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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-20265 Date October 7, 1991
THIS CERTIFIES that the building ADDITION
Location of Property 1325 FACTORY AVENUE NATTITUCK N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 122 Block 2 Lot 17
Subdivision Filed Map No. Lot No.
conforms substantially to the Application far Building Permit heretofore
filed in this office dated June 19, 1991 pursuant to which
Building Permit No. 19976-Z dated JUNE 26, 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 TO EXISTING ONE FAMILY DWELLING WITH 2ND FLOOR
NON-HABITABLE STORAGE AREA.
The certificate is issued to AUDREY WATSON
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPRO~JAL N/A
UNDERWRITERS CERTIFICATE NO. N-205914 - SEPTEMBER 30 1991
PLUMBERS CERTIFICATION DATED N/A
Building Inspector
Rev. 1/81
IOBM NO.
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
CQMPLETION OF THE WORK AUTHORIZED)
N a 19 9 7 6 Z Dote ~...s,~:~:s..... a:.~....., 19.~.(
Permission is hereby grouted
.....~s~!~:!~.~ ~.~"?:1
.....:~6a~ x...
of premises located at .l..r~r~:.~....~ ~~::?...~......d...'....).
.
County Tax Map No. 1000 Section ....'.~-.~-.......pBlock Lot No....~..~
pursuant to application doted .....~..~r!~:R,.....~...1 19.~..(.., and approved by the
Building Inspector.
Fee 5..~s1~.«..~..
Bui ding Inspector
Rev. 6/30/80
Form No. 6 ~ ,
_ ~
~ lJ V~~~~~ ~ TO[dN OF SOUTIIOLD ~ ,
.,a..,,o.-.~.~~ ,..~t, BUILDTOWNDEIALLTMENT
ij~ ' OCT - 3199! 76s-lsoz ~
~ k
° I'L''a's1~"'`!' _ APPLICATION FOR CERTIPICATl: OF OCCUPANCY
i..., ~..-i,t3ttfr'd C7~, w<<'s~,}i-'ii(;~', ,
.1. This application must be filled in by typewriter OP, 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 feaCUres. '
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.
:i. 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.
Fees
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
A1[erations 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 ....(Q~+i~~9?
::uw Construction........... Old Or Pre-existing Building.....'
Location of Property....~3~ . . FHCroI{~/ i¢(/e_.... , , /~/AztiZUCC.
House No. /~J/ Street Hamlet
tlnwur or Owners of Property......~H.4~FfRfJ L4K~FJ~!/
~:ounty Tax Map No 1000, Section... 2:......Block....:Z..........Lot.....~ 7
:subdivision ....................................Filed Map............Lot......................
i'ermit No..~`.TgTI~........Date Of Permit..~E~p,4,~~p,/~/Applicant....~fdlf~f..~-?~Qy/,,,,,,,,,,
:Iealth Dc t. A royal.. J
P PP • .......................Underwriters Approval.........................
.Tanning Board Approval
~'equcst for: Temporary Certificate........... Final Certicate...........
ao
~ee Submitted: $...,af.S
R o~ . ya ~ y'~ ~1.. lcraaE.t~ .
C',0~. c~Oa6S~ APPLI ANT
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AiJI~kF:Y HAT30N, 1325 N'ACRORY AVENUE, FiA9"1'I'PItCK, N. Y.
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Jtwwd prro rwpitWitntaNtlt{r land.
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RI.F:C . ROOM N'C7~9`Pxk S : -l.- L . 5 K . W .
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SAGE & I,AUN:34ANP1 INC. i,TC.$ i615-F
P.O.HOX .I76R
- SOUTHOLU; t»Y, 1.i9't7
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765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ]FINAL
REMARKS:
Z~
DATE 1 INSPECTOR ~ ~
~ g(~ _
°/G
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST ( ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULAT ON
[ ]FRAMING [ INAL
REMARKS: ___~J~
DATE Z INSPECTOR
' ~l
765-1802
BUILDING DEPT.
INSPECTI®N
[ ]FOUNDATION 1ST [)ROUGH PLBG.
[)FOUNDATION 2ND [ ]INSULATION
[ J FRAMING [~`NAL
REMARKS: L = "''~(~1,;~
DATE ~ INSPECTOR
765.1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST ( ] ROUGH PLBG.
[ }FOUNDATION 2ND [ INSULATION
[ ]FRAMING [ ]FINAL
REMARKS: ~
:c
DATE ~ INSPECTOR
rsS-iso2
BUILDING DEPT.
1 NSPECTION
[ ]FOUNDATION 1ST ( ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ RAMING [ ]FINAL
REMARKS: ~-e-32_ _
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DATE ~ INSPECTOR
""'~N~~ ~ 60,\nD OF NE,\LTIf _,.~r
D ~~(a~~~ FORM NO. 1 ] SETS OF~J.,12JS .G!, _ • .
