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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southald, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-32982
Date: 04/15/08
THIS CERTIFIES that the building
DECK ADDITION
Location of Property: 385 SHORE
(HOUSE NO.)
County Tax Map No. 473889 Section 86
LA
(STREET)
Block 1
PECONIC
(HAMLET)
Lot 4.20
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
APRIL 11, 2008 pursuant to which
Building Permit No. 33813-Z
dated
APRIL 11, 2008
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 REAR DECK ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED
FOR.
The certificate is issued to ALBERT J KECK & AVONELLE FAMILY
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMKIIT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
N/A
PLUMBERS CERTIFICATION DATED
N/A
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Rev. 1/81
'[.1
R 15
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
/JJvO.AL 35<;" J~fl'\i JU\.-
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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 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 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. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses:
I. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic
features.
2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is
denied, the Building Inspector shall state the reasons therefor in writing to the applicant.
C. Fees
I. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00,
Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building - $100.00
3. Copy of Certificate of Occupancy - $.25
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date.
Location of Property:
5SS
House No.
Old or Pre-existing Building:
S~oj(e ~
Street
(check one)
Peeon; c:..
Hamlet
New Construction:
Owner or Owners of Property:
Suffolk County Tax Map No 1000, Section
~G
Block
Lot
I.f. ), ()
Filed Map.
Date of Permit. '-/ )111 ())( Applicant:
Underwriters Approval:
Lot:
Subdivision
Permit No. '33"613
S-d~
---------
Health Dept. Approval:
Planning Board Approval:
--.
Request for:
Temporary Certificate
Final Certificate: )(
,
(check one)
Fee Submitted: $ ;< S -
I~M
Ci~. NI27
C.o-t-3.).Qf :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.
33813 Z
Date APRIL
11, 2008
permission is hereby granted to:
ALBERT J KECK
385 SHORE LANE
PECONIC,NY 11958
for :
CONSTRUCTION OF A REAR DECK ADDITION AS APPLIED FOR. THIS PERMIT
REPLACES EXPIRED BP # 29616
at premises located at
385 SHORE LA
PECONIC
Block 0001
County Tax Map No. 473889 Section 086
pursuant to application dated APRIL 11, 2008 and approved by the
Building Inspector to expire on OCTOBER 11, 2009
Fee $
150.00
ORIGINAL
Rev. 5/8/02
Lot No. 004.020
33fl) &--
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST
[ ] FOUNDATION 2ND
[ ] FRAMING I STRAPPING
[ ] FIREPLACE & CHIMNEY
[ ] FIRE RESISTANT CONSTRlJCnON
[ ] ROUGH PLBG.
[ ] INSULATION
[ ] FINAL
[ ] .FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT PENETRA110N
REMARKS:
LtLc-~
DATE
INSPECTOR
'-
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765.1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST
[ ] F~ATION 2ND
[~RAMING
[ ] FIREPLACE & CHIMNEY
REMARKS:
[ ] ROUGH PLBG.
[ ] INSULATION
[ ] FINAL
INSPECTOR
R
d-1~/&:C
765.1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1 ST
[ ] FOUNDATION 2ND
[ ] FRAMING
[ ] FIREPLACE & CHIMNEY
REMARKS: ~. L ~h~
~'-,- ~ Mj' ~
[ ] ROUGH PLBG.
[ ] INSULATION
[ ...,..-FINAL
INSPECTOR
;r~
DATE
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765.1802
BUILDING DEPT.
NSPECTION
[ ] OUNDATION 1ST
[ ] FOUNDATION 2ND
[ ] FRAMING
[ ] FIREPLACE & CHIMNEY
,....-.
[ ] ROUGH PLBG.
[ ] INSULATION
[ ] FINAL
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DATE ~~;? INSHCTOR
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FIELD INSl'ECTlON Rll:PORT DATE
FO~ATION(lST)
----------------------------'----
FO~ATION (2ND)
- '
ROUGH F'RAM:QOG &
PLUMBING
INSULATION PERN. Y.
STATE ENERGY CODE
FINAL
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COMMENTS' ,
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TOWN OF SOUTHOLD PROPERTY RECORD CARD
1000- Be, -1-4_Z-o
OWNER STREET . /'. i_) VILLAGE DIST. SUB.
LOT ~o
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FORMER OWNER
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RES. c7{U SEAS. /
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ACR.
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TYPE OF BUILDING f2,
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1/ 2. (;'3 ::,
S
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VL.~ FARM
COMM. CB.
MICS.
Mkt. Value
LAND
IMP.
TOTAL
DATE
REMARKS
Tillable
Hause Plat
FRONTAGE ON WATER
FRONTAGE ON ROAD
DEPTH
BULKHEAD
Woodland
Meadowland
To~~
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86-1-4.20 01/03 13:' :z..
