HomeMy WebLinkAbout14653-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Z15677 Date .~ P.r.i~...2.2.,. 1..987
THIS CERTIFIES that the building ....A.d.d./. ~. ~9.n. ...................................
Location of Property 3245 WELLS ROAD PECONIC
h~s'e ~iol ....................... 's'de~i .......................
County Tax Map No. 1000 Section . 0.8.6. ....... Block ....0.:} ......... Lot ....7 .............
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
..... .M.a.r.c..h..5. ,...1.9.8.6. pursuant to which Building Permit No .... 1. ~..6.5.3. Z. ...........
dated . Mar cb.. 1.4 o..1.9.~ .6 .......... 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 .........
..... .~.4 ~..~ .hi.o.~...ho..~..~ ~.~.~. ~..~ ~..o.~..e..f.,.m~ .~.~ y..d. ¥?.~.! ~..~.~.. ..........................
The certificate is issued to GUSTAVE AND MARGARET WEIDMANN
..................... ?oYn'e'r, ~'Y-._lC4Jk'x' ...................
of the aforesaid building.
Suffolk County Department of Health Approval ....... [q/A ...............................
UNDERWRITERS CERTIFICATE NO. lq 803894
PLUMBERS CERTIFICATION DATED: April 2, 1987
Rev. 1/81
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PER~IT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
CQMPLETION OF THE WORK AUTHORIZED)
14653
Permission is hereby granted to:
.....~.~.~..~.~ ..................................................
~..~:~.....~.:~.: ....... !.!.5~ ..............
- ....... ..................................................................................
at premises located at ..,'.~...'~..,~..~. ....... ~.~,.,~........,~,~.. .......... .~......,~'..~'~..~,.~ ..............................
County Tax Map No. 1000 Section ........ ..(~....~,..~ ...... Block ...... ..~....~m.. ....... Lot No ..... ~ ................
pursuant to (3pp,t¢otion dated .... ......~......~..~......~. ..................... , 19..~...{~., and approved by the
Building Inspector.
Building Inspector
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
765- 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted ~ ~ 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 featu res.
2.Final approval of Health Dept. of water supply and sewerage disposal-iS-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.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pm-existing"
land uses:
1. Accurate survey of p~perty 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 buildings.
3. Date of any housing code or safety inspection of bui{dings or premises, or other pertinent informa-
tion required to prepare a certificate.
C. Fees: Additions $25.00
1. Certificate of occupancy New Dwelling $25.00, Accessory I$10.00 Business $50.00
2. Certificate of occupancy on pre-existing dwelling $ 50.00
3. Copy of certificate of occupancy $ ,5.00, over 5 years $10.00
4.Vacant Land C.O. $ 20.00
5.Updated C.O. $ 50.00 Date ......
re-existing Building . .;~ ....... Vacant Land ..; ..........
House No, ~ ~ Street ~ I~' [ Hamlet
Owner or Owners of Property. ~.~.. ~. I...~.~.. ~. ~:!.. ~.~. ~.~.e.X..
CountyTa×Map~o. 1000~ect,on ..... ~.~ .... B,oc~ ..... --"-~:.... ~ot ..... ~-'~..~ ........
Subdivision ................................. Filed Map No ........... Lot No ..............
Health Dept. Approval ........................ Labor Dept. Approval ...................... . .
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $.... ,~.:..(~. (~-~ ................
Construction on above described building and permit mee.ts all~pplie~ble c_?des and regulations.
................
Rev, I0-10-78
THE
~m
April
THIS CERTIFIES THAT
NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
15, 198'7 .~p,.l,,~a,,on~o.o..f... 4'08412-86 N 803894
only the electrical ecl~ipm, ent as describ, e~d below and introduced bX the applicant named on the above application nu tuber in the premises of
~UStave Wezdmann~ wells Rd., Rt. 25, Peconic, N.Y.
in the follow, lng location; · [] Bas,ment
~s~xo,.i.edo,, Aprzl 6, 1987
~ lst FI. [] 2nd ~7. Section Block
and found to be in compliance u'ith the reqttlre.tents of this Board
OUTLET ECEPTACLES SWITCHES
D ' FUR
IC~ DI O CT O OF
RANGES
SPECIAL REC'PT
S R
METER
EQUIP.
~w , ~ 3w 3 ~' 3w 3~ 4w NO. O~.CC~CONO
A, W G NO, OF HI-LEG
O~ CC, COND
;~ ~O~T AMP TYP~
OTHER APPARATUS:
LJNIT HEATERS MULTI-OUTLET
SYSTEMS
NO. OF FEET
C
Lot
EXHAUST FANS
DIMMERS
1-G.F.C.I.
