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4
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hail
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20901 Date JULY 28, 1992
THIS CERTIFIES that the building ADDITION & RENOVATION
Location of Property 2425 MILL CREEK DRIVE WEST SOUTHOLD, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section SI Block 6 Lot 40
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated OCTOBER 30, 1991 pursuant to which
Building Permit No. 20258-Z dated NOVEMBER 5, 1991
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 & RENOVATION TO EXISTING ONE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to AL & MURIEL SCHWARTZ
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. PENDING - JULY 16, 1992
PLUMBERS CERTIFICATION DATED N/A
Building Inspector
Rev. 1/81
roBa: xo. 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)
Na 20258 Z Date , 19.91
Permission is hereby granted to:
a;~~5:...~t.~..c.-~~..~ ~,...w
. A:` ..:...............................................................................................................1..................................
at premises located of .~...~.5 ~ W•
~ ....!Yl~a.~..~~....1...~
.:.................~SQ-w..
a
County Tax Map No. 1000 Section ...~.T~..~............ Block Lot No
pursuant to application doted .....~...~"~`'.tt~.,......~a 19.q.~., and approved by the
Building Inspector.
Fee 3.
1 ~c. ~Wl. ..2~0 0.L.
Building Inspector
Rev. 6/30/80
c Form No. 6
TOWN OF SOUT[IOLD °i ~ ~ , ~ E , ~ tTe ~ s ~ ~ ~
BUILDING DEPARTMENT ~ ~ ~ ~ ~ _ ` ~ ~
TOWN HALL f
765-1802 ' i=~, ~ ~ ;~Q~
ii z;°~
r
APPLICATION FOR CERTIFICATE OE OCCUPANCY t
s i~i4~e=~i-~ F., _ ~
A. This application must be filled in by typewriter OF, 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-° 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 - $50.00
5. Temporary Certificate of Occupancy - Residential ~$/15c./00, Commec~rcial $15.00
Date ....~V.~, •I•.~ a. a~./.~?
New Construction.......c.~..,.,Ofld Or Pre-exi~st(i~n~g Buildi~nag~...?.......1.~....
Location of Property.. lr`~U.~...~~w..~VG.ia.r..~}.~,'. vy, ~ ~.W.t.~~~ .
House No. Street ~r~~~ ~H,.a-~m~leet
Onwer or Owners of Property..~~ . ~~~~,.,1~~~~~j, . / ,~,(~FZ, ~Gl~!,~~, , , , , , , , .
County Tax Map No 10n00,, Section.,~~l.:.....Block.. ~3-~..........Lot.~~
Subdivision..~~w ....~-t~~~~ ................Fitaled Map........./.~..Lot.......,. ~.,.a.~...........
Permit No.7/,Y.~i.SZ,G...,.Date OC Permit..~~~.~~.t.~....Appl.scant./:T~~..~~~SN~~-:~,,,,
health Dcpt. Approval ..........................U~iderwriters Approval.........................
Planning board Approval
Request for: T/emporary Certificate........... Final Certicate...~...
Fee Submitted:
!1 ~ C~ APPLICANT
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765-1802
BUILDING DEPT.
f NSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ . FINAL
REMARKS:
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DATE ~ INSPECTOR
~ _..e- =.x.,_
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ] RO H PLBG.
(]FOUNDATION 2ND INSULATION
[ ]FRAMING [ ]FINAL
REMARKS:
t
DATE I ~ INSPECTOR
t
~Z s"~
T65-1802
BUILDING DEPT.
INSPECTION
[ ] FO NDATION 1ST [ ~ ROUGH PLBG.
[ FOUNDATION 2ND [ ~ INSULATION
[ ]FRAMING [ ]FINAL
REMARKS:
DATE f ~ INSPECTOR
~
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ]ROUGH PLBG.
[)FOUNDATION 2ND [ ]INSULATION
[ ~MING [ ]FINAL
REMARKS: =l ~~-~-t_ ~>"~C-~
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DATE 1L ~ INSPECTOR
7ss-1802
BUILDING DEPT.
NSPECTION
[ FOUNDATION i5T ( j ROUGH PLBG.
[ ]FOUNDATION 2ND [)INSULATION
[ ]FRAMING [ ] FINAL""~ ~
` ~ REMA G~~C~t.~ ~
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DATE 6~ l ~ INSPECTOR
INSPECTORS
Victor Lessard v,UFFD~~-
Principal Building Inspector G'p
Curtis Horton ~ SCOTT L. HARRIS, Supervisor
Senior Building Inspector ~
Thomas Fisher e z Southold Town Hall
t'° "°r P.O. Box 1179, 53095 Main Road
Building Inspector ~ ~
Gary Fish ~ So Fax (516) 765 1823971
Building Inspector
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 j{
~ j Y
MAY 8, 1992_ ~ ° ~
tSt
~ E 4
- .11Jt_ ~ 7
ALBERT 6 MURIEL SCHWARTZ i
2425 MILL CREER DRIVE W {
SOUTHOLD, NY 11971 ~ "i.;;.,,-,,?;,
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
ffi An application for Certificate of Occupancy is
not on file. (Enclosed)
%%R No Underwriters Certificate on file.
ffi 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 20258-Z
Please contact our office on this matter. Thank you for
cooperation.
