HomeMy WebLinkAbout17265-z FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office ~f the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 218590 Date NOVEMBER 24, 1989
THIS CERTIFIES that the building ALTERATION
Location of Property 1525 GULL POND LANE GREENPORT
House No. Street Hamlet
County Tax Map No. 1000 Section 35 Block 04 Lot 12
SECTION ONE
Subdivision FORDHAM ACRES Filed Map No. 3519 Lot No. 16
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SLILY 18, 1988 pursuant to which
Building Permit No. 172652 dated JULY 26 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 ALTERATIONS TO EXISTING ONE FAMILY DWELLING.
The certificate is issued to ROBERT S. & DEBORAH A. KOEBELE
(owner, }
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRIT.F.RS CERTIFICATE NO. N057139 FEB. 10, 1989
PLUMBERS CERTIFICATION DATED GERARD STEWART AUG. 8, 1988
aiding Inspector
Rev. 1/81
roans xo. a
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
tTHIS PERMIT MUST BE KEPT ON THE PREMISES UNTiL FULL
COMPLETION OF THE WORK AUTHORIZED)
No 017265 Z Dote t9.t7•~1
Permission is hereb ro ted t
..~r/~ ~
at premises located at ,7~.~....G^:.t.,G:C<E~d.........
...................................................r~~..~:~//6~i~
Caunty Tax Map No. 1000 Section Block .............~~....¢p. Lot No...........~..e.-~......
pursuant to opplication doted 19!/..~, and approved by the
~
Building Inspector.
p O
Fee
~Buil g Inspector
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y.11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted ~ to the Building In~ec-
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 equal).
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: Additions $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 . 0 0 , over 5 years $ I 0 . 0 0
4.Vacant Land C.O. $ 20.00
5.Uodated C.O. $ 50.00 ,t Date ..~//.Z 1.~'y
NewConstruction,,,,,,OldorPre-existing Building Vacant Land
Location of Property !S o2.S
, ~C(~LG-, . , . Po L.~N ~t. • • , • ~/L~~11! p(J(L'T".
House No. Q Sireef Ham/et
Owner or Owners of Property ~~n:~ S'..~...~~~d2a f'~'.. ~":•....fs 0~-.J~Q~. ~ , , ,
i
County Tax Map No. 1000 Section ~S Block ~ Lot .
Subdivision . ~:~h~~.K.....~'.C'~~............Filed Map No. ~-~.~1, ....Lot No.
Permit No. ~.?„~af,~ Date of Permit 7/t-b!&-~ .Applicant . /~q¢~r.-S•. K~Er3EL~.
Health Dept. Approval ........................Labor Dept. Approval
Underwriters Approval ........................Planning Board Approval .
Request for Temporary Certificate .....................Final Certificate .
Fee Submitted $
Construction on above described building and per~jm~ i~t meets all ap/pl~ic~able codes and regulations.
Applicant tg~'r~. t4.O.~~!~:- :
Rev. 10-10-78 ~ 30 GbQ
C d z~~ s yo
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAt•'°.
1000908 BUREAU OF ELECTRICITY
83 JONN STREET, NEW YORK, NEW YORK 10038
Date Y~Y.BN4IANY '1.0,74149 APPlicationNo.onfile 6010R4R9/fr4 N 057134
TNIS CERTIFIES TNAT
only t/w eleetrled puipment a deacrihed below and Introdltesd 6y the opplicent nomad on the ahooa spplk~tion numhsr in the promLea of
1tOBM,BT lCO1KBrti7.F;. 7.5'1,5 Glrrd, Pt1MD~~--~~yyLANF., <;KM~RNPORT. N,Y.
in ehefdlowing loeatlon ? g~.emsn LJ lat Fl. ? Ynd FI. Seetlun Block Lot
,TAN~(ARY , 4 .1.4kt4
ww esemined on andfound to 6e in wmplienee rrith the reyuirementAOf thb Buard.
gX1UM AO1Rf fYVlTd16 T RANORS t~OKINO DRCAS OVBiS DMiN W NAUST FANS
OUTtRTS NCANDltCFNT !Oq!!tClM OTHER AMT. K. W. AMi. K. W. AMT. K.W. AMT. K, W. AMT. M. P.
22 R ?,"4 2) 7 7,7 7 3.5 7 1.2 2 1''
DRYRRS RNNACE MOTORS IUTUM AMUANd INRMf fM011F RSC?T TIMR tXOCKS RML IpEIT INA1RRf 1AIILiSO11TIRi OIAAMRRS
AMT. K. W, dl H. OAt H. AMT. NO. A. W. G. AMT. AMI. AMT. AMn. TRANS. AMT. H. r. NOS
~T MtT. wATTt
7 'i(1 1 I, fi00
SRRVKE DIfCONNSMCT NO. tN S E - R V I C E
AMT. AMr. T11! R•• 1 / tW 1 / tw 7 / ]W ] / AW NO. Or C. COND. A. W. 6. ~ HF~G A. W. 6. NO. p mUttAl6 A. W. G
Iat Or CC. COND. q N4llO p NlUTMI
OTNd MNIKAiUk
4 4.j2 TON ATR CONU7TI;ON-1.
