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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 218374 Date SEPT. 14, 1989
THIS CERTIFIES that the building ADDITION
Location of Property 2900 SOUNDVIEW AVE. MATTITUCK
' House No. Street Hamlet
County Tax Map No. 1000 Section 94 Block 02 Lot 02
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 7, 1989 pursuant to which
Building Permit No. 184002 dated AUGUST 18, 1989
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 ADDITION TO AN EXISTING ONE FAMILY DWELLING.
The certificate is issued to MARION KUEGLE
(owner, )
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
uilding Inspector
Rev. 1/81
rows xo. s
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 Q 1.8 4 0~ Z Date ..Q.~~ ~ 19.r.~.~
Permission is hereby gro ted to: v
' rr~~~.
1J~.ta G.t~li~°~~..~.~,.: ...r:~r~.....
.
at premises located at ......~G..~(~.T,~ ~.€.~~e~...~.Q~!'®........................................
.............................................~..~~...~..y
.~...~/~:5~~.~...........................................................................
County Tax Map No. 1000 Section f.......~.7..°::.. Block ......`~..........~eL^ot No...E~~...'.~
pursuant to application dated ,.....~1...6~ 19..A~., and approved by the
Building Inspector. JJJ
Fee
m"'~
ilding for
Rev. 6/30/80
TOWN OF SOUTHOLD ~ SEP
BUILDING D1;PART2/ENT
TOWN HALL BLUG. DEFT.
TOWS
06= SOUTHOLD
SOUTIIOLD, NEW YORK 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCIIPANCY
q~i1 ~~`T
DATE
NEW CONSTRUCTION .......OLD OR PRE-E%ZSTIN/~))G BUILDING. „ pACANT LAND...._...
Location of Property....~~~711',,,-....'~OUwcrl!/CW _ /~yP__.,_~~j"/,.~~c~C
HOUSE NO. STREET HAMLET
Owaer or Owners of Property.....~.U'd~Y//lOA/__.~~~~~~
'County Tas Map No. 1000 Section ~.1,. Block ~
Lot~...Z.....
Subdivision Filed Map ........Lot...____...
Permit No. /~~pa 1 11 J~ I
.......Date of Permit ~-'•t~t.~.Applicant ..~~~„s`®r!'+ y;~°N/ac
Health Dept. Approval Underwriters Approval.......,,._...
PlanninE Board Approval
Request for Temporary Certificate Final Certificate
GK'S
dd
Fee Submitted: $ „
APPLICANT...`":
~+v~ ~"L
323 ~
9/~~/~9
rev. 10/14/88 C'0 z~~-~~~
I
' i
I
i FORM NO. 6
„~y¢ji ~ ~ TOWN OF SOUTIIOLD
BUILDING DEPARTMENT
i TOWN HALL
- 765 - 1$02
APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS
A. 'This application must bejfiled in typewriter OR ink and submitted to the Building
Inspector with the folloc~ing; for new buildings or new use:
I. Final survey of property with accurate location of all buildings, property lines,
streets, and unusual ~}atural or topographic features.
2. Final approval of Heath 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 certifyiag that solder used in system contains less
than 2/10 of IZ lead.,
5. Commercial buildings, ''industrial buildings, multiple residences and similar.
buildings and installations, a certificate of code compliance from the Architect
or Engineer responsib]~e for the building.
6. Submit Planning Board !Approval of completed site plan requirements.
B. 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, buildings and
unusual natural or top'iographic features.
2. A properly completed application, a consent to inspect signed by the applicant
and a certified abstract of title issued by a title company which shall
show single and separate ownership of the entire lot prior to April 9, 1957.
If a Certificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in wrjiting to the applicant.
3, Date of any housing code or safety inspecCion of buildings or premises, 4r other
pertinent information ~irequired to prepare a certificate.
C. For Vacant Land Certificate of Occupancy:
I, M application for vacant land Certificate of Occupancy shall be submitted,
and a certified abstract of title issued by a title company showing single and
- separate ownership of ithe entire loC prior to April 9, 1957 shall also accompany
the application. If a'Certificate of Occupancy is denied, the Building Inspector
shall state the reason's therefor in writing to the applicant.
