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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-21052 Date SEPTEMBER 29, 1992
THIS CERTIFIES that the building ADDITION
Location of Property 845 COREY CREEK LANE SOUTHOLD NEW YORK
House No. Street Hamlet
County Tax Map No. 1000 Section 78 Block 4 Lot 23
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 28, 1992 pursuant to which
Building Permit No. 20661-Z dated MAY 28, 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 TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to PETER J. & EILEEN M. HUGHES
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
J- Xe-lr~
Building Inspector
Rev. 1/81
1
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)
N°° 206612 Date ...a.......................... 19.
Permission is hereby granted to:
d
.........r.
to
. .......~......lr.. . . r....
at premises located at .........t 5 ~ 14/3
4 R. I-d............... :.,Yr............................................
.
County Tax Map No. 1000 Section Block . Lot No... 47-4
pursuant to application dated 1.91'44J...cT . 19..1, and approved by the
Building Inspector. /
Fee
wilding Inspector
Rev. 6/30/80
Form No. 6 i;i~~.•`fi[..='.~.>>,~: 4;,
'~f s TOWN OF SOUTHOLD S EP e
BUILDING DEPARTMENT SEP 2Ct ~ 199
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..Q S-.~
.1. I;5 4)' ,ANA C5Q( W-49406.....
House Noo,., q/ Street Hamlet
Onwer or Owners of Property.%e,~~ .i)..~~e, l/44:, A.ha6/l,9~
County Tax Map No 1000, Section .Cl...... Block Lot
Subdivision ....................................Filed Map............ Lot
Permit No.,24.441.,,Z..Date Of Permit. 6/. Zc~~yq~,,Applicant.;9r .4 . e,, .".4. ,.4s
Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate...X..
Fee Submitted: $
'q7~J .
AP
INSPECTORS
Victor Lessard 3UFF01
Principal Building Inspector e0' ~
Curtis Horton 4 SCOTT L. HARRIS, Supervisor
Senior Building Inspector
" 'w }
Southold Town Hall
Thomas Fisher
Building Inspector d c ' ni P.O. Box 1179, 53095 Main Road
Gary Fish A>>O~ -R 1 Southold,
Fax (516) 765-1823971
Building Inspector ` Telephone (516) 765-1800
Vincent R. Wieczorek
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
SEPTEMBER 23, 1992
PETER J. 6 EILEEN M. HUGHES
845 COREY CREEK LANE
SOUTHOLD, NY 11971
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
In An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
>3~% 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 # 20661-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
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FOUNDATION ( 1 s t )
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?OUNDATIOiJ (2nd) Ed _ Cyz
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SOUGH FRAME &
-PLUMBING
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Li1SULATIO,t PER N. Y. H
STATE ENERGY
CODE
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FINAL
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ADDITIONAL COMMENTS: m
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M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUG PLBG.
[ ] FOUNDATION 2ND [ ) IN LATION
[ ) FRAMING [ FINAL
REMARKS:
DATE INSPECTOR ,
i
(INSPECTORS 7 5802 o~~SpFF014,
VICTORLESSARD,Principal SCOTT L.HARRIS, Supervisor
CURTIS HORTON, Senior y Southold Town Hall
VINCENT R. WIECZOREK, Ordinance p ^x+ P.O. Box 1179, 53095 Main Road
ROBERT FISHER, Assistant Fire y • Southold, New York 11971
Building Inspectors Fax (516) 765-1823
THOMAS FISHER Telephone (516) 765-1800
GARY FISH
OFFICE OF BUILDING INSPECTOR
TOWN OF SOUTHOLD
STOP WORK ORDER
TO: PETER J. & EILEEN M. HUGHES
12 Windsor Place,
Lynbrook, New York 11563
YOU ARE HEREBY NOTIFIED TO SUSPEND ALL WORK AT:
845 COREY CREEK LANE SOUTHOLD N.Y.
TAX MAP NUMBER - 1000-78-04-23
Pursuant to section 100-283 of the Code of the Town of
Southold, New York, you are notified to immediately suspend all
work and building activities until this order has been rescinded
BASIS OF STOP WORK ORDER:
DECK ADDITIONS AND REPLACEMENT ARE BEING DONE
WITHOUT FIRST HAVING OBTAINED A BUILDING PERMIT
CONDITIONS UNDER WHICH WORK MAY BE RESUMED:
WHEN THE BUILDING INSPECTOR ISSUES A BUILDING
PERMIT TO YOU.
