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Home My WebLink About10557-z FORM NO.4 TOWN OF SOUTHOL.D BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No, . . . . p.1.~$;3;l. . . . .. Date.......... .-!':l:'.~ .~~.". .~~?7...... THIS CERTIFIES that the building. . . . . . .a,C:9~.s.~C?"y. .~'!~~~.~r:'if... . . . . . . . . . . . . . . . . . . Location of Property .....4 Q ~ .5. . . . . . . . . . . . .~~\!-~!<. .r,.~~~. . . . . . . . . . . . . . . ~':l :t.C:~'?'iI~.~ . . . . House No. Street Hamlet County Tax Map No. 1000 Section. . . 9.7. ..... .Block .......~...... .Lot .. .. . .~~. ....... . Subdivision.. . .. .. .. .. .. .J.<. . .. . . .. .. ... . . .Filed Map No. . . . ?': . . .Lot No. ....~........ conforms substantially to the Application for Building Permit heretafore filed in this office dated , . . .J;"p.r.\:IGI:ry. A, . ;1..9.80 pursuant to which Building Penn it No. ....... ~.o.~~?~....... datcd ..... J;,,!:>.r.\:I<iu. A, . ;I..9.~ Q , . . , 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 ... . . . . . . An accessory building. ... ,..... ..........,... ............... ....,....... '" ....,.. ... ...... .,......... BARBARA & PAUL STOUTENBURGH The ccrtificate IS issued to .........,..,.............................................. (owner, ~1K'KXfX!lllKi of the aforesaid building. Suffolk County Department of Health Approval ................' .tll..(\.. . . . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE NO. . .. . .. .. .. . . .. ... . .. . .. ..tll..(\... .. . ... ..... . .. . ... . PLUMBERS CERTIFICATION DATED: !.I / A-- ~dci:4(pp Buil g Inspector Rev. 1/81 . , I j i; ",2 .~ ;~i :,!1: '. ,. , . FORM NO. 2 TOWN OF SOUTH OLD 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) %(/ N? 10557 Z Date .......... .. .............;;f..<<.:...., Y...., li1.r . PermisSion is hereby granted to' .ri.ZJ..L......&~.~/~!C'!.......)4~'lAV1/ I! ....t:.~:....r't...r!..?S,......I.??..s.:...,............. ..", "" ....................,.............~:t.",..4..,..,~"c., C/OCa A... )y I to ~!lr.!....-:f........,&{.r:.-:t.~~ ~ y....:."'4~f.dt",,:.. ......~~~...................., .. .."....".., ",..~ ''7 3 ~- .....................................,...................... .,...............,. ........................................ ................................. . at premises located at ....................t;..c:..I.fi~-~.k..,..6, ......~~,..........,..,....... ................ .........,................,.............................,......,.......,..... .. ..,.,&l.c..tw.t1f.&M~/....!.'}..//.;...,....., '.......... . .................................................................................................................................................,.............,. pursuant to application dated ..........,....................~I...,....~/....., lGz?...., and approved by the Building Inspector. ~ Fee IF..........,....... ~1; ~ ~ iJ/ti. I (JtJll -- 1 7 - '1'- I 'f ....,.. ,... ~.~..... ../~.....:.<{:?......;1................... Building Inspector L,J ~~-( ; j Ii . I !< /" /' ( :/ /' ' FORM NO.6 TOWN OF SOUTHOLD ~ !b1'DI~1 A: Bu ilding Department Tawn Hall 4{)11~~ Southord, N.Y. 11971 765 - 1802 ~) rJ.,j. \\<1'05 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in tYpewriter OR ink, and submitted _- to the Building Inspec- torwith the following; for new buildings ar new use: 1. Finai survey of propertY with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage dispasal-(S.9 farm or equal). 3. Approval of electrical mstallation from Board af Fire Underwriters. 4. Commercial buildings. Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (priar ta April 1957). Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of bu lidings. 