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Home My WebLink About13366-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southoid, N.Y. Certificate Of Occupancy No. ZI5657 Date April 20, 1987 THIS CERTIFIES that the building 0 ne f am i 1 y dwe 11 i n g. Location of Property 272 LUTHERS ROAD. (Breakwater Rd.) MATTITUCK /:/t~t~$~' ~]o2 ....................... ~}r'e~ t' ....................... h~mlet County Tax Map No. 1000 Section 113 ·Block 3 . .Lot 7.4 Subdivision .A .r.l.e.n. ~..M.a.r..v .i.n.. (..M .i.n.o.r. ! ...... Filed Map No .1' ...B...#. ! ? ?Lot No... 3. .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated August 15, 1984 pursuant to which Building Permit No. 13366z dated .A.u.g .u .s,t..2. .0 '~..1.9. 8..4 .......... 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 ......... One family dwelling, two car garage. The certificate is issued to DOUGLAS SHAW AND OTHERS of the aforesaid building. Suf~Ik County Department of Health Approval 14-S0-127 Feb. 3, 1986 UNDERWRITERS CERTIFICATE NO. N735720 Feb. 14, 1986 PLUMBERS CERTIFICATION DATED: May 19, 1987 Mc Cook, Norman Attic deck--non-habitable Temp C.O. ZI4197 Feb. 4, 1986 B.P. amended 10/18/84 Rev. 1781 Building Inspector IrOBM NO. I~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~ z ~o,...(~]..~.....m ......... , Permission is hereby granted to: A _ ~ .....~.~.~,....~.i~-I. ........ ~.....'.'~. ................................ ,o ......... at premises located at ..................... County Tax Map No. 1000 Secti~.....l~...~. .......... Block ...... ..~. ........... Lot No. ,......~..2:..~/ pursuant to application dated ........ ~.~'.. ............... , 19~.~...., and approved by the Building Inspector, Building Inspector Rev. 6/30/80 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. ~T EMP O RARY ){ CertJficafe Of Occupancy No...Z..1.4.1.9..7 ........ Date February 4 ]9 86 THIS CERTIFIES that the building ..... .N.e.w.. p.w.e. 1..1.i.n.g. ............................ Location of Property 272 Luther~ Rd. (Break Water Rd. ) Mattituck h~s~ ~io: ....................... 's'~/~i ....................... h~,~M County Tax Map No. 1000 Section .... 1.1. 3. ..... Block ....0.3. ......... Lot .. 007.2 Subdivision., .A.r.l.e.n..e..M.a.r..v.i.n.. I .M.i.n. qr. ) .... Filed Map No.P~.: ?.1.4..9.LOt No. 3 conforms substantially to the Application for Building Permit heretofore filed in this office dated Aucjust 15 , 19 . .8 .4pursuant to which Building Permit No. . 13366Z dated ...... .A.u.qu..s,t...2. .0 ..........19.8..4, 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 ......... .......... TT7.-.-....N.e.w., .P.r.J:v..a.~?..0..n.e..~.a..m.~.Z.y.. p.w.e. 1..1.i.n.g... T.-.'~ZT." ............... The certificate is issued to SHAW~ VALERIE SCOPAZ & DOUGLAS IAN .................... ?o¥,'o;, ~;J&'~ ...................... of the aforesaid building. Suffolk County Department of Health Approval .............. .1.4.qS. 97.1.2.7. ................. Pendi~ UNDERWRITERS CERTIFICATE NO ........... Applzcatzon" .... ' ' ' '~347163' '~'~ ......................... Building Inspector Rev. 1/81 FORM NO. 0 TOWN OF SOUTHOLD Bulldlng Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application m.ust bo filled in ..W,p. ewrlter OR ink, and submitted .~. m===,a.=~ to the Building In~pec- tot with the following; for new buddmgs or new use: n" 1. Final survey of property with accurate location of all buildings, property lines, streets, and unumal natural or topographic features. A" 2, Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). Z/3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compllanco from the Architect or Engineer responsible for the building. 