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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-22812 Date DECEMBER 23, 1993
THIS CERTIFIES that the building ACCESSORY
Location of Property 2645 REEVE ROAD MATTITUCK N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 100 Block 1 Lot 44
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 9, 1993 pursuant to which
Building Permit No. 21548-Z dated JULY 21, 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 ACCESSORY INGROUND SWIMMING POOL AS APPLIED FOR.
The certificate is issued to JOHN & GAIL MEYER
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-295113 - NOVEMBER 9 1993
PLUMBERS CERTIFICATION DATED N/A
- - -~~L ) , /-Z~
ding Inspector
Rev. 1/81
FORM NO.3
TOWN OF SOUTHOLD
BUILDING DEPARTMEW
TOWN HALL
SOUTHOLD, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Date ...................1..1r~..........................., 19...
N® 21548 Z
Permission Is hereby granted to;
;To...... ...G...! LF..y..~-
°...0.. ........................v.~....
t......... !.x......... or
In~sr .9.r!.......,.,.I dG,ede<,~,} ~S.~r.d~
f ' to ..................Cck-......,................
S .........'-`.ss..... .......?s.........
E
E
,I
I
p ......................p.....
at premises located at .....~~1','............ I...............................
( County Tax Map No. 1000 Section Block Lot No. /YX
pursuant to application dated 21, 19......<.l and approved by the
Building Inspector,
Fee $
• ..~;,.00.
I
~.~?'?7
Building Inspector
Rev. 6/30/80
Form No. 6 '
~m
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
a DEC 2 2 1993
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 19 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 Building - $100.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date
New Construction. Old Or Pre-/e~xisting Building yy~~ 1a
Location of Property.. ace..........~.? °C ......................lllGlfi7K7..
House No. Street Hamlet
Onwer or Owners of Property. ~I....rn M 1K......~
County Tax Map No 1000, Section.~~......... Block 1.......... Lot..~1.................
Subdivision...~l n.~.4 . Filed Map............ Lot.~~n.~~n°°°
Permit o...a:lsq$7....Date Of Permit. A` Applicant 1
Health Dept. Approval.... ...................Underwriters Approval..
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate............
Fee Submitted: $s
q ?3 37 Co ~ as 8l2: APPL .yC T
-~'„+rsvM16s wN~13 .n4k-..u. 1«.nnaa, .,o?Wi +.h~w~tirn&$f..
r
INSPECTORS x~.
Victor Lessard
Principal Building Inspector L'd
Curtis Horton SCOTT L. HARRIS, Supervisor
Senior Building Inspector
Thomas Fisher Southold Town Hall
Building Inspector' P.O. Box 1179, 53095 Main Road
Gary Fish Southold, New York 11971
Building Inspector Fax (516) 765-1823
Vincent R. Wieczorek Telephone (516) 765-1800
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
December 16, 1993
Mr. John Meyer
2645 Reeve Ave.
Mattituck, NY 11952
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 (9,atdate~/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 # BPII 215482
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
Wis.
.c:.~::i ~~J~:,. .:::r(i•1LF1r~ 1
m
a~
OUtIDATION ~ (lst} ~-I ~ ry
Ckn,
-OUNDATION (2nd) _ ZOUGR FRAME Eo I 4~
-PLUMBING
N
' II
rn
:2ISULAT20;! PER N. Y.
H
STATE ENERGY ~I
CODE
A OVA c-
FINAL
70 A45 6~%r
ADDITIONAL COMMENTS:
x
H
r
H
H
-
THE NEW YORK BOARD OF FIRE UNDERWRITERS PACFI r
1195100 BUREAU OF ELECTRICITY
88 JOHN STREET. NEW YORK, NEW YORK 10038
Date NOVE;MMER 09,499-1 Application No. onfile 0524839.31143 N 295113
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
JOHN 14NYE11, 2645 REEVN ROAD, HATTITU(,K, N.Y.
in thefollowinR location; D Basement ? Ist Fl. ? 2nd F1. OUT Section Block Lot
was examined on N 0 V E M B E R 0 2 , 19 4 3 and found to he in compliance with the National Electrical Code.
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS ECEPIACLES SWITCHES INCANDESCENT fIUORESCENi OTHER AMi K. W. AMi. K. W T. K.W. AMT K. W AMT. H P
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS SELL UNIT HEATERS MUL71-OUILET DIMMERS
SYSTEMS
AMT. C W. On H. P. GAS H. P AMT NO A. W. G. AMT. AMP. AMT. Amps TRANS. AMT H P. NO. OF FEET AMi. WATTS
SERVICE DISCONNECT NO' Of S E R V I C E
METER NO.OF CC COND. A W. G A W, G A. W G.
AMT, AMP TYPE EQUIP. WTI ,B' 3W 99 iW 3,e' <W pER a OF CC. COND. NO.OF HI-Ito OF HbIEG NO OF NEUTRAIR pf NEU1RAl
C
OTHER APPARATUS:
ti matte by a qmd Joel p L:sen.
ti
i
SE;ATUCK/KELLEY LTr.,4:t&3t ~ ,
LAURA CT,
P.O. BOB 523 GENERAL MANAGER
SPEONCC, NY, 17.917 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 CER.C IFMA1'E E1JUSTI NO BE ALTERED IN ANY MANINER.