•reAC« r,rt;rl•rrNC~-an
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sar,YArrtirtl. c, r~NAr/7 r,rc,i:t.na4 w,
ri7t;4;7NS I.ANI':
H.N. BOX `J,OR OBIT MAMAOBR
c;r:EF.NYOKT. NY, 7744A ~ /
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Psr f.
Thit grfifieaN mutt not ba ahered in any manner; return to Ilw office of flw Board if ineorrM. Intpetfon ^roY be identified b1 fMir endaretkk f.~.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST 1qT 0E ALTERED IN ANY MANNER.
.
TEL. 765-1802
~pS~~F~~~pG TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
z P.O. BOX 728
v' ~ TOWN HALL
'YOy~o~ ~ SOUTHOLD, N.Y. 11971
C E R T I F I C A T I O N
Date
Building Permit No. Z(r,~~
Owner ~0~~ ~ ~ ~ ~C)~iJ vZ t-- iZ
(please print)
Plumber ~2F~2~ ~ ~i
~.cN t~-~2~j
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1~ lead.
~Q,I.CI.(~ ~RQ~.t.Pu~ _
(plumber's signature)
Swoxn to beforeep me this /f
day of NU C 4--- ~~~.P.Lt~L2 /i~ L/v~~~
19 • EEE~~~`~'"' Notary Public
Notary Public, ~J~L ~t`U L IL COUrity CATHERINE A. WALSN
NOTARY PUBLIC, State of New York ,
No. 4864115, Suffolk County
Commission ExpiresJely 7, 19_,•,~~:
:'1~LD II:SP~C.iON ~~llATE ~ SOa~1MENTS ~
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FOUNDATION-_-. (1st)
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N
FOUNDATION (2nd) ~ y
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ROUGH FRAME ~ (J~
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.PLUMBING C)
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IIJSULATI017 PER N. Y. y
STATE ENERGY
CODE ~ fi
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FIIJAL ~d\
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ADDITIONAL COMMENTS: x
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Robert S. Koebele
198 Gull Pond Lane
Greenport, New York 11944
July 15, 1988
Mr. Gary Fish
Town of Southold
Building Department
Town Hall
Southold, New York 11971
Dear Gary:
I am enclosing a completed application for building permit as
well as three sets of plans and a recent survey of 198 Gulf
Pond Lane, Greenport. In order to assist you in reviewing ~
the plans, I have made a copy of the original plans of the
house and have indicated the partition and closet being removed.
I appreciate the time you have spent with me so that I could
better understand the manner in which the enclosed material
was to be prepared. Should you have any questions, please call
me at my office. The number is 516-654-3500.
Very truly yours,
Robert S. Koebele
RSK: j s
765-1802
BUILDING DEPT.
C ] FOUNDATION 1ST [ ] ROUGH PLBG.
C ] FOUNDATION 2ND [ ]INSULATION
C ]FRAMING C F~NAL
REMARKS : ~
J
DATE 7 INSPECTO ~
r
T65-1802
BUILDING DEPT.
~ f NSPECTION
[ ] FOUNDAT{ON i5T [ ] ROUGH PLBG.
FOUNDAT{ON 2ND [ ] {NSULATiON
[ ]FRAMING [ ]FINAL
i
I REMARKS:
i
f
-
t
C
I _
fk{
f
I
DATE ~ ~S 0 INSPECTOR ~
{
F
ass-isoZ
BUILDING DEPT,
1 NSPECTIQN
[ ]FOUNDATION i5T [ }ROUGH PLBG.
j
[ ]FOUNDATION 2ND [ ]INSULATION
[~RAMING [ }FINAL
REMARKS:
~d s
~
4
DATE INSPEC7'OR./~
n
~ 5 ~
°j BOARD OF HEALTH .
Q . ~ ~ B SETS OF•PLeINS..•....."•'•
,..Fr.~~~ FORM NO. 1 - SURVEY
TOWN OF SOUTHOLD CHECK
$f9BB BUILDINGDEpARTMENT SEPTIC FORPI
TOWN HALL
l1LOG. OF:!'C.N ~ SOUTHOLD, N.Y. 11971 NOTIFY
7pWN~oF S~UrI-rnt.C~ TEL: 765-1802 CALL
..~.~....ww,. MAIL TO :
Examined . 19 ccA.?.r'~
Approved ~?T........., 19lJs~Pennit No.~.?"?.G'„'~~,~ d1~ 53r
Disapproved a/c ~
.
