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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town HaII
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-18233 Date AUGUST 1, 1989
THIS CERTIFIES that the building ACCESSORY
Location of Property 385 SHEPARD DRIVE SOUTHOLB, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 78 Block 1 Lot IS
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 19, 1989 pursuant to which
Building Permit No. 18054-Z dated APRIL 19, 1959
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 INGROUND SWIMMING POOL & FENCE AS APPLIED FOR
The certificate is issued to THOMAS & THERESA BERRHAN
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N-073318 - MAY 25 1989
PLUMBERS CERTIFICATION DATED N/A
Building Inspector
Rev. 1/81
•os>ts xa s
TOWN OF SOUTHOLD
6UILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
6UILDING PERMIT
CfHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
. oq
N°- 18054 Z Date ..........~.9 19.4.A
Permission is hereby granted to:
.~.'??~..~..3...~~
i~ r.z.
at premises located at .~~.~...gJ:rtR.~4~s~%...~~.r...... ~1F::!cSr~r.{:Qi~
County Tax Map No 1000 Sect~onl/....~~.~ . Block .......Q..~........gLot No....1..8........
pursuant to application dated ......?~~~({f~.A!.. . 19...1.., and approved by the
Building Inspector. U
Fee S• •
.
Bu ing tnspector
Rev. 6/30/80
'Y~ :C~ a. o box .385
.'~xu.wr9 uQ~x p ~
FORM NO. 6
TOWN OF SOUTHOLD JUL Z
Building Department
Town Hall
Southold, N.Y.11971 BLDG DEPL
765 - 1802 TOWN OF SOOTHOLD
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted ~ to the Budding 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 p,>:operty showing all property Imes, streets, buildings and unusual natural or
~ topographic features.
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 mforma-
` tion required to prepare a certificate.
C Fees• Addl.tl.ons $25.00 POOLS $25.00 LTERATION $25.00
1. Certificate of occupancy New Dwelling $25.00, Accessory - 10.00 Business $50.00
2. Certificate of occupancy on pre-existing dwelling $ 50.00
3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00
4.Vacant Land C.O. $ 20.00
5.Updated C.O. $ 50.00 Date
NewConstruction,,,,,,O1dorPre-ex~stingBuilding Vacant Land
Location of Property .3$.`~..~~~j? c~-rr~, Q,f ,I, , , ,a~A. J~~Q,I
House No. 11 .-~-y Street I Hamlet
Owner or Owners of Property 11.E M.c~.. '~'....~..Y)Cf:4S.'4 ..~.ri.~ I~ ~a.Y.l .ry....... .
County Tax Map No. 1000 Section ..~//--''D...... .Block , ~ Lot ~ R .
Subdivision ...W 4,3~ ~I.".4~.~.hS~~~Filed Map No. ....Lot No .
f Q .
Permit No ~.~.95~Z. Date of Permit ~l ~~!~9. Applicant Tl i1,X-.1. ~'.~?f}/~.~[44'R~ .
Health Dept. Approval ....Labor Dept. Approval
2 //~py
Underwriters Approval Q.~ >3~ (.O....Planning Board Approval
Request for Temporary Certificate .........Final Certificate .
Fee Submitted $
Construction on above described building and per it meets all applicable codes and regulations.
Applicant . 1~ .
Rav 10-10 78
Q.ec,• 31565
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t3UFFOL,tC C'O. HEALTH DEPT. APPROVAL
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r CONFORM TO TWE STANDARDS OF TH~
SUFFOLK Ct;1, DEPT. OF HEALTH SERVICES
~ APPLICANT,
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SUFFOLK Ct"JUNTY DEPT. OF HEAL7:
` _ SEItVJCE5.~e FOR APPROVAL O:
CONSTRUCTI~iN ONLY ' '
' ~ DATE'
H. 5. REF. N+a,,;236:;~~"f5t. _
SUFfOLK COUNTY OE ENT OF HEALTH SERVICtS APPROVED:
' SING!$ FAM 'Y WELLING ONLY ~ _LL_
i
OATS $EP-~-+~.~87 S, . NO_ ~6-~' ~q ~ ~ -
° SUFFOLK CO. TAX MAP DE5IGhlAT10N:
The sewage disposal and Pty Mcihiies fer this A_ DIST. ~ SECT. ' BL.fJGK PCL
location have been inspe d h this Departmentardfor " '
other agencies d founQd~to be a8stactay., ~ todD !)71~ "I ' _ .t8 .
