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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-24249 Date APRIL 1, 1996
THIS CERTIFIES that the building ACCESSORY
Location of Property 3290 BRIDGE LANE CUTCHOGUE, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 85 Block 2 Lot 19
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 17, 1995 pursuant to which
Building Permit No. 22659-Z dated APRIL 4, 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 ACCESSORY ABOVE GROUND SWIMMING POOL FENCED TO CODE AS
APPLIED FOR.
The certificate is issued to WILLIAM & BLAINE FEDISON
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. M-354209 - JUNE 6, 1995
PLUMBERS CERTIFICATION DATED N/A
ti
Building Inspector
Rev. 1/81
Form No. 6
T014N 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 19 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.
r 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 $155.000, Commercial $15.00
Date ~U.
New Construction........... Old Or Pre-existing Building
Location of Property, 12 Md~.T. C tM .1 k ~
~r~ 9 U 1J. ~.~-Rn.~. . . . . . V .
House No. II Street Hamlet
Onwer or Owners of Property LLIJJ'J14Z.m. d {Z1!~ t'c}~J, Q,>7,
County Tax Map No 1000, Section 8 5.......Block....PZ .........Lot....,./
Subdivision........ .............................Filed Map............ Lot......................
Permit NoccXLS. - ...Date Of Permit# V-.q.S .........Applicant.
Health Dept. Approval ..........................Underwriters Approval
Planning Board Approval /
Request for: Temporary ,Cee7r~tificate........... Final Certicate... Y......
Fee Submitted: $.r 1.•.62/
J..
~l.y APPi,1CANT
o~OgOFFO(,(rc0
o~ Gym
N ~
Town Hall, 53095 Main Road p Fax (516) 765-1823
P. 0. Box 91971 y~ol ~aO~ Telephone (516) 765-1802
SoutholdNewVork 1
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
March 25, 1996
Mr. William Fedison
3290 Bridge Lane
Cutchogue, NY 11935
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)
No Underwriters Certificate on file.
xx The check is not on file. $25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 22659-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
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)
N Date 22659 Z
Permission Is hereby granted to: _
all so A..,
3/°:9®.,X1.. e... .
..C.4-~- ..~~.`.f.........
toVK... /Y......a
tee.. ~/~........,.9.~.<.../. 4~~. ~~r ` ....,,~~.....-9' ~'~i.
a~.....1'ev
at premises located at........3.d.-../..Y..
County Tax Map No. 1000 Section Block k............ Lot No. ../..1
pursuant to application dated Nei .C.17.....t2, 19...9.1....,/and approved by the
Building Inspector.
Fee $.4;-0-:
Buildin Inspect
Rev. 6/30/80
FIELD INSPECTION REPORT IIDATE II COMMENTS
-
II 0 troq ry^,
II II ~ v
FOUNDATION IST)
u n
II n
FOUNDATION (2ND)
ii ii
n~ u
n n
ROUGH FRAME & zo
PLUMBING 11 It
II
u it
II I
II
II II
II II
II i
II It
INSULATION PER N. Y.
STATE ENERGY
CODE
it
ii
I ~
1004
II I H
II I
II
II II
II II
II II
II
FINAL
_ ADDITIONAL COMMENTS:
o
x ~
r
~Q
H
V
M-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
ti
z
DATE, hh INSPECTOR
s
t
5 a -n ( `z
gmum T14-- Fou-
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1001071 BUREAU OF ELECTRICITY
F 85 JOHN STREET, NEW YORK, NEW YORK 10038
Date JUNE 06,1995 Application No. on file 07257695195 N 854209
THIS CERTIFIES THAT
only the electrical equipment os described below and introduced by the applicant named on the above application number in the premises of
BILL EE$cSON, 3290 BRIDGE LADE, CUTCHOGUE, N.Y.
in thefollowing location; ® Basement ? Ist Fl. ? 2nd Fl. OUT Section Block Lot
wasexaminedun JUNE 02,1995 andfound to be in compliance with the National Electrical Code.
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS ECEPTACLES SWITCHES NCANDESCENi FIUORESCENi OTHER Mr. K. W. AMT. K. W AMT K.W AMT, K.W AMT. H.P.
