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• ~ FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22014 Date DECEMBER 8, 1992
THIS CERTIFIES that the building REPAIR & ALTERATION
Location of Property 1875 JACKSON STREET NEW SUFFOLK, NEW YORK
House No. Street Hamlet
County Tax Map No. 1000 Section 117 Block 9 Lat 14
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 9, 1990 pursuant to which
Building Permit No. 18854-Z dated MARCH 9, 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 REPAIR & ALTERATION TO EXISTING ONE FAMILY DWELLING
The certificate is issued to MICHALE GILL & unRRnRn BUTTERWORTH
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-181156 - MARCH 29, 1991
PLUMBERS CERTIFICATION DATED NOV. 9, 1990-PECONIC PLUMB. & HEAT.
? ~ l..
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
COMPLETION OF THE WORK AUTHORIZED)
N~ x.8854 Z Date 19...~d
~ is
Permission is hereby granted t
....C~4r11.
. ~.~.~........t..t.~._3..:s-
ro.........?l~~6~~. ....1 G~....~....
llL...
at premises located at ......f..~..(..L~.......
County Tax Map No. 1000 Section .~.-fy..~/..~...~...... Block ........r~..........p./Lot No.....1....L~........
pursuant to application dated ..........f../.. J...~~!X~...........y......., 19.1.1, and approved by the
Building Inspector.
Fee $
. ~.~..~~...~...°~..d.~...~(~.JP~
Building Inspector
Rev. 6/30/80
- Form No. 6 r
II
' - TOS,1N OF SOUTHOLD
BUILDING DEPARTMENT
Eyt"_
TOWN HALL Li..,~,
7b5-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY " ta~C'LO
A. This application must be filled 'in by typewriter OR ink and submitted to the building
inspector with the fallowing: 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-O 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 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, 1457) 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 - $5.60 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5.' Temporary Certificate of Occupancy - Resident{i~al $15.00, Comercial $15.00
Date .Y. Q: ~...r~.J.~j.4.~~"
p a
tiew Construction..........U. yOld Or~P'r`e-existing Buil~d'ng.. ~!!.\~/~.L:~'~Q~:' z` y~-
Location of Property....~V /,~...e..iq;c.«S°,.S'1~ ~:.:2@-~.....~.'ke1':~..-lC.c)~~cZ.il.{~:J~I,.....
House Nyo,~. i q SStreget - Hamlet
Onwcr or Owners of Property, d: ! C~N'Q~'L~~.jjS7 ! ~ r .'¢:..Uv~x.pgQ~Y~..~`l~~'[~•~ n~~~ • • - • • •
County Tax Map No 1000, 5ection...l~.J........Block.../
.............Lot..
Subdivision..... ............................Filed Map............Lot......................
Permit No.i~~~"l...DRRa~~te/~Ot Permitl':~i.~:~..J.j..C~..Applicant.~t'-0~.~'?~.I.y~4y4~/~13~:~........
1lealth Dept. Approval.....~y.~./~'.' . ......Underwriters Approval.~~6. j r~ , , , , , , , , , •
i ~jJ ~6~
Planning Board Approval..!C..":4.~
Request for; Temporary Certificate........... Final Certicate.. ~
Fee Submitted: $ ~
APPLICANT
C~.~~ `I..S~ ~ 2-
~ ~ , ~l
TEL. 7G5-1802
~pc~~FF~Uf ~0~,, TOWN OF SOYJTHOd.D ~,,,~`"f~'
,?l.i' 1, iY ~`c OFFICE OF IIUILDII.3G INSPECTOR !y""
o P.O. IIOX 728 '
u' E`" '~~~*a-' TOWN HALL
y4,,'~1 SOUTHULD, N.Y. 11971 ,
C E R T I F I C A T I O N
Date
Huildirg Permit No. P ~ ~?F~~j •-Z
Owner tr~gC. aL 17 ,r Y bo,xa ,.1~~- w~.v~l-~
(please p/rint)
Plu^,bzr~~CoiJ/C ~GO/Yl`?"//!4 9~/'l~'~~'~
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1$ leafl. „
L~ ~ v ~ y~j(~O
e
" p tuber's signature)
Sworn to befor= me this
7 day of ~bl.~
,/~~/f~~` ~tZL.r
19 Notary Publi~~r"`r''
tiotarj Public, COUnty BARBARASTEPNOWSKI
' Notary Public, Stata of Naw York
No. 4844752
Quatifird'en SuHotk County
Commission Expires#0. 7 i~
INSPECTORS - -
~Y
Victor Lessard ~~~'~c?,~,FFDj;r
Pn CurBis~Horton ~~~~~v . y ~ SCOTT L. HARRIS, Supervisor
Senior Building Inspector ~ , ,,.x Southold Town Hall
Thomas Fishec 1,.:~ ~ ~ P.O. Box 1179, 53095 Main Road
Building Inspector ~ 4,iso` ,'fir
. ~ Southold, New York 11971
Gary Fish '~Oj a`~~ y Fax (516) 765-1823
Building Inspector y~~ Telephone (516) 765-1800
Vincent R. Wieczorek
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
NOVEMBER 20, 1992 -
-
GEORGE PONTINO
P. O_ BOR 2
CHTCHOG[TE, NY 11935
RE: MICHAEL GILL 6 RARRARA BUTTERWORTH
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the fallowing reasons:
ffi An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
ffi The check is /not on file.)$25.OD
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(A11 permits involving plumbing 'being
issued after April 1, 1984).
