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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 219771 Date MARCH 4, 1991
THIS CERTIFIES that the building ADDITION
Location of Property 530 SCHOONER DRIVE SOUTHOLD
House No. Street Hamlet
County Tax Map No. 1000 Section 71 Block 02 Lot 08
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOV. 28, 1990 pursuant to which
Building Permit No. 19552Z dated NOV. 30, 1990
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 ADDITION TO EXISTING ONE FAMILY DWELLING.
The certificate is issued to JUDITH KOCH
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. PENDING SLIP 3/4/91
PLUMBERS CERTIFICATION DATED N/A
Building Inspector
Rev. 1/81
ny
FORM NO. i
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)
N2 19552 Z Date ..V...... .a 19.2e
Permission is hereby granted to:
~..Y(l
. . . . G~ . . ! t!? .
J...... . .s.t r.^.. ....ll
to . r
. . . .
`
at premises I at .........../~)....c~ A
.
County Tax Map No. 1000 Section ..~J.~~../...... Block Lot No. 71W. t5
pursuant to application dated 44A.Q•'ze-0 ....6;U......., 19.f1, and approved by the
Building Inspector.
Fee 3w1~.•••••
Building 1 or
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A, 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 2/10 of 12 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.
6. Submit Planning Board Approval of completed site plan requirements.
3. 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.
G. 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
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 $15. O, Commercial $15.00
Date ....Ak .
'ew Construction. AWA O ; Old Or Pre-exij~iting Building „
ocation of Property ....n..'~c~nob(1p~ ?J~._ .Sq
House No. ~~nn Street Hamlet
nwer or Owners of Property. ~ V<A. c.. t~." „
ounty Tax Map No 1000, Section.. S „ Block...., g
II(( p~-~' Lot.....,//........
ibdivision...~G~ 1301L t~, ................Filed Map. 1 Z ..Lot.....[.......
!rmit No. ~a55Z Z .,,Date Of PermitAV.3,0 ,q,0
/ ......Applicant. L..-RG4).. yG;t S,.........
!alth Dept, Approval... 4V ...................Underwriters Approval „
`anning Board Approval ...,IlyyJJ
uest for: Temporary Certificate........... Final Certicate,~,
Submitted: 0? .
. APPLICANT
eo Z,/f72/
Izr7rh TEL. 765-18o
oSS~TOWN OIL SOUTHOLD
, z : V~
6Lii11 a _e 01.17ICE OE BUILDING INSPECTOR
u P.O. BOX 1 179
TOWN HALL
SOUTIIOLD, N.Y. 11971
February 14, 1991
Edward E. Williams
150 Seawood Drive
Southold, N.Y. 11971
RE: Koch, Judith
To Whom This May Concern,
Wo are unable to complete your Certificate_
of Occupancy because of the following reasons.
An application for Certificate of occupancy
/ is not on file. (ENCLOSED) .
/lo underwriters Certificate on file.
/~?7/ The Check i:: ( /not all file.) $25.00
No Health Dept. Approval on file.
No final inspection has been made.
Please contact our office on this matter.
Thank yoti for your cooperation.
Ilu.ildir,g Permi.Y. It 1 9 5 5 2 Z
Building upt.
No Plumber Solder Certificate on file.
( all permits involving plumbing being
issued after l\pril 1,1984 )
aisTaaaF~'!rre..+.nX4?FV1WaiR.y`4a+`~h+biYww:u;,.~s.~wWS.:,., iw arm .+nv..:aTUn~ti,.. .-.,s..svksbbis.l;dii':ii2wiia'srsci&'wYi.ss!a`.:.5~..`.:~
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
85 JOHN STREET. NEW YORK, NEW YORK 10038,
Date MARCH 1.I)N! Applieotion No. on file t2, 0„8R.9 1' / q I N 171771q&
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
xFORGE, ICC%CIT, 530 "Hi10i"Y:k~N, Il@ll'V'ki, (>[P'('3ft;C1?7, 14. Y,
Basement 0 1st Ff. ? 2nd FL Section Bork Lot
in thefollowing location? ? GA1{
uws examined on and found Co be in compliance with the rrt[uiremeats of this Board.
FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKINGDECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCANDESCENT FLUORESCENT OTHER AMT K W AMT K W AMT KM AMT K.W AMT H P
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIALREC'PT TIMECLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
AMT WATTS
AMT. K. W. OIL H. P GAS H. P AMT NO A W. G. AMT. AMP AMT. AMPS TRANS. AMT H P NO. OF FEET
SERVICE DISCONNECT NO. OF S E R V I C E
AMT. AMP, nee METER 1.0' 3W 1 ,0. 3W 3,0 3W 3,R' dW NO OF CC COND. A. W G. NO OF HI LEG A. W G NO OF NEUTRALS A W. G
EQUIP. PER d OF CC. COND OF HI LEG OF NEUTRAL
OTHER APPARATUS:
a
~ 5A,(iNi & LF~LII'~@'(A4~Tlt IIP~~> L1.Tf'.If.56;1?)-~~
I 200TF3OIJ), flit', 71971 GENERAL MANAGER
i Per T'-Y-" , -
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.
I COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
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PLUMBING
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:NSULATION PER N. Y.
STATE ENERGY
CODE I '
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FINAL L
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ADDITIONAL CO,Y, ENTS: x
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7GS-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST ( ] ROUGH PLBG.
FOUNDATION 2ND V4114SULATION
[4-`F~AMING [ ] FINAL
REMARKS:
DATE INSPECTOR
I
765-1802
ILDING DEPT.
SPECTION
[ FOUNDATION 1ST [ ] ROUGH PLBG.
L ] FOUNDATION 2ND INSULATION
[ ) FRAMING FINAL
REMARKS:
INSPECTOR
~ DATE
k
SU
OWNER: FF, CO. HEALTH DEPT. APPROVAL H.5 . NO,I~'`"
~r
11}
l,r AREA: T
DEED: ,"vr~l7
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SCALE:
11
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i 1 I® "S SURVEY IS A VIbE~A~ ~ Y
11'irvON 720 EM THE NEW YORK STAY,
~IE2A1Kw SAW.
i k Ltw" SERtVEY /A,1? NUE SF.yHED
~1R'fEroRS IW b SEA, OR
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{ ~i 5...~ ~ v 1• ~D'MRMikESVNOtC
r AHD' N!'kltJA%`
f E +TCyTN8 ND ON FOR WHUITa
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/J) l/f~*rQmmmya d.hT
I I ' D„tiN µdNSTITUTiUN FASTED NfRAa
TITLE u"OVFRNMEiJI.AL ' p
CERTIF. =t;,'S(.~`G-01 G,$)1 mUL. Uo"minis Mf llfaUING INST.
(h V)!"[ 1-or 1 ARE Nor RA
UDti1t711,ARAMR K:Mer~n
I I i •3S YtII-pa,I
' ra:~i._~ ~":i'*`,',;:(t' h/::Ch ..,f L:.:: ..7• ~..1U21'Y(TCPFt,'r,'tC~ t'C,T •~rIG QVtlTia"~'~% SI ATeI)°
Chicago -7"1'+Iu litL~>uvaact! C'<f>rbcVt4l SEAL
-1tJ
EI)yvlf 1:,v" k ~7fJ)]'.9 ~f: C:i?. f^l~i? lY~:.YI(,, et ~~v.,?~ _
RODER[CK VAN TUYL, P. C.
LIC. LAND SURVEYORS.GREENPORT, N. Y.
! 4>/T..)!/~ C:o. ~~/X lvAr~ r.:~:..•art:rt:.r, C:>,' t;;ri: :3.5et.:1Ic~J71,~3i:.:.i:.' :i., M--r.,,L.l
TEST HQ. E SUFF. CO. DEPT. OF HEALTH SERVICES STATEMENT OF INTENT
i
o'
/ FOR APPROVAL OF CONSTRUCTION ONLY
Flie'P" THE WATER SUPPLY AND SEWAGE
Yt?Cr C~. ^ DATE: DISPOSAL SYSTEMS FOR THIS REST-
' SC1<. DENCE WILL CONFORM TO THE
-j%f IGY:I
tHU~~ H. S. REF. NO.: STANDARDS OF SUFFOLK CO. DEPT.
OF HEALTH. SERVICES.
APPROVED:
i
enPal rre nlT
rM. BOARD OF HEALTH 3 SETS OF LANS FORM NO. 1 SURVEY
2 TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC FORM . . . N/A..........
TOWN HALL
BLDG. DEP7' `'OUTHOLD, N.Y. 11971 NOTIFY
C TOWN OF SOUTHOLD
TEL.: 765-1802 CALL
hg MAIL T96WARD E. WILLIAMS
Examined
8UILDING
ISO SEAWOOD D IVER
Approved 191.. Permit No. ./.k. Z SOUTHOLD, N.Y. 11971
Disapproved a/c
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date . Nov...2 F? 15`,1,0.
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 inspections.
.~I?VYI. ,.~?1Ll tA!tis...........
(Signature of applicant, or name, if a corporation)
So. SfAwovD...,.
