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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 2-23827 Date AUGUST 21, 1995
THIS CERTIFIES that the building NEW DWELLING
Location of Property 160 OAK STREET MATTITUCK, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 141 Block 1 Lot 13.1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 1, 1994 pursuant to which
Building Permit No. 22356-Z dated SEPTEMBER 26, 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 ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to MARIE WINIARZ
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-94-0069-JULY 17, 1995
ELECTRICAL INSPECTION CERT. #6333 DATED JANUARY 11, 1995
PLUMBERS CERTIFICATION DATED AUGUST 17, 1995 - BAY BELL PLUMBING
Building Inspect
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 AUTHOR D) y~~/
Date °?4...................... 19 V/• • • •
N°_ 22356 Z
Permission Is hereby granted to;
~ ~ .../.tee... -..I Z.
P o....c.....~.z...
PO° j.../.:.`,..,..l..l...q.77
to....... V'V..eco....... ~..n!'.../'e.r...
.~.~a.....(. AIL ...1........k ........A.r ~ .1.,~. Jam..
at premises located at ~~.......S..l<!.. .........d~C...I..............................................
f!'!. -4L! .............1 t...................
County Tax Map No. 1000 Section...... .67Z!1 Block....../ Lot No. .l- .~..I..,........
pursuant to application dated 19....C/. y', and approved by the
Building Insppector.
- 49L
Fee$.°~/~...
Buil.ding Inspe or
Rev. 6/30/60
3V5-5SV2
Form No. 6 410~
Ala TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-002
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 1% 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
Q 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 Buildina - $100.00
3. Copy of Certificate of Occupancy - $20.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $$15.00•, Commercial $15.00
\1 Date 0 //31QJr'....
. .
New Construction.:71...... Old Or Pre-existing Building......... y..~.....:,
Location of Property...,1~ ....C/~exL / 8 ~ 1 K<:
House No. Street Hamlet
d~ / ' 0 0
Onwer or Owners of Property.... /l Ari.(...... W f4 0!, 144
County Tax Map No 1000, Section ...od~..... .P,.luck....~..,...... ..Lot ...I &I
..Subdi.visi.one........................... ..F110 Map........ ....Lot.............
to J 62 t Permit No.v~~~. ...Date Of Permit dip ...w.197 Applicant. ~?t
health Dept. Approval ..........................Underwriters Approval.../......................
`lanning Board Approval
Request for: Temporary Certificate........... Final Certicate...........
lee Submitted: & WAN ~o
co U~sa
, AUG 2 1 1995
Town Hall, 53095 Main Road Fax (516) 765-1823
Telephone 765-1802
P. O. Box 1179 ~ (516)
Southold, New York 11971
1
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
C E R T I F I C A T I O N
DATE:
Building Permit No. d,,:qos-6 2
a
Owner: "tA~t )CVk'LOA -4-4.
(please print)- y
Plumber: ~i(p l(. Q
se print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
(Plum ers Signature)
DIANE M. CARPENTER
Notary Public, State of New York
No.4964038
Qualified in Suffolk County
sworn to before me this Commission Expires March 19,19
day of 19_q j6
co
Notary Public, County
0000000000000000000000000oooooaooooo000000000000000000
0 (516) 286.6642 ELECTRICAL INSPECTION SERVICE, INC.
0 375 BUNTON AVENUE Q
° EAST PATCHOGUE, NEW YORK 11772 6_333 p
0 Date _1-11-95 APPLICATION No. ON FILE p
0 0
0 0
0 ADDRESS:_ 16O Oak Street _-____VILLAGE_ MattltnCk TOWN: Southold Q
o O
0 ISSUED TO: Ed Turner Q
0 INTRODUCED BY Shamrock lectric Q
O L I C. NO.- 4047-$ p
0 was examined on__ 1-11-95 and found to be in compliance with the National Electrical Code. Q
0 LOCATION XX BASE. Xx 1st. 2nd 3rd XX Attic Pool O
Q DET. GARAGE HOT TUB O
0 Q
O p
0 FIXTURE RECEPTACLES SWITCHES G. F. C. I. DIMMERS FANS AIR. COND. Q
0 15 22 16 2 1 Q
O DISHWASHER DRYER CLOTHES WASH. GAR. DISP. RANGE OVEN SMK. DET. Q
0 - O
0 1 1 Q
O FURNACE OIL GAS CI R. MOTORS BELL TRAIN. SERVICE DISCONNECT O
° e er, m s. ase O
0 1 zone 1 1 1 100 O.H. O
1-KITCHEN HOOD FAN O
O itATER PUMP 0
0 ~ Q
0 President O
0 S U
O p
00 This certificate must not be altered in any manner. O
0 Inspectors may be identified by their credentials. Q
O p
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ULATION PER N. Y. I H
STATE ENERGY II l~
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ADDITIONAL 11~fE11TS:
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M-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
r
DATE INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INS ATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
r F
DATE KPle?~-7- INSPECTOR
ppr-
3 J-Z.
70-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ INAL
[ ] FIREPLACE & CHIMNEY
REMARKS
DATE o~ INSPECTOR
27-
M-1802
BUILDING DEPT.
1 NSPECTI
[ ] FOUNDATION 1ST [ ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:e _
DATE INSPECTOR
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(n 0 W N ~t BOARD OF HEALTH
U FORM NO.1 3 SETS OF PLANS
TOWN OFSOUTHOLD SURVEY
i_
L= BUILDING DEPARTMENT CUEG1
j TOWN HALL SEPTIC FORM
BLDG. DEPT, SOUTHOLD, N.Y. 11971
TOWN OF SO_UTHOLD t TEL.: 765.1802 NDT i FY I
CALL :3.`~JV ,$=S'o ?
