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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-22779 Date DECEMBER 10, 1993
THIS CERTIFIES that the building ACCESSORY
Location of Property 21755 COUNTY ROAD #48 CUTCHOGUE N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 96 Block 1 Lot 18.2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NNE 16, 1992 pursuant to which
Building Permit No. 20740-Z dated NNE 19, 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 ACCESSORY ABOVE GROUND SWIMMING POOL & FENCE AS APPLIED FOR
The certificate is issued to ROBERT & BARBARA TAYLOR
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. PENDING - DECEMBER 9, 1993
PLUMBERS CERTIFICATION DATED N/A
uil ing Inspector
Rev. 1/81
FORM NO. 2
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° 2074OZ Date f..wnX.... .g 19.9..a-
Permission is hereby granted to:
~,....G....`:.......
nx....q..)
..~d~~rs.S...-....:V.:~.r... x(..9..3.5"'.......
to ...5.... .....a.'`?3't14.... II.~~srr? ej.... .
~nn 1
a w......
of premises located at °Z. E 229 9t....................... ..k4-..
...a/S t l e4....1Y.a4~fdl:f.A...c. lA1r . .................................................................p...................
County Tax Map No. 1000 Section .......Q.9. Block Lot No.... ~..A4
pursuant to application dated -4 l R ......./.(o 199. Z-.; and approved by the
Building Inspector.
Fee $1,~....
.
Building Inspector
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
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 $15.00
(ABOVE GROUND POOL) Date .....P~~.•.$a.~~83
New Construction- A Old Or Pre-existing Building
Location of Property....... 21755. County. Road 1148 Cutchogue: New York
House No. Street Hamlet
Onwer or Owners of Property......., ROBERT fi BARBARA TAYLOR
.
County Tax Map No 1000, Section 96....... Block ............Lot..18:?
Subdivision ....................................Filed Map............ Lot......................
Permit No „20740-Z Date Of Permit„ June 19, 1992 Applicant„ ROBERT S BARBARA TAYLOR
Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Certificate........... Final ticate...
Fee Submitted: ?5:00
APPLIC
jl~S1IFFGtA, O
EIAZABET14 A. NEVILIX Gy Town Hall, 53095 Main Ro,
? TOWN CL.ER.K = P.O. Box 1179
0
N 2 Southold, New York 1197
REGISTRAR OF VITAL STATISTICS • Fax (516) 765-1823
MARRIAGE OFFICER Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER
ZZ,
FREEDOM OF INFORMATION OFFICER -
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
APPLICATION FOR PUBLIC ACCESS TO RECORDS
INSTRUCTIONS: Please complete Section I of this form and give to Town Clerk's
Office (agency Freedom of Information Officer). One copy will be returned to you
in response to your request, or as an interim response.
SECTION 1.
TO:
(Department or Officer, if known, that has the information you are requesting.)
RECORD YOU WISH TO INSPECT: (Describe the record sought. If possible, supply
date, file title, tax map number, and any other pertinent information.)
- 13 .2-
Y
Signature of Applicant:
Printed Name:
Address:
Mailing Address (if different from above):
Telephone Number: Date:
( ] APPROVED
( ] APPROVED WITH DELAY* [ ] DENIED*
Elizabeth A. Nev llb Date
Freedom of Information Officer
* If delayed or denied see reverse side for explanation.
SECTION 11. ('For use by Freedom of Information Officer only.)
Your request has been DENIED or the reason(s) check below:
( ] Confidential Disclosure
( ] Part of Investigatory Files
I ] Unwarranted Invasion of Privacy
[ ) Record of which this agency is legal custodian, but cannot be founc
( ] Record is not Maintained by this Agency
[ 1 Exempted by Statute other than the Freedom of Information Act
[ 1 Other (specify)
v
Your request is, ACKNOWLEDGED. There will be a delay in supplying the request
record until
Reason for delay:
SECTION 111. RIGHT TO APPEAL
YOU HAVE A RIGHT TO APPEAL A DENIAL OF THIS APPLICATION IN WRITU
WITHIN 3:0, DAYS OF THE DENIAL. CONTACT THE SOUTHOLD TOWN BOARD (s
below). THE TOWN BOARD MUST RESPOND TO YOU IN WRITING WITHIN TEN
BUSINESS DAYS OF RECEIPT OF YOUR APPEAL.
