
. ~ • . APPLICANT
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INSPECTORS
FRI( ea
SCOTT L. HARRIS, Supervisor
Thomas Fisher co 1' w 2 Southold Town Hall
v^ ,.:s a
Building Inspector ® • t P.O. Box 1179, 53095 Main Road
Southold, New York 11971
Gary Building Fish for Fax (516) 765-1823
Telephone (516) 765-1800
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 : /
Building Permit No. ZQz#Sa
Owner: i C Wd! e 0/7,F1- C7d''~77
(please print)
Plumber: &A &&
please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 12 lead.
(Plumbers Signature)
Sworn to before me this
may of 19
Notary Public, County
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INSPECTORS
Victor Lessard 3iFa(g
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Princ pal Building Inspector
Curtis Horton Y' (`h~ } • s SCOTT L. HARRIS, Supervisor
Senior Building Inspector ~
U' Southold Town Hall
Thomas Fisher Fa
P.O. Box 1179, 53095 Main Road
Building Inspector Southold, New York 11971
Gary Fish Fax (516) 765-1823
Building Inspector
Vincent R. Wieczorek Telephone (516) 765-1800
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
JULY 9, 1993
SCOTT JONES
BOX IS]
HAMPTON BAYS, NY 11946
RE: MR. 5. MRS. ELLIOT E. HEATH, III
To Whom This May Concern:
We are unable to complete your Certificate of occupancy
because of the following reasons:
?xxx An application for Certificate of Occupancy is
not on file. (Enclosed)
&,/'XU No Underwriters Certificate on file.
I/zxx The check is AYXKZXLXNWno.t on file.)$25.00
-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 # 21245-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
CC: MR. s MRS. HEATH, III
ww
Building 40-SUNY, Stony Brook, New York 11790-2356
DATE:
oe~CA'e 91 19c
Z
L y ~sL ~QJ Re:
Thomas G Jorttng
~~73? -d6Z A-1n w x_ Commissioner
Dear '
A review has been made of your
A_A_ 777~~IOV?)l 0661 -2,
Based on the information you have submitted, the New York State Department
of Environmental Conservation has determined that the parcel
project is:
Greater than 300' from inventoried tidal wetlands.
_ Landward of a substantial man-made structure
greater than 100' in length which was constructed prior to 9/20/77.
__,LA~_Landward of the 10 above mean sea evel elevation contour on a
gradual, natural slope., ~
_ Landward of the topographic crest of a bluff, cliff or dune which is
greater than 10' in elevation above mean sea level.
Therefore, no permit is required under the Tidal Wetlands Act (Article 25
of the Erivironmental Conservation Law). Please be advised, however, that
no construction, sedimentation or disturbance of any kind may take place
seaward of the 10' contour or topographic-.crest without a permit. It is
your responsibility to ensure that all-necessary precautions are taken. to
prevent any sedimentation or other alteration or-disturbance to the
ground surface or vegetation in this area as a result of your project.
Such precautions may 'include providing adequate work area between the
10' contour or topographic crest and the project (i.e. a 15' to 20' wide
construction area) or erection of a temporary fence, barrier, or hay
bale berm.
Please note that any additional work, or modification to the project as
described, may require authorization by this Department. Please contact
this office if such are contemplated.
Please be further advised that this letter does not relieve you of the
responsibility of obtaining any necessary permits or approvals from other
agencies.
Very truly yours,
Deputy Regional Permit Administrator
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TRUSTEES SOFFOr,rCO SUPERVISOR
John M. Bredemeyer, III, President D Gy~ S,~OTT L. HARRIS
Albert J. Krupski, Jr., Vice President C4
Henry P. Smith ~y ® Town Hall
John B. Tuthill 53095 Main Road
William G. Albertson P.O. Box 1179
Telephone (516) 765-1892 Southold, New York 11971
Fax (516) 7654823 BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
December 23, 1992
John Laffey
6 Meadow Grass Lane
Southampton, NY 11968
Re: Bruce Heath
SCTM #66-2-13
Dear Mr. Laffey:
The following action was taken by the Board of Trustees at their
regular meeting of December 17, 1992:
Resolved that the Southold Town Board of Trustees grant a waiver
to Mr. Bruce Heath to replace porch inkind/inplace as applied
for. Located Hippodrome Drive, Southold.
If you have any questions, please call our office.
Ver truly yours,
~
ohn M. Bredemeyer, III
President, Board of Trustees
JMB : djh:
rf2
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ FINAL
REMARKS:
' t C
t
17
t
`t
f
DATE Mpl,~'5 INSPECTOR
i
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] GH PLBG.
