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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-32711
Date: 11/02/07
THIS CERTIFIES that the building SWIMMING POOL FENCE
Location of Property: 490 MANOR
(HOUSE NO.)
county Tax Map No. 473889 Section 108
HILL LA
(STREET)
Block: 3
CUTCHOGUE
(HAMLET)
13 .12
Lot
subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
MARCH 23, 2007 pursuant to which
Building Permit No. 32831-Z
dated
MARCH 23, 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 INSTALLATION OF A NEW 4' FENCE TO CODE FOR AN EXISTING ACCESSORY
INGROUND SWIMMING POOL AS APPLIED FOR.
The certificate is issued to THOMAS THOMPSON
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
N/A
PLUMBERS CERTIFICATION DATED
N/A
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Rev. 1/81
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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 iqIC 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 2/1 0 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 aud "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 tl1erefor in writing to the applicant.
C. Fees
I. 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 Celiificate of Occupancy - Residential $15.00, Conunercial $15.00
New Construction:
Da~
Old or Pre-existing BUildint V (Ch:t{ne)~ -. I
Location of Property G\~O \\.ll..\l\\\\2,-\t\\\ .lPt<l\~ \\ \ UL--\"Z
. House No. 11 \ Street ~
Owner or Owners of Property: \) WJ \...".1...... ()\J\A.~S I '{'-
Suffolk County Tax Map No 1000', Section 10 sr Block-3
Hamlet
Lot
13. }:L
Subdivision
Permit No. J lr J-rI--
Filed Map.
Applicant:
Lot:
Date of Pen nit.
Health Dept. Approval:
Planning Board Approval:
Underwriters Approval:
Request for:
Temporary Celiificate
Final Certificate:
( check one)
Fee Submitted $
e...~.l:7)S'
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31-1; 3/ :z-
TOWN OF SOUTH OLD BUILDING DEPT.
765.1802
INSPECTION
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[ ] FOUNDATION 1 ST
[ ] FOUNDATION 2ND
[ ] FRAMING I STRAPPING
[ ] FIREPLACE & CHIMNEY
[ ] FIRE RESISTANT CONSTRUCTION
t~
REMARKS:
[ ] ROUGH PLBG.
[ ] INSULATION
[X FINAL
[ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT PENETRATION
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S-'-I-() 7
DATE
INSPECTOR ~ ~
?;).<?3 l reA.
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY ~
REMARKS:
(L-
.
DATE
INSPECTOR
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.
32831 Z
Date MARCH
23, 2007
permission is hereby granted to:
THOMAS THOMPSON
490 MANORHILL LANE
MATTITUCK,NY 11952
for :
INSTALLATION OF A 4 FT FENCE TO CODE FOR AN EXISTING ACCESSORY
INGROUND SWIMMING POOL AS APPLIED FOR. THIS PERMIT REPLACES 25843.
at premises located at
490 MANOR HILL LA
CUTCHOGUE
County Tax Map No. 473889 Section 108
Block 0003
Lot No. 013.012
pursuant to application dated MARCH
23, 2007 and approved by the
Building Inspector to expire on SEPTEMBER 23, 2008.
Fee $
35.00
~C,~
Authorized Signature
ORIGINAL
Rev. 5/8/02
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IIlSULATION PER N" Y"
STATE ENERGY
CODE
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,FORM NO. I
TOllll OF SOUTHOLD
BUILDING DEPARTMENT
TOllIl HALL
SOUTHOLD, N.V. 11971
TEL: 765-1802
BOARD OF HEALTH ...............
3 SETS OF PLANS ...............
SURVEV........................
SHECK........................ .
SEPTIC FORM ...................
PeDDit lb.
--3>:). ~ I -2.
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N~::VS/b.27~.~?~ .~
Exanined... J.l?-:-......., 19.~
Approved.. .11.?:-:........, 19. ~~
MAIL TO:...................
Disapproved alc ..................................
-
(lbilding
APPLICATION FOR BUILDING PERMIT
Date .M.!J.'/.. .Q.I....., 19.QQ.
