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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 2-24372 Date MAY 21, 1996
THIS CERTIFIES that the building ALTERATIONS & ADDITIONS
Location of Property 505 SKIPPERS LANE ORIENT NY
House No. Street Hamlet
County Tax Map No. 1000 Section 24 Block 2 Lot 2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 22, 1994 pursuant to which
Building Permit No. 22312-Z dated SEPTEMBER 12, 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 CONSTRUCT ALTERATIONS & ADDITIONS TO EXISTING ONE FAMILY
DWELLING AS APPLIED FOR.
The certificate is issued to SHEILA S. BACHMAN
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N336989 DECEMBER 19, 1994
PLUMBERS CERTIFICATION DATED MARCH 27, 1995 PERFECTION PLUMBING & HEAT
Building Inspec r
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 .....SEPTEMBER..' r 19...94....
N°_ 22312 Z
Permission Is hereby granted to:
CHARLES THOMPSON CARPENTRY a/c SHEILA S. BACHMAN
.
P.O. BOR 71
.
PECONIC, NEW YORK 11958
.
to CONSTRUCT ALTERATIONS & ADDITIONS TO EXISTING ONE FAMILY DWELLING
AS APPLIED FOR.
SHEILA S. BACHMAN
505 SKIPPERS LANE ORIENT, NEW YORK
at premises located at
.
County Tax Map No. 1000 Section Block Lot No.
pursuant to application dated AUGUST 22, 19 94 and approved by the
Bullding Inspector.
Fee $ •+~L 7d.
.
Building Inspector
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
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 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 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
Date ....1. Ju~..LS ..ji ~4
New Construction...... Old Or Pre-existing Building
Location of Property ....t~ Villa'%,O~rQe1° $...~r+4h.a......~tCl ~.4~ .
House No. j/4 / Street / Hamlet
Onwer or Owners of Property ......~/1 Q. / J.QJ... !J,... 0.a c.ls~Lv.cav~ ..........7
County Tax Map No 1000, Section .....Y...... Block a.-....... Lot....'`.'o
Subdivision ....................................Filed Map............/Lot......................
Permit No..2..ZsV.9...... Date Of Permit. ,,0712'91-- .v.....Applicant..cryew Alx.. //dh,?t!?Y~....
Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate...4!......
Fee Submitted:
~eC S 13D~ •
APPLICA
-Z ?~3 L
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
:~.75i10~ BUREAU OF ELECTRICITY
86 JOHN STREET, NEW YORK, NEW YORK 10038
Date DECEMBER 19,1994 Application No. on file 86326194/94 N 336989
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
MR.& MRS. BACMIAN, 515 SKIPPERS LANE, ORIENT, N.Y.
in thefollouing locationsCEP ggax e t99 IS, Fl. ? 2nd FL OUT Section Block Lot
DE'4BL'R,1
was examined on and found to be in compliance with the National Electrical Code.
FIXTURE ECEPTACLES SWITCHES FIXTURES 11111 RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS INCANDESCENT FWORESCENi OTHER AMT K W AMT, K W AMT, KW AMT. K W AMT. H.P
16 18 14 16 1 F
DRYERS- . FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL RECTT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
AMT. K,W* m H. P. GAS H P. AMi. NO A. W. G AMT AMP. AMT AMPS TRANS. AMT H P SYSTEMSFEET
AMT WATTS
NO. OF
3. E 1 20 6 600
SERVICE DISCONNECT NO.OF S" E R V I C E
AMT. AMP TYPE METER 1.e3W L,e3W 393W 3%4W NO. OF CG COND A. W.G NO. OF HLLEG A W G NO. Of NEUTRALS A W G.
EQUIP. PER 9 Of CC. CORD OF HPLEG OF NEUTRAL
X 1. 4 1 4
OTHER APPARATUS:
JACUZZI-1
MOTORSt3-F H,P.