[ ] FOUNDATION 2ND INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
Gam..
DATE' ® INSPECTOR - awll
i
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:-218
DATE l INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ I ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[~RAMING [ J FINAL
REMARKS:
P
n
DATE ~Z~INSPECTO 'h
I` CF- G v~
BOARD OF HEALTH
(1 _ FORM NO.1 ~3 SETS OF .1N5 . . . .
~p TOWN OF SOUTHOLD SURVEY
} 1 W 2 3 BUILDING DEPARTMENT ~CIIECK J
TOWN HALL SEPTIC FORM
SOUTHOLD, N.Y. 11971
TEL.: 765-1802 NCIT`<FY' ~
CALL nJoA4f: Zvf _Uf,?U(J
Examined . , , , , , 19 ~-3 MAIL TO
O~ t~ .15-1
Approved 19VPermit No.
Disapproved a/c
~(Buil i Rinspector
APPLICATION FOR BUILDING PERM;
Date ......7/! t......., 19`l f
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
018ireas, 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 have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuan f a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York ther applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for em 1 or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, build' co a housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspec
(Sig atu a applicant, or name, if a corporation)
( ailing a dress app can
State whether applicant is owner, lessee„ agent, architect, eengineer, general contractor, electrician, plumber or builder.
~J~ 5..-. E~/c.>?fJL..~0~?7? (??~-j.46..
Name of owner of premises PiKA ..l
(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. 2,0 3.433A? '
Plumber's License No. 0 4 /2
Electrician's License No. ;?~~76A rF
Other Trade's License No .
1. Location of land on which proposed work will be done. Cz Ik ~ilN.. 1 7''
..........O/~/~/ cal? ~C !/(liit! !774?Z .
House Number / Street .Hamlet
County Tax Map No. 1000 Section ..QG~........... Block ...dq............ Lot ...12/
Subdivision .9671_60VAf. Filed Map No. J#72 Lot ...e
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ...ATr~. . !~??!7,
b. Intended use and occupancy , . , . , . ; . , , , , ,
3. Nature of work (check which applicable): New Building Addi ion ..d1 Alteration
Repair . . Removal , Demolition Other Wor
p ~A (Des6tiption)
s 4. Estimated Cost . Fee 8.~0...........................
(to be paid on filing this app 'cation)
S. If dwelling, number of dwelling, Units . / 3; .~61 Number of dwelling units on each floor. 1,
6. If If garage, number of cars ej . .
commercial or mixed ccupancy, specify nature and extent of each type of use • • . , ,
7. Dimensions
Height ns of . .existing structures, if any: Front : Rear Cpl .Z........ Depth , , , , , , , , , ,
.
. . . .Numfiber of Stories ...1 .
Dimensions of same structure with alterations or ad Itions: Front 79t. Rear ,~tl~-.?r, , , , . , , , , , ,
Depth ~ 'I . Height" ..;w./ Number o Stories . 2-......
8. Dimensions of entire new construction: Front Rear .......Depth ...m
Height . ^ Number of Stories , • , , , , , r • • •
9. Size of lot: Front Rear I.7.~ De th /R . • • • • . • .
.
10. Date of Purchase ~ , : , , , , , , , ,Name of Former Owner ,y/L,y,/~9~!• , ,
111. Zone or use district in which pro tees ar?, situated vq~:.~~ . .
12. Does proposed construction vio to any zoning law, ordinance or regulation:
13. Will lot be regraded j Will excess fill be removed from premises: Ye No
14. Name of Owner of premises 1~1Z t,/17rc4; ,tl, •fl~ 41 H ..Address y~0..('il.lty?TOVe' 1Jr, . Phone No. .45x: z~ . •
Nalne of Architect . !-0//W /f7f~ Address n Ar' . 5~. Phone No.
*if yes, Southold 3 O • • Address nd !s/. /iJm. phone No..~ ~'oflo
15. Name property within 3,00 feet of a tidal wetland? *yes. , X, , , . No........ .
own Trustees Permit may be required.
PLOT DIAGRAM 'r
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.
!I
I,
STATE OF NEW YI~RK S
COUNTY OF'5vtrP.l.K........
• J P • • • S li • • • , • being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract) above named.
He is the Co J rac•if
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the sa rk and to make and file this
application; that all statements contained in this application are true to the best of s kn ledge and belief; and that the
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
A' .day of. .i + ?c~aKy_ 191*'
Notary Public, , , , 'County
FRANKLIN 0. BUTZ Pp .
NOTARY PUBLIC, State of Now
No. 62-a664sae,4 t (Signature of a licant)
Quelifled In Suffolk County
Commission Expires 30,19-J&
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