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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-23895 Date SEPTEMBER 19, 1995
THIS CERTIFIES that the building ADDITION
155 ANTLER LANE &
Location of Property 890 BEEBE DRIVE CUTCHOGUE NY
House No. Street Hamlet
County Tax Map No. 1000 Section 97 Block 7 Lot 8
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 8, 1995 pursuant to which
Building Permit No. 22837-Z dated JUNE 19, 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 GAZEBO ON AN EXISTING DECK ADDITION AS APPLIED FOR
The certificate is issued to CHARLES LEVIEN
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N363089 SEPTEMBER 11, 1995
PLUMBERS CERTIFICATION DATED N/A
Af
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 19.
NP 22837 Z
Permission Is hereby granted to;
.
f r4 ......G............. a.. , ..99.. .
to cm.'fir. r r .:.................~I (Ai?.......... .
~~~......s..............................,..
.I.
at premises located at........... 19 V a..C..........~cQll/~
County Tax Map No. 1000 Sectlon
g.7.......... Block 0./-7 Lot No.
pursuant to application dated 0l?••••••••••••••••••••••••••••.••.•••••19.. and approved by the
Building Inspector. rW
Fee l...
/!~(~nl'nspector
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL S1 !P - g 19C)"5
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 build?ng 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 sewer2ge-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 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 Buildine - $100.00
3. Copy of Certificate of Occupancy - $20.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of,Occupancy - Reside $15.00, Commercial $15.00
C
Date
New Construction.:. Old Or Pry-exis ~ing Bifild'ing., Z U
Location of Property t KZ jW. ...UcU
House No. Street Hamlet
9moer or Owners of Property..~~'-5,,,
_ounty Tax Map No 1000, Section....../, ....B.Iock................ Lot
ubdIVisi.on.................................... F1Ied lisp............ Lot......................
Permit No a J,? ..Date Of Permit ................Applicant...,.........................
!:Iea1Lh Dept. Approval ..........................Underwriters Approval.........................
'lanning Board Approvnl
1equest for: Temporary C,,ppertificate........,,. Final Certicate...........
:'e~e" SubmitLed'
THE NEW YORK OAR.D OF FIRE UNDERWRITERS PAGE I
1001071 _ DUN OF EL.ECTMCITY'
r as,- N. STFMEEKr. NAP mm. WW, .YCff11C too4a.
( Date SEPTEMBER 11,1995 Apoicarion No, on fife 10014095/95 N 363089
THIS CEFMFI£S THAT
only tAe electrical erpdpaaenl as Aswr;W below and Int adomd by the appdicaut ""ocher the chafe application wmMx in Mop aa.is.r of
CHARLES LCVIEN, BEERE DR., ANTLER LAN€~ CUTClmUM;; N.Y.
F-1 i
in rheJoNowing tocadan; El 8aeemene C lst fT. 1_T t sod FL GA$/OUT sectiem Block Lot
roar eramined on SEPTEMBER 05,1995 aed. 06" to t+e or coafpliawrre wWh fie Akaionaf lrlerb W Cade.
RXIWE NXTURRS . KAMM Coq ft11BC1(5?-~--OVENS -DKH WA**SS IDMAUSI FAM
TxenEn ~ fYY1T[11F5 ya(N-im-tM m onscna W NER..-- NAT. Cw, Am. K.W. ? 1 1. AM Aa[. kw AMT. Kf.
3.
4 2 _ F- J
DRYERS RIRNACE WTORS IVtUfE AIt1I1/fKl ROSRS SlRCfAt.MCK^ itNE0=s yu tamI mATm mRS 4um 1 OLVAMS
' - STSTfaIs
MT K. w. ? on K y. ( on R. r. AMT. .,Na , k w. o. AIa. AA, AWV,, - mft . Tws. AMT. K p. !No.(* Fat AMT. wATts
SWVI0 CISCOD Wff Ie0.Of S E - R • •V I C E
CanD. A. w. a. rss. OF Nitcc w. e•. w. W rerRfArs A. w.
Aar. Nv.. To, ' 1 t aw t r aw slaw s,r+w? OF
[OUt?. feeicl oT et ea+o a Sauer ar ,au~iiAe
i
1
OTNN AmAkATIA:
PADDLE FAN-1
HOTORS:1-F H.P.
G.F.C.I,-1
G &'S CONTRACTOR LIC.457f8-E
BOX 215,
'SOUTHOLD, AY, 11971 emu'"AmAm
This cerlificole tlrusf not bh chered in wry gamer; retum to t6 office of the Board it inmrreyct. fns{tector; may be kWfdiw by their cmdentiek.
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Town Hall, 53095 Main Road p Fax (516) 765-1823
P. 0. Box 91971 y~ol ~.ao~ Telephone (516) 765-1802
Southold, New York 1
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
September 13, 1995
Burger Construction Inc.