G.F.C.I:-4
g.C, ELECTRIC INC. 11C. #3823-E
P,OIBOX 518
LAUREL, NY, 11948 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.
Town Hall, 53095 Main Road .i $ - Fax (516) 765-1823
P. O. Box 1179 t T N, Telephone (516) 765-1802
Southold, New York 11971
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
C E R T I F I C A T I O N
DATE: T/2-7&-
Building Permit No. P~3)
Owner: - z2Uvn'-n
(please print)
Plumber: Pgg zazffo» b n~ °4 l Ftr
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
(Plumbers Signature)
Sworn to before me this
2 day of lAAaucu 19 qg;
Notary Publ' County
i
ROBERT 1. SCOTT. JR.
NOTARY PUBLIC, State of N.V.
j No. 4725089. Suffolk Cou
Term Expires May 31,19 ptX
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ I ROUGH PLBG.
[ ) FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [NAL
REMARKS:
C
DATE INSPECTO
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ROUGH PLBG.
[ ] FO DATION 2ND [ ] INSULATION
[ FRAMING [ ] FINAL
REMARKS:
! r
DATE / INSPECTOR
765-1802
BUILDING DEPT.
1 SPECTION
[ ] FO DATION 1ST [ ] ROUGH PLBG.
[ OUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS: /1 1
DATE 2 INSPECTO
m
7OU11DATION (1st)
FOUNDATION (2nd)
2.
ca
ROUGH FRAME
.PLUMBING
r
y
24g, -3
3.
m
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INSULATION PER N. Y.
STATE ENERGY
CODE
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C le -01
4. 1
FINAJL
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ADDITIONAL COMMENTS: s
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OS'aFFOLRCOGys
Town Hall, 53095 Main Road co x Fax (516) 765-1823
P. O. Box 1179 Telephone (516) 765-1802
Southold, New York 11971
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
January 6, 1995
Mr. Charles Thompson
P.O. Box 71
Peconic, NY 11958
Re: Sheila Bachman
Prem: 505 Skippers Lane, Orient
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)
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.
xx No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 22312-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
BOARD OF HEALTH
3 SETS OF PLANS
FORM NO. 1 SURVEY
1. TOWN OFSOUTHOLD CHECK
1! 221 994 BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL " "
E!a TOWNO SOUTHOLD TEL.: : 765-1802 CALL
Examined . Ll o Er I SOUTHOLD, N.Y. NOTIFY I
9y/0 MAIL TO:
Approved .....9 19LY Pennit No.
Disapproved a/c
~
(Buildi o Inspe t )
APPLICATION FOR BUILDING PERMIT
Date
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
C1r 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
ins ections.
(Signature of applica , or name, Wa'c'oiporarion)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
U M(;
Name of owner of premises f.. .c.
lj.e.;./.G/.. ...KJaG[7.M A.V-N..................
(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.
Plumber's License No .
Electrician's License No .
Other Trade's License No .
1. Location of land on which proposed work will be done:
. \'O e?C~ S4',f"OqK t:...AC.4 'k
1 q..........QV.ic,V .
(louse Number Street.
Hamlet
County Tax Map No. 1000 Section Block R. , , , , , , , , Lot- , p~ .
Subdivision Filed Map No. Lot .
(Name)
State existing use and occupancy of premises and intended use alnd Occupancy of proposed construction:
A. Existing use and occupancy Si.xiU /4.../D Av.. a6,!CIr
B. Intended use and occupancy cS/.jj.~C..4pt ?^{(,n),,; iJ9~~
~I
s of work (check which applicable): New Building Addition ..l/ • • ;~1tdT~fod'~`' . Y .
F4.Estimated air Removal . Demolition ..............Swimn`ing pool...........
nis Court Accessory Building Fence .......Othe,r Work:..........
Cast IS .060..40 Fee
(to be paid on^lilingit~ is, application)
S. If dwelling, number of dwelling units Number of dwelling units on each" flo•or`.r
if garage, number of cars 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 •~,S;Q • • • • • • • • • .
