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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-23638 Date MAY 12, 1995
THIS CERTIFIES that the building ADDITION
480 MC GANN PLACE &
Location of Property 1055 SUTTON PLACE GREENPORT NY
House No. Street Hamlet
County Tax Map No. 1000 Section 33 Block 5 Lot 1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 10, 1995 pursuant to which
Building Permit No. 22720-Z dated NAY 3, 1995
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 DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to MICHAEL & CHERIE FINGERLE
(owner's)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Building 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.
NP 22720 Z
Permission is hereby ranted to: I
.
........._79.
d. ~
at premises located at../................. ......y./-]J...`. l)
.............n............
Ayyl,~„!. K. .
.
County Tax Map No. 1000 Section Block e.......... Lot No.
pursuant to application dated ....../7 19 9~A and approved by the
Building Inspector.
Fee S.v`..i.
.1... 4cor
i
g Rev. 6/30/80
Form No. 6
OVI , SCt_ D01-
I'
TOWN OF SOUTHOLD 11.Q,&s_,&AA n
t e
BUILDING DEPARTMENT n ~JQ~~z.st_
? I TOWN IIALL
765-1802 AJ ti LA q
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in b typewriter inspector with the following: for new buuilding o0rRnewkusand ea submitted to the building
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 electricaA installation from Board of Fire Underwriters.
4. Sworn statement from1plumber certifying that the solder used in system contains
less than 2/10 of 1% lead.
5. Commercial buildin , 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 - 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 Buildine - $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
Date _
New Construction........... Old Or Pre-existing Building.........
Location of Property. /.Q.~..S ~F!T,~~d?~/;e y
House No. / Street
Hamlet
Onwer or Owners t~f Property./ IC</6oFG l :r/!~!ZFi?
County Tax Map No 1000, Section .,5. 3 .........Block... 9 9 Lot..?....................
Subdivision.....
...............................Filed Map............ Lot..........
Permit No. Date Of Permit Applicant
Health Dept. Approval ..........................Underwriters Approval Planning Board Approval..
Request for: Temporary Certificate........... Final Certicate...f
Fee Submitted: $
~ nonr.
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FOUNDATION (1st)
FOUNDATION (2nd)
2. z
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ROUGH FRAME &
!PLUMBING (AI
3. m
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INSULATION PER N. Y. y
STATE ENERGY
CODE
^Y
FINAL ~y
ADDITIONAL COMMENTS:
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765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ )ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] *IUL AT 10 N
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE INSPECTOR
BOARD OF HEALTH
j~. Lt' ~FORM NO. 1 3 SETS OF PLANS 11 1_ , - r TOWN OFSOUTHOLD SURVEY
HUILDING DEPARTMENT CHECK .
tM I Q W1 TOWN HALL SEPTIC FORA • • • • • .
SOUTHOLD, N.Y, 11971
TEL.: 765.1802 t;OTIPY;
19~ CALL .STS'. ~Ss l,~~f?~
Exanlined~
MAIL TO:
Approved r Igo ermit No / . 9-,°~.7: ' ~c!r~fo, t .'9.....
I
Disapproved, a/c
..............:..'i?co~ey~,. U~
. ,rzc~r
(B ' di pe tor)
APPLICATION FOR BUILDING PERMIT
Date 19 9~5-
INSTRUCTIONS
-F a. This application must be completely filled in by typewriter or in ink and 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 appl
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 a
shall be kept o.n the premises available for inspection throughout the work. 2~ Y a~c~ Such perm:
e. No building shall be occupied or used in whole or in part for any purpose whatever unti ifcat~BF cupanc
shall have been granted by the Building Inspector. p
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bui d: g ~u a t to th
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other app 'c b e ws, d' antes o
Regulations, for the construction of buildings, additions *or alterations, or for removal or demo °0$ % , 0.11 described
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, a rCl~g'° ations, and t:
admit authorized inspectors on premises and in building for necessary inspe ns.
'C~42~
(Signature 7a.
pplicant, or name, if a corporation)
,J' (o ,~ULY0~..°/...... ,.C...y./'1.2.81......
(Mailing address of applicant)
State whether applicant is owner, lessee, 'agent, architect, engineer, general contractor, electrician, plumber or builder.
GF(17Fe14'THoc ,1/Sllt!s T6 '
Name of owner of premises . ,/~i• /~'Et~'""k C
~...~i~•csG . ~.G-•l~~s"~Ni c?o.~,~~y~.:2'~.4rf-a
r..Vt~¢ x vt .
(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 . . .
Plumber's License No.
Electrician's License No . . . .
Other Trade's License No. y t as~ece c~
1. Location of land on which proposed work will be done.
/o,~j .
House Number r' Street " " " " "
7 ~j Hamlet
County Tax Map No. 1000 Sec tbn p
• Block • ..i>~.....:... Lot ~
Subdivision Filed Map No. 1a 1......... Lot .+.,t
(Name) S".C ~axaia.~vco 3~-ds .of
1 State existing use and occupancy of premises and intended use and occupancy of proposed construction`.
a. Existing use and occupancy c ! . S !.`J1~~/C
b.Intended u ..........i.t. w-,?3 1?=it it .
use and occupancy ~r,,
3i ~;,`l tPAtf=st
' gig.. .,g:. .
rr nrsul
•3. Nature of work (check which, applicable): New Building Addition • • • • • . Alteration .
Repair . . Removal Demolition
r rgtA ork .
(Description)
4. Estimated Cost . (crab ` j ! Fee .
(to be paid on filing this application)
, numb of of dwelling units' , Number o;f dwelling units on each floor . .
5. If dwelling.
If garage, number 6. If business, commercial 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 . . . . . I:ear . . , Depth
Height . Number of Stories . . , , , , . • . . " " " "
9. Size of lot: Front Rear...~z7Sk .....,....Depth
10. Date of Purchase /l/~! y. / ` , . Name of Former Owner r~IY(tXI.f CalrA"p ,
IL Zone or use district in which premises are situated . .
12. Does proposed construction violate any zoning law, ordinance or regulation: ..f/.. .
13. Will lot be regraded t-:'O Will excess fill b remove from premises: Yes No
14, Name of Owner of premises fgddress fc75`t' v7Tp~ lq. phone No.71.e-.
Name of Architect 10y-;5,1x`6 w Address . !a : 1 . e~W?66Phone No.7/
Name of Contractor . , , ; . Address . .,/y.... phone o: .
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: 0 S.S
COUNTY OF.
. J"(J
t?"'? dd4 SsCLv aT~ • • , being duly sworn, deposes and says that he is the applicant
(Nam /b individual signing contract)
above named.
'le is the !?Ch!ii e.
(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 are true to the best of his knowledge and belief; and that the
work will be performed in the manner set forth in the application tiled therewith.
lwom to before me is~
day of ; . Y 19 1. 5
dotary Public, aunty
CLAIRE L.16i:
NOTARY PUBLIC State of New YorM
y /
No
8 , . 4879585
Qualified in Suffolk Ceunt
Commission Expires December ,,1 (Signature of applicant)
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