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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
UPDATED
CERTIFICATE OF OCCUPANCY
No: Z-28097 Date: 12/03/01
THIS CERTIFIES that the building ADDITION & ACCESSORY
Location of Property: 175 SUMMIT
(HOUSE NO.)
County Tax Map No. 473889 Section 78
RD
(STREET)
Block ~
SOUTHOLD
(HAMLET)
Lot 9
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Bu~lding Permit heretofore
filed in this office dated
JANUARY 23, 1995 pursuant to which
Building Permit No. 22578-Z
dated
JANUARY 30, 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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING & ACCESSORY DECK TO
EXISTING INGROUND SWIMMING POOL AS APPLIED FOR "AS BUILT". *
The certificate is issued to GREGORY M. & EVELYN D. DOYLE
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
N/A
*THIS UPDATES CO 2-251]1 dated 7/1
N/A
PLUMBERS CERTIFICATION DATED
Authorized
Rev. 1/81
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
ill'
~owrn
00
, - 3 ?n,ll
BLDG. DEPT.
TOWN
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
A. For new bOOding or new use:
I. 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 1 % lead.
5. Commercial building, industrial building, multiple residences and siruilar 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 nses, 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. Photocopy of Certificate of Occupancy - $ 0.25
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date. Dec. 3, 2001
New Construction:
Old or Pre-existing Building:
(check one)
Location of Property: 175 SUHMIT RD.
House No.
SOUTHOLD. N.Y.
Street
Hamlet
Owner or Owners of Property: GREGORY M. & EVELYN D. DOYLE
Suffolk County Tax Map No 1000, Section 78 Block 9 Lot 9
Subdivision Filed Map. Lot:
Permit No. 22578-Z Date ofPennit. 1/23/95 Applicant: GREGORY DOYLE
Health Dept. Approval:
Planning Board Approval:
Request for: Temporary Certificate
Underwriters Approval:
Final Certificate: X-UPDATED (check one)
Fee Submitted: $
50.00
d~ C', h ~"1{~
A licant :Signature
6\.vc.. (PO~ ~ 1
~eO-cJ8D97
FORM NO.$
TOWN OF BOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y.
BUILDING PERMIT
THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
....................... ..........
N9 22578 Z
Rev. 6/30/80
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-25111
Date JULY 1, 1997
THIS CERTIFIES that the building
Location of Property 175 SUI~MIT ROAD
House No.
County Tax Map No. 1000 Section 78
Subdivision
ACCESSORY
SOUTHOLD, N.Y.
Street Hamlet
Block 9 Lot 9
Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JANUARY 23, 1995 ~ursuant to which
Building Permit No. 22578-Z dated JANUARY 30, 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 DECK TO EXISTING SWIPING POOL AS APPLIED FOR
"AS BUILT"
The certificate is issued to
GREGORY & E~ELYN D. DOYLE
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Rev. 1/81
Building/I~
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
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 comtains
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.
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 tQ__d~ $25.OO~
Alterations to dwelling $25.00, Swimming pool $25.00, ~essory building~L%_0_0~
Additions to accessory building $25.00. Businesses $~.~
2. Certificate of Occupancy on Pre-existing Buildin~ - $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
Jeff Construction..J'i~(... Old Or Pre-existing Building .................
House No. Street Hamlet
/nwer or Owners of Property..~..~.~.~.?. ~..~.~...~.~.~.~../.~...~.~.~.- .....................
ounty Tax Map No 1000, Section..7.~ .......
..Block...~.~ .......... Lot ..... ~ ................
~ermit No ................ Date Of Permit ................ Applicant .............................
.ealth Dept. Approval .......................... Underwriters Approval .........................
ianning Board Approval ........................
equest for: Temporary Certificate ........... Final Certicate ...........
ee Submitted: $ ............................. ~~;/~..~.~ ~
o $ lip ' 7"- ' .................. *
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-25110
Date JULY 1, 1997
THIS CERTIFIES that the buildin~
Location of Propert~ 175 BUM~4IT ROAD
House No.
County Tax Map No. 1000 Section 78
Subdivision
ACCESSORY
Block 9
Filed Map No.
BOUTHOLD, N · Y *
Street Hamlet
Lot 9
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JANUARY 23~ 1995 pursuant to which
Building Permit No. 22578-E dated JANUARY 30, 1995
was issued, and conforms to all of the requirements of the applicable
previsions of the law. The occupancy for which this certificate is
issued is ACCESSORY STORAGE SHED IN REAR YARD AS APPLIED FOR "AS BUILT"
The certificate is issued to
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
Rev. 1/81
GREGORY & EVELYN D. DOYLE
N/A
N/A
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
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 t% lead.
Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Compliance from architect or engineer
responsible for the building.
Submit Planning Board Approval of completed site plan requirements.
For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
'Tpre-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._~ $25_OO,
Alterations to dwelling $25.00, Swimming pool $25.00, ~essory building~
Additions to accessory building $25.00. Businesses $~~~$£
2. Certificate of Occupancy on Pre-existing Buildinz - $100.00 ff-~'~,~O~- ~/~~
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 ..........................
