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. FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
O€f ice of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20599 Date MARCH 18, 1992
THIS CERTIFIES that the building ALTERATION
Location of Property 830 NEW SUFFOLK ROAD CUTCHOGUE, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 109 Block 6 Lot 7
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated DECEMBER 5, 1990 pursuant to which
Building Permit No. 19574-Z dated DEC'ti?MaFR 12, 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 RECONSTRUCT ROOF: SIDING & WINDOWS AS APPLIED FOR.
The certificate is issued to LAWRENCE & ANN MILIUS
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N-228094 - MARCH 12, 1992
PLUMBERS CERTIFICATION DATED N/A
D-
Building Inspector
Rev. 1/81
I
rosti xa s
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)
N~ 19 5 7 4 Z Date ..a.~,..
.........1.. 19.9..a
Permission is hereby grouted
...~4.K...~.~..~
0
of remises located at g3 D ~V.~ p
p ....llS...d ~r"~f. .N~~
.
County Tax Mop No. 1000 Secti^on~......~.. Block ..1D........ Lot No...0...~
pursuant to application doted ......I..~.~.S.A.C!:~!^Sn.~...~ 19.~.~, and approved by the
Building Inspector.
Fee s.S":7~.:...
-~.....~..~.~:t...
.
ding Inspector
Rev. 6/30/80
Form No. 6
. TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
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 o£ 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 2J10 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:
~E 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 iVQ/! P.'~!i3.~f~~.-...~. l
New Construction..... Old Or Pre-existing Building....
Location of Property.:
~ 3:C~..........."~ C;ti.z5,r1.y`°J.`Q~-!`~ ..~~...\:L.~-.'~:T-~Ff~~.~.~~,_,. - ,
House No. Street Hamlet
Onwer or Owners of Property~5?~i~C-.:~/..K".E:.. ~...!~!~1.:!~..~?l.~f.-./..5...........
County Tax Map No 1000, Section ..............Block................Lot......................
Subdivision/
....................................Filed Map............Lot......................
Permit No 5..~.~.,.Date Of Permit ................Applicant.............................
Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate..~....
Fee Submitted: ~
(.0 ~ ct 8S ~ ¢ APPLICANT
z
INSPECTORS ~~gUFFO(kco
(516) 765-1802 O G
VICTORLESSARD,Principal 'yam SCOTTL.HARRIS,Supervisor
CURTIS HORTON, Senior °w Z Southold Town Hall
VINCENT R. WIECZOREK, Ordinance p ^r P.O. Box 1179, 53095 Main Road
ROBERT FISHER, Assistant Fire 9,h ~ 0!~ Southold, New York 11971
Building Inspectors #t Fax (516) 765-1823
Telephone (516) 765-1800
THOMAS FISHER
GARY FISH
OFFICE OF BUILDING INSPECTOR
TOWN OF SOUTHOLD
February 27, 1992
LAWRENCE & ANN MILIUS
P.O. BOX 187
CUTCHOGUE, N.Y. 11935
To Whom This May Concern:
We are unable to complete your,Certificate of Occupancy
because of the following reasons:
An application for Certificate of Occupancy is
not on file. (Enclosed)
XX No Underwriters Certificate on file.
The check is (outdated/not on file.)$25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 19574-Z (ALTERATION)
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
THE NEW YORK BOARD OF FIRE UNDERWRITERS ~nc,~
1(f9@17.1. BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
Bate HXtft(:!I 12,1792 ApplicotionND,anfile 79922~5L/91 N 22b0ur4
THIS CERTIFIES THAT
only the alectricol equipment as deacrihed helow and introduced by the applicant Homed on the shove application numher in the premises of
sn~~v ~Iti:,zlr;;, 6.'Jrn tacr>r sag>?ol,~ a~nnra, Co~rcS[~ar,,.5>a, u.°t,
in thefollowinp locationg ? Basement ? /xt FY. ? 2nd Fl. ~~lil~ .Ser[ion Block Lot
uws examined on MAl2Clf 0~~r1992 orcdfoundto he in coneplimar with the requiremenLx q(this Board.
fIXTURE ECEPTACLE$ SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS INCANDESCENT.FWORESCENi OTHER AMT K W AMi. K. W AMi. KW. AMi K.W AML H P.
`t 1. 7. ^
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS gELI UNIT HEATERS MULTI-OUTLET DIMMERS
AMT K. W. On H. P. GAS H P. AMT NO. A W. G. AMi qMP AMT AMPS TRANS. AMi H. P SYSTEMS AMi. WAiiS
NO.OF FEET
SERVICE DISCONNECT NO. OF S E R Y { C E
AMT. AMP, yypE METER ~ YW ~ A~W 3 A3W 3,e' 4W NO OF CC. COND A. W. G. NO OF HbIEG A W' G NO Of NEUTRALS A' W G
EQUIP. PER % OF CC. COND OF H4LEG OF NEUTRAL
OTHER APPARATUS:
PAUY., R. B1JttNS f,l'C> 562132-hi C/~~~
/
l75 'l°QYdtd !iAh~p~ IrAS~FI
u QDTH(JGL1, NYr 11371 GENERAL MANAGER
r 11 ~Y
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.
j COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
' INSPECTORS
Princiha! Building Inspector o~pSVFFO(~~OG
Curtis Horton a yj2 SCOTT L. HARRIS, Supervisor
Senior Building Inspector ~ = Southold Town Hall
Thomas Fisher v. P.O. Box 1179, 53095 Main Road
Building Inspector ~y ~ Southold, New York 11971
Gary Fish '~Oj ~ ~`a Fax (516) 765-1823
Building Inspector Telephone (516) 765-1800
Vincent R. Wieczorek
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF Bi)ILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOL3THOLD
August 14, 1991
Larry & Ann Milius
P.O. Box 147
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)
XX No Underwriters Certificate on file.