TOWN OF SOUTHOLD SURVEY pf
.1lNd i 91991 I BUILDIN(; DEPnRTMENT C11r.cK . . ,
6~ # TOWN HALL SC[`TIC r0(::t
~F SOUTHOLD, N.Y. 11971
~st~ia!j,.,'s!'~'r~ TEL. 7G5-1802 ,:o-
@ T0~/~=f~ f~" .ire. ''.r r, CALL r
~
rtn[L ro:
pproecd ..~.~A,~>¢, , 19°J1. Permit No.~ 4,~71q.'~,. _ _ . .
isapprovcd a//c .
• a :v U-v. ~ .
\'1/ (Building Inspector)
APPLICATION FOR BUILDING PERPAIT
Date 19
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
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 appG-
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 tvil] issued a Building Permit to the applicant. Such permit
11 be kept on the premises available for inspection throughout the work.
e. 1\ro building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy
11 have been granted by the Building Inspector.
.4P~PLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Penni[ pursuant to the
(ding Zone Ordinance of the Town of Southold, Suffolk County, Ne•,v York, and other applicable Laws, Ordinances or
~ulations, for the construction of bu%ldings, additions or alterations, or for removal or demolition, as herein descnbed.
applicant agree;, to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
ut authorized inspectors on premises and in building For necessary inspections.
tGVu.~st~ .
(Signature of applic rt, or name, rf a corporation)
(1\failing address of applicant)' 4'~
whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
a w a.. .
'e of owner of premises ~~-Q~...[,v~»
(as on the tq.Y roll or latest t(eed)
~plicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Buildcr's_Liccnsc No. ~,~3~3'Ff~"
Plumber's Liccnsc No. . ~,~,8, 8'7/~
Electrician's Liccnsc No. 3J E
Outer Trade's License No . . .
ocation of land on which proposed work will be done. .
X32 5 .~a c~.~ ~'c , .
ouse Number ...~/i
R(,~~,~~,~
. • • Street • , . • . • ~fIantJet
turtty Tax ,,\fap No. 1000 Section ,~,2 Z. , , , , Block , , Z.
Lot....~.7
:bdivision Filed ~11;tp No. .
Wamcj Lot .
ate exrshng use and occupancy of premises and intended use and occupancy of proposed construction:
Existing use and occupant , , , ,
Intended use and occupancy , , , , , , , , , ~~ba, ~L(.~ ~~:tJ;)c, .
3. Nature of work (check which a I , •
RemP'Plicahlc ir~w E3utldin '
Repair g Addition ...lf teration
11
val Demolition Other 1Vurk .
4. Estimated Cast • ~ • •
i ZiGC~~i (Dt<i~nptton)
Fcc
S. !f dwelling, number of dwelling nits , • (to be paid on filint; this application)
• [f garage, number • • • • • • • • • • • • • Ntnnber of dwelling urns on each floor .
• of cgars Tc4occupancy, :pacify nature and extent of each type of use .
7. Diinenstons ot'existin structu . . .
6. If business, comnurcial or• Nu ml}er of Stories Rear Depth .
,
Hci;ht .if any: Front...........
Duncnstons of same stricture with alterations or additions: Front • • • • • • • " "
ePttt .....................I,. Hciltht Nunibcro(Storic~Rcar
g. Dimensions of entire new c Numhction: Front , , • • • , • • • , • • • , • Rcar .
Depth
Height er of Stories . , , , •
9. Size of lot: Front .
0. Date of Purchase Rear ..........Depth
I. ZoncP r tPsc district in which ren' Name of Former Owner
...P • •jises arc situated • ,
Does ro osed construction vioL•ife any zoning; law, ordinance or regulation: • , • • • • • • • • • • • • •
1Vi11 lot be regraded .
No
Name of Owner of remises Will excess Cill be removed from premises: Yes
~ • { ...............Address ~
Name of Architect I hone No •
Address....
NamcofContractor........•• ••••••••••••.•.PhoneNo...
Is this property within 300 feet of a tidaldwetland? ~ • • " • • Phone No...
No.........
*If yes, Southold Town Trustees Permit may be required,
• PLOT DIAGRAh1
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from
:operty lines. Give street and block number or description according to deed, and show street names and indicate whether
tenor or comer lot. II
I ~
rf~
ill
i
•
I „
i
I
T~ or• Nr_~v YoRr,'
NTV of s,s ' . I,
(iv;une of individual si nines ' ' ' ' ' • • being duly sworn, deposes and says that he is the applicant
named, g o corjtract)
the
I (Contractor, agent, corporate officer, etc.)
d owner or owners, and is duly authgrircd to perform or have pcrfonncd the said work anti to make and Gle this
anon; that all statements contained iii this applicaGOn arc true to the best of his knowledge and belief; anti that the
'will be performed in the manncrsct forth in the application filed therewith.
to bcforo me this
...................clay of..... 19
'Public, I •
County
• I
• I •.••,•(Signatureofapplicant)