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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-19697 Date JANUARY 30, 1991
THIS CERTIFIES that the building ADDITION
Location of Property 44360 COUNTY ROAD #48 SOUTHOLD N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 63 Block 1 Lot 20
subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVEMBER 2, 1990 pursuant to which
Building Permit No. 19506-Z dated NOVEMBER 8, 1990
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 BUSINESS STRUCTURE AS APPLIED FOR.
The certificate is issued to WINDSWAY OF SOUTHOLD ASSOCIATES
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. PENDING - JANUARY 29, 1991
PLUMBERS CERTIFICATION DATED N/A
ilding Inspector
Rev. 1/81
FORK 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)
No 1 9 5 0 6 Z Date 2 19. ,U
Permission is hereby granted to:
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at premises located at . l.O.a~.......4 ' ......../..8........
.
County Tax Map No. 1000 Section Block Q.)........... Lot No....
pursuant to application dated .d ShA!m. 192.A., and approved by the
Building Inspector.
Fee 5..~
.
Building Inspector
Rev. 6/30/80
TOWN OF SOUTHOLD
r-TOWNOF fc Form No. 6
BUILDING DEPARTMENT
TOWN HALL
765-1802
LD
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 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 ;~0. , S 1
New Construction..... ~[[.''``7 3Old,~ Or Pre-existing Building
Location of Property .....Y Av/.... .k41 ...........d?!NY!^~~7 L~
House No. I! Street JHamlet
Onwer or Owners of Property. A"!146//..4f f!'G
County Tax Map No 1000, Section... /p.?........ Block ..........Lot...................
Subdivision ....................................Filed Map.......... .Lot................
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Permit No...//S 8~.Z....Date Of Permit.. A; 190 .....Applicant. All' . .
Health Dept. Approval.... .....................Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate...........
Fee Submitted: $
(91k.'I Of 'z
0 Q6 9 7 APPLICANT
ri-ELD INSPECTION JIDATE COMMENTS
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STATE ENERGY
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ADDITIONAL COMMENTS; m
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THE NEW YORK BOARD OF FIRE UNDERWRITERS fF+v~,
BUREAU OF ELECTRICITY
85 JOHN STREET. NEW YORK. NEW YORK 10038
Date F I43R11teFi ~ 9 r i 9i3l Application No. on file N 1746,Q
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
bll,illl.T Td~X Fst1.C.GLl~1r. I.Caf41, CH «R, .,(A)T12t%D, H,Yk.
in thefollowing location; ? Basement ist Fl. ? 2nd Fl. Section Block Lot
was examined on EF~HkI)!1R 3. , r~tj and found to be in compliance with the requirements of this Board.
FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS INCANDESCENT FLUORESCENT OTHER AMT K W. AMT. K.W AMT. KW. T. K W. AMT. H P
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
AMi. K. W. OIL H. P GAS H. P AMT. NO. A. W. G AMT AMP. AMT. AMPS TRANS, AMi H. P. $Y$TEMS AMi. WATTS
NO, OF FEET
SERVICE DISCONNECT NO. OF S E R V I C E
AMT. AMP. TYPE METER 10 2W 1 a 3W 3 q 3W 3,e AW NO.OF CC. COND. A. W. G. NO. OF HbLEG A. W. G. NO. OF NEUTRALS A. W. G.
EQUIP. PER 9 OF CC. COND. OF HILEG OF NEUTRAL
OTHER APPARATUS: -
375 TOWN HARra N t,AIVE
:i t7d1`I'i11JC1(}, Tilt, 11971, GENERAL MANAGER
Peril
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credlntials,
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
! BOARD OF HEALTH
FORM NO. 1 3 SETS OF PLANS , , • . . .
SURVEY
TOWN OF SOUTHOLD QUECR
BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL
SOUTHOLD, N.Y. 11971 NOTIFY:
` TEL.. 765-1802
Examined ..0,t~ CALL . .
1990. MAIL T0:
Approved 1984. Permit No.
Disapproved a/c
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date /.o I5 f'Q
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with
sets of plans, accurate plot plan tfrscale. 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
d. Upon approval of this application, the Building Inspector will issued a Building Permit to he applicant. Such permit
shall be kept on the premises A pble 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
3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
.tc;ulations, for the construction of buildings, additions or alterations, or o rem 1 or de of i n
Clio applicant agrees to comply with all applicable laws, ordinanc ov
es, builc{y WC . dose ' ed.
admit authorized inspectors on premises and in building for necessary inspecti eaAtion~s, an
i.-nature of applicant, or name, corporation)"
(Mailing address of applicant)
;tale whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
t.......pp........ .
