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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-24363 Date MAY 14, 1996
THIS CERTIFIES that the building ALTERATION
Location of Property 7800 GT. PECONIC BAY BLVD. LAUREL, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 126 Block 11 Lot 15
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 19, 1992 pursuant to which
Building Permit No. 20655-Z dated MAY 27, 1992
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 REMODEL & ALTER KITCHEN IN EXISTING ONE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to THOMAS P. & DOROTHY E. FARLEY
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. PENDING - MAY 13, 1996
PLUMBERS CERTIFICATION DATED N/A
N~7
1 ng Inspector
Rev. 1/81
x ..ri
FOOM NO. e
TOWN OF SOUTHOLD
WILDING DEPARTMENT
TOWN HALL
SOUTHOLD, H. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N!N 20655Z Ibte ...1,7 19.19.E--
Permission is hereby granted to: /
.........i
to r.^.... 4t!lssY
s!t......
fGP~.....
at Promises located of ..O ...........P..
County Tax Map No. 1000 Section ...IAi........... Block .......IL......... Lot No Ax
101-
pursuant to application doted ~ 19..~~ and approved by the
Building Inspector.
Fee i..
Rev. 6/30/80
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
X060136 BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NY 10038
Date MAY 17 ,1996 Applicatim No. on file }.411680196/96 H 050026
THIS CERTIFIES THAT
only the electrical equipment as deeeribed below and introduced by the applicant named on the above application number in the pramLes of
THOMAS & DOROTHY FARLEY, 7800 PECONIC BAY BLVD., LAUREL, N.Y.
in the following location; ? Basement [jO in Fl. ? Ynd M. OUT Section Block Lot
was examined on MAY 13 ,1996 and foand to be in compliance with tke National Electrical Code.
EUITUA RANOK COORBA aKKS OVBiS DISH WASIARS EXHAUST FANS
OUnM AOIK NGNDESCEM AuaeSaM OTHER AMT. K. W. AMT. K. W. NAT. K.W. AMT. K. W. AMT. R. P.
Men; RSMSACS MOTORS MUMS A MIANCI tEANf SFSOA/RICM TINT CIOGIf Au UNIT NMTSRS STf T DIMMERS
AMT. K. w. dl M. r, oA5 M. r. AMT. NO. A. W. O. AMT. AMP. NAT. Met. TRANS. AMT. M. P. NO. OF FAT AMT. WATTS
SBIV1aAECOMMrcT No. OF S E R v I C a
AMT. AMr. rm now. 10 3w , p SW 3 w 3W 3.T Aw No. ,A ACo a cc ca' MO. Or MAEa a µlEad No. a NEMALSoi. W. 0.AT
OTMIR ANY"TUS:
*NO VISUAL DEFECTSE "An electrical
survey has been made of the exposed p1 9 - \ - S
electrical equipment in the
premises indicated." "No obvious
unsatisfactory condition was found.
THOMAS & DOROTHY FARLEY L
7800 PECONIC BAY BLVD.
LAUREL, NY, 11948 SIMONS& MANAOQ
11
Per
This tartiflaft moot not be ahatad in a manner; return to 1M office of tlEe Board if ineorratt. Inspectors may be identified ;their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
Form No. b
ID Or EAR LE 'J~ LS V IS ~
~ (JY 3U!li2~ING DcP?R~r?.r\r2 t
TOWN RALL
765-1802 .I1=4 _P?LICA=ION FOR CERTI"ICATE OF OCCti?ANC'; BLDG.DEPf
A N OF SO r*++~ r~
This annlicatio- must be tilled in by typewrit-r OR ink and submitted to the building
4--_spector with the following: 'for new building or new use:
1. Final survev of property with accurate location of all ou'_ia*7=s, property _iaes,
streets, and unusual natural or topographic fea*_ures.
Final Approval from Health Dent. of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical installa non from Board of 'ire underwriters.
Sworn statement from plumber certifying that the solder used in system contains
v less than. 2111O of 1 lead.
Commercial budding, =austrizl building, multiple residences and similar buildings
and installations, certificate of Code Compliance °rom architect or engineer
responsible for the building.
6. Submit ?lann-ne Board 9nnroval of completed site Dian requirements.
3. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
"ore-existins" land uses:
Accurate survey of Property snowing all property fines, streets, building and
unusual natural or topograpni c f=eatures.
A orODerly completed application and a consent to inspect signed by the applicant.
c Oerti=icace o: Occupancy '_S denied, the Building Inspector shall state the
reasons therefor in w__:ins: to Lae applicant.
-ee5
.,__:_=_cate Occupancy - New dwelling 525.00, Additions to dwelling 525.00,
_ylaerations to dwell-^.g S^_5.00, Swimming pool 525.00, Accessory building 523.00,
Additions to accessory building S-25.00. Businesses 550.00.
Cartificate of Occupancy on ?re-existing Buildine - 5100.00
OODV of Certif4_cate of Occupancv - .25c
updated Cartificate of Occupancy - 550.00
Temporary Certificate of Occupancy - Residential 5'_5.00, Commercial 515.00
Date
ew Construction........... Old Or ?re-existing .a L. 04
location of ?roDerty. I, Q U e C,t?n/( c . /JsLY....~3~( ~P.. . .
House No. Street Hamlet
inwer or Owners of ?rover.y..7-1~Q.S../JJ7.15.fJA:E.~....V71 11 rct~ L rRI~~LL':........
:ouncy Tax Map No 1000, Section. Jo:?(........ Block. I/ Lot.
uodiv'_s_on.....JJ....h/../.4... .......................filed MaD............ Lot.....
