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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-18127 Date JUNE 19, 1989 THIS CERTIFIES that the building Location of Property 585 DAISY ROAD House No. County Tax Map No. 1000 Section 106 Subdivision SHNSET KNOLLS INGROUND SWIMMING POOL MATTITUCK~ NEW YORK Street Hamlet Block 8 Lot 41 Filed Map No. 5448 Lot NO. 47 conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 24, 1976 pursuant to which Building Permit No. 8462-Z dated MARCH 31~ 1976 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 INGROUND SWIMMING POOL & FENCE GREGORY A. COU~JRE The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. PENDING - 6/19/1989 PLUMBERS CERTIFICATION DATED N/A Building Rev. 1/81 FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8462 Z Permission is hereby granted to: ............ 2.~:O.....Cox...~,e, ....... C~to&o~ue: ........... to ~,3A..~e~..~$.~a.~e..evcL~g..poe[..v.~.th-.~enee..&..~oesss~ye ....................... at premises located at 1,o¢...Li~.....B~a~...]F,~ItO~.]..S...T.] ................................................................... ....................... · ~. '/~"....~'~s..~a~sey.-~omi ........... ~a~t~¢u~lc'"'H~.~'~ ...................................... pursuont tO opp]ication dated ................... b~.,...~I. ................... , ]9.~ .... and approved by the Building Inspector. Fee $.1..~.,0~ ........... Building Inspector TOWN OF SODTHOLO BHILDING D~PARTMENT TOWN HALL SOUTHOLD, NEW YORK 765 - 1802 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY NEW CONSTRUCTION ....... OLD OR PRE-EXISTING BUILDING ...... VACANT LAND ........ llOUSE NO. STREET HAMLET . co~ r~ ~p ~o. ~000 s~io~ .Zz~.~. ~oc~ ..~ . .... ~ot'. ~[t ..... ............... - Filed Map .$~. -.Lot .......... Permit No. ~H'~>Z' .Date of Permi ...... f.. -Applicant ~*x~m.~?/rfS~ .... Planning Board Approval ..... Request for Temporary Certificate ....... Final Certificate ................ Fee Submitted: $ .................... FORH NO. TONN OF SOUTUOLD B[~ILDING DEPARTMENT TO~ NALL 7~5- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS A. 'This application must be filed in typewriter OR ink and submitted to the Building Inspector with the following; for new buildings or new use: ]. Final sUrVey of property with accurate location of all buildings, property lines, Streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage-dlsposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that solder used in system contains less than 2/10 of IZ lead. 5. Commercial buildings, industrial buildings, multiple residences and similar. buildings and installations, a certificate of code compliance from the 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, ~957~ non-conforming uses, or buildings and "pre-existing" land uses: ]. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. A properly completed application, a consent to inspect signed by the applicant and a certified abstract of title issued by a title company which shall show single and separate OWnership of the entire lot prior to April 9, I957. . If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. 23. Date of any housing code or safety inspection of buildings or premises, or other pertinent information required to prepare a certificate. C. For Vacant LandCertificate of Occupancy: ]. An application for Vacant land Certificate of Occupancy shall be submitted, and a certified abstract of title issued.by a title company showing single and separate ownership of the entire lot prior to April 9, ~957 shall also accompany the application. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing tn the applicant. D. ]- CERTIFICATE OF OCCUPANCY - New Dwelling $25.00, Additions to Dwelling $25.00, Alteration to Dwelling $25.00, Swiping Pool, $25.00. Accessory building $25.00 Addition to Accessory buildings, $25.00 - Businesses $50.00. 2. Certificate of Occupancy on pre-existing dwelling - $100.00. 3. Copy of Certificate of Occupancy - $5.00 - over 5 years - $10.00 4. Vacant Land Certificate of Occupancy - $20.00 5. Updated Certificate of Occupancy - $50.00 6. Temporary Certificate of Occupancy - $25.00 Residential $50.00 Commercial rev. THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ 8~0'?? BUREAU OF ELECTRICITY [~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date JULY 11,1989 ~ppficatlonNo. onfile 67.711999/89 N 080260 THIS CE~IFIES THAT ~y t~ e~t~ ~u~ment ~ ~cd~ ~w a~ int~uc~ by t~ ap~icant ~ on t~ a~ ~pl~ti~ numar in t~ p~m~s of Lot FIXTUI~ O~JTLETS SWITCHSS FIXTURES RANGES OVENS ~,H WASHERS UNIT HSATEI~ MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVIC~ DISCONNL~T S E R OF CC. COND C OF HI-LEG ~{SWIMMING POOL) This certificate ':overs compliance at the date oi tl~spection only. Because of unusua) environments it is advisable to have frequent test and/or repairs mqd~ by a qualified ROSIJ~K EI,gCTRIC P.O. BOX 164 CATCflOQUE, NY, 11935 [,IC. # Grdqlr~AL MANAGIR Per_ This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be ident~fie~ by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. fOUNDATION IOUGH (2nd) FRAME & PLUMBING !