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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-23874 Date SEPTEMBER 14, 1995 THIS CERTIFIES that the building ADDITIONS & ALTERATIONS Location of Property 840 PINEWOOD RD. CUTCHOGUE, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 110 Block 5 Lot 25 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 9, 1994 pursuant to which Building Permit No. 22650-Z dated APRIL 1, 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 TWO ADDITIONS & ALTERATIONS TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR & AS PER ZHA #4297. The certificate is issued to CLAIRE CHAMBURN (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-360184 - AUGUST 8, 1995 PLUMBERS CERTIFICATION DATED AUG. 3, 1995 - JACK GISMONDI ding 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 April.. I.. 1995....... N2 22650 Z Permission Is hereby granted to: CLAIRE CHAMBRUN 840 Pinewood Road Cutchogue, New York 11935 CONSTRUCT TWO (2) ADDITIONS AND ALTERATIONS TO EXISTING ONE to FAMILY DWELLING AS APPLIED FOR. ZONING BOARD OF APPEALS $4297,,,,,,,,,,,,,,,,, DATED MARCH 1, 1995. at premises located at . 840 PINEWOOD ROAD CUTCHOGUE1 NEW.YORR County Tax Map No. 1000 Section 119............ Block .........5 Lot No. ....25.................... JANUARY 9, 1994 pursuant to application dared 19..............., and approved by the . . Building Inspector. Fee ..e . . B /IdIngpector Rev. 6/30/80 lll~~1// Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT a# TOWN UALL AUG 2319% 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 nll buildings, property lines, streets, and unusual natural or topographic features.' 2. Final Approval from Health Dept. of water supply and sewerage-di.sposAI(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in syste(h gontains 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. I 6. Submit Planning Board Approval of completed site plan requirements. 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. 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.OQ 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 ~Ppi di~N °1 0 . K.... Date tq . =_w Construction, Old Or Pre-existing Building . )cation of Property ...V.-I J1 f, o©p yiw y ~n D House No. Street U Hamlet :crier or Owners of Property.....-11, C~ 4,51( _LJQ A. aunty Tax Map No 1000, Sections.... ...;,..Block..., ..Lot. bdivision., ' ...................,...,.....Filed Mnp............ Lo rmit No. At 656>.. Z...Date Of Permit.,...,., .....Applicnnt..CL~r.~.. nlth Dept. Approvnl..... NA • • • • ..........Underwriters inning Board Approval.. luest for: Temporary Certificate.......,.,, Final Certicate...4l........ Submitted: APPLICANT ca ~~38~y LA' TEL. 765-1802 TOWN OF SOUT13OLD .a OFFICE OF BUILDING INSPECTOR c°n `Si° 31'~ , rn P.O. BOX 1179 ,'i, 'r TOWN HALL o~~l?~~O•r SOUTHOLD, N.Y. 11971 ~ AUG 2 3 1995 C E R T I F I C A T I O N Date 3 • I , Building Permit No. Owner ~Q h~.b~uin (please print) Plumber ct c K I°~yRBti~ I (please print) i I I certify that the solder used in the water supply system contains,less than 2/10 of 1%'lead. i I plumber's signature) Sworn to before 0 this day of Lf-tf 19 r GY L Notary Pu li NOtarI Publicr County R-,; JLVANN D.ZARZEOKI ftfit'y Public, State of Now York f NO.4961037 My Commission Expires Jan. 8, ~99~ 1LLD I;.SVEf Ti0N PATE ~ c0114MENT° A W ~ 3 "OUIIII'ATS:014 (t:st) y , r ` FOUNDATION (2nd) _ 2. •j z o