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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 2-23263 Date OCTOBER 6, 1994 THIS CERTIFIES that the building NEW DWELLING Location of Property 1005 HARBOR LANE CUTCHOGOE, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 97 Block 6 Lot 12.4 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 11, 1994 pursuant to which Building Permit No. 21947-Z dated MARCH 16, 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 ONE FAMILY DWELLING WITH ATTACHED GARAGE, SCREEN REAR PORCH & FRONT PORCH AS APPLIED FOR. The certificate is issued to JOHN A. & THERESA A. HOFER (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R-10-94-0008-SEPT.23, 1994 UNDERWRITERS CERTIFICATE NO. N-327814 - SEPT. 22, 1994 PLUMBERS CERTIFICATION DATED OCT. 3, 1994 - LISO PLUMBING & HEATING uilding 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) N Date .1 19. 21947 Z Permission Is hereby granted to: .ter/. f.' /ct'a!ST S/~ !.f.......I to C.C ~ ~f ........./...11a/.C7............ `J l~/ IZ1 ~i~! rxl.......,lf ti .............~.s... r/......~1~~3°..~,.....~~~~.... `1}d'~/........ c9i~°%f........../~5 ~~/4~.......... ~a at premises located at . County Tax Map No. 1000 Section Block Lot No. pursuant to application dated /~1......,....................., 19..... ,./..G.. and approved by the Building /Inspector. Fee $.,421.7 ....../1~ln uildi ctor 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 Building - $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, Commme'+rcial $15.00 / Date ~~...4..~~ t`C.. New Construction.... V..... Old Or Pre-existing Building... Location of Property....../.a~ rrp ~(~~lL ~p G c~ ?C ~R ll....~.Y House No. Street Hamlet Onwer or Owners of Property. n („/~„R ,,1,1~~FLLS.> }~jo t-L2. County Tax Map No 1000, Section 49:....... Block lP...........Lot.f°?:•~• Subdivision......// ...............................Filed Map............ Lot....................... Permit No.V 1 77,~....Date Of Permit.. /...Applicant. Ij P.u.1V..4~.VkQ Ep- Health Dept. Approval .4EFI,.~241.It-1.4........ .Underwriters Approval.,S.*P.1,•.~~ Planning Board Approval Request for: Temporary Certificate........... Final Certicate. Fee Submitted: / 12 l . 4PPt•TCANT 7~a 0 A 312 W =7 INSPP-CTORS ~rizv2,z; ~S11FF0L!{C SCOTT L. HARRIS, Supervisor to x Southold Town Hall Thomas Fisher P.O. Box 1179, 53095 Main Road Building Inspector qt? ' O~ Southold, New York 11971 Gary Fish Building Inspector Fax (516) 765-1823 Telephone (516) 765-1800 Robert Fisher Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR Telephone (516) 765-1802 TOWN OF SOUTHOLD C E R T I F I C A T I O N DATE : C3 c_ 3 4I dt Building Permit No. 19 +r( 7- Owner: J 0 I" 1' r4 f3 ti^ a 2 (please print) Plumber: ~ 15 o~ l t r C. r N V a r r lCi (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Plumbers Signa u Sworn to before me this day of g , 197 - Notary