£~SULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION DATE '~/~__~.__, NSPECTOR ~~ ?~ Examined .. )¥~.G ~ ..~.. ~....[,~ .' ~: ...... 19.[~... Approved ~ ~ / FOEM~ NO. 1' TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLER,K.'S OFFICE SOUTHOLD, N. Y. Application No ................................. Disapproved a/c ............................................................................................ APPLICATION FOR BUILD~NG PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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, rebtionship to adjoining premises or public streets areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. c. The work covered by this application may not be comme~ced before issuance c~f Building Permit. d. Upon approval of this application, the Building Inspector will issue 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 issuance of a Building Permit pursuant to the~0 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.,,t The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. ....... G~o~'-~e...,~o,], e.~. ~..]~ti ~. cl,e z'. ,...Z~c ............................ (Signature of applicant, or name, if a corporation) ....... g~O...Co~c..Lan~ .............................................................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............ ................................................................................................................................... Name of owner of premises ...~.~.e.~.o..zT..~....~..o...~..o.~.$ ............................................................................................................. If applicant is a corporate signature of duly authorized offic~er. George Ahlers. Preszdent ~ ,/~z/t~( ,~,(]~] Builder's License No..~.7.Z7...~.~.:.:..:.:.,..:.~..1. .................. Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be done. M¢p No.: ..~...~...~.e...~...~.~.o.~.~ ........ Lot No. L~7 Street and Number ..~¢%1,~y...~0.~¢~..~,i,.'[;~C~¢ .............................................................................................. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..~,~9,'L~_¢~ ......... .4 .................. : ............................................................................ b. Intended use and occupancy ~t/~ '~ ~../...(~k(~...~... ~' ~ / 3. Nature of work (chec h ~pplicable): Ne~ Building ..................Addition .................. A teration ........ :....;~. Repair .................. Removal .................. Demolition .................... Other Work .~iT~r~,lllll~l~j~..,~.~.:~ ................ . .... ] ~ ~ (Description) 4. Estimated Cost ....~ .......................................Fee (to be pflid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of ~rs ............................................................................................................................................. 6. If business, commerciaJ or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ..... ~.$[~...~ .................................. Rear ....J...~...~, ...................... Depth ...... ~,2...~.~ ............ 10. Date of Purchase ........................................................ Name of Former Owner 1 1. Zone or use district Jn which premises are situated .....~ .............................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... .[~ ............................................. 13. ~ill lot be regraded . ......~f:>., .............. Will excess fill be removed from premises: (~) Yes ( ) No 14. Name of Owner of premises ..~.{~.~...~.~.~ ............. Address .~.~$~....~ .............. Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ...~'~..~..}~f~P~. ................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set~ck 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,~,OR~,,/ ,,~,,~ COUNTY OF ....... ~..~..~.."...~..'~.....~,.~.~ .......................................................... being duly sworn, deposes and says theft he is the applicanl (Narn~e/'of individual signing contracf) above named. He is the ............................................................. \?.~?..C£~£(.. .............................................................................. (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 application; that all statements contained in this application ore true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ................ of .......... Noto Public,. .................. .................. ................................ ~/~ [~ (S~natu re of applicant) [:) 41S'¢ MAY 23 1973 ,JULY t~,1973 YOUNG & YOUNG 4,00 r~STRANDER AVENUE ~IVERHEAD t W Y©RK SIJRVEY FOR: INLAND HOMES INC. -~ =~- -- ' LOT NO. 47," SUNSET KNOLLS,SE Z ~.