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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 &-23006 Date MAY 23, 1994
THIS CERTIFIES that the building ADDITION
Location of Property 7250 BAYVIEW RD.&25 PRIVATE RD. #12, SOUTHOLD, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 78 Block 6 Lot 8
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 5, 1994 pursuant to which
Building Permit No. 22063-8 dated MAY 16, 1994
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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING "AS BUILT"
The certificate is issued to DAVID & CAROLINE McCONNELL
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
ui ing Inspector
Rev. 1/81
FORM NO.b
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWM HALL
SOUTHOLD, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED))
Date 01x0.. 19..f../
N°_ 22063 Z
Permission is hereby granted to:
w~ //11
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~W-4r~........y:..........
to....... /..v ~...........f 1C1'?.........'~~J..........
....f ./1 ~s
:...........~/..t o
.e..../../...................................................
at premises located at ...................7.5 uiF .XC/
...............................p......9............
County Tax Map No. 1000 Section Block Lot No. ....0 9:............
pursuant to application dated `S/ 19..1..~.. and approved by the
Building Inspector.
Fee $......7..5
.
Building Inspector
Rev. 6/30/80
Form too. b
TOWN OF SOUTHOLD.~~
BUILDING DEPARTMENT I )
TOWN.HALL S
765-1802 MAY - 5 IA94
APPLICATION FOR CERTIFICATE OF OCCUPANCY,
TOWN LD
A. This application must be filled in by typewriter OR ink and submitted 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 1%.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, 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 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. Updated Certificate of Occupancy - $50.00
.5. Temporary Certificate of Occupancy.- Residential $15.00, Commercial $15.00
Date .5,44/.9,4....
New Construction....X.:.... Old Or Pre-existing Building
Location of Property.... 7250 Bayyiew Road= Southold AX. `
. .
House No. Street Hamlet
Onwer or Owners of Property David. Mc Connell and CaroliAe,Xg,Cpppp,ll,,,,,,,,,,,,,,,,,,,,,
County Tax Map No 1000, Section. ...78........Block 6............Lot...B.and 9............
Subdivision ..Filed Map .Lot......................
Permit No ................Date Of Permit...... .......Applicant....................
Health Dept. Approval ..........................Underwriters Approval......
Planning Board Approval............
Request for: Temporary Certificate........... Final Certicate.... X......
Fee Submitted: $,,.,?5.00,,,,,,,,,,,,,,,,,,,,
c
APPLICANT'
BOARD OF HEALTH
FORM NO. 1 3 SETS OF PLANS .
TOWN OFSOUTHOLD SURVEY
BUILDING DEPARTMENT CHECK _ - , - . , , •
TOWN HALL SEPTIC FORK
SOUTHOLD, N.Y. 11971
TEL.: 765-1802 t:p~ I FY ;
Examined riCALL . - - - - .
nlL To-
Approved ~0 te.., 19 ~~Permit No. .111 6l 3 .
Disapproved a/c _ ,
765 1 2 2 2
(Bui dir~ Inspector)
APPLICATIO FOR BUILDING PERMIT MAY - 5 1994
4
Dater PT...., 19 TGVNty OF SOUTH.( INSTRUCTIONS
a. This 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 sheets
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 removal 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 necessary " pecti ns
(doYpSiRnature o applicant, or name, if a corporation)
Ruh H. Bruer, as attorney for Mr. Mcconnel.
P.O. Box 1466, Southold NY „11971
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
AS NOTED
DATE,
Name of owner of premises Dayid, and, Caroline. Me. Connell fEE:... . . . -BY•
(as on the tax roll or IatND'llM)3UILDING DEPARTMENT AT
If applicant is a corporation, signature of duly authorized officer. 765-1902 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRED
(Name and title of corporate officer) FOR
2. 2. ROUGH H - - FRAMING FRAMING & PLUMBING
Builder's License No. 3. INSULATION
. • . • • • • ' • ' • • • • • • 4. FINAL - CONSTRUCTION MUST
Plumber's License No. BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y.
Electrician's License No . STATE CONSTRUCTION-& ENERGY
CODES. NOT RESPONSIBLE FOR
Other Trade's License No . DESIGN OR CONSTRUCTION ERRORS
I . Location of land on which proposed work will be done.
7250 Bay view Road,, Aouthgld N..Y....
House Number Street Hamlet
• • •
County Tax Map No. 1000 Section ....7.8........... Block 6
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 One-family dwelling with deck
b. Intended use and occupancy One-family dwelling with, deck.
-3. Nature of work (check which applicable): New Building
Repair Removal • • Addition Alteration . .
Demolition Other Work . , deck .
4. Estimated Cost .1?5.00 (Description)
Fee.....................................
(to be paid on filing this application)
S. If dwelling, number of dwelling units Number 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 of existing structures, if any: Front .
Height Rear Depth
Number of Stories
Dimensions of same structure with alterations or additions: Front .
Depth . Height . Rear .
8. Dime tire new construction: Front . i 0 ~ Number of Stories . . .
Rear . 1O' Depth Depth .....L~,~
Heiglj{~ A* Number of Stories .
5. Size of lot: 1•ront ..6Q.. Rear 4............ Depth ,
10. Date of Purchase eLceagber, ,12,, ,1,952, , • , , , , , Name of Former Owner Juulius. Zebr ski , , , . .
11. Zone or use district in which premises are situated ' '
12. Does proposed construction violate any zoning law, ordinance or regulation: .
13. Will lot be regraded c , Will excess fill be removed from premises: Yes No
14. Name of Owner of premises CAroline Me Connell• ' 23
C/iD• S't'e'v'e'n Me' UbhhellAddress ; Oneida Ave. Phone .62 . .
Name of Architect N/.Q , , , , , , , , , , , , .Address Rockaway;' b... .
Name of Contractor N/9„ "'••••••••••Phone No
15. Is this property within 300 feet of a tidaldwetland? * " " " .Phone No
*If yes, Southold Town Trustees Permit may be required. " No.....,
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 whether
interior or corner lot. { O V S L
iQ F
Ft'Wo o
r 3 +ht A RoowD
~E:CK
At.
4 STATE OF NEW YORK,
` S'S
COUNTY OF.. SUFOLK • . C
` c rn~ Cad n'e being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the ..Ys /R.~aw-f-ta!ni.......... .
#1 e.pf'( (Contractor, agent, corporate officer, etc.)
aFse* owner5or owners, and is duly authorized to perform or have performed the said work and to make and file this
application; that all statements contained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
da MAY... 19..9.4
Votary Publi
.
County
RUDOLPH H.BRUER c
NOTARY PUBLIC, STATE OF NEW YORK , , , , •
N0.52-0465530, SUFFOLK COUNTY • • • • .
MARCH
30,1Cj.~s (Signature of applicant)
COMMISSION EXPIRES
MAP OF P2_OPE Q-T'Y
SUf2VFti'LD FOfZ R
CAROLINE - h/ICCONINELL..
AT
OUTHOLD i
TOWN OF SOUTHO,_D NY
SAYVI E W
ROAD I
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