Southold Town Board
.Southold Town Hall
53095 Main Road
Southold, New York 11971
Telephone: (516) 765-1800
I
INSPECTORS
Victor Lessard
J~.`J G
Principal Building Inspector
Curtis Horton SCOTT L. HARRIS, Supervisor
l a "
Senior Building Inspector
Thomas Fisher Southold Town Hall
Building Inspector P.O. Box 1179, 53095 Main Road
Southold, New York 11971
Bui ding Inspector Fax (516) 765-1823
Vincent R. Wieczorek Telephone (516) 765-1800
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
JUNE 18, 1993
ROBERT S BARBARA TAYLOR
BOX 462
CUTCHOGUE, NY 11935
RE: JENNIE HARRIS ESTATE
C
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
XXX An application for Certificate of Occupancy is
not on file. (Enclosed)
XXX No Underwriters Certificate on file.
XXX The check is QQKUUdXWnot on file.)$25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 20740-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
1cLD IPA-- it o;."fMLNT'~ !
0
J
H Q
7OUNDATION (1st)
a a
w
'OUNDATION (2nd)
z
0
LOUGH FRA14E &
PLUMBING
h
c/i
INSULATION PER N. Y. y
STATE ENERGY II
CODE
` c=
ge-
zls~
FINAL / S
ADDITIONAL COMMENTS: m
x
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• to
H
x
H ~p
Q
O
AN
m
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-o
a
M-1802
BUILDING DEPT.
INSPECTION
[ ) FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INS TION
[ ] FRAMING [ FINAL
REMARKS: C/(/--
DATE INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
L ] FOUNDATION 2ND L ]INSULATION
L ] FRAMING Lam] FINAL P
REMARKS:
Le,
I
DATE INSPECTOR J" j
Q0) y0-2-~
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1~ 37 aN I BUREAU OF ELECTRICITY
85 JOHN STREET. NEW YORK, NEW YORK 10038
NFfcT, R In' 1993 7930'791/92 H {331631
Date A licalum No. on ~e74G
THIS CERTIFIES THAT 'r~, 4f NO.
only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
POBFRT TAYLOR, 27735 NORTH POND ROAD ROU'),N 48, CQT no(,I)f" N,Y,
in thefollowinq location; ? Basement ? Ist Fl. ? 2nd Fl. GAF./ONT Section Block Lot
CFI,PMk1411 09 1393
was examined on ' and found to be in compliance with the National Electrical Code.
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS ECEPTACIE$ SWITCHES INCANDESCENT FLUORESCENT OTHER AMT. K W AMT K.W T.
K.W. M17 K.W. AMT. M P
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL RECT TIME CLOCKS BELL UNIT HEATERS MUITI.OUTLET DIMMERS
AMi. K. W. OIL H. P GAS H P MIT. NO. A. W. G. AMi. qMP. AMT AMPS. TRANS. AMT. H P. SYSTEMS AMT WATiS
NO. OF FEET
SERVICE DISCONNECT NO. OF S E R V I C E
AMT. AMP, TYPE METER
EQUIP. 10 2W 1 q 3W 3,e 3W 3,e 4W NO OF C. COND A. W. G. NO OF HIAEG A W G. NO. OF NEUTRALS A. W G
PER 9 OF CC. COND OF HI-LEG OF NEUTRAL
OTHER APPARATUS:
SWIMMING f'OOL I.
