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Home My WebLink About3690-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. UPDATED CERTIFICATE OF OCCUPANCY No Z-19195 Date JULY 9, 1990 THIS CERTIFIES that the building Location of Property 385 LOCUST LANE House No. County Tax Map No. 1000 Section 62 Subdivision ONE FAMILY DWELLING SOUTHOLD, N.Y. Street Block 3 Lot Filed Map No. Lot No. Hamlet 34 conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 27, 1967 pursuant to which Building Permit No. 3690-Z dated OCTOBER 30~ 1967 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 WITH ATTACHED TWO CAR GARAGE * The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED ROY A. & JOANNE K. SCHELIN 9/26/68-ROBERT VILLA *NOTE: THIS UPDATES CO Z-3328 DATED ,11/26/68. Building Inspector Rev. 1/81 FOEM~ 1~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT ~.{"OWN CLERK'S OFFICE $OUTHOLD, N. Y. THIS CERTIFIES that the building located at .~U~;.~aa~ ............... Street Map No ............. Block No ............. Lot No .... conforms substantially to the Applicati~on for Building Permit heretofore filed in this office 3690-Z dated ...... .0C~Q]~X~.. 2~, .... 192;67 pursuant to which Building Permit No. dated ...... .0~..~:.O~.~..~0~ ...... 19.(~.~., was issued, and conforms to all of the require- ments .of the .applicable provisions of the law. The .occupancy for which this certificate is issued is . ~.1~ .~.~.~:.~.. g)R~. ~IR~..c~e~,]. ;t~..~.i.t.h...a.t ~:.a.c.he:d. t~o. c~ .garage .......... The certificate is issued ~o .R..o~../~.o...&..O'..o.a~R~.. Ko.. ~.~.I~,;~ ......................... (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval ~$1~.t:~:~. Building Inspector FOIlM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 3690 Z Permission is hereby granted,, to:' at premises lOCated at ..............., ................. pursuant to application d~ed ........... ; .......... ; ......... ~.~........~.. .......... , 19.;.~..?.., and approved by the Building inspec¥or. ~:ee ,..~.0..:~ ......... Building In~i~ Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 ! APPLICATION FOR CERTIFICATE OF OCCUPANCY .%. This appiication'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 contm~,s > less than 2/10 of 1% lead. $. Commercial building, indus. Crial building, multiple residences and similar bu~-ldings 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 sho~ing all property lines, streets, building amd 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 -~ ..... ~LLx~cate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date July 9, ]990 ~;ew Construction ........... Old Or Pre-existing Building ................. 385 Locust Lane · Southold, ;.oca~ton of Property ............. . House No. Street Hamlet ROY A. & JOANNE K. SCHELIN ' Onwer or Owners of Property ............................................................. County Tax Map No I000, Section. .62 3 34 ............ Block ....... Lot .................... SubdiVision ' .................................... Filed Map ............ Lot ...................... _ Permit No .... 369OZ 10/30/67 ROY & JOANNE SCHELIN ............ Date Of Permit ................ Applicant ............................. flealth Oept. Approval .......................... Underwriters ....................... ?,' Approval d App 1 ' '" Planning Boar rove ...................... Request for: .Temporary Certificate ........... Final Certicate. $50.00 UPDATED Fee Submitted: ~ ............................ i '. ' '. ........... '" S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date ~P 2 ~ ~ Bldg. Permit No. ~690Z TO WHOM IT MAY CONCERN: The sewage disposal facilities at Locust Lane for a structure located (Give deed location) Southold~ Southold have been inspected by this department and found to be satisfactory. Owner Roy Schelin Builde~-F. F. Gordon District Engineer District Eugineer BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ..................... ............... . Permit No. YOWN O~ SOUTHOLD/7~d~0 ~/~'~' ~t,4,~(e ~7/~. ¢. App,,cat,on ......... =isa.proved (Building Inspec~r) 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 application. 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 far 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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable lows, ordinances, building code and r,~gulations. (Address or oppficant) State whether applicant is owner, lessee, a, gent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .....~.~.~......~w...:....~...c~E...~......"m~..,C:.,~~ ................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done, Map No.: ........................................ Lot No.: ........................ Street and Number .....-~...g.~ ........ ~~......~..,~....) ....... ..~...~,4~ ............................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy ......... :..~'J.~ ................................................................................................ b. Intended use and occupancy ....~~ ........................................................................................................ 3. Nature of work (check which applicable): New Building ..... ~ ....... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Est'~mated Cost ..,.'~.....~,.~.,~,..