Chte ei ureair of Wastewa r anagemem O~~~RS ~DRE56 '
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'rtx~'tC~#~l~'~7t~', N'EWVC~Rlt",:t 'i.'w' FOtAND`rJ
DATE ~ /`f B P q~// Qo
FEE /S'~3. BY ~.L.
NOTIFY BL)ILDtNG DEPARTMENT A7 OCCUPANCY OR
705 1802 9 AM 7O 4 PM FOR THE USE 1S UNLAWFUL
FOLLOWING INS'PECTiONS '
1 FOUNDATION TWO REQUIRED WITHOUT CERTIFICATE ~~p~~Od'~'
2 ROUGHU FRAMINGR&TPLUMBING ~F ~CCUPA(~CY
3 INSULATION d~~ 5k
4 FINAL - CONSTRUCTION MUST ~N
~~~QE
BE COMPLETE FOR C,O 0~
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y
STATE CONSTRUCTION & ENERGY
CODES NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
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LUT TiU~S.
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~ FEE BY - "
NOTIFY BUILDING DEPARTMENT A7
765-1$02 9 AM TO 4 PM FOR THE i'
FOLLOWING INSPECTIONS OCCUPANCY OR
i FOUNDATION - TWO REQUIRED d
FOR POURED CONCRETE USE IS UNLAWFUL ~
2 ROUGH -FRAMING & PLUMBING ~ WITHOUT CERTIFICATE _~~(r~~
3 INSULATION G`'e"
4 FINAL - CONSTRUCTION MUST OF OCCUPANCY
BE COMPLETE FOR C.Q. vQ"~~
ALL CONSTRUCTION SHALL MEET ~
THE REQUIREMENT^a OF THE N.Y.
STATE CONSTRUCTION de ENERGY
CODES. NOT RESPONSIBLE FOR
DESSGN OR CONSTRUCTION ERRORS
BOARD OF HEALTH
3 SETS OF PLANS
FORM NO.t SURVEY
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC FOR:I
' 70WN HALL
SOUTHOLD. N Y 11971 NOT ~ Y li 9 y~ ,~f ~~j~
pp / Q 5~ TEL.. 765 1802 CnLL O • /
Ecanuncd ~+~/wi. <.a1..., 194.1. 1 /~;~~j ~M,,A~IL T0:
:~pProved 99~11Arr!~i~;r...l. ,i 19~ .Permit No J. ~OS~"~`., ~
Y~/;,~,t^'T~" J
Disapproved a/c D
~ row
o°sou~ioLo
(Building Inspector)
APPLICATION FOR BUILDING PERMIT / ;y
Date 1.~... 19 U.
INSTRUCTIONS
a. Tlus application must be completely filled to by typewriter or in ink and submitted to the Building Inspector, wtth
gets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of lot and of buildms on premtses, relationship to adlommg premtses or public stree~
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appl
capon
• c. The work covered by ttus appltcatton may not be commenced before issuance of Building Permit.
d. Upon approval of this apphcaGOn, the Butldmg Inspector will issued a Building Permtt to the applicant Such perms
shall be kept on the premtses available for inspection throughout the work
e. No building shall be occupied or used to whole or in part for any purpose whatever until a Certificate of Occupanc
shall have been granted by the Butldmg Inspector.
APPLICATION IS HEREBY MADE to the Butldmg Department for the tssuance of a Butldmg Permtt pursuant to th
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o
Rceulattons. for the construction of buildings, additions or alterations, or for removal or demolition, as herein described
The applicant aerees to comply with all applicable laws. ordinances, building code, houstn~ code, and regulations, and t~
admit authorized inspectors on premtses and in building for necessary inspections.