INSTRUCTIONS
a. This application DUSt be ~letely filled in by typewriter or in ink and subnitted to the Ibilding Inspector,
3 sets of pI.."" accurate plot plan to scale. Fee according to scheO.Jle.
b. Plot plan obowing location of lot and of bIildings on pranises, relationship to adjoining prenises or J1Iblic
streets or areas, and giving a detailed description of layout of property DUSt be dram on the diagran .tlich is part of
this application.
c. The..orl< covered by this application may not be uo.w:olCed before issuance of Ibilding PeDDit.
d. Upon approval of this application, the Ibilding Inspector will issue a Ibilding PeDDit to the applicant. Such
peDDit shall be kept on the prenises available for inspection throughout the ..orl<.
e. lb Wilding shall be occupied or used in .mole or in part for any JlII1lO&e .natever until a Certificate of
rr...'P"""'Y shall have been granted by the Ibi Iding Inspector.
APPLICATIllI IS IEBEBY MAlE to the Ibilding Del"'L u..,..t for the issuance of a Ibilding PeDDi t pursuant to the
lbilding Zone Ordinance of the Town of Soutbold, lbffolk County, New Yorl<, and other applicable laws, Ordinances or
Regulations, for the construction of bIildings, additions or alterations, or for reDD\1al or damlition, as herein
described. The applicant agrees to ~ly with all applicable 1....., m:dinances, bIilding code, housing code, and
regulations, and to a<bit atthorized inspectors on pranises and in bIilding for necessary inspections.
OCCUPANCY OR
USE IS UNLAWFUL
WITHOUT CERTIFICATP
F~:\-o ~ "- 5 e..~..... ....... .......... ...... .... ....... ...... .......
O;;A ~~' (Signature of applicant, or nall>, if a corporation)
.. H.9.~ .!Y)!!f.!. ~/!-.lJl~?:. J:(t~{;..............
(Mailing address of applicant)
Oi~t is eMler. lessee, agent, archi~t, engineer,. general contractor, electrician, pltober or build::.
..? .W.N.s &......................................................................................................
Bane of owner of pranises ..fp..~J.i!.a.l}Jf.i!-:f:.!YY.p...NMfje^.)./Jl.c.t;..E?ty.;:<!I9.. .........~.. ........ ... ....
(as on the tax roll or latest deed) /........ ~.ct <'-1J3 -
If applicant is a corporation, signature of wly atthorized officer. ..~U 157 -c
....<<1................................................. III: ~~~ .' '
(Bane and title of corporate officer) al w J fI" I I '"
..._.._ ....1HE
... . II
t ru ...... NO rnr....
~ iiUh '..."-l.fJG
.. PINAL . ~ MUIT
Other Trade's License lb. .#.!!.............. .~PORc.o.
AU. CONI'nlUCJ'ION ~Ll MEET
J. , IDeation of land on .tlich proposed ..orl< will be done. ...................... .'RolE- -REQl.IlR6f!I6NTS .O'Lnta ....V....
.... .!fHp......... M/J/:!o.f?:. Hi .Id-:.. .~AN~........................ .~.fT.=ltP.C~8~~;g~...
1Iouse !bdler Street ~eOJllliTRUcnoN ERRORS
County Tax Hap lb. IlXXl Section .. ./.~. ~...... Block .... .1.'. ~q..... IDt t7.0.~ ~.t! 1... /!13, '0/,1
n...... . . A...,$ '1 N"" 1'19-
""""IVISlon ......,"',............................. FI ed Hap lb. ......CT....... IDt ....'.'f.........
(Bane)
Plumbers License No. .........................
Electricians License lb. /Y. ~ . . .. .. . . .. . . . . .. .
Builders License No. ...~~.................
1V4
2. State existing use and "'"'"'1J"""'Y of pranises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .. fI(!1JIi............................ X;;;:':'':i...~,.';;......;;.................
5"4//1 e,". ',,' '. .
b. Intended use and "'"'"''I'''''CY . ....................................: .-..... ~.:....:.........................
J.
1.....u..lU~ U1. W\)ll!.. \UIe(;K WllllJl aWlJcalHej: New llJilding .......... Addition ........... Alteration ..........
