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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 2-24511 Date JULY 22, 1996
THIS CERTIFIES that the building ADDITION & ALTERATION
Location of Property 180 NO. RILEY AVE. MATTITUCK, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 122 Block 3 Lot 38
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 1, 1994 pursuant to which
Building Permit No. 22286-Z dated AUGUST 28, 1994
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 REPLACE SIDE ENTRANCE STOOP OF EXISTING ONE FAMILY DWELLING
WITH OPEN PORCHES AS APPLIED FOR.
The certificate is issued to JEANNE WHATNOUGH
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Bl~elding inspector
Rev. 1/81
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FORM NO.S
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)
Date .,vA•••........... 192V
N° 22286 Z
Permission Is hereby granted to:
2!.~..... ~GCy~
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.................................................y.................,
at premises located at..... f!/.o ........OT... P..
County Tax Map No. 1000 Section .a. Z....... Block Lot No. .e...I......
pursuant to application dated 19.:1...$...., and approved by the
Building Inspector.
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Fee f.. ,,r..
00 WW;4
. . 1.
Building Inspector
Rev. 6/30/80
Foul Vo. b
+ TOWN OF SOUTHOLD
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 oroperty 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.
0. 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 325.00,
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00,
Additions to accessory building 525.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Buildins - $100.00
3. Copy of Certificate of Occupancy - .251,
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential S15j00, ommercial $15.00
Date
New Construction... ..m... Old Or esisti/a~g Building..../.
Location of Property .../.&Q..~... ! C. S N 41C.~..... I S2.
House No. Street 'Let
Onwer or Owners of Property ....~Q 1/.!771.1! ...W. ~jD .G./.•.............
County Tax ?lap No 1000, Section..) 2!J ......Block... Y........... Lot...36
Subdivision.........`` ..'led Man............ Lot........
?_rmit No.. 5!...Date Of Permit.. / J. lpplicant..Y"..
Health Dept. Approval ..........................Underwriters Approval...
Planning Board Approval /
Reeuest for: Temporary CefJrrt~tificate........... Final Certicate.... 4.- .
-se Submitted:
APPLICANT NT , lO,.rc. SI6S'/
co ~aySll
r ,
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE INSPECTOR
r
7GS-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ t-rfRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE INSPECTO \ ~°'h
765-1802
BUILDING DEFT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] F NDATION 2ND [ ] INSULATION
[ FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
r
DATE INSPECTOR
_ LD L.. S: IJ:1l r g
:.ozKMeNr YVv
FOUNDATION (1st)
c
FOUNDATION (2nd)
2.
I zt
ROUGH FRAME &
PLUMBING _
l 0
lit
3.
INSULATION PER N. Y. I y
STATE ENERGY
CODE <
x
FINAL rze
o
ADDITIONAL COMMENTS: x
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lr, -9..1994
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roBLDG. DEPT.
~ OLD
R4SViceiciNS YOUNG 0 YOUNG
900' OS7RANQER AVENUE, RIVERHEAO, NY
ALD& W. YOUNG NON'AX W YOUNO
PROFESSIONAL $NOINCeR ANO LANO SURVEYOR
LAMO SURVEYOR, M.YS 00,, A'a l8 NY$. UO.. M 40093
svivVE/y F[OJR/y e~ r pq py /p /M / I~I'pp I'
Ll vp(~ILY IF Be ~N B/I.~IY M8 )M ~ORN.I, O'P•I 4~/'/•`RI\
A1'
AM rrl7VCYr NC#"lL"YIPLE,OIV/£lOMOF
R7Et N OF c'71490 i"1 rU INSURANCECa
OLD
SC/FF00,1 N. Y. eY wtt~d~ ~
" SCALZF 1"z OAb b`~~a ao turn ~NQ rn .+or
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5 busloess aoys n o. , - . . > r l reu n,
,ontract shall be deemed cancelled and thereafter neither subd. 5 of Section 13 of the Lien t
.e - ~ °''17:S~fa'ns54'.G•D:?f• ~V r.. `:a`ti. su ,l*'.-crT~ir tA. 1•'.aiM: r, _ ,r •
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SCHEDULE A
ALL that certain plot, piece or parcel of land, with the buildings and improvements thereon erected, situate,
lyingand being7n1(d1xx at Mattituck, in the Town of Southold, County of
Suffolk and State of New York, bounded and described as follows:
BEGINNING at a point on the easterly side of "Riley Avenue"
distant the following 2 courses and distances from the intersection
of the northerly side of East Legion Avenue with thew-,sterly side of
Riley Avenue: (1) South 77 degrees 35 minutes East 52.93 feet; (2)
South 06 degrees 45 minutes East 156.93 feet to the point at which
Riley Avenue is intersected by the southerly line of land now or
formerly of James Wasson; thence, along said land, South 77 degrees
35 minutes East 142.46 feet; thence, along land now or formerly of
Julius Zebroski, South 07 degrees 55 minutes East 66.82 feet; thence
along land now or formerly of Elvira Travell, North 77 degrees 35
minutes West 145 feet to the easterly side of Riley Avenue; thence,
along the easterly side of Riley Avenue: (1) Northerly along a curve
which bears to the left and has a radius of 234 feet a distance of 22
feet and (2) North 06 degrees 45 minutes West 44 feet to the point
of place of BEGINNING.
a
(R~ BOAFD OF HEALTH
RR
D L5 9 l5 R FORM NO. 3 SETS OF PLA225
I; I TOWN OFSOUTHOLD SURVEY
BUILDING DEPARTMENT CHECK _ . _ , .
