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40 FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-23191 Date AUGUST 31, 1994
THIS CERTIFIES that the building ADDITION
Location of Property 395 HARVEST LANE CUTCHOGUE, NY
House No. Street Hamlet
County Tax Map No. 1000 Section 97 Block 2 Lot 13.4
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 15, 1994 pursuant to which
Building Permit No. 22226-Z dated AUGUST 3, 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 TO A SINGLE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to PAM & GARY WATSON
(owner's)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
1
Building Inspect
Rev. 1/B1
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)))
N_ 22228 Z Date 19. ?K
Permission Is hereby ranted to:
.......fit .r........41/,... LE/1,t%.fvA/
?7s.... f4?f
to /1 Jf f ,l..l~
4............~/ s
0'4ZA ..A~.. C,...................,..........................................................................................
I
m
at premises located at `~.IcS~...././~19if1s........o..........................................
.....................................`'/..ZSloC~ tf v.........
County Tax Map No. 1000 Section i Block ......6Z........... Lot No. ..T...........
pursuant to application dated 19...n.. ~ and approved by the
Building Inspector.
Fee
Building Inspector
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD j-11,;° _
BUILDING DEPARTMENT
TOWN HALL }yy
765-18021 3
s~i sq
APPLICATION FOR CERTIFICATE OF OCCUPANCY
?~t7<A R Arx t
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 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 Buildina - $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 . .
New Construction.... ..Old Or Pre-existing Building. p
G~ ~G r ~Pdr I'a a C .(~Go~G~J
Location of Property....J c............
House No. Street Hamlet
Onwer or Owners of Property ....~1? . ` G7~ro
County Tax Map No 1000, Section.... Block
Lot ....~:d
Subdivision ....................................Filed Map............ Lot......................
Permit No ................Date Of Permit.. l...... Applicant ...A~` r~.!~,l '...(°1Xf y~.~(C
Health Dept. Approval........ J.. ..........Underwriters Approval ...~J.?/
Planning Board Approval Y!)
Request for: Temporary Certificate........... Final Certicate../......
Fee Submitted: $...,1
-C Y3 (a (p lY.'
APPLICANT
gpfFO(~~OGy
o ~
Town Hall, 53095 Main Road CA Z Fax (516) 765-1823
P. 0. Box 1179 • Telephone (516) 765-1802
Southold, New York 11971 y~ol dap!
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
August 30, 1994
Pride Building Co., Inc.
Box 1464
Southold, NY 11971
Re: Gary & Pam Watson
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.
(If any electrical work done.)
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 # 22228-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
l~iLJ :5:F J:i ~J LNi
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OUNDATION (1st) `il f
OUNDATI011 (2n d ) r
.OUCH FRAME & I )
-PLUMBING
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_IISULATIO;I PER N. Y.
STATE ENERGY II
CODE _
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FINAL
ADDITIOPIAL COM.MFPITS: m
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765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSU ION
[ ] FRAMING NAL
REMA KS:
DATE INSPECTOR
(~7 ~ r BOARD OF HEALTH
rU'_„1w5 I~ 1111 f? FORM N0.1 J SETS OF PLANS l°J Iw5 5~ TOWN OF SOUTHOLD SURVEY . • • • • . .
-1 Mo BUILDING DEPARTMENT CHCCK
5 X94 TOWN HALL SEPTIC FORK
JJL.
SOUTHOLD, N.Y. 11971
Fsilc.,TEL.: 765-1802 t:oTIFY
TOWN 01=:0P.-.H. LD CALL
Exaa 19:l. MAIL TO:
Approved D. l,? 19 `ermit No.aZ~ 01.Lz .
Disapproved a/c
(B g Inspector)
APPLICATION FOR BUILDING PERMIT
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 stieets
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 inspec 'onsI.
ong 4,; 1)d~Kz ..(0"... Z! G..........
(Signature of applicant, or name, if a corporation)
C IDK. 1 ~o g w `l 1 .
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
ct
Name of owner of premises ar:X.. . AA...
(as on the tax roll or latest deed)
If applicant is a cor oration, sig ture of duly authorized officer.
~e and title of corporate officer)
Builder's License No. .......o !:l(jw. Imo........ .
Plumber's License No .
Electrician's License No .
Other Trade's License No .
1. Location of land on which proposed work will be done .
.3% f-lu~~~ ~A ................hurt
House Number Street Haml t
County Tax Map No. 1000 Section ...:~p 7 Block ~ Lot ...ljf 7
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 SI ?~~1(e.... J C! N [ J!lL e Ahn
b. Intended use and occupancy 1 4 J $
. . . . .
3. Nature of work check which pplicable): New • BuildinDemolition Addition Other orkatio'(i,,
Repair oval 4. Estimated Cost .
wU (Description)
Fee
5. If dwelling, number of dwellin (to be paid on filing this application)
g units
If garage, number of cars . . . Number of dwelling ' units on each floor
/(.J .
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use
7. Dimensions of existing structures, if any: Front Rear. Depth Height
• • • • • • • Number of Stories . .
Dimensions of same structure with alterations or additions: Front .
Depth .Height . Number
8. Dimensions of entire new Rear
, , . of Stories . .
construction: Front Rear
. Depth
Height Number of Stories .
9. Size of lot: Front Rear . Depth • •
10. Date of Purchase Name of Former Owner •
11. Zone proposed or use district in which premises are situated , , , , , , , , , • , , , • . • • , •
12. Does construction violate any zoning law, ordinance or regulation: • • . •
13. Will lot be regraded Will excess fill be removed from premises: Yes No
No
14. Name of Owner of premises . • Address . . Phone No.. }
Name of Architect Address • • , • . Phone No.. • • • • . • • . • • • .
