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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-22495 Date AUGUST 4, 1993
THIS CERTIFIES that the building ALTERATION
Location of Property 6325 PECONIC BAY BLVD. LAUREL, NEW YORK
House No. Street Hamlet
County Tax Map No. 1000 Section 126 Block 10 Lot 23.1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated FEBRUARY 12, 1993 pursuant to which
Building Permit No. 21237-Z dated FEBRUARY 23, 1993
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 CONVERT EXISTING ATTACHED GARAGE TO HABIDnRZ SPACE 6
INSTALL ACCESS DOOR TO CELLAR AS APPLIED FOR.
The certificate is issued to BETTY S. CUCCURULID
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-284129 - JULY 27, 1993
PLUMBERS CERTIFICATION DATED JULY 19, 1993 --STEVEN BURNS
uil ing Inspector
Rev. 1/81
FORM NO. L
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)
N °J 9 21237 Z Date . I99.
j Permission is hereby granted to:
. . . ~ L.. . . .
to . G%...
~..Q~..............
at premises located at .~.~'~.`~....f.G.. bl.
.
County Tax Map No. 1000 Section 6FA..... Block ....,1.0t.05?? Lot No...... ~ .~~G
pursuant to application doted .......2r~. Z. 19.9.-x'., and approved by the
Building Inspector.
2/Z 14?
Fee S•
fr . .Bu.... ...1...
g nspec rte,
Rev. 6/30/80
{
Form No. 6
f _
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 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 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 - $5.00 over 5 years - $10.00
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 .
Location of Property...O?v.........+.~~ ~d~....~
House No. eet Hamlet
Cower or Owners of Property...:
County Tax Map No 1000, Section.... ~r a:.~..Block. .IQ.: o `C~......Lot. Q. a~ , , , , , , ,
Subdivision......... /A
Map. ~./.A...y~...L.t..~//A...............
l'Q
Permit NoA J.a .3../. +Z:.Date Of Permit.~JoZ J/. Appli!llcant.15.e,i! / !!l U Cc(-(r(,4
Health Dept. Approval .................`.....Underwriters Approval.........................
Planning Board Approval A7~
Request for: Temporary Certificate........... Final Certicate. X.. /
Fee (Submitted: ~~L(.~=~.[.vecl.C~~S..............
APPLICANT
ca~a~as ~f
o~QSV~FULA-TEL. 765-1802
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
o " P.O. BOX 728
` r Zc TOWN HALL
SOUTHOLD, N.Y. 11971
C E R T I F I C A T I O N
Date 9 -3
Building Permit No./old
~Uc~ UYto GCS
Owner
(please print)
Plumber )7cd Al-
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
(plumber's signature)
Sworlt to before me this
I qW1 day of Q /
19~,
Notary Fj&biic
Notary Public, Su County
Joanne Fagan,
Notary
Public, Suffolk
County, NYOtFAQ991777
Commission Exp. 2 10-9~
THE NEW YORK BOARD OF FIRE UNDERWRITERS FRl>I 1
1000418 BUREAU OF ELECTRICITY
F- 83 JOHN STREET. NEW YORK, NEW YORK 10038
Date JULR{ ,',7'099 Application No. on file ~~~~~'L1Q3193 2EzA1.2~3
THIS CERTIFIES THAT
only the electrical equipment as, described below and introduced by the applicant named on the above application number in the premises of
RETTY CUCCUNULLO, PECONIC hAY BLVD,, POLE 46-5, LAUREL, N.Y.
in thefollowing location; IT Basement [N Ist Fl. ? 2nd Ft. Section Block Lot
was examined on JO L Y 2 1 1 1.9 9 3 and found to be in compliance with the National Electrical Code.
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS ECEPTACLES SWITCHES INCANDESCENT FLUORESCENT OTHER AMT. K W. AMT. K W. AML KW AmT K W AMT. H P.
14 10 15 11 3 1 2. .1 1. 1.4 1 P
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL RECPT TIME CLOCKS BELL UNI7 HEATERS MULTI-OUTLET DIMMERS
AMT. K. W. OIL H. P. GAS H. P. AMT. NO A. W. G. AMT. AMP AML AMPS. TRANS. pMT. H, P. SYSTEMS qMi. WAiiS
NO. OF FEET
SERVICE DISCONNECT NO. OF S E R V I C E
AMT. AMP. TYPE METER 1 ~ ]W I )r 3W 3,e 3W 3,e 4W NO.OF CC COND A W G NO. OF HI-LEG A HI O NO. OF NEUTRALS A. W G.
EQUIP. PER % OF CG COND. OF HIAEG OF NEUTRAL II
OTHER APPARATUS:
SMOKE DETECPORL-1
ALF;RANOER G. ft1Jt3AA[t0 LIC,R:394_g
BOX 22?
AQUEAOiUF L.J.., NY, 17 931 GENERAL MANAGER
1.2
Per
This certificate must not be altered in any manner; 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.
INSPECTORS uxt
Victor Lessard -k'
Principal Building Inspector y O
Curtis Horton Y'> c - SCOTT L. HARRIS, Supervisor
Senior Building In pector C'
Thomas Fisher Southold Town Hall
Building Inspector P.O. Box 1179, 53095 Main Road
Southold, New York 11971
Gary Fish
°.9~
Building Inspector Fax (516) 765-1823
Vincent R. Wieczorek ? Telephone (516) 765-1800
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
JULY 12, 1993
BETTY CUCCURULLO
6325 PECONIC BAY BLVD
LAUREL, NY 11948
To Whom This May Concern:
We are unable to complete your Certificate of occupancy
because of the following reasons:
xxs An application for Certificate of Occupancy is
not on file. (Enclosed)
XXX No Underwriters Certificate on file.
