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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 217630 Date DECEMBER 23, 1988 THIS CERTIFIES that the building ACCESSORY GARAGE 415 FOURTH STREET Location of Property 2000 JACKSON STREET NEW SUFFOLK House No. Street Hamlet County Tax Map No. 1000 Section 117 Block 10 Lot 17 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 12, 1988 pursuant to which Building Permit No. 172392 dated JULY 20, 1988 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. The certificate is issued to MR. & MRS. RAYMOND CROUCH (owner, ) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N043410 PLUMBERS CERTIFICATION DATED N/A r Building Inspector Rev. 1/81 FO~ NO. ~ TOW~ O~ $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, 14. Y. BUILDING PERMIT (THIS pERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 017239 Z Permission is hereby granted to: .~~ ......... :~.:.....u.l..~.~ .......... ,o ........... ....Y.~...~m.~....~.~ ........................................................................................... County Tax Mop No. 1000 Section ........ JJ..~. ......... Block ....... I....~, ......... Lot No....L.~ ................ pursuant to application dated ........ .,.~..~../..,.~'-. ................... 19..~...~..., and approved by the Building Inspector. Fee ~.. s;~'.. .................. Building Inspector Rev. 6/30/80 ...on"`"~"'- TOWN OF SOUTHOLD ~ ~i' B ~I pv LS ,~}p BUILDING DEPARTMENT ~p ~~p(~ § ; TOWN HALL ~p ~ ~ ~l1p(f ~ ~ SOUTHOLD, NEW YORK 1 1971 fil~illi. ~J ci'I~. e..~ TCi~flt1V t)F rid{47t,~; l F, APPLICATION FOR CERTIFICATE OF OCCIIPANCY DATE,,Jv~/~~1F0_ , • • • - NEW CONSTRUCTION ...OLD OR PRE-ERISTING BUILDING......VACANT LPAND..._... Location of Property.~~~ •~L • • • . • •};.)~t~,l• . ~;~•~'C•3L1:. • HOUSE N~(O~.Q ST""""R~~`~EET HAMLET • • • Owner or Owners of Property!; `.^':'t.~~s , , • • • ~~ntf('(,~• • • • • • • • • • County Taa Map No. 1000 Section Block Lot J. Subdivision Filn(e/df Map ........Lot.......... Permit No. ~.f.~:? t. ..Date of Permit .-i~~~~~Applicant ~GD~~O~..~l~~':~.yc'~(o~ Health Dept. Approval Underwriters Approval. Planning Board Approval Request for Temporary Certificate Final Certificate Fee Submitted: ~ . • ~ C,~~# ~ ~~~~D ~ ynT -1n~ APPLICANT. Q~ rev. 10/14/88 ~3 THE NEW YORK BOARD OF FIRE UNDERWRITERS "'~rf' ' 7 t~i17 0?? BUREAU OF ELECTRICITY 83 JOHN STREET, NEW YORK, NEW YORK 10038 PiOV3~.NBP,H (?I,:14k$ SR3~tt?RR/F2i? s+t (7dA?!1 Dote Application No. on file THtS CERTIFIES THAT only the electrical equipment a deurihed 6ebm and introduced 6y the applicant rremed on the ohooe application numher in the premises of ..AV CRC)iJCH, Q't"N, S`PRE1l;"r 6. ~JnCKSQN BVNL, c'tiTt"HOG[IM„ N.Y. t.AK in thefollotcinq locat~p,~S~F17~~A' ,~aaement ? let F(. ? Ynd F'(. .Section Bloek Lot una examined on O) 1 YiS~ and found to 6e in compliance uifh the reyuiremenu of this Board. NXTUR! RXTURES RANGES COOKRq DECAS OVENS DISH W EXMAUET FANS WiIET$ 9TACIES SWITCHES INCANDESCFM.HUGKESCEM v NAT. K. W. AMT. K. W. AMi. K.W. AMT. K. W. AMi. M. P. h ( F DRYERS WRNAC! MOTORS lIIIUR! ANLANCE 1'NDERS SrlpAt REC'?T i1tA! ClOC1t$ qNl UNIT 11EATlRS MUlT1AUTlET gMMERS AMT. K. W. WL H. P. GAS N. P. AMT. NO. A. W. G. AMT. AMI. AMT. AMPS. TRANS. ANT. N. P. N OF !