BUILDING PERMIT # 18854-Z (ALTERATIONS)
• Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
CC: MICHAEL GILL & BARBARA BDTTERWORTH
IFLJ i:: °.:`R 1J:: IIUn:~ I ~v:YC^fSNT.^ ~
1 . - II I e.
II
r'OUtIDATZ0:7 ~ (1st) I~ _
1
~1
?OUIIDATIO?7 (Qnd }
_a ~ ~
2. ~ i i.,.-c o;. , .c .caa.~ Crxr
~~'a'z~
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.',OUGH FRAIIE ~ 11~ ' i~ ~ _ 7.tc•-c ~C c ,c,. Gc f:~~=ice
l ~~a,tiRt ~ L'~-G J
PLUMBING
C
3. .S / ~r m
~ n
IfISULAT207! PER N. Y. ,
STATE EPIERGY
CODE
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II
FI:lAL
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ADDITIOPIAL CO?^.MEtJTS: x
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ass-iso2
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ y]/ROUGH PLBG.
[ ] FOUNDATION 2ND [ NSULATION
[~RAMING [ ]FINAL
REMARKS: ~~C -~-K-~L
~y ~
DATE ~ V INSPECTOR
765-1802 G,.~
BUILDING DEPT ~`~O
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ]FINAL
REMARKS:
~ j
.C
~ ) ` ~
DATE ~ INSPECTOR
D ~ BOAKD OF HEALTH
~CVIt ~`I 3 SETS OF PLANS
p ;f, FORM NO. t SURVEY
J~ TOW V OF SOUTHOLD CHECK • - - • • - .
!E BUICD.ING DEPARTMENT SEPTIC FORa
~ _ TOWN HALL NOTIFY
R~'~
'-"T ~4 • l SOUTHOLD, N.Y. 11rJ71 ~3Y- 5 t~
..._70V'Jtd VF,~..r~:1,~,~..~OLJ e CALL
• "-°~-~-.x...,..<,.~., TEL.:7i;5.7802 MAIL T0:
Examincdryy.~.., ....p/......, 19p.~ . a p
Approved !!~!~ll:...(......, I9 <~Permit No..`.C1'.(,~.~7 Z'
Disapprovedalc
.....................~~,~~~..~6.~~...------
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date 19
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 to scale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public street
or areas, and giving a detailed description of layout of property must be drawn on the diagtam which is part of this apply.
cation.
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 tha applicant. Such permi
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 for any purpose whatever until a Certificate of Occupanc
shall have been granted 6y the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to th
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances
Reculations, for the construction of buildings, additions or alterations, or for removal, or demolition, as herei-t describe
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t
admit authorized inspectors on premises and in building for necessary ins otions.
(Signature o applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is o~wjner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde
\ameofownerofpremises
<as on the tax roll or latest deed)
ff applicant is a corporation, signature of duty authorized officer.
.
(Name and title of corporate officer)
ALL COt7TRACTOR'S MUST B SUFFOLK COUNTY LICENSED
Buildei s License No. . ~ .`~-..q. ~.Z 1-k ;
Plumbcr'sLiccnseNo. ...~ec~h:e...Pt<Ax;~i»~ I t' ~f'eae~
EIcctrician'sLicense No. ~a9Lq,~~, C'n,~ec'~Y-ic L t- ~ e¢'~ec~
Other Trade's License No . .
1. Location of land on wtrich proposed work will be done . .
. ~`s........ J,°~ ~ K an S 3"rQeT....... ('~J.ew. S u,.I`. t`o ~y ry_~
r.i S
House Number Street Hmniet
County Tax tviap No. 1000 Section ~ Lot . .
1 Block 1'/
Subdivision Filed i\Iap No. Lot .
(Name)
State existing use and occupancy of premises and intended use attd occupancy of proposed construction:
a. Existing use and occupancy g. t. ~ ey,`~ Z . , .
~
b. Intended use and occupancy • • • ~.~'.s ` a ems) e` CAE-r~-~4~~
3. Nature of work (check which applicable): Iv`cu• Building Addition Alteration ~
Repair Removal Demolition Other 1Vor .
. ~e.W ~a m~ y~CnPIio )
4. Estimated Cost ..~j~~ 0 d D Fee Csl i>tiC~cru
` (to be paid on filing this application)
5. if dwelling, number of dwelling units Number of dwelling units on each floor .
