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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-22493 Date AUGUST 2, 1993
THIS CERTIFIES that the building ACCESSORY
Location of Property 8460 PECONIC BAY BLVD. LAUREL N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 126 Block 11 Lot 21
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 6, 1993 pursuant to which
Building Permit No. 21326-Z dated APRIL 9, 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 STAIR LANDINGS & PROMENADE DECK BETWEEN WALL & BULIUJEAD
AS APPLIED FOR.
The certificate is issued to LAWRENCE J. CERVON AS TRUSTEE
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
ui ing Inspector
Rev. 1/81
FORM NO. a
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN MALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
NW? 21326 Z Date 19.x'
Permission is hereby granted to:
a...
....o
at premises located of ..~,~`(CJ.®..... 6~....
h
.
County Tax Map No. 1000 Section ........1. Block .........ll....... Lot No...........
pursuant to application doted .....f 19..1 and approved by the
Building Inspector.
Fee $...to? !.^..1
.e
B i I for
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 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. 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 - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00 ,
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date . L/ (gyp
1 1. .
New Construction..... Qpom. Old Or Pre-existing Building
Location of Property.. V.l'P~.. °C~i1)lC l~~...` ),V-.b
"".+;1~1~~
House No. Street Hamlet
Onwer or Owners of Property. (ee")', ~V. , ,Tkurrg ~
County Tax Map No 1000, Section..... ! ...Block..... Lot ...2 1
Subdivision ..........................Filed Map............ Lot.........y........
Permit No.. J~ ..,Date Of Permit1.Vle1L.C.1771pplicant. ZCW.Cl§.
Health Dept. Approval ..........................Underwriters Approval...
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate.........,
Fee Submitted: $pL~l~d .
Wye~
~S .~...I .
"IG?~ 11CANT
~
co aa~93 jj' 02W-3
INSPECTORS
Victor Lessard
Principal Building Inspector
Curtis Horton SCOTT L. HARRIS, Su p
eTvisor
Senior Building Inspector r
Thomas Fisher Southold Town Hall
Building Inspector P.O. Box 1179, 53095 Main Road
Gar Fish Southold, New York 11971
Building Inspector Fax (516) 765-1823
Vincent R. Wieczorek " Telephone (516) 765-1800
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
JULY 23, 1993
LAWRENCE J. CERVON, JR.
70 LINCOLN HILL NE
QUINCY, IL 62301
PREMISES @ 81460 PECONIC BAY BLVD.
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
xxx An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
XXX The check is kKntxJztxxWnot 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 # 21326-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
- AU
~ W
m o ,
~ (V
=OUNDATION (1st)
OUNDATION (2nd) _
~IOUGH FRAME &
-PLUMBING
' I H n
1-11SULATION PER N. Y. II
STATE ENERGY II
CODE
FIiIAL
ADDITIONAL COMMENTS: s~
x 14%
H
. m .
H
s
~l ~f
III%
lull
3
`"mow^.Ta'"Tr-I.,
r
Board Of Southold Town Trustees
SOUTHOLD, NEW YORK k'-
4' Itr
PERMIT NO. 4043 DATE:. May 29, 1992
r it
2
ISSUED TO ........Lawrence. Cc.xvan
glut Dxt~ ii;
v ~ tttinn :
1 Pursuant to the provisions of Chapter 615 of the Laws of !t; 'r
j the State of New York, 1893; and Chapter 404 of the Laws of the
State of New York 1952; and the Southold Town Ordinance en- !Y~
titled "REGULATING AND THE PLACING OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and the
~i
REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM
r LANDS UNDER TOWN WATERS;" and in accordance with the iI
Resolution of The Board adopted at a meeting held on May 28.1
,I^~ 1 19 92„ and in consideration of the sum of $ 150.00 paid by
. ;Is
~ Samuels and, Steelman on behalf of, Lawrence. Cervon
of N. Y. and subject to the
Terms and Conditions listed on the reverse side hereof, G
of Southold Town Trustees authorizes and permits the following: ~
to construct stairs and deck down to intermediate
level and to beach from grade of the residence as per N
survey dated April 22, 1992 t
all in accordance with the detailed specifications as presented in
the originating application.