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1195100 BUREAU OF ELECTRICITY
F 85 JOHN STREET, NEW YORK, NEW YORK 10038 •
Date PI0VRfCi8R 09"1999 Application No. onfile O J~.~~r 3~f /Q.2 N 2951).
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
JOHN MEYER, 24345 REEVE ROAD, N.ATTITUCK, N.Y.
in thefollowing location; 0 Basement El OUT /.et Fl. ? 2nd Ft. Section Black Lot
ants examined on NOVEMBER 0 2 , 19 9 3 and found to be in compliance with the National Electrical Code.
FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISK WASHERS EXHAUST FANS
OUTLETS INCANDESCENT FLUORESCENT OTHER AMT. K W. AMT. K W. AMT. K.W. AMT K.W AMT H.P
x z I. z
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIALRECPT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
AMT. K. W OIL HP. OAS H. P AMT NO A. W. o AMT AMP AMT. AMPS TRANS. PMT. H. P SYSTEMS AMl W
. NO. OF FEET
40
SERVICE DISCONNECT 140.OF S E R V I C E - -
AMT. AMP. TYPE METER 1 A" tW 1 ,8' 2W 3,e' 3W 9,e' 4W NO.OP CC. COND A. W G. NO. Of HbLEG A. W G NO. OF NEUTRALS A. W G
- EQUIP. PER b OF CC.COND OF HI LEO OF NEUTRAL
i
T:E
OTHER APPARATUS:
SWINNING POOL 1.
TIME CLOCK 40 AMP TYPE CB-1
PANRLBOARD9;1-I1 CIR, 60
*(SWIMMING POOL) This certificate
t covert compliance ITt the date of.
+uspection only, BIrcause of unusual
environmento .it is advisable to p
have frequent test/and or repairs
Continues( on Page 2
GENERAL MANAGER
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.
i
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFI ATE @UttlS3 VOT BE ALTERED IN ANY MANNER.
t
rs~.iso2
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST ( ] ROUGH PLBG.
[ FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [G-]-R(NAL
REMARKS:
~N,SI
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ) ROUGH PLBG.
FOUNDATION 2ND [ ]ULATION
[ J FRAMING [ FINAL
REMARKS:
DATE l~ " / INSPECTOR
, 49
.JUL - 91993
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I PIP
SURVEY, FOR rLaA ry u <Y:.m~'i'°' "TH' ~NL~. ,U ..:'*z`4~A1J.`fl:?1,I992
''r~l `rr~' ~autl.='rp11991
JOHN MEYER ,BGAIL-,W MMN H' ?JULY :10,1990
LOT NO.G NOREGON HEIGHTSIH 11 rA'`' rv.~ ~ r• ~ WAN g 1990
1 rt fi`"s ~M ~tEti(~[ t ~aOEC 198
AT MATIITUCK yurs St6 8of. ,
TOWN OF SOU?HOLD TI.
SiUFFOLK, COUNIY•td11EW{
a'UNAu t1~ORlE [b "AC ttR1TI ON oN AOeI tItJN VOr toll+~ EEI4t1 p1 - 'tOrOF
'IV a A YIOLAtION OF SECTION
~itbf bl SNE~ ruddH pp.. ?
NEW YORKSTAT[ IWCNIONIAW "GA .,M,- O °x
tNlt'SURVEY NtlT'GtANG~TtI[AN(f~'s
;K COPIES Of AVI Ntl
AL HA{,L 1!
SURVEYOR'S INRtb SEAL boot tMSOSSED lt N
t
NOT GC CONt10CRt0TD bE A VALID-TAJC COP '5" 1 C 7~,
M6V ARANTC[t INDICAtto,'NCREON SHALL RUN ONLY N w,
TENT - DATA FOR APPRO~C4L TO CONSTRUCT ME FERSON.FOR WHOM V-TNt SURVEY is PRLPARCD ~
AND ON HIt'StHALt TO -TNt TIM EOM PfHY°GOVl1N1 s 1 .qel"`:'~S ,
NI ' RSOURC[ OF WATER MIMTL .?VGLIC NCNtAt: AGENCY AND WOOING INt T11Ut(ON `CtfTEO
AIN-- HEREON, AND TO THE ASSIGNEE!. OF THE LENDING
dfT 1000 S[C TIOM 149_SLOCK I-LOi 44 INSTITUTION OUARANtEC5 ARE NOT TAIMSFENAGLE 14 € v;-
•ELLIIIGS WITHIN 100 FEET OF THIS PROPERTY TO ADDITIONAL INSTITUTION! OR,SUGS[OUENT. t +LM 4lSB9'J
1
SHOWN HERCON 14 OWNERS
&wDSEWAGE DISPOSAL SYSTEM FOR THIS RESIDEIRY WD,StANtE! tNOWN N[REON tAOY%MOPERTV UMtt
•^•Mf OF THE SUFFOLK COUNTY DEPARTMENT 'TOEKISTING STRUCTURE! ARt POW A sPECIMIt e# ND I
'PURPOSE AMC Apt NOT TO at USW to t1 TAOLIt0
i 'PROPAHTr'tilNt! O6 h tDIt to to Et rt~iw„Ot IEN~FtEG rp'«"},..L~'s"`f„~'- zae pry qp ;
fay LIN to ..S>¢~ ,.kNr YA- Y+?I ~HG Jy~S: 1•s,M r 1:'r"yt
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/ Ri'veNHL .
