HomeMy WebLinkAbout24829-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
NO: Z-34291 Date: 05/04/10
THIS CERTIFIES that the building CONDOMINIUM
Location of Property: 935 J34 CALEB'S WAY GREENPORT
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 40 .1 Block 1 Lot 34
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 31, 1998 pursuant to which
Building Permit No_ 24829-Z dated APRIL 14, 1998
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 CONDOMINIUM DWELLING UNIT, (34J) , WITH ATTACHED GARAGE AND DECK.
CORRECTED TO INCLUDE SECOND DECK 5/4/10.
The certificate is issued to WG WOODLYN INC
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R-10-011 01/19/95
ELECTRICAL CERTIFICATE NO_ PENDING 01/28/98
PLUMBERS CERTIFICATION DATED N/A
Auth ized gnature
Rev. 1/81
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
A. 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 I%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 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 $100.00
3. Copy of Certificate of Occupancy-$.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy-Residential $15.00, Commercial$15.00 h,
Date. � .D — C)
New Construction: nn Old or Pre-existing/Buiillding: p I ((cc—heck one)
Location of Property: l �' ��f Cb. l W CA l( Wl 1'4 02+
House No.
, // Street Hamlet
W
Owner or Owners of Property: l9- w b O d l y rZ _ 1 C.
Suffolk County Tax Map No 1000, Section Y D , Block / Lot Ll
Subdivision Filed
I Filed Map. Lot:
Permit No.S� L['& � IQ Date of Permit. 41 Applicant:
Health Dept. Approval: Underwriters Approval:
Planning Board Approval: v
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $
Applicant Signature
npr 30 2010 4: 54PM Edward J. DiMunzio 3311925 p. 1
AFFIDAVIT
STATE OF NEW YORK:
: ss.:
COUNTY OF SUFFOLK:
GERALYN WIESER, being duly sworn, deposes and says:
1. I am the vice president and secretary of WG WOODLYN, INC., a corporation
with its principal place of business at P.O. Box 1304, Cutchogue, New York, 11935,
which corporation is the owner of Unit number 34 in the Pheasant Run Estate
Condominium, which unit is also known as 34 Caleb's Way, Greenport, New York.
2. 1 make this affidavit at the request of the Town of Southold Building
Department to establish the buildings and structures in existence at the time of the
issuance, on February 2nd, 1999, of Certificate of Occupancy number Z-26256.
3. 1 am familiar with Moores Landing Holding Corp., the builder and original
owner of Pheasant Run Estate Condominium. 1 am aware of how the condominiums
were originally built and the situation regarding the deck or decks which were attached to
Unit number 34 a/k/a Unit number 34J a/k/a 34 Caleb's Way, Greenport, New York.
4. Most, if not all, of the units at Pheasant Run Estate were originally built with
one deck. Some units, including the unit at 34 Caleb's Way, were, because of their
location and configuration, originally built with two (2) decks - a rear deck and a side
deck. At the time of the issuance of Certificate of Occupancy number Z-26256 on
February 2nd, 1999, the unit at 34 Caleb's Way(which, on the Certificate of Occupancy, is
known as house number 935 J34) contained two (2) decks: a rear deck measuring 8' x 15'
and a side deck measuring 8' x 16'. Those decks, in their original sizes, still exist at the
unit at this time. It is my further understanding that the words "and deck" in Certificate
of Occupancy number Z-26256, either referred to the additional deck(the second deck)
on Unit 34J, or should have read"and decks".
5. 1 make this affidavit knowing that the Building Department of the Town of
Southold will rely on same to establish the fact that at the time Certificate of Occupancy
number Z-26256 was issued on February 2"d, 1999, Unit 34J contained two (2) decks - a
Apr 39 2010 4: 54PM Edward J. OiMunzio 3311925 p. 2
rear deck and a side deck- and that those two (2) decks still exist on the unit at this time.
LYN IESER
STATE OF NEW YORK, COUNTY OF S OLK) ss.:
On the Z day of May in the year 2010 before me personally appeared
GERALYN WIESER, known to me or proved to me on the basis of satisfactory
evidence to be the individual whose name is subscribed to the within instrument
and acknowledged to me that she executed the same in her capacity, and that by
her signature on the instrument, the individual, or the person upon behalf of which
the individual acted, executed the instru ent.