! IN WITNESS WHEREOF, The said Board of Trustees here-
by causes its Corporate Seal to be affixed, and these presents to
h 2
be subscribed by a majority of he said Board of this datteefJ'{~ i s -
(/V? 14
r„
"11 Oy t- j~
14 .
rustees
\ !~S'i.•d.~r~, sL
i
/ • ..~A v _ /tea A~ A` ~.:,A m
6 (10190)-25c NEW YORK STATE DEPARTMENT Or ENVIRONMENTAL CONSERVATION
DEC PERMIT NUMBER I EFFECTIVE DATE
I-4738-00326/00002-b
FACILITY!PROGRAM NUMBER(s) ALL llSt 19
PERMIT EXPIRATION DATE
y Under the Environmental Conservation Law (ECL) August 31, 1994
TYPE OF PERMIT (Check All Applicable Boxes)
INNew ?Renewal ?Modification ?Permit to Conttruct ?Permrt to Operate
Article 15, 96n of Title
Water CJ SPDES 17, Titles 7, 8: HArticle 27, azardous Waste Management 3
E~j Prct6Water S 5pplytle 15: F-1 AiirriPollution Control F-1 Coastal3Erosion Management
Article 15, Title 15: Article M, Title 27: Article 36:
Water Transport Mined Land Reclamation Floodplain Management
Article Title 15: Article e
19, 27, 37;
Long Island Wells Freshwat Articles
Lon r Wetlands L_J 6NYCRRt380: Radiation Control
Article 15, Title 27: Article l ,
Wild, Scenic and Recreational 5-1 Tidal Wetlands Other: r
Rivers _ Article 27, title 7; 6NYCRR 360:
6NYCRR 608: Solid Waste Management
Water Quality Certification
PERMIT ISSUED TO
Lawrence J. Cervon TELEPHONE NUMBER
ADDRESS OF PERMITTEE
P.O. Box 206, Laurel, NY 11948 ,
CONTACT PERSON FOR PERMITTED WORK
TELEPHONE NUMBER
Ural Talgat/Samuels & Steelman,25235 Main Rd.,Cutchogu~,NY 11935 (5)61 734-6405
NAME AND ADDRESS OF PROJECT/FACILITY
LOCATION OF PROJtCTIFACIUTY
8460 Peconic Bay Blvd.r Laurel
COUNTY TOWN]fiYT~AE4E WATERCOURSEPNETLAND NO NY7M COORDIN
NA TES
Suffolk Southold Great Peconic Bay E.
4
DESCRIPTION OF AUTHORIZED ACTIVITY
Construct (1) 5' x 7' cantileverdd deck and ,a 4f x t5T tstairway. All work shall be
in accordance with the attached NYSDEC approved plan.
By acceptance of this permit, the permittee agrees that the permit Is contingent upon strict compliance
with the ECL, all applicable regulations, the General Conditions specified (See Reverse Side) and any Special
DCo nditioRe lionatled as part of this permit.
td Utitety Atlifrt
PERMIT ADMINIRATOR ADDRESS ttogian 1 • 81 9-
David I)eRidiTer kt~ny prook, N. Y. 117~o•t3s6
AUTHORIZED SIGNATURE
ST
8/19/92
Page 1 of 4
"5~r` BOARD OF HEALTH
t
FORM NO.1 3 SETS OF PLANS
TOWN OF SOUTHOLD SURVEY . . .
APR BUILDING DEPARTMENT CHECK . . .
TOWN HALL
Jet\j SEPTIC FORM p-~ ;,;~•:~,-I:._" SOUTHOLD, N.Y. 11971 oZ ~~So~
O1. fl# w„ TEL.: 765-1802 Na^~ Y
TOWN PIa"~ yJ~tif_~r j CALL . , .
Examined 19TO
Approved , 19% Permit No~l. ~ /cam .
.Disapproved, a/c If2
~ r
ui g Inspector)
APPLICATION FOR BUILDING PERMIT q
Date : IN
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
ox 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~pections.
