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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-22201 Date MARCH 19, 1993
THIS CERTIFIES that the building ADDITION
Location of Property 2440 HARBOR LANE CUTCHOGUE, NY
House No. Street Hamlet
County Tax Map No. 1000 Section 103 Block I Lot 29
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 28, 1992 pursuant to which
Building Permit No. 20991-Z dated SEPTEMBER 30, 1992
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 SECOND-STORY ADDITION TO EXISTING ONE-FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to HERBERT BELL
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N 264888 JANUARY 29 1993
PLUMBERS CERTIFICATION DATED MARCH S 1993
Building Inspector
Rev. 1/81
roan No. a
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)
N2NOO 20991 Z Date t.A.A.~A . 19.E -
Permission is hereby granted to:
`~........1~ P ..............~:M......!.15.7..d
.
at premises located at ...~!!?t.
County Tax Map No. 1000 Section 1.. 3..... Block d... Lot No t:11-qq
.J...........
I
pursuant to application dated ........4.1 ^rxs... a- 1912.-1 and approved by the
Building Inspector.
fk Fee 3. a. /
l ud Q.t G..
B ding Inspector
I
Rev. 6/30/80
k
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT ~
TOWN HALL C
I MAR 18 1993 765-1802
v
APPLICATION FOR CERTIFICATE OF OCCUPANCY
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:
I. 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-digposal(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, i
6. Submit Planning Board Approval of compLcLed site plan requirements.
f
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, Lhe Building Inspector shall state the
reasons therefor in writing to the applicant.
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
w Construction... x.. Old Or Pre-existing Building
cation of Property `.',,,,,,,e!VTz+ jUA .
House No.1.1~~~~Q pp Street Hamlet
wer or Owners of Property ....Tl`-'l.-.. .~.T........ ..~.t" ..L........
WILY 'fax Map No 1000, Section Block Lot.....~~.'.~............
bdivision............
.........................Filed Map............ Lot....................
rmit No.~ ..Date Of Permit. .1, .w ...Applicant."~o 1,~+,!rrI,~0N
1th Dept. Approval ...........................Underwriters Approval.........................
inning Board Approval
:west for: Temporary Certificate........... Final Certicate. x........
Submitted:
z-~ .20 ~
~-t~(,ar~~~ LICANT
i1sil I: I; JI
THE NEW YORK BOARD OF FIRE UNDERWRITERS me
1f09071. BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
Date JANUARY n"r19!n ApplieationNo.or ile 79112292/9 H 264888
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant animation the alcove application number in the premises of
ffRR81R'P Bf, L, 24410 HARBOR LANG;, CUTCHOOUE, N.Y>
in the following location. ? Basement ? Ist Ff. ® 2nd Ff. I Sertion Block Lot
was examined on JANUARY 2 6 , 19 93 andfound to be in compliance with the requirements of this Board.
FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS INCANDESCENT FLUORESCENT OTHER AMT K W. aMi K.W AMT K.W AMT K.W. AMT H.P
5 t 4 7 ''r I S"
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.? AMT. NO. A. W G. AMT. AMP. AMT. AMPS. TRANS. AMT. N P. SYSTEMS pMi. WAITS
NO. OF FEET
SERVICE DISCONNECT NO .OF S E R V 1 C E
AMT AMP TYPE METER L 2W R Ft 3W 1.e 3W 5,e' AW NO. OFE CC COND. A W G. NO OF HbLEG A W G NO OF NEUTRALS A W G.
EQUIP. R AI OF CC. COND. OF HI LEG OF "NEUTRAL
t 200 CD 1. X T 210 1 210
f
OTHER APPARATUS:
' H014Tifi;1 N kl.ll>
£iHf}K~' I)R`f'k;t;T011 F - 3,
~ o
G & B CONTRACTOR d,SC.#57E3 B
BOX 215
SOUTHII,D, NY, 11971 GENERAL MANAGER
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 8f ALTERED IN ANY MANNER.
c~~F V Q(/i•~ TEL. 765-1802
~l TOWN OF SOUTH PJ
1. OL
• . A z a 'r _e_ OFFICE OF BUILDING INSPECTOR
u°, tom' . „ P.O. BOX 728
c•. TOWN HALL
SOUTHOLD, N.Y. 11971
C E R T I F I C A T I O N
_y o
Date
Building Permit No.
Owner 96'ri)< l: E,
(please print)
Plumber ~T~~~L
U dM b t Q ca. i.p COT
(please print) ~
I certify that the solder used in the water supply system
contains less than 2/10 of to lead.