Public, Sli~FeGLC County '41, DOLORM L. USO Notary Public Notary Public, State of New York Suffolk County . No. 4841022 Commission Expires Oct. 31, THE NEW Y6RK''BOaRbi 00 F kt"UNbE'kWR1TERS PAGE 1 1135021 ' 'BURkAU 60 ELIiC~TRf6ITpYp p, F , R4'JOHN" SSTREET. NIEW YORK, NEW 7ORK 10038 Date SEPTEMBER 22,1994 Apolica'tlon No. Yn file t' 85801854/94 N 327814 THIS CERTIFIER THAT ~ • , . only the electrical equipment as deserlbed below and gairoclaved by the eo0kant named on the above application number in thepremises of fi . JOHN HOFFER, 1005 pH-7 ARBOR LANE;1~'NYT #9,CUTCHOGUE; N.Y: in thefoltowing location; L"J Rabeatelit 71 lit Fl. V tad, Ft. G'AR/ATTfC/OUT section Block Lot was examined art SEPTEMBER. 16 ,1994 and found to be in compliance with the National Electrical Code. FIXTURE XTURES . , . " NG S COOKiNO DECKS+ OVENS DISH WASH RS EX AUST FANS OUtLE1$ ECEPTACLES SWITCHES E38 NT FLUORESCENT OTNEn AMT, K.W, ' ,AMT., CWt. K.W. AMT X. W. AMT. H.P. 39 50 43 1 1 1.4 2 F DRYERS FURNACE MOTORS FUTURE APPLIANCE HEEDERS SPECIAL REC'PT TIME CKOCKS EEII UNIT HEATERS MULTI-OUTLET DIMMERS AML K. W. OIL H. P. GAS H. P. Wl NO.' ' A. `AI O. AMt. AMA AMt. • AMPS. 7RANtAmt P. AST. WAn5 1 F 1 600 SERVICE DISCNO. of S E R V I C" 8E METER NO .Of CC COND. A. W. G.. A 'O . A W G. AMT. AMP. TYPE SOUP. IA2W 1030 Rq JW A,e'AW P R.t' Of CC, COND. NO. OF NLLEG OF MHLEO NO. OF NEUTAAIS Of NEUTRAL 1 200 CB OTHER APPARATUS: ' MOTORS:4-F H.P. G.F.C.I:-6 SMOKE DETECTOR:-2 TRACK LIGHTING:-12 THREE "C" ELECTRIC LId.#3327LE ' RT. 41, BOX 45M SOUND AVENUE' " dE Al. MANAGER RIVERHEAD,, NYi 11901ra This cartfficate.must not be altafgd.iq,gnY tpanndr ratarp,)o t~ Gffke~of the lidd,4 it'i eaTteet.,,,Inipoxtors 'Ina identified by Their credentiats. CONMGNT~ Elk I FOUNDATION (1st) ` FOUNDATION! (2nd) 2. 6L • z~ oQ~ ROUGH FRAME -PLUMBING Ila 3. y INSULATION PER N. Y. H~ STATE ENERGY CODE 4. i r I~ a FINAL ADDI TIONAL COMMENTS: 9 me e!5~c c, L~ ozyrfF_2 Gt%3,n'i'.S r~fuv~s ~i,~ .c~.F~.,/~ /n? 7-0 AL 0r , X\ M - S s F ~Ififd O O b ~ rr Q V¢I _JF u J LL J4 > O 3 ¢ 7 V hi U At z r, w ? I ? tt r- 0 0 rc N Y rl' u~ ¢ 3 e w ~C. 1~ ah w¢ F F. ¢ J UI V t4el N L.t E+°~``3 N R~~ s 6 ~ N ¢ a w fi+ /T ~ a`S ~ .7 c . Z Ow Z w a C ? O~ .fit 2C?Ft3~Fe. i,(,_.~-;.,. a . y F N 2x~ ~a~Fw Z ¢ ZOO V ^ W a N ° V ? n I Z O o, w {~:,i- w q - 'mao O ¢ m 0 0 O O V K U! C m F. w h O a U V p ? a 1 F~ w Y In V a w V Z Y ? W: J Jy -1 .J r' ~(g 1 J w ? J IC - O ul O O / F Ill Y ¢ Y V 7 w W O ¢ Ill., . L~ 2 ? t(1 7 2 _ W 1 1 LL i ¢ K J J K W> y, C !V uPi J 1- Z Q ltl Q ~ C LL ; W O O vl O > > 0 LL m ~ ~ O JI f w O¢ a =i O C; 3 N ~u N h- O I J x> O> j In u 1- ul v In In 0 V r` 71 2 I I I o~ ~ f~ d O r.~ O I I ZI W > ICI w y N~I o 4i Z< z :5 z W N~ 7I 7V I ° 3 ~s-U F'a a1 W} M O Z 61, ON z W~C OI al E~ Zi,f '0 ON W 2 w d,' 7 Ir/ 2~u i Q~Z'F t~ J U i 1 f % 2h' t w~v0 2 c~ r Jim Z ~B ON t i 4~m~ t ~ t NO. j YI ~'ti ~ ]2 S{ a \ ,.22 t4 9 \ v~,; ~of n ~ f Ii1l i - 11. y • ~ Q 1 M 7 I"~11 1 701 J vi 3 I ~1 ~ let Z UI , Y1 f 1 a. 1 C t ! { I w I ~ 1 w ~ I s ~~i _r. a r 1 to LL ID li I / ~ , ri f I i } K'tif _ _ 1 r j- ? 