Examined ..k° 19,9. / MAIL TO.
• • .
Approved 19`~Permit No. 5; .
Disapproved a/c
............................?ATION
AA.
uilding Inspector)
APP FOR BUILDING PERMIT
Date ? 19
INSTRUCTIONS
r. 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 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 code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections.
1 l. ~fZa/'lzfZTlrS /n) :C~
L . J .
(Signature of 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.
.....................~F!~rXAL....c,cn
Name of owner of premises PP!;c? l.hj/... I /0,,1 r Wx?,we Lzz
(as on the tax roll or latest deed)
If applicant is a corporation s' authorized officer.
...........E
(Name n title of corporate officer)
f
Builder's License No .
(l,
Plumber's License No .
Electrician's License No .
Other Trade's License No .
1. Location of land on which proposed work will be done. A~/J [3.~1%4...tJ.
House Number Street / Hamlet
County Tax Map No. 1000 Section ..../-7.1/ Block ......~t Lot ...13'.,1......... .
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 ............/'~~19~ 1....L1!Yr?f~
b. Intended use and occupancy
11
3. Nature of work (check which applicable): New Building Addition Alteration .
Repair Removal Demolition Other Work,.............. .
(Description)
4. Estimated Cost..... P. Q610 Fee......................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on each floor
If garage, number of cars
6. If business, commercial or mixedl, occupancy, specify nature and extent of each type of use
7. Dimensions of existing structures, if any: Front. . , Rear wagW Depth
Height VOW Num~er of Stories . ..ate..` , , , , , ,
Dimensions of same structure with alterations or additions: Front Rear .
Depth 1 . Height Number of Stories .
8. Dimensions of entire new construction: Front cl`.6 Rear d Depth . e
Height ....16 . e.. Number of Stories de . . ,
9. Size of lot: Front •(o• 5: , , , , , , Rear . Depth JYA. 4Z : o' 6.Q. ,y'... .
10. Date of Purchase : Name of Former Owner
11. Zone or use district in which premises are situated . .
12. Does proposed construction viol4te any zoning law, ordinance or regulation: ..,PP .
13. Will lot be regraded . V. K-% Will excess fill be removed from premises: Yes No
14. Name of Owner of premises .../01A.1/.h4C2 . Address IPA9PV.,.38, Phone No. y?S $'Rle'yO.....
Name of Architect ..,P,97,4R. , , i P01.04,(~ . , , , • • , , , Address . R/ SyvQ4~RF, , , , . Phone No. - 3:?5:. 9.9it 7 .
Name of Contractor.. C44' , ..,PW. ?.n!c Address . WAS.71141"YXl, Phone No.. ?J" .S.~d ,
15. Is this property within 3,00 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 set-back 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.
Suieu"I
i
STATE OF YORK,
COUNTY OFE SuF ~7 $•S
Name of individual srul • • • • • being duly sworn, deposes and says that he is the applicant
signing contract)
above named.
He is the (f~.(. P. D~....................... .
(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 conta!ned 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
:day 19
, .....`~~?*!f.. .
Notary Public,
• . i County
ROBERT COTT, JR.
NOTARY P IC, State of N.Y. (Signature of applicant)
No. 4725089, Suffolk Cou
Term Expires May 31,19
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CERTIFICATE 6140" K or L on x Ell + - N. ALL LNiMYiI1IN"fAN'fttfttlt, Yo"tNNf-il' NM tttktiAC! t. the p0 Epdht Open bald oaolitiws enawntor" and aea create, C" e atplual tdat"11, at she •otceull 1bda"Tttr. Plans. Ears posts flat a" dinvasion and aaatlity that arc t,c. l enly 11Y 'bY the ituild.t red !late'. Ia the trees idditiwsG wt•it w IVTaMwd lu
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PLUMBING 7'Q ALL PLUMBING As NL sm. _ . V* AALA O roN GYV 11.~ ~+4 - f-' NR Yi CAYACtTY Mt ys.t"d" "1 t.., . CSPAttrY "t"i --~.-~-a--
WATER LINES NEEp n stock. angew A mmior ,fbNrrU iIN DN NtlTM kANt,k.
A P OV D AS NINE TESTING BEFORE COVERING
- DA B.P. a -
FEE. BY. ~
NOTIFY BUILDING DER eT PLUMRERCERT/F/CAT/ON WAM WA, OWN* sa ft4 won 'm ~ all
795-1602 9 AM TO 4 FOR THE ONLEAD rZ! eNp/aM kT, ne'
FOLLOWING INSPECTIONS: CONTENT REFORB 1. FOUNDATION - TWOREGUIRED CERT/F/CATEOFOCCUPAN E _ WMEOV
FOR POURED CONCRETE ai M wA4,
d~"Er 2 ROUGH . FRAMING & PLUMBING SOLDER USED /N WATER .w .w .w
a INSULATION SUPPLYSYSTEM
a FINAJ- c FOR u. MUST EXCEED CA NNOT .000" Lot + a-1
BF COMPLETE r, 0 o. 2110 ALL CONSTRUCTION FOR CTION SHALL MEET of 1/o LEAD. DMn1 as w
0 THE REQUIREMENTS OF THE N.Y. I .w
STATE CONSTRUCTION & ENERGY orwrnwnul •c
CODES. NOT RESPONSIBLE FOR salt IY
DESIGN OR CONSTRUCTION ERRORS UNDERWRITERS CERTI FICATE" REQUIREDt rMt 1 she tested an 'Mut CAM, W
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r' 'N' TYPICAL ROOF
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co exterior plywood raf -see plans Ea.
aiseo. to haTa teas
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