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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-24151 Date FEBRUARY 5, 1996
THIS CERTIFIES that the building ALTERATIONS & REPAIRS
Location of Property 525 ORCHARD STREET NEW SUFFOLK NY
House No. Street Hamlet
County Tax Map No. 1000 Section 117 Block 5 Lot 36
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated FEBRUARY 8, 1990 pursuant to which
Building Permit No. 21271-Z dated MARCH 18, 1993
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 ALTERATIONS & REPAIRS TO A NON-HABITABLE, STORAGE, GARAGE
AND REPAIR SHOP BUILDING AS APPLIED FOR.
The certificate is issued to ROBERT GOODALE
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N317494 JUNE 16, 1993
PLUMBERS CERTIFICATION DATED N/A
uilding Inspector
Rev. 1/81
' Foam Na s
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)
NN9 21271 Z Date . 3 !8 )9 ,3
Permission is hereby gronted t
i .r•
~..,~W.....
00 e
to die,
7 .W.
at premises located at 4~~;f ....i 5=11
.
f
County Tax Map No. 1000 Section
//2 Block *~l Lot No....:~'
Pursuant to application dated .........,i.r 19 r~ and approved by the
Building Inspector.
Fee $...zv¢• A
0.....~
/ B ing I for
Rev. 6/30/80 y~~E P yr J~ / r ~~g
t ~ Y~
Form No. 6 ~~,~L l~T O f5
TOWN OF SOUTHOLD
BUILDING DEPARTMENT„i FEB " 2 1996
TOWN HALL
765-1802 8
BLDG. DEPT.
TOWN OF SOUTHOLD
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).
4. 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 17 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. Cert'ificat'e 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 Buildi.ne - $100.00
3. Copy of Certificate of Occupancy - $20.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $155.00, Commercial $15.00
Date V.........................
New Construction.........tt.. Old Or. Pre--existing Building...............r. . . . . . .
Location of Y`^ ;F-CV 1'04' A!ks; , .
House No. Street Hamlet
Onwer. or Owners of Property ....14U ~L`tEZL ..A00_
.
County Tax Map No 1000, Section.../ ......Block..., )..........Lot. 00 0..........
Subdivision.......... ]...........................Filed Map............ Lot......................
Permit No. 2 1~.?. A Z Date Of Permi-t....... I........ Applicant
Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval..:
'X
Request for: Temporary Certificate........... Final. Certicate..,(.1......
~r Oc/
Fee SCubmitted: $
12Q01, 4
Cep'`=t ~plS J nPPLI :ANF
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~~~SpFFO(~-co
c~ Gym
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Town Hall, 53095 Main Road p • Fax (516) 765-1823
Telephone (516) 765-1802
P. 0. ew York 9 11971
Southold,
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
September 27, 1995
Mr. Robert Goodale
665 Stillwater Avenue
Cutchogue, NY 11935
Re: Building Permit #21271-Z
Premises: 525 Orchard Street, New Suffolk
Suff. Co. Tax Map #1000-117-5-36
During a review of our files it was noted that the above
building permit has expired, and a Certificate of Occupancy has
never been issued.
According to the Code of the Town of Southold, Article
XXVIII 100-284, it is unlawful to occupy or use a structure
until a Certificate of Occupancy has been issued.
Please contact this office as soon as possible so that we
may clear up this matter.
Thank you for your cooperation in this matter.
Very truly yours,
SOUTHOLD TOWN BUILDING DEPT.
Thomas J. Fisher
Senior Building Inspector
a
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
106343 BUREAU OF ELECTRICITY
F 85 JOHN STREET. NEW YORK. NEW YORK 10038
Date .TUNE 16,1994 Application No.onfite 80318093/93 N 317494
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the there application number in the premises of
GOODAU ELIsX"TRIC, 525 ORCHARI:) STREET, NEW SUFFOLK SOUTHO LD, N.Y.
in thefollowing location; ? Basement IN /st Fl. ? 2nd Fl. OUT Section Block Lot
was examined on `TUNE 14 , 1994 and found to be in compliance with the National Electrical Code.
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS IIIECEPTA( SWITCHES INCANDESCE Ni FLUORESCENT OTHER AMT. K. W. AMT K W T. KW. WT. K, W. AMT. H P
16 12 10 16 E F
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
AMT K. W Olt H. P. GAS H P WT NO. A. W. G. AMT AMP. AMT r7- AMT. H P SYSTEMS pMi. WAiiS
NO.OF FEET
SERVICE DISCONNECT NO. OF S E R V I C E
AMT. AMP, TYPE METER L ]W L 03W I3 3W S~ AW NO OF CC COND A. W. G. NO OF HILEG A. W. G. NO OF NEUTRALS A W G.
EQUIP. PER 9 OF CC COND OF MI-lEG OF NEUTRAL
OTHER APPARATUS:
MOTORSt2-F H.1',
G.F.C.'T:-2
TRACK LIGHTING:-8
GOODALE ELECTRIC LTC.#783 E
7555 MATN ROAD
GENERAL MANAGER
MATTITUCK, NY, 11952 11
Per -
This certificate most not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPV FMI BUIP NWM EDEP AR PAL l° C. T I I;s CU112 f OF ` I ; .t ,CP c lfuUCT NO 03., etALTEPE`2 Ed AM' MJ AI'u64I"ERR
roux No. a
y 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)
No 18792 Z Date All%;
Permission is hereby granted to:
7'...