D. FEES: I
1. CERTIFICATE OF OCCiUPANCY -New Dwelling $25.00, Additions to Dwelling $25.00,
Alteration to Dwellling $25.00, Swimming Pool, $25.00. Accessory building 525.00
Addition to Accessory buildings, $25.00 - Businesses $50.00.
2. Certificate of Occupancy on pre-existing dwelling - $100,00.
3. Copy of Certificate of Occupancy - $5.00 - over 5 years - $10.00
4. Vacant Land Certif~~icate of Occupancy - $20.00
5. IIpdated Certificate of Occupancy - $50.00
6. Temporary Certificate of Occupancy - $25.00 Residential
$50.00 Commercial
i
rev. 10/14/S8
~1c.LD II:S:'PC;iU:i ~~Unic ~OMMEN7~
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FOUNDATION .a.. ( 1st )
- C
FOUNDATION (2nd) ~
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P,OUGH FRAME &
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PLUMBING
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3 .
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IIJSULATIOt1 PER N. Y.
STATE ENERGY
CODE
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FIiJAL
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ADDITIOPIAL COMMENTS: x ~
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B0.\RD OF HE.\LTH . ,
FORMN0.1 9 SETS 0 PL.\NS
SURVEY ~
TOWN OF SOUTHOLD CHECK ~.c~Yl7, • , . • • ~ • ~
BUILDING DEPARTMENT SEPTIC FORM • ~ • "
TO6VNHALL
• SOUTHOLD, N. Y. 11071 NOTIFY
~n TEL.:7G5-1302 CALL
[xamined ..~~1 ~ 19 ~I, PSA I L TO : • • . • • • . .
f', 0 53-x. Ic?3'7.
1 Permit No.
~.I
~~t h i
Disapproved a/c ( I~ r ICI
sl?:,~ „ - 7.1989 PdlJ~
(B ildi nspcctor) • . ~ ~ • ~ • ~ TOfn°t~ OF 46u`YFipt~1~~
APPLICATION OR BUILDING PERMIT
• Date ......8. 15~i
INSTRUCTIONS
a. Tltis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with
sots 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 strce
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this app.
nation.
c. The vvork covered by this application may not be commenced before issuance of Building Permit.
Vii. Upon approval of [his application, the Building Inspector will issued a Building Permit to the applicant. Such perm
shall; be kept on the premises avai]able 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 hIADE to the Building Department for the issuance of a Building Permit pursuant to th
3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordutancas c
Regulations, for the construction of buildings, additions or alterations, or far removal or demolition, as herein describec
iita applicant a,rees p 6 mg~,y,~itJ,hall applicable laws, ordinances, buildin, code, housing
admit auzhorized i~~}~to~ on ptemises and in building for necessary ins code, and regulations, and t~
~ _ ?~O CI /AU, C.~ . ;h SOIV IHiL
~r~" ,:,js;,a ~ - ~ (Signature of applicant, or name, if a corporatton)~
..~,lild,,f, , ; (Mailing address of applicant) ~ ~Iqs y• •
State whether applic;Yht+is~to\~ner;'lessee,. agent, architect, engineer, general contractor, electrician, plumber or builder.
\ame of o~vmcr of pretises /~'Irs . ~u , ,
pp ~ t f (as on the tax roll or latest deed)
fa licanti's, co.~or~tio,~si aia,F}:~,:;~~~~~
r ..t~~ g. fora of duly authorized officer.
. (N~'mje sndtfitle of corporate officer) "
Builder's Liccnsc No. ....l~ , , 57'7 '
Plumber's Liccnsc No .
Electrician's Liccnsc No .
OtltcrTradc'sLiccnscNo, -
Location of land on which proposed work will be done. , , , , , , , , • .
C~ D Sou-ac~ l~cw.. f~.~~ /?9n i T, •TucK .
House Number Street. ~ . ~ . ~ • Hantlct ~ ~ .NY. ~ ~ ~ ~
County Tax D1ap No. 1000 Section .....~y....... , : Block , , , ~ . ~ • • .
Lot.
Subdivision FilcJ Afap No. .
(N:unc) Lot.......
