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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-24016 Date NOVEMBER 6, 1995
THIS CERTIFIES that the building ADDITION
Location of Property 255 WINDJAMMER DRIVE SOUTHOLD NY
House No. Street Hamlet
County Tax Map No. 1000 Section 79 Block 4 Lot 41
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 11, 1995 pursuant to which
Building Permit No. 22812-Z dated JUNE 8, 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 AN ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED
FOR.
The certificate is issued to JOHN ABELE
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N367659 OCTOBER 23, 1995
PLUMBERS CERTIFICATION DATED N/A
ilding Inspector
Rev. 1/81
FORM NO.3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOYYN HALL
SOUTHOLD, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK ALIT RIZED)
D 1 r.....
Date
N°_' 22812 Z
Permission Is hereby gr to;
0ue. .&,lr.. . ~I~ ~ti...... /lam
0.,12
.0.r.... . .....6
to , z...,/~G
sue.....,...
mss.......... `
...................p.........................
at premises located at......... QC~...a........lv.. ~ ! ~ . Wk'...........
.~c......
County Tax Map No. 1000 Section 7;~ Block Lot No. ..'154
pursuant to application dated . f/............. 19...,,..Gl..f---~and approved by the
Building Inspector.
F ad
Fee $..77 J.......?
. ........ul.ld...i.nIn g
Bspe or
Rev. 6/30/80
( T"~ Form No. 6
~ V
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
Nov - 2 1995 765-IB02
PLIbA'1'ION FOR CERTIFICATE OF OCCUPANCY
~TONlPf f)F v0E)'dF90L(~ _
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).
13. 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.
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 - $20.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date wo. t i..l'i30
New Construction........... Old Or Pre-existing Building-z4... [VK?12.AAA09.
Location of Proper.ty.. 0,551...µV.tlYb C'~..=05 N".v.t`!Y'.'kon".d....
House No. Street Hamlet
Onwer or Owners of Property.....,,. ~1~"t~"....r`~'? L..'
County Tax Map No 1000, Section Block I Lot..... 1~
Subdivision... 5hQAPZ.QquW Fileeo~dqq Map.......,.... Lot.......................
Permit No. ? ~ilit 1.i !....Date Of Permit. c~W.~, ~.l4S.Applicant.. P"YAQWp?
Health Dept. Approval :SIIy............ Underwriters Approval.- .L05
Planning Board Approval..... A(A%
Request: for: Temporary Certif.icate........... Final Cert'cate...
Fee Submitted: r0
nRQC~~-
W"a~(71 V ,
P 'CAN'
FIELD-INSPECTION-REPORT DATE COMMENTS
I'',I II n~ ro
FOUNDATION (IS
T)
c:i
FOUNDATION_ (2ND)______II__ I -
u
ROUGH FRAME &
PLUMBING 77~~-
INSULATION PER N. Y. y
STATE ENERGY
CODE ii
I ii~li 111
~II 9m
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FINAL ~III__ l
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if
ADDITIONAL COMMENTS:
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THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
r1185077 BUREAU OF ELECTRICITY
I 83 JOHN STREET, NEW YORK, NEW YORK 10038
Date OCTOBER 23,1995 Application No. on file 88763195195 N 367659
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
JOHN ABELE, 255 WINDJAMMERS ROAD, SOUTHOLD, N.Y.
in thefollowinAlocation; ? Basement ® Ist Fl. ? 2nd Ff. GAR/OUT Section Block Lot
wasexaminedon OCTOBER 19,1995 andfound to be in compliance with the National Electrical Code.
FIXTURE ECEPTAClES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS INCANDESCENT FLUORESCENT OTHER AMT. K W. AMT K W AML K.W AML K W AMT. H P.
5 1
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
AMT. K. W. SYSTEMS
OIL H. P. GAS H. P AMT. NO. A. W. G AMT. AMP. PMT. AMPS. TRANS. AMT H. P NO. OF FEET AMT. WATTS
SERVICE DISCONNECT NO.OF S E R V 1 G E
AMT. AMP. TYPE METER 1.0 ]W 10 3W 3 9 8W 3 $ 4W NO.OF CC COND. A. W G. NO OF HI-LEG A. W. G' NO OF NEUTRALS OA. W G.
