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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-22795 Date DECEMBER 16, 1993
THIS CERTIFIES that the building ALTERATION
Location of Property 2545 WEST CREEK AVENUE CUTCHOGUE, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 110 Block 5 Lot -1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 11, 1993 pursuant to which
Building Permit No. 21491-Z dated JUNE 22, 1993
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 ALTERATIONS TO FOUNDATION UNDER EXISTING ATTACHED PORCH
AS APPLIED FOR.
The certificate is issued to GREGG ROBERTS & KATHI McGOWAN ROBERTS
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
ilding Inspector
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)
Date .1. . . 19...
° N 21491 Z
Permisslon Is hereby granted to:
....16
ToL2~L?L~..c-,r~K.`..4'?Sr.1r...ld.`/GIrY~...C!r! .....GC.....~"~1~~!~7.~~...
.
.
at premises located at....f;.T s......!
.
County Tax Map No. 1000 Section ......1/0......... Block `.J............ Lot No....../
pursuant to application dated .........ail 19..~?~....... and approved by the
Building Inspector.
-7 0/
Fee $../....5/]
r/?)/u
lding 0i;spector
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
DEC 1 51993 TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
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 17 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 $15.0000,, Commercial $15.00
Date J. 1 5. .
New Construction...... Old Or Pre-existing Building,./
Location of Property ...°2.5~{5.. 2S{ CTeC AVA.... Ci4 c~L0 u ~
House No. Sheet Hamlet
Onwer or Owners of Property..... re o bc-.r* . U>~A ~ca (o _r 3
County Tax Map No 1000, Section .....I~. Block 5 ........Lot...... /
Subdivision........ ..............................Filed Map............ Lot.... P
Permit No. ~ ) .......7- ...Date Of Permit..(?!? 11.3..... Applicant.
Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate...X
025. Q
Fee Submitted: O
y 73(1 3 APPLICANT
ca ~a14.5
INSPECTORS
Victor Lessard ~~jFFO(
Principal Building Inspector OHO ~'p
Curtis Horton bye SCOTT L. HARRIS, Supervisor
Senior Building Inspector Southold Town Hall
Thomas Fisher fn _
Building Inspector O Sj P.O. Box 1179, 53095 Main Road
old, New York 1
Gar Fish
Fax (516) 765-18231971
Building Inspector COOS South
Vincent R. Wieczorek Telephone (516) 765-1800
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
November 22, 1993
Gregg Roberts s Rathi McGowan
2545 West Creek Ave.
Cutchogue, NY 11935
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
%%x The check is (eutdal=ed/not on file.)$25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # BP/ 21491Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
71lrY9,4 19
H
FOUNDATION _ (1st)
'P
FOUNDATION (2nd)
2.
z
o ~
ROUGH FRAME &
.PLUMBING
y
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x
B• m
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H
INSULATION PER N. Y.
STATE ENERGY
CODE
4.
FINAL
ADDITIONAL COMMENTS: x `lam
H\
O
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v.
m
H
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] 1 SULATION
[ ] FRAMING [ FINAL
REMARKS :
DATE INSPECTOR
F7
765-1802
BUILDING DEPT.
INSPECTION
[/]/FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:-
DATE INSPECTOR G
M-1802
BUILDING DEPT.
INSPECTION
[ FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ I INSULATION
( I FRAMING [ ] FINAL
REMARKS: C_
DATE / ~v INSPECTOR l
h~- Coo u-> /
le
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w a
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el
OCCUPANCY OR f
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UNLAWFUL
USE I
WITHOUT CERTIFICATE
OF OCCUPANCY
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4
BOARD OF HEALTH
FORM NO.1 3 SETS OF PLAIIS
TOWN OFSOUTHOLD SURVEY
i b BUILDING DEPARTMENT CHECK • • - - - -
TOWN HALL SEPTIC F 0 R N . . . .
SOUTHOLD, N.Y. 11971
TEL.: 765.1802 NOTIFY 2
CALL ).3. .r_ Sh- .
Examined ..c°. ~ Z 19/q ,-3 NAIL TO:
Permit No.
Approved ...012....... 194
Disapproved a/c
(Build' g nspector)
APPLICATION FOR BUILDING PERMIT
Date 19q }
t. J.
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
ets 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
)r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apph-
:ation.
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
hall 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
hall 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
3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
tegulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
Flte applicant agrees to comply with aB applicable laws, ordinances, building code, housing code, and regulations, and to
.dmit authorized inspectors on premises and in building for necessary inspections.
(Signature of applicant, or name, if a corporation)
Zr'`15... CS~..~reek..7,..(;;tTc~o ve of
(Mailing address of applicant) Lkcj3S
Mate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
t,wne
\ame of owner of premises G.re ° 6er... F.. 4~`~:..'. ~C~o w4:1
(as on the tax roll or latest deed)
It applicant 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. 3 .5..`. , H . .
Location of land on which proposed work will be done. .
,''rr /.......I
~TJ W¢S~ Q c C_K Aqe l/`' GVvO~U ~
(louse Number Street amlet
County Tar Nlap No. 1000 Section Block Lot .
Subdivision Filed Nlap No. Lot
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
b rC h ~ .6 s~ d \J
a. Existing use and occupancy .
b. Intended use and occupancy ...R J~%G D S ? O t . " . J . e r S i . .e• e . . . . 0 (G . . . . . . . . .
' ....I..............
.
3. Nature of work (check which applicable): New Building Addition Alteration X.
Repair Removal , Demolition Other Work .
(Description)
4. Estimated Cost z Fee .
(to be paid on filing this application)
5. If dwelling, number of dwelling units ......l......... 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 1 .
7. Dimensions of existing structures, if any: Front 6........ Rear ...a.......... Depth ...1
Height Number of Stories
Dimensions of same structure with alterations or additions: Front Rear
Depth Height...................... Number of Stories......................
8. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories .
9. Size of lot: Front q
Rear ,(pZ Depth lP
I
10. Date of Purchase 8 t
9 Name of Former Owner
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation: ~44 .
13. Will lot be regraded ~.d II.. . . . . Will excess tilt be remove from premises: Yes No
14, Name of Owner of remises .Grc„ K,6erTs zs4s cr~eK 56 (,8.„
P `t`t • .....Address .....Phone No. .3~':... .
Name of Architect ° 71~6q a, .Address Phone No. '
Name of Contractor Address one No............... .
15. Is this property within 300 feet of a tidal wetland? *yes.......
*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 tines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
*Ow-tt T,ov
c '
"V i
- DATE:' B P. M
FEE- 6~ stv.
NOTIFY BUILDING DEPARIJONT' AT
765-1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING R PLUMBING
3. INSULATION
4. FINAL - CONSTRUCTION MUST
BF COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y.
STATE CONSTWJC ION a ENERGY
CODES NOT FIESAONSIBI.E FOR
DES~aN oR cowsrRUCnoN EmoRs
TATE OF NEW YQRI{ S.S
OU(NTY OF v .
Uti°?45 being duly sworn, deposes and says that he is the applicant
...~C ec'CL
V `5r ame of individual signing contract)
)ove named.
C vs~
is the .4.......................................................
(Contractor, agent, corporate officer, etc.)
said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the
irk will be performed in the manner set forth in the application filed therewith.
vom to before me this
j,...daor.. 19 ~
nary Public, / ` ' County
N9TAR IC o1N,C (Signature of applicant)
Term 3 19 W