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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-22354 Date MAY 24, 1993
THIS CERTIFIES that the building ADDITION
Location of Property 28265 MAIN ROAD CUTCHOGUE N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 102 Block 5 Lot 6
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 22, 1992 pursuant to which
Building Permit No. 20976-Z dated SEPTEMBER 23, 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 (RETAIL STORE) BUILDING AS APPLIED FOR
The certificate is issued to OLD TOWN ARTS & CRAFTS
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-276267 - MAY 17, 1993
PLUMBERS CERTIFICATION DATED N/A
ui1 ing Inspector
Rev. 1/81
I
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°N9 2097O Z Date 3 19. E
Permis/on hereby gr ted to:
....c.°~
;
....12.
at premises located at ....r
County Tax Map No. 1000 Section ....lp 2:....... Block .........177. . Lot No....,st
pursuant to application dated ....9& 191...2 and approved by the
Building Inspector. '~G 9~~/gZ
Fee .
/yJo2~
j. uil mg for
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD `i ( c0. 0
BUILDING DEPARTMENT
C? 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 $15.00
Date
New Construction........... Old Or Pre-existing Building.............
Location of Property...... a'K ~.~'7.... ~~:1t?..R.) C.qb:A9e
House No. Street amlet
Onwer or Owners of Property... 00 Towfv.. gR 4.
County Tax Map No 1000, Section [.Q.vC....Block... 5..........Lot...
Subdivision Filed Map............ Lot......................
Permit No..v 09 K Date Of Permit ................Applicant.............................
Health Dept. Approval ..........................Underwriters Approval./..........
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate...........
Fee Submitted: r U v
6:Q.C 7
. .
APPLICANT • • • .
C n ~ a a35 `f
THE NEW YORK BOARD OF FIRE UNDERWRITERS Flvt,
1000837
BUREAU OF ELECTRICITY
88 JOHN STREET. NEW YORK. NEW YORK 10038
Date f(AZ 17,199,3 Application No. on file 111.°ICfG}f1 ~i$/4zi ~ '>lfiz b";
THIS CERTIFIES THAT
only the electrical equipment as, described below and introduced by the applicant namedon the above application number in the premises of
OLD TOWN AIZT;; & (10FTa, 21265 ~-yR~AIN ROM), C'CiT'(:HOG'u, N.Y,
in thefollowing location- 11 Basement a 1st Fl. ? 2nd Fl. OUT Section Block Lot
was examined on R 1c I L 2.3 F 13 9 3 and found to be in compliance with the National Electrical Code.
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS ECEPTAGLES SWITCHES INCANDESCENT FLUORESCENT OTHER AMT. K W. AMi K W. AMT. KW. AMT. K.W AMT. H.P
131 17 7
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIALREC'PT TIMECLOCKS BELL UNIT HEATERS MULTI.OUTLET DIMMERS
AMT. K. W OIL H. P. GAS H. P AMT. NO. A. W. G. AMT. AMP. My. AMPS TRANS. AMT. H P NO SYSTEMS.OF FEET AMT WATTS
T
2 20
1
SERVICE DISCONNECT NO. OF S E R V I C E
AMT. AMP, TYPE EQUIP METER 1,e tW 1 IA t $ 3W 3,e ' 4W NO. OF CC. COND A. WCOND. G. NO. OF HbLEG A. W. G. NO OF NEUTRALS A. W. G
. PER.e OF
OF CC . . H6LEG OF NEUTRAL
1 1!i@ C'H 8. 1. :141 1 2!0
OTHER APPARATUS:
EXIT LIG,11'T- 1
seuD9 ~1Tw,c7'11r.c 9~ea1;c11 ~IC.~1~2r
175 381).071. f1G% 166
GENERAL MANAGER
9T. JARES, NY, 11780 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 BE ALTERED IN ANY MANNER.
• • ~ogUFFD(,~C
o ~
PLANNING BOARD MEMBERS W SCOTT L. HARRIS
Bennett Orlowski, Jr., Chairman Supervisor
George Ritchie Latham, Jr. O
Richard G. Ward ~a Town Hall, 53095 Main Road
Mark S. McDonald P.O. Box 1179
Kenneth L. Edwards PLANNING BOARD OFFICE Southold, New York 11971
Telephone (516) 765-1938 TOWN OF SOUTHOLD ' Fax (516) 765-1823
May 28, 1992
Shirley Haubner, President `
Old Town Arts & Crafts Guild
The Guild House
Main Road
Cutchogue, NY 11935
RE: Waiver for proposed
addition to building
SCTM# 1000-102-5-6
Dear Ms. Haubner:
The Planning Board has reviewed your letter of May 9, 1992,
in which you request a waiver of site plan application for an
addition to the above referenced building.
