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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-22308 Date May 6, 1993
THIS CERTIFIES that the building ADDITION
Location of Property 23005 MAIN ROAD CUTCHOGUE, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 109 Block 1 Lot 8.7
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 1, 1992 pursuant to which
Building Permit No. 20810-Z dated JULY 10 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 BASEMENT STORAGE ADDITION TO EXISTING WINERY AS APPLIED FOR
The certificate is issued to ROBERT PELLIGRINI
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-272791 - APRIL 15, 1993
PLUMBERS CERTIFICATION DATED N/A
Z'~ding Inspector
Rev. 1/81
FORM NO. $
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)
NN° 2081O Z Date 1..6.t~tt.1.0 19.7.x-
Permission is hereby granted to:
~.x~.. .r4<Y! e...r....
to cX'...a< ~ ~ ..tom?................
..............<....,a,'...
. uce,. y.....
at premises located at a.3
County Tax Map No. 1000 Section Q.9......... Block C?. Lot No. . 1.
t
pursuant to application dated .....I 191;;~r., and approved by the
Building oInspector.
Fee $J.111 ....J.
ot.
C sl..i,.. t~.°..
Building Inspector
Rev. 6/30/80
Form No. 6 lUJ~,~
TOWN OF SOUTHOLD J APR 2 010
BUILDING DEPARTMENT 3
TOWN HALL L__
765-1802 G. DEPT.
TOWN OEE (ITHOLE1'
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 2110 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 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-existi g Building
Location of Property NtG............c~7c}~,
House No. Street Hamlet
Onwer or Owners of Property 9P.h~~.T....i!~ 1 ~IV~
1.0 ~
County Tax Map No 1000, Section Block Lot.... Q.[
Subdivision ....Filed Map............ Lot.....
Permit No..iggfU...... Date Of Permit. /.0.f Applicant.
Health Dept. Approval........ ...............Underwriters Approval.........................
Planning Board Approval..........'
lequest for: Temporary Certificate........... Final Certicate...........
Pee Submitted:p $
ca-ZOa303, APPLIC T
INSPECTORS
Victor Lessard FO(,
Principal Building Inspector O~~SUF( COG
Curtis Horton SCOTT L. HARRIS, Supervisor
Senior Building Inspector co
Southold Town Hall
Thomas Fisher yi- P.O. Box 1179, 53095 Main Road
Building Inspector Southold, New York 11971
Gary Fish Building Inspector Fax (516) 765-1823
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
April 14, 1993
Eugene Burger
2515 Pine Tree Rd.
Cutchogue, N.Y. 11935
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
XX An application for Certificate of occupancy is
not on file. (Enclosed) A
XX No Underwriters Certificate on file.
XX The check is not on file. $50.00 rrn.•
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 # 20810-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
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APR 210W
BLDG. DEPT.
j TOWN OF SOU7'HOLE?
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aISULATZON PER N. Y.
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ADDITIONAL COMMENTS:
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1 BOARD OF HEALTH
' ' - FORM NO. 1 3 SETS OF PL .INS
JUL i I{Ji'f TOWN OF SOUTHOLD SURVEY . . .
BUILDING DEPARTMENT CHECK
TOWN HALL SErTIC FORM
" SOUTHOLD, N.Y. 11971 '73 q,(o~oS
TEL.: 765-1802 N1>7IPY, -73.q-
19 MAIL : .
Examined C
Approved l . i D . 19 9~- Permit No. a'Z Q.??Y t7 . .
Disapproved a/c
AS S... .
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date 19°
INSTRUCTIONS UUUU
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 necessary inspections.
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whet r plicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises IgQb.Pr. JO. yl~?i... J'~ L-~!l G).f2J /U l
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer) Pet -11-4~1
Builder's License No. 1.
Plumber's License No .
Electrician's License No .
Other Trade's License No .
1. Location of land on which proposed work will be doone.
~ TG.Ez~Q.C~C~ .1 . , .
House Number / Street Hamlet
County Tax Map No. 1000 Section Block / Lot ....x"5..77
Subdivision (N..................... Filed Map No. Lot
ame)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy O P~4~p ( a mclex? , CDwS~Y~ (%i ~.U,q...... .
b. Intended use and occupancy . ~~UGC~f !.(•C~./ll... z ? .
fF5 1 A4 f AI ;4r;.:
3. Nature of work check which
licable): New Building Addition Alteratign
Pa Demolition Other Work .
(Description)
4. Estimated Cost 6 Fee . 0 . .
(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 existing structures, if any: Front Rear Depth , , , , .
Height Number of Stories .
Dimensions same structure wi th alterations or additions: Front Rear , .
Depth . . . . . , • • Height , Number of Stories ........P , , , , ,
8. Dimensions of entire new construction: Front • ! Rear , , . Depth .1- , , , • , , , , ,
Height berofStories .
9. Size of lot: Front „ .m'........... Rear De hy .
1
11. 0. Zone Date of or use distPurchaseract in which premises „ L1', q,l, , , , , , , IN of Former Owner 1 CY7Ja Y. re ' .
,
are situated .......C .
12. Does proposed construction violate any zoning law, ordinance or regulation: .
13. Will lot be regraded Will excess fill be removed from premises: Yes
14. Name of Owner of ises (~~JP;f ~/f/~R/gtAddress ...................Phone No............... .
.
Name of Architect kk'AT4 -A." .5 o+nU Address Phone No.73V G s'..
, Name ofCon tractor tnz-el-er.Cc9.ti!i A47.'? y.. Address • Phone No73...'
5. Is this property within 300 feet of a tidal wetland? *Yes........ No,........
*If es Southold Town 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.
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STATE OF NE ORK S S
COUNTY O
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ame of individual s iu ' ' ' ' ' ' • • being duly sworn, deposes and says that he is the applicant
g contract)
above named.
Heisthe
(Contracto , ag orporate officer, etc.)
of 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 get forth in the application filed therewith.
Sworn to before me this
L day_of . 19.. >Y . .
Notary Public, County
CLAIRE L QLEW
No»ry P+ 0 4879W5
Qusl Nw York g
MlN In Suffolk Co
•Commiwion EMM peoem W 8, 79 ignature of applicant)
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CUTCHOGUE, NEW YORK 11935
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Date. 4 . y z
Scale
i OCCUPANCY OR Sheet Title.
USE IS UNLAWFUL
WITNOUT CERTIFICATE 7~~e,gy a*-vA i BASEMENT
OF OCCUPANCY yIon, 4L n " Y. -QL.- FLOOR F
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749 Z, Gl3VC, D7 %RV p,9:NG & PLUMBING
/ S. INSULA;-110,
yy~i 4. FINAL - CONS! UCTION MUST Sheet No:
RE COMPLETE FOR C.O.
3$~ ALL CONSTRUCTION SHALL MEET THE. REQUIREMENTS OF THE N.Y.
$ STATE CONSTRUCTION & ENERGY
A-2
Db COSIES. NOT RESPONSIBLE FOR 3 : " DESIGN OR CONSTRUCTION ERRORS
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