CJS ^)
Notary Public
CONSTANCE LISOWY
Notary Public, State of New York
No. OILI6110900Qualified in Suffolk ty
Coon"as on Expires June O1,2012
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-26256 Date: 02/02/99
THIS CERTIFIES that the building CONDOMINIUM
Location of Property: 935 J34 CALEB'S WAY GREENPORT
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 40 .1 Block 1 Lot 34
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 31, 1998 pursuant to which
Building Permit No. 24829-Z dated APRIL 14, 1998
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 CONDOMINIUM DWELLING UNIT - 34J- WITH ATTACHED GARAGE AND
DECK AS APPLIED FOR.
The certificate is issued to MOORES LANE HOLDING CORP.
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R-10-011 01/19/95
ELECTRICAL CERTIFICATE NO. PENDING 01/28/98
PLUMBERS CERTIFICATION DATED N/A
Building -Ins.Actor
Rev. 1/81
FORM NO. 3
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)
PERMIT NO. 24829 Z Date APRIL 14 98
Permission is hereby granted to:
MOORES LANE HOLDING CORP.
P.O. BOX 1143
GREENPORT,NY 11944
for
CONSTRUCTION OF A CONDOMINIUM UNIT WITH ATTACHED GARAGE AND
DECK AS APPLIED FOR.
at premises located at 935 J34 CALEB' S WAY GREENPORT
County Tax Map No. 473889 Section 040. 001 Block 0001 Lot No. 034
pursuant to application dated MARCH 31 98 and approved by the
Building Inspector.
Fee $ 682 .50
Building Inspe or
ORIGINAL
Rev. 2/19/98
TOWN OF SOUTHOLD
FEB -11� BIIILDTOWN ING DHALL
TMENT
L � 765-1802
BLDG. DErT.
TntiAVN! F S(IU'7-P-0L0 APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OR ink dQd 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 IASW 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 Buildingt - $100.00
3. Copy of Certificate of Occupancy - _ .2510.
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00/ Commercial $15.00
Date ... .. . ...�lZ/ ?. ....... .. . . .. ..........
New Construction........... Old Or Pre-existing Building.... ..............
Location of Property.... -P/' .......`l9141.3.,10.w��:.......... ..1e."� £00 � /Z.'
..........
House No. Stre/e-t/ Hamlet
Onwer or Owners of Property.... � Fss L��€ fZlQf .. G'O�
Count Tax Ma No 1000 Section •..• ••• HU�l 33-3��
Yp ...�Q........Block....k .l. .Lot................. .....
Subdivision.. .......:..:�.� ..��s Filed Mapaj3&..... ot.....:3'.�... .. . ..... . .
.. .. . ..... . .
Permit No. �. i�........Date Of Permit........ ........Applicant. ..X05.z.: �Q!���/�OF�... ....
Health Dept. Approval....... .. .......... .......Underwriters Approval... ..... . .. . ... ... . .. . ...
Planning Board Approval.. ....... ............ ...
Request for: Temporary Certificate. .......... Final Certicate.. '01 .. ... .
Fee Submitted: $... ... ... ..... .. ... ... 0......
C�. �c.- 55 ?6 0 .... . �.; �........ .. .. .... . . . .... . .... .
6� f LICANT
a a � �
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1195099 BUREAU OF ELECTRICITY
F 40 FULTON STREET, NEW YORK, NY 10038
Date FEBRUARY 02,1999 Application No. on file 17190098/98 N 478778
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of
MARGARET FIELDS, 34 CALEBS WAY PLEASANT RUN, GREENPORT, NY
to the following location; ® Basement ® 1st Fl. ❑ 2nd FL GAR/OUT Section Block Lot 34
was examined on JANUARY 28,1999 and found to be in compliance with the National Electrical Code.
FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCANDESCENT FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. N.P.
25 27 26 25 1 8.2 1 1.2 2 F
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS SELL UNIT HEATERS M SYSTEMS ET DIMMERS
AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT, H.P. NO.OF FEET AMT. WATTS
2 F 1 30 1
SERVICE DISCONNECT NO.OF S E R V I C E
METER NO.OF CC COND. A.W.G. A.W.G. A.W.G.