The Planning Board will not require,the filing of a site
plan for the 723 square foot addition to the rear of the
existing building. However, the addition must meet the required
yard setbacks.
If you have any questions, or require additional
information, please contact this office.
Very truly yours,
Bennett Orlowski, Jr.
Chairman
cc: Victor Lessard, Principal Building Inspector
' e
COKCRET5 'CESSPOOL
COVER 7° BELOW
~RrD /
LDCATC-ED 316 f 1985
> ~t)IL-T ABnOf 1959
t
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p SHAD ROOF
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5TY OPEN r~
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di ( CELLAR _ 2 51Y ~ PAR'S
Iz NTRY G E LL AR N t
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~ 28- 6 j
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a ~ n
50 ALE 1/8 1-0
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ENERGY C,'OUE REVIEW
r '
(non-electric)
7814 (Part 5) 6,000 degree•deys
For IQw^ ~ ~ (`'~~•J'/Per Dwgs
Dated ~A-/ i
r
Envelope Component R-Value
Exterior Wall R-18
Itoof/Gelling R-19
Floor R-19
Foundation Wall R-10
Slab Edge Insulation R-10
Glazing R-1.7
Entrance Doors R-2,5
All IIVAC Equipment to meet requirements of 7014.11
All IIVAC Controk Systems to meet requirements of 7814.12
All Duct Systems to meet requirements of 7814.13
All Ventilating systems to meet requirements of 7014.14
All Piping Insulation to meet requirements of 7814.15
All Service Water Ileating Systems and Equipment to meet
requirements of 7614.21
All Electric Systems to meet requirements of 7814.31
V'
1b the test of my knowledge,
belief# and professional
judgements these plans are
in compliance with the code
,of
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M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ J ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSU TION
[ ] FRAMING INAL
REMARKS:
II
DATE a INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROU H PLBG.
[ ] FOUNDATION 2ND [ INSULATION
[ ] FRAMING FINAL
REMARKS:
DATE 3 v j INSPECTOR vd
r j
1
i
i M-1802
BUILDING DEPT.
r
INSPECTION
[ ] FOUNDATION 1ST [ I ROUGH PLBG.
[ ] F UNDATION 2ND [ ] INSULATION
FRAMING [ ] FINAL
REMARKS: 1 G
DATE INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[FOUNDATION 1ST [ I ROUGH PLBG.
[FOUNDATION 2ND [ ] INSULATION
j ] FRAMING [ ] FINAL
REMARKS:
DATE Ia,~
-INSPECTOR
1~LD , :i ~~J l Ni m
-o .
OUIIDATION (1st) °
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m
OUNDATIO)1 (2nd) p3l
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OUCH FRAME &
.PLUMBING r t
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:NSULATION PER N. Y. I "
STATE ENERGY
CODE
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FI:IAL
ADDITIONAL COMMENTS:
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3VSETS vOF PLANS
FORM NO. 1 SURVEY TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC FORMAQ ~
TOWN HALL wa~~ I-e L
SOUTHOLD, N.Y. 11971 NOTIFY -7 •
TEL.: 765-1802
q MAIL TO
Examined ..9.. a3...... I Y/.
6"')
Approved *~Ji 19!qqPermit No.02ei,9,2~. r
-27
Disapproved a/c r~ SEp 2 2 1919~-
~t1
ilding Spector)
APPLICATION FOR BUILDING PERMIT
Date ...q.I 19TZ
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 ulations, and to
admit authorized inspectors on premises and in building for necessary inspection
(Signature of applicant, or name, if a cox oration)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
........................(.~.....~.............1
Name of owner of premises
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED
Builder's License No .
Plumber's License No . .
Electrician's License No .
Other Trade's License No./ I_.
1. Location of land on which proposed vork will be done .
A r) 04-p C vrc. ~~.c-c<e.................
Z. 6.5 / ~3~~ .
House Number Street Hamlet
County Tax Map No. 1000 Section ~..7 Block Lot &
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 rr'.~.=. r'.. ; - ? . .
b. Intended use and occupancy ...../.~rri .&I. . .
3. Nature of work (check which applicable): New Building Add'tio Alteration
Repair Removal Demolition Other Work
(Descriplion)
4. Estimated Cost ..vim. Fee f1~.~~............ .
` (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, commercial or mixed occupancy, specify nature and extent of each type of use .