Ney Construction ..... Old Or Pre-existing Building .................
Location of Property .......................................... . ... ..... .. ..
House No. Street Hamlet
Onwer or Owners of Property.. ~ y/w ~ ~-
County Tax Map No 1000, Section..~?. ......... Block...~.~ .......... 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 ......... ..
C o 0
FIELD_INSPECTION REPORT !IDATE !1 COI. lffiENTS
FOUNDATION { IST) I~ I~
F~0UNDATION (2ND) Il p ~ ~ ~
ROUGH FRAI~ &
PLUMB~NC
II
INSULATION PER N. Y.
STATE ENERG-'Y
CODE
.................................. i:---~ ~:~::~~;----:7>:------::--
ADDITIONAL COUNTS:
~thold ~n~.c._~°z a tidal wetla ? ~,, · ........ Pho Nm ': ....
?~;~,¥~;;:~:.,.. _,: ~o_,, -~t~ ~er=~ ~_ ~' ~? ........ ~ nc ............. ...
' ' PLOT DIAG~ ~ . .
Locate cle~ly ~d distinctly ~1 bulldogs, Whether existing
prqpe~y ~nes. Give street ~d block numi or proposed, ~d. indicate M1 se; back d"
~te~r or corner IoL a accord~g to deed, and ' ~ensions from
" . . show street n~es and indicate whether
..... .......
named divJdual signing contrac~i .......... g dul~
(Contractor, agent, cor~oratt
i owner or owners, and £s duly authorized to perform or/]ave pe/
~tion; that all statements contained in this application are true to/
4/1 be performed in the manner set forth in the application filed th'
oVER ::
to before me this
Public ...... . ..... ;~. X14'
~/ ~0 OUnty
BEI}T'I,,~COI/Y ~.~ / /, /
NO, 4725089 S~l'tg[k,.~O_u~t~, , ' / .... /- ~
_ Term E~pires May 31, 19 ~ . b / - ~ ................
(Signature .of applicant).
- · If v.~ ~ - u feet ~ ..... -...
· ~-", ~outnold T~,.,. ~_ o4 = ulaal wetland? ~..' .......... Phone~qn ''. ....
. mr,~.~,.~.c may De required. ... ~o ......... ·...
~4 tocate c~ear]y ~d distinctly ~ bu~d~s, Whether existin~ or proposed, ~d, indicate ~ set-back d~eniions from
prope~y ~es, Give ~ireet ~d block m
~Iedor or comer lot. ig ~o deed, and show street n~es and indicate whether
TE OF NEW
NTy OF .... '.~.~.~.~.~_~ S.S //J
...... -
: named, d/v/dual Signing contract) being dul~,
the .........
(Contractor, agent, cor~orat~
~ OWner or OWners, ~d fs duly authored
~tion; that all statements contained · . to perfo~ or have pe/
v~ be perfo~ed ;. ,~ ~ m fins apphcation ar
"' "~,,,anners;::t forth ;- *~- .. i-e true to/
before me this
' no. 4725089, 8an~t~ ~u~ , · / ' · ·/. ~ ....
.... : . Term ~pir~ May 31, 19~ . b , tS~ ; ...........
- · t gnature ofapplic~t) . ,
765..1802
BUILDING DEPT.
INSPECTION
765-~802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGHPLBG.
[ ]FOUNDATION2ND [ ] INFLATION
[ ]FRAMING ~]' FINAL
FIREPLACE & CHIMNEY
(/
765-180Z
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ,] ~ION
[ ] FRAMING [ /-~NAL
[ ] FIREPLACE ~ CHIMNEY
REMARKS. ~
/'/'- / ' /.
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
t TOW~'L[[~DEp'L
~ ..... ~OWNDF,qOIrrHoi D SOUTN,~,.o, N.Y. 11971
Examined ... , 19
Disapproved a ....... ..................... ~ .....
. ..- ............... ............
INSTRUCTIONS
B~ARD OF HEALTH
3 SETS OF PLAtl$
SURVEY ..................
CIIECK .........
HAIL TO:
'Date 19
a. This application must be cQmpletely 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 sti'eets
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appLi-
qation. ·
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 applicaht. Such permit
shall be kept on the premises available for inspection throughout the work.
e. No building shall be occupied or used in whole orin 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 South01d, -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 insp 'OHS. .
_ . (Signa/ure ~ f applica~lt, or name, if acm. poration)
(Mailing address of applicant)
State wl~ether applicant is owner, lessee, agent, architect, engineer, genqral contractor, electrician, plumber or builder.
.......... ....... i .................... ' ....................................
Nme of owne~ of premises.../7. .3- ~ ~/a,/--~/ '
If applicant isa corporation, signature of duly authorized officer. DATE~~B.P. #
·; (N me and title of corporate officer) FOLLOWING765'1802 9 INSPECTIONs:AM TO ~ ,FOR THE
Builder's License No .......................... 't. FOUNDATION o 'B/VO REQUIRED
FOR POURED CONCRETE
Plumber's License No ......................... 2. ROUGH - FRAMING & PLUMBING
.3. INSULATION
Electrician's License No ....................... 4. FINAL CONSTRUCTION MUST
8E COMPLETE FOR C.O.
