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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-24566 Date August 12, 1996
THIS CERTIFIES that the building accessory
Location of Property 80 Arrow Lane, Southold
House No. Street Hamlet
County Tax Map No. 1000 Section 87 Block 2 Lot 14
Subdivision Filed Map No. Lot No.
conforms Substantially to the Application for Building Permit heretofore
filed in this office dated June 17, 1993 pursuant to which
Building Permit No. 21525-Z dated July 12, 1993
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 accessory garage with hobby shop as applied for.
The certificate is issued to Joan C. Kathie
(owner, lessee or tenant)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N 332070 dated November 1, 1994
PLUMBERS CERTIFICATION DATED August 6, 1996
Building Insp ctor
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
k COMPLETION OF THE WORK AUTHORIZED)
F
Date ....l.f 19.3...
N® 21525 Z
Permission is hereby granted to; 1-7
to. .Aw..... /
<
at premises located at... o....... Qmwe ~dawx
County Tax Map No. 1000 Section/......X7.......... Block Lot No. 2..~
pursuant to application dated ..~p.. /1...7............ 19........ and approved by the
Building Inspector.
Fee $ I ~i4.........
Building Inspector
r
Rev. 6130)80
TOWN OF SOUTHOLD @'0' pJ X023{'
k€ 0 d ~mn* ~J~/ 1197/
k4~~ g BUILDING 1T
TOWN HALL
C 765-1802
JUL - 319 96 LLL JJJ
APPLICATION FOR CERTIFICATE OF OCCUPANCY
BLDG. DEPT.
TOWN OF SOUTHOLD
A. is app lcati.on 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 325.00, Swimming pool'$25.00, Accessory building 525.00,
Additions to accessory building $25.00. Businesses 350.00.
2. Certificate of Occupancy on Pre-existing Building: - 3100.00
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 9!.~. L? e
New Construction. V&G Old Or Pre-existing Building
'Location of Propett//ty..... .4.v..... LR. w Q,U3J DG.
House No. Street
~y . Hamlet
Onwer or Owners of Property...~/4 / . ...)1/.
'County Tax :Sap No 1000, Section... f7......Block.. p.~.........Lot..I.X
Subdivision A`.........Filed Map............ Lot..../~.j.~.J..........•~/~•f Br~
fPermit 10. 1. a5/ Date Of Permit.. 7: ~ ??~.~J..Applicant. :C!T ~ /,~dTOLM
;Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Certificate........... Final Carticate...........
ee Submitted: 5
rec. 5179
APPLI ANT
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-G r~ ,jj. LELV,q~O
a
O O~ 9 SUF50D7{I QUNTT~ HEALTH DEPARTh~NT.-
1. +
it Z r DATE . .
The sewage disposal ajd water supply
~T facilities for this location have been
9rf `x3696
OF h E W Y OP - - inspected by this d: to b. satisfactory. ent,~anc~Pound
t Y/%OiqOO OF";CDT 17 Chief of.General Engineering
,l/U,lGf//9i~Ci9 fif/91E.P5 Services
T>.9rE- ?v-vE ~y7¢ gveyavy W LEw.9.v~wxri"
O G
Town Hall, 53095 Main Road Z y Fax (516) 765-1823
P. O. Box 1179 Telephone (516) 765-1802
Southold, New York 11971
10-
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
C E R T I F I C A T I O N
DATE: OCI-'
Building Permit No.
Owner: N/6 6QAJ W l A /
(please print)
Plumber: / 4/odf J i//11
pQ,//
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
(Plumbers Signature)
Sworn to before me this
/ a
(O - day of 19j~
Notary Public, County
MAREA.WODDS
N"P
1YP0609«iew r
cimmsw F.vkaAWN1d,1s0(j
r
o~g~FFO(,~co
Town Hall, 53095 Main Road p Fax (516) 765-1823
Telephone (516) 765-1802
P. 0. Box New 1York 179
11971
Southold, N
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
July 3, 1996
Mr. & Mrs. Raymond Mathie
P.O. Box 1236
Southold, NY 11971
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.
xx No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 21525-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
m
?e 93 IQ
~ V
%OUIIDATIOY (1st) a
'OUNDATIO- (2nd)
2. P e~
o~
goUGH FRAME &
-PLUMBING
• I .
