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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 Z-17942 Date APRIL 13, 1989
THIS CERTIFIES that the building ALTERATION
Location of Property 630 YENNECOTT BREVE SOUTHOLD, N.Y.
House No. Street Hamlet
County Tax Map No, 1000 Section 55 Block 6 Lot 5
Subdivision Filed Map No. Lot No.
n
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JANUARY 30, 1989 pursuant to which
Building Permit No. 17805-Z dated FEBRUARY 7, 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 ALTERATION IN EXISTING ATTACHED GARAGE AS APPLIE? FOR
The certificate is issued to PAUL & ANNE KunFUr.ING
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. PENBING- APRIL 3, 1989
PLUMBERS CERTIFICATION DATED APRIL 3 1989-JOHN E. WALTERS PLUMBING
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Building Inspector
Rev. 1/81
r~oaai xo. s
TOWN OF SOUTHALD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BULLDING PERMIT
(THIS PERMIT MU5T BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N~ 017 8 0 5 Z Date 19.~~
permission is her by granted to:.
/.~Q.aS.~~~.1?.
....v'....
ct premises located at ...~T.Q ..w~~~~.c......................................................
..........................................5~ <~~a^~~~yG
......................................................................r.........................................................................................
Counh~ Tax Map No. 1000 Section Block ~ Lot No..........:`?.
pursuant to application dated ......./../...s~~..0 19.,fS.J, and approved by the
Building Inspector. ~
po
Fee
i
Build Inspector
Rev. 6/30/80
i
' FORM NO. 6
" TOWN OF SOUTHOLD
Building Department
Town Haii
Southold, N.Y. 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted ~ e~u..~ to the Building inspec-
torwith 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 features.
2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equall•
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa-
tions, acertificate 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 "pre-existing"
land uses:
1. Accurate survey of property 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 buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
C. Fees: Addictions $25.00 POOLS $25.00 ALTERATION $25.00
1. Certificate of occupancy New Dwelling, $25.00, Accessory 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 $]0.00
. 4. Vacant Land C.O. $ 20.00
s. Updated C.O. S so.oo Date ...~~a9~&:9............
New Construction,,,,,,OldorPre-existing Building Vacant Land
Location of Property .~~.:30. , . ~i~h/NP_,C J'~f ,~r/`v~ .So. U f/Q.~~ _
House No. Q p Street Ham/er
Owner or Owners of Property ./1h~~~.~:L.!.aUl.!~d,/"~°.,~/(%'!~,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
County TaxMyy~/apNo.t000Sectionpp..~.~......... Block Lot............
Subdivision .,12°.~d/.L~ G 4;~, , y_GLN,~.. , , , , , ,Filed Map No. ,.,/.........Lot No . .
Permit No. 17865 z
: Date of Permit . ~~7.~.~~.Applicant . ~L!c~J,~~?Q L , W/ ~~i Cc l~S
Health Dept. Approval ........................Labor Dept. Approval .
Underwriters Approval ........................Planning Board Approval .
Request for Temporary Certificate .....................Final Certificate ...v............ , , .
Fee Submitted $ ~Zc .
Construction on above described building and %pye~r~mit meets all applicable codes and regulations.
Applicant . ~~~~!-~iZ? ~ ~L2~~GGl~,yrt.~ .
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TEL. 7G5-1802 _
S~FFOL~-~, TOWN OF SOYTTBfO~.D
0~0 -
~ ~ OFFICE OF BUILDING INSPECTOR
o ~ P.U. BOX 728
rr' ` TOWN HALL
~o~Q! SOUTHOLD, N.Y. 11971
C E R T I F I C A T I O N ,
Date ~1"Pl-a-~- J?~ ~Q8 I
Building Permrit No. fI~W
Owner Q/{(.Qt_ K~~~1~1-Ih~~'
(please print)( ~t_
Plumber ~~(o I,QJ~LT6~5 I'"LUilil3l/1eJ-~' I~0.T~'~~
(please print)
I certify that the solder used in the water supply system
contains less than 2J10 of 1, lead.
~ C~~--
(plumber's signature)
Sworn to before me this
Not ry Public
Notary Public, County LINDA J. COOPER
Notary Puhlic. State of New York
No. 4822563, Suffolk County/,~D
Term Expires December 31,18
l~~a~
765.1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ] IN ULATION
[ ]FRAMING FINAL
REMARKS: C
DATE ~7i ~ INSPECTOR
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7?65-1802
DUILDING DEPT,
INSPECTIt'~N
( )FOUNDATION 1ST ~ ] ROUGH PLDG.