AMT. AMP. TYPE EQUIP. 1 0 2W 1 0 3W 3 0 3W 3 0 4W PER 0 OF CC.COND. NO.OF HI-LEG OF HI-LEG NO.OF NEUTRALS OF NEUTRAL
1 150 CB 1 X 1 2/0 1 1/0
OTHER APPARATUS:
G.F.C.I:-5
SMOKE DETECTOR:- 4
JI11 SAGE ELEC. INC. LIC.#3635E L t
PO BOX 38
GREENPORT, NY, 11944-0038 GENERAL MANAGER
11
Per
This certificate must not be altered In any manner;return to the office of the Board If Incorrect. Inspectors may be Identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
-�-055 .stain ::;()ac n �
soc:zncic vawx�crx97'1�. G' �► 31ec,r: a
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OFFiCF OF THE BUILDING lNSPEC70R
TOWN OF SOUTHOLD
C E R T = F C ? T C v
3u. d _zg oa=Zii t Yc . G/04
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CwT;e Y . )V1 OO ,ICS 1, Ot r�t -,l o l�,°p., qL< � '•
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contains t ess tia.n 2/ !0 ct �eGd
?umbers 'signat.i
zworn :o before `?1@��."1=S
day 7
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VC L_
JOYCE M.WILKINS
Notary Public,State of New York
No.4952246,Suffolk Counj
Term Expires June 12,1 a "/
T65-1802
BUILDING DEPT.
INSPECTION
[ FOUNDATION iST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE 8 CHIMNEY
REMARKS:
DATE � �'� �g INSPECTOR ��
17
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ J ROUGH PLBG.
[ GjfOU NDATION 2ND [ j INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
09
v 47
DATE `3 z2 98 INSPECTOR
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ROUGH PLBG.
[ ] FOUyDAT10N 2ND [ ] INSULATION
[ FRAMING [ ] FINAL
[ ] FIREPLACE 8 CHIMNEY
MARKS:
L
DATE INSPECTO l000
suauiNa DEPT.
INSPECTION
[ ] FOUNDATION IST [ ROUGH PLBG.
[ ] FOUNDATION 2ND [
INSULATION
[�RAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: ��
DATE // / 9 8 INSPECTOR __1� o:����
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST /IFINAIL H PLBG.
[ ] FOUNDATION 2ND CATION
[ ] FRAMING
[ ] FIREPLAC CHIMNEY.
REMARKS:
DATE INSPECT
•
(
75
• / LLL -- �Z�i��.:..� �.
ISI
TIN
iii
BOARD OF HEALTH ::. . . . . . . . . . . . .
O FORM NO. 1 3 SETS OFPLANS
TOWN OF SOUTUOLD SURVEY . . . . . . . . . . . . . . . . .
BUILDING DEPARTMENT CHECK . .. ... . . . . . . . . . . . . . . . . . . .
MAR ' TOWN IIALL SEPTIC FORM . . . . . . . . . . . . . . . . . . .
SOUTHOLD, N.Y. 11971
TEL: 765-1802 NOTIFY:
it BLDG.DEPT.
TN F CALL . . . . . . . . . . . . . . . . . .
., 19.... MAIL TO: . . . . . . . . . . . . . . . . . . . .
Examined
Al��rwed...•7,f7 •C�•... 19.... Penult No.� ...................................
...................................
Disapproved a/c ..................................
• %jilding Inspector) .
AP CATION FOR BUILDING PERMIT
. Date. . . . . . . . . . . . . . . . . 19. . . .
INSTRUCTIONS
a. 'Ibis application must be canpletely filled in by typewriter or in ink and sud=mitted to the Building Inspector w
3 sets of plans, accurate plot plan to scale. Fee according to scllech'le.
b. Plot plan slvwing location of lot and of buildings on premises, relationaliip to adjoining premises or Ixd)lic
streets or areas, and giving a detailed description of layalt of property mist be drawn on the diagram which is part of
this application.
C. 'n,e work covered by this application :nary nco
'lot be mnencecl before issuance of Building Permit.
d. Upon approval of this application. the Building Inspector will: issue 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 sihole or in port for any purpose whatever until a Certificate of
Occupancy shall have been granted by the Building Inspector.
APPLIC/1rI N IS tEW-By MALE to the luilding 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, a 'ail
the e applicant agrees to comply with all applicable laws, ordinances, building code, housing
regulations,,and to admit authorized inspectors on premises and in building for necessary inspectionsA-1,16 �./}
W..
..I AK.....,fie....... ......................
(Si nature of applicant, or if a corporation)
(Mailing address of applican•)•
State wl►ether applicant is owner, lessee, agent, architect, engineer,'general contractor, electrician, p1trdber or Ix1i1dE
....................� ............................... ............ . ...................................
..............................
Name of owner of premises ........... ........ ... .k?S/.!. r..k.-
(as on the tax roll or latest deed)
If appl' ant i a ra ,,//siiVature of duly authorized officer.
