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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-19699 Date JANUARY 30, 1991
THIS CERTIFIES that the building ADDITION & ALTERATION
Location of Property 445 ALVAH`S LANE CUTCHOGUE, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 109 Block 1 Lot 30
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 30, 1990 pursuant to which
Building Permit Nc. I4371-Z dated SEPTEMBER 7, 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 & ALTERATION TO EXISTING ONE FAMILY DWELLING
The certificate is issued to ROBERT L. SCOTT
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-163515 - DEC. 5, 1990
PLUMBERS CERTIFICATION DATED JANUARY Z5, 1991 -PREFECTION PLUMBING
B ilding Inspector
Rev. 1/81
roans xo. 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)
D - Date ,
N_ ~~3% Z ..9..7
............................................19..9a
Permission is'her~ granted t~ ( _ i~~~~~~
r
ro ...C^~~;71~.G?cllC.~Q!?r. ....~..r
...Ct~~.~..,4~5~.~e~.r~...l~7ytr~~P
,
~ v
of premises located at .........~~..id.~....... .:G.~~.~...,,~Qtt~.r~
.................................................................../.....q.
County Tox Map No. 1000 Section ......f.~/........... Block Lot No.........~~....~.....
pursuant to application doted ~s~l..Q 1 and approved by the
Building Inspector.
Fee 5... ~9.~ ..~(r~
. . ~
i a t
!
. . . . . . . . . . . . . . . . . . .
B ' ing 1 for
Rev. 6/30/80
~7.r
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/J~i FORM NO. 6
TOWN OF SOUTHOLD
Building Department
7 ~ ~ ~i ~ Town Hall
GCi1~~~~~~' Southold, N.Y. 11971
/ 765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted ~~r to the Building Inspec-
torwith the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal-(S-9 form or equal).
3. Approval of electrical installation from Board of Fire Underwriters.
' 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa-
tions, acertificate of Code compliance from the Architect or Engineer responsible for the building.
5. Submit Planning Board approval of completed site plan requirements where applicable.
' B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or
topographicfeatures.
2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
C. Fees: Additions $25.00 POOLS $25.00 ALTERATION $25.00
1. Certificate of occupancy New Dwelling $25.0.0, Accessory x$10.00 Business $50.00
2. Certificate of occupancy on pre-existing dwelling $ 50.00
3. Copy of certificate of occupancy $ 5 . 0 0 , over 5 years $ 0.00
4.Vacant Land C.O. $ 20.00 )q
S.Updated C.O. / $ 50.00 Date ~ 2.1.1.9.7.1....
NewConstruction,,,/,,, pldorPre-existi//n--g Building Vac~~an__tL//and
Location of Property ~ ~!•r~• • • ~C.y 7;
G~/~-t.7 L~-;Q-; .
House No. y, r Street Hamlet
Owner or Owners of Property ..~d ~/!'C ~~i• • ~
• • ~•u•~•5~~• • • • •~4-• • • • • • • • • •
County Tax Map No. 1000 Section I.®.~........ Block Lot..... .
Subdivision j./~
........................).......Filed Map No. ......./.~,.~,.~L~~o~t,,~N,.o~,.,,............ .
Permit No, /.x;37/ Date of Permit ~?./9v,Applicant . U• .o. ~~-r.". `.'e~`..:.".~- '
Health Dept. Approval ........................Labor Dept. Approval .
Underwriters Approval . ......Planning Board Approva , .
Request for Temporary Certificate .....................Final Certificate .
Fee Submitted $ .
Construction on above described building and p r it meets all applicable codes and regulations.
Applicant .....~~7.~'~ . .
Rev. 10-10-78
~~~~9~~q
THE NEW YORK BOARD OF FIRE UNDERWRITERS l
Ifil)f7,1 BUREAU OF ELECTRICITY ~ ~ '
65 JOHN STREET. NEW YORK, NEW YORK 10038
Date ~x<C"iRP<IH'Pzlt f,iti, Ir}c)O APPlication No. on fide 791~~If TJI'~f°'1 tl `~f~~:>~~,
~ THIS CERTIFIES THAT
}}~~only((~~++thryei electlricapl egqui(pment 11as describteTd below and Li~ntrodu{ce(d {6y thle(applpicayynt Homed on the above applicotion number in the premises of
Rl~tt)r, IZI ~t.tr'I"p. Mi `I ~I ~liil t~.llii ILA.,, i1111 If ~'I['d~C;}11jlMtlke, d'l.dn
I~ I~C{TI tTT,I`I'
in the following locatio Bgsern t LJ 1st FY. LJ 2nd F'1. .Section Bloek Lot
Nt)~I~;I.73iFN ~1D1~(~NU
uws examined ort and found to 6e in compliance with thr. rwyuiremerzts q~ this Baard.