.s
to...
at premises located at.... r.....
.dGY~..
County Tax Map No. 1000 Section .......11 Block 3...... Lot No S~3-4~........
pursuant to application dated 151-1......................1 19YA, and approved by the
Building Inspector.
Fee
.t.
r
Rev. 6/30/80
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION iST [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ] INSU ATION
[ ] FRAMING [ FINAL
[ ] FIREPLACES CHIMNEY
REMARKS:
DATE INSPECTOR Glu
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ I ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING ( INAL
lY-7s`r3
REMARKS: 6.0
.
DATE 3 4 ! 77 INSPECTOR
I
o~OSsafFOtjr
o~
ca
x
Town Hall, 53095 Main Road "p • Fax (516) 765.1823
P. 0. Box 91971 Telephone (516) 765-1802
SoutholdNewYork 1
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
January 24, 1996
Mr. Robert Goodale
665 Stillwater Avenue
Cutchogue, NY 11935
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.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 21271-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
ti
7. J
7OU11DATION (1st)
c `sue
FOU!lDATIO!! (2nd)
2.
3 e
ice
ROUGH FRAME & ~Q a
-PLUMBING
3..d
m i
r
INSULATION PER N. Y.
STATE ENERGY
CODE
FINAL
ADDITIONAL C MMENTS: m
d` O
• m
• A `
3 \
`m
M
o
m
b
H
INSPECTORS
Victor Lessard
Principal Building Inspector
Curtis Horton SCOTT L. HARRIS, Supervisor
Senior Building Inspector o
Southold Town Hall
Thomas Fisher P.O. Box 1179, 53095 Main Road
Building Inspector Southold, New York 11971
" .
Gar Fish
Building Inspector Fax (516) 765-1823
t,.• Telephone (516) 765-1800
Vincent R. Wieczorek
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
MARCH 10, 1993
ROBERT COODALE
665 STILLWATER AVENUE
CUTCHOGUE, NY 11935
PREMISES @ 515 ORCHARD STREET, NEW SUFFOLK, NY
PLEASE NOTE: PERMIT #18792-Z HAS EXPIRED/•RENEW PERMIT.
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
XXX The check is not on file.1$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 # 18753-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
Page No. Of Pages
~ 11•,
GOODALE ELECTRIC,,,
RR1 Box 15A Main Rd. t
MATTITUCK, NEW YORK 11952 ~EC ~99Q iE= "
Phone 298.4157
BLDG. DEPT.
UTtiOt-D °
RO SAL SUBMITTED TO PHONE -
STREET OB NAME
l
~P, l ODE
CITY, STATE AND ZIP C JOB LO
ARCHITECT DATE Of PLANS /sJ
.per /"j' /J '7.~ /
:W 7/
k ~(S 0 S' lr-Fo~-t< ,
I
i
4
i
I
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t
l
Or FCnpD.SF hereby to furnish material and labor - complete in -accordance with above specifications, for the sum of:
i
i dollars
Payment to be made as follows: -
All material Is guaranteed to be as specified. All work to be completed in a workmanlike
manner according to standard practices. Any alteration or deviation from above specifica. Authorized
tions involving extra costs will be executed only upon written orders, and will become an Signature
extra charge Over and above the estimate. All agreements contingent upon strikes, accidents
- proposal may be
or delays beyond our control. Owner to carry tire, tornado and other necessary insurance. Note: This
Our workers are fully covered by Workmen's Compensation Insurance. Withdrawn by us if not accepted within days.
rreLworkas of Frapood -The above Prices, specifications
and contisfactory and are hereby accepted. You are authorized Signature
to do thified. Payment will be made as outli ned above. Date of - Signature -
FORM 110 COP"RiGHT 1000-NEW ENGLANDBV91NEas aEewOE, INC, TOWNSENn.MASe-01A68 -
19
O i BOARD OF HEALTH
D 3 SETS OF PLANS c~4~¢
CCM 8 ~pp~~ FOFM NO. 1 SURVEY " .
~'CV mow/ TOWN OF SOUTHOLD C11EC1;
BUILDING DEPARTMENT SEPTIC FORM
TOWN D . DEPT
TOWN HALL '
SOUTHOLD. N.Y. 11971 NOTIFY I
ww p TEL.: 7G5.1802 o,(
Examined CALL •O`.. 19p/~ MAIL TO:
Approved 19/. Permit No.
Disapprovedaa//c
.
APPLICATION FOR BUILDING PERMIT
Date . 15 .
INSTRUCTIONS
a. This application must be completely filled in b "0 "
y 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, housinI- code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections.
(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.
.
Name of owner of premises
.
(as on the tax roll or latest deed) . .
If applicant is a cprpp_g[i
{ qp,, s gupj4Tgrg(f Duly authorized officer.
( m ,p 0•jiyj_5,of,ggrp9ratc officer) .
