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1
FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-19239 Date JULY 25, 1990
THIS CERTIFIES that the building ACCESSORY
Location of Property 1825 PECONIC BAY BLVD. LAUREL, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 127 Block 8 Lot 11
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 12, 1990 pursuant to which
Building Permit No. 18866-Z dated MARCH 13, 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 ACCESSORY GARAGE AS APPLIED FOR.
The certificate is issued to JAMES HURRAY
(owner)
of the aforesaid building.
SUFFOLK COUNTY BEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
B ilding Inspector
Rev. 1/81
roast 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)
0 18866 ~......t..~ 1994.
N _ Z Date .
Permission is hereby granted to:
. ;~v~trkwr...........4.~a:!.~~..:..CYti~..
.......1~.~.K...~o.~
N.:.`.~.:......J..!.~.~: g............
at premises located at ..f a J~.. ~
~a°.:^".::....~.°~.'.~....~:......... ~..S:~r4~!.X~
County Tox Map No. 1000 Section Z.7......... Block Lot No..
nn
pursuant to application dated ....~~42!~...L~,,. 19.4.4., and approved by the
Building Inspector.
Fee
Bu ding Inspector
Rev. 6/30/80
L Form No. 6
~`Q~~~v TOWN OF SOUTHOLD
T./~ ` BUILDING DEPARTMENT R ~ lJ
a ~ ~ ~J 1 TOWN HALL U
` Y~~L 765-1802 ~
cg,- JUt 2 3 t990
APPLICATION FOR CERTIFICATE OF B4DG.DEPT, ,
N OF SOUTHOLD
.1. This application must be filled in by typewriter OR i muted 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 LZ 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.
T~. 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 o£ 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. Upuated Certificate oY Uccupancy - $50.00 ,
5. Temporary Certificate of Occupancy - Residenti^a1l $15.00, Commercial $15.00
f Date 7~aa~l~.a.......
:yew Construction... U...QQ.~.... Old Or Pre-existpinlg Building.......... t.......•1..
;.ocation of Property..I.t7~~ ~'~.'Oft?~'r~R~J4J!/~ ..................4~~V1:'~.1........_..._.....
House No~~. -yy Street Hamlet
Onwcr or Owners of Property..,dra~r:w:: .C~!'!~:~,5~......~j
County Tax Map No 1000, Section. Q~.~........Block..... A .........Lot..
Subdivisiont....//. .tt ..............................Filed Map............Lot.............':
Permit No. .l$ ~.IOJ4.......Date Of Permit ................Applicant.............
health Dept. Approval ..........................Underwriters Approval.................
Planning Board Approval
Request for: Temporary Certificate........... final Certicate........... ,
Fee Submitted: $
hex, '~b09 7 . ~z~•".~.1
APPLIC• ~
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OUNDATIO:J _ (tit) ~
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'OUt1DATI0:J (2nd } ~ - m
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.',OUCH FRAh1E ~ I
PLUMBING
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IIiSULATI02i PER N. Y. I ~ ~ ~
STATE EfIERCY
CODE II
~ ~ ~ ._J r
H
FIIIAL
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ADDITIONAL C0:^.ME11TS:
[*r
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ro
' H
9
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.a
60'
5 35' 24'
Proposed
Garage
Lot 20
O
N
pLOT PL,~ 3/8/90
FOR JAMES HURRAY
PROPOSED GARAGE
Sr.A1 ~ i_=
30'
~j ~ 5T io~o -/8? - S - l f
1 ~Y 765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[v]~RAMING [~NAL
REMARKS: ~-~-P
DATE 3 INSPECTOR ~~1,
l ~
765-1802
BUILDING DEPT.
1 NSPECTION
[1/] FOUNDATION 1ST ( ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING ( ]FINAL
REMARKS: / ~z~'
~~e'(~ ?
DATE 3 INSPECTOR
BOARD OF HEALTH
3 SETS OF PLANS .
FORtvi NO.1 SURVEY •
D ~
` f TOWN OF SOUTHOLD CHECR
t Zi~ BUILDINGDFPARTMENT SEPTIC r•oarl
~I~ L ~ ! ~I! TOWN HALL
$OUTNOLD, N.Y. 11971 NO ;
- : -7
TOaVn~tC F g:n r, TEL.: 7G5.1802 CALL /:~`'..~J. .
~...__..u._.._ _ .
MAIL T0:
Exattuncd . . l .3 • 19t't~.
n
Approved . ! Y.'.Q~S->~..l. 199x. Permit No. ~ ~ ~e?~o..~.. .