(Name•a title corporate officer)
Builders License N�. .........................
Plumbers License No. ..•. f�•�J••�••••••••
Electricians License No. •••
Other Trade's License No.
I. Iocation of land on ids proposed work will be &xie... ..... •... "
... 3 . ........... A: . 5... ... ................ �� , .... ...............
.. house Nunii�er•• . .
Street ]{stmlet
` .... ��?:... �d
County Tax Map No. 1000 Section ....�...!•... Block ....../....... Lot
Subdivision ...................................... Filed Map No. ................ Lot ...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of Proposed construction:
a. Fxisting use and occupancy ................. _...............
b. Intended use and occupancy ........................................
I. Rature of work (d►eck whid► applicable): New Building Addition .....
1
Iteitair ............ Removal ............. Demolition . ........... Other Work . C €+
J.*...... ... ..
scfW4)
.,:�.
4. Estinoted Cost ..... �.akG�........ fee ......................... M
(to be paid on filing tl .s•a
5. if (Lielling, cudper of dwelling units ...> ... �•�'... .,c orl .. . ;�. ...
.. ti�nlper of. chrel l ing ►units on eacl► Floor ......
If garage, txnlper of cars ..................�.................. .........
6. If. Ixcsioess, cemcvercial or mixedocarpancy, specify nature and extent of each type of use.........
7. Dimensiats of existing structures, if any: PYcxtl'................ [tear Deiptl► .. ...
Ik:ig1►t .........17............ Kitther of Stories ...... .................
Din�ensiats of satnrcture With alterations ort1 ilions:•,Front•...��..., Rear
Deo th ........ ......... lleiglct .............l.... Kxd)er of Stories .... •. .......
8. Ditnensiocts of entire new construction: Front ................ Rear ............... Depth ..............
Ileilo►t ......................... Kober of Stories•......
9. Sire of lot. IkOnt .................... Rear .................... Depth ....................
Ip. IL•,te of Purtliase ..................... Name of Porccter (>Vxter ......
..................................
11. Zone or use district in chid► premises are situated .....
.........................................................
12. Does proposed cca►struction violate any zoning law, ordinance or regulation: ........................
13. Will lot be regraded .................... Will
t�excess
fill be r ed from premise YES t0
14. Nares of Amer of p lsea ` �l .sS�:1" �l-:='t; �dAcklresp���-c!.,;�!D�t.�y34� X .... N►one No. 7�' yd
Naiie of Ard►iteet .. ... � ... :j f........... Address !:f. ? '':.. �Aavpx< ►one No. ............
Nare of Contractor ................................... Acklress ...............................Phone No. ..............
15. is this property within 300 feet.of a tidal wetland? * YES ..........
*Ili YLS, Swnan lum 711U. ms PLrliMt'l'MAY Bit W. A)lRM.
PLOT DIAGRAM
locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions
frau property lines. Give street and block nudger or description according to Gleed, and slow street nanes and indicate
%Aietl►er Interior or corner lot.
r
SI'/1113 (lir Nil Yaw,
SS
Q11NIY (ll� .......................
...........being; duly swarn, delxpses and says ll►at he is lite applicant
(t4e of i►)(lividcial igniog contract)
above ►unied,
lie is lite .................,.. � ! .�. ... .
.. ...
(Co►►tracto ,'ager -corporate officer, etc.).
of said awner or owk-iers, afx . c ly authorized to perforin or have
1 lcerfornrs�l lite said work and to nr►ke aril file this
+tigpl icaticr►; that all statements contained in this applicaticxn are tnve to Lite best of his lupowledge acid belief; aixi
that Lite work will be performed in the nsun►er set forth in like application filed therewith.
96xom to bef. re me this
....�� .....day of ...19.�.
Notary Public
HEl ESE D. HQRNE (Sigttr►t*ur*
) ............
Not..ry PUbiio, State of New York
No.4951,164
t2uelif'Pd in Sllff tlk County
1
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MAP SHOW/NG
UNITS 33 & 34
"AMN M MAP OF MOOIRESLAN D "
abo known as
PW-ASANT RUN ESTATES
COAVOMMMMS I N a N
EKED AAE 13, MM FKE NO. 257A
A T GREENPORT
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N. Y.
