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Town of Southold Annex 1/24/2014
P.O. Box 1179
54375 Main Road
Southold, New York 11971
CERTIFICATE OF OCCUPANCY
No: 36732 Date: 1/24/2014
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 90 Oak Ave, Southold,
SCTM 473889 Sec/Block/Lot: 77.-2-6
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
1/14/2014 pursuant to which Building Permit No. 38622 dated 1/14/2014
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:
electrical survey and as built hot water heater as applied for
The certificate is issued to Markowitz, Carolyn
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 38622 1/10/14
PLUMBERS CERTIFICATION DATED
Auth Signatur
y~e TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit 38622 Date: 1/14/2014
Permission is hereby granted to:
Markowitz, Carolyn
734 Stewart Ave
Bethpage, NY 11714
To: electrical survey and as built hot water heater as applied for.
At premises located at:
90 Oak Ave, Southold
SCTM # 473889
Sec/Block/Lot # 77: 2-6
Pursuant to application dated 1/14/2014 and approved by the Building Inspector.
To expire on 7/16/2015.
Fees:
ELECTRIC $125.00
AS BUILT - SINGLE FAMILY ADDITION/ALTERATION $200.00
CO - ADDIT O DWELLING $50.00
al: $375.00
Building Inspector
Form No. 6
TOWN OFSOUTHOLD I , ~J~ 15
BUILDING DEPARTMENT V~ v VVV
TOWN HALL
765-1802 1 v J10
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
I. Certificate of Occupancy - New dwelling $50.00, Additions to dwelling $50.00, Alterations to dwelling $50.00,
Swimming pool $50.00, Accessory building $50.00, Additions to accessory building $50.00, 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.
New Construction: Old or Pre-existing Building: (check one)
Location of Property:
HoaseeNo. ` Streetr Hamlet
Owner or Owners of Property: ~i~G C~a~ - 7t=r--v coo-tTr75~.5 LI-c
Suffolk County Tax Map No 1000, Section Block Lot
Subdivision Filed Map. Lot:
Permit No. _1*r~4 Date of Permit. Applicant:
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $
+Air i
pF SOUjyolo
Town Hall Annex yy yy Telephone (631) 765-1802
54375 Main Road T T Fax (631) 765-9502
P Box 117 ~
Southold, , NY 11971 1-0959 roger. riche rt(cDtown.southoId.nv.us
11M,~
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Tim Hill
Address: 90 Oak Ave City: Southold St: NY Zip: 11971
Building Permit#: 38622 Section: 77 Block: 2 Lot: 6
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: as built DBA: License No:
SITE DETAILS
Office Use Only
Residential X Indoor X Basement X Service Only
Commerical Outdoor X 1st Floor X Pool
New Renovation 2nd Floor Hot Tub
Addition Survey X Attic Garage
INVENTORY
Service 1 ph 100a Heat Duplec Recpt 9 Ceiling Fixtures 6 HID Fixtures
Service 3 ph Hot Water 1 GFCI Recpt Wall Fixtures 1 Smoke Detectors
Main Panel 100a A/C Condenser Single Recpt Recessed Fixtures CO Detectors
Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps
Transformer Appliances Dryer Recpt Emergency Fixture Time Clocks
Disconnect 100a Switches 4 Twist Lock Exit Fixtures TVSS
Other Equipment: ELECTRICAL SURVEY--no visual defects, 1-exhaust fan, 1-well pump,
1- hot water heater
Notes:
Inspector Signature: Date: Jan 10 2014
81-Cert Electrical Compliance Form.xls
DATA COMN[NT3.
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TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following, before applying?
TOWN HALL Board of Health
SOUTHOLD, NY 11971 4 sets of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 Survey
SoutholdTown.NorthFork.net PERMIT NO. Check
Septic Form
N.Y.S.D.E.C.
Trustees
Flood Permit
Examined ,20 Storm-Water Assessment Form
Contact:
Approved , 20 Mail to:
Disapproved a/c
Phone:
Expiration , 20
Building Inspector
APPLICATION FOR BUILDING PERMIT
Date 20
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 of lot 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 Southold, 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.
~SC
nature of applicant or name, if a corporation)
:19
41: C(Mailin addr s fapplicant)
c~ CPIs,., rY l0(3C3
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
OLeo L)L
Name of owner of premises t/ wC'7L P r~~Cs C
(As on the tax roll or latest deed)
If applic is a c r ration, signature of duly authorized officer
0,1 LAku -
ame and t oI'corodrate officer)
Builders License No:
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be done:
90 t4sz AkA
House Number Street Hamlet
County Tax Map No. 1000 Section Block Lot
Subdivision Filed Map No. Lot
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ~t IS~iy~h /k(=
b. Intended use and occupancy w F{ y ~s~
3. Nature of work (check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work L(~i LLa2"YZ IAA (
(Description)
4. Estimated Cost Fee
(To be paid on tiling this application)
5. If dwelling, number of dwelling units 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.
7. Dimensions of existing structures, if any: Front Rear Depth
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 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_ NOWill excess fill be removed from premises? YES_ NO
14. Names of Owner of premises Address Phone No.
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.C. 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 )
being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named, COW41E D. BUNCH
Notary Public, State of New Yolk
(S)He is the No. 01BUS186M
(Contractor, Agent, Corporate Officer, etc.) Commieetoe Etgtree Aprfi 14, 2_
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
SS'k-f~\ day of 20L~
.1`4
Notary Public Signature o Applicant
1-8 168
GOOSE CREEK COTTAGES LLC 22_10 1007
23 OXFORD RD.
WHITE PLAINS, NY 10606.3607 Date /U -
Town Hal: Pay tot a cQQ~ 07 1-
` $'f
54375 Mai
P.O. Bo (7-l,~_ Dollars:
Southold, "1 C1 ibank'
WIEMIK NA En hw
NIMMIMONECKLYENUE
, NT1RE PlNNBT. NY~tOWS
Memo
+1:021000CJ"89~ 2? 1007 -
f A°
REQUESTED BY:
Date:
Company Name:
Name:
License No.:
Address: a) _
r ( S
Phone No.: 01 K (
r Es
JOBSITE INFORMATION: (*Indicates required information)
*Address:
*Cross Street: cis lv( r
*Phone No.: ~j (c(
Permit No.:
Tax Map District: 1000 Section. Block.
Lot.
*BRIEF DESCRIPTION OF WORK (Please Print Clearly) a e cam,'
SckrUe,c,
(Please Circle All That Apply)
*Is job ready for inspection: YES / NO
Rough In Final
*Do you need a Temp Certificate: YES / NO
Temp Information (If needed)
*Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other
*New Service: Re-connect Underground Number of Meters Change of Service Overhead
Additional Information: PAYMENT DUE WITH APPLICATION
4 I a~s -
82-Request for Inspection Form *,G S