N~~,.~ SOUTHOLD TOWN BUILDING DEPT.
'`ry')Af~(Dy99' /I Y yA~ /~~j``qq// OAD~ ~I ~~~jq
„~u~ ~ a.~ ~ a„~ " e~-vim. ~d~~~
~
INSPECTORS
Victor Lessard
~;UFF13(~,
Principal Building Inspector `p ~
`J .f
Curtis Horton ::~'j~ % SCOTT L. HARRIS, Supervisor
Senior Building Inspector ~ r ti
as ~ €^;+1"°; ~ Southold Town Hall
Thomas Fisher , 'tti
~ )`6 ~ P.O. Box 1179, 53095 Main Road
Building Inspector ~ r~ ~
9 ry,~~~zj~ ~~~4 So Fax (5 6) 765 823971
Gar Fish
Building Inspector ~ Telephone (516) 765-1800
Vincent R. Wieczorelc
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
MAY 8, 1992
ALBERT S MURIEL SCflWARTZ
2425 MILL CREER DRIVE W
SOUTHOLD, NY 11971
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)
%Xx No Underwriters Certificate on file.
x%x 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 # 20258-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
New York State Department of Environinentai Conservation
Building 40-SUNY, Stony Brook, New York 117'90-2356
a
Albert Schwarth ~(;C ~ August 7, 1991
Mill Creek Drive V~; , ~ ~ I
Southold ~ Thomas C. Jorling
,
, NY 11971 i' Commissioner
a k+~ ~e~t e3
Revision to August 1,1991 Letter of Non-Jurisdiction
~'A #1-4738-00336j00001-0
C~^mer -Albert Schwartz
Property -Mill Creek Dr. W., Southold
Dear Mr. Schwartz:
A review has been made of your proposal to construct a 24' x 10' addition to the
existing residence at the property referenced above as per the survey by Roderick Van
Tuyl dated 3/23/87 and last revised on 6/25/91. SCTM #1000-051-6-40.
Based on the information you have sukanitted, the Neta York State Department of
Environn~7ta1 Conservation has determined that the project is landward of the
topographic crest of a bluff, cliff or dune which is greater than 10' in elevation -
above mean sea level.
Therefore, no permit is required under the Tidal Wetlands Act (Article 25 of the
Shvironmental Conservation Law). Please be advised, however, that no construction,
sedimentation or disturbance of any kind may take place seaward of the 10' contour
or topographic crest without a permit. It is your responsibility to ensure that all
necessary precautions are taken to prevent any sedimentation or other alteration or
disturbance to the ground surface or vegetation in this area as a result of your
contourt oru
o precay~~ions may include providing adequate work area between the 10'
pographic crest and the project (i.e, a 15' to 20' wide construction
area) or erection of a temporary fence, barrier, or hay bale berm.
that hhere be resdisturbari~e belowleevation 141~ation, the Depzsti;;e:,t recorcnends
haybales at the top of the bank in the area of constdruction.e applicant install
Please note that any additional work, or modification to the project as described,
~Y require authorization by this Department. please 'contact this office if such are
contempl~-.ad.
P'-rase be further advised that thid letter does not relieve you of the res
bilit}' of obtaining any necessary perntits or approvals from other agencies. -
ponsi-
Very truly yours,
~
David DeRidder
Deputy Regional Permit Administrator
cc: K<..en pxholm
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TRUSTEES G,c
John M. Btedemeyer, III, President o°'-Z SUPERVISOR
Hetuy P. Smith, Vice President W ~ SCOTT L. HARRIS
Albert J. Krupski, Jr. ~ • ~
John L, Bednosld, Jr. y~~1 ~ ~a~~ 53095 Main Road
John B. Tuthill
P.O. Box 1179
Telephone (516) 765-1892 BOARD OF TOWN TRUSTEES Southold, New York 11971
Fax (516) 765-1823 TOWN OF SOUTHOLD
June 11, 1991 §
- Karen Oxholm ' i r ~
Oxholm & Daughter
41 j
P.O. Box 133
East Marion, NY 11939 ~~~'a., ~;'?°"5,~_„_
RE: Albert Schwartz
SCTM #1000-51-6-40
Dear Ms. Oxholm:
The following actions were taken by the Board of Town Trustees during
its regular meeting held on June 6, 1991:
RESOLVED that the Town Trustees APPROVE the request for a waiver for
the following:
To renovate house as shown on survey dated May 20, 1991.
