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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-21085 Date OCTOBER 14, 1992
THIS CERTIFIES that the building ADDITION
Location of Property 660 BAYBERRY ROAD CUTCHOGUE, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 118 Block 1 Lot 13.1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 10, 1992 pursuant to which
Building Permit No. 20550-Z dated APRIL 15, 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 ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to JOANNE McSHERRY
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. PENDING - SEPT. 21, 1992
PLUMBERS CERTIFICATION DATED OCT. 5, 1992 - MATTITUCK PLUMB.6HEAT.
Building Inspector
Rev. 1/81
FORM NO. f
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)
N°-N° 2055OZ Date .....1 >I 99.z
Permission is hereby granted to:
`..Z
.......~I........-? A
` ?s 1:1-.7 -
to .....SA .A...... .....i ...,-L...
964~
at premises located at .Sv. Q....
.
c c
....fla ..........................................................1.............
County Tax Map No. 1000 Section I..~.. Block Q.,............ Lot No.....~.~a...l.........
pursuant to application dated ~.Q 19.bw, and approved by the
Building Inspector.
Fee $J.a-p:........
iild4li'na
nspecctor
Rev. 6/30/80
i Form No. 6
7, ' TO,.JN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
/ APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OF, ink and submitted to the building
inspector with the following: for naw 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 1W
New Construction........... Old Or Pre-existing Building.......
Location of Property..... '.:'.a....... ~,"..<:~:.L:.. .,?v.............. S~:4G... i
House No. Street Hamlet
Onwer or Owners of Property ...<.C
County Tax Map No 1000, Section..ii.~'.:..... Block l Lot...:.-?'./
Subdivision ....................................Filed Map............ Lot......................
Permit No.~ OSJ.v ......Date Of Permit ................Applicant.............................
Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate...........
Fee Submitted: $
( 9c, y`f9 : W
cozy )O& s APPLICANT
TEL. 765-1802
~oS~FFQth gyp`/ TOWN Or SOUTHOLD
f Y ~c OFFICE OF BUILDIJdG INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
d
C E R T I F I C A T I O N
B1-DG. DcPT.
TOWN:aF SCJS}T~Ot-D
Date
Building Permit No.
Owner 30C,,\n<- WC- e ry
(please print) ) I
Plumber Xo- 4 -7 UC- ~ P l Um1'n
(please- print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
r
/V l ~ ~V l l j
(plumber's r(03)
Sworn to befor me this
f1,7_144day of ('eTdBEe
19/x.
Notary Pu c
Notary Public, County
lOtIN R. JIICK90P1
y N0. 4OM750Nwr Yolk
OuMW b s df* County
Tom B ns Feb. 16, 1992
INSPECTORS
Victor Lessard c jFfO(,Y
t Principal Building Inspector
Curtis Horton SCOTT L. HARRIS, Supervisor
Senior Building Inspector o`
h F" ' Southold Town Hall
Thomas Fisher u • .
Building Inspector P.O. Box 1179, 53095 Main Road
P?, 9 r
Southold, New York 11971
Gary Fish a_~l vim. Fax (516) 765-1823
Building Inspector
Telephone (516) 765-1800
Vincent R. Wiecwrek
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
SEPTEMBER 21, 1992
S s Z BUILDERS
BOX 722
CUTCHOGIIE, NY 11935 [n
RE: JOANNE McSHERRY SEP 2 4
To Whom This May Concern:
We are unable to complete your Certificate of occupancy /
because of the following reasons: L~
SE ~ G Z L LE ; [`tee` 1J
XXX An application for Certifica a of occupancy is Z - e
not on file. (Enclosed) S~ DEL $S"
ffi No Underwriters Certificate on file. l~ ~(1
ffi 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 # 20550-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
?CC: JOANNE McSHERRY
r1j~LD> 5 -i jj :n il
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STATE ENERGY II
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ADDITIONAL COrIMENTS:
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DERICN CRITERIA 6,ooo Degree Da.ym
(FOR NONwELECTRIC HEAT) O.A. 1001 I.A. 70eF
f 0 R PER . J/W j l5 CJY~ J 7Jn
1y, pt-S~Cr T/1FR1/Al
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>I~IJJ S F/r MI. A Q E A .u~ R~ITrNG REAOPle5
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TOTAL t Z
Noteal
Rwllding Envelope Syntemn to Meet req"irementm of 7GlJ-J
HVAC FgnirmenA to meet regVirmmentm of 7915.11
HVAC'Eymtemm to meet regOrememtm of 7R15.lt
Dart Eymtemm to moot requirementm of 7615.13
Vonttlationm Syntemn to meet regairementn of 7x15.14
Immiilatlen of Firing Symtemm to Beet regairementm of 7F1'5.15
eervlce Mater "eating Eymtemm and Fg nipment to meet RegnireMentm of 7415.!1
Electrical and Lighting Symte%m and Equipment to meet regnirementm of 7H15.31
Ta t-e blurt of mr Knowledge, tpp NEW k0
belief, and rrefemmional y~pt~rr_EM T~ 91
1odvement, theme nlanm are in t
comrliance. with the cede,
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' aA~fESS1~lk
765-lW2
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS: '
DATE ~ 1 INSPECTOR
i
i
i
i
M-1802
BUILDING DEPT.
INSPECTION
[ FOUNDATION 1ST ( ] ROUGH PLBG.
