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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-23066 Date JUNE 24, 1994
THIS CERTIFIES that the building ADDITION & ALTERATION
Location of Property 2350 HAYWATERS ROAD CUTCHOGUE, NY
House No. Street Hamlet
County Tax Map No. 1000 Section 111 Block 6 Lot 13
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 16, 1994 pursuant to which
Building Permit No. 22102-Z dated JUNE 2, 1994
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 DECK ADDITION AND ALTERATION TO EXISTING ONE FAMILY
DWELLING AS APPLIED FOR.
The certificate is issued to ANNEMARIE ARRA
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Building 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) p
Date.. ~G' 19/.1..
N°- 22102 Z
Permission Is hereby granted to:
to
4 g .......~r
.
at premises located at..... o... ......R
,l
County Tax Map No. 1000 Sectioonn........ r~ Block .....45 Lot No. .
pursuant to application dated ..,;1. 19... j~..., and approved by the
Building Inspector.
ere
Fee $...%ts.
/ Building TnspecTor
Rev. 6/30/80
r l/ l~ ~ Irk it
TOWN OF SOUTHOLD
BUILDING DEPARTMENT -
TOWN HALL i
765-1802 1
e . ~t
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 Ii 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 - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date
New Construction.......... Old Or Pre-existing Building
Location of Property.. U ..............!~.4.1 t` C.t,Q1 Q.
House'No. Street Hamlet
Onwer or Owners of Property..q~').h.41, f J.Is!ti:
County Tax Maps No 1000, S~e"c~tioon., Block <1 ........Lot....,.q
Subdivision 1i~115+~( 1[~? .N.. . . Dat{(~te Uq Of Pe?¢unit . . . . ...//...Filed Map. Lot.... ~.3
Permit No. J. 4:6AAI......Apl,lican
, ow./ejzS
Health Dept. Approval./))/) .....................Underwriters Approval.. ,
Planning Board Approval.../
Request for: Temporary Certificate........... F' er t is ate..,,,
Od
-Fee Submitted:
APPLICANT
i
:1 LO 21MLNT"
m
C~
H ~
FOUNDATION (1st)
FOUITDATI011 (2nd)
2.
z
r~
ROUGH FRAME &
1C~
PLUMBING
cn
H
3. m
m
j
II4SULATIOf1 PER M. Y.
STATE ENERGY ryj
CODE
s
r.
4. ~
2
FINA1.
ADDITIONAL COMMENTS: x
/ f
H
~ V
~7 % ALL 22 aft
r.~
.3
m
-v
H
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INS TION
[ ] FRAMING INAL
REMARKS:
DATE INSPECTOR
BOARD OF HEALTH
FORM NO.1 3 SETS OF PLANS
TOWN OFSOUTHOLD SURVEY
BUILDING DEPARTMENT C1IFCt :
TOWN HALL SEPTIC CORN
SOUTHOLD, N.Y. 11971
TEL.: 765.1802 t:OTIFY;
a~ CALL I
Examined , y • • • • • 19 !Mn I L 70
Approved .
~ , 19 !./Permit No. ~l-2-.~~. _ .
Disapproved a/c
, Spector
(Bui I. .
MAY ! 7 '0,qd APPLICATION FO,fR( BUILDING PERMIT J
Date ...-~rl. (lo 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.
U 1 /2G . J3 m I:;_ 1JT- L& Fa3 T t _±-h)................
(Signature of applicant, or name. if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
G :e CC, , .
Name of owner of premises A.t~tJh1 hYt 1 p, ILA .
(as on the tax roll or latest deed)
If ap Ica gk P tipn signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No. ..1~..........
Plumber's License No .
Electrician's License No .
Other Trade's License No .
Location of land on which proposed work will be done .
.17.................:....RV:Ik1Wv9)R 0 L~~1G~_t.:.:.............
House Number Street Hamlet
County Tax Nlap No. 10000 Section I..... .(1 Block ~j rO...... j.......... Lot /3
SubdivisionOPs f~A C.\uh Filed Map No. . Fa Lot ...3.(o.)
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy 0 )J.~.
,Feevn I
b. Intended use and occupancy G ~ C ~ n, I • • . • • • • . • . - . •
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CARRINGTON ROAD 7"
L1= 9
F. M 806 SURVEYED 7 SEPT.1990
FILED MAY 7,1926 SCALE I"=40'
1 TAX MAP NO 1000-111-06- 13
1
SURVEY OF
LOT 367
IN
MAP OF NASSAU POINT CLUB PROPERTIESIIINC,
SITUATE
NASSAU POINT 'CUTCHOGUE'SUFFOLK COUNTY- NEW YORK
SURVEYED FOR ANNE MARIE ARRA
C-arantees Indicated here on chap n
only to the Peron for wham the tun
is prepared, and alt hY b9half to the
Nile cempany, CM•t entltt Agency,
ie & MiMIF4 M feed hernM, on-
GUARANTEED TO. to R19 9eeifrre" of It" 19n2ing ins:;' SURVEYED BY,
.
ANNEMARIE ARRA Geteren6ose 9ft nM tram r:FI STANLEY J. J AKSEN, LR.
FIRST AMERICAN TITLE INSURANCE CO additional imtl9bone ar P.O. BOX 294
CENTERBANK MORTGAGE CO. £W SUF 'K, Y. 119
TOWN OF SOUTHOLD / C, P;25 Of this
naul~- ltrmtian or addlfion tr
Section 72^S h. $pr - - LICE E LAND SUR
L N.Y. LIC. No. 4927
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