co ROUGH FRAME / O ..IIPfE.ING k~. \ H m INSULATION -PER'N. Y. .STATE.,.ENERGX CODE x a 4. r ~o FINAL Q 'A"NDIT 2IAL COMMENT-S: m H • y ~q O 2 a • r H S m 1, - .n H Ai APPEALS BOARD MEMBERS ~o~~SUFFO(~ co p Southold Town Hall Gerard P. Goehringer, Chairman c 53095 Main Road Serge Doyen, Jr. ti x P.O. Box 1179 James Dinizio, Jr. O Southold, New York 11971 Robert A. Villa yy/ O~ Fax(516)765-1823 Lydia A. Tortora Ol ~O Telephone (516) 765-1809 BOARD OF APPEALS ACTIok0 TAEWiT1A0OF APPEALS DATE OF ACTION: March 1, 1995 APPL. #4297. APPLICANT: CLAIRE CIIAMBRUN LOCATION OF PROPERTY: 840 Pinewood Road, Cutchogue. COUNTY TAX MAP DISTRICT 1000, SECTION 110, BLOCK 5, LOT 25. BASIS OF APPEAL: Notice of Disapproval issued by the Building Inspector dated January 9, 1995. "Proposed construction will have insufficient side yard setback." PROVISIONS APPEALED FROM: Article III, Section 100-30A.3. RELIEF REQUESTED: Part of a corner of the proposed addition of protrudes five feet into the restricted side yard area. The corner point will be 10 feet from the northerly side property line at its closest point. The remaining major portion of the addition will meet the side yard setback requirement of 15 feet. MOTION MADE BY: Serge Doyen, Jr., Member SECONDED BY: James Dinizio, Jr., Member ACTION/ RESOLUTION ADOPTED: Granted as applied. REASONS/FINDINGS: 1. Due to the angle of the existing single-family house which was built more than 30 years ago, 2. due to the substandard size of the land which is 100 feet deep by 140 ft. wide. 3. The relief requested is very minimal and affects a very small amount of land area. VOTE OF THE BOARD: Ayes: Serge J. Doyen, Member James Dinizio, Jr., Member Robert A. Villa, Member Lydia A. Tortora, Member Gerard P. Goehringer, Chairman-Member This resolution was unanimously adopted. .z Ik GERARD P. GOEHRING ER, CHAIR N f APPEALS BOARD MEMBERS ~o~~gUFFO(kcO p Southold Town Hall Gerard P. Goehringer, Chairman c y` 53095 Main Road Serge Doyen, Jr. COD x P.O. Box 1179 James Dinizio, Jr. O Southold, New York 11971 Robert A. Villa y~J O~ Fax (516) 765-1823 Lydia A. Tortora Telephone (516) 765-1809 BOARD OF APPEALS TOWN OF SOUTHOLD r l 4 March 7, 1995 Mrs. Claire Chambrun 840 Pinewood Road Cutchogue, NY 11935 Re: Appl. No. 4297 - Variance for Corner of Addition Dear Mrs. Chambrun: Please find enclosed a copy of the determination rendered by the Board of Appeals and filed today concerning your variance application. A copy of this determination has also been furnished to the Southold Town Building Department pertaining to your pending building permit application request. However, it will be necessary for you to submit the final drawings and location map with the Building Department before your building permit will be further processed (if this has not already been done so). If you have any questions, please feel free to call our office, or that of the Building Department at 765-1802. Very truly yours, ~zCa.> JCaoc,-e+,. hinda Kowalski Enclosure cc: Building Department ,1`~yb 1~tlSY9 "WI'.w+`h.u. •.,.VF(~• ,Pa V5 x.c CbN ~ ..~.{y.r ~Tr Vn°R' HL $ . ,•"Y 1. '9 1 Yt(...A'P. 3~ Y '.li ~ypRp„'.c, ' FORM NO.3 .'s,.::..,.. _ TOWN OF SOUTIIOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL Date ......,`~........,19/j TO C((,//~../lJ ~~J• /~~~(J//~ T.Q ./11 PLEASE TAKE NOTICE that your application dated ~ 19. for permit to ~C .L~I~Y~ L, P~ ? / at s, Location of PropertyH..ou.se , ,tLZ ~17 0 No. Street ~J Ham et County Tax Map No. 1000 Section Ar , • Block Lot . Subdivision Filed Map No. Lottt/ No. is re urnedd herewith and disapproved on the following grounds f ..ma y.. 0., p....