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Home My WebLink About17190-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY Nc Z18091 Date JUNE 7, 1989 THIS CERTIFIES that the building ADDITION Location of Property 425 SKUNK LANE CUTCHOGUE House No. Street Hamlet County Tax Map No. 1000 Section 97 Block 04 Lot 01 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 1, 1988 pursuant to which Building Permit No. 17190Z dated JULY 1, 1988_ REPLACES B.P.#15256Z 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 SHED ADDITION TO EXISTING BARN. The certificate is issued to OLIVER A. CAMPBELL III (owner, ) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. H008235 MARCH 3, 1989 PLUMBERS CERTIFICATION DATED N/A ), 4z uilding Inspector Rev.Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z18092 Date JUNE 7, 1989 THIS CERTIFIES that the building ALTER & RENOVATE Location of Property 425 SKUNK LANE CUTCHOGUE House No. Street Hamlet County Tax Map No. 1000 Section 097 Block 04 Lot 01 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 1, 1988 pursuant to which Building Permit No. 17191Z dated JULY 1, 1988 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 ALTER & RENOVATE AN EXISTING ACCESSORY BARN. The certificate is issued to OLIVER A. CAMPBELL III (owner, ) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. H008235 MARCH 3 1989 PLUMBERS CERTIFICATION DATED N/A Building Inspector Rev. 1/81 FORM 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) N2 017190 Z Dote ........... a Permission is hereby granted to: .4.X. .Ul.................................................. .. ' ......... to ...C4. ,,. .. ...Q t.....a C.. . .. .......... . ......... ... .......... .... .n..... V 1 ................................................................. ........... .......................................... ....................... at premises located at ..L,1�... .......Q 2............. . ... .. .R'r!lis.............. frtrx. .�—,...... 4 s .Ca?...../.. ..�7. ?. ......................................................................................................... County Tax Map No. 1000 Section ......Q.Q..7..... Block .......Q..7........ Lot No. ..... J............. pursuant to application dated .......� ........................... 191X, and approved by the Building Inspector. / Fee $..)K...,- ...... ...............4............. Building Inspector Rev. 6130180 FORM 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) NO 017191. Z Date ,r<- �c....I..................... 19-2. Permission is hereby granted to:g' ,In . V I� c�. ..1..1... .........................V.......................... to .. . f .. .....ca.cS -O' ....1. ?.M.. ........... z... ... �►t-............................................. .. (� .................. at premises located at ........... ............. .,.... ................................................................................ ................................................................................ ................................................................................................................................................................ County Tax Map No. 1000 Section ..... Block .......Q...4..... Lot No. .!: J.............. 12 pursuant to application doted ............ ..'..................... 1911, and approved by the Building Inspector. Fee $..�� ..:.. .... .... ........................ ................................................ Building Inspector Rev. 6130180 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N415256 Z Date .. .�?.` !T`!- ...... ............ Permission is hereby granted to: r .......... .......... . . -.............. .......[1.5.....air .... ................ ....9�-� - ........................... to ... sr......i?w...$.�1{.QS,.....S .R24. .. 3.....a......... ....... GW-,.a.:..................................................................... . . . ..........(.. ...`.. ........ ................................. at premises located at `1", '"-"�l � ova-n. . ................................................................................ ................................................................................ ................................................................................................................................................................. 0....� County Tax Map No. 1000 Section ......0 ...... Block .......QA...... Lot No. ....�...\............ r pursuant to application dated ...... .......A.N .. .4!!R4.... ..........., 19. .