Ifgarace,numbcrofcars
6. IC business, commercial or mixed occupancy, specify nature and extent of each type of use .
7. Dimensions of existing structttres, if any: Front ......1~~. • Rear `sit ~v....... Depth ..:3~........ .
Height ......~,a+...... Number oC Stories (•~r~ y...........
Dimensions of same structure wit}t alterations or additions: Front ....`sz',. ~v.......... Rear ..A"'~,G'
Depth 3Co. ~ Height ~ ~j.. f Number of Stories ..~~y\ .
8. Dimensions of entire new construction: Front Rear ...............Depth .
Height utttber of Stories ~ .
• ~;c .
9. Size of lot: Front Rear ......l ~.x.'........... Depth ..../:~Gt' .
0. Date of Purchase}'U~aYc.{.} ~1.`T.`J.4 Name of Former Owner .......~kG!'~e.'~............. .
1. Zorte or use district in which premises are situated .........'~,~.bras'.iir~ .
2. Does proposed construction violate any zoning law, ordinance or regulation: ..~.(S . .
3. Rill lot be regraded ~.21. (I5!~4tFC?. (jr~iV'll excess fill be removed from premises: Yes ~NS
4. Name of Owner of.premises~lY?9Ewm..(y.i.1,1, , , , .Address .j`~.~w..Stt ~~~l~l:C... Phone No. ~13,y.-.,~~~Fi . .
Name of Architect ~nr Address ...Phone No
Name of Contractor (7~ 4Y. Q....1,4Y1~t :l'! D.... Address . ~~S 3 ~':t!t.Q ~4~~.... Phone No. '~J.~.7f..
5. Is this property locato'd within 300 feet of a tidal wetland? Yes No .y.,...`'
*If yes, Southold Town Trustees Permit may be re uired.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from
roperty lines. Give street and block number or description according to deed, and show street names and indicate whethe.
~terior or corner lot.
~ ~ -
9
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~
iATE OF KE~C YORii, S.S
OL;\7Y OF
. . . . . . . . . . . . . being duly sworn, deposes and says that he is the applican
(lame of individual signing contract)
ove named.
:isihc
(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 thi
nlicatian: that all statements contained in this application are true to the best o[ ltis knowledge and belief; and that th
irk will be performed in the manner set forth in the application filed therewith.
:orn to before me this ,
~._...day off/.... T?'~~-LG.~.-...... , 19,~~.
star}^-j'ublic, ,1C"; , . ~f-. ~~r.. County
HfI.EN K OE YUE . .
HpT'p6YPUB110.°tlbt~~ (Signature of applican)
No. 47p787S, Sutfofk
Term Expves Much 30.1
THE NEW YORI~~Afl'~9 OF FIRE UNDERWRITERS Par,E 1
1185077
s Au oF`iti_ecrRlcirY
BE JOHN 13TRlET. NEW YORK, NEW YORK 10030
N]IRCH 29,1991 69078590!90 N 381256
Date Applleetion No. on file
THIS CERTIFIES THAT
_ only the s?actrlcal equipment r dweri6ed 6doeo and 7nerodaced IAY the applicant named ow tM chow application wuaa6ar is tAe pwmiwa of
- MICHAEL CILL, JACKSON ST-4TH ST, NEW,,]jS~~UFFOLK, N.Y.
in the follotcinq loc ~X, nt ~ I At F!. LI Ynd F1. OUT SKrtion Block Lot
°fd~Cx `a5B1'94Y
urea eromined on and found to he incompliance erith the reyuiremenM of thL Bwrd.
MXTIM! XTIIEiS QOOXIt10 MGIS OVEVS f>fiN W FiXNAUST FANS
OIiTIlTS ACIK ~T~ INGNalSC[Nr rlU0tE6ClM OTNlR NAT. K. W. NAT. K. W. AMf. K.W. ANT. W. AMT. N. I.
s 22 25 17 20 2 F
r fXSYMS RIMSACE MDTOXS IYTIIM AN11ANp MIS ~C?1 iMllYlOCKS SRLL INMT IIH1TEEf MMI4QMTItT OWkMFtS
AMT. K. W. pl N. r. GAS N. r. AMT. NO. A. W. G. AMT. NAr. AMT. AMIt. TRANS. AMT. N. r. Ib. t)< 1~ AMT. WATTS
1 30 5 600
SRRVI01 DIftOlBNCT NO.Or S ! R Y I G E
AMT. AMT. lYr! 1 / SvI t 1 TV ] l TM S X AvI ~~C,COND. ~ w. NO. OF HIdtG A.~ G. NO. a NlNMIS OF ~r
EYTGMI
1 150 CB 1 X I 1/0 i
oxen AAMATYS:
G. F.P.I:-3
~ ROSLAR SL&CTRIC LIC./3677E FLT
P.O.BOX 164
CUTCHOGU&, NX, 11935 ~
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