1
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
AMT. K. W. OIL H. P. GAS H. P. AMT. Na A. W. G. AMT. AMP. MAT. AMPS. TRANS. AMT. H. P. SYSTEMS qMT. WATTS
NO.OF FEET
SERVICE DISCONNECT 140. OF S E R V I C E
MT. AMP. rypE METER 1.0 M IF 3W I3 0 3W 30 4W NO. OF CC. COND. A. W. G. NO. OF H4LEG A. W. G. NO. OF NFUTRAl3 A. W.G.
EQUIP. PER a OF CC. COND. OF HI. OF W.0. NEUTRAL
OTHER APPARATUS:
G. E.C.II-1
G & S CONTRACTOR LIC.#578-E
BOX 215
SOUTHOLD, NY, 11971 GENERAL MANAGER
11
Per
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credeAtials.
COPY FOR QUILbING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
BOARD OF HEALTH
FORM NO. 1 3 SETS ? PLANS , .
TOWN OFSOUTHOLD SURVEY q 2__......,,..
BUILDING DEPARTMENT CHECK -AS'fj_ .
TOWN HALL SEPTIC TORN
SOUTHOLD, N.Y. 11971
TEL.: 765-1802 N OT I FY ;
9 c CALL 7..Y_..4$a
Examined 4Y'
. 192. 9 - MAIL TO: • • .
Approved , 199 . Permit No. . .
Disapproved, a/c .
(Building Inspector)
I ~i~ Ev
W 1710
AP AT ION FOR BUILDING PERMIT !~C
BLDG. DEPT. Date 19
T01NN OF SOUTHOLD 1
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 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. i iillR3~l?fi'3mWA30141)
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Buil ing3Permit pursuant to the
Building Zone Ordinance of the Town of Southol Wode, , and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, addi ' emoval or demolition, as herein described.
The applicant agrees to comply with all applicable housing code, and regulations, and to
admit authorized inspectors on premises and in buildin.
-2dI'1.
'(Signature of,applicant, or name, if a corporation)
- (XId ng address of applicant)
State whether applicant is owner, lessee, agent, architect, epiginaer,-,general contrgctor, electrician, plumber or builder.
0.wMe-,
.....................i...`..`........."....`................................
Name of owner of premises J.Q.:hJ.
¢.4..WI1' eC Fe.djsvh
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
nt ,
Builder's License No. .
Plumber's License No .
Electrician's License No .
Other Trade's License No . * -
't
1. Location of land on which proposed work will be done .
ne C.'V.T.c..YQ.G.0.~F
House Number Street Hamlet
County Tax Map No. 1000 Section Block ......4 q
Lot....../
Subdivision 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 .
b. Intended use and occupancy . .;wYv."„ ~q
'~tY4J7 ,c>1YtP il~ift1 i
R
,3. Nature of work (check which applicable). New Building
pur roval • • • Addition Alteration
• • • • • • • • • • , Demolition Other Work ...~PncW *6Aio.
4. Estimated Cr:..:(Description)
Fee....
S. If a number numb of of dwellin (to be paid on filing filinng g this this application) .
dwelling, ~ application)
g g g units . . . . Number of dwelling units on each floor
6. If business, commercial or mixed occupancy, specify nature and extent of each YY of use . . . . . . .
7. Dimensions of existing structur
Height es, if any: Front , , , , , , , , , ,Rear . .
Number of Stories Depth pth .
Dimensions of same structure with alterations or additions: Front . .
8. D pth of entire new construction: • Height . ' ' • ' ' ' ' ' • • • • • Rear
auction: Front , . ' • Number of Stories .
Height Number of Stories , Rear , , , , , , , , , Depth • • .
9. Size of lot: Front .136 I
0. Date of Purchase • , ' Rear I a 0, I De th 3 ' i
It)._. _7 . Name pfFo or Owner P r ~.9
] L Zone or use district in which promises are situated , ,
I?. X5.1 Cl . I~ W .
12. Does proposed construction vio ate any zoning law, ordinance orrrregulation: • n o
..13. Will lot be regraded .
14. Name of Owner of remisesh).': 4 Will excess fill be removed from premises: •
P I'Rmr,E~¢jpA
Yes No
Name of Architect ,
F )bDtlAddress3.~Q4, hi,.-i f~p,..W. . Phone No.
7.Y-505p2
Name of Contractor . . • . . . • . . • • • ' ' • • . Address . Phone No.. .
