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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 E-24369 Date MAY 20, 1996
THIS CERTIFIES that the building NEW DWELLING
Location of Property 65300 NORTH RD.(000NTY RD. #48) GREENPORT, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 40 Block 3 Lot 10.2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 20, 1993 pursuant to which
Building Permit No. 21569-E dated JULY 29, 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 ONE FAMILY DWELLING WITH ATTACHED GARAGE & DECK AS APPLIED FOR
The certificate is issued to SIDNEY D. CYMBALSKY
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 93-50-11-MAY 14, 1996
UNDERWRITERS CERTIFICATE NO. N-364766 - SEPTEMMM 27, 1995
PLUMBERS CERTIFICATION DATED MAY 11, 1996-VAN ETTEN, ROBERT
(;'1L 'h4 lze~
Building Inspecto
Rev. 1/81 T
FORM NO.3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOYM HALL
SOUTHOLD, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Date . 19..~..
N2 21569 Z
Permission is hereby granted to:
.../~r...
4.T..........` ...............u!~
c ' ........5 G. w~ r d
f! G ,......c iJ. s ~~r° ''1- -
at premises located at
County Tax Map No. 1000 Sectlon Block Lot No..... f..~~.'.
pursuant to appllcation dated .......I..................., 19..../.. and approved by the
Building Inspector.
Fee $•.,S4J`7~•
lfi~l
/Iic~in
B Inspector
Rev. 6/30/80
U __R..... Form -No.
LS LS U U LS
7 U TOWN OF SQUTIIOLD Lam- ry,
r• I'
r BUILDING DEPARTMENT
TOWN HALL lr`~ V\Ft1~jt /!C!/'
765-1802_
_-bLLG.DEPT. , C°ICCn f~ ,l)\( ll~tlt/
SOP 12
- . 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 2110 of L 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.
5. Submit Planning Board Approval of completed site plan requirements.
B. For existing buildings (prior to April 9, 1951) non-conforming uses, or buildings and
"pre-existing" land uses:
L. Accurate survey of property showing all property lines, streets, building and
unusual natural or topographic features.
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, Commercial $15.00
/ Date `..l. J L
New Construction ....Y.....: Old Or Pre-existing Building
Location of Property..W.1 ~u...10.0. . RN,..6 77 rl/d~ ........~~SPCr'/`~~C~./.,?,/,...
House No. (Street Hamlet
Onwer or Owners of Property N~.
. . ~ek . •
.~~u//.......
Block...,3...........Lo l.
County Tax Map No 1000,ySection...../T{.b......
Subdivision IVM))~/j Slq ('~"/i L C O~ Vu !......Filed Ma Lot
Permit No..l-110. z..~...Date Of P= it 7-P ,y.... ApplicantJtG~!~.E'~).D~~/~y/M{~J9~+1'kk.....
Health Dept. Approval 27-.-g qh ..0AI R Underwriters Approval. =7.L.1.~{~~
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate...........
1 f
Fee Submitted: f....... P .J
(S.9.c.- 5)30 d y.,,~ / .
APr r.11:ArIr
CO-2-a4369
ui 3-I~.Z
THE NEW YORK BOARD OF FIRE UNDERWRITERS P~tiet 1
1195@9? BUREAU OF ELECTRICITY
F 85 JOHN STREET, NEW YORK, NEW YORK 10038
Date SEPTEMBER. 27, 1999 Application No. on file S 3't791?4 /94 N 36471A6
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
S'TDWf CYMPULSKI, ROUTE 48, GREENPORT, N.Y.
in thefofloteinq location; 19 Bmement EX Ist FL ? 2nd Ff. GAP`/ATTIC/OUT Section Black Lot
Seas examined un SEPTEMBER 15 , 1995 and found to be in compliance with the National Electrical Code.
FIXTURE ECEPTAttFS SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCANDESCENT FLUORESCENT OTHER AMT. K, W. AMT. K.W. AMT. K.W. 11 AMT. K.W. AMi. P.