:ame of owner of premises (f v du•~,~~ ,Q
(as on the tax roll or latest deed)
applicant is a corporation, signature of duly authorized officer.
(Name and title of /corporate officer)
Builder's License No. -PXV/?dW -!J., s j
Plumber's License No.
Electrician's License No.
Other Trade's License No .
Location of land on which proposed work will be done: nn
f rouse Number Street
Hamlet
County Tax \lap No. 1000 Section 6 3 j
Block Lot . A? D
Subdivision . • . • • . •
Filed Map No. . Lot .
(Name)
Stzte existing use and occupancy of premises and intended use and Occupancy -of proposed construction:
A. Existing use and occupancy..
B. Intended use and occupancy ........?P~... /CI d?l~• q
Nature'of work (check which applicable): New Building Addition Y Alteration
Repair Rlimoval Demolition ,Swimming pool.. • . • • •
Tennis Court . Accessory Building ......•••.Fene•e
4 • • .Other Work .
Estimated Cost......... . q t?••ir,$. Fee
(to be paid on filing this application)
If dwelling, number of dwelling units Number of dwelling units on cach,floor
If garage, number of cars , " " " "
if business, commercial or mixed occupancy, specify nature and extent of each type of use I90.D,P,Te0aa..
Dimensions of existing structures, if any: Front , , S04 , Now S..., Rear Depth Lo ~ ' o~FYy~-
Height Number of Stories
.
Dimensions of same structure with pltcrations or additions: Front Rear . • •
Depth , , sleight . . Number of Stories . , .
Dimensions of entire new construction: Front Height • r2.° Rear Depth . ~ Gi "c^`t
Height Number of Stories . .4 V.0
Size of lot: Front.. .1. Rear,.` .....................Depth....................... .
Date of Purchase , t,7,I? , , , , Name of Former Owner . • . ' '
Zone or use district in which premises are situated • • • • . . , • . ' ' ' ' ' ' ' ' ' ' '
Does proposed construction violate'any zoning law, ordinance or regulation: • •
Will lot be regraded .N!? IVIRcess fill be removed from premises: Yes J . , No .
Name of Owner of premises ~t,tpp¢ y q aut(1utyf. Address iA .%G(Ve2! , . ?"trIub, Phone No..~60:
Name of Architect p Address • .
Name of Contractor (n1%?A{ fNish /3a?ib: 2bj, Address Phone No. Phone No. lee=i"Jr
).Is this property looted within 300 feet of a tid..al...w.e..t.l.a.nd? * .YCS... .NO.,1:.:...00
*If yes, 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
)party lines. Give street and block number or description according to deed, and show street names and indicate whether
crior or corner lot.
'%TE OF NEW YORK,
UNITY OF. S.S
`indiviciuall signing b 1` • . . ' ' ' ' ' ' • being duly sworn, deposes and says that lie is the applicant
(Name of contract)
rvc named.
is the ...........4~ W.N.{1~ .
i
(Contractor, agent, corporate officer, etc.)
:aid owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
lication; that all statements contained in this application are true to the best of his knowledge and belief; and that the,
k will be performed in the manner set forth in the application filed therewith. r
)m to before me this
~t....day of...:............ 194. / \
ary Public, .Cl:..: ` ; County /
HELEN K. DE YOE • • • • '
NOTARY PUBLIC, State of New Ymkl, • • • • ' • • • • • '
T o.E47078s 8,Su of jaunty (Signature of applicant)
m March
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&`rv BEFORE
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765-1$02 9 AM TO A. PM FOR THE ..n
FOLLOWING INSPECTI NS. `t
{ FOUNDATION - T OREOUIREO`~., t7 r' FOR POURED CONC. ETE
2. ROUGH . FRAMING !L PLUMBING -
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- q., NSULATIO CONSTRUCTION MUST _ i
9E COMPLETE FOR C U MEE7 - „
ALL CONSTRUC nurv ° THE NY. f
' THE REOUIRE.MENT OF ENERGY I
STATE CONSTRUCTI N & {
CODES. NOT RES ONSIBLE FOR DESIGN OR CONSTfl CTION ERRORS
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CERTIFICATE OFOCCUPANCY
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