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FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20467 Date JANUARY 10, 1992
THIS CERTIFIES that the building ADDITION TO ACCESSORY
Location of Property 160 LAKEVIEW TERRACE EAST MARION, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 31 Block 9 Lot 17
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 21, 1991 pursuant to which
Building Permit No. 19981-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 ACCESSORY GARAGE AS APPLIED FOR.
The certificate is issued to NORMAN & JUNE WOODCOCK
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ~I~'
UNDERWRITERS CERTIFICATE N0. H-025009 - NOVEMBER 6 1991
PLUMBERS CERTIFICATION DATED N/A
Building Inspector
Rev. 1/81
rows xa •
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
CTHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N 19 9 81 Z Date ............~..rt~,.e..... ~..~a......., 19..x..!
Permission is hereby granted to:
to ...~~-.`.~.....'^~'4~1~}....ft.Srr:.....°~^.:1.....~cfr1..~!h~!~f~..1.°....01:!: 1....rQ.'.~
of remises located at....~.~°.~...~~-R!~.~~....Ir.SN?::°~.5~...y..~.:4,od:...~...
County Tox Map No. 1000 Section .....Q.~.,....... Block Lot No.... ~..1
pursuant to application doted e~.d.M.
A,......~..~ 19.~.a., and approved by the
Building Inspector.
Fee S...a?.~.:
~:5~~: ?r
ing Inspector
Rev. 6/30/80
+r Form No. 6 .':'r e
I _ I ~ „ R i - ~ ~ ! ~
TO[JN 0 F SOUTIIOLD f~ ~ `
BUILDING DLPART:IGNT JAN
TOWN IIALL ~ ~ ~
765-1802
APPLICATION POR C[RTIFICATL OF OCCUPANCY`
Tftis.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 features.
2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form .
3. Approval of electrical installation from Board of Pire Underwriters. )
4. Sworn statement from plumber certifying that ttte 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.
3. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
°prc-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.Op, Businesses $50.00.
2, Certificate of Occupancy on I're-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
.•ew Construction........... Old Or Pre-existing Building „
Location of Property.. .`(70,,,~,/~JfL JlJ.~(w.
House No. " " "
Street Hamlet
~nwur or Owners of Pro ert d.~d?d,' y "
P Y. ~'7 f~.`~". .'~.1~'O.tO~e'.. ~~rS,,~F:pC,~YL...........
:uun[y Tax Map No 1000, Section.,Q,,,~,~,,,,,,,Block.. ~
.......Lot.../ 7
subdivision... "
...Filed ~i:tp....,. .Lot..
crmLt No.~~~~f.{., ?~r/1n G%~r64G-t.~ / I
,,...Date Of Permit.•6/.~6,,lf/ „Applicant. f`./2Rlylj~7;J,,,{,11,c7o
J.C. 4t .
ealth Dept. Approval...
" " " •••••••••••••••..Underwriters Approval.,
inning Board Approval
equcst for: Temporary Certificate.,,,,, ~~77
Final Ccrticate..l:.
'e Submitted: $.1~'J/
~~c• ~13~0 ~
t" d ~ a ~ APPLICANT ~
_ -,d~~,,,.. ..~«.~.~.,t
y. _ ~ -
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAr,R t
9029754 BUREAU OF ELECTRICITY
83 JOHN STREET, NFyV YORK, NEW YORK 10038
Date JANUARY O'L,1992 APPlicotionNo.unfile 7ti557191/9t H 026257
THIS CERTIFIES THAT
only the ekrcerleal equipment as dsserihed helore and introduced by the app/icont nomad on the ahoee appBcation numher in the premises of
NORMANH. if00D000K, 150 LAKEVTEN TERRACE, FAs'T MAR10N, N.Y. ~
in thefoilouinp loc DE(:~,IfR~ Beserf4ets4 2 ? IKt £I. ? snd Fl. f'AR Sertiun'31 BloekQ Lot ~
u~os esaminNf un 6(: 79 , 1 Yy and found to he in compliance wish thr requiremenfa of this Bwrd.
A%iURE R%TURK RANGES COOKING DECKS OVENS pSM.WASIMRS EXHAUST FANS
OOTIETf BTACtK SWITCNB NCANDESCENT f1d711E5CENT OWNER AMT. K. W. AMT. K. W. AMT. K.W. AMT. K. W. AMT. H. P.
3 2?. 1
ORYtRS RAiNACE MOTORS IVi1N1E A!lIIANC! sNDERS SMgAtEK7T TIME CIOCKf qLL OMIT IIEATlRS MUlT4WilET DIMMERS
- AMT. K. w, dl N. P. GAt N. I. AMT. NO. A. W. c. AMT. AMI. AMT. AMPS. TRANS. AMT, N. r. ~ T AMT. WATfS
SERVIOS OKCONIIECT NO.OF S E R V 1 C E
AMT. AAV. 1rT! ~ t / t W t / SW T / 3\v 3 / AW OPFNCeCOND. Of CC. COND. ~ N41E0 HI ND. W N[DTtAlS p ryFUTR~I
OTNlE ARiARATUS:
' NORMAN Ii. GOODCOCK
15U f,AKEVI}:li TERRACE _
P . O . ROX 6 2 ~i T+~+eA~ M,~,IAp~
E.MARIOtr. NY. 11939 11 ~
Per
This certificaN must not bs albred in any manner; return to fhe office of the Board if incorrect. Inspectors may be identified by their credeMia .
