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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-32262 Date: 03/27/07
THIS CERTIFIES that the building DECK ADDITION
Location of Property: 2345 PEQUASH
(HOUSE NO.)
County Tax Map No. 473889 Section 103
AVE
(STREET)
Block 12
CUTCHOGUE
(HAMLET)
Lot 15
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
FEBRUARY 26, 2007 pursuant to which
Building Permit No. 32769-Z
dated
MARCH 1, 2007
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 "AS BUILT" DECK ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to THOMAS & SHARON GOELLER
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
N/A
PLUMBERS CERTIFICATION DATED
N/A
~".~-
Rev. 1/81
'-
Form No.6
TOWN OF SOUTIIOLIl
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
A. For new building or new use:
I. Final survey of property with accurate location of all buildings. property lines, streets, and unusual natural or
topographic features.
2. Final Approval from Health Dcpt. 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 2/1 0 of I % 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.
B. };"or existing buildings (prior to April 9. 1957) non-conforming IIses. or bllildings and "pre-existing" land uses:
I. Accurate survey of property showing all propeliy lines, streets, building and unusual natural or topographic
features.
2. A properly completed application and consent to inspect sigoed by the applicant. If a Certificate of Occupancy is
denied, the Building Inspector shall slale the reasons therefor io Writing to the applicant.
C. Fees
I. Certificate ofOccupane)' - New dwelling $2:'i.OO. !\ddit!ons to dl\'elling $25.00, Alterations to dwelling $2:'i.OO,
Swimming pool $25.00, Accessory building $2:'iOO. Additions to accessory building $25.00, Busll!csses $:'iO.OO.
2. Celiificatc of Occupancy onl're-exlstillg Huildln)! _ $IOO.O()
3. Copy of Certificate of Occupancy - $.2)
4. Ilpdated Certilieate ufOecupancy - $50.1111
5. Temporary Certitlcate of Occupancy - Rc;-;)(krllial $15.()(). COllll11LTL'i,t1 ~ 15.00
llak
.IW
? 23 07
__ '_, n______
New C01lstruction:
/
Old or Pre-existing Building:
_ (check one)
u P:e. q; iA-o.. s 0J.Vf ~
U Street
. 71d..&~Ci '-S ~}lt40Y--LGL0~'_
Suft(,lk Connty Tax Map No 1000, Seetion _ I [) 3_ Hlod, I. L
Location of Property: _2 3_Y)_
IIousc No.
1 .
/', -,+dtJ'JCru.i2- _
-~ ------ .-----u ---- - --- ~--
llamlet
Owner or Owners of Property:
l,()l
IS
SubdiviSl(lll
Fikd ~I"p.
1,01
Permit No._3_'L7 &:,U_
Date of l'ernut2/ Lt I Q 7 .
~/A
rJ/^
Applicant 5h(<-"Q"l(l~,^-
\ Indcrl\'rilers Approval _ ~^:
Health Dep!. Approval:
Plal1llill!2 H()(lrd i\ppru\'ill
Request [(Jr
'Il'llllklrary C\Ttilicatc
Fin;!! CtTlillcillt':
/
(check one)
'I?: tJO
Fee Subnlltted: $ 0" -J c---
LfuAAdM c,UJ.( ~~
Applicant Signature
~~.7Jd 5J-./
cn-c3:.u~j...
FORM NO. 3
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)
PERMIT NO.
32769 Z
Date MARCH
1, 2007
permission is hereby granted to:
T&S GOELLER
2345 PEQUASH AVENUE
CUTHCOGUE,NY 11935
for
"AS BUILT" DECK ADDITION AS APPLIED FOR
at premises located at
2345 PEQUASH AVE
CUTCHOGUE
County Tax Map No. 473889 Section 103
Block 0012
Lot No. 015
pursuant to application dated FEBRUARY 26, 2007 and approved by the
Building Inspector to expire on SEPTEMBER 1, 2008.