XX The check is (NOT ON FILE) $25.00
No Health Department Approval on file.
- - - No,~£ina-1- inspect-ion has-been made. - -
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 19574-Z ALTERATION
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
/~s~s~
~ 765.1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ) ROUGH PLBG.
[ ]FOUNDATION 2ND [ ] INSU ION
(]FRAMING [ INAL
REMARKS:
DATE INSPE~TOR
INSPECTORS
PrincipaltBuilding Inspector Q~pSUFFO~~COG
Curtis Horton y~ SCOTT L. HARRIS, Supervisar
Senior Building Inspector H Z Southold Town Hall
Thomas Fisher t++ P.O. Box 1179, 53095 Main Road
Building Inspector ~ •
y,~ p! Southold, New York 11971
Gary Fish O,( ~ ~0 Fax (516) 765-1823
Building Inspector Telephone (516) 765-1800
Vincent R. Wieczorek
Ordinance Inspector
Robert Fisher
Assistant Fire Inspectrn OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
August 14, 1991
Larry & Ann MiliuB
P.O. Box 147
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)
XX No Underwriters Certificate on file.
XX 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 # 19574-Z (ALTERATION)
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ]ROUGH PLBG.
[ ]FOUNDATION 2ND [ ] INSU ION
[ ]FRAMING [ FINAL
REMARKS:
4
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DATE INSPECTOR `~G ~ "I
c lELD Z;:S:`?~TiU;J IIU6:5 II ~O.M~'NENIS '
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FOUtlDATION (1st) ' A~
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FOUtlDATTOtJ ( 2nd ) _ - /
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off,
P,OUGH FRAMI's & o
P1.UMHING p~
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3.
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ItJSULATIOM PER N. Y.
STATE ENERGY ~
CODE a
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FI;JAL
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ADDITIONAL COMh1ENTS: x~
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77
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T6S-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ J FO NDATION 2ND [ ]INSULATION
[ FRAMING [)FINAL
REMARKS:
DATE ~ ~ INSPECTOR
BOARD OF HEALTH
J SETS OF PL.1N5
fORM NO. 1 SURVEY . •
TOWN OF SOU7HOLD x,CiIECI: .
BUILDING DEPARTMENT SEPTIC FORtI
TOWN HALL
- ~ $OUTIit1LD^L~Ly_lL`1IL t7OTIFY
TEL.:7G5~tII02 CALL
} 2.19 9 V MAIL TB:~ 1 • . •
Ezantincd ~ 4J`~d ~
Approved tiLJ.°.~~^."~.. ~ 19 ~k Pctmit No. 19 5 7 ~ ~ : :^i .
Disapproved ajc . I I rr~S
:Y.~~'~- ~
(Building Inspector) . `
BLUG Dt. .
APPLICATION FOR BUILDING PERl41I7 TOWN OF SCUi!sCa :
Date IS .
INSTRUCTIONS
a, This application must be completely ffllcd in by typewriter or in ink and submitted to the Building Inspector, trio
sets of plans. atrttrate plot plan to scale. Fee ac~otrtin; to schedule.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stye:
of areas, and giving a detailed description oC layout of property must be drawn on the diagram which is par[ of this apF
cation.
c. The work covered by this application may not 6e commenced before issuance oC Building Permit.
'd. Upon approval of this application, [he Building Inspector will issued a Building Permit to [he applicant. Such perr.
shall be kept on the premises available Cor inspection throu^_hout the work.
e. No building shall be occupied or used in whole or in par[ for any purpose whatever until a Certificate of Occupant
sFtall have been granted by [he Building Inspector.
APPLICATION IS HEREBY hfADE to [he Building Department for the issuance of a Building Pezmit pursuant to t~
Building Zone Qrdinance of the Town of Southold, Suffolk Count ,New York, and other applicable Laws, Ordinances <
Rc_ulations, for the construction of buildings, additions or a ration or for removal or demolition, as herein describe
The applicant agrees to comply with all applicable laws, finances, b ildin~ code, housin, code, and rcoulations, and t
admit authorized inspectors on premises and in building f necessary j(+_soec*_i^^s.
(Si, azure of ppliclnt or name, if a corporation)
• (Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
...................../.........n...J.........................................................
Name of owner o[ premises l.~.t-:-y.. , .hz t~t kf .
(as on the tax roll or latest deed)
if applicant is a corporation, signature oCduly authorized officer.