0 rv Lij to u.j LLl !f P LU p~ _ c~ : In LLJ LI. ....iv i ,7 f f a ~l I tg1.2 ~ 00 W' LANt ---y I 1J f l~: fA1N _ L Nil v 95 THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1.135021 BUREAU OF ELECTRICITY 83 JOHN STREET, NEW YORK, NEW YORK 10038 Date SEPTEMBER 22,1994 Application No. on file 85301894/94 N 327814 THIS CERTIFIES THAT only the /ectrical,,equipment as described below and introduced by the applicant named on the above application number in the premises of JOHN Hi) 1005 HARBOR LANE, NYT #9, CUTCHOGUE, N. Y. 6M 'LF- l~ L~ in thefollowinp location-- F] Basement C-1 1st Fl. U 2nd Fl. GAR/ATTIC/OUT Section Block Lot was examined on SEPTEMBER 16,1994 and found to be in compliance with the National Electrical Code. FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS INCANDESCENT FLUORESCENT OTHER T. K W. AMT K.W WT K.W AMT K W AMT. H P 39 50 43 38 1 1 1.4 2 F DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS Mr. K. W. OIL H. P. GAS H P AMT. NO A. W. G. AMT AMP. AMT. AMPS TRANS. AMT H P NO. SYSTEMS FEET AM T. WATTS 1 F 2 20 1 5 600 i SERVICE DISCONNECT NO.OP S E It V I C E MIT. AMP TYPE METER 10 tW Txr7l OF CC COND A. W. G. NO. OF HfLEG A W G. NO OF NEUTRALS A M' G EQUIP. PER .B' Of CC.COND. OF HbLEG OF HEVTkAI 200 CB 1 2/0 1 2/9 OTHER APPARATUS: M0TORSI4-F H.P. G.F.C.It-6 SMOKE DETECTOR:-2 TRACK LIGHTING:-12 THREE "C" ELECTRIC LIC.#3327-E RT. #1, BOX 45M SOUND AVENUE GENERAL MANAGER RIVERHEAD, NY, 11901 Per r° 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. M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ROUGH PLBG. FO NDATION 2ND [ ] INSULATION [ FRAMING [ ] FINAL REMARKS: i i DATE L~ INSPECTO I M-1802 BUILDING DEPT. INSPECTION ] F UNDATION 1ST [ ] ROUGH PLBG. [ FOUNDATION 2ND [ ] INSULATION [ ] FRAMING FINAL REMARKS:t DATE t ` INSPECTOR - 41 765-1802 BUILDING DEPT, INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ FRAMING [ ] FINAL REMARKS: J 5V,41/1 LC k of --T DATE INSPECTOR M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] RO PLBG. [ FOUNDATION 2ND [ INSULATION [ ] FRAMING [ ] FINAL REMARKS 0 zt a? ~e- S~ 1~1~~DATE INSIDE i BOARO OF HEALTH FORM NO. 1 /3 SETS OF PLANS TOWN OF SOUTHOLD /SURVEY M ~rr?~ BUILDING DEPARTMENT / CIIECR . . . . TOWN HALL /SEPTIC FORM . . SOUTHOLD, N.Y. 11971 TEL.: 765-1802 <FY CALL jj Examined VAP , 19 ~Y- NAIL TO: -700 Approved V~0........ 19 7rPermit No. t y~7 . _ Disapproved a/c . . . . . . . ( it ig Inspector) APPLICATION FOR BUILDING PERMIT 1 Date / R.'m(/.'• . 19 .1. 