5, Submit Planning Board approval of completed site plan requirements where applicable. 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 natura~ 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 Mspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy New DwellJ. ng.$25.00. 'Acce.~sory .~10.00 Bua[nes.'~ $50.00 2. Certificate of occupancy on pro-existing dwelling ~ 50. O0 3. Copv of certificate of occupancy $ 5.'00, over 5 yea~s $10.00 4.Vacant Land C.O. $ 20.00 5.Uodated q.O. $ 50.00 Date. 6. ~lterat~on $~.00 New C on s b r u c ~ i on. D... Old or PreT~istipg Bulling ............ Vacant Lend ............. o ..r o, o, .;:;7. ................. ~,~ ~ ~ ~o. ~ooos~o~ .... //.> ....... ~o~ ..... & ........ m...7'.¢ ........ Subd~msmn ~/~ ~.,, ~, .~ .......... Filed Map No ........ Lot No ...... Permit No. ~ ~ Date of Permit .Applicant ........ ~.~,i.~,~ ~,,o~.. EL~...~ ........ ~..~.~ ,o~,a ~,,,o~ ..................... Bequest for Temporaw Certificate ..................... Final Certificate ,~ .................. ~ee Submittea $..~ .................... Construction on above described building an~ermlt meets all applicable codes and regulations. ,~ ~_ Applicant .......................... ~.~ .3 ~ 7~ 'u . FORM NO. 6 TOWN OF SOUTHOLD Bu ilding Department Town Hall Southold, N.Y. 11971 765 - 18.02 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted ilaa~m~ to the Building Inspec- tor with 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, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p2"operty 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 $15.00 Date..~.~.~....L~..,. ~,C{ ~.(w0 ........... New Building ¢' Old or Pre-existing Building Vacant Land Location of Property ....... House No. Street Hamlet Owner or Owners of Property ........................................ County Tax Map No. 1000 Section \ \ ~ Block ~ Lot Subdivision, . ~..~. \ .... Filed Map No ...... ! .~.Ot..Lot No...~. ......... Permit No ........ Date of Permit pplicant .................................. Health Dept. Approval . .\?c..-...~-~. 9..-..\ .'~.-.~! .... Labor Dept. Approval ... Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate...:~. ~ ............ Final Certificate ....................... Fee Submitted $ .~¢:~o__~ . ~ ~,~t~ · u \% Construction on above described building a~it meets a~.,plicable codes and regulations. ~,~-J~ ~H ~(o Applicant~.~;~-~''¢/~%' · '¢--~' · [ ........................ Rev, 10-10-78 TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No. 155~(~ ~ Owner -~o~c~$ ~ ~S- ~ (please print) Plumber (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this day of Notary Public ,C/~_~3~_J3~_~ (plumber's signature) ~... ... County ~ Commf~ion Explros ~?; .,~, .~ ,, ~F 1 E L~D INSPECTION COMMENTS FOUNDATION FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING O.4'- INSULATION PER N. STATE ENERGY FINAL ADDITIONAL COMMENTS: (VACANT') TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN IIALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 This is to advise you that the job under building permit no. 13366Z iesued to Valerxe Scopaz Shaw on 8/20/84 for New Dwel~[-f~g is completed a fi.,~al inspection has ( ) has not ~X-~--been done. and tn order to complete this file, it is necessary that a Certificate of Occupancy be issued. Please fill out the enclosed form, retttrn same to the above office with a check for $25.00 payable to the Town of Southold. Please indicate to Whom the Certlficste of Occupancy is to be mailed, and arrange with this office for an inspection date Occupancy or use in unlawfnl without a Certificate.of Occupnncy. t'lnnne, help u~ to cleat up thi~ matter so that legal action does not have to be taken. Thank ye, for yo,r prompt attention. Very truly_y~, Victor Lessard Executive Administrator VL:gar encl . 