P.O. Box 934
Cutchogue, NY 11935
Re: Charles & Alice Levien - SCTM#1000-97-7-8
Prem: 890 Beebe Drive, Cutchogue
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
An application for Certificate of Occupancy is
not on file. (Enclosed)
xx No Underwriters Certificate on file.
The check is (outdated/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 # 22837-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
o~osuFFOt,~oo
o~
CA 2
Town Hall, 53095 Main Road p ' Fax (516) 765-1823
P. 0. Box 1179 Telephone (516) 765-1802
Southold,, New York 11971
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
September 13, 1995
Burger Construction Inc.
P.O. Box 934
Cutchogue, NY 11935
Re: Charles & Alice Levien - SCTM#1000-97-7-8
Prem: 890 Beebe Drive, Cutchogue
To Whom This May Concern:
We are unable to complete your Certificate of occupancy
because of the following reasons:
An application for Certificate of Occupancy is
not on file. (Enclosed)
xx No Underwriters Certificate on file.
The check is (outdated/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 # 22837-Z
Please contact our office on this matter. Thank you for
l cooperation.
SOUTHOLD TOWN BUILDING DEPT.
FIELD INSPECTION REPORT DATE COMMENTS
II Cu
FOUNDATION (1ST) II `1
II II
I I b
rouNnnTloN (zNn)-- --Ir-_ ---,I---------------------------- - ~ o'• m
__________________--°---H----____ t
lI
ROUGH FRAME S I °
PLUMBING
l
to
INSULATION PER N. Y. II - y
STATE ENERGY - --Ij-` -
COnr; i li -
if---- i~---
a1--
FINAL
11---
ADDITIONAL COMMENTS:
-
H
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-
LETTER OF AUTHORIZATION
Charles Levien
Antler Drive
Cutchogue, NY 11935
June 6, 1995
1 hereby authorize Thomas C. Samuels of SAMUELS & STEELMAN ARCHITECTS
to act as our agent in obtaining all permits required by SOUTHOLD TOWN and NEW
YORK STATE for an addition to our residence on Antler Drive in Cutchogue, NY.
0A
harles Levien, Owner Date
6 rP"1 Uf
c~ 7t
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ )ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
NEY
REMARKS:
DATE I~ S INSPECTOR A7
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1001071 BUREAU OF ELECTRICITY
85 JOHN STREET. NEW YORK, NEW YORK 10038
Date SEPTEMBER 11,1995 Application No. on fife 10014095/95 N 5630 39
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
CHARLES LEVIEN, BFFRF DR„ ANTLER LANE, CUTCHOGUE, N.Y,
in thefolfowing location; ? Bneement ? At FI, ? 2nd Ft. GAR/OUT Section Block Lot
.4 was examined on SEPTEMBER 05,1995 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. AMT. K.W. AM3 K.W AMT. H P.
4 2
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC-PT TIME CLOCKS BELL UNIT HEATERS MU171.OUTLET DIMMERS
1 AMT, K.W. OIL H. P. GAS H. P. AMT. NO. A. W. G. AMT. AMP. AMT AMPS. TRANS. AMT. H P SYSTEMS pMi. WATTS
NO.OF FEET
i
SERVICE DISCONNECT NO.OF S E R V 1 C E
AMT. AMP. TYPE SOUIP 1.02w 103W 393W 3,e<W NO OPER COND. Of CC. COND. NO. OF HbLEG ~ N LEG NO OF NEUTRALS OF NEUTRAL
t
OTHER APPARATUS:
i
1
I PADDLE FAN-1
{ MOTORS:1-F H.P.
f G.F.C,Ie-1
G & S CONTRACTOR LIC.Ik578-F C//ice
BOX 215
SOUTHOLD, NY, 11971 GENERAL MANAGER
11
Per
This certificate must not be altered in any manner; return to the office of he 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.
!Y/~OARD OF HEALTH
FORM NO. 1 ' 0? SETS OF PLANS
TOWN OFSOUTHOLD ~SItRVEY
BUILDING DEPARTMENT ,/Ct1ECK
TOWN HALL SEPTIC FORK NA.....,,,
SOUTHOLD, N.Y. 11971 .
9 TEL.: 765.1802 NOTIFY
6~ CALL . JJ
Examined . . . . 19
. t4AIL TO:
Approved ( / 19/V. Permit No. J ~ej f.& .
Disapproved a/c .
(B d' Ins ector)
JUN APPLICA ON FOR BUILDING PERMIT
Date ..l11~71/t5 195
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the building Inspector, with 3
etsbf 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
r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
ation.