XXX The check is not on file.)$25.00
-No Health Department Approval on file.
No final inspection has been made.
%IX No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 21237-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
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m
:OUNDATION (13t)
C/I
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OUNDATION (2nd) -
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;OUCH FRAME &
-PLUMBING 3
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INSULATION PER N. Y.
STATE ENERGY
CODE \
1,7
FINAL
ADDITIONAL COMMENTS:
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M-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST ( ] ROUGH PLBG.
FOUNDATION 2ND [ I INSULATION
[ ] FRAMING [ ] FINAL
REMARKS: 7WI-!-~041>
DATE b hz~ INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ FINAL
REMARKS:
i
DATE INSPECTOR 7
M-1802
BUILDING. DEPT.
INSPECTION
FOUNDATION 1ST (~6/ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
k-'FRAMING FINAL
REMARKS:
DATE 41&M INSPECTOR .
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Pp7P y r „ BOARD OF HEALTH
FORM NO.1 3 SETS OF PLANS
TOWN OF SOUTHOLD SURVEY . .
FEB 2 2 IM BUILDING DEPARTMENT CIIECRi . . . .
TOWN HALL SEPTIC FORM
SOUTHOLD, N.Y. 11971 q
fr TEL.: 765-1802 1:oTIFY J Gy ~j w~/C~
OO~ CALL . (0,/17
Examined P,~J• . , , , . • 199-3 MAIL TO:
Approved .3 19?. Permit No. °2 /0`..'~..7 ~ _ .
Disapproved a/c
(13Gilding pector)
APPLICATION FOR BUILDING PERMIT
Date . 12, ,February, , , , 19.93
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
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 giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
cation.
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 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 whatever until a Certificate of Occupancy
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 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 in ections.
C / x . .
(Signatur f applicant, or name, if a corporation)
17 Fox Hunt Lane, Cold Spring Harbor, NY 11724
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
owner
Name of owner of premises BettX Cuccurullo
(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. .~,.CO.I.~f!r'Y.
Plumber's License No . .
Electrician's License No . ................J......~
Other Trade's License No . .
1. Location of land on which proposed work will be done . .
6325 Peconic Bay Boulevard Laurel
House Number Street Hamlet
County Tax Map No. 1000 Section 126:00 10. 00 023 .001
Block Lot...................
Subdivision I ......N/A Filed Map No. N/A...... Lot .....N./A....... .
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ...Single Family . Re. .siden.c.e
b. Intended use and occupancy , Single Family Residence
3. Nature of work (check which applicable): New Building Addition Ater c;o xxX......
Repair Removal Demolition Other Work . , . , .
)
4. Estimated Cost A?0,, 000: 00 o p ~ ~ (Dd'gd'tipP t i 0 n
Fee ...7 i~-
(to be aid on filing this application)
5. If dwelling, number of dwelling /UUnits ..9ne. , , , . • , , , , Number of dwelling units on each floor'. N/A
I
If garage, number of cars
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .N/A, , . . .
7. Dimgension15f existing structures
Numb if any: .Front. 60.'.:........ Rear ....6 9 Depth 60'
.
Dimensions of same structure with Number of Stories ,One
u alterations or additions: Front AQ Rear . 60', . • •
Depth . Numb. Height . Number Stories One
8. Dimensions s of of entire re new new construction: Front t * NSA . , , , , , , , , Rear . N/A Depth N/A.. .
Height N er of Stories . , IVA , . • •
9. Size of lot: Front 1..3. • : 99...' 146.93' 250.00'
A r i l Rear Depth
10. Date of Purchase P • 1. .1 * 9192 Name of Former Owner
1. Zone or use district in which premises are situated R .-40
.
12. Does proposed construction violate any zoning law, ordinance or regulation: NO
, , • , , , • , • . '
13. Will lot be regraded . N4 Will exjce~ss fill be ffem~veLd from premises: Yes No
14. Name of Owner of premises . Beatty. cuccurull(Address CC lldox n 1l~bnePhone N0.516- .
692-58
Name of Architect Mark McKee Address 6t5 Kn8wgodnphone No.516-298651 r
M&Vt.'3tat'lf; .NY
Name of Contractor to, be determined . , , , Address Phone No........ .
15. Is this property within 30
0 feet of a tidal wetland? *yes,,,,,... No,XXX.,,,
*If es, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
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.
See enclosed survey.
STATE OF NEW YORK,
S.S
COUNTY OF. ......:..k
Y
(Name individual signing • ' ' • ' • • • • being duly sworn, deposes and says that he is the applicant
contract)
above named.
Owner
le is the
I (Contractor, agent, corporate officer, etc.)
)f said owner or owners, and is d authorized to perform or have performed the said work and to make and file this
application; that all statements contai d in this application are true to the best of his knowledge and belief; and that the
,vork will be performed in the manner set forth in the application filed therewith.
iwotm to before me this
.day o . 19 .1/
Notary Public. . County
a
ALUEN
NotaYy r ?Jiic, S',ai; o`~ f<atu YOfk~
(Signature of applicant)
quwlifi3d in Su~zotk County
commission E)T"' Jul 19,