. (I cn
3• y
cv
!i1SULATI03 PER N. Y. y
I n
STATE ENERGY II
CODE
7' //J~yy c•~:~~
L/ y
FINAL
ADDITIONAL COMMF,NTSI S
x
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SOFFO~~-earn
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Town Hall, 53095 Main Road p Fax (516) 765-1823
y~O~ Telephone (516) 765-1602
P. 0. ew York 9 11971
Southold,
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
December 14, 1995
Ms. Joan Mathie
P.O. Box 1236
Southold, NY 11971
Re: Building Permit #21525-Z
Premises: 80 Arrow Lane, Southold
Suff. Co. Tax map #1000-87-2-14
During a review of our files it was noted that the above
building permit has expired, and a Certificate of occupancy has
never been issued.
According to the Code of the Town of Southold, Article
XXVIII 100-284, it is unlawful to occupy or use a structure
until a Certificate of occupancy has been issued.
Please contact this office as soon as possible so that we
may clear up this matter.
Thank you for your cooperation in this matter.
Very truly yours,
SOUTHOLD TOWN BUILDING DEPT.
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M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] 1 ULATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
I
REMARKS:
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I
DATE INSPECTOR
THE NEW YORK BOARD OF FIRE UNDERWRITERS PACE 1
10014.33
BUREAU OF ELECTRICITY
85 JOHN STREET. NEW YORK, NEW YORK 10038
Date NOVEMBER 01,1994 Application No. on file 83356794/94 N 3320170
THIS CERTIFIES THAT
only the electrical uipment as described below and introduced by the applicant named on the above application number in the premises of
eq
A*h 12
MR.RAYMOND..I4PP', 80 ARROW LANE, SOUTHOLD, N.Y,
in thefollowinq location GAR/OUT
s Bj Bagement 1st Fl. In 2nd Fl. Section Bloch Lot
nas examined on OC°TQ " R LB , 1994 and found to be in compliance with the National Electrical Code.
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS ECEPTACIES SWITCHES IN CANDESCENT FLUORESCENT OTHER AMt: K W AMT. K. W. AMi KW. T. K.W. AMT. H. P.
8 y 12 8 1 F1
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS FELL ' UNIT HEATERS MULTI-OUTLET DIMMERS
AMT. K. W Olt H. P. GAS H. P. AMT. NO. A W. G. AMT. P. AMT. AMPS TRANS. T. H P. SYSTEMS qMi. WATTS
NO, Of FEET
SERVICE DISCONNECT NO. OF S E R V I C E
AMT. AMP. TYPE METER I X tW 1 e 3W 3 d 3W 3,e' AW NO. OF CC COND A. W. G. NO OF NbIEG A W G' NO. Of NEUTRALS A. W G.
EQUIP. PER a OF CC. COND. OF HI LEG OF NEUTRAL
OTHER APPARATUS: - -
PANELBOARDSt1-11 C,IR. 100
L^e~~~
THOMAS J, BALL LIC.#2500E G!/%
P.Q. BOX 1708
SOUTHOLD, NY, 11971 amotAt 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 MU$7 NOT.BE ALTERED IN ANY MANNER.
BOARD OF HEALTH
FORM NO.1 3 SETS OF PLANS
TOWN OF SOUTHOLD SURVEY . .
BUILDING DEPARTMENT CHECK . . . . .
TOWN HALL SEPTIC FORK
SOUTHOLD, N.Y. 11971
TEL.: 765.1802 t:aTIFY;
/y
Exami CALL
ned 19%p, MAIL TO:
' ~7 / ~
Approved .12- 19 l Permit No
.
Disapproved a/c l Vr UQI - :~F J
7 4-E~6
(iuitdtspector)
APPLICATION FOR BUILDING PERMIT
Date E,l7....... 19'16
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
kor 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 inspecd
..........1. 1 1. (!~ll?•:b.l+~~
(Signature of applicant, or name, if a corporation)
015J
(Mailing address of applicant)
State whether applicant is owner, lessee, 'agent, architect, engineer, general contractor, electrician, plumber or builder.
h^.a?................:.......
Name of owner of premises ..30AQ ARAL'( 10.14 1" 17 I~~ .
(as on the tax roll or latest deed)
If applicant is a rporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No.
Plumber's License No... ~51 .K . TW- M.5i10(zi z35I -
Electrician's License No.
Other Trade's License No.
1. Location of land on which proposed work will be done.
Bt. i~t2U~J l0:r. . .........GCP-r.t 4.QL.1O
House Number Street Hamlet
County Tax Map No. 1000 Section T~). I Block ..•Z Lot. .t~..
