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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-19402 Date OCTOBER 1, 1990
THIS CERTIFIES that the building ADDITION
Location of Property 575 VANSTON ROAD CUTCHOGUE, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 104 Block 12 Lot i8.3
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 14, 1989 pursuant to which
Building Permit No. 17926-Z dated MARCH 16, 1989
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 ATTACHED INGROUND SWIMMING POOL DECK SHOWER & FENCE
ENCLOSURE TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to DANIEL, ESTHER & MAURY HARRIS
(owners
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N-70320 - MAY 5, 1989
PLUMBERS CERTIFICATION DATED N/A
*SLIDING DOOR TO BE SECURED WITH ANGLE IRON NOT TO OPEN.
ui ding Inspector
Rev. 1/81
!'08M NO. f
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
ffHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N Q 017 9 2 6 Z Date 19i~~
Permission ~s hereby ra ted t ~ ~ - / 1
a~~~~i s;~~ ' ~
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at premises located at . ~l..~~.._......1~L2~. Y f."Q`ll.:tw.....~~~....
. . .
Caunty Tax Map No 1000 Section ~Q.~ Block Lot No ..l~r .~Q
pursuant to application doted 3 r~...... 19 and approved by the
Building Inspector.
ss~~ 9 ~
Fee 3.P..`..1i..~...~' .
r
.°t~....
uildi for
Rev 6/30/80
Form No. 6
a
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
,j1
APPLICATION FOR CERTIFICATE OF OCCUPANCY
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 ?ept, 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 Cade Compliance from architect or engineer
responsible far the building.
6. Submit Planning Board Approval of completed site plan requirements.
3, For existing buildings (prior to April 4, 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 of. Occupancy is dens.ed, the Building Inspector shall state the
reasons therefor in writing to the applicant.
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
Updated Certificate of Uccupancy - $50.00 ,
S. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
- / Date ....5~~o?(ri~~A
':ev Construction.,.!/,..... Old Or Pre-existing Building
:.ocation of Property. 7.~~...1~!-j/JSlC~ly. ~Q1,31~ r1d~ rC/~D~rtJE
House No. SCreeC Hamlet
')over or Owners of Pro ert ~r~NrcL C•'S~~~~,7F MJ~ljJ,le,y, ~~f~~r'.~
P Y.........a...,...
County Tax Map No 1000, Section... ~~~~1~~...Block....~:~ : U~.....LoC. Q~S~.tL)t%:ry
Subdlvision.....pp...~~//
............................Fitl~ed Map............Lot.....................
?ezmit No.,l7,t,~?~~{,,,,,DaCe Of Permit..~fl~'~~1.....Applicant.~~f.U~`.y.~s~~C~.~ir~.........
Health Dept. Approval ..........................Underwriters Approval.
;i
?lanning Board Approval
Request for: Temporary Certificate........... Final Certicate..Y ,
Fee Submitted:
/
y0S 9S ~ APPLICANT ~ ~ .
Co 19~I0.~-
_ _ _
_ _ ~ -
THE NEW YORK iOARD OF FIRE UNDERWRITERS PAGh ~
1Og1093
1#111ltAU OF RLEGT~RIGTTY
NAY 05,196N ~ ®S JOHN STREET. NEW Y?bRK, b 390#O$MC/80088 N 070320
Date Aplicotion No. on file 6 3
" THIS CERTIFIES THAT
only the electrical paipment a dsecrihsd 6s/oto end introdeead by the epplieant named ow the aheoe eppHetlen nemker Jn the promisee of
RRAY HARRIS, YASSTON ROAtt, /POLE#5A, CUTCHOGU$, N.Y.
OUT r
in thefoUoteinp nt ? Ist Fl. ? End F1. Sw~tiun Bieck Lot
'Oe9fE~iL ~,Bf9~'P 4
Feaa examined un and found to 6e in compliance kith the requirements of thb Bond. i
AC7K RX RANDES tOOKItW EECKS OVENS qEM W AUET MNS i
Sf:eM FlUOEtiCENT OTNER MIT. K. W. AMl. K. W. AML k.W. MIT. K. W. AMT. N. P.