[ J FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING FINAL
Wa P.P a S`
REMARKS:-/"-,)
f
1
DATE O INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ I ROUGH PLBG.
[ ] FOUNDATION 2ND [ INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
i
i
DATE INSPE R t C1~
i
r
'575
765-1802
BUILDING DEPT.
INSPECTION
j ] FO NDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
L
[ 7 FRAMING [ 7 FINAL
REMARKS:
DATE G 2/` INSPECTOR
1oL,~U~
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ I ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ?~/FINAL
REMARKS:
Z
C.
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F
i
DATE ~ INSPECTOR
/.~---65=1$02
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST OUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMAR S:
a
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DATE ~i~ INSPECTOR
BOARD OF HEALTH
S- FORM NO.1 3 SETS OF PLANS
\V7~4;`;rR, TOWN OFSOUTHOLD SURVEY
~l 'J~ BUILDING DEPARTMENT Cocci :
3t i,
APR J 01992 TOWN HALL SEPTIC PORN
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
t: f
Exartlincd.;i°.)°`',`t. .....i'`f-i.. 19... ALL
NAIL TO:
'approved 19 g2: Permit No..c~
Disapproved a/c .
(Building Inspector)
APPLICATION FOR BUILDING PERMIT/ /
Date
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
ets~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
)r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
ation.
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
:tall 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
hall 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
tuilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
:egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
'he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
dmit authorized inspectors on premises and in building for necessary ins ect'
~f . .
(Signature of/a~pplt'ca'nt,/o~r na/me,/if a corporation)
(Mailing address of applicant)
state whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
?d~ C~!9/ G p4 . .
lame of owner of premises /.....5. , , , , , , , .
(as on the t , roll or latest deed)
"applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No. .1 3 Dy. , , , ,
Plumber's License No .
Electrician's License No .
Other Trade's License No .
Location of land on which proposed work will be done.
~ y 1Jmn ..6.ia.~......:./~''/~,5~5f 1!... ~Joi~!~
House Number Street Hamlet
County Tax Map No. 1000 Section Block I Lot . / ..J.............
Subdivision Filed Map No. Lot
(Nam.e)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ...l.).~:.~
b. Intended use and occupancy s.../4 .
r ,
I
3. Nature of work (check which applicable): New Building Addition ^ .Vterati'on
Repair Removal , Demolition Other Work .
4. Estimated Cost ....C/Q b0v (Description)
Fee
/
g (to be paid on filing this application)
S. If dwelling, number of dwellim• 'snits • , • , , , , , 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 structure's, if any: Front Rear Depth • •
Height Num''ber of Stories
Dimensions of same structure with alterations or additions: Front • . • • • • • • • '
De th. Rear........
P .1.. Hcight • Number of Stories . ~y
8. Dimensions of entire new construction: Front
Height Rear ...W.z......... Depth
Number of stories ; ,
. ~7. . I. Depth
109 . . Size Date of of lot: Purchase Front ~ Rear Depth
i•••••••••••......NamCOfFormer Owner
11. Zone or use district in which premises are situated • • . • • . ' • • • • • ' ' ' ' ' • ' ' • ' ' '
12. Does 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 .
Name of Contractor . • • • • • . • • • • • • • • Phone No
15. Is this property within 3Q0 feet of a tidaldwetlandl * " " " `Phone No
*If yes, Southold Town Trustees Permit may be required, No
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.
i
^
I
~I.
LATE OF NEV
RK~
3UNTY O S.5
QSfI.L..... being duly sworn deposes and says that fie is the
N c of individual applicant
( signing gig contract)
ovc named. ,
is the ~ . .
(Contracto agent, corporate officer, etc.)
said owner or owners, and is duly auth
,on a_ rform or have performed the said work and to make and file this
- lication; that all statements contained +n this application are true to the best of his knowledge and belief, and that the
rk will be performed in the manner set fprth in the application filed therewith.
om to before me this
.day of T.. 1....., 100
:ary Public, County
CLAIRE L. d(EW II
• Nc1sry Public Stets of NeW Vorlf
No 4879808 (Signature of applicant)
Ouilliflstl In Sufic°"
Commission`cpirgs Dscetitpsr Bounty
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OCCUPANCY OR
USE IS UNLAWFUL
WITHOUT CERTIFICATE
OF OCCUPANCY
t
<< -
PLUMBING
. ALL PLUMBING WASTE
6 WATER LINES NEED TESTING BEFORE COVERING
CBMRWE - wommullm
- - f'ATr,1! iz-_e, : /aosse~i
I - I *Aft Is tow F E E. M NOTIFY
far dW&Utk* - - - - JUS -I$E
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- of lVpMKmL I. COiFN ra„ ;vL tEQUIHED
is- FOR POURCGY70P.IC,'RETE 2. RO;JGH I'RAN;IING d frLUM 81PJG
PLUMBER CERTIFICATION' a iNSULAncN BEFORE 4. FINAI. COiaS1 RUCTION MUST
ONIFAOCONTENT BE COMPLETE FORGO
CERTIFICATE OF OCCUPANCY ALL CONSTRUCTION SHALL MEET
-
SOLDER USED IN WATER THE REQUIREMENTS OF THE N.Y. NOT STATE CONSTRUCTION & ENERGY
SUPPLY SYSTEM AN ~(jLEAD, CODES. NOT RESPONSIBLE FOR OF f DESIGN OR CONSTRUCTION ERRORS
EXCEED T/f0
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