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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
Date: 05/31/07
No: Z-32377
THIS CERTIFIES that the building
ADDITION
Location of Property: 4910
(HOUSE NO.)
County Tax Map No. 473889 Section 110
PEQUASH AVE
(STREET)
Block 3
CUTCHOGUE
(HAMLET)
Lot 27
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
OCTOBER 24, 2006 pursuant to which
Building Permit No. 32450-Z
dated
OCTOBER 24, 2006
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 "AS BUILT" ADDITION TO AN EXISTING ACCESSORY BUILDING AS APPLIED FOR.
The certificate is issued to LAUREN ZAMBRELLI
(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
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 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 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 c::>f 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
New Construction:
Date.
5h~c:L .
Old or Pre-existing Building: 7 (check one)
Location of Property: ~ 9/0 Pl Q.. U Il<sh 4v~ C tJ -(--LAo 7 u ~
House No. Street I
Owner or Owners of Property: L q u (' e./1. ~ b Te..-J )1
Ltu
:5- -c2/-07
tu y /A~
Hamlet
Suffolk County Tax Map No 1000, Section
Block
5
Lot
;;)7
Subdivision
Permit No. '3 a\.f-5 02-
Filed Map.
Applicant: Lcr.vre...t)
Lot:
24m !Jr~!k r
Date of Permit.
Health Dept. Approval:
Planning Board Approval:
Request for:
Underwriters Approval:
Fee Submitted: $
Temporary Certificate
d~~J()
Final Certificate:
~. l:Jfc2tf
Co .:e3:)37,
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.
32450 Z
Date OCTOBER
24, 2006
Permission is hereby granted to:
LAUREN ZAMBRELLI
4910 PEQUASH AVENUE
CUTCHOGUE,NY 11935
for :
AS BUILT ADDITION TO AN ACCESSORY BUILDING AS APPLIED FOR
at premises located at
4910 PEQUASH AVE
CUTCHOGUE
County Tax Map No. 473889 Section 110
Block 0003
Lot No. 027
pursuant to application dated OCTOBER
24, 2006 and approved by the
Building Inspector to expire on APRIL
24, 2008.
Fee $
150.00
Rev. 5/8/02
ORIGINAL
3~lf50 Z-
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING I STRAPPING p<ZFINAL
[ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRucnON [ ] FIRE RESISTANT PENETRAnON
REMARKS; ~ ~ ~Dk,
r-~O,
DATE
S-Io - 07
INSPECTOR ~~
-.- -
--.-.-, .- , -, ....
3 ~V60 tr-
--".-~"......... ~
- . .-
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [
[ ] FOUNDATION 2ND [
[ ] FRAMING I STRAPPING [
[ ] FIREPLACE & CHIMNEY [
[ ] FIRE RESISTANT CONSTRUCTION [
] ROUG" PLBG.
] IN LATION
FINAL
] FIRE SAFETY INSPECTION
] FIRE RESISTANT PENETRAnON
DATE 3PY() 7
INSPECTOR
VIcrOR P. WlBREW, P .E.
7 FEUIS ROAD
HAWLEY, PA. 18428
511-226-0665
eeu: 631-513-2118
15 May 2007
Town of Southhold
Building Department
Re: Shed installed at 4910 pequash Avenue, Cuthogue, NY
To Whom It May Concern:
This letter is to confirm that all foundation posts supporting this shed are a
minimum of 36 inches below existing grade.
J~ pUffi'
,
FIELD INSPECTION REPORT DATE COMMENTS UJ"'d
FOUNDATION (1ST) y~
~~
\)J:;t: ?
-------------------------------------
'~e
FOUNDATION (2ND) o Rboo r
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ROUGH FRAMING & -"QtJ!j
PLUMBING (\ ~
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INSULATION PER N. Y. ---- ~~--"- tJ!j
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STATE ENERGY CODE
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FINAL /J I {' ./""" ~ (0
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ADDITIONAL COMMENTS ~
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Exprration V /'2- r
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PERMIT NO.3J- y<C>
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BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
Board of Health
4 sets of Building Plans
Planning Board approval
Survey
Check
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN PALV
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www.northfork.net/Southold/
Examined
Approved
Disapproved alc
Mail to:
Phone:
, 'J 5 " ',I'
l.. ;0
APPLICATION FOR BUILDING PERMIT
I
-_-1
Date
(o//d-
20 tJf:7
'-
i
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INSTRUCTIONS
a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location oflot and of buildings on premises, relationship to adjoining premises or public streets or
areas, and waterways.