15. Is this property within X00 feet of a tidaldwetI - 'Phone N
and? *If yes, Southold Town Trustees Permit may be reqquuir' ired,
NO
PLOT DIAGAM
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all
interior or corner lot. set-back from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
dimensions indicate
I
UNDERWRITEV CERTIWATt Pool will be ) oea-Fcd
REQUIRED plus or hilnvs )5' gram
r I ~ Praper~~ lrh~ Glnc~f
~ r6Pa6e I N
1 Above ~rou I M P~uS oe- minus yd~
/ Poo l iron, hack of
.y 1'D Lnit XQyt c cA ra ge.
OCCUPANCY OR jAP R
7VE ASNOTED
USE IS UNLAWFIDA
WITHOUT CERTIFo' -FEE: BP.# w
OF OCCUPANCY 765 8 2 8 A 1 1>D 4 PM FOR THE
C••I•or - Cf p') FOLLOWING INSPECTlON$:
~eG t. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH . FRAMING & PLUMBING
a~e 1 {-~o uSe 3. INSULATION
4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
A
LL CONSTRUCTION SHALL MEET
THE EQUIREMENTS OF THE N.Y.
35 ` STATE CONSTRUCTION & ENERGY
3 9o ri bs~ ft~~
STATE OF NEW YORK, I R U RS
COUNTY OF.. .....S. °
S LoT
. i.h.. J9
(Name of individual signing
. . ' ' . ' • ' ' • • being duly sworn, deposes and says that he is the applicant
above named. contract)
He is the ......,CSC.?? 1 ey- . •
(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 filed therewith.
Sworn to before me this
day of . 1 19
Notary Public, •N
4WIPUM
W M N+
wn
Si
(gnatur¢ of applicant)
Ju 9t ,
b
ale I . .
SUFFOLK CO. HEALTH DEPT. APPROVAL
VACAn T) H. S. NO. ~i G 62
Ci rlt 1, 12 0. 0
9p / 1. _ ~ 1 i ~ ~ i ~ ~ 1
\ 7rv;T THE WA7
'Q? r I SYSTEM'. STATEMENT OF INTENT
U j ~~'?'v UE CONFOR
SUFFOLI THE WATER SUPPLY AND SEWAGE DISPOSAL
p~j 1f11
ll~ ~ ' ~ Fit fv.~ SYSTEMS FOR THIS RESIDENCE WILL
(
1 I ts~^ CONFORM TO THE STANDARDS OF THE
SUFFOLI SUFFOLK CO. DEPT. OF HEALTH SERVICES.
5
S E R V I I APPLICANT
CONSTRI
L ! ryc, t DATE:_ SUFFOLK COUNTY DEPT. OF HEALTH
r H. S. REP SERVICES - FOR APPROVAL OF
APPROVI CONSTRUCTION ONLY
DATE:
i
QIoS Or , j e~-SO'62
_ irs.noS p~~ 1 SUFFQ H. S. REF. NO.: .
7 ISO :na. \ DIST. APPROVED:
col Li 1
OWNERS SUFFOLK CO. TAX MAP DESIGNATION:
DIST. SECT. BLOCK PCL.
t Dec.s
,
\ `SALE 50 : f
i X0 55 2 19
OWNERS ADDRESS:
a F;~ uJ y r---- - \ o=FtPE_ ill ~7D?l~EHLJ12S'T
! 1
'4Yr a F.,I
I1746
tw-d -4,
wFL ~ Jg ,f DEED: L. h%P.
LIJ
O u~ 1 ~'E r~j TEST HOLY- STAMP
E r4:, Ji(p_ i.,/;-[' I pnc:nhoi-r`•!slinro!ion MtCt!tim
1 - _1_I L _ to ihi• nw^Y it a roNfion of
72LY-C:h-. NAVrYVk f-uto
re gt7ta Lnw.
(,~qe• d tti- wo "n ,9 nr, b•ndn,)
n t VB" vu h ccl Y., 6+c'+nau' rs0
to L
1 7... G ~j '-D L . I. 2 . 1 J r c j = 1 ate! _ I.. ' Gur.•cnN-r 1. ,1 h - ('I f - II -
- . C rt.- t l.G c i Ie: .r,
lil-2I?~`! to
SEAL
t OF NE
S 1,'_ k ti 1' r
RODE`R IICK VAN T-UYL, P .C.
LICENSED LAND SURVEYORS \=cF~~ j/
GREENPOF NEW YORK
u.,