AlO~N W.Y Nli'; NAIr
6- STAKE w
BOARD OF HEALTH
FORM NO.1 3 SETS OF PLANS
~,~~~~~i~~` TOWN OF SOUTHOLD SURVEY
BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . .
JUL - 91998 TOWN HALL SEPTIC FORK
SOUTHOLD, N.Y. 11971
TEL.: 765-1802 t;DCALL
CALL
E ,19~~ ttAIL TO
.~Cq
C~~1.
Approved !(l~ 19/. Permit No.. ~ fir, 00 r ..M.
rm s , • .
Disapproved a/c
• . ~ ~ JU(- _ S 1993 .
wilding Inspector) DL t7L"- „ `
TOWN OF STFCOLL7
- APPLICATION FOR 6UiLDiNli F OtI
ER14i1T
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 streets
ar 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 inspe On"
~v
(Signature of applica.r name, if a corporation)
(Mailing address of applicant) O~
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
D W nv~ . ~PPIzOYEA AS MOiEQ
n v ~t L 1 /J-y 2-
Nameofownerofpremises DATE: B.P.E ;A"..BY.... ; .
(as on the tax roll or latest BUILDINGOEPAR ENT AT
If applicant is a corporation, signature of duly authorized officer. 765-1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRED
(Name and title of corporate officer) FOR POURED CONCRETE
2. ROUGH - FRAMINGa', a PLUMBING
Builder's License No. 3. INSULATION
, .Z, , 4. FINAL - CONSTRUCTION MUST
Plumber's License No. 13E COMPLETE FOR C.O.
1 ALL CONSTRUCTION SHALL MEET
Electrician's License No. , , THE REQUIREMENTS OF THE N.Y,
STATE CONSTRUCTION & ENERGY
Other Trade's License No.r ."O0 . q3 CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
1. Location of land on which proposed work will be done. ° . .
I9'45 . . . . . . . . . ..rfuc_ 119.
a
House Number Street Hamlet
County Tax Map No. 1000 Section ...:.4. .o......... Block Lot . ~
Subdivision o....... d IJ' lh.I TS , . , , _ , • Filed Map No. . . . . . . . . . . . . . . Lot ..:"f`.y
.
(Name)
2: State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ...f. ~..a-m I~t, ..179 r1 t .
.p. U Qp . .
b. Intended use and occupancy ! l ~...pbd....ts1 • • . • .
I
(check
of work ch applicable): New Building , , , Addition Alteration
Repair .
3. Nature Re oval Demolition Other Worh "6}4r,Z7 1..~ .P~~.
00*951 OW, -..(besci?r Lion)
4. Estimated Cost ~ Fee
If garage, number of cars (to be aid on on each fili floor this app,, ,,lication)
5. ifdwellrn number of dwelling units . . . . . . Number of dwelling units
,
e
3
6. If business commercial or mix '
d occupancy, specify nature and extent of.each type of use .
7. Dimensions of existing str•ucturies, if any: Front Rear , Depth
height Number of Stories .
Dimensions of same structure ~yith alterations or additions: Front
De Rear ,
8 Number of Stories...........:...........
e 0 Height
. Dimensions of entire new c nstruction: Front . Rear Depth
Height mof Stories .
9. Size of lot: Froni Rear, . , Depth .
10. Date of Purchase Name of Former Owner .
11. Zone or use district in which premises are situated
1 2. Does proposed construction violate any zoning law, ordinance or regulation: .
13. Will lot be regraded • . . Will excess fill be removed from premises: Yes No
Name of of i
premises
Name of Architect,,,,,,,, •••.,Address,,,,,,,,,,,,,,,,,,, Phone No............:...
14. Name of COontractor remises • . , , Address Phone No................ .
Address Phony No...............,.
15. Is this property within '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 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.
ro m
.
ins s'+h ~i7rc q.
~JIII ~uF ~ ~Cd e Wea~~~ - 44,16
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•
STATE OF NEWQ S
COUNTY OF...,..,:...
• • • • • , • • • • • • , being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
SHe is the ! Cr W-NIW .
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is dulyi authorized to perform or have performed the said work and to make and file this
application; that all statements contained in this application are true to fire best of his knowledge and belief; and that the
work will be performed in the mannerlset forth in the application filed therewith.
Sworn to before me this
.r ayo .
`
otary Public, S
. County ROBERT I. SCkoa NOTARY PU
BLIC, No.4725089, Su l (Si lure of applicant)
Term Expires May 31,19 T
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