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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-20795 Date JUNE 16, 1992
THIS CERTIFIES that the building ADDITION
Location of Property 3395 SKUNK LANE CUTCHOGUE N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 97 Block 9 Lot 11.1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 7 1992 pursuant to which
Building Permit No. 20618-Z dated MAY 11, 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 DECK ADDITION OVER EXISTING CONCRETE SLAB AS APPLIED FOR
The certificate is issued to JOHN & MARIANNE ANDERSON
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
e
lding In e or
Rev. 1/81
FORM 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)
i
NN'; 206162 Date .,1 19-
Permission is hereby granted to,
vv.-..e
G%~cv
to ~1 ~a....~~ Zs$...G.. crri.........
.....a-lee,
at premises located at ../i `J........ kILQ
•
County Tax Map No. 1000 Section ,7~.,?....... Block ...........4,?........ Lot No..... /
pursuant to application dated 19.,~'...,- and approved by the
Building Inspector.
Fee 3... .
k
E t
i
c...........
4 Buil I for
Rev. 6/30/80
Form No. 6 ~vop L")77•~ ~~9
TOWN OF SOUTHOLD
JUN 8.1992 BUILDING DEPARTMENT
TOWN HALL
765-1802
'f~il~dl9 o='r ~~1',~ r~:•, P
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.
3. 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.
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
7 Date 6// 6/% a
2w Construction.,°~" !o" Q POld Or Pre-existing Building „
C
)cation of Property...,139S•.5x~a-iF qtr:..... z/17e,1 l!F
House No, Street
/ Hamlet`s
wer or Owners of Property..... `i
unty Tax Map No 1000, Section.,., ,,,,,,,Block...
bdivision..........
.Filed Map. ...Lot.. `
rmit No.Pl~6~~Z ,,,,Date Of'Permit.....
.....Applicant...a~iaNo/<AP sOt
alth Dept. Approval..........
•••••••••......,Underwriters Approval
.inning Board Approval
7ucst for. Temporary Certificate.,,........
Final Certicate...........
Submitted: $
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[RHORaED ALTERATION OR ADDITION
O THIS SURVEY IS A VIOLA EW TO ST
-
730V OF THE NfW YORK ST
MAP Of' PIP-Op „ Lb,e RI..~
bN LAW. ,
[S OF THIS SURVEY MAP NOT BEARING -
LAND 3VSVEYOK'S INK.lV 5'At, OR SU t~V E:Y f? F°O
SSE
LE
SLAL SHALL NOT DE CONSIDERW
UIJAAKU~S AVALID ICrME AC t . JOHN DAVID ' 4f° MA21ANNE ANDSZ'50N'
'
14Y To iN0!CARO H[RLON THE RUN
N( TO iM, Y'.SUI, fJY, Vq:UTA THE SV:VET
"fFARW. A1.0 O;. HIS UlIA[S TO H4 Al . r:YIf COAMAI: Y, u V[A , sir•,AL h NCY AN, `
i v V C.9 L _ ;
~n+R wus.;:..as •;E . D:xG INSP. Q 3 11-1
~ ^ , WA[At6:`,L .4' , ~ql tM16T:[A.. }1
::.u„..1:5OR SUbSFOUC' ISOVJN S0U'l%-i0LG, N. ~1•. '
SL
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Ti+1e N9 O"r-87766 AmBrtdec~ Mar.1Z,th8a•
PATE I~ i.. 1. ;Kt't L N T.~
'OUNDATION (1st}
)UNDATION (2nd)
I o
UGH FRAME & 14
-PLUMBING
H
m
m
LATION PER N. Y.
STATE ENERGY I F
CODE I C*4
16
d
FI41AL 2,- el'o f,a"
O
/Oil
ADDITIONAL COMMENTS: x
. x
•v
H
O 1n
m
r
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• v
• m
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H
M-1802
UILDING DEPT.
1 NSPECTION
[ ) FOUNDATION 1ST [ ) ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS: lvz&ez
' , r
DATE INSPECTO
BOARD OF HEALTH
ti a(( FORM NO.1 3 SETS OF PLANS
TOWN OF SOUTHOLD SURVEY
MAY i~ 2 BUILDING DEPARTMENT CHECK .