275 Town Harbor Lane
Southold, N.Y~ 11971 Lic. 282
GENERAL ~ANA~I~R
'""
This certificate must not be attered in any manner; return to the office of the Board if incorrect Inspectors may be identified by'their credentials.
TOWN OF $OUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
CERTIFICATION
(please print)
~(pleas~, print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
Sworn to before me this
Notary Public,.)~J~,~ l .~ ~ County
(plumber's signature)
Notar~ Public
UNDA J. COOPER
Notar~ Publl~, State of N~/~
- No. 4822563, Suff~dk Cou _nty
mrm E~ires December 31, 1~
FiELD.INSPeCTION
FOUNDATION
FOUNDATION (2nd)
2.
ROUGH FRAME &
?LUMBING
COMMENTS
INSULATION PER N. Y.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
95-20-6a (9/851
ADDITIONAL GENERAL CONDITIONS FOR ARTICLES lS (Title S), 24, 25, 34 and 36 (
10. That if future operations by the State of New York require an al- 14 Any material dredged in the prosecution of the work herein permitted
11
12.
13
teration in the position of the structure or work herein autl~brized, or
if, in the opinion of the Department of Environmental Conservation
~t shall cause unreasonable obstruction to the free navigation of said
waters or flood flows or endanger the health, safety or welfare of
the people of the State, or cause loss or destruction of the natural
resources of the State, the owner may be ordered by the Department to
remove or alter the structural work, obstructions, or hazards caused
thereby without expense to the State, and if, upon the expiration or
revocation of this permit, the structure, fill, excavation, or other
modification of the watercourse hereby authorized shall ~ot be com-
pleted, the owners, shall, without expense to the State, and to such
extent and in such time and manner as the Department of Environmental
Conservation may require, remove alt or any portion of the uncompleted
structure or fdl and restore to its former condition the navigable
and flood capacity of the watercourse. No claim shall be made against
the State of New York on account of any such removal or alteration.
That the State of New York shall in no case be liable for any damage
or iniury to the structure or work herein authorized whi~:h may be caused
by or result from future operations undertaken by the State for the
conservation or improvement of navigation, or for other purposes, and
no claim or right to compensation shall accrue from any such damage.
That if the display of lights and signals on any work hereby authorized
is not otherwise provided for by law, such lights and si8nals as may
be prescribed by the United States Coast Cuard shall be installed and
maintained.
All necessary precautions shall be taken to preclude cqntaminaflon
of any wetland or waterway by suspended solids, sediments, fuels,
solvents, lubricants, epoxy coatings, paints, concrete, Jeachate or any
other environmentally deleterious materiats associated w~th the
project.
shall be removed evenly, without leaving large refuse piles, ridges across
the ~ed of a waterway or f(oodplain or deep holes that may have a
tendency to cause damage to navigable channels or to the banks of
a waterway.
15 If any material is to be deposited or dumped under this permit, either
An the waterway or on shore above high-water mark, it shall be deposited
or dumped at the locality shown on the drawing hereto attached, and,
if so prescribed thereon, within or behind a good and substantial
bulkhead or bulkheads, such as will prevent escape of the material
into the waterway.
16. There shall be no unreasonable interference with navigation by the work
herein authorized.
17 If granted under Articles 24 or 25. and if upon the expiration or re-
vocation of this permit, modification of the wetland hereby authorized
has not been completed, the applicant shall, without expense to the
State, and to such extent and in such time and manner as the
Department of Environmental Conservation may require, remove a{I or
any portion of the uncompleted structure or fill and restore the site
to its former condition. No claim shall be made against the State of
New York on account of any such removal or alteration.
16. If g~anted under Article 36, this permit does not signify in any way
that the project will be free from flooding.
19, All activities authorized by this permit must be in strict conformance
with the approved plans submitted by the applicant or his agent as part
of the permit application.
Such approved plans were prepared by
Bobette Suter on 1Q/25/85 ,
SPECIAL CONDITIONS
Supplementary Special Conditions fA) through (J) attached.