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..a. wilding Permit pursuantanto the Building Zone Ordinance of the Town of Southold, Suffolk C~'ounty, New York, d ofherripplicab ee Laws, Ordinces or Regulations, for the construction of buildings, additions or sl erations, or for re oval r~emolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building co hop atg`coi7e, n regulions, and to admit authorized inspectors on premises and in building for necess aly;;zrtSpechon~_... w (Signature of applicant, or name, if a c poration) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. OwtQG2 Name of owner of premises . Frl...x' , . / (./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 . , AIA z1 nr~.....G! ............).N.TI~.I.-~C. .U .z House Number Street Hamlet County Tax Map No. 1000 Section ~.7 Block (0 Lot. . 14:2. ° 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 ~~-/J..O':. ~ N V................. b. Intended use and occupancy ...d we 4Gs', . 3. Nature of work (check which applicabl New Buildi Addition Alteration Repair , . Removal . Demolition . . . . . . . . . . . . . . Other Work • • (Dell cription) 4. Estimated' Cost Fee , . (to be paid on filing this business, applicl tion) 5. If dwelling, number of dwellin um s Number of dwelling units on each floor If ara . ,ptJC. ......................I... . 7. Dimensaessions of number commoferciaexistingl cars or mixedstructures' occupancy, y Front ancY. sPecilY ~n(at~ure and extent Rear of each type of use Depth . . . 6. If Height Number of Stones Y..~ ' . . D Depth imensions of same structure with alterations or a i ipps: Front . Rear , , , , , , , 'v 8. Dimens.. of a ire new construction: Height . , , , y,, , • , Number of Stones P . III, cFront ...S Rear 101 Depth T , 3 . Heigh umb t er of Stories . 9. Size of lot. Front ./s,/6 a!5 Rear Name q~Former Owner. Depth JG l 3 ~(-7 30 10. Date of Purchase . . . . . . . . . . . . 11. Zone or use district in which premises are situated r.~b , , , , 12. Does proposed construction violate any zoning law, ordinance or regulation: . U 13. Will lot be regraded N 0 . t....... Will excess fill be removed ~ni remises: Y6s No~ 14. Name of Owner of pr .Iscs DI P~ iD~ ~y .fc' . AddressGt.6' =qS .S'id2,l re on 1~l Name of Architect .~C4?. ~I.. P. , , Addresss:'kw! K& wlja(c!c4 , , Phone No..' Name of Contractor Address Gam" one No....... q~ 15. Is this property within 300 feet of a tidal wetland? dyes, No. . If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM r Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate 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 ely - I i STATE OF NEW YORK, OF . ?FFC1 S .S COUNTY SOHN.A .A(Name« HOF.ER .individual. . . . .lignin. . , . • ' ' ' • • • • • • being duly sworn, deposes and says that he is then applicant t contract) above named. He is the ownex........a ........................................................L....... (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 an file this application; that all statements contained in this application are true to the best of his knowledge and belief; an that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this . ~P.i-t..........day of..7?1.PR~tI , . . . . 