7. Dimensions of existin structures, if any: Front L Rear .3. Depth . 1 .
Height Number of Stories Z .
Dimensions of same structure with alterations or addition Front Rea .75.......... .
Depth 7~ F." 4.......... Height ....2.I Number of Stories
8. Dimensions, ofdentire Fnew construction: Front Z.FL Rear .?.4.'~ Depth 7:1.-A
Height ..~.d..: Number,of Stories ..................r...............
.
ear S. orb:.......... e th 2-b. t..'.. .
9. Size of lot: Front .....b. Rear''..-
10. Date of Purchase 14. S.3 Name of Former Owner 174. / , ! .....~t a<t,~.-. !Ni PD
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 . P. Will excess All be mov d from premises: Yes No
14. Name of Owner of premises VFW? Tflwg! 467YO ddress 00fk MD... L?X#Phone No.734(; • . • • • • .
Name of Architect Address Phone No............... .
Name of Contractor la .?1?.. ?...Address Phone No .
15. Is this property located within 300 feet of a tidal wetland? *Yes .....No
*If yes, Southold Town Trustees PermitPLOma b
~ e required.
MLocate 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
anterior or corner lot.
4L--c:: !"t r 7r c H L~7
STATE OF NEW YORK, S.S
COUNTY
b - being duly sworn, deposes and says that he is the applicant
q~ . (Name of individual signing contract)
Above named.
Heisthe
ontractor, agent, corporate officer, etc.)
Df 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
Se }e~'~er.....19
dotary Public, , Y:ounty o~` N
(VV1~
J E R. MINERVA .
NOTARY PUBLIC, State of New York (Signature of applicant)
No. 4853108, Suffolk County
Commission Expires February 18,19T.Z-
! vl T Nu,rL l` 1 I lllf FENCE
PENNY+4 KATE CRAW- D
CUTCA0 C~ UE , L. I. N.Y I
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NE-5 FRoM SURVE f BY
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w. YO UN q , L. S.
.CH 1939
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C.o-r ai c. ROZN~ED6t2 19 5
s 38°qa'w 176.56'
r'
ENERGY CODE REVIEW
(non-electric)
7814 (Part 5) 6,000 degree days
For Old /,Per Dugs
Dated ~~rL7 j
Envelope Component- R-Value
Exterior Wall R-18
Roof/Ceiling R-19
Floor R-19
Foundation Wall R-10
Slab Edge Insulation R-10
Glazing R-1.7
Entrance Doors
R-2.5
j
All IIVAC Equipment to meet requirements of 7814.11
All 91VAC Control Systems to meet requirements of 7814.12
All Duct Systems to meet requirements of 7814.13
All Ventilating Systems to meet requirements of 7814.14
All Piping Insulation to meet requirements of 7814.15
All Service Water Heating Systems and Equipment to meet
requirements of 7614.21
All Electric Systems to meet requirements of 7814.31
7b the best of my knowledge,
belief# and professional
judgement, these plans are
in compliance with the code
t of NEW yp
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IpI7 ~~r°1.5 P~ Al R0 ED AS NOTED 'ED UNDERWRITERS CERTIFICATE
DATE-9 i3 yB.Ra G' G REQUIRED
zn u~ /?i n~^^p f! I. FEE:
'a Non / BY BOIL 1 G DEPA T Al OKENT Al
+ " r p + 786.1802 9 AM TO n PM FOR THE A FOR THE ,,,of NEW
~pc:nil',Rrr/ SKr NGE .TG0
nll,nrr~ ' o - ~fl i. Cn ._M1• ..~I.. i."'~7.6_ I~~1r~ U !((;j.6J a ~~G t r+ MN4'c~ l ZOF R ROUGH - POURED FRAMING rF s F • e C r
F- 7 d' I , 1 ' ft P UId ,V,"ii ~LUN/.+PJEi r ~ c
3 msULAVION ( w r
q, FINAL - CONSTRUCTION MUST TION MUST ~ ~~FQ 0322641 ~?(V
{ BE COMPLETE FOR C O TALL MEET i \~AOFES]IEMn~
2+5 f, 8-m. 6 -K ALL CONSTRUCTION SHALL MEET F THE N.Y, t
THE REOUIREMEMS OF THE N.Y. N Yp 5 s++ mod?-`- M STATE CONSTINCIION B ENERGY!"
CODES. NOT RESPONSIBLE F0~ 51BLE EIF (0ti
t 1 r - e. d C its2G~ DESIGN OR CONSTRUCTION ERRORS ON ERRORS
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