Q% ........1.re..........
(Signature of a ,cant, or name, if a corporation)
70 t-fw0(N 4~ 11k nr1=-
.
(M iling address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
bu? N
Name of owner of premises cRvoaI.. ..'2.1
(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. C7.Ll4e......... .
Plumber's License No .
Electrician's License No .
Other Trade's License No . R
1. Location of land on which proposed work will be done. ..l...'...... pkw . v .
House Number Street Hamlet
County Tax Map No. 1000 Section / l. ; Block It Lot ...19
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 i;r < '
p~pSY P• -•rc a_S
b. Intended use and occupancy
pf#J7~
p (check which a which applicable): New Building Addition Alteration
3. Repair of work oval Demolition Other Work~'..~9C-.... .
~i (Description)
4. Estimated Cost .'J/. ter'... t Fee 5Si./........................
(to be paid on filing this application)
5. If dwelling, number of dwelling !,units Number of dwelling units on each'floor .
If garage, number of cars ....j
6. If 7. Dimensions business, of commercial or iii xe occupancy, specify nature and extent of each type of use • • • • .
existing structures, if any: Front Rear Depth
Height Number of Stories
Depth .
, • • with alterations or additions: Front Rear .
Dimensions ons of 'same structure w Height Number of Stories
S Dimensions of entire new construction: Front Rear Depth .
Height Number ofStories
9. Size of lot: Front Rear Depth
10. Date of Purch
. in which . • • • • • ' ' • Name of Former Owner
11. Zone or Puse. urchase e
mare situated .
12. Doeq proposed construction violate any zoning law, ordinance or regulation:
13. Will lot be regraded . Will excess fill be removed from premises: Yes No
14. Name of Owner of premises Address . • • Phone No.................
Name of Architect Address Phone No........... , .
Name of Contractor Address . • .....Phone No............... .
15. Is this property within 300 feet of a tidal wetland? *Yes.. No......... '
*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.
STATE OF NEW RKJ S•S
COUN1TY OF 1 I ` I
• \ • 2..0 e.~Mn being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the ~.u).r
(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.ail 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 m, t Ns
day of r 1 . I 19~
Notary Publi County
N
CLAIRE ta QLFW
Notary Public, State Now York
No - l , .
No. 48796of of N878FiQ6 ' "'a
Qualified In Suffolk County q (Signaturre of applicant)
Commission Expires December 8,19.(.
izt~9~ IONS :
4.279x_
BITE DATA:
~BCTN / 1000-126.-11-21
i
i~ OWNER: Lawrence J. Cervon 70 Lincolin Hills East
Quincy, Illinois 62301
ry Tel N 217-222-9499
O 14
I~- Existing : Low-Density Residential
f r r zoning (R-40) 9
Lot Area : 24,373 S.F. Site plan taken from survey prepared by:
EXI6TIrrIG IJ TILI'IY -A
DOLE " N~/, TE~,st 2~I" Q S August Nappi Land Surveyor
io P.O. Box 673
I N.Y. Lic.# 45021 Dated: 11/2/88 W
7 r A a s,
Elevations shown are ba:ied on National
7 ~I y 1 Geodetic Vertical Datum. V O
Z
a
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ExIaTItiG LTiLITY POLE Luur.f
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~Ca~~CY O S of S,~E LAUREL ~
~d err 1 ~ J10LR REI.IC~vATic+~l) I .
6x1aTiNy GR a EL DRIVE nY I
F WVE.D AS TTEDDATE: B.P. # NOTIFY BUILDING UEFARTM AT 1194 5:?:,
1 „ y9 W
765-1602 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: ' -
1. FOUNDATION . TWO REQUIRED 1 L~-4TIC* MAC
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUNIBING
3. INSULATION 4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O. E><iSTII-I Cq
ALL CONSTRUCTION SHALL MEET LJTi L.iTY LINE, 1 iJ/F 4Jlc UEYZMOTT
THE REQUIREMENTS OF THE N.Y. 1
STATE CONSTRUCTION & ENERGY -
cgR.vpE CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS
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