7ermlt NO..47Clkr.,;~ -;F-..Date Of Permit ................Applicant.............................
teai:h Deoc. ADDroval inde-wrizers -,-ourova..........................
_arriag 30ard Approvall
;e4ue5t ?emnc:arv Oe_ ___..c._........... .al CeT_tica_c...........
e=_ 5uom-'fed: S............................. 12
dec. 1270 2i??1...
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FOUNDATION (1st) I ~
a
?OUNDATIOJJ (2nd) m
2.
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.',OUCH FRAME &
-PLUMBING
3.
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INSULATION PER N. Y.
y
STATE ENERGY
CODE
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r
FINAL
ADDITIONAL COMMENTS:
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M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] 1 LATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: Lzn~~
Al Z2
2
DATE INSPECTOR
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BOARD OF HEALTH
FORM NO.1 3 SETS OF PLAUS
TOWN OF SOUTHOLD SURVEY . . .
BUILDING DEPARTMENT CHECK _ .
TOWN HALL SEPTIC FORn
= ` - SOUTHOLD, N.Y. 11971
Examined TEL.: 765-1802 t:oC I FY ;
S~ T 19 MAIL CALL .
. AIL TO:
Approved ...`}/d 19/yPermit No.. r'oSS. . .
Disapproved a/c - - - .
.
uilding Inspector)
)
APPLICATION FOR BUILDING PERMIT q
Date ..?~./~1........., 19
INSTRUCTIONS
Pa. 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 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 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 buildine_ for necessary insor.rtionc n
IJ.G[!r2.~N.fii~r?/L . rn, ~cr4!..........
r (Signature of applicant, or name, if a corporation)
its....? k:..Rel. _«l'.... 7q(F>..
(Mailing address of applicant)
State whether applicant is wrier, lessee, agent, architect, engineer, general contra electrician, plumber or builder.
I _
Name of owner of premise V (as on the tax roll latest deed) J~ JB PS
If applicant is a corporaton, sere of duly authorized officer. DATE: ABP 4 _
DSO, L
NOTIFY BUIBUILDING D ENT AT
7651802 9 AM TO 4 FM FOR THE
(Name and title of corporate officer) UNDERWRITERS CERTIFICATE
REQUIRED FOLLOWING INSPECTIONS:
Builder's License No. ~s- ..5`-, /(a , f><t. , , , , . 1. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
Plumber's License No. 2. ROUGH - FRAMING & PLUMBING
3. INSULATION
Electrician's License No. 4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
"77 ALL CONSTRUCTION SHALL MEET
Other Trade's License No. a
THE REQUIREMENTS OF THE N.Y.
u" STATE CONSTRUCTION & ENERGY
1. Location of land on which proposed work will be done .00DES: • NOT • RESPONSIBLE- AOR.
7?Cd FFC'Oi4J/r?.,4.y gZVA p UCP9~~~~.
House Number Street Hamlet
County Tax Map No. 1000 Section l4~ Block Lot.
Subdivision Filed Alap No. Lot
(Name)
Statc existing use and Occupancy of premi s and inte ed use and occupancy of proposed construction:
a. Existing use and occupancy
l~ct... .......................MUMINNG..........
b. Intended use and occupancy ALL PLUMBING WASTE
&Vt44TEAUNESNEED.......
TESTING BEFORE COVERING
3. Nature of work (check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work /1E~~c'E/11V'7
(Description)
4. Estimated Cost Fee
(to be paid on filing this application)
5. If dwelling, number dwelling units Number of dwelling units on each floor. . . .
If garage, number of cars /t1Qrr//G • , , , , , • , ..........6.,~If business, commercial or mixed occupancy, specify nature and extent of each type of use
Dimensions of existing structures, if any: Front Rear Depth
Height Number of Stories .
Dimensions of same structure with alterations or additions: Front . Rear
epth Height Number of Stories .
Dimensions of entire new construction: Front • . . . . . . . . .
' .Rear Depth
eight Number of Stones .
ize of lot: Front Rear .
Depth
Date of Purchase Name of Former Owner
it. Zone or use district in which premises are situated .
12. Does proposed construction violate any zoning law, ordinance or regulation: a
13. Will lot be regraded Will excess fill §e removed from premises: Y;s No
14. Name of Owner of premises • Address 7 slocy..iE e< YyJ /
Y . Phone No. ....99.......... .
Name of Architect Address Phone No............... .
Name of Contractor Address Phone No.
15. Is this property within 300 feet of a tidal wetland? *yeS,,,,,,,, No
*If yes, Southold Town Trustees Permit may be required.
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.
vp C, "~Ac- w~.v~dw s.
euTMM" ~S G~/~TNvu7- FtiG[.~/ pQ~~P~9T/U~cJ~ ~
STATE OF NEW YAVK, S S
'OUNfY OF. AA-
. eC:.. being duly sworn, deposes and says that lie is the applicant
(Name of individual signing contract)
ibove named.
le is the ~vNTC~~ra2
(Contractor, agent, corporate officer, etc.)
)f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the
vork will be performed in the manner set forth in the application filed therewith.
,worn to before me this
A .....day of .t, !y~~ 19
,otary Public, ~ , , • c C
Z County Sv/r
• fi1;C".iv i S. PR<x;itA ,P:Z
,.•h.rl;.R'i F""JU':L?~ SFA7£ OF NF.I"J Y."J.R~ ~~fGGZ2
ft2-s1C589D
OIIALIFIED -wFaO COUNTY (Signature of applicant)
C01,414v7jON E.'RIR..S l9f__3
o e