21 23 34 21
F
I 1 10
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
AMT. K. W. OIL H. P. GAS H. P, AMi. NO. A. W. G. AMT. AMP. MIT. AMPS. TRANS. AMT, N. P. NO. SYSTEMS
FEET AMT. WATTS
3 F 2 -
SERVICE DISCONNECT NO. OF S E R V I C E
AMT. AMP. TYPE METER 1 g 3`N I g 3Y•' 130 3W 3 g AW NO. OF CC COND. A. W G. NO. OF HI-LEG A. W G NO. OF NEUTRALS A. W G•
EQUIP. PERl OF CC. COND. OF HTLEG OF NEUTRAL
1 2011 CB l X 1 2/0 1 2/0
OTHER APPARATUS:
PADDLE FANS-5
MOTORS:5-F H.P.
G.F,C.I:-5
SMOKE DETECTOR:-3
JIM SAGE ELEC, INC. LTC.#3635-E
350 MARINE PLACE
GENERAL MANAGER
GREENPORT, NY, 11944 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 MANNFR
Town Hall, 53095 Main Road Fax(516)765-1823
P. O. Box 1179 Telephone (516) 765-1802
Southold, New York 11971
f .
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
C E R T I F I C A T I O N
DATE:
Building Permit No. cz / r6 7 -Z
Owner: ~(g~31L
( lease priri )
Al
r 1" .
Plumber: V,41V,6 7 71 ~/tJ p1ayCrl 200 V-/9
(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
day of O"~tiy 19
Notary Public, County MAR I
JOYCE M. WILKINS
Notary Public, State of New York
No. 1952246, Suffolk Courvty
Term Expires June 12, 1 9-9-'
sufFOCXeoGy~
o~
W i
Town Hall, 53095 Main Road p . Fax (516) 765-1823
P. O. Box 1179 y 0~ Telephone (516) 765-1802
Southold, New York 11971
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
February 2B, 1996
Mr. Sidney Cymbalsky
65300 Route 48
Greenport, NY 11944-2211
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
xx 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 # 21569-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
,t4%0 F04
Town Hall, 53095 Main Road
Fax (516) 765-1823
P. 0. Box 1179 A". Telephone (516) 765-1802
Southold, NewYork 11971
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
December 14, 1995
Mr. Sidney Cymbalsky
65300 Route 48
Greenport, NY 11944-2211
Re: Building Permit #21569-Z
Premises: 65300 County Road #48, Greenport
Suff. Co. Tax Map #1000-40-3-10.2
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.
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ INAL
[ ] FIREPLACE &CHIMNEY
REMARKS: 2~~
ti
DATE INSPECTO i
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION iST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INS TION
[ ] FRAMING [ INAL
[ ] FIREPLAC?E-& CHIMNEY ~p
REMARKS:
r
DATE ` INSPECTOR
All
I
M-1"2
BUILDING DEPT.
INSPECTION
[ J FOUNDATION 1ST ( ] ROU H PLBG.
[ ] FOUNDATION 2ND [ INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
r
DATE INSPECTOR
Z2
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST 'V,- ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[,FRAMING [ ] FINAL
REMA S:
C
DATE I L L INSPECTOR
- t (
765-1802
BUILDING DEPT.
INSPECTION
[ ] FO NDATION 1ST [ } ROUGH PLBG.
[ FOUNDATION 2ND [ ] INSULATION
FRAMING [ ] FINAL
REMARKS:
. l
DATE INSPECTOR -t-4
T1 'X
.q_L
!%OU11DATION (1st1 % y
FOUNDATION (znai n
. o ~
ROUGH FRAIME &
-PLUMBING
ri
n
1-11SULATIOR PER N. Y. I ^3
STATE ENERGY II
CODE
FINAL I ry
ADDITIONAL COMMENTS: s
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SUL
'93 08:33 MYS ENV CONS,
30New York State Department of Environmental Conservation
Sulidtna 40-SUNY, Stony Brook, Now York 11190-3356
12 March 1993
TO.
~
j Sidney A. Cymbalsky t" Thomas o„todinp
65300 North Road t3amtnt~wton.r
Greenport, NY 11944
RE: DEC I I 3 GC 7 /c r.: c c;l~c
Dear Mr. Cymbalsky;
In response to your request for a freshwater wetlands determination for the property identified
below, the New York Statp•Departmant of Environmental Conservation has determined that the q
proposed project is more than 100 feet from regulated freshwater wetlands, 'T'herefore, no permit is
required under the Freshwater Wetlands Act (Article 24 of the New York State Environmental
Conservation Law).
