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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-24442 Date JUNE 19, 1996
THIS CERTIFIES that the building ACCESSORY
Location of Property 5025 MAIN ROAD GREENPORT, NEW YORK
House No. Street Hamlet
County Tax Map No. 1000 Section 35 Block 2 Lot 11
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 14, 1996 pursuant to which
Building Permit No. 23310-Z dated MARCH 18, 1996
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 ACCESSORY PIIMPHOUSE "AS BUILT" IN REAR YARD OF ISLAND END
GOLF COURSE AS APPLIED FOR.
The certificate is issued to FLOYD KING, JR.
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-382715 - APRIL 10, 1996
PLUMBERS CERTIFICATION DATED N/A
Building Inspec r
Rev. 1/81
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)
I 19.1. .
Date...................." (......................
NR 23310 Z
Permission Is hereby grant Aid to;
. ,... ..... .........................
A .
to ... ....... ......... i .... .. . .. -f�,�t.. ....�. - -
.. ............ � ...' .... ......... � `'�' ..............
......,,�. .... .. ...=���. ........ � 6.. .. t� ..... �' ......
...........�5....... /�' .-.r >k?
-....................................................................................
.................................................................................................................................................................
at premises located at.......... ..T.......................................
..................... ......./ -.`/ ...................... ............
County Tax Map No. 1000 Section ........d.. �...... Block.....�............... Lot No. ...//.....................
/..... 19 and approved b the
pursuant to application dated ..............c1./'`..��.�..��. �.„�.••., ..••�„tv•, pp by
the
Inspector.
Fee
. . ....... ..............
Building Inspe or
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OR ink and submitted to the building
inspector with ,the following: 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 17 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 a 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 - .25z,, - -
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. . . . . . . . . . �j
Location of Property. . .,S7� . G:* . .11 .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
House No. Street Hamlet
Onwer or Owners of Property. . . . 'Lo�(,a. I�!?✓. :. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
County Tax Map No 1000, Section. . . .:?,. . . . . . .Block. . . .�. . . . . . . . .Lot. f . . . . . . . . . . . . . . . . .
Subdivision. . . . . . . . . . . . . . . . . . . . . . . . ..... . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . .
Permit No. .`:t /C? Z. . .Date Of Permit. . . . . . . . . . . . . . . .Applicant. . .":L:
Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . .'. .
Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . .
Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . .... . . . . .
Oro
Fee Submitted: . $. . . . . . . . .:�� . . . . . . . . . . .
!�
APPLICANT
eo �aT4q
S%3FF01.t
o� Gym
CA
Town Hall, 53095 Main Road_ S • Fax (516)765-1823
New York 11971 9 ��Ol � �aO� Telephone (516)765-1802
Southold
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
April 30, 1996
Mr. Robert Brown - Architect
P.O. Box 521
Greenport, NY 11944
Re: Floyd King - Island End Golf & Country Club
Prem: 5025 Main Road, Greenport - SCTM#1000-35-2-11
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons :
xx An application for Certificate of Occupancy . is
not on file. (Enclosed)
No Underwriters Certificate on file.
xx The check is not on file. $50.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984) .
BUILDING PERMIT # 23310-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE i
1195099 BUREAU OF ELECTRICITY
F 85 JOHN STREET, NEW YORK, NEW YORK 10038
Date APRIL 10►1996 Application No.on file 88.597395/95 N 382715
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicanunamed on the above application number in the premises of
ISIMND END GOLF COURSE, ROUTE 48, GREENPORT, N.Y.
in the following location; ❑ Basement Ist Fl. ❑ 2nd Fl. 1lL{T Section Block Lot
was examined on 14MC IJ 07,199G and found to be ih compliance with the.National Electrical Code.
FIXTURE Cl FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
RECEPTACLES SWITCHES
OUTLETS INCANDESCENT1 FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P.
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. .AMT. H P SYSTEMS AMT. WATTS
NO.OF FEET
SERVICE DISCONNECT NO.OF 5 E R V I C E
AMT. AMP. TYPE METER L.0 2W I,B'3W 3,N 3W 3 0 4W NO.OF CC.COND. A.W.G. NO.OF HI-LEG A•W G. NO.OF NEUTRALS A.W.G.
EQUIP. PER b- OF CC.COND. OF HI-LEG OF NEUTRAL
1' 4Qi[? aTr$ 1 X 2 :3/0 2 3/0
OTHER APPARATUS:
STEP DOW TRPNSFORkMR-1
100A DISCONNECT 50 R�+.MP-1 ,
480 V PM4P 50 H.P.-1 ..
MOTORST1-50 H.P.
TRANSFOR14ER:1—30 §^trA -
G.F.C.I;--1
JIM SAr.;E ELEC. INC. LIC.4i 3Fi35— 'i GENERAL MANAGER
350 MARINE PLACE
Per
"This certificate nLustLrfA1jbela,Itere4Siny any yrrpnner; return to the office of the Board if incorrect. Inspectors may be identified by!'their credentials.
COPY FOR BUILDING DEPARTMENT.THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
765.1802
BUILDING DEFT.
INSPECTION
[ ] FOUNDATION iST [ ] ROUGH P
[ ] FOUNDATION 2ND [ ] 1 TION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & HIMNEY�
REMARKS:
0
DATE INSPECTOR
ul.ml lu'volvi, DATE
r5
FOWIDAT I 011 (RID)
ltoI)(;Il FRAHF &
I'Llffill I NC
----------
In
INSULATTOff 111,1t N. Y .
STATE" EUI-j(Gy
Cl
----------
-----------
F I*IIA 1.