COPY FOR BUILDRIG DEPARTMENT. THIS COPY OF CERTIFIGTE MAST NOT- BE ALTERED IN ANY MAtNlR.
,3 . _ _ _ _ _ r _
r._.__~_.-._-~ - _
THE NEW YORK BOARD OF EIRE UNDERMF!lfTERS
RU7R?.84 fUREAU OF ELfGMIGITY
83 JOHN STREET. NEW YORK, NEW YORK 10038
NOVS;MH,r:k 06.199? APPlicatienNo.onjiie X474.81?91/91 H 115i1OQ
THfB C.ERTIRIEf THAT
enl!' tAe ak~eerioal Kuipwuwt Y deecli6ed 6e/ots end iwtrodwced 6y tM a~tlteatt Mined on the a6aros appNntiott nYmMr in tks promiws of r
NORMAN H. 8000~OOK, t;0 1'~AKF',JLH;N 'I'RRRRr:P;, pslf,};~t?.SH, FACT StAR.(ON; N.Y. ~®_l
iw tkafaUewinS locations 0 BYement ® lst Fl. ®End FL (1119' SerNoa?.~ &cek" Lot '-i
Yw eremined un .hCA'OB F;R (17 , ?.941 end found to be in rnmpliewce Yith the reywinmentx of this Buerd.
RItiYS! _ _ _ _ _ WIOIS tbO1nN0 MOtf i OVINi_ _ ~~INI WA_SNNS ~ EXMAUST FANS
t)1RtlES ACiK SMTGKf NVCANeEXEM IIUGtEKEM OTNER AMT. K. W. AMT K. W. AMT. K.W AMT. K. W. AMT. N I io
71 3 ~7 ~ ~ F H•
Iv
OtY*i /IId1ACi MpTOllf IIIi11N ANYANCE IoOYf MC/I TMMC>.Oglf RRl IMYTIMT~S tiUlT40Ui1lT DNWAlRS ~
AMT. K. W. ql N. I. GAS N. I. AMT. MO. A W. G. AMT. AAV. AMT. AMTS. MAN/. AMT. M.I. Lek ~T AMT. WAtTt
7, ~ -
lVIC7 DMCOSMCT ND. q S. ! R V 1 C -11'
AMT. AMr. TVK /t
01~ i / ew i e ew t i Tv t / Aw. ~~ceca+o. W cc
L°' o. 01 Ni.uG s7f No. or NEUTtAIS ~ ~Inurnu ,
z ? oo ca ? x ? a
tmw APrAf1ETU5: - - _ _
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MOTORS:?.-.50 H.Y e
G. F.C.7:-6
6
SMOK}: OE;TECTOR :
NORMAN H. NOO7)CpCK G/~~~ a
1.6Ci ?,AKRVJ 7:51 T'F1RRX!'}: ~
F . O . ROX h 5 OMAL MANAOlR
f;AST MF.,N;)Pk, MY, 9 iv '15 /
Per Y _
.Thu nrliRtob Ilwd not bo _ aN~red_in at~r manwi. rMUrn to 1M offia_ of the lomd if intornd., kKlpactors _ ratY M idantifiad by Moir cndaMiok. -
COPY FOR !~1lARf11~IT. 71RS COPY OF INGk NN1~T' K A~T~ IMMIlR.
clcLLJ ~Ii:S:'ECTiU;J ~~l)A:E ~ i;OMMGNT°
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PLUMBING
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IIJSULATIOPI PER N. Y. y
STATE ENERGY ~
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" - FOAM NO. 3
~~i,~
r, ! MAY .
TOSVN OF SOUTHOLD
p~p,I4t~j°-~`~ _ BUILDING DEPARTISIENT
~.'q'tr~~k~EU FYI Ynv,..~~t~f ~t YV.~'~... ,
Y,Y,i ~ TOWN CLERK'S OFFICE
SOUTHOLD, N.Y.
NOTICE OF DISAPPROVAL
f~ ~ / _ ~ ~ Date 191. .
To fl~L»:J.. . ~ ~4~~.. y/C~~'r~c~r
~r./.y..~?r.`'.! //9.39
PLEASE TAKEN TICE that your application
dated .~l?, , , , , , , , , , , , , , , , „ 19g`.
for permit to .'r~Y.(i,C~~ ~L( , rr~
s ~,t'~,~ r
Location of Property ~ ~?~J.. }~~~~"r~
House No. Street ~ ~ ~ ~ ~ ~ ~ ~ Hamlet
County Tax Map No. 1000 Secti n . , , BI ck ......Lot ..!.7 .
Subdivision ed Map No. Lot No. .
is returned herewith and disapproved on e follow g grounds .~~.f~/.