�, and approved by the Building Inspector. '— ._-- Fee ............. ...... ......................................................................... Building Inspector Rev. 6130180 J D U 0vc j� __.� • l�`i ��7 TOWN OF SOUTHOLU C e� BUILDING DEPARTMENT ` TOWN HALL OLDG DEPT.(( SOUTHOLD, NEW YORK 11971 TOWN OFSOUTHOLD 765 — 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY DATE. , ./h� NEW CONSTRUCTION . . . L.OLD OR PRE—EXISTING BUILDING. . . . . .VACANT LAND. . . . . . . . Location of Property. . .-! S . . .,�.�� . �j HOUSE NO. I STREET UAMLET Owner or Owners of County Tax Map No. 1000 Section .6. (.7 Block Q _'L . . . . Lot Subdivision . . . . . . . . . . . . . . . . . . . . . . . Filed Map . . . . . . . .Lot . . . . . . . . . . Permit No. .G.1,� [C(� ,*?,Date of Permit ;- ,4./&A plicant . . Health Dept . Approval . . . . . . . . . . . . . . . . . . Underwriters Approval a�. ! 6 Y $ Planning Board Approval . . . . . . . . . . . . . . . . Request for Temporary Certificate . . . . . . . Final Certificate Fee Submitted : APPLICANT. i8b9 � 00 rev- 10/ 14/88 L FORM NO. 6 TOWN OF SOUTHOLD "F BUILDING DEPARTMENT TOWN HALL 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS A. This application must be'lfiled in typewriter OR ink and submitted to the Building Inspector with the fallowing; 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). :3. Approval of electrica} installation from Board of Fire Underwriters. �i. Sworn statement from plumber certifying that solder used in system contains less than 2/10 of IX lead. 5. Commercial buildings, lindustrial buildings, multiple residences and similar buildings and installations, a certificate of code compliance from the Architect or Engineer responsible 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: g 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic 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 writing to the applicant. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent information ',required to prepare a certificate. C. For Vacant Land Certificate of Occupancy: 1. An application for vaunt land Certificate of Occupancy shall be submitted, and a certified abstract of title issued by a title company showing single and separate ownership of the entire lot prior to April 9, 1957 shall also accompany the application. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. D. FEES: 1. CERTIFICATE OF OCCUPANCY - New Dwelling $25.00, Additions to Dwelling $25.00, Alteration to Dwelling $25.00, Swimming Pool, $25.00. Accessory building $25.00 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 Certificate of Occupancy - $20.00 5. Updated Certificate of Occupancy - $50.00 6. Temporary Certificate of Occupancy - $25.00 Residential $50.00 Commercial . rev. 10/14/88 / TOWN OF SOUTHOLD 71 BUILDING DEPARTMENT TOW wd.FN OF Urwa�o TOWN HALL _ SOUTHOLD, NEW YORK 11971 765 — 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY DATE. NEW CONSTRUCTION _ _ , �OLD OR PRE—EXISTING BUILDING. . . . . .VACANT /LAND. . . . . . . . Location of Property. .'',5 . . . . .�/15�C.t_y,�.C, , , _�y. _ . _ _ _ . _ _ . j HOUSE NO. STREET • .HAMLET Owner or Owners of Property . A -C.C1. 1, .�—.Fl-- County Tax Map No. 1000 Section Block Lot . Q J. Subdivision. . .^. . . . . . . . . . . . . . . . . . . . Filed Map . . . . . . . .Lot . . . . . . . . . . Permit No. �,� /��!_ U,Date of Permit 7./i /.0 rApplicant , Health Dept . Approval . . . . . . . . . . . . . . . . . . Underwriters Approval . . . . . . . . . . . . . . Planning Board Approval . . . . . . . . . . . . . . . . Request for Temporary Certificate Final Certificate . . . . . . . . . Fee Submitted : 691 a . . APPLICANT. (IZ `��i�yo��•Ft 3 � Hj0 rev. 10/ 14/88 FORM NO. .6 al TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS A. 'This application must be filed in typewriter OR ink and submitted to the Building Inspector with the following; for new buildings or new use: i 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusuali,natural or topographic features. 2. Final approval of 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 solder used in system contains less than 2/10 of 1Z lead. S. Commercial buildings,! industrial buildings, multiple residences and similar buildings and install,,ations, a certificate of code compliance from the Architect ' or Engineer responsible 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 topographic 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 writing to the applicant. