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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-23484 Date FEBRUARY 6, 1995
THIS CERTIFIES that the building ADDITION & ALTERATION
Location of Property 2745 PINE TREE ROAD CUTCHOGUE NY
House No. Street Hamlet
County Tax Map No. 1000 Section 104 Block 3 Lot 6
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 2, 1992 pursuant to which
Building Permit No. 20689-Z dated JUNE 5, 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 AN ADDITION & ALTERATION TO AN EXISTING ONE FAMILY DWELLING
AS APPLIED FOR.
The certificate is issued to ROBERT KITTREDGE SCRIPPS
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N255907 NOVEMBER 5, 1992
PLUMBERS CERTIFICATION DATED SEPTEMBER 13, 1994 K & K PLUMB & HEATING
Bui ding Inspector
Rev. 1/81
F{
FORM NO. f
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°-N° 20668Z Date 19z
Permission is hereby gran d to:
J.X,~- aA ;as
......~-~.....q......s...
19 a-'s,
Ala.... ~-344..................................
at premises located at ..t.T~.. v~.......~ ~f !?ses.LJiA w
~-5 S .
,II
County Tax Map No. 1000 Section .../..0..7......... Block ..Q...Z........... Lot No. Q.~
pursuant to application doted A4-r)-9 ATI~ 19.1.4 and approved by the
Building Inspector.
Fee &46....a.......
.
k Qmg
Inspector
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD(
BUILDING DEPARTMENT ¢~ls;
-I TOWN HALL "F t f
o3Lv~~S32- 765-1802 1 8 - f .
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G. DE PT. R
CCSSf~7S) APPLICATION FOR CERTIFICATE OF OCCUPANCY R~s _ TOVV Byp LDpS0UTy0L0
A. Th s application must be filled in by typewriter OR ink and submitted to the building
1 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 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 Buildine - $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 f,t../..
New Construction.........., Old Or Pre-existing Building.......
Location of Property..... 7.Q
House No. / Street Hamlet
On,..rer or owners of Property..... r'010 'r , _ , . , ...pp . . . .
County Tax Map No 1000, Section ljQ'f Block 4V.,~ ....Lot.....~,~?............
Subdivision .Filed Map............ Lot.......
Permit No... ,-..99 ,..7 e Of Permit. Y'.(' ....Applicant...
Q.Q1-(.a:1`!/Y~
health Dept. Approval .V,A „ ,,,,,,,,,,,,,,,Underwriters Approval...... z
Planning Board Approval.... IV
3equest for: Temporary Certificate........... Final Certicate....
gee Submitted: ,ed
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TEL 1
TOWN OC SOOTHOLD
Or r1CC OIr UUILbINO INSPECTOIt
b }I vW . ' r P.O. BOX 728
O~~ t?? TO%VN IIALL 1
SOUTHOLD, N. y. 11971
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C E FZ T I F I C A T I O N
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Building permit No. ~`dO`~~Z [ Owner
p as pr ntl:46
plumber L6rJ. Du PT
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. Ip ease printl_zow~OFS~t~Tt~GLts_ ,'t.4,
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t certify that the sotdnr used in the water bupp1 b bt1aM
'~Cehtiling lb9g than 2/10 cif lA lead. Y Y
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I. Sworn to befcrh a" tthhis
day of
9
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flolary NubLia~ otary publiq.~_
ounty
JOYCE M. WILKINS° r
Notao.4952ry Public, State of New York 4a .s#S
N246, Suffolk Cou~~yFtl, x
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c~~~FU(~C TEL.163.18o2~.~
O M„ Old TOWN OF SOUTHOLD '
°~•e OfFICC OF bUtLbIPfC INSPECTOR
P.O. BOX 728. t
p c TOWN HALL A ( 1 0~` i ,'e {
SOU'ritOLD,N.Y.11971 a
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BLDG. ~SEK,
TOWN O SOUT'NO-0
C E R T IF I C A T I O N ? i rt
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' Building Permit No.