@T AMT. WATTS SRRVICE MSCONNLCT NO.Of S E R V 1 C E AMT. AMP. ITPE p Ev i l ]W 113W ] p ]W ] l IW ~q DCOND. ~ CC. COMD. a X41EG a NO. Or NEUTRAIS a NEUTGRAI OTNEq AMARATUS: l7AitT3L80ARDS'1.-'2. CYt?. 1()il 40~ HOX ~"15 S<)t3'PHQLD. NY ~ 11977 OYMRAL MANAGER ~ I : ~ I.TC7?NSR NU. 5"i8R Per ?'r'"~~1 E This certificate must not be altered in any manner; return to tM office of the Board if incorrect. Ins rs may be idemifiad by their «adEhKols. COPY FOR BUILDING DEPARTMENT. TIRS COPY OF CERTIFIGTE MUST NOT BE ALTERED IN AIIY M11~M~1ER. ~,~F' r TEL. ?GS-180 o,; ,o%,z To~rr or sou~o~.D ~-:l~~vi~. OI'f'1CI:O['BUILDINGINST'ECTOR v `'~i. 4~t:~j;~t. = I'.O. BO`C 1 t 79 ' ;d~ SO1JTItOLD, N.Y. t 1971 ~o ~,a . Q.o.~ lyya. i y. 119 s ~ cam.: Caa.t~ • To Pihcm Thi.^, May Concern, 41e arc unable to complete your Certificate of/Occupancy because pf the folloc•ring reasons. An application for Certificate of Occupancy is not cn fil.c. 2~'~~~-~- / / Dto Underwriters Certificate on file. /i// 'i'hc cliccl•: .i:: ( ~ ' l/not on tile.) .p~ f 0. U'D No tica].th Dept. Approval on file. No final inst~~ect:ion has been made. Please contact: our o-fficc on this matter. - Thank you for your cooperation. Ilu i lc] my Pcrm i.l-. U ~ ~ ~ ~ Z Builclinq Dept, t1o Plumber Solder Certificate on file. ( all permits involv.i.ny plumbing being .issued after .~pri.l 1,1984 ) :'1::LD I~:S:'EC:iU,i ~~UATE ~ i;Oa~iMENTS 1, r ~ m v ~ l~i _ ~ W H wC ?OUIJDATION (1st) OUNDATIOIJ (2nd) _ ~ 2. z ROUGH FRAME & PLUMBING ti 3. ~ a~ m m IIJSULATION PER N. Y. fq'jl STATE ENERGY Z CODE H FI;JAL o ADDITIOPJAL COMMENTS: ~ " x ' x 'a H A H H ~ tl z x rn a ~ r y S d m H ~ I ' ~ ~ ~ I ` i i . APPR011E[1 A9,NO~EDt L_ 1 ' f.- ~ l.. 1.. I j , ~ a - GATE '7 .ao Y27 fi.P N ~3 ~ ~ ~ I ; I ' ± 1 1 i -i- j ! _ I /~I}? y ' NOTIFN BUIL~IN~ fd~F'ARTMENT AT ~ j ~ °~,cG~P~N~i ~ i I i 765.1802 9 AM TU d ;'tVt FDR THE, i iUT~;G Sr II~L~,~I~~~ I ~ ' I FOLLCSWING INSF'ECT~UNfi ~ 1 ,.I'r~o .1 UI n! 1. FOUNDATI N ' • ~fWQ REQUIFtEd; ~ , ~ " 7. RO,UGMURFRAMINGR&rPlUM81NG ! I ! O' O!CC~)PAN~Y ! I ~ ~ ~ I j 3. tN$ULATION ~ ~ , ~ ~ I ~ ~ ~ I US7 I I ' nuE~o°NS 4rquc~noN ~A N MEEt ~ } r... ~'~oi~ ~ S ~~5~ I -c,. t-s ' THE AE~1UN1 OF E ~ N.Y,. ; i '~~j ~ ~ I i i ~ ! I ~ I CrOO68. Ndr I~ LE FOR ! i- ~ ~ ~ j ~ ~ ~ i i I f ~ ~ I i , DES1t14iN OR CY~ ~'RRORS , ' c~ I I ! ~ 1 ~ ! ' ~ ~ .1 ' i l i i i~ 1 ~ l ~ l i i .j ~ ~ I i~ j i i _.1~ 1 I 1 I ~ ( ~ I I l ; l i! I ~ ~ jaX~ j lfl~ ac.l I ~ i~!I I I! I~ I ~ j i ~ i j( I l~ j ~ l~~~ j j l~ ~i~= I f ~ ~ I ~ ' -y... _ - - - i 1_ _ ~ i~ _ ' ~ ~ I ~ ~ I ~ ' ' I ~ ~ ~-jRgi ~~lA:~ ! ' Vl~"J ! I I I ~ ~ i { I I j i ~ ' . ' I~ ~ i t ~ ~ t I I I • ~ i pJe'/ 'v 1 ; ! ! . t . ~ p°. !x_'70 -I--._...r _ _ ~,.~(.5 k~. ~ 'I 6.~- j ~ ~ I I j i ~ I ~ I~-~ -i I ~ I~ ~ j ! ~ ~ I I I~ 1~ - I I I j - ! . I . r----1-- j - , - - - i - - I ~ ~ ~ I ~ I J ~ ~ I ~ ! I ~ ~ I~ j I; ' I j ~ I I L i I I ; I j ! i i I ~ ~ 1 i I --I ~ I I I i 1 I ~ I ( I I II ~ I ~ A 2 ~ 1 ~ I i ~ 1 I j i j ; i ~ j ~ i I i 1 i 1 . 