../.4~.. tf?~J~c.Y..~:. sous..,. .
(Signature of applicant, or name, tf a corporation)
(blatlmg address of applicant)
State whether'applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
(9. ~'~l/~'C-D1; L-. C07!I ~L~C TO'~ . ~~•tt .
Fame of owner of premises ....1~..~O.m~...t.-....~~~je<2Lt~f.~.... .f.~~"~1(.l'f~N
(as on the ta:c roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
.
(Name and title of corgporate officer)
Builder's License No . ~ ! 2. • • • • • -
Plumber's Licensc No
Electrician's Licensc No. ~.°~~-'.n:N ~:~Z!
n~G
Ot}ier Trade's License No .
1. Location of land on which proposed work will be done. . ,~fj~~?/N?!7 •r/f~./Ut~ , ...S~d?<-~t~ ~ I
house Number Street ~ • • ~ ~ ~ ~ ' '
Hamlet pq
County Tai ~fap No 1000 Section ~.7•~ • Block I Lot / 4......... .
Subdivision Filed ~fap No. Lot . .
(Name)
State c~isung use and occupancy of premises an~~dJfintendcd use and occupancy of proposed construction
a Ertsting use and occupancy l.'~~ sue. T~/~'L
/~f
b Intended use and occupancy l `~~~~?!!~!~Z ,
f},~ r ry n~ t wG
3. Nature of work (check which apphcable). New E;uddmg Addition ~Uterauo .
Repair Removal Demolition Other 1Vork .
(Description
4. Estimated Cost Fee '
(to be paid on fihng thu apphcaUOn)
5. If dwel]ing, nuinbcr of dwelling units Number of dwelling units on each floor .
If gara;e, num bcr of cars .
6. If business. commercial or mieed occupancy, specify nature and extent of each type of use .
7. Dimensions of existing structures, if any Front Rear Depth , .
Hi:ight Number of Stones
Dimensions of same structure with alterations or additions Front Rear ,
Depth . . , Iicight Number of Stones .
Diinensie~w construction. Front . Rear Depth .
Height ..............x Number of Stones .
4. Size of lot: Front Rear Depth
I0. Date of Purchase ....................Namen
of Former Owner .
,
1 1. Zone or use district in which premises arc situated `rte. ~ .
12. Does proposed construction violate any zoning ]aw, ordinance or regulation•
13. Will lot be regraded ..~ll0 1Vi11 excess fill be removed from premises: ~ I
14. Name of Owner of premises /.~L-2~(~~i?i•! ......Address ...,~D.4~7.`~L/?.. ..Phone No .
Name of Architect ......Address ...................Phone No.
Name of Contractor . l~.•.~2l: % ~L yrS.4?r!...... Address ..!?I./¢,~/,T!~:C(G, ,phone No.. °t-"?~:
IS.Is this property located within 300 feet of a tidal wetland? *YES....NO.~.
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distuictly all buildings, whether existing or proposed, and, indicate all set-back dunensions fro
property lines. Give street and block number or description according to deed, and show street names and undicate wheth
interior or corner lot.
1
r
STATE OF NEW YORK,.
COUNTY OF S'~L>~/. , , . S.S
~o~(~~ , .iJ..:.~~ ~ LL.~..~.. being duly sworn, deposes and says that he is the apphca
(Name of individual signing contract)
above named
[ie is the ~Q~"t!.~.~k!~`~~C-~~............................................ , .
(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 m this application arc true to the best of lus knowledge and belief; and that t
work wdl be performed in the manner set forth m the application filed therewith
Sworn to before me this
....day of .....Ce.- 19
~j~ V
\otary Public, !"e..-~~:. • ~ G~Q'e County
tiF1EN K OE YOE • . •
fWTARYPUBtIGStmofNewYorli (Signs t~~ applicai
Na 471178%8, 8u91otk C
term Exmres fAerch 3a, i