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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: 11/01/07
No: Z-32710
THIS CERTIFIES tbat the building WINDOW REPLACEMENT
(STREET)
Block 2
CUTCHOGUE
(HAMLET)
Location of Property: 33900 MAIN RD
(HOUSE NO.)
County Tax Map No. 473889 Section 97
Lot 11
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in tbis office dated SEPTEMBER 10, 2007 pursuant to which
Building Permit No. 33416-Z
dated SEPTEMBER 24, 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 REPLACEMENT OF FRONT PORCH WINDOWS IN EXISTING SINGLE FAMILY
DWELLING AS APPLIED FOR.
The certificate is issued to ROBERT W RICHMOND
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMEIIIT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
N/A
PLUMBERS CERTIFICATION DATED
N/A
~ze~
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 i~ and submitted to the Building Department with the following
A. For new building or new use:
I. Final survey ofpropeliy 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 buildiugs 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. Ifa Certificate of Occupancy is
denied; the Building !J1spector shall state the reasons tlierefor 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 Celiificate of Occupancy - $50.00
5. Temporary CCliificate of Occupancy - Residential $15.00, Commercial $15.00
Date. If) I J ') I 07
y
Old or Pre-existing Building:
(check one)
New Construction:
Location of Property: '33 qoo ~ tl-c1-
House No.
Street
~~t
Owner or Owners of Property: 6?-JN'- - G<, ~U>--l-L
Suffolk County Tax Map No 1000, Section ~ 7 Block ;?.
Lot II
Snbdivision
Filed Map.
Date ofPerm.it.~ Applicant.
. Underwriters Approval:
Lot.
Permit No. n Y I Co .z:.
Health Dep!. Approval:
Planning Board Approval:
Request for:
Temporary Celiificate
Final CertifIcate: ____ (check one)
Fee Submitted $ _ --2 5, crtJ
Iii;- tJ e:~f~~
Applicant Signature
k. /J; lfr
C.o-b3J/IO
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.
33416 Z
Date SEPTEMBER 24, 2007
permission is hereby granted to:
ROBERT W RICHMOND
33900 ROUTE 25
CUTCHOGUE,NY 11935
for :
WINDOW REPLACEMENT AS APPLIED FOR
at premises located at
33900 MAIN RD
CUTCHOGUE
County Tax Map No. 473889 Section 097
Block 0002
Lot No. 011
pursuant to application dated SEPTEMBER 10, 2007 and approved by the
Building Inspector to expire on MARCH
24, 2009.
Fee $
200.00
ORIGINAL
Rev. 5/8/02
3 3 +1 t, 2-
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING I STRAPPING P1 FINAL
[ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
REMARKS: F~ ~
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DATE
/O-~6_61
INSPECTOR
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FIELD INSPECTION REPORT DATE I COMMENTS IJJ
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TOWN OF SOUTHOLD IOPERTY
RECORD CARD
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OWNER
STREET:3 39.~; c
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VL. I FARM
TOTAL DATE
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RES. die
LAND
Ii SEAS.
I IMP.
26 (J
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4000 .
0/117:1 /
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AGE
NEW
NORMAL
Farm
Acre
Tillable J
Tillable 2
Tillable. 3
Woodland
Swampland
Brushland-
House Plot
Total
2.(,00
::2
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5/30 5 ?
VILLAGE
DISTRICT SUB.
LOT
BUILDING CONDITION
BELOW
ABOVE
Uf.-
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Value Per Acre
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ACREAGE
023.7
TYPE OF BUILDING
iw
COMM.
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Pe ,,( 407'7
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REMARKS
LAJEDGl
/,2~"h) 0'
c; .. ~~J . (,;1..) ~ 't g 7
Yalue
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Sliders
Window Options
7100
Whne s
Colors Beige 0
Earthbrown 0
Clear S
Low-E 0
Glass Low-EJArgon 0
Obscure 0
Tempered 0
Double Strength 0
Colonial Flat 0
Grids Colonial Profile 0
Diamond 0
Prairie 0
Foam Filled Frame 0
Other Full Screen 0
3-lite 0
5 = Standard 0 = Optional NA;; N9t Available
.
-
7100
Horizontal Slider
For maximum penormance and ultimate
energy efficiency, the 7100 Slider is
designed with:
Frame
. Miter cut fusion-welded corners for
superior structural integrity and prevention
of air and water infiltration.
. 70 mil thick vinyl profile extrusions.
. Beveled exterior frame.
. Optional foam filled frame.
. Optional glass packages.