7GS-1802 BUILDING DEPT. INSPECTION FOUNDATION 3LST FOUNDATION FRAMING REMARKS: ROUGH ~PLBG. ' ZND [ ] INSULATION DATE ~INSPECTOR BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING ~ ] FINAL ~fJ~ REMARKS: INSPECTOR ~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 Ta .. .. 19~.t! · ....... ',pp · .....o~ 19~.{. Permit No. ].~..~..~.(9~ Disapproved a/c ..................................... · (Building Inspector) APPLICATION FOR BUILDING PERNIIT Received ........... ,19... INSTRUCTIONS a. This application must be completely filled in by Wpcwriter 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 st'~eets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this al?pli- 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 pu[suant 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 insl>ectio.ns. (Signature of applich~t, or name, if a corporation) · ./.o.: ..doZ.. ~. 3. Z/. ?...~.,,.~-q~.<. ,../.r.~..~. ......... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... .o..~.~..<e,....~...4c7.a(.~ .,~......~..~...re~..~.~. ................................................... Name of owne~of premises~, q.u¢. · .c~$../.t~....~fl..~qo.... !..g~,..~....~f.T~...~.~..~.~.a-~......?~..~.~1. ~.q~.. ~e0.z:.../~..%C .L..... (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..O~.{~ Plumber's License No..~.d~ .................... Electrician's License No. trig ................... Other Trade's License No..~ ................... ~.~ 1. Location of land on which proposed work will be done. ~..~.q.r/(.W~.. ~. ............. . ./-~..,~. ,,... ~,. . ~ 7.'. .~/~. . . ~~e~q .e ~. ~.~ ~ . ~. ~z~. ~., . . . ~w ~ ............ House Number Street Hamlet County Tax Map No. 1000 Section ...~[~ ........... Block .. ~ .............. Lot..~..~.'~.. Subdivision .J~Z~.. ~.~ ....... Filed Map No. /~t~ .O.~} 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 ~WW~ ~t~ 3. Nature of work (check which applicable): New Building ~ ' Addition Alteration Repair .............. Removal ............ Demolition .............. Other Work ............... ~ ~ i (Description) 4. Lstimated Cost ....~.~/...O~.. i/.~.~..d-~. .............. Fee ...................................... i ~' (to be paid on filing this application) 5. If · number ' i ' ~4/o~' · · dwelling, of dwelhng,umts ............... Number of dwelling umts on each floor .%(~. ........... If garage, number of cars .TA~.o, .............................................. 6. If business, commercml or mixed occupancy, specify nature and extent of each type of use ................. 7. Dimensions of existing structur0s,if any: Front ............... Rear .............. Depth ............... 4H Iteight Number of Stories Dimensions of same structure wlith alterations or additions: Front ................. Rear .................. Depth ................... !.. Height ...' ' · .................. Number of Stories ' ' ' ........... ?i ......... 8. Dimensions o£entire new construction: Front .~ .......... Rear .. ~.,g .......... Depth .~.~' Height . .J'J ........... Number of Stories . ?-A/~ ................................................." 9. olze of lot: Front .../7.~.i~ ............ Rear ../~Z?., .