TOWN HALL SEPTIC FORM ,
1 l SOUTHOLD, N.Y. 11971
TEL.: 766-1802 t:OTIFY.9~
&~~~1. rs a ~~"z CALL . 7.
/y
Examined . !.L . 197.- MAIL TO :~'L7 7 - 21-110
Approved ..3 , 19~~Permit No.. .
Disapproved a/c
x~
(Ubil b Inspector)
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.
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner ofpremises ~v~irl , t1, a~,?YSGr y~ //a y j ¢n(te,a~ ~l~yS,on „Cd~
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
P ~
(Name and title of corporate officer)
Builder's License No. ~.~C.. .
Plumber's License No. ........./p.............. .
Electrician's License No. ......//.///v
Other Trade's License No. !.V a
1. Location of land on which proposed work will be done .
..9s..........ink..~Q~~ ..........................C.vrc:/~
House Number Street H[~amlet /
County Tax Map No. 1000 Section ~1...... Block cc~~... ( Lot I~'..`.... , .
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 ,h. r. ! ~u .r.? .
b. Intended use and occupancy ...~~!.~..i,. aaF''a,reta~ ~.&5
w.,,.. ~ X n;~, k•`4<3: sirs$'~ " i;4•yw"~ BY4T"i1~
3. Nature of work (check which applicable): New Building Addition Alteration : .
Repair Removal Demolition Other work ...a e. C .
(Description)
4. Estimated Cost ODO: Fee . : dry
(to be paid on filing this application)
S. If dwelling, number of dwelling 'units Number of dwelling units on each floor ......1......... .
If garage, number of cars .
If business, commercial or mixe occupancy, specify nature and extent of each ty~e of use ...N~,
7. Dimensions of existing structure's, if any: Front 6 Rear a Depth , , , , , , ,
Height ;Y, ~ Number of Stories ......a .
Dimensions of same structure w' • .
4th alterations or additions: Front . . . . Rear
Depth . g Height Number of Stories , , , , , , , , , ,
8. Dimensions of entirg new construction: Front -6:;~ f r..... .Rear 1. o•
Depth . .
Height !O. ) t1G. Number of Stories 0
9. Size of lot: Front / Rear ......9. I.............. De th S, /G7Ja ,iv, . >SH, :yi, .
»,;c ae/.J °
101. Zone or use district s. . a //i,..... , ' ...Name of Former Owner ~-.~~.n...~~.~.~,~:
in which premises are situated /Y
12. Does proposed construction violate any zoning law, ordinance or regulation : v'o..... • .
13. Will lot be regraded 'ill/ IV P Will excess fill be removed from premises: Yes
14. Name of Owner of premises J?J4, y; dMere ,ry;ejltidfvsoaddress vePhone No... r3 y' ,Gi9i
Name of Architect Address Phone No... .
property within 3 Address Phone No................ '
15. NaIs this me of
00 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 dumber or description according to deed, and show street names and indicate whether
interior or corner lot. j n Ter i 'br ~O r
pl
A)ROED AS NOTED
CtAlEr MR 2+1aL~~
NO~'IFN B111L, I L)EPAR AT
TG -t80'l. ; AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3. INSULATION
4. FINAL • CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y.
STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
STATE OF NEW
COUNTY OF K.... S'S
d'rvidual si L~ ~~r1 ' ' ' ' ' • being duly sworn, deposes and says that he is the applicant
Name of individual `
gm ij 9 contract)
above named •
+leisthe..,.... G~.....
(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. Iii rnCll
19 .~5
Votary Public, . County
C
UNDAM.TONYE9 % ~j<<;:L.........
taM of NewyW (Signature of applicant)
No. 494288& Suffolk Cony
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LICENSE 4GREEMENT~y TC =EMENT TO US/~E 100.200'
PORTION OF PROPC-27Y PURPOSES GRANTED PROPEFTY FOG P42I4MG II ;RANTED 7`0 MRS, Q i
X 1 ORI P({p„CY OR P4 TRIC/A ORPS505 O 2'05505 ON NOV. 27, 1977 ~I
- 21Z TAA/k' USE IS UNLAWFUL
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