2-BT'~ 3:2-x ~~ - Cf~~ ( /2/7 6,0 0&15
M. g. 3x"2- - c;,
Extension IOXI! -="-lb5"
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tens. n ~9:;' r ('"
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Extension
Foundation f0- Both Dinette I
P5ra;' E'EN L;-Y,? ,.. i!5r~:> ) 1?- tU 172- Basement ~,-L{ Floors K. I
l2><;1:.3
Porch Ext. Walls ~LCI~t( ( Interior Finish LR. I
Breezeway I, 3 y; JJ, =- ,i)q5? 1,25 141 Fi re Place Heat Qr1/J DR. I
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Garage Type Roof Rooms 1 st Floor " BR_ 2-
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Patio Recreation Room Rooms 2nd Floor FIN. B
O. B. d f1r" A,~ Dormer Driveway
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Total l1//l{ --;c
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<,ct<
PERMIT NO.
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
Board of Health
3 sets of Building Plans
Planning Board approval
~9'1't' ~~:;
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
Mail to:
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
.
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www.northfork.net/SouthoIdJ
Examined
<?:/s.
Q;1,j...
I
Approved
Disapproved ale
,20~
,20~
Expiration
aJ-I
,20--5-
Phone:
._._._-~._.._--_...
,
f Sf":":)
APltLICATION FOR BUILDING PERMIT
Date
7/2./ Ie, c3
/
,20
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 waterways.
c. The work covered by this application may not be commenced before issuance of Building Pennit.
d. Upon approval of this application, the Building Inspector will issue a Building Pennit to the applicant. Such a pennit
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 Inspector
issues a Certificate of Occupancy.
f. Every building pennit 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 from 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 pennit for an
addition six months. Thereafter, a new pennit shall be required.
APPLICATION IS HEREBY MADE to the Building Department for the issuance ofa Building Pennit 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. ~ ~
(Signature of applicant or name, if a corporation)
,
/Jvl3 V j ST ~ /f./jP II?r&
/- (Mailmg address of applicaht)
State whether applicant is owner, lessee, agent, architect, enginee , general contracto , electrician, plumber or builder
Name of owner of premises A L f!> G" R r t( G" c../\
(As on the tax roll or latest deed)
. s a ofJl ation, signature of duly authorized officer
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
7>91 }II
/y;;
I. Location o!J.lmd on which proposed work will be done:
? ~~ ShOll:!' /..../'t ,
House Number Street
So c<- n d t..-./J
Hamlet
County Tax Map No. 1000 Section
Subdivision
9;6
Block I
Filed Map No.
(Name)
Lot
Lot
L(.:JO
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy / r/:;it'>'? ILY LJ tv ~LL/ /V-'
b. Intended use and occupancy .51'1 nnF
.
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
Addition Alteration
Other Work LJ$C~
2~ Ox ~'" ' (Description)
4. Estimated Cost
f S rrO
5. If dwelling, number of dwelling units
If garage, number of cars
Fee
(To be paid on filing this application)
Number of dwelling units on each floor
~
6. Ifbusiness, commercial or mixed occupancy, specify nature and extent of each type of use.
~,A.
7. Dimensions of existing structures, if any: Front
Height Number of Stories
Depth
Rear
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: Front
Height Number of Stories
Depth
Rear
9. Size oflot: Front
Depth
Rear
10. Date of Purchase
Name of Former Owner
II. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation? YES_NO ~
13. Will lot be re-graded? YES_ NOt- Will excess fill be removed from premises? YES_ NOK-
14.NamesofOwnerofpremisesA[B~r ff>ftl;Address Sho/f6 1.14 Phone No.
Name of Architect Address Phone No
Name of Contractor /301'3 i3oJ,AJ Addressf" 134,1( s:-r Phone No. 7t.,,r )/19
;0,4"0 IV 1<-
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES _NO L
* IF YES, SOUTHOLD TOWN TRUSTEES & D.E.e. PERMITS MAY BE REQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES _ NO---+-
* 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 OF )
being duly sworn, deposes and says that (s)he is the applicant
(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 this
ex I day of 0..Iu 20.Q,;L
r f
~ ~/~ . fJU'fPA_1
otary bite
Sik..
LINDA J. COOPER
Notary Public, State 01 NewYofk
No. ~22583, Suffolk Co~ t9. DO b
Term Expir811 December 31,
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FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
1> \ "'?:J
1:J'!:J
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO.
29616 Z
Date AUGUST
1, 2003
\
Permission is hereby granted to:
ALBERT J KECK
PO BOX 443
PECONIC,NY 11958
for :
CONSTRUCTION OF A REAR DECK ADDITION AS APPLIED FOR
at premises located at
385 SHORE LA
PECONIC
County Tax Map No. 473889 Section 086
Block 0001
Lot No. 004.020
pursuant to application dated JULY
21, 2003 and approved by the
Fee $
150.00
Building Inspector to expire on FEBRUARY
ORIGINAL
Rev. 5/8/02