Fee $
400.00
ft.u~~ C~
I Authorized Signature
ORIGINAL
Rev. 5/8/02
3~1~1 2-
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING I STRAPPING .M FINAL
[ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTR~ION [. ] FIRE ~ESI~T PENETRATION
REMARKS: ~ (04-- ~
'\,tv 6t ~ C~VI
DATE f J-f -() 7
INSPECTOR
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.
- COMMENTS
FIELD INSPECTION REPORT DATE
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FOUNDATION (1ST) ~ -
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FOUNDATION (2ND) en ?
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ROUGH FR~ING & ---....--... ---~ '"
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INSULATION PER N. Y. -- fs: ~
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STATE ENERGY CODE
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ADDITIONAL COMMENTS f!;
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OF SOUTHOLD PROPERTY RECORD CARD
FORMER OWNER
STREET Z ~ '-I' 0:::
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VILLAGE
DIST.!
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ACR.
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TYPE OF BUILDING
J070"'<::.k.. P.'
r=:;ve / Y (j F I e.e+
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W
RES.~ I ''''11 SEAS,
LAND IMP.
012
12- 'Ot> 000
VL. ~'
TOTAL
I FARM
COMM. CB.
MICS.
Mkt. Value
I
I
Tillable i FRONTAGE ON WATER _ $ tf, 0-0 / / S-~ '),-
Woodland i FRONTAGE ON ROAD /9 ]:P< ~ =' /4T/
j.
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Meadowland DEPTH I ;:\ /\ j'.;;}'/.
House Plot . BULKHEAD I .; (Al/oe Lof
. I
Total I I
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.
1<.<-' TRIM '-'-' ,-1-&1
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M. Bldg. I l./J- ~ 2.4 = loc>~ 3,00 3oZ.'i ! !
i
Exten5ion \ I
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Extension I i
I
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Extension \
Foundation 2t Bath !Dinette
,
Porch Basement Fvll Floors (1'A-f'.:>~ K.
Porch Ext. Walls U"'AJ4( Interior Finish LR.
Fire Place I Heat
Breezeway NO 0; I DR.
Garage ~ype Roof r Rooms 1 st Floor iBR. '3
1S'l&le
Patio Recreotion Room - Rooms 2nd Floor FIN. B
O. B. Dormer - Driveway I
Total . 31.....
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AREA = 39,864 sq,ft,
[LEVA nONS ARE REFERENCED
TO AN ASSUMED DA rUM.
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SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
FOR APPROVAL OF CONSTRUCTION ONLY
DATE
APPROVED
I1S. REF. NO.
R-IO-940038
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/ am {ami'lior with Jhe STANDARDS FOR APPRO VAL
AND CONSTRUCTION OF SUBSURFACE SEWAGE ,
DISPOSAL SYSTEMS FOR SINGLE F AM/L Y RESIDENCES
and will abide by the condilions set forlh Iherein and on Ih~
permit to cons/ruel.
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CER TIF-.IED TO'
WARRf!N YANTZ
BARBARA YANTZ
USDA FARMERS HOME ADMINlSTRA TlON
S.c. T.l.c. 33094 - /478
The locations of wells and cesspools
shown hereon are from field observalions
and or from dolo obtained from o/hers.
Prepared in accordance with the minimum
standards for tille surveys as established
by the L.t.A.L.5. and approved and adopted
tar such use by The New York State Land
Tifle Association.
L
NO. 49618
1/971
nA
M~
TOWN OF SOUTH OLD
BUILDING Dt:IIARTMENT
TOWN HALL
SOUTHOLb, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www.northfork.net/Southold/
BUILDING PERMIT APPLICATION CHECKLIST
PERMIT NO.
3J..7l..9 C-
Do you have or need the following, before applying?