Owner p e a se mac..;
print)
Plumber
-51
(p ease print?
fi rn'
I eorti£y that the sotder used in the water supply system
;Contain8 14188 than 2/10 of 18 lead.
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(plumber's signature)
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r"Swo2n to before mo this F(
day of 161 Q d`C/L '
19&
Notary Pub is
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CLAIRE I . r l ON
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y oknCy irublla~ County Not9ry Public, State ofNewYork
No.4879505 f
1 1,
Quelified in Suffolk County f
Commission Expires December 8, 19
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Form No. 6
a ~ - TOWN OF SOUT110LD
BUILDING DEPARTMENT
TOWN HALL
M5
765-1802
Tr~yUtvi•a' 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 1.7 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 Buildin¢ - $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 ...,JANUARY 27,,1995
New Construction....R Old Or Pre-existing Building
Location of Property.. PINETREE ROAD CUTCHOGUE NY
House No. Street Hamlet
Onwer or Owners of Property R.R. SCRIPPS 6 ANO AS TRUSTEES
County Tax Map No 1000, Section M Block ...3............ Lot....f'
Subdivision ....................................Filed Map............ Lot......................
b/5/92 Applicant...' nIA ROBINS
Permit No.,20589.Z . . . Date Of Permit........
Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate.... X......
Fee Submitted:
APPLICANT
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] IN ULATION
FINAL
[ ]FRAMING [
REMARKS:
i
DATE ? INSPECTOR
T6S-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION iST [ ] ROUGH PLBG.
[ J FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
R MARKS:
et-
OzO
f
DATE a INSP
F5
7sS-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG. U
] FOUNDATION 2ND [ ] INSULATION OO7 /
[ FRAMING [ ] FINAL Q~'°yi~?Gn--
QRE,MA/RK~S.
r
DATE k~ y INSPECTO
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7OUNDATION (1st) I J,
'OUNDATION (2nd) m
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2 9a ti
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-PLUMBING
.7
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_NSULATION PER N. Y. y ~5
STATE ENERGY II
CODE
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ADDITIONAL COMMENTS:
x
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~ Ne~~ G ? COOF CAICUIAI
DFaICN CRITFRIA 60000 Degree Dkyn
(FOR NON*ELECTRIC HEAT) O.A. 10°F I.A. 70^F
tJ 13 S/ J rC Mi A Q E A p -rye eR N~ L R E N A R !t s
Fiterier Nalln (Opaque) J4,-5- 0j 4, /3 -
C7 a , n 33 53 y rJ A7~a
Deem Zf~)
C•flfna/roof (Opaque) ~3 S 0~ v
Skvllohtn 96 a 39- - ~j
Fl~~r S7~ 0-S,
Foundation Walla
Slab Immulation
VIM 4 6-7
Noteai
rVilAi„g ftvelope Sjeteskn to Meet requireskente of 761%4
HVAC'Fquipskent to Feet regtitementn of 7915.11
HVAC-Synteam to Meet regt1regoAtn of M8 ilf ,
Dtct System* to Moot rogtitementn of 7815.13
Vbntila.tienn•S~Nteskm to meet,requireMentm of 7815.14
lnmulation of Pibina Srmteskm to meet regijirexentm 'of 781'5.15•
Service Mater ueating SYmtemm and E4ulpmPnt to skeet Regiilre%ente of 7815.71
Flectriciil and Lighting STnteskn and Egnipskent to skeet regairementm of 78i5.3l
Ot NEW YQ
T6 tie boat of %,v Knexledaet ire . r~r tfi
bolieft and rtefemnional CO jolamoontt theme nlanm arP in a r a
etarlfance with the code.
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BOARD OF HEALTH
FORM NO.1 3 SETS OF PLANS
TOWN OFSOUTHOLD SURVEY
' BUILDING DEPARTMENT CIILCK
TOWN HALL SEPTIC FORtl
MAY 992 SOUTHOLD, N.Y. 11971 12c
TEL: 765-1802 NaTILL A-7:7-4-7 6X
Examined et..42'f~ , • • 19 g a NA I L TO:
Approved _ .