State existing use and occupancy of premises and intended use and occupancy of proposed construction: .
a. Existing use and occupancy . .
b.lntended use and occupancy ...........C~.-,-•~
.t
4
3. Nature of work (check a•iyich applicable): N'cw Uuild'
Repair Removal tng Addition .Vteraugqn
" • • • • • Demolition Other 4ti'ork . ,(J~er~'~ "
4. EstimatcdCost,,,,, /SflO•• ~
(Dacr;pu~
Fee.....
5• If dwelling, number of dwelling units (to bo paid an filing this a
If garage, number of cars
• • • • • • • • Number oCdwelling units on each floor, , ppligtion)
6. If business, commercial or'mixed occupancy, specify nature and extent of each t e • • • •
7, Dimensions of existing sttyctures, if any: Front , • ~
Height yp of use •
• • • • • • • • Number of Stories . " • • • Rear Depth . •
Dirncnsions of same sttvcttjre with alteration • ' ~ ' ' ' ' ' ' ~ • ~ ~ ~ •
Depth. soradditions:Front.••..••....•.••........•.••••••.
' 8. Dimensions of c........ ' • !!eight , , • Rear •
ntirc new construction: Front , • Number of Stories .
Height .''NumberoC Rear .
9. Size of lot: Stories • • • • • • • Depth
firont....
10. Date of Purchase r ' ~ Rear „ • DcPth .
11. Zone or use district in tvhicl,t premises arc situated , • ' N°mc of Former Owner • ~ • ~ • "
13, D' Il lotrbaoced cons[ruction~ violate any zoning law, ordinance or regulation: /)~.v, , ~ • ~ ~ • ~ ~ • • • " " • . • . •
r.radcd
14, Namc of Otvner of premises , , • • ' ' ' ' ' ' ' • • Will excess fill be removed from premises: Ycs
Nameof,architcc[ '''',,,,Address. .PhoneNo..
A'ame of Contractor • • • ..Address ...................Phony. No.. ' • • • • • .
IS•Zs this property lgcated w'• •"•""Address. Phone No..••~•~••~•~•
*If yes, Southold Tbwn TrusteesnPeOrmitemay bearequircdetlaud? *ygg,,,,170~"„~
PLOT DIACRAbf
Locate clearly and distinctly',, ail buildings, whether existing or proposed, and. indicate all set-back d'
property lines. Give street and block number or description according to deed, and show street names and '
interior or comer lot. uncR~ions frc
mdicatc what
AP RO D AE NOTE~/~
DATE: ~ /c~ •9.P, N ~~D is
NOTIF UIL01 G bEPARTM A
78b•T802 9 AM TO 4 PM F THE
• FOLLOWING INSPECTIONS:
T, FOUNDATION T~NOpEQUIRED
FOR POURED CONCRETE
2. ROUGH .FRAMING & PLUMBING
3. INSULATION
Q. FINAL; - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y.
STATE CONSTRUCTION 8 NERGV
CODES. NOR RESPONSIB~ FOR
DESIGN OR CONSTRUCTION ERRORS
T,1TL• OF \Ew YORf;,
OUNTY OF ',S.S
bcingdul swo
(~arnc of individual si;ning contract) y m, deposes and says that ha is
:eve named, the applicant
is tltc
sail ,''••'••(Contractor,agen[,corporateotCicer,ctc.)•.•~•
owner or owners, and is duly authorized to perform or have performed tttc said work and to make and filc•tltis
~lication; that al! statanents contained in this application arc true to the best of his knowledge and belief,
rk will be performed in the manncrasct forth in the application Glcd thcrcwitlt.
ern to baforc me [his ,and that the
a•
/Public,
......'~-€.(/6.~..... County
HELEN R DE VOE . U. ~ / J
NOTARY PUBLIC, State of New Yak • • • • ~rv ~ J• C..r
No. !17070')R, Suffolk Coutttk~ . i ' ' ' ~ • a'~ • • • .
Term Expires March 30, laa ~r
t (Signature of applicant)
I [
I'
rss-iso2
i3UiLD1NG DEPT.
INSPECTION
[ ] FOUNDATION 1ST ( ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] IN CATION
FRAMING [ FINAL
REMARKS: C
DATE U INSPECTOR
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