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A
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20481 Date JANUARY 15, 1991
THIS CERTIFIES that the building ACCESSORX
Location of Property 300 INDIAN NECK~LANE PECONIC N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 86 Block 4 Lot 1.6
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 27, 1988 pursuant to which
Building Permit No. 20085-Z dated AUGUST 13, 1991
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 ACCESSORY INGROUND SWIMMING POOL & FENCE WITH DECK AROUND
POOL AS APPLIED FOR.
The certificate is issued to RALPH & ELIZABETH SCHEIDER
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-219197 - JANUARY 7, 1992
PLUMBERS CERTIFICATION DATED N/A
~ G
Building Inspector
Rev. 1/81
FOBM NO. f
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N 2 0 0 8 5 Z _ Date I9.?,l.
Permission is hereby gran ed o:
of premises located at 3~,p..........~~f ,
.
County Tox Map No. 1000 Section .....(J.~........... Block ............T........ Lot No........1..°...~~........
pursuant to application dated .......~~1:~.~ 19~., and approved by the
Building In`spector. /
Fee 5.~/.1~:1..Do~.. ~ C y
9..
in I for
Rev. 6/30/80
Form C;o. 6
_ ~ i lam` ~
; ~1 i~; i"~ ~ TOtJN OP SOUTIIOLll ~
- ~ BUILDING DBPARTNGNT
13,~,f;) eil TOWN HALL
' JAN ~,.s..,~.. ~~.:e;~ ~6s-lao2
14m
S
APPLICATION FOR CGRTIPICATti OF OCCUPANCY
1. This application must be filled in by typewriter OP, ink and submitted to the building
inspector caith the following: for new building or new use:
1. Final survey of property caith 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 L'oard of Pire Undenariters.
4, Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of 17 lead.
5. Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Compliance from architect or engineer
responsible for the building.
G. Submit Planning Board Approval of completed site plan requirements.
.i. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
"pre-existing" land uses:
t. ,lc curate survey of property showing all property lines, streets, building and
unusual natural or topographic features.
~ 2. ,1 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.
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
1. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
4, Updated Certificate of Occupancy - $50.00
S. Temporary Cert/ificate of Occupancy - Residential $15.00, Co pmmercial $15.00
.V.... Date ..........y~~~~/a~
':cv Cunstruction.. Old Or Pre-existing Building.......
!.ocatian of Property 300;1/Ic~iGU'1, (]JACK,~ct :................~~C.on~e....... _
House N//~~o~~. ~S~7treet / hamlet
.;over or Owners of Property.!IFG~fJM. c; ~~(Z!LDGv'!. UC,~~jq.~{
~:uunty Ta:< Nanp No 1000, Section.. Q g(P.......Block...,,y,,,,,, ,Lot.....1;~
;ubdivlsiun.TCCsc~'~nic. ~ScW. Co ................Filed Map...~i59....Lot.....~.~.w..............
Pcrmlt :;o. ~OODS":Z-...l.Date Of Permit.~:~~~.:G~,,,..Applicant.~~l~:?R~~`:'1.4~.~=.~/~l~leF......
:icalth Dept. Approval ..........................Underwriters Approval............/.............
•':.uuiin~ I;oard Approval
~equest for: Temporary Certificate........... Final Certicate...........
..oo Submitted:
~~.N~~~a.y ....'~-c~:- ~:v
~ n~ r~ 0 y 8 J APPLICANT ,
_ _ _ _
THE NEW YORK BOARD OF FIRE UNDERWRITERS Pnr~:
10004TG
BUREAU OF ELECTRICITY
- ~ 85 JOHN STREELNEW YORK. NEW YORK 10038.
JANOARY 0'1,7.992 G'+7'75.^•.90/90 N ?,19197
Dote APP/iration No. on file
THIS CERTIFIES THAT
only the electrical equipment Eu descrifAed 6ektw and introduced 6y the applicant named on the shoos application numher in the premise+ of
kAI,:PH SCHE;IASR, :100 LNDTAN idRCK (•iiNE; pCtLP 5, PRt'ON?C, N.4.
in thefollouinp krc B t ? IAt FI. ? Pnd FL Section Block Lot
i una examined an and found W 6e in complianrr with the rwtairemenra of this Buord.