199 !Votary Public, S... .1~ County W( OMS , u sew" - - l . ~t!a ubiio,Stateoi,N `l t 0 (Signature of No ot9 p icant) No. 52X04085- SUffdlkO amborau30, 993i~ Commlaskm Wras Nov 1 Zl 03J NItiiW O Ot IZ'E21 " PyO>~- t;.; 00 w 3 ~ I I r" i ~ < I '4. i i ~1 - oyt Tt I C) I of Lc- yi, ~ I m I y 3 i i i ' ' `w7 tti p - 1 z p I-rili im o p m c r in [it - o Ca ~ . r~ . At• i t17 ~ I (~A 'OH s U c 1, n E:. % r+oz~ne 1Y1 m r A~G~77 m m (~Ot ~I,i~, la 1Q Z ui_ftfil iii~pi~Il1 v m { lo I$If NIf f4°~•t t{ SI m Q v Gl I Z '.C7 1711 A ,n . 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P :ep p On m v D p umi -Zi v\ -i 'I in 'tn 7c A r a a m D i Y k a c~ z OOm 2 vmmZ D` < m z _ 'moo / r ~,x.~ +fl t a n p i s8 k 0 r m A O m in p 06 ~y r li r n -i O ! 0 S m r r ! i ---J - I ~uF~ I4t., utF; p~,;.Ja Q N o4t~+r~r ~iyrrrr TM Own 14 o r-WELL , ItV LE FAMILY IDWELWNO ONLY a~ .raa 9 i r; C"POOLS i (RESIDENCE) STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL ~~.75(O ;^'r aN~lObr~ ESYSTEMS F \ ~M OR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE 1 N a, SUFFOLK CO DEPT OF HEALTH SERVICES. a ;09. 36 4 NI N 0a1t,P,E.am ISI APPLICANT PUN" 1 owe SUFFOLK COUNTY DEPT. OF HEALTH i ti. SHED Ho. 6 SERVICES FOR APPROVAL FOR CONSTRUCTION ONLY I +_•?s•~-- r~~ j'~ DATE. i 1 M RFR. 1 4 0 S~-! Q H.S. REF. NO APPROVED rr - p _ 150 - rl~r~pvfC WELL SUFFOLK CO TAX MAP DESIGNATION: • ~~5 TC p ~'PL ~r~ - - - ; - - - - - - - - - T - - - - j.. - - DIST. SECT. BLOCK PCL. 30 R1 G i' cr OF IS v~/AY ..y, ~ H 12.4 OWNERS ADDRESS: ~.71 _o w X49 6uk 399 In CUTCHOGUE ,N.Y. 1193$ F0 ZTE S7ERLING - I f , ~ :E55POO, 5 1 , V EED L. P ' ~VACAP~T) 2E5IDE'vC= TEST HOLE us.G= STAMP 1 .1 i - , 0TN405 EFSk Aiv J;riLEP 11-Ar M1111402 JBJ4y'11SION TOPSOIL ioaek ~'JQV~ E i : l,c ou FOCI PETE Il t w(.wYS c- s rai ' - ~s rs(y Only U, if ; r- ,s ~QN" ~'Uf ,-t2UP~ :rF: CG, Q.P.W. AE2lA_ SUE2V Y~NGVD~ . 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FEE: NOTIFY BUILDING DEPARTMENT AT 785-1802 9 AM TO 4 PM FOR THE PLUMBING FOLLOWING INSPECTIONS: ALL~~PyL~UAUR MW40VAM 1. FOUNDATION - TWO REQUIRED &Y UNEB N= FOR POURED CONCRETE, TE$71 QKFORE COVERNO 2. ROUGH - FRAMING & PLUMBING PLUMSERCEIMRCAflON 4. INSULATION 4. FINAL = CONSTRUCTION MUST ON LEAD CONTENT BEFORE BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET CERTIFICATE OF OCCUPANCY THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY SOLDER USED IN WATER CODES. NOT RESPONSIBLE FOR SUPPLY SYSTEM CANNOT DESIGN OR CONSTRUCTION ERRORS EXCEED 2110 of I% LEAD. OCCUPANCY OR i -7 USE IS UNLAWFUL WITHOUT CERTIFICATE r„ OF OCCUPANCY - - i 71 60 NOT PROCEED f_ - - - - UNTIL nd PURVEY of 'LL"- ' - - - - - FOUNDATION LOCATION - - HAS BEEN APPROVED IN - L T, -rjj L~ 950 Q \ 7 u.1 1.2., Bf I rTl I Fl, n w n. 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