Proposed action; Construct single family dwelling, septic system
Surveyed by: Roderick Van Tuyl Date: March 8, 1993
Location: South of North Road (C,R, 48), Greenport, NY
Tax Map Number: 1000.40-3-10.2
i
Please be advised that this letter does not rellevt: you of the responsibility of obtaining any necessary
permits or approvals from other agencies,
Very truly yours,
~ . ;n.. ~ Y 4 l I, Cam, l C'ti'~..• 6~ , '
U ~qtda
Deputy Regional Permit Administrator ~V J
o.saUear o
cc; Bureau of Environmental Protection
L-IWARIj~sou tt
y^~ rrnmo m rtwA "pow
fFO^ TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
N
TOWN CLERKS OFFICE
' SO4THDLD, N. Y.
Date j......... 30;..1993
Mr. Paul Campagnola
Commissioner of Public Works
Suffolk County
Yaphank Ave., Yaphank, N. Y.
Dear Sir:
In accordance with Section 239K of the General Municipal Law of the
consolidated Laws of the State of New York, this is to notify the Commis-
sioner of Public Works of the County of Suffolk that ...5WNU. CYMBALSRY...
65300 CTY RD #48 (WORTH ROAD)
GREENPORT, NY 11944
has applied to the Town of Southold for a permit to construct a building
on CTY ROAD 148, GREENPORT, NY 11944
as shown on the attached plot plan, submitted in triplicate, dated
MARCH..8, 1993 and titled MINOR SUB .MAP OF EMIL CONRLIN ESTATE
We shall withhold further action on this application for ten days or as
otherwise provided in the aforementioned Section 239K.
Very truly yours,
CAR J. FISH,
Building Inspector
Town of Southold, N. Y.
WWM-061 (Rev. 1/92) 4.~
v.
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
BOARD OF REVIEW
SUFFOLK COUNTY CENTER
RIVERHEAD, NEW YORK 11901
APPLICATION' FOR VARIANCE OR WAIVER FROM~F FSrI1LATIONS Oft $~E~Ir IQATIOt3$
TO: Chairman of the Review Board
Q o teeidi-rtc}/ doing
1, -Wl ' .A7 P D. C~`7/3A7L shy y9?-kkf
business at (mailing address) IV19R7-4 `j Q.'~(3(
rx$?Ee 7 1p/t7' N - V , request a variance [ ]
or waiver [ ] from (indicate Article and Section Number)
of the (cross one out) New York
State/Suffolk County Sanitary Code, and is in reference to (indicate Health Services
Reference Number, name of proposeedT realty subdivision/development and Suffolk County
Tax Map Number) Ll S L . y ( / 7~ ?,X /Obb - oW 3 -16 , ,2-
65,30o A)o,m A0,9d S, Afiddlph P ,3.38' E,oFCVuePa sT) (i~ee~noaT
This request is based on the following (brief explanation of why variance/waiver
should be granted): Vilbgr't- 0X68Pe NnyAT~Pr 7- ORoyia~ SP[JP2AG P.. Q-r
- ~ P
PPR Le7ren air 1-,24-9.3 .heeTui'?~ /'~AVon Pe IL v- GeA* c? IJ.NicKsa.J /a aTTLIZ-
To ePT Fun r4en cfonirric oi/oa. MA l~ic/Cso.o iod vHCed J07XIn,, F4R74et Fito_,
y!(ac~Jj/~S~ PuRl~r t~.o7"rn.[Pn.._T,t/.y) ",b Pr q~oyP.P .3-/~-93
Date 3,3/- F3 Signature (s) ACT 9
Print Name (s) Sid,-J e y L, 0 X MA4t SK X
lv =Type or print legibly. 2. Submit completed form to the address at top of application.
