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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-22678 Date OCTOBER 27, 1993
THIS CERTIFIES that the building ADDITION
Location of Property 4515 PEQUASH AVE. CUTCHOGUE, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 137 Block 4 Lot 5.2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated DECEMBER 2, 1991 pursuant to which
Building Permit No. 20604-Z dated MAY 4, 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 EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to JAMES & JOHANNA CANCRO
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT of HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-291222 - OCTOBER 1, 1993
PLUMBERS CERTIFICATION DATED N/A
C/ _
/Pzilding Inspector
Rev. 1/81
FORM No. S
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°O-N° 206042 Date 1.4 191A
Permission is hereby granted to:
....`1P. AF............ ......(1.4&e
to XhM,afit.....MMasA..... tt l~ca....:
1 ~ !J
at premises located at ...7 . ~.5 9 O.k~-vf N...-t . ~ t x..
County Tax Map No. 1000 Section .......!.:41........ Block .......Q.1....... Lot No.
pursuant to application dated ....~~~Q~~*4?.....L, 193.)..., and approved by the
Building` (Inspector.
Fee 17:~~...
...ifn
ector
Rev.
6/30/80
Form No. 6
a~~cAr -j t!`
TOWN OF SOUTHOLD z!.
BUILDING DEPARTMENT
TOWN HALLS bl!7 1i~
765-1802 t l
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 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.
.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 Inspecior 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
New Construction........... Old Or Pre-existing Building...... Y.........
Location of Property
House No. Street Hamlet
Onwer or Owners of Property}~n1~„!~ ~c1~Y1,C,,,,c~n(,~, .
County Tax Map No 1000, Section...121....... Block ~t......... Lot. t~;.A
Subdivision.f., I l.r0. ......Filed Map............ Lot
Permit No. Qb&,t,K,Date Of Permit.. ...Applicantsa/.M! _K q', fD6A..CAj SZ-AK) a
Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval............
Request for: Temporary Certificate........... Final Certicate...,~
Fee Submitted: ,
dec. ?Q/'......'
APPLICANT
co
aaG78
INSPECTORS «.x , .
Victor Lessard r:~UtFt](6(,
Principal Building Inspector
Curtis Horton 'r4 SCOTT L. HARRIS, Supervisor
Senior Building Inspector a
cn : -'4± t'•;;.9~? ~ Southold Town Hall
Thomas Fisher
J _ 7 P.O. Box 1179, 53095 Main Road
Building Inspector
Gary 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 9, 1993
JAMES J. CANCRO
4515 PEQUSH AVENUE
CUTCHOGUE, NY 11935
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
%Y.lc' An application for Certifica e of Occupancy is
not on file. (Enclosed) 0-1-
No Underwriters Certificate on file.
xu 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 # 20604-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
1iLD ; ::~IN
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FOUNDATION (1st)
c
FOUNDATION (2nd) nom.
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;OUCH FRAME &
-PLUMBING N(
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:11SULATION PER N. Y.
STATE ENERGY 'I
CODE I >
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FI:)AL I - I
ADDITIONAL COMMENTS: x
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THE NEW YORK BOARD OF FIRE UNDERWRITERS PATE it
1000343 BUREAU OF ELECTRICITY
F 88 JOHN STREET, NEW YORK, NEW YORK 10038
Date OCTOM 01,1993 Application No. on file $OU05fig3/a3 kJ 2912?2
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
JANE5 CANCRO, PROIJASH AVENiJE, ClIT HOGH, II.Y,
in thefollowing location; ® Basement FX1 IRE Fl. 0 2nd Fl. Section Block Lot
was examined on H E T T E H H E ft 0 3, 1 9 9 3 and found to be in compliance with the National Electrical Code.
FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS IRI INCANDESCENT FLUORESCENT OTHER AMT K W. AMT. K.W T. K.W. AMT. K.W. AMT. H P
4 5 3 3 2
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
AMT. K. W. OIL H. P. GAS N. P. AMT. NO. A. W G AMT AMP AMT AMPS TRANS. AMT H P. SYSTEMS NO. OF FEET AMT. WATTS
SERVICE DISCONNECT NO.OF S E R V 1 C E
AMT. AMP. TYPE METER I,9'3W 1,e'3W 3,93W 304W NO. OF CC. COND. A.W.G NO Oi HbLEG AWG. NO OFNEUTRALS A. W.G
EQUIP. PER B OF CC.COND OF HbLEG OF NEUTRAL
OTHER APPARATUS:
' 13000hLE ELECTRIC
1355 HAIN ROAD
GENERAL MANAGER
HATT1TUCK, NY, 11952 L1
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 MANNER.
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New York State Department of Environmental Conservation
Building 40-SUNY, Stony Brook, New York 11790-2356
(516) 751- 1389
Thomas C. Jorling
Commissioner
April 13, 1992
James J. Cancro
4515 Pequash Ave.
Cutchogue, NY 11935
RE: 1-4738-00450/00001-0
Dear Mr. Cancro:
In conformance with the requirements of the State Uniform Procedures
Act (Article 70,ECL) and its implementing regulations (6NYCRR, Part 621)
we are enclosing your permit. Please read all conditions carefully. If
you are unable to comply with any conditions, please contact us at the
above address.
Also enclosed is a permit sign which is to be conspicuously posted at
the project site and protected from the weather.
Very truly yours,
ev L /'LZ3(.A~ '~3I .
Roger Evans
Sr. Environmental Analyst
RXE/nw
enclosure
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M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND Vj"INSULATION
[ ] FRAMING !J FINAL
REMARKS:
.
DATE ~3 INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[FRAMING [ ] FINAL
REMARKS:
DATE INSPECTOR 2:P24~1
Y
k6b~ _
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ I ROUGH PLBG.
[ OUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
DATE b INSPECTOR G,r,y~
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ I INSULATION
FRAMING [ FINAL
[7
REMARKS:
DATE 1 INSPECTOR
BOAFD OF HEALTH
#VVt/i~FORM NO.1 -3 SETS OF PLANS
TOWN OF SOUTHOLD -SURVEY _ .
DEC _ 2 199' BUILDING DEPARTMENT '-CIIEC>; TOWN HALL SErTIC FORM . .
SOUTHOLD, N.Y. 11971
TEL.: 765-1802 ttOT I FY ; 7
CALL
Examined.. p~ AIL TO:
Approved . 19gA Permit No.~ O (D0 1 .
_ . .
Disapproved a/c ~ . .
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date ...~.F'C 199.
INSTRUCTIONS
z. 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
hall 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
3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
tegulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
(lie 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.
ic
^t pp r name, if a corporation)
(SiffF/// ature of a l o
ys.ss° ~Ar4 Rye Cv~c d .vti
(Mailing address of applicant) /6"'! . /(g3S-
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
. \~11 0 n.e.&
Name of owner of premises U.4.vp7.e. i... / J Q 41 0. 1 4. ..4. A .4 i=.,efo
(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 .
Plumber's License No.
Electrician's License No . . .
Other Trade's License No .
Location of land on which proposed work will be done. ..y.'~ .
y. / VATk...a ~C.ra~.~.~,
(louse Number Street Hamlet
County Tax Map No. 1000 Section . J 3~ Block ...7 Lot
Subdivision P47 E.CY¢? D, 0.O.....1 : AV?-: Filed Map No . Lot
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy C.S.. (7 C' "C ,<<:.-..,..:.
b. Intended use and occupancy
~ ~~je~se~ otiSu/3~ytfe~ ~7/4r?~'
(check which applicable): New Building AdditioyY' . . Alteration `
Repair .
Removal Demolition Other Work
4. Estimated Cost :R . C?........................ Fee (Description)
(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 .
6, If business, com in ercial or mixers occupancy, specif ynature and extent of each type of use
. . . .