~'~ ............ Depth 3/.~.~..~..~..,~, ........ 10. !)ateofrurchase ....~.././(~ff'. ................. Name of rormer Owner .4~d~..'Y.~7....,'Y,A%~..?/.~. .......... 11. Zone or use district in which pr~mises are situated .... /~z._: ~4~.6~... ~..,~. ~'(.~ .............................. 12. Does proposed constructionxioiate any zoning law ordinance or regulation: . .z?.o. ..... 13. Will lot be regraded .... ~g~t'.t. i ................... Will excess fill be removed from premises: Yes 14. Name of Owner of prem!ses .~. g.,t.~.rp~. ~..2~'F.~.~... Address ~°.-.~tPiq ~.~Y...~..~..c(cPhone No..7.a.~T~.'~:s-,~?-..~.. Name of Architect ~?. ~ .'b2{.a;~.... !/..g~tg'.. t%~.6d.'r~..... Address ................... Phone No. ~b.°. :-.~-It. (. .... Name of Contractor 'g6{'?"§~" i '~' '~' ?~q' ' '~' '" ......Address ./Y~..~?T?..c~. ......... Phone No. ?b.~.-.~.K}~..[ PLOT DIAGRAM ' , Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions fr m property lines. Give street and block )rich according to deed, and show street names and indicate whe' er interior or corner lot. STATE OF NEW YORK, COUNTY OF ............. S.S ...... ~/.~. · ,~'. · .~...~. · .~.g'. · · · · .'-~. · ................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named· He is the ................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dui authorized to perform or have performed the said work and to make and file this application; that all statements con aired in this application are true to the best of his knowledge and belief; and that the work will be performed in the manta r set forth in the application flied therewith. Sworn to before me this . .. /.~:..~/....da- o~ /? ...... 7- ~.c./' ...............~/ ~ ,_,/ ~ ,/¥ .i"'~ ....... 19 Notary Public, ..z,,~.~ .... .~..~:- ~..~.~...t~. County/ , r~~ NOTARY PUBLIC, State Of Ne~, ' ,~ ...................... \ No, 4107878. Sufl0ik C~,a~ ' ' L/ (Signature of applicant) COUNTY OF SUFFOLK Property Tax Service Agenc' .{ n ~ U, 2, IOE. ~4s,~o ( ) ,% now or forrnerl~ ~o~, o. so~ ~ Alice ~. Bergeh I I ~.' I I z ~I ~ ~ ~ I I ~m°n~l Tsonlos ~ I ~ I 0 ~0~ OF formerly I ~ ~ ~, ffa=l ~ltl~ fer this loeattO~ ~ve been ~ Z tn~eted by this depart~t ~ ~d ~ o C~ief of Ge~eml ~nee~tn~ ' ~ 0 Are~ = 5~9t4 S.~ I i Lot 25 I , 25.~' RIGHT OF WAY ~1 ~ ,o,. ~294.79' TO LUTHERS ROAD~, , ~ ' .o.. o.~7 N./ ~ S.88° 30'~O'W, 174.89' now or formerly now or formerly Michal E ~ Joyce Mattes~ August A. Stahl ~ ~ Lot 24 I su~ FOR suF~ ~ouN~ DEPArTmeNT O~ H~LTH se.wce~ DOUGLAS tAN SHAW & VALERIE SCOPAZ SHAW ; DEC. 23 ~ 1985 AT MATTITUCK '~ DATE:~ DEC. ~ , 1984 ~R, APPROVAl. OF CONSTRUCTION ONLY , ~WN ~ ~TH:OLD N.Y. SCALE: I" - 40' BATE~HS REF. NO._ SUFFOEK COUN~ NEW ~RK , NO. 84-1257 . .~UTH~IZEO ALTE~ATI~ On AOOITlON m mis GUARARANTEED SURVEY ~:A VI~iTION :~ SECTION 7209 ~ THE DOUGLAS lAN ~RIE SCOPAZ SHAW ~, ' ~ NG~A~A~EI INDIUT[O KNEON ~kgc RUN ~LY ~ USLIFE ~URANG~&~. ~ N.Y. H[~ O~A~ ~T-OATA F~ APPRO~ TO C~STRUCT ~s ~ ~ w~oM ~E SU~EY tS PREPAREO e,,~cn. ~ ~ ~,.~, -:'~'; ~p ;*~ECTION I1~- ~CK QO~ LOT 7,~ ~E~, AND TO ~E ASSIGNEES ~ THE LENDIN6 1 ~ A ~ ~/-' - ] I · OTHER THAI THOSE~SHOWN HER · ': OWNE S ~ '~ ' '~0 -WI~ M '~ T~[ iTAN~ OF THE S~[K CO~TY DEPARTMENT TO [X{JTI~6 $TRUC~R[S ARE FOR i SPECIFIC ~[~ AVE~E ' - . -,. · ' ,.YOUNG S YUUN RIVER~AD, NEW~RK /I AL~ENW. YOUNG, PRO~ESSION~ ~GIN[ER ' , ~'~ I '~:Y~S. LICENS~NO.45e93 IB EJ E--1 0 EM- .D ,01,£Ei 2 :o I 2 I'% II Il II I II II J II 1I II II II il"*"1~ ..... --~ -*1111 IL ....................... JL , .il ........................ 11 ' iT II II : '"1 1.1.1 II Il