l a l
AtrrlE R Aarolls tuyw At7UANt! tatiEEE sEecuu mlr.T ttw QOCKS tlmi tAtrr NuiBf ouu+uEs
AMT. K. W. Oll M R OM M. P. AMT. NO. A. W. 6. AMT. AMP. AML AMPS. TEAttS. AMT. n 1. . ~ ~T AMT. WAYS
1 20 1 4
EERVIQ EM00MFMC? sq.0i S E R V 1 C E _
AMT. AIM. TrR ; / Tv i / Av a r 3vJ t x aw a~crcoNO. W cc
' ' o. NO. a NLIEG Oi'N Mo. nF NNmAlS orA'NWt4KfAt
oTwE •ErhEhtut:
=~w.a.c,.T:-l
afSWIMNING POOL) Tbia certificate
coves coayliance at the data of
l.AayeC.tiOA UAly. BeCaUBP. O~ 11XlUaUal
environmeata it is advisable i.o
have frequent teat/and or repa:lra
made by a qualified person.
tiARY DOROSRT LTC,#'L9Al E
920 NONSBLL LN.
CUTCROGUR, NY, 11935 OESIElAt iAmR
lI
Psr
Thit ceAificgh mtM not be ohered in aay manner; return ro tM offiu of the Eoard ii incorrect. Inspectors nay b~? idEntiiiEd k.
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WILDI A Al
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55 Valley Greens Drive
Valley Stream, N. Y. 11581
September 2E, 1990
Town of Southold
Office of Building Inspector
Town Hall
P.0. Box 1179
Southold, N.Y. 11971
Re• Building Permit Ivo. 1792E
Daniel, Esther, Maury Harris
575 Vanston Road
Bear Sir:
Enclosed please find:
1) Completed application for Certificate of Occupancy
2) Check for $25.00 fee
Please mail the Certificate of Occupancy to:
Maury Harris
55 Valley Greens Drive
Valley Stream, N. Y. 11581
If you have any questions, please call me at (516) 791-9431 or
(212) 392-2095. Thank you.
Sincerely yours,
Maury Scott Harris
-IcLD i;.S:EC:iu;i ~~Ui,^.~ ~ OOMMLNT~
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FOU2lDAT'`10N ( 7 s t )
FOUNDATION (2nd) _
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ROUGH FRAME &
PLUMBING
3.
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ra
I1ISULATION PER N. Y.
STATE ENERGY
CODE
7
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FIi~AL
) ADDITIOjTIAL CGM ENTS:
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BLDG DEPT.
TOWN OF SOUTHOLD
55 Valley Greens Drive
Valley Stream, N. Y. 11561
September 9, 1990
Town of Southold
Office of Building Inspector
Town Hall
F.O. Box 1179
Southold, N.Y. 11971
Re. Building Permit No. 17926
Baniel, Esther, Maury Harm s
575 Vanston Road
Dear Sir•
As per my telephone conversation with Mr. Tom Fisher last week,
I am writing to request a six month extension for the above building
permit.
If you have any questions, please call me at (516) 731-9431 or
(212) 392-2095. Thank you.
Sincerely yours, ~
Maury Scott Harris
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ) FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ INAL
G o .?-A/1~7~
REMARKS: g~~~ri32
Y S ~
t
DATE ~ ~ INSPECTOR `
BOAKD OF HEALTH
2 f- (IC~l1(-~; 3 SETS OF PLANS
~ L} ~J IS~ FORM NO 1 SURVEY .:Q~ f-l:.... ,
TOWN OF SOUTHOLD CHECK .!~.7J-
MAR 141y89 ~ ~ BUILDING DEPARTMENT SEPTIC FORM •
TOWN HALL NOTIFY
BLDG DEPT SOUTHOLD, N Y 11971
T01NN OF SOUTHOtD TEL.: 765-1802 CALL - • • • • • .
MAIL To: 7G s"- 3/~.~
Examined a. l'~ , 19
Approved /b , 19~ Permit No j ~9~~
Disapproved a/c
uil d Inspector)
APPLICATION FOR BUILDING PERMIT
Date v ' ~ ~ 19~
• INSTRUCTIONS
a This application must be completely filled m by typewriter or m 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 detazled description of layout of property must be drawn on the diagram which is part of this appli
canon.