(plumber' ign e)
S orn to beforQ me this
(eday of
Notary P is
Notary Public, County
O M A JACKSON
IN" F16 k Sims of New York
No. 1920753
OudW h Suffolk Coucty
' Tam Expires Feb, 13, IB'S'./
MAR i S
INSPECTORS
Victor Lessard
Principal Building Inspector
Curtis Horton
~'V SCOTT L. HARRIS, Supervisor
Senior Building Inspector_ .
Southold Town Hall
Thomas Fisher P.O. Box 1179, 53095 Main Road
Building Inspector
Gar Fish Southold, New York 11971
Building Inspector Fax (516) 765-1823
Vincent R. Wieezorek r - " Telephone (516) 765-1800
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
MARCH 10, 1993
HERBERT h. RUTH BELL
145 RAYMOND STREET 1= is
a
ROCKVILLE CENTRE, NY l1570 V
PREMISES @ 2440 HARBOR LANE, CUTCHOGUE, NY
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.
%B% The check is 0XKXXKVAWnot 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 # 20991-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
FRAMING [ INAL
REMARKS:
r P
CIO,
DATE ` INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
] FO DATION 1ST [ } ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
i
i
I
DATE
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST RO PLBG.
[ ] FOUNDATION 2ND [ INSULATION
[ ] FRAMING [ ] FINAL
REMARKS: t
4441-
DATE O INSPECTOR''
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [&,rROUGH PLBG.
[ } FOUNDATION 2ND INSULATION
RAMING [ ] FINAL
REMARKS:
DATE ®o~~' ?i INSPECTOR
1vI D i. 7C.:.::i ~fJ~.n I~ ;;i;:-!i•1l:NTC
H .•A
0UIIDATI04 (1st)
- II
1 c 2
No-
OUNDATIOt1 (2nd) rrYb/
1,4b A~-
o
OUCH FRAME &
-PLUMBING
H
7~D Z N
rn
n
:1SULATION PER N. Y. 71
STATE ENERGY
CODE
r22 V1
FINAL
ADDITIONAL COMMENTS:
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BOARD OF HEALTH
FORM NO.1 S3 SETS URVEY OF PLANS
i P 7 1, TOWN OF SOUTHOLO CIIECr ••~yZ~p • • ' • " • • ' • •
BUILDING DEPARTMENT SEPTIC FORt.1 • • . ' • •
TOWN HALL
SOUTHOLD hl•Y_ 11271
TEL.: 7G5.11302 ttoT l F Y
ExanrineJ •.•..4~ 191 CALL oZ9~:S°2:7~' ~''RCEtiJ
YYGYGQ, q MAIL TO:
Approved V 194.?.- Permit No.a(Z 4 ! 1 .
Disapproved a/c • _ .
L
61.~!I v.~
(Building Inspector)
APPLICATION FOR BUILDING PER(411T
Data
I19.
NSTRUCTIONS
a, This application must be completely filled in by typewriter or in ink and submitted to the Building
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings on Premises, p~tnr, tvitt
or areas, and giving a detailed description of layout of must relationship to adjoining
cation. property must be drawn on the diagram which is Part or public s pF
C. The work covered by this application may part of this a
-d• Upon approval of this application, the Buildint be commenced before issuance of Building permit.
shall be kept on the premises available for inspection thro
Inspector will ugh ut the work d a Building Pcrmi[ to the a
e. No building shall be occupied or used in whole Orin part for any purpose PPhcanL• Such petr
shall have been granted by the Building Inspector. Y P Pose whatever until a Certificate of Occupant
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws Ordinances describe(
Rq; lations, for the construction of buildings, additions or alterations, or for removal or demolition, as herpursuant to tl
ances c
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, re
adrr;it authorized inspectors on premises and in building for necessary inspections. as hgula tons and
t
Ri?{5r0t. C0N5Ta1CV0 .
(Signature of applicant, or name, if a corporation)
?io5.crnp Nt
rnin.a
(Mailing address .applicant)
State whether applicant is owner, lessee ( g of applicant)
, agent, architect, engineer,
general contractor, electrician, plumber or builder
'Name of Owner of premises Po 02-7, ...l .
(as on the tar roll or latest deed)
If app~i Jant is orp rayon, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License NO_ a
Plumber's License No. . , , , , ,PeN'01 N
Electrician's License No. 11
Other Trade's License No. I...............
