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Home My WebLink About12901-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N,Y. Certificate Of Occupancy No...Z. 1.3..1.4.4 ......... Date Jan. 16 198..5. THIS CERTIFIES th Addition at the building ................................................ Location of Property 3 0 7 5 Indian Neck Lane Peconic h3~s', ~id ....................... 's't/ebi ....................... hb~/~ County Tax Map No. 1000 Section ....0.8.6 ...... Block ... 0..5 .......... Lot ....0 .1.4 ........... X Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated Dec. 18 .., 19 83. pursuant to which Building Permit No. 12901Z dated ....... M. 9.r.c.h. ...... 2. ........ 19 .8.4. , 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 ......... The certificate is issued to PETER R. STOUTENBURGH (owner, le,'~ee-t~r-ter~t~) of the aforesaid building. Suffolk County Department of Health Approval .......... .N/.A. ............................ UNDERWRITERS CERTIFICATE NO .................. .N.6.7. 2. ~.2.4. ....................... Building Inspector Rev. 1/81 FO~ NO. ~ TOWN OF $OUTHOLD B~JILDIHG D£PARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 129O1 Z Permission is hereby granted to: · ........ ,o ....... ~~...~.Z~....'~....~...~z~? ................. ~ f ... ~:~.a.~4~.....~~......~ ...... : ............ ~ ............................ ot premises I~ated at ...~ ................... :~.~ ..... ~ .............. ................................................................... . .................................... ~a~%....~,..~ ..... co~,~ ro~ M~v No. ~ooo s~,,o, ...~. ....... ~k .....0..~.'~ ..... lot No ..... ~r¢. ....... Building Inspector. Fee $...Z(...(. ................ Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N,Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res, 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 New Building ............. Old or Pre-existing Building -~ Vacant Land ............. · ocat on of Property ................ ...... : House No. Street Ham/et Owner or Owners of Property .~..~..-~.~..~ .... .~....~..~3 ~.~.e. ~..~ ~.~. ~ .................. County Tax Map No. 1000 Section .. D~,~ .~ ....... Block . .~.~. ......... Lot...~../..~. ......... Subdivision ................................. Filed Map No......~- .... .Lot No .............. Permit No. ).~..C[ .~).I.. Date of Permit .~. I .°~.1.~..~..Applicant .~..~.~ ).~...~??..~..~.../~.1~.~.~.-~).~ ~ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval .~...~..7.~. ,c'{, ,~,, ~ ......... Planning Board Approval ...................... Request for Temporary Certificate .................... iFinal Certificate .................... Fee Submitted $. ~ .~. .................. Construction on above described bu ildi,ng a,n~ j~/e)C~~ble codes and regulations. Rev. 10-10-78 ~LOO~LO~3 THE NEW YORK BOARD OF FIRE UNDERWRITERS O1 BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 r~' J~u~r~ ~, ~985 ~039/8~ ..,. ~..,,~.,,.. ~o...~,,~ N 672924 THIS CERTIFIE~ THAT only the el~ trial equipment ~ described below a~ introduc~ by the applicant named on the above eppH~ ~mber ~n the premises of ~vi~'~t E~t~ I~. ~75 Indivn ~ee~ L~e, P~i~ N Y w~ examined on ~8~ ~) ~ ~ ~r~d found to be in cotnp~iance with the requirements of this Board. FIXTURES RANGES OVENS EXHAUST FANS E~XIURE SWITCHES SYSTEMS NO. OF FEET E R V I C NO. OF CC. COND A. W G. NO OF HI-LEG A W G, NO. OF NEUTRA[$ A W, G OTHER APPARATUS: 425 Monsell '~.~ This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspecto~ may be ,identified by their credentiaJs. COPYrOR B~ILDING DEPARTMENT. THiS COPY, OF r NOT BE ~LTEREO IN ANY' MANNER ~ FQRM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL Date....'~-.~..~.' .(<'..~?'?. ~. · ~ 19..c/7f7( File No ................................ . ~o~..~/. .:.~ ............... for pe~it to const~ct... ~.~d~ ~ ..................... :,- .......... ~ .... at ~cation of Property...~. Z ~ ....... ~~ .~/~.~.' ...... ~' House No. Street County Tax Map No. 1000 Section .............. Block .............. Lot .............. Subdivision ................. Filed Map No ................. Lot No .................. is returned he~wiih and disapproved on the ~ ....... . e~ .... ~ ~-....~... ~,~y....~x,~ ~. ~..~..~..::~.. ~..~.. ~/x c~.~o~.:...