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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-22665 Date DECEMBER 15, 1995
THIS CERTIFIES that the building ADDITION
Location of Property 2925 SIGSBEE ROAD LAUREL NY
House No. Street Hamlet
County Tax Map No. 1000 Section 126 Block 6 Lot 4
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 28, 1995 pursuant to which
Building Permit No. 22685-Z dated APRIL 18, 1995
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 AN ADDITION TO A ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to ROBERT NORELL
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N365975 OCTOBER 10, 1995
PLUMBERS CERTIFICATION DATED N/A
Building Inspector
Rev. 1/81
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) 9
Date ...........1 19..1...
N? 22685 Z
Permission Is hereby granted ;
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To ...~t ' > ................l................ r.
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at premises located at.........s......'19'1~/-T 0~v
County Tax Map No. 1000 Section .6('.......... Block 6// Lot No. ®`l
pursuant to applicatlon dated 19.... and approved by the
Building Inspector.
Fee $
Building Inspector
Rev. 6/30/80
t
i - Form No. 6
TOWN OF SOUTHOLD
a BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OR ink and submitted to the building
inspector with the following: for new building 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 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 2/10 of 17 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:
1. Accurate survey of property showing all property lines, streets, building and
unusual natural or topographic features.
2. A properly completed application and a 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
1. 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 Buildine - $100.00
3. Copy of Certificate of Occupancy - $20.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.000, Commercial/ $15.00
Date ..N•C?CPj'?4:P:~...~2.~..I.l.~:..........
New Construction........... Old Or Pre-existing Building..... X
Location of Property... Z 9Z. ......:....5~~56~ ,IeCI e'AlA Wr*
House No. / Streeet/ / Hamlet
Onwer or Owners of Property .
County Tax Map No 1000, Section 4A Block .......F7........ Lot....... /
Subdivision .....................................Filed Map............ Lot......................
Permit No, Z Z`' g s ^ Z ...Date Of Permit Arli..... H/a/Applicant
Health Dept. Approval ..........................Underwriters Approval....... .K
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate....
Fee Submitted: $..~.".42U
APPLICANT
o, SAFFO(,tco
Gym
y x
Town Hall, 53095 Main Road p • Fax (516) 765-1823
P. 0. Box 91971 Telephone (516) 765-1802
Southold, Now York 1
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
November 6, 1995
Mr. Robert Norell
2925 Sigsbee Road
Laurel, NY 11948
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
xx An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
xx The check is not on file. $25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 22685-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
O~~gOF1`01.t Q
c~ Gys
CA 2
Town Hall, 53095 Main Road p • Fax (516) 765-1823
Telephone (516) 765-1802
P. 0. Box New York 9 11971
Southold, N
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
November 9, 1995
Mr. Robert Norell
116 Wellington Road
Garden City, NY 11530
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
xx An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
xx The check is not on file. $25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 22685-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
FOF.LTY'USPECTION REPORT "DATE II
COMMENTS
ro
of ~
FOUNDATION _(1ST)
I1 0I'I
II ~n
FOUNDATION ND)
-
II II -
ROUGU FRAME &
PLUMBING
INSULATION PER N. Y.
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STATE ENERGY I j~ r
CODE
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11 II
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11 l~ II
FINAL l
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ADDITIONAL COMMENTS:
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FAIRWEATHER BROWN
ARCHITECTS & DESIGNERS
BOX 521,122 Front Street Garden
Greenport,N.Y. 11944
516-477-9752
(fax) 516-477-0973
TRANSMITTAL
Date: ~~fp.
To: u V, tl~tAot ( CSk4 C~ i ~1~~
cJDuL1 DLtD Tb)A)O f,'JLC i Dom(.
Re:
kpft L P tbt~'
We are sending, enclosed, the following:
[ "Drawings [ j specifications [ ] samples [ ]
for your:
[ ] use [ 1-4,pproval [v (information
No. Date Description
Remarks
By:
cc:~ .
