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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 2-20778 Date JUNE 9, 1992
THIS CERTIFIES that the building ADDITIONS
Location of Property 395 SEBASTIAN COVE ROAD MATTITUCK, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 100 Block 3 Lot 11.2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 10, 1991 pursuant to which
Building Permit No. 20010-Z dated JULY 11, 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 DECK & GARAGE ADDITION TO EXISTING ONE FAMILY DWELLING
The certificate is issued to PETER STOUTENBURGH
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-233738 - APRIL 24 1992
PLUMBERS CERTIFICATION DATED N/A
y B ding Inspector
v
Rev. 1/81
WORM 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 a 20010 Z Date ...........1-4m 1911.
Permission is hereby granted to: i
rXl.i7ls~d'7...... 4tz..
to .....................................4.... ~45. . .....°5,.~91, ea c~R...A~ct4. ...L.P....4c!cl..
ma~y-~---- d ~~pp
at premises located at ..9 fig.......................,.... ....:Y...
..0./.5 `..r' Y ~ .
County Tax Map No. 1000 Section I.9P........ Block Z-56... Lot No t:
pursuant to application dated ....LQ 193.1.., and approved by the
Building Inspector.
Fee $
.
Bull ng Inspector
Rev. 6/30/80
c, ' Form No. 6
1 y!~ TOWN OF SOUTHOLD
BUILDING DEPARTMENT
1
lit JUN - 3199Z
TOtJN HALL
+ll \N, 765-1802
APPLICATION FOR CCRTIFICATI: OP OCCUPANCY
This application 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 contains
less than 2110 of 1% lead,
S. Commercial building, industrial building, multiple residences and similar buildings
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.
0:1. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
"pre-existing" land uses:
1. Accurate survey of property showing all property lines, streets, building and
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,
Alteration's 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
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential y$~115.00, Commercial $15.00
Date ..~/6 -;Z .
::ew Construction........... Old Or Pre-existing Building. ~j
Location of Property... 95............ 554 a ?ek ,1!!!~r,~ &CC /
House No. Street
d Hamlet
Unwer or Owners of Property..-4P' .G~PC SJLCG!
:uunty Tax Map No 1000, Section.... l~a..... Block , Lot..
:Subdivision IK?kJ ...........1j/...Piled Map..~C~ G.~.7L,Lot... "
Permit No. bd.~D.--..Date Of Permit714X, / ......APplicanc~r9~!!~~
!!ealth Dept. Approval ..........................Underwriters Approval.........................
:Tanning Board Approval
,equcst for: Temporary Certificate........... Final Ccrt}C` te...........
:'cc Submitted:
{ ,K, yg030 C /J APPLICANT
eo2:ao77e
- - - - - - - - - - - - - - - - -
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1t1 C~; i~93 BUREAU OF ELECTRICITY
85 JOHN STREET. NEW YORK, NEW YORK 10038
Date APRIL. 29,1.992 Application No. on file b4409589i N 233`/;38
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number in the premiers of _
PETEC 5"O11TEJBERG, SEBASTIAN'S COVE; RO., OTD POLEWYC, NATTTTUCK, N,Y,
in thefollowing location; ? Basement 0 let Fl. ? 2nd Fl. GAR Section Block Lot a
was examined on APRIL 2 3 , 19 9 2 and found to be in compliance with the requirements of this Board.
FIXTURE RXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUSTFANS
OUTLETS KEPTACLES SWITCHES INCANDESCENT FLUORESCENT OTHER AMT. K. W. AMT. K. W. T. KW. qMT. K. W. AMT. H.P.