RECFVTACL9S-1
G.F.C.I-1
"(onmiLfING POruI Thir.. CR'r'(Afjcate
covers vamOliance di, the dai,e of
inspection nnlq. Nel'&ndie of Ullui+nal
wlvirlonlKlanCs Lt, i,s actoisaltie to
have fiequeol, qua+~l.lfii,d p of zeha9rrs
Iaarle b by y a :a gnPie 1~le risou.
Krc Coutinued on Pa(0 2 *a>
GENERAL MANAGER
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.
-
THE NEW YORK BOARD OF FIRE UNDERWRITERS Prtcr) '
B037504
BUREAU OF ELECTRICITY
F 85 JOHN STREET, NEW YORK. NEW YORK 10038
D£~cvmlmm; 1<b,t99 79,163792197 if 03907
Date erh7IiPnrl ":and'IM0
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
ROBERT TAYLOR, 21755 NORTU POW) ROAD ROUTE 48, CflTCflOGUE, N.Y.
in theJollowing lacattlgrEli f~Pl~ Bop4.tnelr4t~.1? /xt F1. El 2nd Fl. GAR/OUT Section Block Lot
was examined on G Il V 7 i and found to be in compliance with the National Electrical Code.
FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS INCANDESCENT FLUORESCENT OTHER AMT. K. W. AMT. K.W AML K.W AMT K.W AMT. H P
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL RECTT TIMECLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
AMT. K. W. OIL H. P GAS H. P AMT NO A. W. G. AMT. AMP AMT. AMPS TRANS. AMT H P SYSTEMS AMi WATTS
NO. OF FEET
SERVICE DISCONNECT NO.OF S E R V I C E
AM7. AMP METER
TYPE 1 ]W I S, 3W ],e' ]W 3,e' dW NO.OF CC COND. .W G. NO OF HIAEG A. W G' NO. OF NEUTRALS A' W G.
EQUIP. PERe Of C. COND OF HbLEG OF NEUTRAL
OTHER APPARATUS:
1Ctt7:0O1. M' TAYLOR
C70X 462
CUTCflOGUF, NY, 11939 GENERAL MANAGER
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.
.FLOQ2. . .
-"PJ.7LESS.AUAPr2R FQUODATIOM
5G.P.M."PUMP
42r,AL-TANK -
¢ 6 N.
TOWN_ AF'.-c;OUT OLD 4) <,t*
__L-ROUND' WATER
:.W ELL POINT
CKtDN[ FFN~,=
zoo 3--
TYPICAL WELL`:'. _JQP.Q _t~o
l
~lj
! Z
+j.• D z LOT I 3 LOT 2 Li
ft}". ' 2$,5025.6 x(951" .Q v
~Pool ~Q-
i
' a A Y2i _
j 19 '41 POOL
fi 1 ryHO. wYLtl. tl 1 F2H0, l75
rooLi
12
YII ~~r ,r T,i sits U3
...7 tao.o , lao.o ' wa~+
IMMEDIATE - -
ENCLOSE' POO TOZ:00~ - _3,z ° ?v w ZGC.~ ' 918' * TV cox'S i AN E - - -
UPON CO LETION
BEFORE' ATEfV
APPROV AS NOTED MIL-VLE C,12g8 120Av -
`DATE: ? B.R 39
a.~~. OCCUPANCY C
- NOTIFY BUILDING DEPARTMENT AT
765-2£302 P+ AM TO :S PM FOR THE USE IS UNLAWFUL
FULLOVUIIV.L", INS~~~TI~~~~ -=~9~#~~` C~LC ~
1. FOUNDATION 'M/0 REQUIRED t OF OCCUPANCY - . POURED? CONCRETE
2. ROUGH - FRAMING 2, PLUMBING
3. INSULATION
4. FINAL - C ON:;TRuC'rm MUST UNDERWR R9R NIMTE
BE COMPLETE FOR C.0 1
ALL CONSTRUCTION ,rxl-ALL MEET
THE REQUIREMENTS OF THE N.Y.