A` gUPfQC~,
JUDITH T. TERRY ~a Town Hall, 53095 Main Road
TOWN CLERK un~ n P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS~.`;j~ Fax (516) 766-1823
MARRIAGE OFFICER 1'~~"Ly Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER , s'y~'d
FREEDOM OF INFORMATION OFFICER'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
May 8, 1995
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Attn: George Williams
Capitol State Contracting & Development
193-04 47th Avenue
Flushing, New York 11358
Dear Mr. Williams:
Your check No. 760, dated March 28, 1995, in the amount of
$75.00 to the Building Department for a Building Permit has been
returned by the bank due to Uncollected Funds. Enclosed is a copy
of your check and notice from the bank.
This office is required to collect the money for the check and
an additional $15 charge for a returned check. Payment must be
cash, money order, or certified check. The total amount due is
$90.00 and must be received no later than Town Hall closing time at
4:00 P.M. Thursday, May 11, 1995. Until this matter is resolved
you will be unable to issue a check to any town department or agency
and the Building Permit will be invalid.
Failure to pay this amount within the specified time will result
in referral to the Town Attorney's Office for collection.
Thank you for your anticipated cooperation.
Very truly yours,
itontl• I
address
rnd it to V G~~~
l6e return i Judith T. Terry
Southold Town Clerk
the g"Mo'd Enclosure
l
cc: Town Attorney
nteaaressee! Southold Town Building Dept.
this 1eteipt. ltt
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765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ INSULATION
[ AT41RAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
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DATE INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] F DATION 2ND [ ] INSULATION
[ } FRAMING [ ] FINAL
[ ] FIREPLACE CHIMNEY
REMARKS:
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DATE ~y INSPECTOR
y~ M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE CHIMNjEY
REMARKS:
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DATE INSPECTOR
I/ / 1 7
11 11
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1045095 BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YO W YORK 10038
pate OCTOBER 10,1995 Application . on file 6795/95 N 365975
THIS CERTIFIES THAT PERMIT 0. 226852
only the electrical equipment m described below and introduced he applicant na ad on the above application number in the premises of
MR.NORELL, 2925 SIGSBEE DR., MATTITUCK, N.Y.
in thefollowing location; ? Basement IN Ist FL ? 2nd Fl. OUT Section126 Bloc
was examined on OCTOBER 03,1995 and found to be in compliance with the National Electrical Code.
FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS INCANDESCENT FLUORESCENT OTHER AMT. K W. AMT A. W. T. K.W. AMT 9. W., AMT. H P
5 8 5 5
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIMECLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
AMT. K. W. OIL K P. GAS H. P. MAT. NO. A. W.0 AMT. AMP. MIT. AMPS TRANS. AMT H P. SYSTEMS AMT. WATTS
NO.OF FEET
2 600
SERVICE DISCONNECT NO. OF S E R V I C E
AMT. AMP. TYPE METER I X 2W l e 3W 3 % 3W 3 X 4W NOAF CC COND A. W. G. NO OF HI LEG A W. G NO.OF NEUTRALS A. W. G.
EQUIP. PER % OF CC. COND. OF HI-LEG OF NEUTRAL
OTHER APPARATUS:
PADDLE FAN-1
MOTORSEI-F H.P.
JOHN C. D'ARIES LIC43910E
70 HAIGAT STREET
DEER PARK, NY, 11729 GENERA} MANAGER
11
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 credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
FORM No.7 ~JOSETSOOFHPL\YS
TOWN OFSOUTHOLD /SURVEY
MAR 1995 r~u?LD1N^ OEPAfiTMGNT icllccl • . . . .
TOWN HALL SEPTIC FORM
SOUTHOLD, N.Y, 11971
JQVINOFSOUITIOLu_ ,.@
- Ile TEL.: 765.1802 t;O '777
CALL .~5 7-4
Examined ....°/`~j...., I HAIL TO:
Approved 197J. Permit No. vzl ?5-27 • • . • . • • . .
Disapproved. a/c _ .
(B ~,pector)
APPLICATION FOR BUILDING PERMIT p
Date ...'r~, .U......... 10~-
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with
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 stieet
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appL
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 permi
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 Occupanc
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 th
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o
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 co e, housing code, and regulations, and V
admit authorized inspectors on premises and in building for necessary insMature (Si applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
~ L
Name of owner of premises . pla.41 • , , ,
(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 NoWT.O.9e?'(; 6lij; , .