Builder's License No.
Plumber's License No.
Electrician's License No . '
Other Trade's License No .
Location of land on which proposed work will be done:
. . '
(louse Number Street
Hamlet
County Tax %lap No. 1000 Section 4/Z.......: Block , , , ,
Subdivision Filed Nlap No. .
Lot
(Name)
State existing use and occupancy, of premises and intended use and occupancy of proposed construction:
a. Existi ~~~~--,,GG
ng use and occupancy , *Z4V_ -
b. Intended r
use and occupancy .~P~ ~ • l~Z~l~'~...~/~!~d/ .
3. Nature of work check which applicable): New Funding Additierv,. , Alteration:
Repair R moval Demolition . ?ng 1.
Tennis Court v..., Acc ssorY Building g ..Fence .~.•.Other Wo.rk,R.,j.
1. Estimated Cost 61tW............................ Fee ~q S. ,ria,.T....
(to e••paifl••art''nlhg'itifs app`licatron)
i. If dwelling, number of dwelling units Number of dwelling units on each floor
If garage, number of cars ,
i. If business. commercial or mixed oc~upancy, specify nature and extent of each type of use
7. Dimensions of existing structures, if 'any: Front . , • • Rear Depth .
Height Number ;ofStories
Dimensions of same structure with alterations or additions: Front Rear • . .
Depth Height Numbcr of Stories .
3. Dimensions of entire new constn:ction: Front, Rear Depth
Height ........NumberofStories .
Size of lot: Front Rear Depth . .
0: Data of Purchase , , , , , , , , Name of Former Owner . . .
I, /ortc: or use district in which premis~ts are situated
Does proposed construction violate any zoning law, ordinance or regulation: , . • • • • • • • - • • . • • . • • •
3. Will tot be regraded . Will excess till be removed from premises: Yes • No..
4. Name of Owner of premises..r!1''S*rKi4?,~/. Addres4(e-.(: ST/!~444;Al~C. Phone No. 7.T/<,L- ,
Name of Architect Address Phone No............... • • .
Name of Contractor . Address Phone No. A!1
:NO....
15„Is this property located within 100 feet of a tidal wetland?'*YES~.
*If yes, Southold Town Trustees Permit may be required.
i PLOT DIAGRAM
Locate clearly and distinctly all bupldings, whether existing or proposed, and. indicate all set-back dimensions from
roperty lines. Give street and block nuT her or description according to deed, and show street names and indicate whether
nterior or comer lot.
AP?O ED AS NOTED
DATE; k
a B.R 79"_
FEE: ~BY:
NOTIFY BUILDING OEPAR AT
786-1802'9 AM TO el PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION • TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING IN PLUMBING
3. INSULATION
b. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y.
STATE CONSTRUCTION G ENERGY
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
STATE OF NEW YORK
COUNTY OF S S
• • a......... , being duly sworn, deposes and says that he is the applicant
(Nainco f individual signiml' contract)
above named.
I
He is [lie I
I (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 perfornlc4 in the manner set forth in the application filed therewith.
Sworn to before me Ellis I
4 . .day of. 19 V.
NOta,t, Ill • ~~L(/
ry Public, County
HELEN K BE V0
• • • • . • • • • "
NOTARY PUBLIC, Stele of ew~York *;.natu
pplicant)
Tem F piresMerch30~9. J~ re of a
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PLUMBER CERT/F/CA
ON LEAD CONTENT BE - Z. (2
CERTIFICATE OF OCCUp
SOLDER USED IN WA JE SUPPLY SYSTEM CAN EXCEED 2/10 of 196
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- - o,~TTi~S u o D42_FiaQ -
Dpsr tubing is used
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srsesm; oiping ~ I $h-all bs -17 i -T
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OCCUPANCY OR _ ti~REZ¢ ~r~F _ 6 sK b BflL I I - i
USE IS UNLAWF N
1THOUT CERTIF[Ck 1 i
' ~ Sf G~ I ~ I
O OCCUPANCY I I _ - ' ~ ST
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T C UPANCY OR
U,Se-E IS UNLAWFUL A P VED A8 N01ED
BR. j ~ 4 ff BOUT- ERTIFICATE DATE.
- UPANCY - NOTIFY°6UI MG DE - I- - 786-1802 9 AM TQ 4 MI THE THE
- _ FOLLOWING INSPECTIONS:
- - - - I -.Ff 1. FOUNDATION - TWO REQUIRED RED
- _ I_ _I_ _ - / .---7 - -u_~~- 2. ROUGH - FRAMING d MBING ING
- 3. INSULATION-
_ 4. FINAL - CONBTRUC ON MUST UST
J' _ _ - - - - _ BE COMPLETE FOR C.0
MEET gr~ Qti J~ _ - CONSTRUCTION SH 44 ALL _ TL CONSTRUCTION- ERGS!- IEET
THE TA REQUIREMENTS 0 LL THE MEET S N.Y. RGY-
/j-~ --I - - - -I - CODES.- NOT', RESPON 0LE FOR FOR
NERRORS _-LN OR CONSTRUCTI DES I DRS
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