1000 - 40.01 - 01 - 33 & 34
SCALE 1" = 30'
SEPT. 21, 1998
NEW yD
NX
ANY
t. Merjc�'p¢
ANY AL MA TION AR ADaTM TO THS SW MEY 0 A VIOLA7)QV
W SECTAV 7109 W TAE AEW YOW STATE EnLTXW LAM. i .:?• 1
agcy As PFR sicn;N►7109-sw4 w z Allcqrrmqnm N. LIC. NO. 49616
MM4V ARE VALO FOR THS MAP AAV COO Ammar dAL Y F
AW
0�a"COW APMRSST SEAL Of TAE SCRVEYAR
AAKIONALL Y TO 000%Y INTO SAO LAW TAE MW'AL JEW BY' (5/6)
UST SE 4W BY ANY AAV ALL SN WYVRS MAW A COPY P. O. BO
OF AAVTW.0 96VEYOWS MAP. 7MW 94f A$ TFR'AAV 1230 TRA
LD, N Y ST EET
79WOtaGNT-TMA TE'ARE MT N WWW"ININ AE LAM, SOU
93 - 300 ( 33 & 34 )
o� y<
CA Z
Town Hall,53095 Main Road A� Fax(516)765-182365-1802
P.O.Box 1179 y �� Telephone(516)7765-1
Southold,New York 11971
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Feb. 2, 1999
Moores Lane Holding Corp.
P.O. Box 1143
Cutchogue, N.Y. 11935
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
XX An application for Certificate of Occupancy is
not on file. (Enclosed)
XX No Underwriters Certificate on file.
XX The check is (not on file. )$50.00
No Health Department Approval on file.
No final inspection has been made.
XX No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984) .
BUILDING PERMIT # 24829-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
BOARD OF uEAI.TTI : . . . . . .. . . . . . . .
FORM NO. 1 3 SETS OF PLANS . . . . . .
TOWN OF SOUTIIOLD SURVEY • . . . . . . • • .
BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . .
MAR TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . . . . . .
SOUTHOLD, N.Y. 11971
BLDG.DEPT. TEL: 765-1802 NOTIFY:
F CALL . . . . . . . . . . . . . . . . . .
ed.. /f. ... . • • . .
19. MAIL TO: . . . . . . . . . . . . . . .
L�mnin ..
A1>tarwcrl... 7 �Z,l,/0 ..., 19.... Pepsi t No.�.J•Q .�1.
Disapproved a/c�................... ............... ...................................
.•.
• wilding Inspector)
AP CATION FOR BUILDING PERMIT
Date. . . . . . . . . . . . . . . . . 19. . . .
INSTRUCTIONS
a. 'this application must be completely filled in by typewriter or in Ink and stimitted to the Building Inspector w
3 sets of plans, accurate plot plan to scale. Fee according to schedule.
h. Plot plan allowing location of lot and of buildings on premises, relationship to adjoining premises or ptablic
streets or areas, and giving a detailed description of layout of property must be drawn on the diagram Which is part of
tills application.
c. The work covered by this application may not he commenced before issuance of Building Permit.
d. Upon approval of tills application, the Building Inspector wilf issue a Building Permit to the applicant. Such
permit shall be.kept on the premises available for inspection througluuut 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.
APPI.ICNrl(N IS TERERY MAIL+ to the building Department for the issuance of a Building Permit pursuant to the
Huilding 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,imd to admit authorized inspectors an premises and in building for necessary inspections.
06
(Si nature of applicant, or Z, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, leasee, agent, architect, engineer, general contractor, electrician, pltnber or Wilde
............•...•... ................... .... ..... ........... ..................................
Name of owner of premises ....... .. a ... ! ... �..............................
(as on bre tax roll or latest deed)
If spill, ant i a a �,/siplat�u�re�of duly authorized officer.
VFr.••�,, ....I.......
(Name a title corporate officer)
Builders License No. .............Q.............
Pluduera License No. .....
Electricians License No. ......,.l.[P•r�...
Other Trade's License No.
I. Location of land on I proposed work will be done....
f�rSi � ..............�� 6...... .
�- 3 n � '. ..0 � , ......................
. ... .. .
House Rmber Street Himlet�
County Tax Map No. 1000 Section ..... •C.... Block ....../....... Lot ....
Subdivision ...................................... Filed Map No. ........:,..... Lot ...............
(None)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .........................
b. Intended use and occupancy ...... U�l. ......l.. ......... . !................