(Bu' ing Inspector)
Ai:. APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. Tlus 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
i 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, far 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 inspector on premises and in building for necessary ins ections. A ~j
(Signature ai applicant, or name, if a corporation)
r~>; CllLL oU;+sr) L/FN~ ~ fc'Ea~.~ fC/RT AJ:~e .
' (Mailing address of applicant) r ~ I ~jt.~c~l
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
...Q1.t1A:t~.~
Name of owner of premises .~t~~vf4Z-::~...`~~~:~U1Z$!+..J~:..~i~~r"~-.5-~...........
(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 . .
Plumber's License No . .
Electrician's License No . .
Outer Trade's License No . .
1. Location of land on which proposed work will be done.
.'.....:~Sa.'S ~].u
4~..Go,~~ ~-1d !t!~:.........l>2~Eet!~i:t2 ri^.......... .
House Number Streets Hamlet
.3J'....,.
County Tax Map No. 1000 Section Blpck ........7......... Lot ~ v: .
q .
Subdivision .%z72i>f/lJ!"'l, /'~`(.~I~j Riled Map No. Lot .
(Name) t .
State existing use and occupancy of pppr~~emises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ....P.r: ~f vvr~ , . /Zdjr.D E:,v,~re
b. Intended use and occupancy 0'.2....+9 . 'f"~~•~`
«._s..,r.
3, Nature of work (check which applicable): New Building , ,
Repair Rerpoval • • Addition Alteration , , , ,
• ~ ' • ' ' ' • • • • • • • • • • Demolition Other tVork .
4. HstimatedCost.~/."~S'~O,L?(~, ~ (-ascription)
Fee...~~~.~
.
' S. If dwelling number of dwellin ' (to be paid on filing this application)
g units , , . , , ,l , , , , Number of dwelling units on each floor .
If garage, number of cars , , , ~ .
6. If business, commercial or mixed occupancy, specif nature and extent of each tyY pe of use , , , , , , , , , , , ,
Dimensions of existing structurpber of Stories , , , , ,
Height Nures, if any: Front . ,~d, , , .Rear Depth .4`G. f.~.y~?n~;~ . .
Dimensions of same structure with alterations or additions: Front ,~$,hJ , , , , , , , , Rcar ,:S,Q.,~ j • , ' • •
8. T>imensions o~ent~re new const~ ~ Iloight ;r!~M„~z; , , , , , , , ,Number of Stories ...:S:cd;M/~ , , . : •
nrction: Front .....!`!/1~..... Rear Depth
I-Ietght . Number of Stones .
9. Size of lot: Front , . , f ~,r ''Rear . . .
10. Date of Purchase . 1Q'Q?25 . ylr l S 6 pr.. ' ........../.4'f. , , epth ~ 7
p • • • • • • , Name of Pormcr Owner ~4~'~h~~T ~,LisGi~ ~.4L~,E11
1. lone or use district in which r
,4: .
12. Does ro osed construction vio~mises are situated . , .lzESJ~lL~,v, r.rv3L ' ' ' • '
P P late any zoning law, ordinance or regulation: . . • • •
13. 1Vi11 lot be regraded , N t), , . Nill excess fill be removed from premises: Yes
14. Name of Owner of remises ~S:
P .KQtsr3!~~ ~ Address l~E [iutt pu,.n1 ~h o
t.~ . Phone No.:'y?7 : ? ¢ i
Name of Architect M~N ~?L , • , . , ,Address C~2E'6,vArJ,2r •'N°~ • • • • 'y' ' '
' .Phone No. ~J-N-•3 rd o
Name of Contractor 4).rNnr,f~yt_;. , , , , ,Address , yc ~ • c' ' „ '
IS.Is this property located within • • • • • • Phone No.. l7 lJ, •
X00 feet of a tidal wetland? *YE ..a<.NO...,
*If yes, Southold Towrj Trustees PermiC 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.
SE~ A•rr~ac,fGt. Ju2v?Qy
i '
i,`
I~
STATE OF NE1V YORK,
COUN,pTY OF . S;S
• • • ,11(/,a ••~~mcsf individual si~nif ~
• • ~ ' • ' ' ' K0~6~~ • • • • • being duly sworn, deposes and says that he is the applicant
tg contract)
above named)
tlc is tltc .....('.,~,?.vN F~-!L,' G(1`iu~?l n .
(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
'pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the
work,wdl be perfamted in the manner $ct forth in the application filed therewith.
itvorn to before me this tt
. ~ ........day of . ..J , .
nn 19~~
rotary Public, , , , , , ~ (t,J.L (Jd~. , .
County `!!n ,~/J
N6TARY PU9L1C. SUte of Npwr ~ .
No.4707l7&SuMdkq
TermEsplres ch311, (Signature of applicant)
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