FIXTURE ECEPTACIE$ SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCANDESCENT FWORESCENi OTHER AMT. K W AMT. K. W AMT K.W AMi. K W. AMi. N P.
DRYERS FURNACE MOTORS FUTURE APPl1ANCE FEEDERS SPECIAL REC'PT TIME CLOCKS ggLL UNIT HEATERS MULTI.OUTLET DIMMERS
AMi. K. W. Oll H P GAS H. P. AMT NO A. W G AMi. AMP AMT AMPS TRANS. AMT H P. SYSTEMS qMi WATTS
NO.OF FEET
' l.r,Cl~
SERVICE DISCONNECT NO.OF S E R V I C E
AMT. AMP. TypE METER ~ A. pW 1 H. 3W 3 N 3W 3 4W NO OF CC COND. A W G NO.OF HMIEG A W G' NO OF NEOtRAlS A. W G
EQUIP, PER .9 OF CG COND. OF HbIEG OF NEUTRAL
OTHER APPARAtUS:
Id't.T:i.T7+'~ Fi;Tt k';'t"GAY ?Lll17:f't'it~PP-2
G.F.C,~:-7,
~7,t;. 1;~hb;<:'C'Rlt' 7,hii3. d,1t1.~'i8e4~.l~
F.0.13«k X13
Y+AtiR}Pl., N"$. 1.19/!& GENERAL MANAGER
it ~
Per ~ ~ ~
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may 6e identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
TEL. 765-1802
~5~FF0~-~0~~ TORN OF SOIU'~~Od.D
' ~c OFFICE OF BUILDIIQG INSPECTOR
P.O. BOX 728
~ ~ TOWN HALL
"O ~ ~ SOUTHULD, N.Y. 11471
C E R T I F I C A T I O N
Date ~ >
Building Permit No. ~g?'~~ Z.-
Owner_ AU~~~ ~~~T
please print)/
Plumaer .ei ~C~~3N Lrn P3/~> _K f%l~'GJ%'~
(please print) 7`
i certify that the solder used in the water supply system
contains less than 2J10 of to lead.
~ ~ ~L~
(plumber's signature)
Swo t~o before_mc this
q~f a y o f ~y-~~~--~~'
19~. Notary Public
Notary Public, County ~ry~
~ps~i„Eyy ~
No.4S79606
QwNifieA in Suffolk County 7i'
CaMnhsbn EMpiree December 8,19....
-~r~~~, TEL. ?C>5-180'
S,~EF01."~~' ` To~rrr or souT~o~.n
•;:1ti~7Cuwi~ 3'., -c OPi'(CIiOPIIU1LDINGiNSPF.CTOR
a~ ~l~~i. .'n
a~js ~ T01VNilALL
' ~ SOIJT'IIOLD, N.Y. i 1971
"%Ypl .
January 8, 1991
Mr. & Mrs. Robert Scott
445 Alvahs Lane
Cutchogue, N. Y. 11935
'Po tVhom Thin May Concern,
47e arc unable r.o complete your Certificate
of occupancy because of the following reasons.
An application for Certificate of Occupancy
is not nn file.
/g~ DIo tJndcrerritcrs Certificate on file.r.~~ 1~4~
'Phe clu_c:F: .i:: (~~cc~~tsc~c~lnot on file.) $25.00
No ilcal.th De{~t. Approval on file.
No final insi~ect:ion has hero made.
Pleasr., contact our office on this matter.
T`sank you for your cooperation.
lhsildir;cJ Perm.i-t: II ~ .3...3. __._7 1 Z
Duildinc{ Duet.
`"Jx~C tla I'lumbcr :;older Ccrt.ificate on file. tom.
1(~s19!
( nl.l pr:rmiL•s involvi.ny plumbing briny
i~~ucd aFt.cr ~1pri.1 1,19174 )
m V
0
7. % ~
FDUt7DATI0N { 1st) -
FOUNDATZOtd (2nd)
2. _ ~ z
0
P,OUGH FRAME &
PLUMBING
w
H
3. ~
H
IIdSULATI0I1 PER N. X. ~
STATE ENERGY
f~ ~
CODE
ci
4. H
FI;IAL f ,j
f=G'•
ADDITIOIlAL COMMEI7TS: x
c»
x
. ro v
H
9
y
N
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- - _ _ _ _ ~
d IINN
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b
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765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST ( ] ROU~GH~PLBG.
[ ]FOUNDATION 2ND ~ S1~ ULATION
[ ]FRAMING [ ] FINyA~L -
REMARKS: c Gi-C c_r~i
-c~„~~,
d C ASS
DATF,~ ~ INSPECTOR
T65-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION i5T (ROUGH PLBG.