The Trustees request that all roof runoff be contained on site.
Please return to the Building Department for a determination on the
need for any other permits which may be required for this project.
Very truly yours, ,
G~- ~r~"~' ~
John M. Btedemeyer, III
President, Board of Town Trustees
JMB:jt
cc: Bldg. Dept.
File
THE NEW YORK BOARD OF FIRE UNDERWRITERS ~A~f; 'I'
11 )3112 BUREAU OF ELECTRICITY
8S JOHN STREET, NEW YORK, NEW YORK 10038
,TUT,Y 2;;,7.392 76Npr,~t92/~12 Cd 24.409 ~
Date Application No. on file
THIS CERTIFIES THAT ~
only the electrico/ equipment as described 6ebw and introduced by the applieont named on the oboroe appiicotion number in the premises of
Al, uG'}IWAIiT7., ?42!i Wf;u%' Pt1:I,I, CREFf; OIt7VEt SDIITWOI,II, N.Y,
in thefallowinry' loco s ent ~ /st F'l. ? 2nd Fl. .Section Block Lot
~'fi't:x ~,9~~~
wos examined orL artd found to 6e in contp(ianre with the requirements q(this Board.
FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCANDESCFNi RVORESCENi OTHER 5 AMT. K W. AMi. K W. AMT K.W PMi OK. W). AMi. H P
1 1f ? J d ~.tJr tS ~ d,4
?t
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI.OUTLET DIMMERS
AML K. W. Oll H. P. GAS H. P. AMT. NO. A. W. G. AMT. AMP. AMT MAPt TRANS. AMT H. p SYSTEMS pMt WATiS
NO.OF FEET
3 t;00
SERVICE DISCONNECT NO.OF S E R V I C E
METER NO. OF CC. COND A W G. A W. G. A. W. G.
AMi. AMP. TYPE EQUIP l,P ]W 1 ,e' 8W 3 %~W 3,6' 4W PER d Of CG COND. NO OF HI-LEG OF HLIEG NO. OF NEUTRALS OF NEUTRAL
OTHER APPARATUS:
f{Q ~'fl ~.eft2-y If.~.
c,>'.c.zt-2 ~
sACe ~r,ao~ffAtal~ xlfc~i~,sAC~ L3C,;Ia~s~•f•,
e.~, I?ox se
(i (t frFNL'n ZNS't DI%, 1f.944. GENERAL MANAGER
1t
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 F R BUILDING DE ART ENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
~,.,~r.~y~
w (.r `.;.^.y~~~~~~;:~'~~~~~~ BO.1RD OF HE.1LI'F{
r~ ~ r: 1, ~ ~ FORM NO. 1 3 SETS OF PL.1 :7S
~ ~_v ti
l y
' I _ S B fi V E Y
,''~7 'i',°I TOWN OF SOUTHOLD - - - .
l,ot', ~C~ ~ 0~99~ ~Ir~ BUILDING DEPARTMENT CItCCI:
1 y .~1,,,/ TOWN HALL SEPTIC FORA _ _
<4a'sj~{-lCLK3r~,,,,,,,, SOUTHOLD, N.Y. 11977
70UJs',='1a~..„."."."`" TEL.:7G5-1802 ::D:' 'f: ~/~,E~ ?.~t
"'"-yp~wK,~.1 I9~.I. CALL .?~2kl~~q~~ ~XF~~L:.I.. .
xammc ~Nn L T0: 4Z~'9(o3~0
PProved .~!~"`"^`~!~,5, 199t.PcrmttNo..~~?°'}a.$."~2~.. Z7yt-4CJl.C1`'.t.p+4l~6tf~.l~.l.
isapprovcd a/c Q.O..~~ 1'~2-'..~: MflRlO~
~.'f t~939
t .~4 s~'wc... .9.....o aa.~(.....,
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date ~T. Z~...... 19~{
INSTRUCTIONS
a. T}lis application must be completely filled in by typewriter or in iltk and submitted to tltc Building Inspector, with 3
s 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
.areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appfi-
ion.
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 tfle applicant. Such permit
11 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
II 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
lding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
;ulations, for the construction of buy!dings, additions or alterations, or for removal or demolition, as herein described.
applicant agrees. to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
lit authorized inspectors on premises and in building for necessary in ec ~SZ _ ~ _ _
(Signahire of applicant, or name, l a corporation)
(Mailing address of applicant) v~•~,
:e whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
to of owner of premises . ~'Fr,Q.-'`, .rzl ,F.•~,(7R.1.Yr.L!.. ~:L~~1~;1-zr .
