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Home My WebLink About409-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22123 Date JANUARY 25~ 1993 THIS CERTIFIES that the building. NEW DWELLING Location of Property 425 STILLWATER AVENUE CUTC~OGUE~ N.Y, House No. Street County Tax Map No. 1000 Section 103 Block 1 Hamlet Lot 10 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 11, 1958 pursuant to which 'Building Permit No. Z409 dated AUGUST 11~ 1958 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 ONE FAMILY DWELLING The certificate is issued to KELLY J. KAELIN & DOROTHY W. HORNE (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 /~ ~'uildin-g Inspector TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE DOUTHOLD, N. Y. (THIS PERMIT MUST DE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ...~,~ .~. ~.~...., J%.,',~j~ ............................................. to . .]~J,~.~ ~:~(~; ~1:~:c. J,~.;.~ ............... at premises located at i~../.~ .~f~}~..Z,~,,~.f~.i,(tZ'.. A¥..D. ................. ............................................................. ~.~.o.~:.q?.~ ........ ~%.~, ............................................................ pursuant to application dated ..................... J),EttE?¢t~.JS...~.~ ..... 1 ~o ~ 9~.. , and approved by the Building Inspector Fee ............ ..;~.~..~.t ................................................. ..%. Bui ding inspector ~ FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y, CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located ot....e/..lt..~.~.&~.~f~.~...~.~.e.~.~..e..~....O.~t.g?~Llf~ Map No. *** Block No. *~*' . . **e ................................................ LOt'No ..................................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............................. A..1,~..~....~......., 19.~..~.., pursuant to which Building Permit No ...... ~...~..0.,? ........... dated ............................ ~1~..~..~.~,,~...,~....~....., 19....~.~, was issued, and conforms to ali of the requirements of the applicable provisions of the law. The occupancy forwhich this certificate is issued is .............. PRIVATE Ot~E FAMIL~ DWELLING This certificate is issued to .~..e..°..?..~.?..,~.a...~L..O...~....o..~.. ....................................................................... (owner, lessee or tenant) of the aforesaid building. ............ ~' Building Inspector HOWARD M. TERR~ Form No. 6 TOWM OF ~OUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 JAN22 O APPLICATION FOR CERTIFICATE OF OCCUPANCY 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 residen£es end'similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. Submit Planning Board Approval of completed site plan requirements. '6. 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, Swinging 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 ~ew Construction .......... Old Or Pre-existin Bu ' ~ocacion of Pro ert ~ House No. Street ;ounty Tax Map No I000, Segtion...[~ ...... Block ...... I ....... Lot...7 ~ ........... ;ubdivision .............. Filed Map Lot ......... Date Of Pe~it ................ Applicant .... ealth Dept. Approval ...... ~.~ ................ Underwriters Approval ...... lanning Board Approval .... ~J~ ............... equest for: Temporary Certificate .......... f Final Certicate ....... ee Submitted: $ ~.6~ INSPECTORS (516) 765-1802 VICTOR LESSARD, Principal CURTIS HORTON, Senior VINCENT R. WIECZOREK, Ordinance ROBERT FISHER, Assistant Fire Building Inspectors THOMAS FISHER GARY FISH OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD January 20, 1993 SCOTT L. HARRIS, Supervisor Southold Town Hall P.O. Box 1179, 53095 Main Road Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 Ms. Kelly Kaelin 425 stillwater Ave. Cutchogue, N.Y. 11935 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, The check is not on file.)$25.00 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 # Z 409 Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........ .~..~...A~..../..(. ........... 19..~....~.' - Approved ........................................ 19 ........ Permit No ....... Disapproved a/c ..... (Building Inspector) Application No. ~/ O ~.. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. 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 location. c. The work cov, ered 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 permit shall be kept on the premises available for inspection throughout the progress of the workl e. No building shall be occupied or used in whole or in part for any purpose whatever until .o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanoe 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. ........ ......... .................................. (Signature of applicant, or name, if a corporation) ....... ~ .................... ; ...~.. ;3.....~,,.~.. 4~,- ....................................... (Address of applicant) State wheth,er applicant is ow,,De~ lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................... ........................................................................................................ Name of owner of ' pFemlses ....... ~ ............................ ~.~ ........................................................................................................ If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work wiIJ be done. Map No: ............ : ............................... Lot No: .................... Street and Numberu~,~ ~ \',~",~,~t~,,d~..mc.. Municipality 2. State existing use and occupancy of pr. emend, intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................................................................................................... b. Intended use and occupancy .................. ~.z..