[)FOUNDATION 2ND [)INSULATION
~MING [ ]FINAL
REMARKS: ~=ti~J D' v2-e-~
i_
DATE INSPECTOR ~-C~
~~3~~
a65-1$02
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ]ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ }FRAMING INAL
REMARKS:
i
4
DATE INSPECTOR
r
~i
765.1802
UILDING DEPT.
INSPECTION
(]FOUNDATION 1ST ( ] ROUGH PLBG.
()FOUNDATION 2ND INSULA'~IAN
(]FRAMING [ FINAL
REMARKS: ~
~~~cc, ErS `Z~'
tip=z-
DATE ~ INSPECTOR
t _
r
~~3~/
765.1802
BUILDING DEPT.
1 NSPECTION
[ ]FOUNDATION 1ST [ ]ROUGH PLBG.
[ ]FOUNDATION 2ND [ INSULATION
[ ]FRAMING [ ]FINAL
REMARKS: .~Q- C~nn~!~--
F ~ ~y~/
DATE D o~~ ~a INSPECTOR
a.
~ ~ 765-1862
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ]FINAL
REMAR S: ~'G-i1~~ c~
DATE ` ~ INSPECTOR
~ X37/ rss-is®2
BUILDING DEPT.
iNSPECTI~N
[ ] FO DATION 1ST ( ] !ROUGH PLBG.
[ FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING ( ]FINAL
REMARKS; G~~
DATE ~ INSPECTOR
~
~K~~~~~~
~
~ ~
G o , ~
~ ~
~
~
~a ~
~ ~rvt~S
~ ~ ~ l~~k ~
3. Nature of work (check which applicable): New [luilding diticn . l... • .Uteration
Repair Removal Demolition ..........Swimming pool............
Tennis Court Accessory Building.........77.~~'Bence , : . , ~.o.Other Stork........... .
Q. Estimated Cast Fee .....~9 7 .
(to be paid on tiling this application)
5. If dtvellin„ nurnber of dwelling units Number of dwelling units on each Sloor , , . .
Ifgarace.numbcrofcars
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use
7. Dimensions of sting structures, iC any: Front Rear ..•.wC3........ Depth ..C~'+~........ . .
Hei•_ttt o....... Number of Stories .
Dimensions of sa c ructure wtth alterations or ad ttions: Front ~:v........ , Rcar , .
Depth Height , . ~C~ a!1!4C........ Number of S[orics . , ,
8. Dimensions of entire new constntction: Front ...,}yam Rear ....~.~i:......: Depth , , , , .
Height . ~,~~Yt , , , , Number of Stories . C/'. .
9. Size of lot: Front ~ Rear Depth
10. Date of Purchase . N e of Fo,,rm'eraOwn ,
1 I. Zone or use district in vvhiclt premises are situated ~.~~r~a.~.~~-:~Ci~ . .
1 Does proposed constructignf,violate any zoning law, ordinance or regulation: •
l3. 1Vif1 lot be regraded N i1 , , , , , Nill exec s fill e r oved from remises: Yes '
1~. Name of Owner of r ise .Address PI one No. .
Name of Architect h , Address .........Phone No.
Name of Contracto ; ~~:CGtc.~ .~~~175-~~~?`Address ..Phone No.~~~~~~ ~ .
IS.Is this property located within 100 feet of a tidal wetland? =YES._..NO.~c.
*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 ,
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF r' lV ORK, S,S
COUNTY
l/ being duly sworn, deposes and says that he is the applicant
• (Name of individual signin~ract)
about named. ,
fkistltc
(Contractor, agent, corporate officer, etc.)
aC said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
tpplieation; that all statements contained in this application arc true to the best of his knowledge and belief; and that the
work will be perforntcd in the manner set forth in the application fled therewith.
iwom to before me this
~0
/
lotary Public . , County / , ~~j
yy ~ ~ ~(/7.
(~?ARY P~U~I~
Stye ofy
New York • . : ' • •
. • ! - . • • . .
Te~•Fx~>Mirch30 ~ a (Sig r~t/ure of applicant) .
rs~ w
,
ti•
BOr1aD OF HEALTH
3 SETS OF PLANS
FORrAN0.1 SURVEY
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC roar[
TOWN HALL
$OUTHOLD, N.Y. 11rJ71 NO c 7~,~. Jy-~ j rJ
y/~ TEL.: 765.1B0~ CALL !
. / . I9~Q A T0:
Examined
Approved ...G~. 1~~. Permit No.~/ .
DisaPProved aJc .
ildi Inspector)
APPLICATION OR BUILDING PERPr11T
Date~(~.30......., 15~V.
INSTRUCTIONS rJ.
ra
a. Tlris application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
sets 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
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 appjication may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issued a Building Pcrmi[ to the applicant. Such permit
shall be kept on the premises available for inspection throughout the work.
