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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-23664 Date MAY 25, 1995
THIS CERTIFIES that the building ADDITION & ALTERATION
Location of Property 975 INLET LANE GREENPORT, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 43 Block 2 Lot 2.1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 11, 1992 pursuant to which
Building Permit No. 20629-Z dated NAY 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 & ALTERATION TO EXISTING ONE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to ANNE LAWRENCE & ORS. `
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-313428 - MAY 10, 1994
PLUMBERS CERTIFICATION DATED SEPT. 13, 1994-K&K PLUMBING & HEATING
Building Inspector
Rev. 1/81
FORM N0.2
TOWN OF SOUT14OLD
BUILDING DEPARTMENT
TOWN HALL
SOUTH OLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
19
NMI 20628Z fate
3
Permission is hereby granted to:
.
L4
to w::....
• r
i pp
at pre YS located at
i M•.• aaaa a.•...• ......•.....•••............r..
.
County Tax Map No. 1000 Section Block Lot No...... z............a..
pursuant to application dated 19..~~! and approved by the
,E Building Inspector.
t
i Fee 3....7.~:
i
l
.
din Inspector
3
Rev. V30l80
Form No. 6 ~
T ' ' ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL /l ~lvd'
765-1802 !v
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
a. 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 Buildina - $100.00
3. Copy of Certificate of Occupancy'- $20.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date .A ./.f'.
New Construction........... Old Or Pre-existing $uil'd'ing ~./.7-/.Q(?
Location of Property...... q 1.2~.././y.< z1h+I.~...~%A.O~R.7
House No. Street Hamlet
Onwer or Owners of Property....Ce!°~5~~~,Q
County Tax Map No 1000, Section W.-.5..... Block " ....Lot.................
Subdivision .Filed Map............ Lot......................
Permit No... .9 Z-. Z Date Of Permit.. /S .ApplicantA1eV-Sf( S~.
Health Dept. Approval. .........................Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate...........
Fee Su~mitted• $
gS37 ol~
2 G
LQ GT J 6 APPLICANT.
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~ 4~~1fU~C ~~L/ i18Sr~OVif~~~x ~n~`~3{5~"S•°a~ii
TOWN Or SOU'THOLU
t OF ICC Or bvlLblFrc wsreCTOtt ` yE 4
P.O. BOX 729
TO%VN HALL l
i'i ~!O! 1 t rfl0 SOUTHOLD,N.Y. 11971
~ t
a Y 5
C C R T I F I C A T I O N
' bate
Building Permit No.
Owner
p ease print) i ( oas eLDG• CEP '
i p e print) y~ l SO
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. 4tZ°:v Vii:
p 4;
fly !il
olx
,Ek 2 certify that the eotdmr used in the water eu 1' '
}contains lesg than 2/10 of 1% pp y sy'stli
lead.
t a,.
i (plumber's signature)
Swern t zf
to beforo mo this
,day of .
19C~ q
flolar s 1 N my Pubiic
t Y 1 ubLlo Count• 1 i+ q
JOYCE M. WILKINS
Notary Public. State of New York`
No. 4962246, Suffolk Coun ~f
Term E;o1reqJune 12, * !
{
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FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
~1~1+,; • SOUTHOLD, N.Y. 11971
T 765.180
Examined ......1197 y Rece iveld........... , I9.. .
Approved ....Y?/ 19,". ermit No.
Disapproved a/c .....................................~!jQ 0
uil1ng Inspector)
APPLICATION FOR BUILDING PERMIT
4 -
Da te 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-
catign.
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 ins ection . i2v? cttt 13ULr u
~At want - Brw,30/ra&A,
1....
(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.
~ aC. kA t'fvf .
Name of owner of premises ...b!V.Zft. A..iMPAS .
(as on the tax roll or latest deed)
If applicant is it corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No. O. f/11 `1. 3'~JI F ~ • • .
Plumber's License No .
Electrician's License No .
Other Trade's License No .
I. Location of land on which proposed work will be done .
~;~ur~. .at1.. `~.'7,~ . ,~iv,^'.~T .Fa.~... ~/~?~inmzr .
House Number Street Hanilet
County -fax Map No. 1000 Section R~ 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. Fxisting use and occupancy S'. .R. .
b. Intended use and occupancy
Addition f/• • • • • • • Alteration
Removal ble): New Building . . . . • Other Work .
k which
Repair of work .check whi Rch appal Demolition .