(Name and title of corporate officer)
IIuildcr's Liccnsc No.... QLVLeCl: .
Plumber's Liccnsc No .
Elcctr.u.;;; ~ Liccnsc No . .
Otlicr Trade's Liccnsc No .
1. Location of land on which proposed work will be done; JJ
UL~ ~'J
Strcct.
flousc Nuntbcr Hatnlct
• 1
County Tax \tap No. 1000 Section • • • • • • • • Blue:k • • , , • , , , , , , , Lo[ . . . , ,
Subdivision Filed Alap No. Lot .
• ~(Namc)
Sixte esistfno use and occupancy of premises and intended use and occupancy ofproposed constnction•
A. Existing use and occupancy... SIAyI~ ~tnv~.,~\'. ..`t~C.SIC~Cnc.`
s
B. Intended use and occupancy.~
r e
3. Nature of work check which applicable): New building Addition Alteration
Repair RFmoval Demolition ,Swimming pool......... .
Tennis Court q (Accessory Building, .........Fence .......Other Work:.
4. Estimated Cost y~,•IOI(~t]+J~; Fee .
5. If dtvclling, nutnbc~rllloC dwcllino (ta be oaid on filing this application
~I units Number oC dwcltin~ units on each Cloor .
IC garacc, number oC cars • • : . : .
6. If business, commercial ar miscd occupancy, specify nature and extent of each type of use , . , , , , , . ,
7. Dimensions of existing structurFs, if any: Front . Rear Depth .
Hcigltt Nuriitber of Stories ...tf ~~i... .
Dimensions of same structure tgith alterations or additions- Front . . Rear .
Depth Flcigltt . Nurttbcr of Stories , .
Dimensions of entire new constntction: Front Rear............... Depth ,
Hcicltt , Number of Stories , ~~~~jj •
4. Size of 14~,tk~ tlrror na ~ • j Rear ...~,Ge.~.6 Dc •Tj,
h . , N..~s~ ~ r ;!s a F,(; G7
lp, Date of Purchsse .....1~ (zl,?„~, , • • , Namr_ of Partner Owner ~(•CC 1~... r . .
Y 1. lone or use district in wlticlt premises arc situated ,
12. Does proposed canstrdction vio.h~l1te any zoning law, ordinance or regulation: /1/t~, • . • • • - • • • • • • • •
!3. 1Vill lot be regraded ,IY.V . . 5Vi11 excess (ill be removed from premises: 1'~s - •
14, Name of Otvner of premises . _~.4VY-Fi;v}s~., , jll~iui-Address ..trc~.~ cft~4 ~ .......Phone No. : ~'~.-f ~ • .
Name of Architect , .......Address ...................Phone No.... .
Name of Contractor ~ ~ ' .Address . .Phone No.. • .
1S_Ls this property-located within •300 feet of-a.tidal•wetland? ^yCS-••.2t0!5,••
*IE yes, Southold Town Trustees Permit may be required.
~ PLOT DIAGRAti1
Locate cleazly and distinctly al~ buildings, whether existing or proposed, arid.indicate all setback dimen;ior.'.:: '
property lines. Give street and block number or description according to deed, and show street names and indicate w::c:'.
interior or corner lot.
~es~e~~1~1 1J .
s~rt~ ~ ~d~~~~ ~~~sS lb~, •
1la c.l~ ~ Q~~r~~~ • wJ ~(p~w/~ -
~ ~ l.tJr~,<~ot.~s .
~lPPRt~U~I.D AS i°dt3'(~D
DATA: ~?~Yo l3.P ~J .L`LS`2.~..~.
' NOTIFY t31i6!_C?VNC; t~E:F'ARTt\AEN'P lti'
766-1£402 t3 AM TO 4 P(Vi i"•Ofe 7'HE
FOl.LOWLNC; tN>F'F.CTIONS
1. FOIJND,41'I()N - TtNO REC!UIRED
' p~~G~l qR• FOR POURED CONCRETE
- ACC
S ~~~'P~~
CA~~° 3. INSULATION AM1NCi & PI.IJMBtNG
HO~~ ~UppNCY ~ aE COMPLETE FOR C.O tON MUST
QC Alt. CONSTRUCTION SMALL MEET
THE REQUIREMENTS OF THE N.Y.
- STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
STATG OF NEN YORE, ~IS,.S
CnuU-rv ttr- - - ~ ,
• ~ • (T\amc oCindividual si~ti ' ' ' ' • bang duly sworn, deposes and says that he is the appiica~
ing contract)
above named. Iii
llcisthc
(Contractor, agent, corporate officer, eteJ•
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file tl:
application; that all statements contained in this application arc true to the best oChis knowledge and belie(; and that t:•.
work will be pcrforntcd in the mannc'Ir set forth in tltc application filed therewith.
Swom to before me this
• ...............:5.. .,.~d~ay~o(''!......~?-~/;` .......,19%0
Notary Public, 1:~'•~ ..I~...~~4!Y~ . County
HELEN K DE VOE ' '
H~gy0187A, Su~tfolk C
un
~ • • • • • • • • • - , • • '
TermEMpiresMerch30,19~ (Si;namrcofapplic~'