3. Regardless of any prior submission to the Bureau of Wastewater Management, you
must enclose with this application
a. copy of survey for residential construction, site plan for cotmuercial
construction, or map of proposed realty subdivision/development; and
b. copies of all pertinent paperwork (i.e., Notice of Non-Conformance,'letter of
rejection; estimate of cost to extend public water, etc.).
4. SUBMIT CERTIFIED CHECK OR MONEY ORDER FOR $'41& QO, MADE PAYABLE TO SUFFOLK COUNTY
ENVIRONMENTAL HEALTH. A t/ V -
5. DQ_NOT CA~I,,_THI~_9Fg'f$ You will be notified in writing of the date, time and
place for the hearing.
6. The hearing will be scheduled as soon as possible; however, all hearing schedules
will be based on a first come-first served basis.
- _ IB-/2B S..t/92
3. Nature of work (check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work
(Description)
4. Estimated Cost...... Fee
(to be paid on filing this application)
5. If dwelling, number of dwelling units J Number of dwelling units on each floor
If garage, number of cars
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 ofStories
Dimensions of same structure with alterations or additions: Front Rear
Depth ......................Height Numbed f Pories
Dimensions of entire new construction: Front ...S?. 8 .t..... Rear Depth 3O... :X .
Height .....~fa Number of Stories
9. Size of lot: Front . ..........p......... Rear 3. 5................ Depth `l~tls...............
10. Date of Purchase ....799 Name of Former Owner NORM{9/i(,G. C r?N/( i lAl , , , , ,
It. Zone or use district in which premises are situated A.. R e£ AfiA .
12. Does proposed construction violate any zoning law, ordinance or regulation: A16
13. Will lot be regraded /VQ Will excess fill be removed liom premises: a No
14. Name of Owner of premise sSJOtN?y. A.C X!'?A.A (SKYAddressWft?!`~•Rr fi4CC-,,Pd. 11'hone No.y'~~•. 4.... .
Name of Architect 4,9 h1 fiP^t ~e.... 7:kT A M AddressRQX.4od AlfetNp.aPIZ - Phone No. y?9.: ~k4 ~ .
Name of Contractor ........-SR r Address Phone No.................
15. Is this property within 300 feet of a tidal wetland? *Yes........ No..le~
*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 block number or description according to deed, and show street names and indicate whether
interior or corner lot. - IJAT&R 1%7/4104 -
MlddLe R o q - CA y8 - 01? r/7 AoAd
Q 4eee•v sr a/0. y/ A4ouT
133V 7-o
6S3o /voigrh AoAd % MoDaet 1.9-
6ReeNpo2T N.y.MPk - 1` 1!0.
E- !ld `3~ E- yy`•-).
Jy F -Gyn., Duetli o~ 30
ad.3,asr .
mss,, 9 .
s~7 sss '
TATE OF NEW YORK, S
OUNTY OF .
~M!~! r° } being duly sworn, deposes and says that fie is the applicant
(Name o individual signing contract)
)ovc named.
is the...........~LJ.M.'t2
(Contractor, agent, corporate officer, etc.)
said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
Plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the
irk will be performed in the manner set forth in the application filed therewith.
•om to before me this
a ..........day of. t 19
tarY Public, ski 'l- 7 F.-........` County
/ / Nole7 P blf we d~?twYatt
Np,4844751 (Signatureofapplicant)
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NOTIFY BUILDING CPA AT
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(TEGO ~q•2X/O L 1-- dam O'Za 1. FOUNDATION - TWO REQUIRED
~ .SfryngEV- ~•irdet 2a •2x FOR FOR POURED CONCRETE
2, ROUGH - FRAMING A PLUMBING
3. INSULATION 4. FINAL - CONSTRUCTION MUST
V 01 BE COMPLETE FOR C.O.
8.x8 •tI •C ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y. 1111 `YY`'' 4 STATE CONSTRUCTION 3 ENERGY
Fit dpotage F/oor CODES. NOT RESPONSIBLE FOR
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1- 91 UNDERWRITMCEIMFICATE I '
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WITHOUT CERTIFICATE 0,1;-n ens/&/75 for fo S/arfii~9 ~i?ane y~I~y ~n~n ~/g(' WALE: III I-OBI APPROVED BY DRAWN BY
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