(Description)
4. Estimated Cost Fee
O 00 o
(to be paid on filing this application)
5. If dwelling, number of dwelling units . . . . . . . Number of dwelling units on each floor 7'""......... •
/ .......I...........
If garage, number of cars ........I• • • • • • • • . • • • • ,
6. If business commercial or mixed ocpupancy, specify n tirr~ an . . d . extent . . of each. ~e of use .llN~A: •3 I•
7. Dimensions of existing structures, if any: Front Rcar
Height X5,1. Number of Stories .
Dimensions of same structure with alterations or additions: Front . • • • • • • • • Rear . . .
Depth Height ! 7~... I Number of Stories .
8. Dimensions of entire new construction: Front t IA.... • • • • • Rear Depth ! .
t
Height Numberlof Stories P... 22?............... 11
Rear W . . De th
9. Size of lot: Front 2Qv. •1•
10. Date of Purchase Name of Former Owner ..2li3a:~T : : : : .
11. Zone or use district in which premises are situated
./..40
12. Does proposed construction violate~any zoning law, ordinance or regulation: .
13. Will lot be regraded .....a . • • • . • • • Will excess fill be removed from premises: Yes
14. Name of Owner of premises j6.1A M7?0 n•ye • • • • Address P100%.~45 t ....08..tJ.v. ,Phone No..~q .3 Z
d . , ...Address ..Phone No..
Name of Architect /L~3ir/5 ~52~b$T~~/Ic33~/?~~27 Phone No.. LC77'l~ok •
Name of Contractor ........5. • • • • • • • Addr s
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 whetfh, er
interior or corner lot. j
~ ~ ~~Vcc9xJ S
~I
STATE OF NEW S
COUNTY OF.
• • • • • , • , , , , . , being duly sworn, deposes and says that lie is the applicant
r /ZZ p W ,J $
(Name of individual signing contract)
above named.
.
He is the......... L
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have perforned 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 marmet set forth in the application filed therewith.
Sworn to
before me this da of
Z 9 y 199 2
Notary Public, . Count`
..........V;.~.-
(Signature of applicant)
E
' $USANNE J. pERRI
N~OTARY PUBLIC, Stato of ew Yorli
No. 4882799
Qualified In Suffolk County '
Commission Expires Jan.20, 19q 1 3
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765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSU ON
[ ] FRAMING [ AL
REMARKS:
DATE INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSU TION
[ ] FRAMING INAL
ARKS:
6 Y4,90",
U
DATE INSPECT0
77
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ INSULATION
[ ] FRAMING [eflNAL
REMARKS: 1z
DATE 7 INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] IN ULATION
[ ] FRAMING FINAL
REMARKS:
DATE 5 Z 5- INSPECTOR Z/C 7W
M-1802
BUILDING DEPT.
?XV,-ANSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING "RML
4 z
REMARKS:'
DATE Z INSPECTO a
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST ( ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
DATE / ` INSPECTOR vj
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS: zcl~-
DATE INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[4*RAMING [ ] FINAL
REMARKS:
v-L,-- aFA
DATE INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUN ATION 1ST [ I ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
L
[ ] FRAMING [ ] FINAL
REMARKS:
.QZ
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DATE / `~2 - INSPECTOR f
M-1802
BUILDING DEPT.
1 SPECTION
] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
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76 785-1802 B AM TO 4 PM FOR THE client/owner. FOLLOWING INSPECTIONS.
n FO
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FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING 3. INSULATION M/~lj. %YRNE~9.
, 3. 4. FINAL - CONSTRUCTION MUST O G/VV14~ JeCAP
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• =o ALL CONSTRUCTION SHALL MEET W N y ~~4
=y P _o ~y y .~a'„__ ~e-iT nr~~ cnr~~ USE IS UNLAWFUL AL WITHOUT CERTIFICATE TH THE REOUIREMENTS OF THE N.Y. STATE CONSTRUCTION d ENERGY N
- 9 N ~ tPmiiuNt7aw CODES. NOT RESPONSIBLE FOR
¢S OF OCCUPANICY co DE DESIGN OR CONSTRUCTION ERRORS
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