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 issue a Building Permit to the applicant. Such a 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 what so ever until the Building Inspector
issues a Certificate of Occupancy.
f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of
issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the
property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an
addition six months. Thereafter, a new permit shall be required.
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 South old, 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 inspections.
'I
L
'f. Q910
Pf:&uJ,5J Itvp ~1.,vIi. AJV IlJJJ'
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises LIk}Y<8h ?aM ~re / II '
(As on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
1.
County Tax Map No. 1000 Section
Subdivision
II 0
~
Hamlet
Block 3
Filed Map No.
Lot
Lot
c9-7
r~'
(Name)
" ..'
';'''';
;l( State existing use and occupancy of premises ~d _intended use and occupancy of proposed construction:
!" a. EXIstmg use and occupancy ....4!;., Q,,,~ " ~ .
b. Intended use and occupancy
~~~Qn,- 0
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
Addition
Other Work
/
Alteration
(Description)
4. Estimated Cost
Fee
5. If dwelling, number of dwelling units
If garage, number of cars
(To be paid on filing this application)
Number of dwelling units on each floor
6. Ifbusiness, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front
Height Number of Stories
Rear
Depth
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: Front
Height Number of Stories
Rear
Depth
9. Size of lot: Front
Rear
Depth
10. Date of Purchase
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? YES_NO_
13. Will lot be re-graded? YES _ NO_Will excess fill be removed from premises? YES_NO_
Phone No.
Phone No
Phone No.
Address
Address
Address
14. Names of Owner of premises
Name of Architect
Name of Contractor
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO
* IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REOOIRED.
b. Is this property within 300 feet of a tidal wetland? * YES_NO ~ -
* IF YES, D.E.C. PERMITS MAY BE REQUIRED.
./
16. Provide survey, to scale, with accurate foundation plan and distances to property lines.
t:.. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey.
STATE OF NEW YORK)
COUNTY O~\ ~
(5cu Y\€ '( , ~ h I p-l Yhu \ I, 'V'\ being duly sworn, deposes and says that f.Bhe is the applicant
(Name of individual signing contract) above named,
fS)B:e is the ~ ~O-<G~
(Contractor, Agent, Corporate Officer, etc.)
of said owner or 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.
20 O~
L2-Jl2~
Signature of Applicant
BARBARA ANN RUDDER
Notary Public. State of New York
No. 4855805
Qualified in Suffolk Countya') ^ ( 0
Commission Expires April 14, ~
. ~~cQ.
APPRO'JEO AS N01EO
OATE:...'-" /'2--< 1,,- B.P. # ~'-\ .,-0:'
FEE' ~ BY~~-
NOilF BUILDING DEPARlMENi Ai
765-1802 8 AM iO 4 PM FOR iHE
FOLLOWING IN ONS:
1. FOUNDAilO - iWO REQ
FOR POUR CONCREiE
2. ROUGH - F AMING & PLUMBING
3. INSULAilO
4. FINAL - CO
BE COMPL iE FOR C.O.
ALL CONSiR CilON SHALL MEEi iHE
REQUIREME S OF iHE CODES OF
YORK SiAi NOi RESPONSIBLE OR
DESIGN OR CONSiRUCilON ERR RS.
F\LL CONS1RUC1\ON SHF\LL
MEET iHE REQUIREMENTS OF iHE
CODES OF NEW 'lORK S1 F\1E.
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NECOMPL Y WITH ALL CODES OF
W YORK STATt: & TOW
AS REQUIRED AND CONDI~lg~~~
. SOUTHOLD ]C''iN ZBA 'l L
SO.\HHOLD TOWN PlANNING ~P411-......
OUTHOlD TOWN TRUSTEES
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