~ . t.: Building Inspc.... RV 1/80 6-C M-1802 BUILDING DEPT. INSPECTION [ /FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL ARKS: R T d DATE INSPECTOR /""OJ x M-1802 BUILDING DEPT. INSPECTI [ ] FOUNDATI N 1ST [ [ ] FO DATION 2ND [ ] INSULATION [ RAMING [ ] FINAL REM PKS: C J1 L DATE ~ 5 Jr' INSPECTOR M-1802 BUILDING DEPT. INSPECTION [ ] FF UNDATION 1ST [ ] ROUGH PLBG. C41 FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ FINAL REMARKS: ' DATE J INSPECTOR G~`~ M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ OUCH PLBG. [ ] FOUNDATION 2ND [tr(N'SULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE s G ~ INSPECTOR 74 e~lG' 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INS ION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY REMARKS: C DATE L INSPECTOR THE NEW YORK BOARD, OF FIRE UNDERWRITERS PAGE 1 F BUREAU OF ELECTRICITY ! 85 JOHN STREET, NEW YORK, NEW YORK 10038 6ot'o' AUGUST 08,1995'' "'Application No. onfile 88048895/95 N 360184 THIS CERTIFIES THAT PERMIT NO, 22650 only the electrical equipment as described below and introduced by the applicant namedon the above application number in the premises of CLARE CHAMBRUN, 840 PINEWOOD, POLE LIL 2, CUTCHOGUE, N.Y. in thefollowing location; ® Basement ® Ist Ff. ? 2nd Fl. Section Block Lot was examined on JULY 31,1995 and found to be in compliance with the National Electrical Code. FIXTURE ECEPTAClES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT FLUORESCENT OTHER AMT K. W. AMT K. W.. T. K.W. AMT. K. W. AMT. H. P. 6 8 5 5 1 1 F DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIALREC'PT TIMECLOCKS BELL UNITHEATERS MULTI-OUTLET DIMMERS SYSTEMS AMT. K. W. OIL H. P GAS H. P. AMT. NO. A. W. G AMT. AMP. PMT. AMPS. TRANS. AMT H. P. NO. OF FEET MAi. WAiiS SERVICE DISCONNECT NO. OF S E R V I C E WT. AMP TYPE METER 10 3W 1.9 3W 39 3W 3,e AW No. 0' CC COND A. W. G. NO. Of "I-LEG A W' G' NO. OF NEUTRALS A W G EQUIP. PER .O" OF CC. COND. OF N,.,& OF NEUTRAL OTHER APPARATUS: CEILING FAN-1 FAN CONTROL-1 G.F.C.It-1 SMOKE DETECTOR,-1 MICHAEL J. HURLEY LIC.#4221-E 9905 NASSAU PT. ROAD CUTCHOGUE, NY, 11935 GENERAL MANAGER 11 t- 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 credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. - BOARD OF HEALTH FORM NO.1 3 SETS OF PLANS TOWN OF SOUTHOLD SURVEY _ . BUILDING DEPARTMENT CHECK . . TOWN HALL SEPTIC FORM SOUTHOLD, N.Y. 11971 TEL.: 765.1802 t70'r I FY CALL. Examined l , 19 rIA I L TO: Approved ...17L... 19?J._7Permit No. °Z. d.................. . Disapproved a/c ./~0 _ ; . (But di In ctor) ` A 1990 APPLICATION FOR BUILDING PERMIT [lEC Date 19 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. 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 inspections. ec.tt Q1..C~ (Signature of applicant, or name, if a corporation) ..................&1. ~f~ . 1i736s _ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises 'd. (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. Te) f) / v< Plumber's License No. Electrician's License No. Other Trade's License No. L! 1. Location of land on which proposed work will be done. ~..>7! c . .................Hamlet... House Number Street County Tax Map No. 1000 Section AP.. , • , , , , , , • , Block `6 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 ...