STATE CONSTRUCTION ENERGY APProwd in •rcor&w,
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
SUBJECT TO COVENANTS!
APPROVED 13
PIAF•7ulP'_ C042D [Hau
~FFOLKCOUNrYD
oreNew York 01 T09Mt3 OP SOJTHO LD tEtily that Ma{
DAT for_
tj. un ibe abo
BOARD OF HEALTH
l'• .:_.a~~' , FORM NO. 1 3 SETS OF PL.121S
Il TOWN OFSOUTHOLD SURVEY
Jul 1 71992 Ih,~ i BUILDING DEPARTMENT CIIECF
TOWN HALL SEPTIC FORA
SOUTHOLD, N.Y. 11971
1 VU13!°t'3.97fi•'1'. TEL.: 765-1802 t: DTI FY
PlOs~ ;3(1F8d3i..D CALL
• . v.
.H+,~..
Examined... • . 9a-- MA I L TO:
• • - .
Approved . 197L: Permit No. ;Z9. l+A 3~ .
Disapproved a/c _ .
.6~ .
(Building 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
Dr 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
lullding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
tegulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
.he applicant agrees to comply with all applicable laws, ordinances, building code, housing a regulations, and to
dmit authorized inspectors on premises and in building for necessary inspect' s.
_
(S at Yfe of applicant, odare,i fa corporation)
(Mailing address of applicant)
hate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.
dame of owner of premises
.
(as on the tax roll or.latest deed)
f applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No. ...d&)4~! t/ , , , , , • • ,
Plumber's License No.
Electrician's License No . -
Other Trade's License No .
Location, of land on which proposed work will be done . . . .
/ 75 5~ G~yfi!
House Number " " " " " " "
~j /Street Hamlet
County Tax Map No. 1000 Section • (a.... Block r, , , , , , • • , , Lot . 17.
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 .....a,
b. Intended use and occupancy ....fill..°...... '
Nature of
work (check
which h applicable): New Building Addition Alteration
oval Demolition Other Work • • • • .
/!(/.i 010 (Description) . .
4. Estimated Cost . . Fee ...~C~
(to be paid on filing this application)
S. If dwelling, number of dwellin units ,
Number of dwelling units on each floor . .
If garage, number of cars S
or mixed
6. If business,
occupancy, specify nature a
g , , and extent of each type of use . . .
7. Dimensions of existing structures, if an Front
Nm ber of Stories Rear Depth , , , , , , , , , , , , ,
Height
Dimensions of same structure with alterations or additions: Front Rear .
Depth 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 viol
,
13. Will lot be regraded ate any zoning law, ordinance or regulation: .
Will excess fill be removed from premises: Yes No
14. Name of Owner of premises .Address . Phone No. .
Name of Architect Address . . Phone No. .
Name of Contractor Address • • .
15. Is this property within 300 feet of a tidal wetland? *Ye . " " .Phone No .
*If yes, Southold Town Trustees Permit may be required, " ' No.........
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.
r
_ r
TATS OF NEW YORK,
OUNTY OF S.S
• being duly sworn, deposes and says that lie is the applicant
(Name of individual siSning contract)
,ove named.
is the
(&n tractor, agent, corporate officer, ctc.)
said owner or owners, and is duly authorized
to perform or have performed the said work and to make and file this
plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the
)rk will be performed in the manner se't forth in the application filed therewith.
om to before me this
1. ......day of. . J 19. Z
tary Public, < , ,.-County
CE M. WILKINS
Notary Public, State of New York r?
No. 4962246, 622X, Suffolk Gou " " " " t
Term Expires June 12;18 (Signature of applicant)
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aw 'FKIfiF4~3.T'AV NhAP'PNV
HY F'.
AWENU&O Fee. 29,1989
• FEB.,15~1991
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