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 permi
shall be kept on the premises available for inspection throughout the work.
e. No building shall be occupied or used m whole or m pazt for any purpose whatever until a Certificate of Occupant;
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 th_
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o
Regulations, for the construction of buildings, additions or alterations, or for removal or demohhon, as herein described
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 i specY his n r~
SOUTHOI.D POOLS lNC. (Signature of applicant, or name, if aLcorporation)
? P.O. B0~ 539
SOUTHOLD, NY 11971 P' , S3 ~..'.i
N~~~ 1~~.. .
(Mailing address of applicant)
State whetherrrapp--licant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
~i. w.~ .~V t•
Name of owner of premises .~~~.1~=•(_.~(fS)l~~l~~, Ar"~ YhAu2~f ~-~Ac!RR.,.~_
.
(as on the tax roll or latest deed)
If applicanticant
i~ra ion ignature of duly authorized officer
(Name and title of core a officer)
ALL CONTRACTOR'S MUST BE SU FOLK C9UNTY LICENSED
Builder's License No /j ?3.5~ ^ ~ 1.
Plumber's License No ,
Electrician's License No
Other Trade's License No
1. Location of land on which proposed work will be done. `r?=~~
House Number Street Hamlet
County Tax hlap No ]000 Section /U'1 Block IZ Lot . dG 3 , .
Subdivision Filed Map No Lot . . .
(Name)
2 State existing use and occupancy of premises and intended use and occupancy of proposed construction
a. Existing use and occupancy Qi'~- ~O~y.< 4r'~ FA~+ ~ Y ~('"I%=I(~ .
b Intended use and occupancy /Y`'G2uu~~ ~tti~Y.-, ps~yl~~.~LC1<, j~.,l~ S4W~,.i~;_f~,. A (.I~C~C
3. Nature of work (check whtch applicable) New Building Addrtron Alteration .
Repur emoval Demolition .Other 1Vork Ste? I ~ ~v,"~ : .
(Descnpfion)
4 Estimated Cost~i ~ JAS Fee . ~ ~f..
(to be paid on filing this apphcaUon)
5. If dwelling, number of dwelling units Number of dwelling units on each floor
If garage, number of cazs .
6 If business, commercial or mixed occupancy, specify nature and extent of each type of use
7. Drmensrons of extstrng structures, rf any Front Rear Depth
Height Number of Stones .
Dunensrons of same structure with alterations or additions Front Rear .
Depth .Height Number of Stones .
8. Dunensions of entire new construction Front .Rear . Depth
Height .:Number of Stones , . . .
9. Size of lot Front S 1.2 Rear / .a De}p~th 1 .~7
10. Date of Purchase . l~^ " . N me of_Former Owner . C: faAQ.. ~:.ul=Lt1~"`~'' ~
11 Zone or use district m whrch premrses are situated R~`J~ ~ A~- • • • • • • • • • • •
12 Does proposed construction violate any zoning law, ordinance or regu]atron )CAS.
13. Will lot be regraded 1Vt11 excess fill be removed from premises. Ye No
14 Name of Owner of premises ~*~?"=1-~4=}"NWC~!''`~.~ Address Phone No . x.4.1 'q y ~ r.
Name of Architect . EIAP.~i S Address Phone No.. . .
Name of Contractor .kSU vil~o~ h ¢i~il ~ Address ~r V.$~`i ~~`d. ~ Phon~ ~ ~-a`~. ' 3)2c~:c,
15. Is this property located within 300 feet of a tigidal wetland? *Yes No
*If yes, Southold Town Trustees PermztPLO~ DIAGKAMed.
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dunenstons from
property fines Give street and block number or description according to deed, and show street names and mdreate whether
interior or corner lot
/JC.~~
STATE OF NEW YORK, S.S
~OUNTY OF
being duly sworn, deposes and says that he is the applicant
(Name of mdwtdual signing contract)
above named
-Iersthe
(Contractor, agent, corporate officer, etc.)
if said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
ipphcat~on, that all statements contained in this application are true to the best of his knowledge and belief; and that the
.vork will be performed m the manner set forth m the application filed therewith
Sworn to before me this D q
~ 3 day of f ~ ~/t/~?~R+ . 19
Jotary Public, !'1LK~*! . ~ "-'-t-. County n ,
lam .
HELEN IL DE VOE (Signature of applicant)
NOTARY PUBLiC, State of New York
Ne 4767878, Suffolk Ccu
Term Fxp¢es March 30,19
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