F NDATiON 2ND [)INSULATION
[ FRAMING FINAL
j REMARK
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765-1802
BUILDING DEPT.
INSPECTI~JN
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[ ]FOUNDATION 2ND [ INSULATION
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BUILDING DEPT.
INSPECTION
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[ ] FOUNDATION 2ND [ ]INSULATION
[~RAMING [ ]FINAL
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REMARKS:. G~
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BOARD OF HEALTH
3 SETS OF PLANS
FORM N0. 1 SURVEY
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC CORM
• TOWN HALL
SOUTHOLD, N.Y. 11971 NOTIFY
TEL.: 765-1802 CALL ~.n
Examined MAIL T0: (~$Q s4R2w~,0.1 ,
19~~ y ,
} t .
Approved .7.........., 19~Permit No. ~.?~~.Jr..~' ~ ~r
Disapproved a/c
I ~ JAN3p
BLOCa. C5Ep7.
vcrWN tJF sourMOt.o
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date ~ ~ 199
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 in~~~s(((~~~~+ __gg``\\~~//''tons. nq 1)~ ~f'f/J~/
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, azchitect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises . )V` (Ld:.~R!~.....1`.~C.ts:`.Q.... ~ll~.~' .
(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. I s ~ • •
Plumber's License No. w
Electrician's License No. ~ .
Other Trade's License No . .
1. Location of land on which proposed work will be done . .
House Number Street Hamlet
County Tax Map No. f 000 Section ....5.~........... Block ~ Lot . °S.............. .
Subdivision Filed 1\lap No. Lot .
(Name)
2. State existing use and occupancy `of p1r-e~mises alnd intended use(a(nd occupancy of proposed construction:
a. Existing use and occupancy ...I ..z. d.~~•t•!•y • • • ~•~•v'~~~ .
~ b. Intended use and occupancy • • • A~•~• •~~•A'r'•`.~Z-,b~St~.`f-.~Vt~c~ )Zriyt
t - _ _
Y
I
3. Natpure of work (check whiRe;lpplicable): New [3uilding Addition Alteration .
Re air rhoval . Demolition Other Work .
(Description)
4. Estimated Cost .
....c~~~.(j"D,l~ s . . Fee .
(to be paid on filing this application)
5. If dwelling, number of dwellin
If garave, number of cars ~ units . Number of dwelling units on each floor .
" i
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use , , , .
7. Dimensions of existing structutes, if any: Front . . . . . .Rear Depth , .
Heigftt . Number of Stories .
Dimensions of same structure ,with alterations or additions: Front Rear . . . . .
8. D
~ensions of entire new c~nU• • •`'t1IC1~t ' • ' • • ' ' ' ' • • • • • • Number of Stories , , , ,
traction: Front . , Rear Depth
Hei ht tuber of Stories . ~ • • • • • ~ •
9. Size of lot: Front......., Rear' . ..................Depth.......................
10. Date of Purchase .........P~!.•...,,,,,,,,,•,,,,NameofFo[merOwner
one or use tstrict in which
p p t•emises are situated . . .
. .
12. Does ro osed construction vtQlate any zoning law, ordinance or regulation: .
.,h
i3. Will lot be regraded . , , , , ,Will excess fill be removed from premises: Yes
14. Name of Owner of premises .t9tU,~::1'~.N.h ,~(C/~f~1~t1kS• Address~~Nn~FogJ; ,fJ,~, , • , , ,phone No. ~(a.~; ,t,$ 7~ , , , ,
Name of Architect .Address . .Phone No. .
Name of Contractor .~'p~, ,'~j.~•tl qvi.~$, , • , , , • ,Address 5~,~.w~a-+~ bra. , ,phone No.~bS.: 3
IS.Is this property looted.within 300 feet of a tidal ~etland? *YES...p
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
~.ocate cleazly 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 t+shether
interior or corner lot.
STATE OF NEW O K, o 'IS.S
COUNTY
• ~
. W -4 . ~.~?w:-: ~ .
b • . • • being duly sworn, deposes and says that he is the applicant
(Name of individual si^ning contract)
above named.
He is the ~ ~ .
(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 alt statements cont~med in this application are true to the best of Iris 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 ii
b.........day of 19
Notary.,publiC . a.1. . c , , , County
rryy QETH ANN NE1/ILLE ~ (Signature of applicant)
No. 62.812B860taSuffolksCoYork
_ Tarm Expi ga October 81,18