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
hall 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
hall have been granted by the Building Inspector.
i
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
:wilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
:egulations, for the construction of buildings, additions or alterations, or foK removal or demolition, as herein described.
i 'he applicant agrees to comply with all applicable laws; ordinances, building code, housing code, and regulations, and to
dmit authorized inspectors on premises and in building for necessary.inspection
.
(Signature of applicant, or name, if a corporation)
cs~o735 fv?r9/r? Jow.
• Cf>/eyD
/
(Mailing address of applicant)
j sate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
lame of owner of premises 0#*1 is 10VIe~~ 4 moo-
(as on the tax roll or latest deed)
f applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No. f~j. ~ yr.... 46V& 50 CGi1r f Q"~/
Plumber's License No....... r. A
Electrician's License No . s a~r~C~ie/C
Other Trade's License No .
Location of land on which proposed work will be done .
CorcFXxv' .
House Number ~y Street y Hamlet p
County Tax Map No. 1000 Section Block Lot O
Subdivision Filed Map No. Lot
(Name)
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 tpfl es }{':e + :',t' Y , 'I
. .a-,.lt •~-$~-n~dJu.T IaY+b~
3. Nature of work (check whipplicable):'New Building Addition " Alteration
Repair Removal Demolition , Other Work
(Description)
4. Estimated Cost. /b/ DOa Fee.....................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units , Number of dwelling units on each floor ?1i¢....... .
If garage, number of cars WA . .
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .......415v.l , . , , , , , , ,
7. Dimensions of existing structures, if any: Front ....?CS Rear . t FT, Depth . .
Height , Nunjber of Stories 7i~tl+`~.. 1= ,f3 E/y.Alr r
Dimensions of same structure with alterations or additions: Front ...1P!q'/f , Rear .....04".C
Depth cN. F7~........i Height O*Pr........ , Number of Stories
$ Dimensions of entire new construction: Front /.'tr: IT Rear .4`.F. Depth . • .LSiF , .
fiber of Stories ....7i w..Q.................. .
9. Size of lot: Front .....NCO 1&T Rear , . , . , /,OQ, ,FT, , Depth 6 7
10. Date of Purchase vLl'18 , , , , , , , , , . , , Name of Former Owner ......0 . T .
41, Zone or use district in which promises are situated , .........A $VQ, $N_ .r'/!~3G, ~j4Q , , , , , , .
12, Does proposed construction violate any zoning law, ordinance or regulation: , , , ,
13, Will lot be regraded .......~./1/Q, , Will excess fill be removed from premises: Yes No
14. Name of Owner of premises 4CW44W Address . 04)7!Ph/ PRV Phone No. llt43~
Name of Architect .~1C~. 417E6L/?Y~3iY , Address Phone No. ~f3 , .
Name of Contractor ~C~ . Address . Phone No.-~rZ~, ,
15. Is this property within d00 feet of a tidal wetland? *yes,,,Y..,, 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 dinierisions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
Of UN~iYCLLiSED G4-ZA60
ov~,e ExisriNcy pez!A- sT Tu :
060tl-T Z-1~_1V40W e,0 Off` 6XZS7-Wi 1
671eVC7 VA,~E'S 1 P06S nlC)rr 6?/~Zr"/6POA/ d'/D6/SpeyV /WyP2
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d'r ;F iA-77"rylGr5~6D ORa9trrd/~
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STATE OF NEW YORK, S .S
COUNTY OF
l~?l3~cs' . 0'. d'
(Name of individual Zs..... ' ' ' • being duly sworn, deposes and says that he is the applicant
contract)
above named.
lie is the > .
(Contractor, a agent, corporate officer, etc.)
if 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
.vork will be performed in the manner ',set forth in the application filed therewith.
iworn to before me this
........day of.!.. 191. S!
rotary Publics/%r' County /U~
LIRA FORMICN
Nmary Pubk, SwedNawYoBC
No. 4986883,SuftCmd (Signature of applicant)
Tom EVkes SVL 3,195
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UNDERWRITERS CERTIFICATE DATE: S•P.S .1Y837t Projert No•
FEE: REQUIRED NOT~.. LDING By- DEPARTMENT AT OTIFV BUILDING DEPART ENT AT\ MIS ~
766-1802 9 AM TO 4 PM FOR THE Drawn By: TS
FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRED Checked By: J S
OCCUPANCY OR~y ~1 FOR POURED CONCRETE
3. INSULATION Date:
USE I3 UNLAWFUL 2. ROUGH - FRAMING b PLUMBING
WITHOUT CERTIFICATE. 4. FINAL - CONSTRUCTION MUST ,'71 BE COMPLETE FOR C.O. I • Scale: 35.0' j'• I ~ ~ I~. yiol.a,i
THE REQUIREMENTS OF THE N.Y. 7
OF OCCUPANCY ALL CONSTRUCTION SHALL MEET STATE CONSTRUCTION & ENERGY - I Sheet Title r
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