N~A Page ..,2 of 3
DEC PERMIT NUMBER
10-85-1344
FACILITY PROGRAM NUMBER(s)
I~/~
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
PERMIT
Under the Environmental Conservation Law
EFFECTIVE DATE
1/1-~/86
EXPIRATION DATE(s)
12/31/87
~-IArticle 15, Title 5:
Protection of Water
~-~Article 15, 'Title 15:
Water Supply
r-lArticle 15, Title 15:
Water Transport
r-]Article 15, Title 15:
Long Island Wells
I-I^rticle 15, Title 27:
Wild, Scenic
and Recreational Rivers
E~]6N~'CRR 608;
Water Quality Certification
[~]Article 17, Titles 7, 8: SPDES __
I-]Article 19:
Air Pollution Control
r-]Article 23, Title 27:
Mined Land
Reclamation
[~Article 24:
Freshwater Wetlands
[~Article 25:
Tidal Wetlands
N--New, R--Renewal, M--Modification
r-~Article 27, Title 7:
Solid Waste Management
[~]Article 27, Title 9:
Hazardous
Waste Management
{~ Article 34:
Coastal
Erosion Management
[-]Article 36:
Floodplain Management
[~Articles 1, 3, 37; 6NYCRR 380;
Radiation Control
C--Construction, O--Operation, (if Applicable)
PERMIT ISSUED TO
Peggy Weidmann
ADDRESS OF PERMITTEE
P.O. Box 221, Wells Rd.r Peconic, N. Y. 1~5~
AGENT FOR PERMITTEE/CONTACT PERSON
gutter &Suter, 51 Woodlawn Ave,,E.Moriches.NY 1L~40
NAME AND ADDRESS OF FACILITY (If different from PermitteeJ ": ~ , '' ~: ' :'
N/A
LOCATION DE PROIECT Richmond ~COUNTY J TOWH/CJTYW..LAC;E
;reek,between lands of Ho ~O~ Suffolk. Sou~o~d
DESCRIPTIONOEPROIECT/FACILITY & Schultze,PEconic
Construct a 24' l~n~ addition onto east .~d~_ nF h.n,~.~ !~,
of house and 21'
TELEPHONE NUMBER
878-46(]2
JUTMCOORDINATES
wide off side
wide at the northeast corner of garage a minimum of 75'
landward of mhw.
GENERAL CONDITIONS
By acceptance of this permit, the permlttee agrees that/he permit im coeti,a~ent upo~ ~rict c~mp|iance
with the ECl., all applicable tegulatlom and the conditions specified herein or attached hereto.
~. Thepermitteesha~f~einthe~ffice~ftheappr~priatere8i~na~permitadministrater'~r~ther~fficedesignatedinthespecIalc~nditi~ns~anot~ce~fintenti~ntoc~mmence
work at least 48 hours in advance of the time of commencement and shall also notify him/her'promptly ~n writins of the completion of the work.
2 The permitted work ~hall be sublect to inspecbon by an authorized representative of the Department of Environmenta~ Conservation which m~y ocde~ the work suspended if
the public interest so requires.
3 The perminee has accepted expressly, by the execution of the application, the full legal responsibility for all damages, direct or indirect, of whatever nature, and by whomever
suffered, arising out of the project described herein and has agreed to indemnify and save harmless the State from suits, actions, damages and costs of every name and descnp-
hen resulting from the said p[oject
4 The Department reserves the right to modify, suspead ot ~evoke this po~rnit at ~,ny time after due notice, and, if requested, hold a hearing when:
a) the scope of the project is exceeded or a violation of any condition of the permit or provisions of the ECL and pertinent regulations are found; or
b) the permit was obtained by misrepresentation or failure to disclose relevent facts; or
c) newly discovered information or significant physical changes are discovered since the permit was issued.
5 The permittee is responsible for keeping the permit active by submitting a renewal application, including any forms, fees or supplemental information which may be required
by the Department, ,~o Jate~ tha~ 30 days (1~0 days fo~ SPDES ot SoB~ o1 Hazar~uous Waste Manaaement permits) prior to the expiration date
6 This permit shall not be construed as conveying to the applicant any right to trespass upon the tands or interfere with the riparian ri8hts of others in order to perform the
permitted work or as authorizing the impairment of any riBhts, title or interest in real or personal property held or vested in a person not a party to the permit,
7 The perminee is respens~ble for obtainins any other permits, approvals, lands, easements and rights-of way which may be required for this project,
8 Issuance of this permit by the D~partment does not, unless expressly provided for. modify, supersede or resciod a~ order o~ consent or dute~minat~on by the Commissloner
issued heretofore by the Department or any of the terms, conditions, or requirements contained in such order or determination
Any modification of this permit gran~t%d ,by the Oepa. nment_m_ust .be in writing and attached hereto,
PERMIT JSSUANCE DATE '~A~I~'~]~I~A'~/O~D'a/ J ^DDRESSBldG.40, SUNY, Room 219
1/13/86 I Charles T.~amilton j Stony Brookr NY 11794
AUTHORIZEx ~ t ,,,SI ATURE ,~ JPage 1 of 3
76.5-1802
BUILDING DEPT,
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
FRAMING
[ ] FINAL
DATE: INSPECTOR.~,, ~' ~,*~:i:f , ~
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
Approved...~. O4>.c~. ! ~.., 19~¢.. Permit No. [ .Q. ~..,~..~...Tq.
Disapproved ale .....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
BLDG. DEPT.
TOWN OF SOUTHOLD
Received ........... ,19...
Date ' ., 19 .?.~
INSTRUCTIONS
a. This applicgtion 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. IJpon 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 inspections.
