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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-32233
Date: 03/08/07
THIS CERTIFIES that the building
ALTERATION
Location of Property: 3650 EUGENES
(HOUSE NO.)
County Tax Map No. 473889 Section 97
RD
(STREET)
Block 8
CUTCHOGUE
(HAMLET)
Lot 6
SUbdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
FEBRUARY 27, 2007 pursuant to which
Building Permit No. 32756-Z
dated
FEBRUARY 27, 2007
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 RECONSTRUCT AN EXISTING PORCH ROOF OF AN EXISTING SINGLE FAMILY
DWELLING AS APPLIED FOR.
The certificate is issued to MARY E GILBERT
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
N/A
PLUMBERS CERTIFICATION DATED
N/A
~ri~
Rev. 1/81
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
~U2.. io tA) ( 6() ~ ,,J
ef .2 '-t ~.:?J "3
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:
I. 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:
I. 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
Date.
~/;< ~I/O t
(check one)
New Construction:
Old or Pre-existing Building:
1/'
(U~j~J'"
12. G,lbCl'f (J/7/7/7..f.-)>j/)
1'7 Block ~
'1{ ct
Street
Hamlet
Location of Property: ..3 h ,-)0 ;: u,r fl!n ~<;
House No. (/
Owner or Owners of Property: tJJ IJ/t t/
, (
Suffolk County Tax Map No 1000, Section
Lot
If!
Subdivision
Filed Map.
Lot:
Permit No. 3;;17 S G ~ _ Date ofPermit.....2J Q 7 /07 Applicant:
Health Dept. Approval:
Planning Board Approval:
Underwriters Approval:
Request for:
Temporary Certificate
Final Certificate:
t/"
(check one)
Fee Submitted: $ .25. 0-0
~. 7rQfj./
C.O ~3;L;)~.J
t1J% I: ~hPn~ ~~
. plicant Signature V
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.
32756 Z
Date FEBRUARY 27, 2007
permission is hereby granted to:
MARY E GILBERT
3650 EUGENES ROAD
CUTCHOGUE,NY 11935
for :
REMOVE AND RECONSTRUCT AN EXISTING PORCH ROOF OF AN EXISTING ONE
FAMILY DWELLING AS APPLIED FOR. THIS PERMIT REPLACES BP 24233.
at premises located at
CUTCHOGUE
3650 EUGENES RD
County Tax Map No. 473889 Section 097
Block 0008
Lot No. 006
pursuant to application dated FEBRUARY 27, 2007 and approved by the
Building Inspector to expire on AUGUST 27, 2008.
Fee $
75.00
ORIGINAL
Rev. 5/8/02
~ ~ ~ ..
- ... - ....--....,...
C?--~ ;L,.3 3 Z-
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING I STRAPPING [] FINAL
[ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSlRUCTION [ ] FIRE RESISTANT PENETRATION
~/L
REMARKS:
,
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DATE ;}---;-7"- () 7 INSPECTOR ~ ~
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OCCUPANCY OR
USE IS UNLAWFUL
WITHOUT CERTIFICATE
OF OCCUPANCY
f~~ASNOTW
DATE: B.p.# ????33/
FEE: 7.r~ ~
NOTIFY BUILDING D~
765-1802 9 AM 10 4 P
FOLLOWING INSPECTIONS. FOR ,HE
1. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
2. ~~UGH - FRAMING & PLUMBING
3. .N.,llLATlON .
4. Fi!"AL . CONSTRUCTION MUST
^' ,81: COM~LETF FOR C.O.
",LL CON:iTRUCTION "'HAL .~
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,-." REO"IREMt'NTS OF
".;7Ay...., ,-~ __ ". - THE N,Y
. ....c ..JJl'iSTRUCTION & EN- .,
t" '^"O' ,. l:R(. {
;:',:;,,~;". ,~,m RESPONSIBLE FOR
, ....,1" OR CONSTRUCTION ERRORS
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UNOOlriR'ItRS &tt/11fltA1i
REQUIlIED
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TOWN OF SOUTHOLD PROPERTY RECORD CARD
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OWNE
VILLAGE
DIST.
SUB.
LOT
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FARM COMM. CB. MISe. Mkt. Value
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RES. ~I 0
LAND IMP.
ACR.