12 r
_ a
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS 'y
SYSTEMS
AMT. K. w. OIL N. P. OAS N. I. AMT. NO. A. W. G. AMT. AMP. AMT. AMPS. TRANS. AML N. P. NO. Of FEET AMT. WATTS
SERVICE DISCONNECT NO.OF S E R V I C E MET ANT. AMP. TYPE EQUIP. 1-e 2W 1 % 2w s % xW S % AW NO. OPER %COND. Of CC. COND. NO. OF HI LEG A. W lCO NO. OF NEUTRALS OF EUT IAL
1 ?4'0 CE I S 1 2;Q 1 2x0
OTHER APPARATUS:
FANELBOAROS;I. ; CIR. 1.00
G.F.C.Ic-2
X~
GA6Y 00ROSK1 GtC,f2941-E
425 NONSELL LANE
CUTCHOGUE, NY, 11935 GINIM MANAGER
l
Per 1
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
f /tP~1P/ll~tt~ 'fv/~2 Pact
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Environment East, Inc.
R. R. No. 3 - 3075 Indian Neck Lane
Peconic, New York 11958
516.7347474
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BUILDING DEPT.
INSPECTION
[e] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
cau
DATE INSPECTOR ~
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOU DATION 2ND [ ] IN TION
[ FRAMING FINAL
REMARKS:
DATE fAQ 2,-- INSPECTOR
D nC ON IfDAiE 1 COa11MLNT°
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FOUNDATION ( 1 ) ~[~J
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FOUNDATION (2nd)
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PLUMBING }n(rn
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to
INSULATION PER N. Y.
STATE ENERGY
CODE
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FINAL
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ADDITIONAL COMMENTS: x
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R. R. No. 3 - 3075 Indian Neck Lane
Peconic, New York 11958
516-734-7474
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"Rx NO. a
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°- 18037 Z Date 1 19.~.A
Permission is hereby granted t~o:. J G
N.:y...........
,..t.9 s.
to
;
at premises located at ...%93.a;... I........... ........I................... V4-
...I..C.....' :fit. .'La.....Z)4.'.:~. 2-: :1...........:J
County Tax Map No. 1000 Section LU??........ Block .....a......... Lot No.. y.........
pursuant to application dated ........l... - 19. c. , and approved by the
Building Inspector.
Fee $.1..~?.r.:.s...
cif ac
Building Inspector
Rev. 6/30/80
i
D • • BOARD OF HEALTH
3 SETS OF PLANS
set FORM NO. 1 SURVEY
, TOWN OF SOUTHOLD CHECK ..1... .
BUILDING DEPARTMENT SEPTIC FORM
a G. DEPT, TOWN HALL
TOWN OFSOU*OLD SOUTHOLD, N.Y. 11971 NOTIFY
I/~ q I TEL.: 765-1802 CALL .....23 y, ,
Examined I MAIL TO:
• ,Ad O 1 O ~
Approved Permit No-
Disapproved a/c
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date A?riI .6........, 19~1
INSTRUCTIONS
.
a. This application must be completely filled in by typewriter Orin ink and submitted to the Building Inspector, with
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 stree
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this app
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 perm
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 Occupant
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 tt
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe(
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t
admit authorized inspectors on premises and in building for necessary inspections.
_py~ponment -ast= Irlc:
(Signature of applicant, or name, if a corporation)
307 Indian Neck Lane
Pe c.oai c , .:?X .11958 .
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
~.n ttrFtctor
Name of owner of premises Pe to r..F., , S t.qU G~ bur f h• .
(as on the tax roll or latest deed)
If applic nt 'S/a corporation, signature of duly authorized officer.
t 4 ~a President
.1'.L
(Name and title of corporate officer)
Builder's License No. . f555611I
Plumber's License No .
Electrician's License No . .
Other Trade's License No .
1. Location of land on which proposed work will be done.
395 Sebistian Cove :Road
at.tituoic...............
House Number Street Hamlet
County Tax Alap No. 1000 Section 100 Block 3
Lot. ..11.2............
Subdivision . Seb„ stun Cove Fled Nlap No. 220 2
(Name) . . . . . . . . . . . . t Lot
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .:Z q4. J.:*a`_ly..dwe7) itals...... .
b. Intended use and occupancy .Qn~. f a?~ l ,c)1a~~ l nf• faith f araf . e
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