(Mailing address of applicant)
State whether applicant is owner,4- lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
6 Uit Z
.II./n....../....u
Name of owner of premises -T-A \rc; ~q .
(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. J 3 / O ?~...u
Plumber's License No.
Electrician's License No.
Other Trade's License No .
1. Location of land on which proposed work will be done . ............../.DD..o.. .
5 Sc ooh flL QR SOV'f- ld
House Number Street Hamlet
County Tax Map No. 1000 Section Block ..z Lot r'
Subdivision ....h~~ o2 t`~l .tS Filed Nlap No. . y Z /
Lot
(Name)
2. State existing use and occupancy of premises and in use and occupancy of proposed construction:
a. Existing use and occupancy ! FAt"t` `1; •
.
b. Intended use and occupancy • g£D.2oc)wt.... . et,(-*,
~il~ i11ii~ rAf t
I
3. Nature of work (check which § t-~~ if1
applicable): New [luilding
Removal , . w,
Repair Addition
Demolition , • . ' Alteration .
Othei.fy.11........ .
rn/ (Description)
4. Estimated Cost . .oC. :~t.D Feet/ df o .
(to be paid on filing this application)
5. I
If garage, number of f dwelling, number of dwelling units . Number of dwelling units on each floor .
6. If . Dimensions mmercal r or mix' . occupancy, specify nature an .
business, co red d occu occupancy,, specify cify nature ure and extent of each type of use .
7
of existing structures, if any: Front \ • , . Rear . . . Depth
Height :q!r, . Number of Stories 1 .
Dimensions of same structure with alterations or additions: Front Rear Depth . Height ...4. ' Number of Stories ( .
8. Dimensions of entire new construction: Front . , . Rear . , f.4 Depth .aa~.
Height el c? . Number of Stories • .
9. Size of lot: Front !,'21.77:......... Rear.....vd.......... ........Depth.....
10. Date of Purchase Name of Former Owner .
11. Zone or use district in which premises are situated
12. Does proposed constructio violate any zoning law, ordinance or regulation: . N°.
,
13. .
Will lot be regraded P G7 ' , • Will excess fill be r moved from premises: Yes EO:
14. Name of Owner of remises J1, , , Address !Fc4g tA. 01. P..... Phone No.. ( 765:
Name of Architect G"02. Address . . Phone No. .
Name of Contractor . rz ?t , , iG G!prhr . Address . Phone No.
15.Is this property located within 3qefeet of a tidal wetland? *YES ....NO...
*If yes, Southold Town Trustees Permit may be required.
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.
~ S
I
I
STATE OF NEW YORK,
COUNTY OF I S.S
(U
D ~ 60)afht the applicant
'''•~'''''•••..•',S••••••••••.•.•.... being duly sworn, dePosesandsaYsthatheis
(Name of individual signing contract)
above named.
He is the ...ow{"ewri
(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 contained 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.
Sworn to before me this
v I
!°Z.4.. dayof,,.......... ~ 'k 19
Notary Public, Cl~! County //panll
1 : C{ v ! . . . ( .
VNIMM 0 (Signature of applicant)
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REQUIRED A~F+1'tdtpTDASNOTEd9 f Y ~ AY
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hN'~J S.e+u e
f?UlLblhlG DL_-PARTMEN AT
cr±-i80" E AM TO 4 PM FOR THE . - - - +r 1 n4NJd(, IN SPF_CTIONS;
TWOREQUIRED _
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-v ' SSLLAiION c}y \ c 395 ~ _
- [ i.,hL CGhS7F~UCTION INUST RE COPPLETE FOR C.O. 2fl 4t 'F~xEn ~"~.L9Im~w t ._.....+4~..7::~~ t Ye+.MYR~~~~i r T ~~S1~ ~y~i
ALL CONSTRUCTION SHALL MEET _ 1 " i~ r tJ t o ~"NR.rto- J.'W~9`'Y~y"&,y r s
- - - - 'VHE REQUIREMENTS OF THE N.Y. ? F` K
\ _ ~ i h_ ~~h-1 I STATE CONSTRUCTION & ENERGY
COgQ2S. NOT RESPONSIBLE FOR - FRJ I ~ k
DFS41N OR CONSTRUCTION ERRORS F SC s S.5 .I
t7kisTlu *'3u'>I-rJG P~OViGE yV r2h PLUMBER CERTIFICATION
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E! yrlt `'4'f" ~t sJl W F r -i ~ ~e
CERTIFICATE- OF_00ECUPANCI`
SOLDER USED IN WATER
SUPPLY SYSTEM CANNOT \
EXCEED 2110 of I% LEAD. I
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