~G' GG b. Intended use and occupancy X& 3. Nature Repair of work (check which applicable)- New Building Addition , Alteration . • • • • • Removal Demolition Other Work . (Description) 4. Estimated Cost../.?,.4 0 Fee....... If dwelling, number of dwelling (to be paid on filing this application) ' garage, units . . . . Number of dwelling units on each floor . If number of cars 6. If business, commercial or mixgd occupancy, specify n ture aryd extent of.each type of use 7. Dimensions of existing structures, if any: Front .....2 Rear Depth 2-..?~ , , , , , , Height 1K Number of Stories . Dimensions of same structure With alterations or addi ions: Front . . , • • , , . • • • • • . Rear ...../d / Depth 8. Di nsions of entire new cnst' ruction: FHeightronnt t Rear . . . . Number of Stories . Depth , ; . E.. ~ Depth . Height Number of Stories . • . • 9. Size of lot: Front . Rear . ! O ................Depth ~'e . 10. Date of Purchase i,, , , , , , , , , , Na e of Former Owner . . 11. Zone or use district in which premises are situated • • • • .12. Does proposed construction violate any zoning law, ordinance or regulation: . Yrs • 13. Will of be regraded premises Will exc ss fill a removed from premises: Ye.s 14. _ Name of Architect fiP L f ~ ' Address , Phone No. ~ Address ...................Phone No................. Name of Contractor . . Address . . Phone No. , 15. Is this property within 1300 feet of a tidal wetland? eyes„ 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. Pe ~ iL - I ~I STATE OF NEW YORK, COUNTY OF ....s~.... S; S • being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. 91Ie is the O~nN0f (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 er set forth in the application filed therewith. Sworn to before me this l~ yo N w. 19.1. _ Notary Public . oun y RNOTANo. 4715089, Suffolk Coin - (Signature of applicant) Term Expires Map 31,19 p N/F NUGENT -SO - [ - - F02 N.5742 00"E, 140.0 AIT a °~ca I o m TOWN OF SGUTH- .D N m £ To fwoA.. Z i TO FNPA• •q -(c - 4028 - " Y , o~ 03 lb- 5.57 42 00+W. 140.0 - - 50' SOUTHERN CROSS 20RD j i AS SURVEYED AUG.9 199 ~~ODEfcIC1~ `JF'.r~ TUY s~ Llr. LAN0 S:~IZVEY; 'YZEENPCRT, FJ, Q'. SUFF. C4. TAX MAP DATAIOOp-1;0-5.25 ^F Ls 3~ Dc.GE~,S©fW , ~ _ SloeYvRp r~-o T,'U - ppG. ~UNt~b~or..l k1L>L~ aJ SIC In z ° " ' All d' ' ~ Lea II' 2 x ra wR - ~ ~ "'i 1 6-'ate-~ :1 x 8 G~ ~ 1G••% I 8(35 ~ ~a(T~, 40.2 14 I: _Q U N >?~A.Ua~? o ~I t~ -~/42r'bKID 'F• it r ° v 1 111 .LI it I= _I o~ Z. - - - OV i ~ ~yH G~ I - -PLOT `FL ~_"-_-OI 2`O-o" n 2'-fo * - Y ~l b 'lTiKr~1 ~F.r.•M llR:F"~ ~ a~in61 1-- D 6N aN b1Y op i7ffnf - i 7 (-',ca) ate. :n I - Q N I ~Il~ III -u ~ II I ~ ~ ilII I ~ i a it ' N 4" aa~ SL1~ c ~ . O of f, r a d _ PLUMBING ' ~c k ALL M.UMBING WA STE Cl ~Ui~ t~lCLI-S- _ I~ = aVATER UNESN ED O I, 4'-- Ci 'MONO BEFORE C E RING 0 conk,SU`~ I 1 --~-(I - " - - PLUMBER CERT !CATION OIV LEAD CONTEXT BEFORE CERTIFICATE OF CCUPA 1N1''{{ji SOLDER USED) V Y?ATF~R 7 I r f N 'I w 1-01 SUPPLY SYSTf CANN T EXCEED 2110 O I%LEAQ.j Z P,~ Ai lp I ~ I 1 ii of ~I I'~ i if copper tubing is us d I A:m.:M.1in In system; piping shall I: a - m i(~! of tyrypeaKorLonly i jam; ~YUjs Lam; !CA - - - F C~ it Trl ~ 1==E R~ nt'Jr.1J ~I I I UNDERWRITERS CERTIFICATE i REQUIRED y "'UP fPs MOT VP °3z~ Z rt\ 4,. 0 cot-z. 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