EQUIP. PER 9 OF CG COND. OF MILEG OF NEUTRAL
OTHER APPARATUS:
G.F.C.I:-1
ROSLAK ELECTRIC LIC.#3677-E
P.O.BOB 164
CUTCHOGUE, NY, 11935 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 credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
o~,cSUFFO(,~c0
y x
Town Hall, 53095 Main Road p • Fax (516) 765-1823
Telephone (516) 765-1802
P. 0. Box 91971
Southold, New York 1
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
October 16, 1995
Mr. David W. McGahan
P.O. Box 602
Cutchogue, NY 11935
Re: Mr. John Abele - SCTM#1000-79-4-41
Prem: 255 Windjammer Drive, Southold
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)
xx No Underwriters Certificate on file.
xx The check is not on file. $25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 22812-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
Kili~RiltOrt. LisHr.~c ,JrAt:
17
W-594 ag;
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2' y. • 'wink amvel' is r vWtiDn of
ti 4 9 266ti 01*411 79 of (na NOW Yak lute
fdwAgon Law
MAP OF PROPERT)e P,piaa urvm oaveymrD n ecsrlnp
tnb lan't WMei P 11,14M aa~i or
a'$ URVA•y610 JCOS amWraee 401.1 fhrll nm tW wnmdbr.d
' ne a volic' kun eo;+y.
../Of N J. $ 07/4 Amt A 3 F nd:cr ••t her; nn th -11 f run
the ,t son fl. n the ho
P D rod, eM on his his N ariek to the
atie
tilln mums, enyornmhnN1 eq>t,cy n
ONS1 1VAI-ATO AS 44*W,p..p0 d WOVVM ON ftN4# ' undi InShl lhpn lkixd herxn encl
I to tho .4nooe of the landiha hnti.
A $41~" . G s'!" ,5TH7E~5 F . mtm+ta'i. prl,nettuNene Of al"Olqued
(rrSlAaIaOALK /~d. P40W mo.,q~~,) .
f' r
AT
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'a"•" , C .:.ty~.aa;~:sw%LttL11Na1lUf16Yufddu)ilei,Yh~L'
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION iST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING INAL
[ ] FIREPLACE & CHIMNEY
REMARKS: l~
DATE INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION iST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND ( ] INSULATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: C.er -
DATE ` / 7s INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] RO H PLBG.
[ ] FOUNDATION 2ND INSULATION
[ ] FRAMING [ } FINAL
[ ] FIREPLACES CHIMNEY
REMARKS:
401
L
DATE INSPECTOR
pa
765.1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] F ATION 2ND [ ] INSULATION
[ FRAMING [ ] FINAL
[ ] FIREPLACES CHIMNEY
REMARKS: f~~V- --foeeg~S
<
DATE INSPECTOR k/Li,
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ;tNDATION 2ND INSULATION
ING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE INSPECTOR
I
M-1802
BUILDING DEPT.
INSPECTION
( FOUNDATION 1ST [ ] ROUGH PLBG.
[ UNDATION 2ND [ ]INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE CHIMNEY
REMARKS:
{q, y~
DATE INSPECTO
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3'ec ~ dumonLa Ulw
MAP OFAeOACRI"Y ~LANo C'm',0Mr•,W "lmmmlecatlne
land Nrvevp , Inx A „rl or
S UR V1o'YMP SON emtx•cwe 0"1 n•a W onnelee•,d
Ao . vuha 1110 cc. Y.
we binn••Y n¢r: on [h it nm
JOHN J. <,f 2UT14 ANN ABEL E e p t al<i on h's Nr,aq to ,h
G Hilo mpetY. 9nvcrnm,,w1 tla m a
OSS16VAIMP A3 441r.N4 ..00 spitowN YN Aw ,1'• lan<;i nrYn.ihnn n.t, nnrrot frc
`{I"a OA W to t7•o ~Vnuos ut tho lotting o
•,"ARBeaF~' LZ", 5'7-ATCO~'-f $~C% Luton grant.ea arc not er,n.f,r,>I
m eoe~io I •rspt•nlens of aubnQued
j f tffl~'6~
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BOA90 OF HEALTH
FORM NO. 1 3 SETS OF PLANS
MAY 1119c~5 TOWN OF SOUTHOLD SURVEY _ .