1 i i I 1 I i i I I j ; ~ i ! I j i ~ ~ ~ 1 _ . . ' ~ i i 4 i ~ ( i ~ I I 1 I I ! ; ~ i , j I I ~ ~ I i j ! j j ~ ' j ~I j 1 I 11 ! i ~ j , ~ I ~ ! I i ~ ! I ~ i i ~ i 1 ~ I ~ I ~ j j 1 1 I 1 ~ I i I k, ~.d hl' ' ~ ~ C , f i ~ i ~ i ~ ~ i ~.G ~ y i ~ ~ I t._ ~ ~ ~ ~ i ~ ^ r , 1 ~ "j___ J' t ; - . r ~I ~ ~ _F j i r { t ~ i i ~ t ; ' f d ~ (`J ~ ._j,__. i ' i _ ; ' j I ~ i ~ I I r~; _ ~ r- 1 ~ ~ ~ i i ~ j ~ . 1 ~ ~ ~ i ~ ~ ~ , ~ ; ~ ~ f ~ i I I i ~ I ~ ~ I i i ' ~ r ~ 1 _ : ~ 1 ~ ~ ~ ? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ - i ~ ~ , '___._;__..1..:.1 i S ~ ~ I w j ~ ~ ~ I ~ ~ j i ~ ~ ~ ! ! ~ f ~ ~ A~ i~ 1 I~ i ~ ~ 1 1 ~ 1. i r' ~ ~ i ~ ~ . i ~ j ~ ~ ! i j ~ ! I I_ ~ ~ j ~ ! j ~ t I I 1 I f i i ~ i 1 i ( tt 1 I I 1 ~ i lily ~ I 1 • i I , 1 1 h~ 1 i . , I ~ _....1 1 _ 1 ~ - - rj4 _ !i I IJI; I I , I, 1 I ~ 1 ~ I I j 1 ~ j 1 ? ! I I I ! i. f ! I. I._.~ I I i 1 ~ I 1 i ~I I ~ ~ ~ ' ~ i ~ ~ i I i 1 I i ~ i i ! _ .,,...I.._ ~ I-- - I ! ~ i { ~ , 1' - ! 1 I ( . i 1 ~ ! ~ ~ ! ~ ~ 1 I I ! ! ~ q. - - - _ r~ ~ ~ - _ -I ' ~ - I I 1 ~ I • 1 I 1 f i I r i ~ i . i _ - - . ~,~,~I ! - - _ . • ;lip it ii I !I - 11 i .1_.,. I _ . , _ 1. _ _ J_~ _ __f~_ _ ~ ~ ~ 1 i i i Ali j ; 1 i ~ ~ ~ I. ~ ~ ~ _ 31° (I ' I 1 ' ~~1 oVa.,I V~fcL•.:,~...'~t~n~ ~ i ~ i i ~ ~ I j ! ~ ~ 17~~g~- ass-iso2 BUILDING DEPT. INSPECTION [ FOUNDATION 1ST ( ] ROUGH PLBG. [FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: ~ DATE 1 NSPECTOR . . 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING NAL REMARKS: r DATE I A INSPECTOR BOARD OF HE~ILTH 3 SETS OF PLANS FORMNO.1 SURVEY TOWN OFSOUTHOLD CHECK BUILDINGDEPARTMENT SEPTIC r•oart • TOWN HALL £OUTHOLD, N.Y. 11071 NOTIFY • TEL.:7G5-1802 CALL ~J Y~ MAIL T0:"}•~ot~,yr ~~iyw"P~'~, Examined / s?-~.., 19 Approved 19~B.PermitNo..(7a39'~. ~ 1/91d- ~ a~ Disapproved a/c 21988 ~ • ' : •G'S' TOSNN OF 5OUTHOLD (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ...I..C~........., 15 INSTRUCTIONS a. Tlus 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 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 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 for any purpose whatever until a Certificate of Occupancy 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 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 iemoval or demolition, as 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 necessa inspectionrs. (Sigryature at""applicant, or name, if a corporauon) ' (Mailing address of applicant) • State whether applicant is owner, lessee, agent, azchitect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises :`.`.~~:~....~r~-©U~'~ . (as on the tax roll or latest deed) IC ap licant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No . . Plumber's License No . . Electrician's License No . . Other Trade's License No . . 1. Location of land on which proposed work will be done . . ?~?..........~?tx,U• •~e~~~ • r~ yam.......... EJe~...~-~-1..