Other T ade s License No ...................... ALL CONSTRUCTION SHALL MEET
"- THE REQUIREMENTI~ OF THE N.~.
1. Location of land on which proposed work will be done. STATE CONSTRUCTION & ENERGY
, /-,., ...............
./~ .~,,/"- .~ .~..)./... DESIGN Oa CONSTROClION E.HR.O.H.~...'
ltouse Number , Street Hamlet
Cotmty Tax Map No. 1000 Section ...iff...f/ ......... Block ....~..~.. ' Lot....O.~ .............
Subdivision. ~.-~..~.y.~./.o/~7.-. ~..~;.~.~. <'~..~.z.- ........ . ..... Filed Map No..~.O..~f./ ....... Lot . ./.~. ...........
(Name)
State existing use and occupancy of premises an,! -~ ndev ~oe and occupancy of proposed construction:
a. Existing use and occupancy t~,/t,~/~ cz~ .........
· . b. Intended use and occupancy... ~./i~TZ'~q'?/..'....~'7'
¸8.
9.
I0.
11.
12.
13.
14.
Locate clearly and distinctly all
propez~y lines. Give street and block
interior or corner lot.
a. Addi '
Nature ofwor check which Ppi/cable): New Building ...... tion .......... Alteration ..... '
Repair .............. Re oval .............. Demolition .... · ...... Other Work. ....
·" (Description)
Estimated Cost..~..~.'?. f.o..,
Fee ......................................
. , (to be paid on filing this application)
If dwelhng, number of dwelling units ............... Number cf dweliing units on each floor
Itgarage, number of cars .. , · · ...............
' ~d 'fY .................. use .................. ~ ....
usiness, commercial or mix occupancy, spec~ nature and extent of.each De of
Di~nensions of existing st~ctur s, if any: Front ............ Rear
ight . . ~ .................. Depth .
He ............. Number of Stories ...............
~ith ..................................
Dimensions of shine structure ~ alterations or additions: Front .................
Depth .... ' . , ' . ................. Rear ............
.. ......... ~..He~t ......... , ......... ,..NumberofStofies .... . . i..' .....
Dimensions of enhre new const~ction: Front . ~ Rear ~. ~' · ...... t .......
Height 7 ~ '. xr ~t. ~ - ' ....... · Donth
' ', ......... ;. 9pincer o~ Stories . .. . ...... ~ ......... ~ .......
~- .... ~ ........ t~nwmcnpr~mmesares~tuated... ~d'~d~e .............. : .......
roes proposed Construction violate an ..... ' ' ~. ' ........................................ '. :. · ·
...... ~ y ~umng ~aw, ormnance or regulation .. ~ ................. '~..
wiIlmtbetegraded ..~. .; j . .
N~e of Owner of~remis~ ~/--zTML '~[' >L'" ' Will excessfll~ be re~ve~ from premises: Yes
Nme of Architect ~ · .
N , · ............... Address .... Phone No.
me of Contractor ~ ~-~ ............... · ..........
I ' · · , ............. Address . .
s th~s property wtthtn 300 feet .... ' .................. Phone No ...............
' of a tidal wetland? *Yes ........ No .... ,
· If yes, Southo~d Town Trustees Permit may be required. ' .....
PLOT DIAG~
bufld~gs, ~hether existing or proposed, ~d. indicate ~1 set-back d~ensions from
mmber or desc~ption accord~g to deed, and show street nines and indicate whether
TorTE OF NEW YORK,.._ -- S / " ' '
Nam ..... , . ' .......... being duly sworn, deposes and says that he is the applicant
( e oflndw~duals~gnm contract)
~Ove named. ,
(co t ;cto t; ........... ' ..............
· I n r r, agen corporate officer, etc.)
· said owner or owners, and fs duly mthorized ~o perform or have performed the said work and to make and file this
plication; that all statements contai~ .~d in this.application are true to the best of iris knowledge and belief; and that the
~rk will be performed in the manner set forth in the application filed therewith. '
eom to before me this
.' " .........
TN~y ~.~9u~_~ , , t~ ($.gnature of apphcant).
/
&04~9
SURVEY OF
LOT 17
MAP OF
'.'BA YSIDE TERRA CE'
FILED MARCH II, 1953 FILE NO.203zt ,
A T BA YVI£14/
TOI'YN OF SOUTHOLD
SUFFOL, K COUNTY, N.Y..
I000 :- 78 - ~9 - 09
Scde I' = 30'
Nov. 2, 1987
CERTIFIED TOI
FIRST AMERICAN TITLE INSURANCE
COMPANY OF NEW YORK
RIVERSIDE HOMES, iNC.
LIC. NO. 49668
ENGINEERS, P.C.
Prepared in accordance with tho minimum
s;andards for title surve,v~ as e~tabli.shed by
the L I. A. L.S. and approved and cldopted
for such use by The New York State Land
Title As~aciatlon.