Subdivision . 1J.UVA)A 1,a M A u) A'G'15?! S Filed Map No . Lot ...17:
(Name)
2: State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy 1,ARP .
b. Intended use and occupancy ~gf~C~1
3. Nature of work check which applicable): New Building . ,
Addition Alteration
Repair Removal . , , , , . , , , • , , , Demolition . Other Work .
4. Estimated Cost (Description)
,
Fee...............................
(to be paid on filing this application)
S. If
of o cars wellin J. g units Number of dwelling units on each floor
If garage, t„ number number
6. If business commercial or mix..................................................................
.
ed occupancy, specify nature and extent of-each type of use .
7. Dimensions of existing structures, if any: Front . ' • ' ' , • ' Rear Depth
• • '
Height Nu mberof Stories .
Dimensions of same structure with alterations or additions: Front . • ' ' • • ' • ' • '
Depth . Height . Rear
8. Dimensions of entire new construction: Front , ,Z Number of Stories ' , , , , , , , , ,
Height Rear Z 8 Depth . X
••t~';1'.7.~..... Nu~rberofStories ...,G.,,
9. Size of lot: Fra,rt . Rear . .
10. Date of Purchase Depth
11. Zone or use district in which premises are situated , ' ' Name of Former Owner , , , , , , , , , ,
12, Does proposed construction violate any zoning law, ordinance or regulation:
13. Will lot be regraded „ ; , 1-, , , , , • , • . , , , , , Will excess fill be removed from premises:
14. Name of Owner of premises . . Address . es No
Name of Architect . ( Ri1k~ , ,qEN ` , ' • • • ' • • • • • • • • . Phone No.'lh
Name of Contractor , , , Address ?%VWk 153. ~•N(RQuQPhone No. `}7,~ b, ,
• . 1•i• • • PhAddress Phone No.
15.' Is this property within ~00 feet of a tidal wetland? * " ' " " ' '
*If yes, Southold Town Trustees Permit may be required, No..
PLOT DIAGRAM
Locate clearly and distinctly all1 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.
I
I
I
i
STATE OF NEW YOLK,
S iIS
_OUNTY OF.
• . • being duly sworn, deposes and says that he is the applicant
(Name of individual signin¢ contract)
:bove named. f
le is the ...........1 ,'i /Contractor, Ir.~~ ~.(v ! rQ .r .
agent, corporate officer, etc.)
f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
pplication; 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 anner set forth in the application filed therewith.
worn to before me this
day o .I AE~ . 9.
otary Public, t
ou
. ouny ~
ROBERT il {eJo NY.
NO
TARY PUBL ogcC of (Signature of applicant)
No. 4725089,
Term Expires ay $1,19 f
't
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N coPDw tubing b used . for wain distributing
system: piping "I M
types K or L I - - .
pwmmm0
- -
~ YWSfE - _ ~ypTERLINESNEED
' , 7MM13 EEFM CONERMG I _ - - - . - - ~ -
PLUMBER CERTIFICATION
ON LEAD CONTENT BEFORE 1 AW41
CERTIFICATE Of OCCUPANCY E I . I '
SOLDER USED IN'WATER f _
SuppLy SYSTEM CANNOT
EXCEED 2110 OF 1% LEAD.
_ ~ I ~ _ NpY pR ~ !
IT i;AeN6 TI t~ pGpOPA ILpWFQ~ I pR CyZE IS %p
II ~irc~ o P ~ ~ § ~ pSE '(1F AP, er ~o ASNorco C
ls'7s II GAWbfi ! W1SHp ppppPAN ` f ~ pF I 7 36.R n i
BY:
'NOD"ICY B II! G DEPAF 7 AT
7(j5-1802 9 AM TO q PM FOR THE - { - - - .
FOLLOWING INSPECTIONS:, 11 - t ~ ~WSfG F9afci ' ~ . 1 ' FPO?', I<Kaof)
I, FOUNDATION - - 'nNO REQUIRED I W u;1;fG ~1r3CF'~WFiS
FOR - - POURED.CpNCRETE PLUMBING 2. ROUGH- FRAPAING V II
3. INSULATION-
111ttt q. FINAL - CONSTRUCTION MUST
- BE COMPLETE FOR C.O.
_ ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y. WL/~ WA1, STATE CONSTRUCTION 8 ENERGY - frJ W YT%V M1+ f' F! ' CJ~t?aL YIA~ It ~i~, lll~J ir, 0
CODES. NOT RESPONSIBLE FOR -
DESIGN OR CONSTRUCTION ERRORS (ff~~~6f D~ _
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