3. Date of any housing code ar safety inspection of buildings or premises, or other pertment informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $25.00 -- BUSINESS $50.00 ACCESSORY $10.00 2. Certificate of occupancy on pre.existing dwelling $50.00 3. Copy of certificate of accupancy $ 5. 00 , over 5 years $ 10.00 4.Vacant Land C,O. $ 20.00 Ls'UPdated C.O. $ 50.00 Date .......................... N Constr'uction 1- Old P .. B 'Id' V L d ew ...'... or re.exlstmg UI mg............ acant an ............. Location of PropertY ..............................s: ":- .u.-':'.~ .. .. '-::'. ':'."': . . . .. . ~ ':' .':'~.~ .0. ~.": ":" House No. Street Hamlet Owner or Owners of Property .. /~~ !l,~.~.~.:':'.~.. r ~.~ .t...:.. . . .~. ~~. ~. .;:-:":'~:(~.':'~~~.7 . . County Tax Map No. 1000 Section... ?'/'. ... . .. .. Block..... or. ....... Lot...... (r... .... . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. ......... .Lot No. ............. . 1()6"~1"2- . Y"/~p . p""..... ~,."'''-';-':r........4.......'-''''..,.. Permit No. .......... Date of Permit . .. .... .Applicant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Health Dept. Approval. " '" . .. . " . " ... ..... .Labor Dept. Appraval ...~............... Underwriters Approval. ...... .. . ~. ....... .Planning Board Approval. ..-::-::. ........ ...... Request far Tem7Y Certificate. ..... ......... ... . . .Final Certificate... ,.. .1...... . ........ Fee Submitted $. . /~. . ~ ~. .l:# .'?:??~~. . .. Construction on above desCribed building and permit meets all apPlicabl~es and regulations. t.t)~\'5'b~<.} . ~~~ ~ ~ -1kc.. '11.0. 3;?d;D~ Appllcanr . . . . . .'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rev. 10-10.78 ,'_~ I it: ," ___. "_'" ~_ _' ~'" l"" ,,,.....~ y '.'~,'''''A.~' ,~,J"'""">.,, ',' -"'_ ,,~W. _..._ ",. ,.,.,.. ".,~,. ,,/, w') _"'..",., ""","",","'"'''~',,''''.' , 0.-" ~~ , '. ";''''_0 ~ ~ ,":'*"";'.;;,~;;-,.r,~_ok.:e;,> ~_.- ---~-;;;-;:-, ..J; "'" " /UiC'/~IN C. "PE (2.. rVI1T =Ft ';""J ,," :-, ~ ~- D . ~-;.:.; ~n~;~_,;~:~'- jl~~-; I - - Co 1'-AiV\ C ~0 T'S '- __'_'n. - ...- I;;:; '!, , - - ~ I I "'" 1 F.6'-''-' .oATI CJ /\.1 j $(" I .~ , . ..!I! ~f'..- I , .. c~ I I ""\ ! ':J>t\ ( 01 " 2 ~ ' i R I 2 I : - ~--t: ::0 L.:1 c:; H FtC.A Iv'\ E I; ~ '2 r; ?L u /VI (3 I N G I; ~ "l I I t~ I I ~ 3 Ii I >- I 1'-1 S U LA. T I 0 t--:l I : ~ .f..-J.y. 'STATe ~ ~" E'I'-.I E. r2 Ci v Co D::' 1~--'----'- - .. <i- .. - -. .. -- --.- :...-&1~'- - --.Cr:'" --~/" "\ -~-..~--_..- ~ F'i 1'-.1 A L i ~/ J'i'6 / ~ ( /#>tf' } ' I 0h~if'7 /1/ L-. '-;Ln j (--?a/A) -::v I / I # ~/jJfo j/(' /\. (/ i : 'II ()~ , c~ '" '/ __ .____ _ _ _ __ _.__ __..____ _ .. ___._ . _ ?'17i AODITlocvAL COfJl/V\-IVIS . "_"n _u_ .. 15<. ~ fiJ~ ____.n______,_ _.__ . ,.. , n___ <::. 7IJ ___n'" If' . 1- ~ " ~--I: 11 q~' ~ - - I , --.--------------- _ ____. ___. ._._______.___ ---1-. I "",. ,1 " r _____ _ '.' ""i!. i;..._.~~1, ~..IL ~_'" J", ~.,. ....- - --- n... , ~~- - --- +- r- ~ I " ~I d' \..'\ \') " ,~ 'I ...., \. v\ <; ~ ~ 'f1 ~ ~ () l' lY> t - C ~ !'\. ,~ " !1""" " " ' ::',' G7,~', C~'C'~ ~ I .. f:I "" r IA t. r. ~ . '"_ ",?/". "., "") I ~ "\\ , r' '"'~ '."). " , - ."!') >>,,' ~ '~ ~ ~ C]" "";",,.") '. ,:: I ',; .' , ' ,;.~.<' i',' .,~ ~ "" . I't, ~. ! : ~ fi .' ",y fV' . ~ {~' {f"':"" , \.> ... , ~ ~ - '. " , , "'t:--W.. , [ '. ,-....?J l.. r ....." ' I (- \ . . ") '" '..] I, - 'I t:Wd, ,,' d ,1 ",-~ '-"'-'.:'J ~I '~ <3"... ;~:::) ~'j ::"'-';::'L-...:-)_ ,:::1 11\ 1 ~ p \')CI ~ - \:1 l- f .'1) \;' ---- .,... I r I :~~~/~: o>tl~~~ / ?f I DATE tlFE . jl)''v r"(: ,~..~__ ~.JOi L '\/ S' 1 1 iY' :.'; r"'~, \[') T.\I\!- r"!T AT ~ I :"'7SS 1 (v"> ., /'.'.. Ii /. f':.