. Available in standard white and optional
beige or earth brown.
. 3-llte slider availaqle in
1/4,1/2,1/4 or 1/3, 1/3, 1/3
Sash
. Miter cut fusion-welded comers offer the
ultimate in strength and weatherability.
. Sash removes for easy cleaning.
. Integral pull rail provides
fingertip perfonnance.
Meeting Rail
[IJJ
.1/4, 112, 1/4
. Meeting rail interlock mates the sashes
when the window is closed reducing the
threat of air/water infiltration.
. Weathersealed interlock for Improved
thermal performance.
ITIJ
1/3, 1/3, 1/3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HJ\LL .
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www.northfork.net/Southold/
Approved
Disapproved ale
,207
,20
--
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
Board ofRealth
4 sets of Building Plans
Planning Board approval
Survey
Check
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
PERMIT NO. :3'3 Lf I~
Examined
Mail to:
Expiration
,20
Phone:
\
,
\ (j
AJLICATION FOR BUILDING PERMIT
- Date 4f. 7
INSTRUCTIONS
,20~
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 inspection~ .{;/.' L
!< (Signature of applicant or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber ()~ builder
,7i1C/-fmo/"lP
(As on the tax roll or latest
e ~.
DATE: '.... .5'5'://60
FEE' ~--:..~
NOT . B:jF_;~ "d'!;ENT j."
765-18')2 8,,' ,'l "FOR THE
FOLLOWiNG ':3: ,":TIOI,S:
1. FOl''Ji>J,v'' ': :/0 REQUIRED
FOR Pj.':C.=; CONCRETE
2. ROUGH . Fii.~rvLNG & PLUMBING
3. INSULA liON
4. FINAL. CC'STRUCTION MUST
c-- BE COMPIFl'E);Oa,c.Q.
- ).() ~1iTHO,trfO't-l ~~T TIIC
~Iet -"TS OF THE CODES OF NEW
YC 'JOT F c,TONSIBLE f Y!
Block DE:"lul~ i.Jh CG~lr'luC flON ERfiOI1S.
Filed Map No. Lot
,'1.'.-''''
"'....,-
Name of owner of premises
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builders License No. +IJ 7 ~tf - f/
Plumbers License No.
Electricians License No.
Other Trade's License No.
7
I. Location of land on which proposed work will be done:
33900 Rr...:2..5 C~/LflN;:'/.I/
House Number Street
~ County Tax Map No. 1000 Section 71-;' -1/
Subdivision
(Name)
2. State existing use and occupancy of premises and intended u and occupanc of proposed construction:
a. Existing use and occupancy QoNT V-SS
b. Intended use and occupancy
Ke?U\( .C=:-
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
Addition Alteration
Other Work i(ot9LffC-r-- Wr'flfd.or.J9
(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 oflot: Front
Rear
Depth
10. Date of Purchase
Name of Former Owner
II. 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_
/) --;::;))p J 3~'1bll R.7. ;Z..5"-II'I35
-14. Names ofOwnerofpremises~~( ~ddress eA.JTUfl!(j.t./';:,IY.'t Phone No. 63/-1J<j..-tA'OS
Name of Architect Address ' Phone No
_ Name of Contractor Address Phone No.
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.e. PERMITS MAY BE REQUIRED.
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.
17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey.
18. Are there any covenants and restrictions with respect to this property? * YES_NO_
* IF YES, PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY OF 5\11'171,/4-
Ro bur vv. fS.LvhvY\t? ncf being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the
~,
(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.
Sworn to before me this Sef. \ 1_. /
1 day of Umj(.I(Y'2oJ!:L ~ ~
\f)~ y~ MElANlEV.~ JJ 1
Notary Public NMJ ~ =~ IA.. \ Signature of Applicant
QuaIled In Moll CauIty
Colnmllllon &pAs Od. 19..;Lev 00
.
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Extension
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II ;(1<,1,
X 1)...--
Yj{I/J~,f(;
K. 5" ~ ';"S
Foundation Cc,"',/'",:::" Both 1
Basement ? A ~.:r Floors P'I/V ,E
';l.1 ;{ 1.t-;1.I/ Ext. Walls fA)O~ SF/ Interior Finish 1ft/.. Bb.
,--
S"o 333/ Fire Place Hem
/- A' C S1'fl,4.
/~o .50'1/ Porch Attic
-J. 7...~ ~. Porch Rooms 1 st Floor
"
tf.J 0" / Patio Rooms 2nd Floor
3-
Driveway
M. Bldg.
Extension
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