TOWN HALL SEPTIC TORN
SOUTHOLD, N.Y. 11971 ~
BLDG. DEPT. TEL.: 765-1802 t:OT I FY /y GFryII~
WN FSOUTHOLD CALL..-
Examined . , 19 MA IL T0:
Approved , 19WP ,rmit _ .
Disapproved a/c t _ .
(Buildi",i spector)
APPLICATION FOR BUILDING PERMIT
Date . . . . . . 19
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 stieets
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
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, 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 c e, and regulations, and to
admit authorized inspectors on premises and in building for necessa inspections.
ignature of applicant, or name, if a corqtion
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
~•Q . . k
Name of owner of premises 4ZA-C._1• • C . .
(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.
Other Trade's License No . J
I. Location of land on which proposed work will be done. per... .
......................................................./2(
C.,. ?~1..~2Z
House Nu.m. ber Street
Hamlet
County Tax Map No. 1000 Section 1. PC.~ Block : , , , Lot
Subdivision Filed Nlap No. Lot
(Name)
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 l!(/ , 1~., , , L(A c
F3. Nature of work (check which'
aPPlicable): Now Building
Repair Addition wl, ffnt
Aloe anon .!i , . • . .
, . Demolition Other Work
4. Estimated Cost Y Df ( (Description)
Fee....................................
to he d"i` Son' film this
5. If dwelling, number of dwelling g, is application)
, If garage, number of cars t units , . . .
Number of dwelling units on each floor
6. If business, commercial or mi ed Occupy cy, specify, n pre and extent of.eac t . • . ' ' ' '
7. Dimension of existing structures, if any: Front ~ P~ of use . ~(r,o, ,
Height !,~f Rear
!Xt> Number of Stories Depth . ay .
Dimensions of same structure with alterations r add'
tl'ons:WFro
Rear .
Depth . v~.. Height ...'OIQ3 f ,
8. Dimensions of entire new cons Number of Stories .
Height ruction: Front V1,Q. ~tI.GQ .
r Depth
Nutuber o Stories • • • .
9. Size of lot: Front , ear
10. Date of Purchase 0 t~ d•~
Depth
f ( q Name of Fp~~graae*'Owner .
11. Zone or use district in which p emises are situated 1(~Q~t CtL
12. Does
Proposed construction violate any zoning law, ordinance or regulation: Q
13. Will lot be regraded \k, 0 • . • .
14. Name of owner of pre ise p Will excess fill be r ved rom premises: Yes
S NAddress ''one No.
err' : s n~c a.~~
Name of Architect Phone No.
V Address
15. Is this property within Name of Contractor . yU0fe t of a tidal Address wetland? Phone No. .....,5 $
*If yes, Southold 'down Trustees Permit may be required. No......... '
PLOT DIAGRAM "
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions fh+im
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
1W A Ue c 1
;TATE OF NEW YORK,
:O Y OF. .
(
' ' being duly sworn, deposes and says that he is the applicant
individual signing / . •
(Nameof gmingcontract)
bove named.
e is the N. ~ .
(Contractor, agent, corporate officer, etc.)
said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
,plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the
ork will be performed in the manner setforth in the application filed therewith.
vom to befor/e me this
(day Of...!I , 19.sy
Mary Public, . . . ounty
JOYCE M. WILKINS~•`c* V. f 1. r
Notary Publlc, State of NOWVorRt LLL////// 0
No. 4952248, Suffolk Counyyy~~ (Signs a of a licant)
Term Expires June 12, X
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PROPeSFp "PCrtLq FD TOrtcH es ~
RNUERIyR - -
REQ~UIRkDO~FR ATE
OCCUPANCfON
W THOUC CER~ FICA
' OF OCCUPRNCV I _
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c I 16•-i9(y1 f+ AM TO d RM AT POLLO4NING'At PECTI OR THE' i - Y. FOIlf11D OM1S.
! ATION . TlNO REQUIRED F"()R MIMED CONCRETE
N,' P.ORK;H - FRAMING & PL G
UMBIN INSULATION
5. F!P!A! - CONSTRUCTION MUST fi'. _ BE COMFLETE Fnc r n -
1 ALL T E CONSTRUCTION SNRLL THE MEET
FE-7E REQUIREMENTS OF THE 4C1CS ~_c y~_~ n'
OTfiTE CONSTRUCTION & ENERGY CODES. 6I NOT
DESIG RESPONSIBLE FOR _ N OR CONSTRUCTION ERRORS
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rf NDr To LE lagl 'fop .
Pv.nl.. VIEW - '
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180 N_ RILEY AVL
MATTITUCK NE -W YORK
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