\ t ~;I< 1 t"!f.-: ~ tI -'f:Oll t' \ ! <t., 1(" /" , ,~ ' " "'~ .('~. <:0 l) II Q i'i f'r," "!~ '\ , i "', 1 <,:r\ p; n'j~r:c) ..... ':> I 't:,. i~ :t r~~' 1'r'! ' to'"" " " th ~ "! '~ r'" l '>',\,\'t-'_ n r-" ~J: ",~: 11',JG t 1'1 , '\~ I~' Q ". !)~ ,'" ,t! A, i ~ "'- I .,j Lt. FI1,' 'I .~ J !/,~}:';T ~i -", ~' '. , t "" ' [' '~ ' (-, c I'fu.. ( , : '/,,!~! F.A,~ )-T I ~ ~~ 0-: r ~ { , , ^ " "F,,~ C;"o n-:.. NY. 'I ctf 1\--1.: '~';);': )~-()I;C I Jc.)N Pv. [-)\:1 ~)GY <:k)D! ~ ) t....:'"'f R.F~J)()t!5Jr3LC FOr~, I I~'TV,~ Of{ CCNS1RUCTIOf\J CRRORS. ~;' :: ),,1, I - --- J , , ;,,\ , ',j ~,' j "' "",-. " ~ .. fORM NO.1 TOWN OF SOUTHOLD #/' BUILDING. DEPARTMENT TOWN HALL SOUTHOLD, N.'(.11971 TEL.: 765-1802 -- JI: L( ?O ---- Application NO.! P -!.~7- . . . . Exammed . . . . . . .. ...... " 19 , . . Approved...,.. .711:, Y., 19 f'~Permit NO.! ~ ?-?? Z- -- -- Disapproved a/c . . . . . . . , . . .~ ' . , . . . . . . . . . . . , . . . . , . . . ..... ,..... .,'.,...........,.....~:::: :~: :;;1~~ (Building Inspector) . APPLICATION FOR BUILDING PERMIT Date. . . . . . . . ~f. y. ., IP INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector" "Yith 3 sets of plans, accl!rate_plqt pla.!).t(L~2.~. Fee according to schedule. . b(Plot plan show1ng location of lot and of buildings"1>n premises, relationship to adjoining premises or public streets or areas, andgiV'ing'a-aaailiid aescnpfion 01' hiyouCorproperty must be drawn on the diagram which is part ofthis 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 issue 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. i 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 buildings for necessary inspections. ' , .....c?~.~::.~......... , I I i . (Sign':i'thre of applicant, or name, if a corporation) ,\ ...... .~~.-.'.. .~. .~.'.: .~':~:1::::. .).v..!. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . . , . . . . . , . , . . ONne:r. '. . . . . . . , , . . ~ . . . .' , . . , . . . , . . . . . . . . . . , . . . . , . . . . . . . . . , . , . , . , . . . . , , . . , . . . . . . . . . . . Name of owner pf premises ,~?-\<;L. ,q.t;1P. .~iJ.:rPfJ..r:!j.$ j:;p:q 1;~(lp)-\:r:gp.. . . . . . . . . , . . . . . , . . . . . . . . . , . . . , . . , . . . . , . , (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. .Qwa~:I?,...,.., .'"... .. Plumber's License No. ...................,..,. Electrician's License No. .....".,....,.. ,...,. Other Trade's License No. ..................... I. Location of land on which pr~osed work will be done. .,.........,.....................".......,...... I-fDf5 B.o.x .105 . SkUnk. Lane. , . . . .. ,............' .Gu tc.hogU6J. .NY. . . . . . . , . , . . . . . . . . . . . . . . , . . . . . . . . . House Number Street Hamlet / County Tax Map No. 1000 Section ...,... L , .97. :. .. Block.....,.., . .9. . . . .. Lot....'....., 14. . . . . . Subdivision. . , . . . . . . . . . , . , . . . . . . . . . . . . . . . . . . . . . . Filed Map No. .............. Lot ............... (Name) 2. ~tate existing use and occupancy of premises and intended use and occupancy of proposed construction: E'f d - ~H ~.&""'1/ a. XIS mg use an occupancy ...,... .-. -. . . . . . . ... . . . . . . . " . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended use-a..GGCup.aooy ............... c?~... .~A... ~QqQ. iJ.h.e.4...................... i , 'I 1 .3$." ___"'... ..-o.i I: , ,_ h." ,', , 3. Nature of work (check which applicable): New Building. . . . ?C. . . . . Addition. . . . . . . . .. Alteration .......... Repair .............. Removal . . . , . , . . . . . . .. Demolition .............. Other Work. . . . . . . . . . . . . . . '. (Descriptian) 4. Estimated Cost tlP.QEiI . . . . . . . . '. . . (old. .wood.).IOO.1. . . . .. Fee 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , (to be paid on filing this application) 5. If dwelling, number of dwelling units. :-:-.