Failure to remedy the conditions aforesaid and.to comply with the
applicable provisions of law may constitute an offense punishable
by fine or imprisonment or both.
DATED : MAY 20, 1992
V (.1tif.~.~~ tX ~[Rca.
VINCENT R. WIECZOREK v
ORDINANCE INSPECTOR
I'
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST ( I ROUG PLBG.
[ ] FOUNDATION 2ND [ ] IN LATION
[ ] FRAMING [ FINAL
_LI =
REMARKS:
Z
,
r
DATE ~l71 INSPECTOR
5 co JZr~~ C~~~ L
5 o u `r ~+o L.~ ~ Kk, 765-1802
7 _ BUILDING DEPT.
1 NSPECTION
[ ] UNDAT 1ST [ ] OUG LBG.
[ ] FO DATION 2ND [ ] 1 ULATION
[ FRAMI ) FINAL
REMARKS: b n Nn I c 6 w-r t 4(4,5-
A- 2u t uh t kc6% ~ttE-Cyl~ L T t s N61-6
DATE J 9,~INSPECTOR '
i Im_-
Ar-
~rn / I STATEMENT OF INTENT
tJ / THE WATER SUPPLY AND SEWAGE DISPOSAL
D~ cf,? SYSTEMS FOR THIS RESIDENCE WILL
_r +
DtpXFT16 CONFORM TO THE STANDARDS OF THE
T
couNTY So ,iaS
SUFFOLK CO. DEPT. OF HEALTH SERVICES.
A su AUG 1 1983 R• D. #L--~~ (S)
APPLICANT
water SuPplYT -
n
a rr.l The SeanFf d=spoe°1 p° h TGT11nd ySUFFOLK COUNTY DEPT. OF HEALTH
and
faclli' =department ~.nn I^'CSERVICES - FOR APPROVAL OF!
+ SnSPeCte t for Gl CONSTRUCTION ONLY
' Tel to be Setis.ac tLEn6lneerln3 DATE
O General _ S Q _ t
p Chlef •f services H. S. REF. NO.
A / 7 17 i~V<l~ APPROVED:
t i SUFFOLK CO TAX MAP DESIGNATION: j
!O~ E. DIST. SECT. BLOCK PCL-
B6 ~Y c~ iono 4
\g n OWNERS ADDRESS:
of Z3
t y `
fl~l Al ,
W
DEED: L. n/. A. P.
3(~ ~~`6ools _ TEST HOLE STAMP
,f r r 4t $ r y, ; ry' II AVTIouuu ,..i..•..~n L!E ADOmoA /J1 `7 ;t. TL EO THIS SURVEY IS A VIOLATION OF
1,' 4 Y+`~ C~ ' - g j, V - SWOON 7109 Of THE r?FM' YOU STATt
EDULAnON LAW.
O/ 30 t \ r r ri ,.i 1 FOPIES OF THIS SURVEY ~ NOT a..,.,
THE IAFSJ SURVEYOR'S INRED SEAL
"7 r, ^ EMROSSm SEAL SHALL NOT NOT RE CONS' W_
' i 'i ~f! C~ ' ? "'i f [O BE A VAUD TRUE COPY.
/..Or/. /may, `~J GUARANTEES INDICATED HEREON SHALL a""
(Vac Arnencled Jr,". ZST 198 " ONLY To THE PERSON FOR WHOM THE we
t ?u / y 10, 1983 IS PREPARED, AND ON HIS BEHALF TO M'
TITLE COMPANY, GOVERNMEMAL AGHW"
( f tENDUIG INSTITUTION USTFD HEYON,
f TO TXETN1YASSIGNEES OF THE LMOMO Ir
. ` ~ ARE NOT TRNtS+
. ~ n. / fU,. WASAMETES ~u•. r. •1/ I •O ADDITION
61711 .wNFeT. I
GV rq s l SEAL
-/es Lo/ nuw6efrs shown ,re-(<, r 7110 '11,171C 0~
G reek ~•s ~cY ~c s >~Y /el,~ i H G ..JGr ~T c, ~k G-oc~r- ~ f . ~r ~ ~.E u C. T>~. ~ . r _ cl
o f~'4~ GtS P, ?R ~I QNS 5h0 11i ?J e" tROD~Ri~K VAN TILYL. P.C.
~r p•in.,.rte 7z en rrt~~an sea level •-~c Q
x 4 LICENSED LAND SURVtYORS
' 1,u,Ts GREENPORT NEW YORK
3 F -5 .yb 7.tr'. it.Y9~'I,
~w BOARD OF HEALTH .