NXTURE EPTACIK SWRCXES RXTURES RANOES COOKING t/FCKS OVENS DISH WASHERS EXHAUST FANS
OUTURS INCANDESCENT FLUORESCENT OTHER AMT. K. W. AMi. K. W. AML. K.W. AMT. t. W. AMT. N. P.
DRYERS FURNACE MOTORS FUTURE APPLtANC! RIRERf SMCIAI REC'IT THE CLOCKS pls UN17 NEAiERS MULiI.OUTIET DIMMERS
AMT, t. W. Oll N. P. GAS N. P. AMT. NO. A. W. G. AMT. AMP. AMT. AMPS, TRANS. AMT. N. P. SYSTMIS AMT. WAITS
NO.Of R!T
SlRVIt'~ DISCONNECT NO.OF S E R V I - C E
AMT. AMP. TTn ~I11PR t p tW t .e ]W ] l ]W 3 A AW OPER BCD' Of CC. COMD. ~ HI-LEG D{'ryl
lfG ~ NEUTRALS Of 'NEUTNAI
OTHER APPARATUS:
DLC [I1d3T Fl'P-1
ti
HII:ARY H. HOI~T,HORIJ k SON^ .,7C'.#?.55~R.
10::-5 CARSIFTON bYE.
7SLIP TRkk.; i9V, 7.'1.951: ORNERAI MANAp//Nt
it 4
Per CC..
This certificate must not be alrored in any manner; rNurn to tM office of IM Roard if incorrect. Inspectors may ba identified by their credentials.
q:
~ OOPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFIGTE MUST NOT BE ALTERED IN ANY MANAER.
INSPECTORS r
Victor Lessard y~J~^+,jFFE1,~-~
Principal Building Inspector
Curtis Horton i~l? SCOTT L. HARRIS, Supervisor
Senior Building Inspector t(o .
N u~ "~s--,, e ~;7~ ~ ' Southold Town Ha11
w e ~ ,..~,a,. T
Thomas Fisher " " P.O. Box 1179, 53095 Main Road
Building Inspector ~ `'ew ~ Southold, New York 11971
Gary Fish .d Fax 516 765-1823
Building Inspector ` sY ( )
Vincent R. Wieczorek Telephone (516) 765-1800
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
JANUARY 8, 1992
RAT PA 6 ET,IZABF.TA SCAF.IDER
300 INDIAN NR.CR LANE
PBCONIC, NY 11958
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
xAR An application for Certificate of Occupancy is
not on file. (Enclosed)
1CtY No Underwriters Certificate on file.
xxx The check is not on file.) $25.00
No Health Aepartment Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 20085-Z
Please contact our office on this matter. Thank you for
cooperation.
50UTHOLD TOWN BUILDING DEPT.
_a _.v . _ _ .~,~n,;.m~;.:;
r1ELD It:S:'EC:IUN ~~UATE ~ i;Oh(MENTS
r a
7. ~
3
H
_ _ _ y
FOUIIDATION (1st)
~'L
ti~i~
FOUNDATIOt1 (2nd) - m~
2.
z
o n„
ROUGH FRAME & `a~'
PLUMBING
H
3. ~
m b
H
I1ISULATIOf! PER N. Y.
STATE ENERGY
CODE
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A ITIONAL COMMENTS: x
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+ OCCUPANCY Ott ~ ~ ~ n
v~~ ~ USE IS UNLAWFUL ~ ~ -:~~~a: ~ ~
~ WITHOUT CERTIFICATE ~ ~ ~
OF OCCUPANCY
EEUOYNt ASf NItd,7~ y~~ ~ ~
r
rsS-iso2
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION iST [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INS TION
[ ]FRAMING [ INAL
REMARKS: ~ ~ F
DATE INSPECTOR
7~5-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION i5T [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INS TION
[ ]FRAMING [ INAL
REMARKS: -
DATE INSPECTOR ~
, ~ . , _A. f_._. wy~d_re . . ,.r_
-THE NEW YORK BOARD OF FIRE UNDERIINRITERS pArF,
~i~o~ ~>i
BUREAU OF ELECTRICITY RK
A111>il„T 1485 JOHN STREET, NEW YORK. N~b~~.'~tn LS1~fP~ N t)2,?5l J
Date Application No. on file
THIS CERTIFIES THAT
only the electrical equipment w described 6ebw and introduced by the appNcant nomad on the a6oce application number in the premiser of
RALPH SCH'I:Il3$R, i00 T.Fd[17AFi N~p,Y'K bANB. Pt)i,i4~NY9'S. uF;C"I?IFCC, ti.Y.