Disapproved a/c
!IN -21992 . i. 4
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date.. 19 7 Z
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 necessa spections.
Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, ent, architect, engineer, general contractor, electrician, plumber or builder.
QQ.I~s. -
p4af' ..lN.c
Name of owner of premises K 1..... ~G F ~C/((PQS .
(as on the tax roll or latest deed)
If a licant is a corporation, signature of duly authorized officer.
• co . .
(Name and title of co;orate officer)
Builder's License No. . YZI91 4.. ~ I.........
Plumber's License No .
Electrician's License No .
Other Trade's License No .
1. Location of land on which proposed work will be done .
......t~r.~ ~!z GfUrau.4
House Number Street Hamlet
County Tax Map No. 1000 Section ?-I Block ~.3......... Lot D*......... .
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 ....5/.Dl?C~
b. Intended use and occupancy 1?C??!C I. c[ .
r
3. Nature of work (check which aP licable): New Building Addition
~ Alteration
Repair Removal Demolition Other Work
(Description)
4. Estimated Cost O Fee .
(to be paid on filing this application)
5. If dwelling, number of dwelling units RNA 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 existing structures, if any: Front ....46! Y/ .om....Rear 44 ! Depth. Zls ~ .
Height 2.4 Number of Stories ) . .
Dimensions of same structure wi$h alterations or additions: Front ......+A Rear 4a r , . , .
Depth Ala . Height Number of Stories l.(";;t r.....'....... .
8. Dimensions of entire new construction: ction: Front Apt....... Rear „4p ! Depth ...2.fn..........
Height ....?4! Number of Stories 1.%2r .
9. Size of lot: Front //.o. ! !r Rear ......../.R.io ! Depth 3. .
1
11. Zone 0. Date of Purchase ....~Ge? a? , ,(,9.9,/..... Name of Former Owner
P
12. Does or use district in
premises are situated
PrsPseed construction viol ate any zoning law, ordinance or regulation: A>P
13. Will lot be regraded PIV.+.................. Will excess fill be removed from premises: Yes
14. Name of Owner of premises RR74T.c!2 Address Phone No............... .
!
acne Name of of Architect Contractor J ' ' • • Address Phone No................ ,
~04rbr WI...... Address?R•.O.a.k L.-we A'-Pl.. Phone No...¢7.7-.I.70e. .
15. I this property 3within 00 feet of a tidal wetland? Yes,,,,.... No.........
*If yes, Southold own 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
STATE OF N O !
COUNTY IS.! S
• • • • • • • being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the <CC
ont ractor, gent, corporate officer, etc.)
of said owner or owners, and is duly autherform 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
.l .....day of , 119.
Notary PubIi County
NoterY public. C ic. 8ttate 5 of 06 New YO*
No, S
ouelified in Suffolk Cour (Signature of applicant)
&mmisslon Expires December 9
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APPR VEDAS NOTED
DATE: A-j Q? e.R n
O~J~Q NOTIFY SLIILDING DEPARTMENT AT
765-1802 9 QQ~~~~4~\FOLLOWING AM TO 4 PM FOfl THE
INSPECTIONS 0NS N5,
1. FOUNDATION - TWO REQUIRED ~~Jy QQri~L~11~ FOR POURED CONCRETE
A,
J ~(>J pf2. ROUGH - FRAMING PY PLUMBING Cq Q 0 3. INSULATION
- O~ - - - 4. FINAL - -CONSTRUCTION MUST - - -
PLUMBER CERTIFICATION BE COMPLETE FOR C.O. ~pF NEWY
ON LEAD CONTENT BEFO.~` ALL CONSTRUCTION SHALL MEET / ~ yCP~ECIGE -Tb ~~'F
CERTIFICATEOFOCCUPAIJCY THE REQUIREMENTS OF THE N.Y.
SOLDER USED IN WATER STATE CONSTRUCTION & ENERGY - L
SUPPLySYSTEMCANNOT CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS - ~ m J t
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N4:iiii Road
rrR[LNPORT, w.1'. 11944
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