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informationrequired to prepare a certificate. C. For Vacant Land Certificate of Occupancy: 1. An 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, the entire lot prior to April 9, 1957 shall also accompany the application. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. D. FEES: 1. CERTIFICATE OF OCCUPANCY - New Dwelling $25.00, Additions to Dwelling $25.00, Alteration to Dw4ling $25.00, Swimming Pool, $25.00. Accessory building $25.00 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 Certificate of Occupancy - $20.00 5, Updated Certificate of Occupancy - $50.00 6. Temporary Certificate of Occupancy - $25.00 Residential $50.On Commercial APPLICATION ON BACK rev. 10/]4/S8 FIELD JNS,lECTION llATE COMMENTS ta' x H FOUNDATION ( 1st) FOUNDATION ( 2nd ) _2 . z I`P F(wv 0 .c r ROUGH FRAME & PLUMBING y 3 . � 3 H INSULATION PER N . Y. STATE ENERGY CODE y 4 . �Z y FINAL z ADDITIONAL COMMENTS : x Q x b va H xl H O H � O '• x ra yZ x � d � ro H i THE NEW YORK BOARD OF FIRE UNDERWRITERSL't, .I fi1�1f1� ;3 BUREAU OF ELECTRICITY 88 JOHN STREET, NEW YORK, NEW YORK 10038 Date t'tAbf:}D {tf 1Ti>519 Application No.on file 60664889/89 F1 tiat7g;.; 3; THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant namedon the above application number in the premises of �1,1T1k,s� 1L . ca�Jr��arr.,. 'Ita SSrlltd�i Lt�lOY,, I'€5'TC�SL1i>17tti, Af.Y. in the following location; Basement ❑ 1st F'!. ❑ 2nd F'l. 8 Section Black Lot was examined on FIIV004hF "'i' 1 '-02t9 arzdfound to be in compliance with the requirenaenLs of this Board. FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT FIVOP; :I OTHER M1i K W AMi. K.W. AMi K.W. AMT K W. AMT. H.P. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS OIL H.P. GAS H.P AMT. NO A.W.G AMT. AMP. AMT AMPS TRANS, qMT H.P SYSTEMS AMT WAIIS NO.OF FEET li SERVICE DISCONNECT NO.OF S E R V I C E AMT. AMP. TYPE METER 1 tW i A 3W J.e'3W J,e dW NO OF CC.COND A.W.G A W.G.EQUIP. PER.e OF CC.COND NO OF HIAEG OF HI W.G. NO.OF NEUTRALS Of NEUTRAL0. OTHER APPARATUS: F.C."I . .. !.1Y, "KC.INK d,r"ai<IF. i;f,11't')f:3ri(tF;, CdY, J (9 $(i GENERAL,MAWGER Per- This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their creifentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE.MUST NOT BE ALTERED IN ANY MANNER. FORM NO. 5 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ORDER TO REMEDY VIOLATION Date ........Apr.i.1... ................................ 19...88. TO .....Oliver Cmpbl I . ........a..........el.......I...I........................... (owner or authorized agent of owner) 425 Skunk Lane CutchoA34e. ... .:Y.:...,1, 1U3 ......................... (address of owner or authorized agent of owner) PLEASE TAKE NOTICE there exists a violation of: Zoning Ordinance Chap . 100 . ................................. Other Applicable Laws, Ordinances•or Regulations ............................................ at premises hereinafter described in that ,y.ou...ar,P... unning,,,bu,sinesses in a r. .......es- (st ... ate character of violation) idential district,, ,altP,red l,arge,,,b,arn,,,(,added door) without Building Permit , expired Building Permit without C . unsafe structure & no ...o.> ...Rr .cu.P.anGx....RA.r....atn.as.sn.r.x...lau.il.di.n.g................................................ in violation of ..�,00-30 , 100- 141 , 100- 144 , 100-30c2a , 90-3 ............................................................. (State section or paragraph of applicable law, ordinance or regulation) YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the law and to remedy the conditions above mentioned forthwith on or before the Immediate 1 ...........................y........................................... day of April ..........1 19....8.$ ............................................ The premises to which this ORDER TO REMEDY VIOLATION refers are situated at 425 Skunk Lane (Bay Ave . ) ...........................................................County of Suffolk, New York, Suffolk Co . Tax 111000-97-4- 1 Failure to remedy the conditions aforesaid and to comply with the applicable provisions of low may constitute an offense punishable by fine or imprisonment or both. . ............................... Building I pector Vincent R . Wieczorek BOARD OF HEALTH 7APR7, 3 SETS OF PLANS FORM NO. 1 SURVEY . . . . . . . . . , • . . - - • -7 TOWN OF SOUTHOLD CHECK . • . . . . . . . . BUILDING DEPARTMENT SEPTIC FORM . . . . . . . . . . . . . : TOWN HALL 7UVU�N ✓ NOTIFY OF S�OlflHOLU SOUTHOLD, N.Y. 11971 CALL ,p ". " " °"�" TEL.: 765-1802 8 ' . MAIL T0 : � � • �Le�,�t9� 4.. Examined . . . . . Approved . . . . ' / . .f'• • ., 19V Permit No. �. .7 �. Q 0 eLte.v $.?Sb ( -1 / 9 / 1 Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .L . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Building Inspector) APPLICATION FOR BUILDING PERMIT Date . rf. `. . . . . . . . . . . .. 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, andAv regulations, and to admit authorized inspectors on premises and in building for necessary inspe i/p(Sign � 4 . . . . . . . . . . . . . ature of applicant, r name, if a corporation) g. . .-k4,,.k �4�. . .6�. r, (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . . . . . . .0. .t<!.?�l4. . . . . .{.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. T o (Name and title of corporate officer) ALL CONTRACTOR' S MUS BE FFOLK COUNTY LICENSED Builder's License No. . . . ..3 7 . . . . . . . . . . . . Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . . Electrician's License No. . . . . . . . . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . � � 5 . . . . . . . . . .5. .... . .l� C, ` � . . . . . . . . . . . . . . . . . . . . . . � . ., . . U , c-? . . . . . . . . .. L ' House Number Street Hamlet County Tax Map No. 1000 Section . . . . `. . . . . . . . . . . . . Block . . . . . . . .(. . . . . . . . . . Lot . . . . . . . ! . . . . . . . . . . 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .�. . „ . . b. Intended use and occupancy tX . . . . . J.c c� rv„. . . . . . . . . . . . . . . 3. Nature of work (chec -which applicable): New Building . . . . . . . . . . Addition . . . . . . • Alteration : . . . . . . . . . Repair al . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . . . . . . . (Description) 4. Estimated Cost . . . . . . . �. .� .'. . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) 5. If dwelling, number of dwelling units . . . . . . . . . . . . . . . Number of dwelling units on each floor . . . . . . . . . . . . . . . . Ifgarage, number of cars . . . . . .'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mixed 'occupancy, specify nature and extent of each type of use ;. . . . . . . . . . . . . . . . . . . . 7 Dimensions of existingstructures)if any: Front . . . . . . . . . . . . . . . Rear . . . , . .-. . . . . . . . Depth . . . : . . . . . . . . . . . HeightNumb. . . . . . . . . . . . . . erofStories . . . . . . . . . . . . : . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front ... . . . . . . . . . . . . . . . Rear . . . . . . . . . , , . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . .'I. Height . . . . . . , . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . 8. Dimensions of entire new construction: Front . . . . . . . . . . . . . . . Rear . . . . . . . . , . . . . , . Depth . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . Number of Stories . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front . . . . . . . . . . . ... . . . . . . . . . Rear . . . . . . . I . . . . . . . . . . . . . . Depth . . , . . . . . . . . . . . . . . . . . . . 10. Date of Purchase . . . . . . . . . . . .'.. . . . . . . . . . . . • . . . . Name of Former Owner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. Zone or use district in which premises are situated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. Will lot be regraded . . . . . . . . . . . . . . . . . . . . . . . . . . . Will excess fill be removed from premises: Yes No 14. Name of Owner of premises . . . .1. . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Name of Architect . . . . . . . . . , .j. . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Name of Contractor . . . . . . . . . .'. . . . . . . . . . . . . . . Address . . . . : . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . 15. Is this property located within 300 feet 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. i STATE OF NEW40n;,;�-- S.S COUNTYy�OF . . .: ' . . /1011• 0e• • •�� ,�•c•/. • • • . • • . . . . . . being duly sworn, deposes and says that he is the applicant (Name of individual si ning contract) above named. Heis the . . . . . . . . . . . . . . . . . . . . . L. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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 iset forth in the application filed therewith. Sworn to before me th�i day of ay . . . . . . .119 . . Notary Public, !4e . . . . . . . . . County CLAIRE L MAW s . . . . . . . . . Notary Public,State of NoNYotk (Signature of applicant) No.4079606 Qualified In Suffolk County Commission Expires December 9, 1;_ c �cHl� . FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT I O�gg� ii TOWN HALL SOUTHOLD, N.Y. 11971 � � ��p; TEL.: 765-1802 TQ�A �, DEVt 6t � Examined . �u! "`l►!� •!4•, 19 �O Received . . . . . . . . . . . , 1 9 . . . Approved zAi •��•> lq$� PermitNoA. S?.��4 Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Building Inspector) APPLICATION FOR BUILDING PERMIT Date . . . . . . . . . . . . . . . . . .. 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 p p g necessary inspections. �; . , . admit authorized inspectors on remises and in building or (Signature of applicant, or 1 me, if a corporation) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . t� �k1l,; �f4 �W o v, (mailing address of apWicant) . . State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . . . . . .0. G.v�,.11. . . . . . . . . .0. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises . . J 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Name and title of corporate officer) Builder's License No. . . ! .r. . . . . . . . . . . . . . . Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . . Electrician's License No. . . . . . . . . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . House Number Street HamleC County Tax Map No. 1000 Section . . . �.�. . . . . . . . . . . Block . . . . . . .V. . . . . . . . . . Lot . . . . . . . . . . . . . . . . . . . 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . b. Intended use and occupancy . . .4�1M. . .11e �CR%?✓teL�rQdC -r. . . . . . . . . . . . . . . . . . ( applicable): g Addition , r 3. Nature of wor check which a licable : New Building . . . . . . , . Alteration . . . Repair . . . . . . . . . . . . Removal . . . . . , . . . . . . . . Demolition �, , , Other Work . . . . . . . . . . . . . . . C mil (Description) 4. Estimated Cost . . . . . ... .4 _' - . . . . . . . . . . . . . . . . . . . . . . Fee . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) 5. garage, . . . . . . . . . . . . . . . . . . . . . . . . . son each floor . . . . . . . . . . . . . . . , If dwelling,number of dwelling units . . , . . . . . . Number of dwellingunit Ifnumber of cars . . . 6. If business, commercial or mixed occupancy, specify nature and extent of each type . . . . . . . . . . . . . . . . . . . . . 7. Dimensions of existing structures, if any: Front . . . . . . . . . . . . . . . Rear . . . . . . . ! . . . . . . Depth . . . . . , . . . . . . . . . Height . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . , . . . . . . Depth . . . . . . . . . . . . . . . . . . . . . Number of . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . 8. Dimensions of entire new construction: Front . . . . . . . . . . . . . . . Rear . • . Stories . Depth . . . . . . . , . . . . . . . Depth . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front . . . . . . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . 10. Date of Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NameofFormer Owner . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. Zone or use district in which premises are situated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • . 12. Does proposed construction violate any zoning law, ordinance or regulation: 13. Will lot be regraded excess fill be removed from premises: Yes No 14. Name of Owner of premises . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . , . . . . . . . Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . . . Address Phone No. . . . . . . . . . . . . . . . Name of Contractor . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . 15. Is this property located within 100 feet 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 ail 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. li I i STATE OF NEW YORK, S S 'OUNTY OF . . . . . . . . . . . . . . . . . ' • ' • . . . . ' • • • •(Name• • • • • • • • • • • • • • • • • • • • • • • • • . . • . . . . being duly sworn, depose's and says that he is the applicant of indi vidual signing contract) bove named. [eisthe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this ..)plication; that all statements contained in this application are true to the best of his knowledge and belief;and that the ,ork will be performed in the manner set forth in the application filed therewith. worn to before me this a �r 1. . . . .day of. ' .pAll . . . . . . . . .1 19 X otary Public, . . . 