n OiY'J'
in thefolbteinR brea~j~rY 1-I~.4yR~ent ? /st Fl. ? Ynd Pl. Sertion Black Lot
uns examined on and found to 6e in conlplianre with the requirements of this Board.
q%TURE WXTtJRES RANGES COOKING ORC%S OVlNS DISH W EXHAUST FANS
OUTIETS lCBTAClES SWITCHES INCANDESCENT ~ IlUOI1ESCENi v AMT. K. W. AMT. K. W. AMT. K.W. AMT. K. W. AMT. N. P.
DRYlRS RIRNAC! MOTORS gliUR! A/g1ANC! R;laRRS f/lCIAI R[C'FT iKlt! ClOC1[4 RlLL U1ai HEATERS IAUITIAUTIlT DIMMlRS
AMT. N. W. Oll N. P. GAS N. I. AMT. NO. A. W. G. AMT. AAV. AMT. AMTS. TRANS. AMT. N. P. ~5 T AMT. WATTS
1
SlRVICE DISCONN[CT NO.OF S E R V I C E
AMI. AMI. Tl'Pt 11 Z'e t F SW ~ B SW 3 / IW ~ER BCOND. OF C
CGO~i-ID. NO.Of N4lEG HI's NO. OE N[UTRAIS a
~G..
M OTHER AMARATUS:
6.Y.4'. T._{
A{t;iJ.I~MMT~N6 lai)O,I.} 'I'};jc ~.ntl7-3icatF _ _ - -
rravprs rnmpl attre aC the <Iatw o%
~irwnecticlrt only. P.a>rAarsa of tlalavual
_ ~*srvT.ronlnPncs 3t is advis~ahltt
have fregtlant testlanli or x-~~rair<:
n_il4s tty ~ gv:~litied Iasrsnn.
°l
d(JDY PI11~T-(FLU
PAT LANE
t3ATTiTItf„K, NY . 7 1.`+t+? lE~~
_ i l MANAEIER
I,[<'I;'NSR NO. 23tT0 F. Per
This cartifcaM must not be ahered in any awnlrr; roWrn to the office of tln bard it incorrect. MspMors may be identiiiad by Nlair cradaMials.
s
COl~f FCR Wit.DNIG OS~. TlNS Cr'IrY OF C~TIfICl1TE MYST NOT ALTNMAMY IMNI~t. - _ _ j
absai xo. a
TOWN OF SOUTHOLD
BUILDING DEPARTMEN4
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON 7HE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
O 01718 Z Dote I ~ 4
~ ~ ~4tr~.l.....~ 19.......
Permission is hereby granted to:
k...y 3....~.... d`!~.
,
n /J
A
ct premises located at ~...~I~JK.a:-ra...~R-4.f.~..... . ~R:......~s.~:~:.".`:~.~
County Tax Map No. 100~tion .......Q Block Lot No......~.l.
pursuant to application doted .......~/.~Ll.K1R....°~.~ 19~ g.., and approved by the
Building Inspector.
Fee $•LA~~
~dL
. .
Building Inspector
Rev. 6/30/80
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~ USE IS UNLAWFUL 's,' ~:~b~~, ; ~ ti,4,,,
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BOARD OF HEALTH
D 3 SETS OF PLANS
FORM N0. 1 SURVEY .
TOWN OF SOUTHOLD CHECK •''•110.6• • r~~d
2o-A,a r if c~v`'~i,~
~'Z ~ ~ BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL NOTIFY
1oDWN~OF .DEPT; SOUTHOLD, N.Y. 11971 CALL
SOUTHOLD TEL.: 765-1802
MAIL T0:
Examined ~ ~ 19 ~
Approved ~A..f~..(...., 19~~. Permit No. I I •
. ~ / f,
~ ~ Y~
Disapproved a/c 118 Q r,~
Y ^ 4•!°.~.. ~2i~.•s6u
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date ~~~7........, 19
INSTRUCTIONS
a. This application 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. Upon 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 ins ections.