7. Dimensions of existing structures, if any: Front ..y. , , , , , , ,Rear o'"t .
Height ..`o~i.o3......... Number of Stories (y Cl. Q „@ r0, .o•!~ . ..Depth ....3......... .
Dimensions of same stnyctur/,. ith alterations or additions: Front .~Q. ' , , , , Rear S, .1 .
Depth , /S, 6 . Height a,2 ;41 Number of Stories . . ?.9, . ,
8. Dimensions of entve new construction: Front 6n, ~ . , , , , , , , • , Rear
Height . Number of Stories e an p 04 e ati Depth /S 6
9. Size of lot: Frontf°.°...... j ..'r
Ream .e . Depth !.T/, ~
.
10. Date of Purchase l y
1 1, Zone or use district in which promises . • ' ' ' ' • • • Nam. of Former Owner 4M, AA. a, (3 •f/,(2 fR,C~ f , , , .
+ violare situated .
12, Does proposed construction viol
ate any zoning law, ordinance or regulation:.. v.,o .
13, Will lot be regraded n/ O
eyisfiil be asec remises: Y...No
14. Name of Owner ~ . Will ill Yo ,p
C xr y 7''}Ycgh No.7. ~ Y : 7. Y. 0,,!;
.
Name of ArchitectC7MF/y.', (J,(C,U&I , , , • , , Address .Qq,0.~F; .Ua/1.e. Pfgl, . Phone NoC;.0:)
Name o Contractor Q 9`e.d7
c Y
~ Phone No.
15. Is this property within 3!00r
If yes, Southold Tfeet of a tidal wetland? " " " " "
* own Trustees Permit may be require 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. rye S/ S e u w s h A v , G u 7' Crfn o~ c !)(,r;' ,j'/7 7L-r_(?ior? z o-7,
;
it
TATS OF NEW ORl A S.
OUNTY OF . c.L~
• ' ' ' ' ' ' 4 ~•l•4•C) being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
)eve named.
eisthe...........~..Nr........
(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
)rk will be performed in the manner set forth in the application filed therewith.
torn to before me this
.o. .............day of. I s ? f .,19 . l.~
Mary Public, ~~Lej.. unty
0 OE
Notary Pub N S
to ofNoow York (J 4961364 Qualified In Suffo k Courjty (Signature of applicant)
Commission Expires May 22, 11¢2
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APPROVE APPROVED AS NOTED
I- DATE; S46i ATE; Ji~*29- B P N O O
FEE' ~E. BY x!L~~! EX `rI~G W/+LL IL FE KFMOII Gty
~A~?C Ni PiN7 IiCY LL NONFV BUILOIN( O IFY BUILDING DEPARTMENT AT WFF Vi WALL TQ FjE (,UhI°-`(RUGTEC~ U
_ 765-1802 9 AM 35-1802 9 AM TO 4 PM FOR THE
FOU OWING INSP - E.xR:7Ih G WALL ro zGMAIh KIOWING INSPECTIONS
- - - - - 1. FOUNDATION FOR POURED( rOUNDATION - ONO REQUIRED FOR POURED CONCRETE F I f77 h r L'G v L p J.. P,'N - ! g F O lJ N ~O ~ NDA-(10 N (~L~N ~ d
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INSULATION e7 - - - - - - 3 /4j1='I
tl s I, II 3 INSULATION /4 I U Q. FINAL - COI FINAL - CONSTRUCTION MUST ( f~~I~ s II BE COMPLETE FOR C.O j ywo ~
OCCUPANCY OR BF COMPLETE
USE IS UNLAWFUL ALL CONSTRUCT THE REQUIREME .L CONSTRUCTION SHALL MEET IE REQUIREMENTS OF THE NY.
WITHOUT CERTIFICAII. STATE CONSTRUI 'ATE CONSTRUCTION & ENERGY a O
OF OCCUPANCY C )DES. NOT RESPONSIBLE FOR
ODE .Ofl r DESIGN CONS :SIGN OR CONSTRUCTION ERRORS