2 v e - , , County WE �. . . . . . . . . . . . . . . . . �� (Signature of applicant) LIBEF9102PIGE225 S"ndard N Y.89'.U. Form BW2-20M —Bargain and Sale Uea,l,wsh(bvenanb against Gnmm',A"'—Individual or(iinnj"nn pmgle'heel) CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT•THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY THIS INDENTURE, made the day of nineteen hundred and eighty-one 5 BETWEEN 0 � OLIVER A. CAMPBELL, IIIF residing at , 118 Skunk Lane, Cutchogue, New York, and DIANE CAMPBELL, his wife, residing at (No No.) Main Road, Southold, New York, party of the first part,and OLIVER A. CAMPBELL, III, residing at ;Nq 118. Skunk Lane, Cutchogue, New York, SECTION BLACK LOT party of the second part, 0 12 1: 1 21 26 WITNESSETH,that the party of the first part, in consideration of ten dollars and other valuable consideration paid by the party of the second part, does hereby grant and release unto the party of the second part, the heirs Or successors and assigns of the party of the second part forever, ALL that certain plot, piece or parcel of land, with the buildings and improvements thereon erected, situate, lying and being iMix at Peconic, Town of Southold, County of Suffolk IS RICT and State of New York, bounded and described as follows: 0 BEGINNING at a point on the Easterly side of Bay Avenue where the same is intersected by the Southerly side of land now or E TION formerly of Doroski; RUNNING THENCE along said land (1) North 75° 33' 30" East 0 7 186.82 feet; and (2) North 750 41' 50" East 343. 16 feet; THENCE South 60 38 ' 10" East along land now or formerly of CK Krupsky, 169.42 feet; THENCE South 820 51' 20" West, for part of the distance along 0 4 land now or formerly of Luce, 525.27 feet to the Easterly side of Bay Avenue; and T THENCE North 70 08 ' 40" West, along the Easterly side of C�O1 Bay Avenue 103 feet to the point or place of BEGINNING. JJ ��JJJ BEING and intended to be the same premises conveyed to the Q parties of the first part by deed dated July 26 , 1978, and recorded in the Suffolk County Clerk' s Office on August 16 , 1978, q in Liber 8480, page 476. I R CE VED 115G,' REAL ESTATE' NQY 16 Bel TRANSFER IAA SUFFOLK 4 CoU(JTy U , %t TOGETHER with all right, title and interest, if any, of the party of the first part in and to any streets and roads abutting the above described premises to the center lines thereof; TOGETHER with the appurtenances and all the estate and rights of the party of the first part in and to said premises; TO HAVE AND TO y "�l HOLD the premises herein granted unto the party of the second part, the heirs or successors and assigns of C. i the party of the second part forever. r , t LI —Q AND the party of the first part covenants that the party of the first part has not done or suffered anything whereby the said premises have been encumbered in any way whatever, except as aforesaid. rAND the party of the first part, in compliahce.with Section 13 of the Lien law, covenants that the party of L� the first part will receive the consideration for this conveyance and will hold the right to receive such consid- eration as a trust fund to be applied first for the purpose of paying the cost of the improvement and will apply " ' O the same first to the payment of the cost of the improvement before using any part of the total of the same for any other purpose. c ._Q The word "party" shall be construed as if it read "parties" whenever the sense of this indenture so requires. IN WITNESS WHEREOF,the party of the first part has duly executed this deed the day and year first above written. IN PRESENCE OF: 16LIVt A. CAMPBELL, III DIANE CAMPS LL 1B tg81 ARMUR J. FELICE li (� C 0 R 0 r, D. Roo Clerk of soffoik County Ij I I , i 'sl��v''ltiNkN�t�� 51P;1�y(a�v ky -- I L I j .ry — t. 1 II L i ��6 R➢rf4�'�(c ( I Pusvv 6 I e a� --7 17190$. I 'I`V 2S)��t➢'fi^7 ru:k-.nE;�� ;at' 'N4T`sD __—_- - -• - ---- ---- - --- -- - -- --- Gtid� ,ou ZXr3 - FEE ?a' Der v ANT - -- - - C CUPANCY OR NOFB1 HO�c�ik-nqn CTOi Gp'f41 b�OR THE u S IS UNLAWFUL r0'. c�Uvu•,� ,NsprcTIOW;: <WO �+rct1UIRED FGvp MOUb3Ys.i {aP!C�¢':'n * Fe0M0ING WITHOUT CERTIFICATE ➢M"➢UI_A rIa➢r,� 4. tI ➢n., ( C CIS. FOR FOR CO MUST Ix. OF OCCUPANCY � ccak,nP, e E.7 -O k ALL COrvdu'➢ iXTION SHALt MEET u •� r, -� tit ! THE flEGLtYr�tifNENTS OF THE N.Y I vAJG STATE COtVS'I RUCTION 8 ENERGY _ _ n➢ r,� p{�,�yl� I I CODES NOT {1Eh"0'OMSISLE FOR nMCN OR CO:ISTRUCTION ERRORSDRAWN AV C�tixItiN�Rpd�9� " 1�9�6�� '7 I ur.ov.n.n 0. :,, ➢ i I ouWwo xuYq.. 5KoOK & Cu�� ofi