Name of Contractor . Address . . Phone No.
15. Is this property within '300 feet of a tidal wetland? *Yes•, 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 blocklnumber or description according to deed, and show street names and indicate whether
interior or corner lot.
•
STATE OF NEV~fO
F.R ~ S~.S
COU~y q ,
being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named. ,
He is the
(Contractor gent, corporate officer, etc.)
Df said owner or owners, and is duly!aut 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
.vork will be performed in the manner set forth in the application filed therewith.
Sworn to before rme thi L~
4 '...day of. 19
. . .
Jotary Public, P . ` `lwQ..
Y
CLAIRELGLEW f • • • • Count
Nptery Publlo, rate of NevNYotk /
n
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Commo n .4879606
8 19~ (Signature of applicant)
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SURVEY FOR
GARY WATSON 81 PAMELA WATSON
AT CUTCHOGUE DATE OCT. 23,1992
TOWN OF SOUTHOLD SCALE I" = 100'
SUFFOLK COUNTY, NEW YORK NO. 92-0915
N UNAUTHORIZED ALTERATION OR ADDITION TO THIS CERTIFIED TO+
SURVEY e A VIOLATION OF SECTION 7,t.~9,OF THE GARY WATSON
NEW YORK STATE EDUCATION LAW PAMELA WA SO
may"
NCO/IBS OF THIS SURVEY NOT BEA .GFi,,TXL LAMO CENTERBANK ,OBE
SURVEYORS INKED SEAL OR EMSO fb.'SEAL SMALL SECURITY TIT
NOT BE CONSIDERED TO BE A VALI r~U,E COPY P
M GUARANTEES INDICATED HEREO SMALL RUN ONLY TO
HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT THE PERSON FOR WHOM THE SU RY, IS PREPARED C 'D1!
AND ON HIS BEHALF TO THE TIT E COMPANY, GOVERN- y
N NEAREST WATER MAIN_MI 2 *SOURCE OF WATER PRIMATE J PUBL4 MENTAL AGENCY AND LENDING 4jTITUTION LISTED T
M BUFF CO. TAX MAP DIST 1000 SECTION 97 BLOCK 2 LOT 13.4 HEREON, AND TO THE ASSIGNVS OF THE LENDING
MTHERE ARE NO DWELLINGS WITHIN 100 FEET OF THIS PROPERTY INSTITUTION GUARANTEES ARE NOT TRANSFERABLE
OTHER THAN THOSE SHOWN HEREON TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT fr
M THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FOR THIS A[SIOENCE * DIS ANCES SHOWN HEREON FROM PROPERTY LINES 'ate
WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT TOEKISTING STRUCTURES ARE FOR A SPECIFIC] ~~i'1V A~~c
OF WEALTH SERVICES. PURPOSE AND ARE NOT TO BE USED TO ESTABLISH
APPLICANT- PROPERTY LINES OR FOR THE ERECTION OF FENCES
ADDRE $S
TEL YOUNG a YOUNG R400 IVERHEAD, NEW YORK
NOTE: ¦=MONUMENT 0=STAKE O=PIPE ALDEN W. YOUNG, PROFESSIONAL ENGINEER
RE : LOT 3, MINOR SUBDIVISION - "CREATIVE VENTURES„ AND LAND SURVEYOR N YS. LICENSE NO. 12845
HOWARD W. YOUNG, LAND,SURVEYOR
m NM LOCATION OF WELLIW),SEPTIC TAMMSTIGCESSPOOLS(CP) SNOW" HEREON N Y.S. LICENSE NO 45893
a ARE FROM FIELD OGSERMTIONS AND OR DATA OBTAINED FROM OTHERS -
BRANOIS A SONS INC. A.C.
GA FA Gt
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au WHAT ARE THES>_
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Fill I - I o
UNDERWRITERS CERTIFICATE
REQUIRED
i - et p 0
I~
I U _ OCCUPANCY OR
USE IS UNLAWFUL
WITHOUT CERTIFICATE
OF OCCUPANCY
2-CCA 2k~ fatiwRc (INA(- FOt'NDA-rOA •c L'7E b I{
- 1 - - ~I- - _
14-
/G P c AP R VED AS NOTED
~9 2x0.-----.- DATE 3 B.P.B Zz12A2- w
. _----b---____.. - FEE: BY.
'Fla lsu 6 f NOTIFY BUILDING DEPARTMENT AT
'FACE .i Fpo ~4nr 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS:
T(,4 L Fncr- or 1. FOUNDATION - TWO REQUIRED
-i 4-F' FOR POURED CONCRETE f
(111 N b n 1 IrC' 1 _PL R 2. ROUGH -FRAMING & PLUMBING , - 3. INSULATION
X744_ "-y 'b v 4 , O 4 FINAL - CONSTRUCTION MUST r
BE COMPLETE FOR C.O.
S'O ALL CONSTRUCTION SHALL MEET T - THE REOHIREMENTS OF THE N.Y.
F L00« STATE CONSTRUCTION & ENERGY
CODES NO' RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
Za C`cA t x
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R Uecu. w. ~7LCD I.OwEft nECK \ 5~r~ i;!'f-~ri,~c, CCA ?x4 - I `~!n t
2~a- CCA 2xB- I~' Dc c ~ m ~FfJGET ti~ f7 U" ~ ~ irkK CL'A 7 GKA%k I . Phone A / 0400
z z Y o_ 2 ~A 2x$ y c,
CCA- Lar rer - - Mui3a F2uad
O ecA z~c6.l~"ae. GREENPORT, N.Y. 11944
\PJ- - NOT ri CTID' B ` a <~,ROSS SECTon} P ~4 JAIT-
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