Location of land on which proposed work will be done:
. 440 4,~ le, 60 l2- LA N ~ G
Clouse Number U T O(~ U
Street " " '
County TaX Map No. 1000 Section
Sub Block .....I ? 1
Division Lot.. State cxistin~ (N.uuc) Lot
use and occupancy of premises and intended use and occupancy of proposed construction:
A. Existing use and occupancy VNE,, (,Y ,
B. Intended use and occupancy...... ON ~Z?yY/It~{ „ SIpjN~E1
f Al~~t^~
3. Nature of work (check which applicable): New Building Addition ! ~•2~~•~ teration x...... .
Repair Demolition .Swimning pool. . ,
Tennis Court . Rpm Accessory Building.......... Fence .......Other W
4. Estimated Cost . ~50A M ork........ .
Fee
t (Lo be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on each floor
If I .~C'ti+g~lrvG.
6. If business, commercial or mixed',occupancy, specify nature and extent of each ype of use '44:
7. Dimensions of clisting structures, if any: Front 7...., , , ?4' Dc th ..4Q,, .
. P
Height Rear ....774
• •~•+~o• Number of Stories . i .
Dimensions of same structure with alterations or additions: Front " • • . • . .
Depth ...:4:0."...... ....7`~:~......... Rear Z`} .
. • • Height " . Nurnbcr of Stories ....%l+
8. Dimensions of entire new constriction: Front :q' Rear .
Height 12." . Number of Stories . .1 , • , . " Depth
• ........1
9. Size of let: Front . . (Q~ " Rear . ! :
IO, Date of Purchase j , , Name of Former Owner
11. Zone or use district in which premises are situated . q a
12. Does proposed construction violate any zoning law, ordinance or regulation: NO .
13, 1Vi11 lot be regraded NQ, Will excess 611 be removed from premises: Ycc 140:,
14. Name of Owner of premises _FIFP4'JEl71 Ir Address LN_~4pT4f!4k Phone No. 73 .1651
Name of Architect 1 IiJ~LZbN L PE Address .Mi?~j'J~ (UCjC (0~, , . Phone No. Z-1PV-
70
Name of Contractor MftTHs!0t gNSrt .Tb(AYW 4VW. Address . Pf N~?
CIK
?T.l"It2 ...Phone No. ?fL0..54?$.. .
IS-Is this property loca4ed within 300 feet of a tidal we. .land? ^YES....HO.yS.
*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 dime=iocl is
property lines. Give street and block number or description according to deed, and show street names and indicate w::ct:
interior or corner lot.
ItSor
Poop
1 "
' ENO
STY *Ow-
it,
3
2
. ?3231 ~
ob t
Hr PAR- Pac>Ie•-• LN
STATE OF NNE1V Y RK:
COUNTY OF.. -S S
tm V being duly sworn, deposes and says that he is the applicae
(t\ame of individual signiltg contract)
above named.
Hv is the _VL
(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 tit
aPPlication: that all statements contained in this application are true to the best of his knowledge and belief; and that t::
work will be performed in the manner,set forth in the application filed therewith.
Sworn to before me this
~j ....day of 19 .1.~
Notary Public, ?~;c; . c,Q~~ i , . ounty
HELENE D. HORN6
Notary Publo, State of Now York • • • • • • • : r (Sign • • atu• . • , •
No.4961384 re or appli can'
usllfled in Suffolk Courrt~ltyy
Comm salon Expires May 22,19_ a?
I
~Z 7)WIZ
a
ILI
LL-L-
OCCUPANCY OR PLUMBER CERTIFICATION
-
USE IS UNLAWFUL ON LEAD CONTENT BEFORE
WITHOUT CERTIFICATE CERTIFICATE OF OCCUPANCY
OF OCCUPANCY SOLDER USED IN WATER
SUPPLY SYSTEM CANNOT
EXCEED 2110 OF 1% LEAD.
UI~ 0PROVED MNXOy
DATE: B.f~,IJJas:I
FEE BY q_-
bl0'I'fFV RUIL.ilEPI(; DE°F."ATMEIVT AT
rwmmNe 16.1-M02 ~?I ANY TO N PM FOR THE
KL Fo y _OVVING ;NSPI:CT![%S, t E11LINES E FOLNDATIOJ TWO REQUIRED
TESTING BEFOORE RE COVERING r0r^ POURED rONCRETE
2. ROUGH - FRAMING t4 PLUMBING
3 ;NSULARON
ME Kt RONYNd 4i 1:KJ,%L CONSTRUCTION MUST BE COMPLETE FOR C.O. for WOW disvibutIP9 ALL CONSTRUCTION SHALL MEET
pipim"libE THE REQUIREMENTS OF THE N.Y. wilmm STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION FRonec
I ~u U \ a u~ _
I
-
_
BDALE: /.'J ~?C C APPROVED BY OMWN 8Y
DATE: G IJG~ 5
DRAWING NUMBER
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