Repair ............ Rewval ... ~....... ilenDlition ............ Other WOrk>:<................................
(Description)
4.
EstioaJ:ed Cost :."1.........~.tf(Jt1.....
5.
fee ...:..........................................
(to be paid on filing this application)
If Welling, rumer of Welling unit~ .....f!~... !bIDer af Welling units on -;'ach floor ...:NI1:.......
If sarage, rumer of cars ...~t1...............................
If business, C<JDnercial or mi>CE!d occupancy, specify ~ture and extent of each type of use....~.~.............
;f"~ ~ I a'l?: U:11") ~/A'.)
D. . f' t' \d'f.e 'f . Fron 6 Re . ,.. De tl 'r-r.~' v.(a/ [N./
lI..,nSlons 0 <!XIS Ing _"S,l any. t....,....... ar... ..~..... p I ......__,..~.....
l!eight ..H.~................... !bIDer of Stories ..........t'!./J.....j.. . f3p 135"'
Dimensi""" of "'"'7~tructuI}! wi th alterations or addi tions: Front. . . :..... .. . . . . ... Rear ...c . . .. ..'
Depth 1I:'i01?:;'. .VK:(1;JjJ.!l1eight .... -'f~............. !bIDer of Stories . N.~.........
6.
7.
8.
15.
Dimensions of entire new coostruction: Front ................ Rear ............... Depth ...............
Ileight ......................... !bIDer of Stories ..................... _
/
Size of lot: Front...... $.~f.~........ Rear ....... }.~~...... Deptll ...'1. 'f. '!.:. .'f:L...
Date of Purchase J:IINe, .19.'l.'t...... N<me of Former Omer .!}fl8/}ftI!.!'J...1:: ./i~-/."!N.~.~M.I!I....
Zone d'" -L'ch" A~ IRES
or use lstrlct In ....1 prelDlBeS are ssbJate<l .... O-"............i;J.....................................................................................................
Does proposed coostruction violate any zoning law, ordinance or regulation: ... .kPo................
Will lot be regraded ......k.!!........... Will excess fill be ramved frcm pranises: YES @
N<mes of <M1er of pranise~ .Jft:~~fft1:,~'k~;.;~.. Address .f{ff../!?tJ.<<':'f:.!f(':f-:.~(t.. H10ne lb. .~IJ/!D.'<J..
N<me of Architect ...A.(.............................. Adc\ress .............................. H10ne lb. ..............
/l/It
N<me of Contractor ................................... Address............................. ..H1one lb. ..............
Is this property within 300 feet of a tidal wetland? * 'YP..s .......... I[).~.......
*IF YES, 9:l1i1IID TlIti 'lllIJSl1lI!S H!ltfIT HAY HE ~.
9.
10.
II.
12.
13.
14.
PLOT DIAGRAM
Ineate clearly and distinctly all buildings, .....ther existing or proposed, and indicate all set-back dimensions
fran property lines. Give street sod block rumer or description sccording to deed, and show street oanes and indicate
.....ther interior or corner lot.
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&'oc.l( '3 1.-\1\Ie- lS. 0 I 0 I)..st'.oo Se.6t. '''6 8'-'. Lots's._.... .4
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li.....~llti.;t;"..U ~"'M__~ in this application are true to the best of his knowledge and belief; and
t 'tlilt'wtk "11l.)d"~:lnJlllflranner set forth in the application filed therewith.
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UNDAJ. COOPER
Notary Public, StMe of New'tbrt
No. 4822683, Sufrolk ~
Term Explr811lleGember31. ~
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13.fOTOWN OF SOUTHOLD PROPERTY__CORD CARD
STREET '1 VILLAGE DIST. SUB.
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TYPE OF BUILDING
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CB. MICS.
Mkt. Value
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REMARKS
AND IMP. TOTAL DATE
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FRONTAGE ON ROAD
DEPTH
BULKHEAD
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Ext. Walls ~f III Interior Finish -;? LR.
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/ 'S' ..5'5'0 I Type Roof JI,} Rooms 1 st Floor BR.
, 10 I r;, Recreation Room Rooms 2nd Floor FIN. B
5'fo I ;)00 / Dormer Driveway
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