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---------------
BOARD OF HEALTH .
• • • • •
3 SETS OF PLANS . . •
FORM N0. 1 SURVEY
TOWN OFSOUTHOLD CHECK . . . . . . . . . . . .
BUILDING DEPARTMENT SEPTIC FORM . . . . . . . . . . • . .
TOWN HALL
SOUTHOLD, N.Y. 11971 NOTIFY
TEL.: 765-1802 CALL
Examined. 'c. If"l19 MAIL TO : .
. . . . .
Approved Aaz .` 19 e Permit No �
Disapproved a/c . . . . . , , , y q
41996
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . a ` .
OI_DG.DEPT
. . . -�Ow ��sOuHa�_D
(Building Inspector)
APP 1 ATION FOR BUILDING PERMIT
Date . /�3 . . . . . . . . . . .. 19'7k
INSTRUCTIONS '
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with
sets of plans,accurate plot plan to scale. Fee according to schedule.
Plot'plan;sho}ving,location of lot and of buildings on premises, relationship to adjoining premises or public stree
or areas, and giving cation. a detailed description of layout of property must be drawn on the diagram which is part of this appi
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 issued a Building Permit to the applicant. Such perm:
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 whatever until a Certificate of Occupanc
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to th
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c
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 v
admit authorized inspectors on premises and in building for necessary ins
p
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, age t, architect, ngineer, general contractor, electrician, plumber or builder
A: I-A. . . . . . .. . . . . . .
. . . . . . . . . . . . . :. . . . . . . . . . . . . . . . . . . . . : . . . . . . .
Name of owner of premises . . . . .�? �5.MP. -`04o "W' .G'BUIN".4WA*. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
. . . . • • . . .(Name and title of corporate officer)
Builder's License No.
Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . .
Electrician's License No. . . . . . . . . . . . . . . . . . . . . . .
Other Trade's License No. . . . . . . . . . . . . . . . . . . . . .
1. Location of land on which proposed work will be done. . . .f „75, �! �bJ/I ,�/��T �/y
. . . . .
House Number . . . . . . . . . . . . . . . . . .Strcet� . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..
Hamlet
County Tax Map No. 1000 Section . . . . .?�", . . . . . . . . . . k ?.
Bloc . . , . . . . . . Lot . . ,�7/ . . . . . . . . . . . .
Subdivision . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. Lot
(Name) �. . . . . . . . . . . . . . . .
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy . . . . . . . . //Z/wa?m .�UM,/?�DU �. . :'.'. : . . : . . :. . : . . . . . . . . . . . . . . . .
b. Intended use and occupancy . . . . . . . . .= '. . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Nature of work(check which applicable): New Building ... . . . . Addition . . . . . . . . . Altera ion
Repair . . . . . . . . . . ... . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work 0.50�'`�,
(ption)
4. Estimated Cost . . . �200.OD. . . . . . . . . . . . . . . . . . . . . :. . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(to be paid on filing this application)
S. 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 . 15� Rear . ... / �. . . . . �'� 4
Height . . ..1/.�4:�. . . . . . . Number of Stories . . . . ./. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Depth . .�. . . . . . . . . .
Dimensions of same structure with alterations or additions: Front . . Rear .
Depth . . . . . . . � . . . . . . Height . . . . . . . . . . . . . . . . . . ... . . Number of Stories . . . . . . _ . . . . . . . . . .
S. 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 FormerOwner• . . . . . . . . . . .
I.I. Zone or use district in which premises are situated . . ' ' '
12. Does proposed construction violate any zoning law, ordinance.or.regulation: . . .NA . . . . . . . _ '
13. Will lot be regraded . . . . . J.tI,O, , . Will excess fill be removed from premises: . . . . Yes • . • . 'o
14. Name of Owner bf premises . �S Q,Olf4bl?* Address �,7r,�'. �`�. .r�,$ T, , ,Phone No. .� g�9Q
Name of Architect . . /�2�� �/�{ZD�j�,t�/ , , , , , , Address IV RP. �J, ,tj��,�
�. 1 ?. Phone No. .9�
Name of Contractor . . . .. . . . . . . . . . . . . ... . . . . . . . . Address . . .
. Phone No. . . . .
15 .Is this property located within 300 `feet of. a tidal wetland? *YES ?�.NO.
*If yes , Southold Town Trustees Permit may be required. (OrgUCTC)gg te, r''f.Q -rjd*v3
PLOT DIAGRAM POO Fr VV4M BOND
Locate clearly and distinctly all buildings, whether existing or proposed, and,indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF \ R �,� J
COUNTY I Y d( S.S
. . . . . . . . . . . . . r -. . . . . . . ��? � . . . . . . . . . . .
u T . . being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
fie is the . . . . . -
(Contrad.or, age; f c rporate officer, etc.) • . '
of said owner or owners, and is duly authorized to per orm 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 nett is
day of. . ..... . .., 19 (�.
I"
Notary Public, . .
.. . . . . . . . . . County
CLAIRE L.GL
Notary Public,State of Now York .
No.457g5d5 . . . . . . . . . . . . . . . . . . . . . . . . . .
Qualified in Suffollt County �D
Commission Expires December 9,19...,,( (Signature of applicant)
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L CONSTRUCTION W/ail e0 C�x�Z'1
.,. BE COIYPLETE FOR C.O. MUST Y i i j i , i 1 'l
A CONSTRUCTION SHALL MEET ;
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REQUIREMENTS OF THE N.Y.
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CO ES. NOT RESPONSIBLE FOR ,
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