~.:'.'.r~."u..~....~:'..~....:~. .................................................................. 3. Nature of work (check which applicable): New Building .................... Addi ion .................... Alteration Repair ............ ~....Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost.......~,..~..~.~........~... ....................... Fee .L~.. ................................................................................. (to be paid on filing 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 .....~..,4) .............. Height ............................ Number of Stories ..... ~..~ ..... 9. Size of lot: Front ....../..~......:,.. ...... .Rear ........... ~.. ............. Depth ...... ~J ........ , ~.-~ ,~ _ ]0. Date of Purchase ........ ~.,.~.. ...... ~...~4~.. ............... Name of Former Owner ..... ~...~..~........~.:'..~..~..~. ............. ] ]. Zone or use district in which premises are situated ............ A.;. ....................................... ..~. .................................... 12. Does proposed construction via.late?/,., 7'2_any zoning law, ordinance~ . . ]%~.,,°r reglcJ,atio~n? ...~....j.~.....Q 13. Name of Owner of premises..~...l.w~....?.,.....,..-"'"'~.,;.Address .....~~.~:.";. ............ Phone NO ..................... Name of Architect.,....x~......~.~.;u'~, ~/ ........ ~ ........................ Address ........................................... ,,, u ~ ¢ Phone NO ..................... of Contracto~.~..'.~,.~ Address .~...., r~*~..~....Sr'~y~''~]/ Phone NO Name 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 numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEV~yQ~,~, /] // ) S S COUNTY OF .~,,py~p~,.C~f.£....) ' ............................. ~...~ ....... ~.~ .................. ~ duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ..................................... ~~ ......................................................................................... (Contractor, agent, corporate 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 man~er sC, forth in the application filed therewith. Sworn to before me thins ......... ¢..~. day of ........ Notaw Public, ..~¢~.&~.~¢~¢.....r,.....:.~..~ou~ %~/~ ~ .,~ ,t / , -~ ,,~7 , ~ ; TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .......... ~'-¢..../. ......... 19..; ..... Approved ................... !i.~I.. ............... 19! ....... Permit No...~.....~./...!~..~. ..... Application No.../.Z../.i...~...Z ............ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted Jn duplicate to the Building Inspector. 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 port of this location. 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 permit shall be kept on the premises available for inspection throughout the progress of 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with ell applicable laws, ordinances and regulations. (Signature of applicant, or name, if o corporation) (Address of applicant) State whether applicant is ow~~~h~i~it, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... ~.....~.~.. .................... J/~.. ....................................................................................................... If applicant is a corporate, signeture of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work wilJ. be done. Map No: ........................... "~-*~-~..'. .............. Lot No: .................... Street and Number ..... /...: ....... ~.~...=.=.:~. ............................................................................................................ Municipality 2. State existing use and occupancy of p~emises~.~nd intended use end occupancy of proposed construction: a. Existing use and occupancy ..................................................................................................................................... b. Intonded use ond occuponcy ........ : ......... P~:..~. .................................................................. 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repmr ............ ~.....Removal .................... Demohhon .................... Other Work (Describe) .................... 4. [stimated Cost ................................... Foo .[ .................................................................................... (to be paid on filing 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. Dimensians of entire new construction: Front .......... ~ ............ Rear ...... ~..~....~ ............. Depth ..... ~ ............... Height ............................ Number of Stories ....~ ...... 9. Size of lot: Front ..... /...~....O. .......... Rear ...... ../..~.--~....Q. ......... Depth ..... 10. Date of Purchase ........ ~Z~....~/f...~........~...~. ................ Name of Former Owner ....}~..~..C,.:%..L-....~Z~....~.: ........... KD 11. Zone or use distr,ct which premises are s tuated ............ ...... Name of Conilrac;:~: ~g:~ ........... Address "~'~:~L-~'~ ........ Phone NO ..................... 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 numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NFA'q~)Y~.,K,~//' ) S S COUNTY OF ~"~'Y'4~.~:-t ...... ) ' .................. ff..~......~ ...................¢ be ng duly sworn, deposes .and says that he is the applicant (Name of individual signing application) above named. 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 m.an~ se}o~rth in the application.filed therewith. Sworn to before me th~s