~4~...:' ~ ~,~- ~,~ ~~... ~ ' ' · 7 Building Inspector ~/*~ ~ ~/8o FIELD INSPECTION~ COMMENTS FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 "r,9~;'~!.O ~ SOUTHOLD E, UILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y, 11971 TEL.: 765-1803 .... , Approved .A(..~.~...~.., ,,~e~,, ~o../Z~P~. Z ~,~o~, ~/o .~ .~~: ............. (~~r>~ ...... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No...], .~.~..~../. ....... a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets o[ 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 sheets 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 Pemait. 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. The applicant agrees to comply with all applicable laws, ordinances, building code, hounding code, and regulations, arid to admit authorized inspectors on premises and in buildings for necessa~a~o~ (Signature of applicant, or naFne, if a corporation) .... ~o. z~. g-~ .~.~,,,. ~ .,,: .~...,.?~,_.. (Mailing address of applicant) State whether applicant i~ lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... ...... - ..... 0. [~ ................ ~. ....... (as on the tax roll or latest debd) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... ~../..L.[. ....... ./.~.~.~. ~(..h--o~(~ Plumber s License No ......................... Electrician s License No ....................... Other Trade's License No ..... : ................ 1. Location of land on which proposed work will be done .... ~.[.i. ~.(~....~. ~.~..~.... ~..~.~ ........ .... .~.o..~ ~. ............. ~c~.d. ~. ~.'...n.~..c. (.~.. g.~ .. ....... ~..~...~.( ..c-. .............. House Number Street Hamlet County Tax Map No. 1000 Section ..... O.~'.~. ....... Block ......... ~ ....... Lot .... / .(/f. ............ Subdivision...: ........................ ~..' ....... Filed Map No ............... Lot ............... (Name) 2, State existing use and occupancy of p~'misea an ,dc.~_tended use and occupancy of proposed construction: a. Existing use and occupancy .. b, Intended use and occup~cy/.. ~ ~ ~. ~,., ;,~.~ ~q ,~., .~..~ { Z. ~.~...~.~ ~ ~. ~:.. . 3. Nature of work (check which applicable): New Building .......... Addition< . ter n .......... Repair .............. Rem6val .............. Demolition .............. Other Work ............... 4. Estimated Cost ........ . .' ................. Fee ................................ (to be paid on filing this application) 5 If dwelling number of dwellinglunits .'-.. ~ ~'. Number of dwelling · , .......... units on each floor ............... If garage, number of ears .... ; .2-.. ............................................................" -- 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ._._....'w~. _..... 7. Dimensions of existing structures, if any: Front .... ~.r_~. ....... Rear..~. ........... ~ Height .. ~o ......... Nunlber of Stories...2<..~. ............ ~ ~C) ................... ... i;: .... Dimensions of same structure with alterations or additions: Front . . .~.'/.. {t ......... Rear .... ~.'7, ~. ~.~: .... Depth .c(.~ ~ Height '.xr Ce. Number of Stories "~ 8. Dimensions of entire new construction: Front...1.3 .......... Rear ... l .... ~.t ...... Depth ...~, 9 ......... }?ight .... .~ ~ ........ Number of Stories ...... [ .... '~ i ....................... 9. Size oflot: Front ..... ~..~'~.: ........... Rear... l .......... Depth .... ~ .............. 11. Zone or use district in which pr~mises are s~tuated ......... .R,£.q~'~3O.45 ...0-:~. .............................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ., .~ .~. ......................... 13.- Will lot be regraded .... .x4~ ................... Will excess fill be removed from premises: Yes No Name of Architect ......... i ................. Address ................... Phone No ................ Name Of Contractor ' ~ Address 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!number or description according to deed, and show street names and indicate whether interior or corner lot, · . '. .... C~ame o7,,~ng¢ontrac;{ being duly sworn, deposes ~d t the applicant above named. , corporate officer, etc.) of said owner or owners, ~d is duly autho~zed to perform or have perfomed the said work and to m~e ~d file this application;2 that all statements contained M this application am true to the ~est o~ knowledge and belief; and that the work will be perfomed in the m~n~r set fo~h M the application filed therewith. Sworn to befor~ me this '4'