(as on tltc tart roll or latest deed)
>plican[ is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No.~o~~ , ~V.NT=.... .
Plumber's License No. . M~ SH,G!.yv~ i
Electrician's License No.S,~~~, ,r+l, !~~S?~t~?'~
Other Trade's License No. - - - - " -
acation of land on which proposed work will be done. . M ~u.,~~~~,~-~~...~,,.r .~y~V
tip... ~
oust Number
Street Ilantlct
nlnty Tax hlap No. 1000 Section ~5.~ Block .
tR Lot .
ibdivision . Filed hlap No.
Lot...............
(Name)
ate existing use and occupancy of premises and intended use and occupancy of proposed construction:
Existing use and occupancy , , .~J ~(~,I,r~, (~.,p.. , Ia~~+Na~- Vr~"~o ..l SPi;.t`
Intended use and occupancy , , , , , , , , , , , , ,t?d: C.`~ ' ~
• • • • • .„.,wrs•,i'.:w tf:%t:,~1'r.r.:.iitiv'16;'••.-r'dmq-"tx'a. .
i
3. 1aPure of work (check which applicable); Ncw Building ,
Rc atr Addition . , Alteration .
r al
Remoy Dernolition Other Mork .
4. Estimated Cost pp 23 I~ ~ 5~ (Descnption)
Fcc .
5. If dwellin • number of dwellin^ nits (to be Paid on filing this application)
b rr
[f garage, number of cars • • • • • • • Number of dwelling units on each floor ,
G. If business, comrnercial or mixed 'occupancy, specify nature and extent of each type of u`c • . • • ~ ~ • • ~ ~ ~ • • ~ ~ •
7. Dimensions of existing structures„if any; Front , , , ' ' ' ' ' ' ' ' ' ' ' '
Heigh[ (tear Depth .
• • • • • • ~ Number of Stories .
Dimensions of same structure with alterations or additions: Front ~ ~ • ~ ~ ~ • • ~ • • ~ • ' ' ' ' ' ' '
Depth Height............ Rear..................
~ ..........Numbero,~f,~Storics .
9. Size of lot SF o flue new construo . • • • . • • . • .
Hei~ltt $'r. 1,~?.', , , , . , ,Numb lion: Front . ~(Z,X, ~„,4, i-, Rcar ~?~4; ; ,
r of Stories . ,1.......... Depth . . .
0. Date of Purchase I Rear Depth
' Namc of Former Owner • • • ~ ~ ~ ~ ~ ~ ~ •
I. Zoncoruscdistrictinwpcrttjsesaresituatcd,,,,,,,,,,,,,,,•...•,..,
Does proposed construction violate any zoning law, ordinance or regulation: .I(~O : .
3. Will lot be regraded , , , , , , , , , ,Will excess fill be removed from premises: Yes No
4. Namc of Owner of premises , • ~ ~ • • ~ ~ ,
Namc of Architect ' ' ' ' ' ' ' ' • Address , , , Plrone No.........
N~rC? ~ ~N) ~Cklct l-~ Add ress ~ T%', ..~~~:.I°i3. Phone No.:~`J.~ `)l~~i . .
Name of Contractor ,
i. Is this pro art within 300 ~ • • • • • • • Address .Plrone No. °
If es Southold Tow feet of a tidal wetland? ,e V.,.•...
y n Trustees Permit may be required. N.~-•~~"
• PLOT DIAGRAM a-4skt7,~._.__.
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from
roperty lines. Give street and block nurylber or description according to deed, and show street names and indicate whether
rterior or corner lot. I
I
_
II, .
tiT); OF N VYOR S.S II
1NTY OF,~,~~~^,, I~'-l
(N~c~of ir~i dual g ing Cotl~ ~ ~ ' ' ' ' ' ' • being duly sworn, deposes and says that Ire is the opplicant
'c named, rtract)
;the III
(Contracto ;agent corporate offrc~r, etc.)
nd owner or otvncrs, and is duly authorized to per orm or have perforntcd the said work and to make and file this
cation; that all statements contained ir1 this application arc true to the best of Iris knowledge and belief; and that the
will be pcr(ormed in the manner set fo'~th in the application Gled tltcrcwitlr.
n to before me t~~hisnn~'/-
.~.~•!.F.~`.dayof.. ~ ~19~C
/ /~/jam ~ ~ ~ ~j,, ~ .
ti Public\~~..rk•'''rr : .
• • '\f-~' County
Newry rublt0. State of Nwir YMk . ' ~~rryt,_
' CLAIR46795QB ~
•
QuItlMled In BuNolk Coupty • . • • • • .
~pnmlukME~keApermmMr8,7feJ.fi" (Signature of applicant)
i