`~~ 1~ House Number Street Hamlet County Tax blip No. 1000 Section ~ ~ : 1...... 1..... Black • , , , , • • • • , • , Lot . Subdivision Filed ~1ap No. Lot . (N:unc) s State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existinguscandoccupancy ....~1a:•••••••••••••.•.........• b. Intended use and occupancy . ~ • ~.h e, • • ~~;t'-• • CQ`i v'CvQ'~°-;'° ,...r~; . . 3. ( 3. NaPure of work checl. which applicable): New Eluilding , , , , , , , Addition Alteration ; . Re air oval (n • Demolition Other Work . 4. Estimated Cost .~6,t~?`Q (Description) ~ Fee ~ (to be paid on filing this application) 5. If dwelling, number of dwelli g c g units . . . . . . . Number of dwelling units on each floor , . If ara~e, number of cars . 6, If busyness, commercial or mid ed occupancy, specify nature and extent of each type of use , , , 7. Dimensions of exrstmg structures, if any: Front ' ' ' ' ' ' ' ' ' ' Hci;;ltt Rear Depth . ••••.........Nu,mberofStorics. imensions of same structure lvith alterations or additions: Front • ~ ' ' • ' ' ' ' Depth....... Rear............... • • • • • • . Number of Stories . 8. Dimensions of entire nee { N ~ .~~Icight , ' v constnrction: Front . Rear , .Depth Height , tuber of Stories . 9. Size of lot: Front ....~.~P?-: ' Rear . .~,L'l, a.` l©2.-` . 10, Date of Purchase ' ' • • • • • • • • • • • • • • Depth • 11. Zone or use district in which ' ' • • • • • Name of Former Owner . . . premises are situated , , , , , , , ' ' ' ' 12. Does proposed constructron violate any zoning law, ordinance or regulation: ~ ~ • ~ ~ • • • r~, ° ' ' ' ' ' ' ' • • • • • • Nill excess fill be removed from premises: es No ill lot be re~radedp tel.: G~fC[h Address ...................Phone No. 14. Name of Architect remises , ,Address , , , , , , , , , , , ,Phone No. Name of Contractor IS. Rs this property located within ~~•'Address ...................PhoneNo. *If ~ 300 feet of a tidal wetland? *YES....NO.... yes, Southold Town Trustees Permit may be required. . PLOT DIAGRAM Locate clearly and distinctly alj buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and bloc)S' number or description according to deed, and show street names and indicate whether interior or corner lat. , 3` -1- - I\ Q~ ~ , ~a~~ ~ Ir ~ - . I ~ I ~l ~'~~S'~c~~ c~ '~'"Ov~~ , STATE OF NE~V Rh, COU Y OF~. S.S ~..Y, ~ ~ , ;~-oh • • • (rirame of individual signit • ' ' ' ~ ' ' ' • • bcin dul • ~g contract) g Y sworn, deposes and says t at he is the applicant above named.' I lie is the ~ Oh?S~"~cCi-o? . (Contractor, agent, corporate officer, etc.) ~ • ~ • ~ • ~ • • ' ' of said owner or owners, and is duly'i~authorized to perform or have performed the said work and to make and file this application; that all statements contaiyicd in this application are true to the best ofltis knowledge and belief; and that the work will be performed in the manner $et forth in the application filed therewith. Sworn [o before mye this I .............~aC-~-.day of. ~ , 1~~. Notary Public, • ...~~~GG~~ounty Note~ry7p ~ANNNEVILLE (SiSnaturc of applicant) No. 52.81 t)c, State of New York Term ~8~. Suffolk Co Expires October 31,