3. N:aUue of work (check whidr applicable); New Building ,,,,
Re pair ......, l -. Adklition .... {s
I Reanva ...`.1. ....... Ikmol i t ion .......... Other Work
4. Estiwatedl Cost .. ., �.ar�l�........ sc
fee
(Lobe paid on filing this a cai;:a(i ....7—j
5. 1t dk4eliing, rxuber of dwelling units ...62 r.. .•: -, .
/.... tknlner of ch+elling rumina on eacia-floor.......... .,-�
If garage, rxnber of care ...........
6. If Ixraiaeas, ccmercial or mixed!occupancy, specify nature and extent of each type of use......................
7. Dirrenaiaus of exist' ng structures, If any: Front................ Rear at
Ikdglrt .........17.........., Mnber of Stories . 1 Ir .................
Dinenaiaus of sA trx:ture with alterations or inions: Front ...�.
Depth ......... // .... !tear ..
. ... ......... Ileiglat' ...........,.l.�„ Mniaer of Stories ....�. ,.
8. Dimensions of entire new construction: Front .... Rear ......
Ilei01t ......................... Maher of Stories•... .....
. .............
9. Size of lot: Front ..... Rear .. Depth ....................
M. Male of Har(Jdase ...... Nano of Former Ownrer .........
. .................................
11. Zone or use district In uiiidd premises are situated .....•
...................................................
12.
Does proposed construction violate arty zoning lawn, ordinance or regulation: ........................
13. Will lot be regraded .................... Will
t�excess
/�fill be ed from from preii/see YES NG
14. Nares of (Mier of p�` °�iis-�es !/.�rlNf.�..rirQi.!`??g-YVKt %dress .... (It/3f�✓ I'lane No
Nage of Arcdrl[ecL' f........,.. Address N{�7X� p
Ilene of Contractor ......... ff` ...... ..�� ��are No. ............ ..
......................... Address ......... Mane No.
.................. ..
............
15. Is this property within 300 feet.of a tidal wetland? * YES ..........
*IF YES, SWn D 101ti IS SFEES M441l' MAY Bit RF�(XIIRFD, NO
PLOT DIAGRAM •
Locate clearly and distinctly all buildings. ulaetber existing or proposed, and indicate all set-back dimensions
from property lines. Give street arxh block rueber or description according to deed, and show street nares and indicate
(dretlrer interior or comer lot.
r
SI'A'lli (F NW Y(MtK,
SS
(IMINIY (M' ..
6 ZVI
r
•••••••••••....l)eiaq; duly sworn, deposes sal says Umt he is the appl.icsnu:
(M-111LofirxlividkaaL igning c(xatract)
alxive aprmed,
Ileis the ................... , ! '....................... :................................
(Carer
acto . ager -corporate officer, etc.)
of said corset or owners, and, c ly authorized to perforin or have perfornecl the said work and to nuke anal file this
11144 icatioo; that all atatenerts contained in this application are true to the best of his lunualedge and belief; aixl
that the work will be performe(l in the manner set forth in the application filed therewith.
9wom to bef9re me this
(lay of =•yc(h P fll ....19.
Notary Public .,/D�it(.K%;,,/..
...........
. IU--L.
HELENE 0. HORNE (Signature )
Not..ry public, State o;New York
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MAP SHOW/NG �y+�
UNITS 33 & 34
"AANDW MAP OF MOOPESLAAID
also known as
PW-ASANT RLAv ESTATES
CONINCANS< N at I
EKED .NAW 13, 1988 FEE NO. 257A
A T GREENPORT
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N. Y.
1000 - 40.01 - 01 - 33 & 34
SCALE 1" = 30'
SEPT. 21, 1998
OE NEW y�
ME TIC�4��
40
ANY ALTERATION QR A0070V TO 7W"vEY IS A VIpLATKw
OF sEcnnw nos Of TIF ACEI raW STATE EOU41 TKw LAI
acapT As A&SECTKw 7tO"OMWV t ALL C&T0r.AX Shmav N. LIC. NO. 496/B
SAD MAP OR V ��� AC SWVE'OR
WIM SHWA TWE APPEARS MWOM PEC V C.
AMITMALL Y TO CPAft Y 4TN SAD LAI TME TTh�y 'AL TERED Or (51
NP61
"T OE EW OY ANY AAV ALL SVEMS t/TLQIKB A COPY P. O. BO
Of AVOW SY.RWyars A . MW 9JQf As 2WECTm'AM9 1230 TRA VE R STREET
7 OWIFT•To-PATE'ARE NOT N CMUAMCE hTN TME LAIR SOUTHOLD, N.Y. 11971
93 - 300 ( 33 & 34 )