Height ....E~~...... Number of Stocks _-9
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
8. Dimensions of entire new constriction: Front A Rear ..:~:SS Depth ..1$0 .
Height . ZX Number of Stories 2 '
9. Size of lot: Front Rear ...,l.V.2., V........... Depth ;lC7d..~ .
10. Date of Purchase Name of Former Owner .
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation: !?ca .
V.
13. Wi11 lot be regraded ,!?.o. Will excess fill be removed from premises: Yes No
Z•4~ 3 3 . .
14. Name of Owner of premises A I./cl..,(cc k) ' C. vaAddress ~v 1~~..4u~ib~ • • Phone No. .3.23
e. 1"
Name of Architect Address . Phone No
Name of Contractor . Ciouv~c • • • • • Address ..ccori c N J • • Phone No..
15.1s this property locatl,ed within 300 feet of a tidal wetland? *YES ....NOk> .
*If yes, Southold Townl,Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, andAndicate 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.
I
I
i
I'
STATE OF NEW YORK, S'S
COUNTY OF ..../............7.
~y /1~ ' . 6 being duly sworn, deposes and says that he is the applicant
Pr L...t 6 h
(Name of individual si° 'ing contract)
above named.
He is tile
(Contractor, agent, corporate officer, etc.)
of 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
work will be performed in the manner set forth in the application fled therewith.
Swom to before me this i
..dayo~~f,,••rr ,ppll ....,19 .x/
Notary Public, < h v County
YCE M. WILKINS
Notary Public, State of New York .
No. 4952246, Suffolk* (Signature of applicant)
Term Expires June 12,1
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I FOit14OATION - '11A RATION . 'RW() REQUIRED
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Fi71A+R - i;ONSTRL CONSTRUCTION MUST
- - - - - - - BF CO.MPV_ETF. FOR C )IViPLETF. FOR C.O.
- - - - ALL CONSTRUCTION INSTRUCTION SHALL MEET I - - - i -----I 1
THE REQUIREMENTS '.OUiREMENTS OF THE N.Y. 1 i CONSTRUCTION & ENERGY - - NOT RESPONSIBLE FOR C
- - - - - - STATE CONSTRUCTION
, OR CON:iTRUC OR CONSTRUCTION ERRORS ~jL! ST Elf' V.4 T~QN
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I G R N E R A L N O T E S
1. ALL CONTRACTORS TO VISIT JOE SITE, CHECK EXISTING COMDI~rIONi
MEASUREMENTS AND pHERE EXTENSION IS TO BE CONSTRUCTED.
2. ALL FOOTINGS TO REST, ONUNDISTURBED SOIL.
3. POURED CONCRETE TO BE 3000 PSI 28 DAY. 4_ ALL WORK SHALL CONFORM TO THE MEN YORK STSTE CONSTRUCTIEN,r~
CODE AND ALL RULES AND REGULATIONS OF THE LOCAL TOWN. fi
5. ALL STRUCTURAL LUMBER SHALL BE A MINIMUM OF 1200 PSI.
T~T ~,EX/ST/NG CELLAR AREA 6. GRADING AROUND ALL MEN CONSTRUCTION SHALL SLOPE AWAY AND
BLEND INTO EXISTING.
7_ ALL BACKFILL DUNDEE FLOOR TO BE NELL TAMPED AND WATERED. 8. ALL ELECTRICAL WORK SHALL EE BOARD OF FIRE UNDERWRITERS
APPROVAL. ELECTRICAL CONTRACTOR SHALL VERIFY EXISTING
SERVICE AND SYSTEM'S CAPABILITY TO SERVE ADDED REQUIREMENTS
AND PROVIDE MEN CIRCUITS AS REQUIRED. ii
9. CONTRACTOR AND/OR OWNER TO OBTAIN ALL PERMITS AS REQUIRED
AND FILE AND OBTAIN CERTIFICATE OF COMPLETION OR OCCUPANCY.
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