-:'. . . . . . . .,. Number of dwelling units on each flo'or. . .--:'. . ;";'7':". . . . . . If garage, number of cars ..... ,. . . . . ':":-.-. . . . . . . . . .. ............................................... 6. If business, eommercial or mixed occupancy, specify nat re and extent of each type of use . . . . . . . . . . . . . . . . . . . . . I 7. Dimensions of existing structures, if any: Front . .-.-.-..._~ ....-..... Rear .............. Depth.. . . . . . . . . . . . . . Height ............... Number of Stories. . . . . . .. ............................................... Dimensions of same structure with alterations or additio : Front ................. Rear . . . . . . . . . . . . . . . . . . Depth. . . . . . . . . . . . . . . . . . . . '. . Height. . . . . . . . . .. .......... Number of Stories. . . . . . . . . . . . . . . . . . . . . . 8. Dimensions of entire new construction: Front. ?I. . . .. ...... Rear . .~ '. . . . . . . . . . . . Depth . 8 ~ . '. . . . . . . . . . . ,e. , 1 Height ................ Numper of Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size oflot: Front I24,Q. . . . . . .:. . . . . . . . . .. Rear~ /?1JI!3. . . . . . . . . . . . . . . . .. Depth ........... .310. . . . . . . 10. Date of Purchase ..... '. . . . . . :. . . .19.55. . . . . . . . . . Name of Former Owner B:L11a;r>.d . . . . . . . . . . . . . . . . . . . . . II Z d. . . hi h . .t t d I residetlt'fal . ' one or use Istnct m w c prennses are Sl ua e ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .......... .t;li? . . . . . . . . . . . . . . . . . . 13. Will lot be regraded .QO......:................... Will excess fill be removed from premises: Yes '(~') 14. Name of Owner of premises .e,p.r;L.i,q'~tl:t;. . . . . . . . Address. . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Name of Architect .......t:\C! 9-!'. . . . . . . . . . . . . . . . Address .. . . . . . . . . . . . . . . . . . Phone No. .. . . . . . . . . . . . . . Name ~f Contractor . . . . . .tJ,C! t;l~ . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone Na. . . . . . . . . . . . . . . . ! 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 .Jot. ' . J SI<vNI<. L.+;.JE.. - ~~, J ~~P5 ! ll.! '1, 7' A-C-11.E.5 .~ ~ ~, ~ ~1eC./f.A"fC>"',tIz.. l6()ot> >- J\J. ! ""...4. , ~ ' , ~ '~ - I '" Q,.. >'Td:ur/!.N~"","1..""+- J? cfJ'O \ tv:) ::> 'I. o~ ,,~'l ~I, \ -I rz..4-. _0' <. ~ .g'" : \J q,1V ~ 'J 1f , \l T-:Jo s;i-oVTl;'~'t'~v/Lf.>4 D ~..J. I/1/.,.A (: I /31,/-d...,,,"I.1> Ri!>. r+~r(.Jrt...j%- ---f ~ (>~"n~~4""-"'V p -+$71.11/-i!.. /,7 A : ,'2... 1'\" , ($ ro v ';'1'L;II?tV.u,H.J STATE OF NEW v: RK, :L IS.S I COUNTY OF . .. ..... . .. , I . . . P;.a.tvJ.. ~ I3.Jb.QWP.\3.o. . . :rg.t\ . . . . .:. . . . . . . . . . . . . .\. . . . .. being duly sworn, deposes \,and says that he is the applicant (Name of individual signing contract) above named. He is the. . . . . . .' . OW.QEilX' . . . . . . . .j. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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 eont*ined 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 applieation filed therewith. Sworn to bezore e this 'J: i '-~ fV .......... .~~..... dayO~,""" ..............,l,~... ..".. ' ~ '~. # Notary Public, '. . . . : . . . . . . .. .. .. ~ . . . " ......: County ~ .. .. ' MUR~~ :' .. .. .. '" .... .~.. .. ; .. .. .. .. .. . .. . , NOTA~Y PUBLIC:, Sf,}, 0.' N~w ~o.k I (Signature of applicant) No 52.4522026 - S.;Lclk Co\.~,)(y }::?yj Com:n~$fiion r.:.xpirQJ; 1-..1<11'1:11 30. 1 \1'm~t: --