D D FORM NO.1 3 SETS OF PLANS
TOWN OFSOUTHOLD SURVEY
MAY 2 210 BUILDING DEPARTMENT CHECK , .
TOWN HALL SEPTIC FORti
BLDG. DEPT. SOUTHOLD, N.Y. 11971
TOWN FSOUT LD- TEL.: 765-1802 rIOTIFY:
7 CALL . .
Examined ..!'/....!l):B 19n7. MAIL TO
Approved . d.1 197. L Permit No.
Disapproved a/c.. _ .
~~y~?
(B no. Inspector)
APPLICATION FOR BUILDING PERMIT
Date
INSTRUCTIONS Q
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
.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
2egulations, 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
idmit authorized inspectors on premises and in building for necessary ins ? oo S.
(Signature of applicant, or ame, if a corporation)
~~f f Corey CNeel< Lq .s.u.....~..
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
0W 7t e I^'
Name of owner of premises ~C; 2W ~(t {t2S `I? ~I feeA M yu `(GS
g g.....
(as on the talc roll or latest deed) (aP:ail IVE0 A NOTED
[f applicant is a corporation, signature of duly authorized officer. C?AI`E < ~Z~ a.P #e~p Ln
FFE: n-o~ork3Y; _ '
I . • • • • • • • • NOTIFY € L Pi.OIN(; OE PAR MENI"F AT
Name and title of corporate officer 765-11302 c% AM TO 4 PM FOR THE
FOLLOWINGi, INSPECTIONS:
Builder's License No . 1. FOUNDATION - TWO REQUIRED
FOR POURED CONCH ETE
Plumber's License No . 2. ROUGH - FRAM NG & PLUMBING
S. INSULATION,
Electrician's License No . q FINAL _ CON''IRUCTION MUST
BE COtt PLFTF, FOR C,O.
Other Trade's License No . ALL CONS'-RO CTION SHALL MEET
THE REC IAREMENTS OF THE N.Y.
I. Location of land on which proposed work will be done . STATE . J'Q xTRUCTION..&. ENERGY .
froDrSLA- g~f ............ea.we~ ~'Neek lane........... JUCCTI()XEBRORS..
House Number Street Hamlet
County Tax Map No. 1000 Section .....7. F Block Lot....-2.3 .
Subdivision 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 k,.k.I-! "4-41
.
b. Intended use and occupancy r.... . . .
3. Nature of work (check which applicable): New Building Addition Alteration i .
Repair Removal Demolition , Other Work .
~ rr
4. Estimated Cost ...r d ~~d .,description)
} Fee ...V.~~. a
5. If dwellin number of dwelling un, (to bepaic oan.Filing this applipation
,
g. its . . Number of dwelling urri'ts'dit 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 structures, if any: Front • • . Rear • Depth • .
g
Height Number of Stories
Depth wth alterations or additions: Front Rear
h . . . .Dimensions. .of. . same structure Height Number of Stories
8. Dimensions of entire new construction: Front • Rear Depth Height • . Number of Stories .
9. Size of lot: Front Rear Depth .
10. Date of Purchase • • • Name of Former Owner .
11. Zone or use district in which premises are situated .
12. Does proposed construction violate any zoning law, ordinance or regulation: • .
13. Will
• • . • • • Will excess fill be removed from premises: Yes No
14. Nameoof g Owner of premises PC P
.Hu.9.k4S...Address~fdt'o~yCNeek.LO.PhoneNo. 74S'`44~....
Name of Architect j Address Phone No............... .
Name of Contraactory within 300
Address Phone No............... .
15. Is this property artSouthold To feet of a tidal wetland? *Yes No.~.....
*If y , n 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 number or description according to deed, and show street names and indicate whether
interior or corner lot.
i
i
iTATE OF NEW ORIK
O NTY OF .
~e">L2 W • • being duly sworn, deposes and says that he is the applicant
(Name of individual signingicontract)
above named.
le is the L(1i.r......................... .
.
(Contractor, agent, corporate officer, etc.)
-f said owner or owners, and is duly authorized to perform or have performed the'said work and to make and file this
pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the
Mork will be performed in the manner set forth in the application filed therewith.
Worn to before me this
~
ay of„j. 1 19.07
votary Public, .~C County
CLAIRE L.. Olke If
Noaary Public, State of New York
No.4878508 (S ature of applicant)
Quelifled in Suffolk County
Commiealon Expires December 0,18