Board of Health
,..4 sets of Building Plans
Planning Board approval
./ Survey
,/ Check
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
- f ,20~
Examined 1/
Approved ,20 07
~I
Disapproved ale
Expiration fill ,200~
Mail to:
Phone:
/)~
, Building Inspector
:r-r ') 6
\ ,-_J L
APPLICATION FOR BUILDING PERMIT
Date
2/( (p /
1 r
,2022
INSTRUCTIONS
a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
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 waterways.
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 issue a Building Penn it to the applicant. Such a 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 what so ever until the Building Inspcctor
issues a Certificate of Occupancy.
f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of
issuance or has not been completed within 18 months trom such date. If no zoning amendments or other regulations affecting the
property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an
addition six months. Thereafter, a new permit shall be required.
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.
Allt<A&vz to JfIUf16tJ
(Signature of applicant or name, if a corporation)
Po cA.Q
ieant) 11
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
(Q cA..? Vl-Vv
Nameofownerofpremises IVl~as O. CLvtd Sh::LvOVl W. Cloei1ef
(As on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
I. Location of land on which proposed work will be done:
z-:J4<7 Pf~ W1..5Vl 1+v0.
House Number Street
C U. tc.t-L 1O 3 0le-
Hamlet .
County Tax Map No. 1000 Section
Subdivision H up 0 r 131-~ C,{Pk'...vl
(Name)
10 ~
At',.rt.-S
Block / Z-
Filed Map No.
1:)7'57
Lot 15'
Lot
1
2. State existing use and occupancy of premises and intended use and occupancy of proposed constn.,ction:
a. Existing use and occupancy E. '" +-ex- (e,-y tAl C-u cZ ~ clc
.
b. Intended use and occupancy
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
Addition v'
Other Work
Alteration
(Description)
4. Estimated Cost
Fee
5. If dwelling, number of dwelling units
If garage, number of cars
(To be paid on filing this application)
Number of dwelling units on each floor
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front 'i 2., '5 ;
Height Number of Stories .L
Rear 4 Z. 5 I
Depth 2'+. 3 I
Dimensions of same structure with alterations or additions: Front
Depth Height Number of Stories
Rear
1
8. Dimensions of entire new construction: Front ,24'
Height ;2 , '5 I' Number of Stories
IIA '" }t?13. /+ ;
9. Size oflot: Front----.! ~ ./ . Rear _ VI_, "'_
Rear Jc+ /
( 2..(
Depth _
Depth 20 3'
10. Date of Purchase Ie) I C1 /00
.
Name of Former Owner WOxv-(' ,CIl. O-Md. t)?,-" V.JClV (< '1"'1 + L
11. Zone or use district in which premises are situated R. - 10
12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO V
~ ~
13. Will lot be re-graded? YES ~ NO / Will excess fill be removed from premises? YES ~ NO ~
'Sha-..".... ;
14. Names of Owner ofpremiseSlhOV\'1u> G,.eQte~
Name of Architect( S (J(!, \';11; >A \ (1 +-lri r t,t.Mi
Name of Contractor
Addressfb~1 1'1'1{' C.u.~.Phone No. 73'+- 'II ( I
Address Phone No
Address Phone No.
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO V
--
* IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES NO V
--
* IF YES, D.E.e. PERMITS MAY BE REQUIRED.
16. Provide survey. to scale, with accurate foundation plan and distances to property lines.
17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey.
STATE OF NEW YORK)
SS:
COUNTY oFS,-,H'cLw
:5 ~I[L' C v', l ,J. G vi" tee ri being duly sworn. deposes and says that (s)he is the apI'lican,t
(Name of individual signing contract) above named.
(S)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 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 thk
/ day of P/'Vf/' y
.
2007
I ttlu'~'Yl-L;fj .J1/;.ctf,J'-
. Signature of Applicant
ID("~,'.!!':-' ;',:<>:',:[8,
Noti'ry p.~t,i~c, ") ;:-: i\i:wYork.
~'h:; /:', ,~<,':~:
O~'cM;~',,~ i:', S<,:::,l C(l.unty
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