' e. No building shall be occupied, or used in whole or in part far any purpose whatever until a Certific•.ate of Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MA~E to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of'buildings, additions or alterations, or for removal or demolition, a5 herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary in;pe¢tion~ 1
•(Sig~~nat~/ere ai applicant, or n e,`if a corporation)
• • • • • • . • • ~ • • (Mailing address of applicant) . ~ . • • ~ • • •
State w ether applicant is own lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name f owner of premises ~Q.J:~"`.~.`.'Z • ! .
I (as on the tax roll or latest deed)
1C applicant is a corporation, signature; of duly authorized officer. '
(Name and titi~corp~o~~ ffi9Gr) ,Q_~~
Builder's License Na • } ~,~'y`: Fly) ~ /
Plumber's License No . .
Electrician's License No . '
Other Trade's License No.
1. Location of land,
o/n
which proposed w rkw, il/l~be done; / / . ~:,'v _ 1 • ~J .
house Number I Street Hamlet
f
County Tar \tap No. 1000 Section • . • ~ ~ • • • • • • • ~ Brock • • • • • • • Lot ..~U....... ! , ,
Subdivision Filed flap No. Lot .
State esisting use and occupancy of premises and i~nte/,nded us~e_and~occt~cy of proposed construction: ~ -
a. Existing use and occupancy .J ~K~''~.G~k:
p. ;4Y
. . : .
. ~ .
b. Yntended use and 0~ ~r ~ • • • " " " " "
occupancy , ~x:~; , ,u
:C I
TITLE NO. S - 600477
1
now or f rmer/y ~
A M. igbee r
" Z
N. 72°09~30~~E. 249.93
4' N/BN P/PE PoUNO /NON POST POUND J. J ~ ~ 1 prpe
0.9' SOUTH 0.T SOUTH Qp 2°s' fro Chicken ~ ~ Ind.
/.S' EAST % COP iw w'
IW N,
N 221_p l0 9i ~
~ ; ~ r.pclnd ~
o ~ ~
' ~ 26.0' ro T.9' ~ ~ 31'1' .
r' I' (b YVO ~ P ° O -
~ 2 story frame
Area = 24,726Sgff. 11~, house w ~5,,-____
. ~ ° ~ ~ O N"". 28.3' 7.9• ~
DE pEc!lDblhHE9~ Z'
_ ~ 20.1 ~ ~ T4•FE7`1 1 Z
g rrome (rPtTv~ r"~.c=~l'IiCl~wlo~l ro+~~ o nl
0 goroge ~
` ° o ~ Ig35S
0
o
1 Jnd.
f ` S.72°03'/O"W. 252.62
ow or former/y 2
I . L. McCoffery, ?r. ~ ~
11 w A
\ O a
O
MA/N ROAD (N. rs Rte 251
;t,
I - 30
SURV Y FOR
ROB RT SCOTT B LOU/SE SCOTT
AT C TCHOGUE oarE ?AN. /9, /978
TOWN .OF SOUTHOLl7 SCALE: /~~=30~
SU`FF LK COUNTY, NEW YORK' NO. :78'/8
~ ik UNAU ORIZEO ALTERATION OR AOpIT10N TO THIS OUARANTEEO TO•
t SURVEY IS A VIOLATION OF SECTION T209 OF THE RIVERHE BANK
C NEW YO K STATE EDUCATION LAW. 9ECU ~{Fjl~ Ar/ti NTY CO.
iF COPIE OF TH 13 9URVEY NOT BEARING THK lANO
SURVEY R'S INKED REAL OR EMBOSSED SEAL 9HAL4
NOT BE ONSIDERED TO BE A VALID TRUE COPY. ~{TO
ifDUARA TEES INDICATED HEREON SHALL RUN ONLY TO Q:~ Y
THE PER ON FOR WHOM TIjE SURVEY IS PREPARED, G
- ANO ON 18 BEHALF TO THE TITLE COMPANY,60VERN• Z
- MENTAL AGENCY ANp LR,NDINO INSTITUTION LISTED O
HEREON ANO TO THE ASSid NEE9 OF THE LENDING
INSTITU ION. GUARANTEES ARE NOT TRANSFERABLE
TO ADDI ZONAL INSTITUTIONS OR SUBSEQUENT '
OWNER
iE DISTA CES SHOWN HEREON FROM PROPERTY LINES ~L~'~i~
TO EXIS IMO 9TRUCTURE3 ARE FOR A SPECIFIC ~ 45899/` v
PURPOS AND ARE NOT TO 8E USED TO ESTABLISH
` PROPER Y LINES OR FOR THE ERECTION OF FENCES. V
f • .MO UMENT PLACED
I
r YOUNG 8r YOUNG RI~VERNEAD"NEW YORK E
ALDEN W. YOUNG,PROfESSIONAI ENGINEER
t AND LAND SURVEYOR NY.S.LICENSE N0.12845
f HOWARD W YOUNG, LAND SURVEYOR
I N.Y.S. LICENSE N0.45893
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