Disapprovedalc
e .
(Building Inspector)
APPLICATION FOR BUILDING PERPr11T
Date ..:...3 I 15
INSTRUCTIONS
F a. Tltis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stre:_
or areas, and giving a detailed description of Iayout of property must be drawn on the diagram which is part of this app
cation.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such pern
shall be kept on the premises available for inspection throughout the work.
e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan~
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to t
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances
Regulations, for the construction of buildings, additions ar alterations, or for removal or demolition, as herein describe
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and
admit authorized inspectors on premises and in building for necessary inspections..
Co>n? iG ~1~,LO k~ (`~IEt'UT Ceti
is
(Signature oi'hpplicant, or name, if a corporation)
(Mailing address of applicant) ! 1 Q$`L.
State whether applicant is owner, lessee, agent, azchitect, engineer, general contractor, electrician, plumber or builde
Name of owner of premises ..mil !7v.! t.~.g... ~(.1~~ ~ •
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporat-e~officer)
Builder's License No. ~ r Z
1 .
Plumber's License No . .
Electrician's License No . .
Otlicr Trade's License No . .
1. Location of Land on which proposed work wilt be done;
f[ouse Number Str~e7e't, Hamlet
County Tax \lap No. 1000 Section ~ / Block ~ `
• Lot...(..........
Subdivision Filed ~1ap No. Lot .
(Name)
State existing use and occupancy of premises and intended utse and occupancy of proposed cof nstruc~t~io~n~(: ~
p y ~ .....~'fJ~.. l ~J ~ 0
a. Existine use and occu anc : l ! ~T':tv:':
b. Intended use and occupancy • g•~9-Vl(1 • • • • „ • .
3. Nature of work (check which applicable): New Eluilding ~ A iticn ~UTCratibStt'"`.'• .
Repair Removal DemgN on .r~... , .....Swi:nciing pool.......... .
Tennis Court Accessory Building.......,..Fehce AW
4. Estimated Cost ~~0 DUO. • ~ . Fee ~ g......... .
(to be paid on filing this application)
5, If dwelling, number of dwelling units _ Numbet of dwelling units on each floor ,
If garage, number of cars .
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use , , , , , , , , , , ,
7. Dimensions existing structures, iC any: Front . . Rcar Depth .
Hci~ht ..............Number of Stories .
Di lions of same structure with alterations or additions: Front Rear .
cpth . . IIcight Nuntbc ~ Stories , . .
Dimensions of a fire qqey~ constniction: Front ....~.Jr........ Rear Depth y, , , , , , , ,
Hcigltt . , , , b , , , Number of Stories r .
.........r............
9. Size of lot: Front ~QO Rear , Depth .
10. Date of Purchase
.............................NameofFormer Owner
1 1. Zone or use district in which premises are situated . . .
12. Does proposed construction violate any zoning law, ordinance or regulation : .
13. Hill lot be regraded . ~Vi[l excess fill be r moved from premises: Yes , N._
14. Name of Ocvner of premises .~ft)':l`!~.~C,g,) :4~~-~Addressi~' ~:~i9'~.'~J~Ur?; L~RELPftone No. Z:~'.~~0~ .
Name of Architect Address ,,rr''P~~hone No. ¢
Name of Contractor g!ikM~Gg.'K,~?~~ C'g"^?~; , Address~~:~.~~ .'A!I;A';~;i!~!~Phone No. ?2~, _~76~
]S.Is this property located within 100 feet of a tidal wetland? =YES....NO.~•
*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 whethe
interior or comer lot.
STATE OP NE1V YORK, S.S
CQ1LI~NTY OF ..~..p~........... .
1~ E.~ r.C.4rh ~ Q `.'t L' being duly sworn, deposes and says that he is the applican
(Name of individual signing contract)
above named. ,
lie is the . ~Co~ \ ~r~. U~LO~ t~~~'~" CC`Z~.1 : bE¢.TZt<-K S ~ou.3R'M1+~} o,JL~t~2S~~.AM
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file thi
application; that all statements contained in this application arc true to the best of his knowledge and belief; and that th
work wi14 be performed in the manner sc[ forth in the application filed therewith.
Sworn [o before me this ~ / p ~ p
1. ......day of. I; UGC ~!~~r!l., 19
Notary Public, Count
CLAIRE L. GLEIN
Notary pubih:, State of Now Yak .
No. 4879506 L
Qualified in Suffolk Cotnrty (Signature of appticani
Commission Expires December 8.1