1.500
TYPE OF BUILDING
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R/ ,./j' /;..'~
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TOTAL
DATE
REMARKS
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NORMAL
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NEW
FARM
Ci, I bt' ( -+
Acre
Value Per
Acre
Value
Tillable 1
Tillable 2
7 t L'" , '}"J.. kQVhliWltfJ. MIL
If' :Jfl f,/',.f )':;,) · , 14 ~ ",0,7."''--' f- ., ~:t '::, 'I ' I
I~ ',:y."-' _,-A - ton": . C)I)( ',<, "r 'j I-}", ,'f i fW\
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Tillable 3
Woodland
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FRONTAGE ON WATER
FRONTAGE ON ROAD
DEPTH
BULKHEAD
,
.ilSjdf @ 6~
Swampland
Brushlond
House Plot
Toto I
DOCK
..j.P.!L- Yo toundatian g)-Ie}.:, Bath
--"-~ --. .._.__..,~. ----
'" f.;i t Floors
~IJ-_
xt. Walls ILJk. Interior Finish
_.CJ.!!.. e Heat
Type Roof """ . Roams 1 st Floor
(.:7c /; /p
Recreation Room Rooms 2nd Floor
Dormer
r" .I .).. "> G ( Driveway
M. Bldg.
Extension
Extension
Extension
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\Ll Y. 2'1 ~
\-J<"" ''i'c.
Parch
7
: Porch
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Breez!!-~ay
Garage
J c, '.
Patio
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Total
COLOR
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Dinette
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DR.
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FIN, B.
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FORM NO. I
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL: 765-IB02
3~7~
Permit It>.~
BOARD OF HEALTH ...............
3 SETS OF PLANS ...............
SURVEy........................
CHECK .........................
SEPTIC FORM ........,..........
Emni t
:, Tn!",'"
Aw,.,.."d,.-.
Di
(;';;-,,"'-
i l') m & m n on R-.r"\l
..c'~~;-
91 7
,'::i
NOTIFY:
CALL ..................
MAIl. TO:....................
.. .. .. .. . ~ . . . . . . .. .. .. . . . . .. . .. .. . .. . . . .. . . . .. .. .. .
.........................................
ICATION FOR BUILDING PERMIT
. Date. L.~..7......., 19l!.?
INSTRUCTIONS
a. This applicatioo DUSt be ~letely filled in by typewriter or in ink and subnitted to the Building Inspector with
3 sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing locatioo of lot and of wildings 00 premises, relatiooship to adjoining prenises or piJlic
streets or areas, and giving a detailed descriptioo of layoot of property nust be drawn 00 the diagran which is part of
this applicatioo. .
c. The...me covered by this applicatioo "IlY oot be Lu""",oCe<I before issuance of Building Permi t.
d. Upon dl'l',uv..l of this applicatioo, the Building IllSJ'!'Ctor will issue a Building Permit to the applicant. Slrll
I permit shall be kept 00 the premises available for inspectioo throughoot the...me.
e. It> wilding shall be occupied or used in whole or in part for any JIJT1lO8e whstever uotil a Certificate of
Occupancy shall have been granted by the Building Inspector.
llPl'LICATIlII IS IEREBY MAlE to the Building IlI>psrtnEnt for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Sootbold, &Iffolk Coonty, New York, and other applicable Laws, Ordinaocesor
llegulations, for the coostructioo of wildings, additioos or alterations, or for rermval or deIoolition, as herein
described. The applicant agrees to """"ly with all applicable laws, ordinances, building code, hoosing code, and
regulations, and to adnit oothorized inspectors 00 premises and in ~i~.: ..~:.'~~~a~~~:.....::-..........
(Signature 0 lcant, or n<m', if a corporatioo)
~ 1.7. ~ e"K.Md.e:././. .s~f:I.~.....
(Hailing address of applicant)
b=d~~~;=:.=~:.=~~~~:.:~~~: .~~~~.~~~~~~:.~~~~~~~~~: .~~:~.~.~~~~r.
Name of owner of premises .~~~J(.~~~~...............................................................
(as 00 the tax roll or latest deed)
If applicant is a oo'l"'H.tioo, signature of duly authorized officer.
.................................................................
(Name and title of corporate officer)
Builders License It>.
Plumers License It>.
LIZ
r:[-:':-:-.~..................
,~. ' .
Electricians License It>. .....................
Other.Trade's License~. ...............:.... 30- S-o ~ "",., t? <;, L~ l
Locatloo of land 00 whIch I"~...me wIll be dorre......................f:................,.../!;................