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plmnber or builder.
Nameofowner ofpremises ~e~/'~-~ld-~lq'~.~l)f)~ ~;k.)~ IC,~V4~' C ~ .~. ....................
(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..
Plmnber's License No ............ ]
Electrician's,License No .......... {~/ ...........
Other Trade s License No ........ ¥.~. ...........
Locatiqn o_f land o,n which proposed work will be done, ' ~~ ~. -'%-~'g;:~f.-~.. ~.~.w3..4.
................... .......... ................ ,..
House Number Street Hamlet
County Tax Map No. 1000 Seciion ...C~..~.[4>. ........ Block ...... ~ .......... Lot .... ~ ............
Subdivision ..................................... Filed I~lap No. . .~...r::~...C.~. ..... Lot ...............
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy . . ~ 1. t-,,J. C~.~...~,,...¢?.~.t'~, ~,L, .x.l....f~,.~.\.%r4~.~,.-r>kB-.k bNt,.., ................
b. I!atended use and occupancy .... .i~. ~.b~_~../~'7.... ~..~..~. ~ .........................
3. Nature of work (che'~k whiehiapplicable):
Repair .............. RemOval...
4. stimated Cost ........ ';'i .........
N B ildi ' Additi ~.. Alt ati r/~
ew u ng .......... on ....... er on .....
........ Demolition ........ Other Work ...............
(Description)
~ ~' (to be paid on filing this application)
5. If dfvelling, ntimber of dwelling units ...o~1~ ....... Number of dwelling units on each floor .................
Ii'garage number of cars .~¢.~>4ff--~.~ .~¥-) .~.?. ).~.~
6. If business, commercial or mixed occupancy, specify natu,re and extent c~f each tyl?e of use .....................
7. Dimensions of existing structure!s, if any: Front...ko.~.. .......... Rear . Co.~'~ ..... Depth .~.c:¢..~ .'..c~." .....
Height .... L,-~.~.' ........ Number of Stories..c;~M~-,.. .................................................
Dimensions of same structure wtth alterations or additions: Front ... ~.' ......... Rear...U?.~..' ...........
~'~ ' ' Height ~' Number of Stories
Depth ..........................................................
8. Dimensions of entire new construction: Front ............... Rear ...~.c?.'.z .~.'~... Depth ...
' ~ ~ ' Number of Stories ~ ~
Ilaight .................................................................
9. Size of lot: Front ...... ~..c?.c:?.' .......... Rear ..... ¥ .~ .CC..' ............ Depth .. [ .~C>.'. ..............
10 Date of Purchase k .c3.(o~B. Name of Former Owner
11 " · or use district in which pr~mises are situated
. Zont ......................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: .. ,t,4 Cb .........................
13. Will lot be r~graded ....... ~,~ ................. Will excess fill be removed fro~ ~:~e~2.mises: ~ No
14. Nmne 0f O~¥[6~r no¥[~r~e~l~[f~,~_ .~,.~:¢~..~.. Address'~..;>.,fg~>~ .~_,.';.\. ~'~h-~ No.."~..~q_~,',',',',',',',','~?.-:
Name of Architect ff:,~,.>. --r~&~.....--~....~ ........ Addres~ .o.,.~;;q::~e,¥~, .~on~o..'~D..'~..%t~.~'Z,...
Name of Contractor Address ' Phone No
PLOT DIAGRAM
Locate clearly and distinctly ali buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and blocklnumber or description according to deed, and shvw street names and indicate whether
interior or corner lot.
STATE OF NEW YORK,
COUNTY OF t~.. ~?..~?.:~:, ..... S.S
~ (Name of individual sigoing contracO
above named.
...... being duly sworu, deposes and says that he is the applicant
He is the ........ c~.'>~,, ..> ~9,=,_~-~,I ......... . ....
(Contract~rl ;~;~t', ;;;~;[a't; ~fbi;;;,'dt;.~ ............................
of said owner or owne~, ~d is duly authorized to perfom or have perfomed the said work and to m~e and file this
application; that all statements contained ~ this application are true to the best of his Biowledge and belief; and that the
work will be performed in the m~ner set forth in the application filed therewith.
Sworn to before me this
.. 4
..........................
y Public, State of New ~ork ~ .~ · · · ~ ...........
No. 4~2180 ~ ~- ~ C~ (Signature of applicant)
~lified in ~uffol~ County.
~sion Ex~tres ~eh 30, 19g '7
OCCUPANCY OR
USE ,IS uN~WFUL
WITHOUt' CERTIFICATE
OF OCCU?~NC¥
NOTI~' ~L~IL~!NG DEPART~4ENT AT
II
~0
~o~
MU'ST BE
PROSECT',,,, ~ :-"