~.,~..,.~.,;. ............................... Fee .......................................................................................... (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 a,Jterations or additions: Front .................................... Rear ............................ Depth ................................Height ............................Number of Stories ................................ ...... ~...~.....~.. ........ Depth 'o~ ............ 8. Dimensions of entire new construction: Front ....... .~..~......~.. ............... Rear ............ Height .... ../...,~'...~. ....... Number of Stories ..... ..~.~ ....................................................................................................... 9. Size of lot: Front ....('~-..'~.:...~'..~'.. .......Rear ...... ./,~...~..:,.~Z ............. Depth ...... ./..~...~.~:;~.~..../~.~.:/~__,4 10. Date of Purchase ~..~....~..,,,...~.~..~.Z. ........ Nome of Former Owne~.~l,..,~-,~c,.~..c~./h~-~.~......~.. --1 I. Zone or use district in which premises are situated ........... ~. ....................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? .,.~ ................................................ 13. Name of Owner of premises-,~.....~c..:..~..'%~..Address ...~~ ................... Phone Name of Architect .~..~..~..~.....~....~....(~..~...Address ~ ................. Phone No.~.....~..~..~..~...:l...~. Name of Contractor ~'.....$~...:.~ .~..~ ......... Address ...~..~....~ .................. Phone 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, end show street names and indicate whether interior or corner lot. STATE OF NEWcYORJK~4 /Ii,- }SS COUNTY OF ..,~l~/f?~4...~.......~' ' ' ............................... .V.~,.~g~;.~....~..:..~~.....being~ duly sworn, deposes and says that he is the applicant (Name of in~livid~al sign' ' lng application) above named. He is the .............................. ~¢,M,4~:..; ...... ~':'~;":'f':'"~%' 'k~"~ ................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and i$ 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 ...... · ~..~...~? .......... day of ..... ~ .............. , 19...~.,.? ~ ~ ~//' . . .,, // ..... : ........ ............................. Notary Public, ~...Y.(..~.....~..:.~~. County [ (Signature of applicant) ~'erm Expires ~arch 30, ~,9~ ! FO~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No..~./..~....(~t ......... APPLICATION FOR BUILDING PERMIT Date ......, ......................... · .................... , 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 application. 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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. ..... .................................. (Sign6ture of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..~...~.....~....:...~ ...... ~..~.......~..:..~....~ .................................................. If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ........................ Street and Number ....................... ...~..~......~...~.....~........~..~ .............................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .~.....~-~M..~ ..-~....~...~.~.~ ......................... b. Intended use and occupancy 3. Nature of work (check which applicable): New Building ......f~... ........ Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ....~..,qC..C.~..Q..Q...~..: ................................... Fee .......................................................................................... (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 a,[terations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ...... ¢~..~.....~. ................. Rear .....~,..~/...*..¢~.../.~. ...... Depth .,...~....~...:. .......... Height .. /. ..--'~. .. .~ .......... Numb'er of Stories ....... ~ .................................................................................................... 9. Size of lot: Front .../~¢-.].*...~..~. .......... Rear ..... /..~...~.:..¢..../ .............. Depth ...../...¢,~.,...~..¢....~'.~'...¢.:.¢..z¢ / 10. Date of Purchase ~...~.....~./.+..J.¢..~..~.. ....... 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? ....~ ............................................... 13. Name of Owner of premises ~..~..~...,,~.,...,~¢~...Address ....~.'~'22~,¢4¢-~& .................. Phone No..c~..~.~..-...'~'..~..'"/~ Name of Architect ..'~..-....k~,..'~,~...~....Address ,¢~¢-¢¢~¢;¢-~ ............... Phone No..~..~..?..-...~..~...-¢.Q Name of Contractor .~...¢~...:.~ ........ Address ....~.~ ................ Phone No?~..?...~'..~..~...~..~.:~4- 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 i'nterior or corner lot. STATE OF NEW~"¥O~./),~f COUNTY OF ~~. -,':'~';.....,..f .... .............................. V..~...~.:..~ ...... being duly sworn, deposes and says that he is the applicant (Nameme of indiviC6aof indivi al signing applicati obov,, named. He .s 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 manner set forth in the application filed therewith. Sworn to before me this .......... ......... o day of ........ ........ , ...¢' ~ . _ . ~'.......~ ' .,... ,....../~.¢'¢r.~.,'_..,~2r~.z;,,.~. ...................................... Notary Public, ...~.~.¢.J,,~.:~A~ftl~/A.,CqCr~4~ County ~' (Signature of applicant) Z / t' it L