BUILDING DEPARTMENT CHECK
TOWN HALL SEPTIC FORM
SOUTHOLD, N.Y. 11971
TO FY
TEL.: 765-1802 NOCALL . . V~
~ `Y~j/?(` CALL
Examined . . • • / MAIL TO.
Approve 19/ s . Permit No. f! .
Disapproved c
Building Inspector)
APP C ION FOR BUILDING PERMIT y~
Date ...~r!C y 1995
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 19cation 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, r re ov I or demolition, s herein described.
The applicant agrees to comply with all applicable laws, ordinances, ildin c d ousin wide and egulations, and to
admit authorized inspectors on premises and in building for necessary i s ect' n .
- (Si at~urre of a -lie or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, 'agent, architect, engineer, general contractor, electrician, plumber or builder.
~i v1.4 1 .
Name of owner of premises v. ~ .0. `~e
(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. t.:`~~~ .
Plumber's License No . . .
Electrician's License No .
Other Trade's License No. .
1. Location of land on /which proposed work will be done .
pZSS UV('vlc~~ .....re.'..:17i~',•, Sl~VTt(OL~
House Number Street Hamlet i~i l
County Tax Map No. 1000 Section ...:..72 Block Lot
Subdivision iHq rzgr.. ~ 1. r Filed Map No . Lot
(Na~e) ,
2: State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ....U!?°/,%h
b. Intended use and occupancy ......R.lK .
Repair which applicable): New Building , Addition . v Alteration .
3. Repair of work (check eck . which Removal . Demolition .:...:.........Other Work .
a (Description)
4. Estimated Cost ~0 I~ e) . o Fee , .
.
(to be paid on filing this application)
S. If dwelling, number of dwellin units . Number of dwelling units on each floor , .
If garage, number of cars , , .
6. If business, commercial or mixed occupancy, specify,,ifi~attire end extent of.each type of use
7. Dimensions of existing structures, if any: Front . , ,655. Rear. ; ~S, Depth
Height Number of Stories , Y47 ' o . . . • .
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 ......rib Rear /off , : Depth v2{?o
10. Date of Purchase . Name of Former Owner .
11. Zone or use district in which premises are situated ......A .
12. Does proposed construction violate any zoning law, ordinance or regulation: 1"U .
13. Will lot be regraded Will excess fill be removed from premises: No
14. Name of Owner of premises , , ,Address . Phone No.
Name of Architect .(~:77•Lit. 4A . i Its , Address . S~'VTNf~.4~• , u: phone No. .
Name of Contractor
within '300 Kl~~l . • ' • Address ('.YT, c I l.4 U~ ,phone No. .
. . . .
15. Is this '300 feet of a tidal wetland? '
Yes........ No.QC.....
*If yes, SoutholdTown 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.
1
•
'
i
STATE OF NEW YOI
COUNTY OF \lc.... S s
lv G
(Name of individual N . • • • . ' ' • • • being duly sworn, deposes and says that he is the applicant
gcontract)
above named.
He is the . .
.1.
(C Facto , agent, corporate officer, etc.)
of said owner or owners, and is duly, authorize o 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 manneri,set forth in the application filed therewith.
Sworn to before me this cy
/ . .day of 19
Notary Public, County
~ I
JOY4`
NNo. A 62 E M. WILKINS . . Pub o, State of Now York (Signature of applican
Term Exp ree June tk2 ta.Z1
~4. r pr 1x1 , X1
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low
NE-? ADP TIO~I
FZE A R EL~.~~ ~ r..~
UCcUPAN+ GCUPANCY OR
USE IS U0 5E IS UNLAWFUL
WITHOUT ITHOUT CERTIFICATE
OF OCCUF = OCCUPANCY
"MOO
APP? ED AS NOTED
U UAT,-~7 2- -7
G GEE: BY:
fil fifOFVFV 6l11Lt11NG DEPA T
7 cI 7e:5-1802 9 AM TO 4 PM FOR THE :I
°CL l- W NG INSPPCTIONG:
nAlORCOUIREO q~Pl I.h; C'J CONCRETE
- "ANUNO $l FLUMBING j. PNA ULAHON
n 4 HINAL - CONSTRUCTION MUST
RE COMPLETE FOR C.O.
Al ALL CONSTRUCTION SHALL MEET
TE THE REQUIREMENTS OF THE N.Y.
C( STATE CONSTRUCTION 8 ENERGY CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
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