(Signature of applicant, or name,'if a corporation)
(Mailing address of applicant) ~ ~ 9~° Z
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises .
(as on the tax roll or latesbdeed)
d./3,i. - i/' . '
If pli t is a corporation, sign ture o duly authorized officer. ~ ;,vtt ~~9r1~4~. F~!.zs:: ~ .
ti
~F`~a '~.Pt~~r~~< :313 Y-5Y: t
(Name and title of core e officer) ~~i'S~is`~~r',~<2'v'i~`~irf,;z ' =
ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY 'LICENSED
Builder's License No. ...'~~2.->..~.~-.~....... .
Plumber's License No . ,
Electrician's License No. . ~d n~~ ~z~~~~ C-
Other Trade's License No . ~\13a~
1. Location of land on which proposed work will be done. .~~/.~h! ..~L~~ ...~•.d.~~?L .
House Number Street ~~yy Hamlet
County Tax Map No. 1000 Section • •Qb.~. Block Lot ` f. .
Subdivision Filed Map No. Lot .
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .~L.L~~~~'wTL~L•••••••.•••••••••••••••••••••••••••••••
b. Intended use and occupancy f.4~~L~~"~ T~°~~-, . - ..I~Qq.~...... .
~,i r W ~ rv~ K. InIC /706c
( plicable): New Building Addition• '~S . .{y ~ .
3. Nature of work check which a
Re azr Rem ~ 1l.',-.:_,.~ a
p oval Demolition 4 t r:-r :`"O£Tier Work a.~. ~ .
!
iF p ~ 1 .3
4. Estimated ost
a Fee........'-.,,~....'..:..........:............
` (to be paid on-~),ing this applioation)
5. If dwelling, number of dwelling units Number of dwelling units on each -floor .
If garage, number of cars .
6. If business, commercral 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 ............e..'....................'.:................... .
Dimensions'of same structure with alterations or additions: Front Rear .
Depth L ..Height Number of Stories .
8. Dimensions of entire new construction: Front Rear Depth .
Height NutStber of Stories .
9. Size of lot: Front ..........I........•..'..' Rear Depth
10. Date of Purchase L ..................Name of Former Owner .
11. Zone or use district in which premises are situated ............./.Z~.l.!JG^.!Tl.~4:..................... .
g late an oning law, ordinance or regulation: .
13. W
11 lot bee radedpructton vt~ Will excess tll be removed from premises:
No
14. Name of Owner of remises G~7!/. ~./J.4~:~..... Address ...~~.~-S~l!' 4 .....Phone No .
Name of Co tractor ./.9:- • ' ' ' ' ' ' ' • • • Address Phone No.. .
P p y '1.44Y. f:. ~wJ ..Address . ~??147~1• PW. .Phone No..~~~.~ld.~s~
15. Is this ro ert lacatedlwithin 300 feet of a t__gidal__ wetland? *Yes No
*If yes, Southold Town Trstees PermitPLO~ DIAGRAM ed.
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.
APPRpVED AS N07ED
DATE• ? I pig Ci.P, tl ~ ~ Z~
FEE /S"y, BY, _ Q.1.,.~
NOTIFY BI/IL.DING DEPARTMENT AT
7E;5. t8()2 13 AM TO 9 PM, FpR 7HE
FOId.pUUING lNSPECTlpN~l
1. FUUNDATION TWp REQUIRED
FOR F'pURED CONCRET
2. ROUGH -FRAMING & F~LUMBING
3. INSULATION
4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHgLL MEET
THE REQUIREMENTS Qp THE N.Y,
STATE CONSTAUCTtplk A I ENERpY
ca°EB' NOS wR OCGUPANGY OR
DESIt3N OR CONBTRUC'RR~~ ROBS
USE IS UNLAWFUL
! WITHOUT CERTIFICATE
STATE OF NEW YORK, ' S.S OF OCCUPANCY
COUNTY OF
IL being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named. ~
He is the
~I (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 coniCained 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.
Swom to before me this
Notary Public, 1~-~-&+~~a .1~.~..~•G l~'.!~-:.... County
NEIEN K. D
e
to~Idew Yak
99ff
NOTARY PUBLIC, Staf
Term
Exgres Merch!!'~0. joun r'e of applicant)
U ~ 'Aid t 31$91 _ ~ I
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