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 :...................c~s , .......L.:
House Number
Street Hamlet
County Tax Map No. 1000 Section ~.oS .~o......... Block
(o....... Lot... y
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 001.0.1C .
b. Intended use and occupancy ...~~r1/.T(U! . „ , , • , , , • ,
(check Addition . • Alteration .
Ree
3 Repair of work which . oval applicable).: . . New Bu.il..ding Demolition , , . Other Work .
p
(Description)
4. Estimated Cost . , Fee .
(to be paid on filing this application)
5. If If dwelling, garage, numbnumberer of of cars dwellin g units . Number or dwelling units on each floor
s s>
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .
7. Dimensions of existing structu'res, if any: Front Rear Depth .
Height Number of Stories .
Dimensions of same structure with alterations or additions: Front Rear .
Depth . . Height . Number of Stories . • . • I • ~ • I ' • •
8. Dimensions of entire new construction: Front , . , • , , , , , Rear . . Depth
Height NuinberofStories
9. Size of lot: Front , Rear........... 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 . , , Address . . Phone No.. .
Name of Architect . . . Address , Phone No....... .
Name of Contractor . . Address . , , • , . Phone No. ,
15. Is this property withinl'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 setback 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
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STATE OF NEW R S.S
COUNTY OF o
(Name of individual s)gm'' 1 being duly sworn, deposes and says that he is the applicant
pg contract)
above named.
ie is the .
ontrac agent, corporate officer, etc.)
)f said owner or owners, and is duly) u crform 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
vork will be performed in the manner set forth in the application riled therewith.
;worn to before me this
o~ g ...'...day of • >~~C rL.~ 19 .
County
otary rskalic, a m o
Mo, 52-£31~~sII f~, Suffglk l=oan . . . .
Term Fxgirm Octobsr31,19 (Signature of applicant)
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SURVEY FOR ROBERT E. NORELL
LOTS 116 8 117
"AMENDED MAP OF MATTITUCK PARK PROPERTIES, INC."
AT MATTITUCK DATE JUNE 2 , 1963
TOWN OF SOUTHOLD SCALEe 1" • 30'
SUFFOLK COUNTY, NEW YORK NO. 83-400
*UNAUTHORIZED ALTERATION OR ADDITION TO THIS GUARANTEED T01
SURVEY IS A VIOLATION OF SECTION 7208 OF THE
NEW YORK STATE EDUCATION LAW CHICAGO TITLE INSURANCE COMPANY
R COPIES OF THIS SURVEY NOT BEARING THE LAND
SURVEYORS INKED SEAL OR EMBOSSED SEAL SMALL f NEW
NOT BE CONSIDERED TO BE A VALID TRUE COPY tL ,,I,
OGUARANTEES CATE THE PERSON FOR WIHOM T EE SURVEY IA9 PREPAREOYTO a~P j W. y() h
AND ON HIS BEHALF TO THE TITLE COMPANY,DOVERN-
MENTAL AGENCYAND LENDING INSTITUTION L13TED0 0
HEREON,AND TO THE ASSIGNEES OF THE LENDING
INSTITUTION. GUARANTEES ARE NOT TRANSFERABLE 4
TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT
OWNERS.
NOTE: *DISTANCES SHOWN HEREON FROM PROPERTY LINES y17 q
TO EXISTING STRUCTURES ARE FOR A SPECIFIC
1. MONUMENT FOUND PURPOSE AND ARE NOT TO BE USED TO ESTABLISH
2. SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF PROPERTY LINES OR FOR THE ERECTION OF FENCES.
SUFFOLK COUNTY ON JAN. 12, 1926 AS FILE No. 801 "q
3 sUFF.CO7A%MAPI 01sT. SECT. BLK. LOT YOUNG e YOUNG 4 OSTR DER AVENUE
1000 126 06 6 004 RIVERHEAO NEW YORK
4. AREA•14,000S.F. I
ALDEN W. YOUNG, PROFESSIONAL ENGINEER
AND LAND SURVEYOR N.Y.S.LICENSE NO.12845
HOWARD W. YOUNG, LAND SURVEYOR
N.Y.S. LICENSE NO. 45S93
un ANDIA S SONS. ~Hr 1618
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