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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-24137 Date JANUARY 26, 1996
THIS CERTIFIES that the building ALTERATION
Location of Property 52125 MAIN ROAD SOUTHOLD NY
House No. Street Hamlet
County Tax Map No. 1000 Section 63 Block 5 Lot 10.2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 5, 1993 pursuant to which
Building Permit No. 21597-2 dated AUGUST 16, 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 TO BASEMENT ENTRANCE AS APPLIED FOR.
The certificate is issued to ST. PATRICKS R.C. CHURCH
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Building 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)
Date 19 ?3
N2 21597 Z
Permission is hereby gr me tt
.........w"...............................
to.
..or
................................................n..........
at premises located at...~.7....y'..... 54
Y...
County Tax Map No. 1000 Section rp'-, Block Lot No.
pursuant to applicatlon dated 1............................................. 19.97;x...... and approved by the
Building Inspector.
Fee /0......
Building Inspector
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD
^ J~r_)
k i, 1 BUILDING DEPARTMENT , ~eLtu L/V
TOWN HALL
765-1802
T D_ AICATION 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
7 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 Buildine - $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
,,ppf./......//. ...~.y/..........
New Construction....' L(/ . . Old Or Pre-existing DBuildin~~. . . .
Location of Property..../. C1:~ ct(s-.W~ ...............Sa.. .....4..........
House No. Street Hamlet
JOnwer or owners of Property .....J....f.~c FOG•••f C
County Tax Map No 1000, Section... 6. .......Block..... . ........Lot...?
Subdivision Filed Map............ Lot......................
J Permit No.:; t.~q. ?.....Date Of Permit ...O)A 1 ? J ...Applicant..
Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval
JRequest for: Temporary Certificate........... Final Certicate.... V/
Fee Submitted: s
P0C'-4~ Sv111a_ ~A c~
x
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n,~yG~' i1 7 APPLICANT
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Town Hall, 53095 Main Road p • Fax (516) 765-1823
P. O. Box 1179 Telephone (516) 765-1802
Southold, New York 11971
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
December 27, 1995
St. Patrick's R.C. Church
52125 Main Road
Southold, NY 11971
Re: Building Permit #21597-Z (enlarge basement entr.)
Premises: 52125 Main Road, Southold
Suff. Co. Tax Map #1000-63-5-10.2
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.
o~'rgUFFOCk~O
o~ Gm
NJ =
Town Hall, 53095 Main Road p • Fax (516) 765-1823
y~lpl Telephone (516) 765-1802
P. 0. Box ewYork 9 11971
Southold, N
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
January 9, 1996
St. Patrick's Church
52125 Main Road
Southold, NY 11971
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. $50.00
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 # 21597-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
70-1802
BUILDING DEPT.
INSPECTION
[ J FOUNDATION 1ST [ ] ROUGH PLBG.
[ J FOUNDATION 2ND [ ] INSU TION
[ ] FRAMING [ INAL
[ ] FIREPLACE & CHIMNEY,
REMARKS: l c'ly~ `
DATE f INSPECTO
1"LD I::Sl 11D_11 "OMMENT° ~t
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FOUNDATION (1st)
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FOUNDATION (2nd) m
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ROUGH FRAME &
PLUMBING
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INSULATION PER N. Y.
STATE ENERGY
CODE
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FINAL
ADDITIONAL COMMENTS:
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BOARD OF HEALTH
t' FORMNO.1 3 SETS OF PLANS
TOWN OF SOUTHOLD SURVEY
i ce' I' BUILDING DEPARTMENT CHECK
~1~ TOWN HALL SEPTIC FORK
L7 SOUTHOLD, N.Y. 11971
TEL.: 765-1802 HOTiFY
s?V/4: j3 IJO,
CALL
Ex min > t3U't' aC3 ,,rl
* . . MAIL T0:
Approved e 1 Permit No. _ .
Disapproved a/c
(Bull' din ectoo, µ
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 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, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections.
.............................................r
(Signature of applicant, or name, if aso 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 corporation, signature of duly authorized officer.
(Name and title of corporate officer)
r
Builder's License No. l/L i Z Z;A v 0, x e /K1
Plumber's License No.
Electrician's License No .
Other Trade's License No .
1. Location of land on which proposed work will be done .
.7~ ...............q.cti!?:......:.............5'~vfihz?(0
House Number Street Hamlet /
County Tax Map No. 1000 Section Block !~7 Lot ~s
Subdivision l , 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 .
b. Intended use and occupancy ...RJ.l...........
.;zr
3. Nature of work (check which applicable): New Building Addition Alteration
Repair Removal • . Demolition
Other Work...............
4. Estimated Cost ...fp (Description)
~............I Fee....................................
(to be paid on filing this application)
5. If dwelling, number of g units c-- Number of dwelling units on each floor .
If garage, number of cars w... i V ,
6. If business, commercial or mixo'd occupancy, specify nature and extent of•eac ~t pe of use A
A'p
7. Dimensions of existing structures, if any: Front I,.g. , , , , , ,Rear J/~. Depth , , , , , , ,
Height Number of Stories , . .
Dimensions of same structure with alterations or additions: Front . , , , , , Rear
Depth ......I,... Height Numbed Stories ...aik+l? Pr.pp:~ . tr..... .
J• • • • t mhtenstons o " ruction: Front t Rear r .....Depth ...7C%
Heim
10. entt3re new /cot, ~ °
A umber of Stories .
of lot: bront
y. Siza Rear
Depth ....30..........
Zone or use district in which pr r ' ' • • ' ' • • Name of Former Owner ....:"'~~a . T'ra',i
11.
Date of Purchase emises are situated . . . . . . . . . . . . . ~;,JJ
12. Does proposed construction violate~ ny zoning law, ordinance or regulation: .........4
13. Will lot be regraded ' ' 74 j Will excess fill be remoQved from premises: e No
14. Name of Owner of remises ' .Iomkl'fe5: Address ...:ANN. r
, Phone No. 7' st
Name of me of Architect
tractor , • ' • • ' . • • Address Phone No.......... .
Na
. Address . Pllope No.. . •
15. Is this property within 300 feet of a tidal wetland?yeS „ No " '
*If yes, Southold flown 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. Xt~1 flit ? o'7-
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STATE OF NEW S.S
NTY (Name of individual ' ' • • . being duly sworn, deposes and says that he is the applicant
contract)
above named.
He is the . • f<!
(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 filed therewith.
Sworn to before me this
........................day of. 19
Votary Public; c%,j,nty
HELENE D. Notary Public, NoState 6 N wYork
•....i.........
111
Guaiffied in Suffolk County pp5 (Signature of applicant)
Commission Expires May 22,19 G
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It ~0~6?N 4w wni i, cNrr~~ y~ 9 8" REQUIRED cnrr'E~ y Nt wig ntlcx, __,y § ~u'r N''AURED 'CRET
wa, nan.n2 aovs NRC)UG M MINGRETE Z R(SiJGN - FRAMING 61 PLUMBING
i"I wr1 L~~ 3 ENSULATION
FINAL . CONSTRUCTION MUST
BE COMPLETE FOR C.U.
1 LOo FLOOR "PL.A iJ ALL CONSTRUCTION SHALL MEET \ Vv I,nM o~,`.uPA~y~'i~{ oR THE REQUIREMENTS OF THE N.Y.
USE lS UN`'~WfU4 STATE CONSTRUCTION & ENERGY CODES, CER~~F~CATE DESIGN OR CONSTRUCTION ERRORS
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