~...4~1~,..~,~i`r ~,~.~GB~
.........l.......
...................y
. t
„ ~ ~ B~ i1di~ Inspector
K y
RV 1/80 ~ ~ .
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BO,1FD OF HEALTH
FORMNO.1 3 SETS OF PL1NS
TOWN OF SOUTHOLD SURVEY _ _ .
BUILDING DEPARTMENT CiICC}
: .
TOWN HALL SEPTIC FORM . .
SOUTHOLD, N.Y. 11971
TEL.: 765-1802 r:oTIPYI
CALL ~
xamined !u^.'!~R,. aZ<..., 19q°L1. p 2 rtnlL T0:
pproved . !u-Y,~Q. , ~ .(f 19 / Permit No. I ~ ~ ~ • • • ~ .
Disapproved a/c .
. ........~-r~.. .
(Building hispector)
APPLICATION FOR BUILDING PERMIT i
Date ....fr2A.y.:3U....., 191.1.
INSTRUCTIONS ~ ~I
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
is 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 appli-
ition.
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
call 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
call 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
uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
egulations, 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 code, and regulations, and to
imit authorized inspectors on premises and in building for necessary inspeG ions. G
(Signature of applicant, or name, if a corporation)
:'•.~4x.~d~../.d.~.~~><r?1~Lv.TG.•7.9t3'.•.~.~.1.'llf1.1~/.G,i~l,oU
(Mailing address of applicant) / I y,3
Mate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
~ u':~!~1~
dame of owner of premises .N.rt~i
I1?~n1, 1'uN. F..W SO,,O ~ .
(as on the tar* roll or latest deed)
f applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No. , . ~t-!~.~L~ . .
Plumber's License No . .
Electrician's License No . .
Other Trade's License No . .
Location of land on which proposed work will be done . .
House Number Street Hamlet
County Tax Map No. 1000 Section c 3 ~ • . • Block 9........... Lot . .
Subdivision Filed Map No. Lot...............
(Name)
State existing use and occupancy of premises an/d int`e/nded use and occupancy of proposed construction:
a. Existing use and occupancy l~1.71/.~1.:.lyl1.U5~~ .
b. Intended use and occupancy .....I:.GI;f/? , Cr/.'~II~/~.~i.'L~
Nature of work (check which applicalble): New Building , , , , Addition Y • • • Alteration .
Repair . . Removal ~ , , Demolition Other Work .
(Description)
Estimated Cost :
~ Via. ~ . Fee , .
(to be paid on filing this application) ,
If dwellin number of dwellin ~ nits, Number of dwelling units on each floor .
g, g
If garage, number of cars i
If business, commercial or mixed occupancy, specify nature and extent of each type of use .
Dimensions of existing structures, if any: Front Rear Depth , .
Height ...............NumberpfStories........................................................
Dimensions of same structure with alterations or additions: Front Rear .
De th eight Number of Stories
P ~
Dimensions of entire new constructio ~ •
n: Front ! Y.......... Rear 1. Y, , , , ..Depth .
Height . Number of Stories .
Size of lot: Front Rear ! . ? ~ Depth .1. ~ 5................. .
Date of Purchase . ,l. 9:? y....... '
: ..............Name of Former Owner e ~!"3.i~~ g .
Zone or use district in which premises are situated .....1 A.v v .
Does proposed construction violate any zoning law, ordinance or regulation : . .
Will lot be regraded ..Y. ~5..~~~p ' Will excess fill be removed from premises: ~ Yes No
.'.>~FiaF)~/>!~w~~~/~c,o~,r~Address/GO.LAXt~Vw:k:%P7~!? .Phone No. ~.?7.'.~^.3.7.`1.,...
Name of Owner of premises , ~ H~1 /IiU~t. r
Name of Architect : .............Address ...................Phone No.
Name of jf treStorSouthold Town' • , • . • • ~ ~ Address Phone No................
Is thi* property within 300 feet of a tidal wetland? dyes........ No
y Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from
aperty lines. Give street and block number or description according to deed, and show street names and indicate whether
:erior or corner lot.
SSG SX~ ~~J4/~ ~~N aN S d,~ I>l:
.~1~'S f> O'L; 9NS 5" U @ iyi / ~17z''d u'~ .i9-/.li°G>v!~?/a ~
I,
K
SATE OF NE R ~ IL
......./.h.
3UNTY OF L' q
. , . j?1:(,Q.N... (r ~ ~,Nr~ , . , being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
ove named.
;is the ........................t'.~ i;'L..~
(Contractor, agent, corporate officer, etc.)
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
xk will be performed in the manner sef~, forth in the application filed therewith.
vorn to before me thisC~ I
Mary Public, .~~U 4~ County
. fJ,,
• CLAIRE L. GLEW ! ~(l7•ZK,I.(.~` ~ ~~,"f~Y•::~f:~': C..+~ .
Notary Pubiia State of New York • • • • • • • • •
No. 4879506 (Signature of applicant)
Cluali}led in Suffolk Cppnty ' 2._---~
Commission Expires December 8,18
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