_,
1.
..0_.__.........................................................................................................................
::;:Haplt>. IlXXl Sectioo ~~1.7......... Block ...8......... Lot ....:??.....
SltxIivisioo ...................................... Filed Hap It>. ............... Lot ...............
(Name)
:~a::::i:: ~ =.~1:~1:~~.~.~~~~.:.~.=.~~.~.~~~:~~~:......
2.
b. Intended use and occupancy ......................................... ,fll...nroe ,tT,,~fJO""""""'"''''
IwIi -... 10 ..,..2 .~ilduq ",.toM
"",,0:> lIIotlIJ2 ", btt,lil....,g
uoas:rl>J2 to .oM
,ft yeM ...iqx31lnlW
l.
~illllr" (J[ work {check ..tdch SI~)1 icshl"l;
Hel..ir ............ Henvvsl .............
V
151 Iklilding .......... Addition.......... Alteratiun ..........
IlBooli tiun ............ Other Work ..................................
Olescriptionl
I,.
Est iU.:Jter.l C..oat
..?~..~.........
fee
(tu be paid un [iling this
If dl.oIell ing, 1I.,her of dwelling units....f...... tblt>er of (J\\lell ing lmits on eacll
If garage, 1_J1'ler of C81"S ..... _.. _ _............... _............
6. If husiness, canrercial or mixed occupancy, specify nature 8IXl extent of eadl type of use......................
5.
sppl icationl
o
floor ....'~_..........
7.
UillensiOlIS of existing stnK:tures, if any:
Front. .. . . . . . . . .. . ... Rear ............... llepth
lleight ......... _.... ........... ItJliJer of Stories .......... _ _ .. _ ... ... .
nillEosicns of SilIl':! struc.ture with alterations or additions: Front _. _............ Rear _............ -.
(lepth .................:... lIeight .................... N.llher uf Sturies ...............
niuensiOlUf:.o'f enti're ~ construction: li'ront _....~'l-.....- Rear ..~!.._..... Depth ...g........
"
l\eight ......................... IUmer uf Sturies .....................
9. Size of lot: Front .:.:..~,............... Rear .................... Ilepth ....................
8.
10.
II.
12.
13.
Ilate of Purchase ..................... ft.-.re of Forner ()..lner ........................................
Zcxle or use district in w.id. premises are situated ..............................................................
~s proposed CDnstructi~ ,iulate any zoni~ law, Urdir....lCe nr regulatioo; ...:................. ~
win lot be regraded ..t:f.<..'>............. win excess fill be ramved fran pr..mses: YES LV
Nares of Owner of PrElllises&yKmt?~.~...__.. Address Jf<Mg,,?M"!:J.hL........ HIOl'" lb.. ..............
N<:JIe of Arcl.i teet .................................... &klress .............................. P\lOlle tiJ. ..............
II,.
lime uf r.ootractor ................................... IIcklress .............................. .HlOOe lb.
15. Is this property within 300 feet of a tidal wetland? "YV.-S.......... tll..........
"IF YES, &l1nnn 1Ua-l11l1JSlliES PI!.'\tIrI'MAY IlE RFJ1JIRIID.
1'1.0'1' 11IAGRAH
locate clearly and distinctly all buildings, "'",I:1",r existing or proposed, and indicate all set-ll8Ck dineosions
fran property l'ines. Give street and block D.llber or description according to deed) and sllaJ street nmes arxl ilYlicate
,....telher interior or cornee lot.
sri\:1E \J1 1"4':11 YlXlK,
~ 55
(mNlY IX" .......... ~.U: . ... . . .
~(4!.J...Du.n.o.p.................. ..... ...Ix,il~l duly
(Nflre of individuat sig.ning contract)
alxJVe (}fIned)
f,'worn) delX)5eS and 8<-'1Y8 lh.,lt he is the applicant
Ik~ it) the
.orporate officer) etc.)
of said (,.mer or OWI'lerR) HI.I is ( lLy m.Jlhodzed to I'erfonn or have perrorned the said work and lo rooke and file lhiR
nppl icaticnlj thnt all Rtatarents contained in lids appl kntiofl are true to the heAt of hi" klKJWIec:lge nlKIIM~1 ief; and
t hal the wurk wi II he perfomed in the 1I1<1I11K~r set forth in the aplll. ication filed therewith.
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