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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 23106-Z Date JULY 19, 1994
THIS CERTIFIES that the building ACCESSORY
Location of Property 495 PADDOCK WAY MATTITUCK, NY
House No. Street Hamlet
County Tax Map No. 1000 Section 107 Block 4 Lot 2.10
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated OCTOBER 1, 1993 pursuant to which
Building Permit No. 21714-Z dated OCTOBER 15, 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 POOL HOUSE.
The certificate is issued to OWEN & LAURIE MORREL
(owner's)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N317496 JUNE 16, 1994
PLUMBERS CERTIFICATION DATED MATTITUCK PLUMBING & HEATING JULY 12, 1994
Building Inspec r
Rev. 1/81
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 2-23107 Date JULY 19, 1994
THIS CERTIFIES that the building ACCESSORY
Location of Property 495 PADDOCK WAY MATTITUCK, NY
House No. Street Hamlet
County Tax Map No. 1000 Section 107 Block 4 Lot 2.10
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated OCTOBER 1, 1993 pursuant to which
Building Permit No. 21714-Z dated OCTOBER 15, 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 INGROUND POOL AND FENCE ENCLOSURE IN THE REAR
YARD AS APPLIED FOR.
The certificate is issued to OWEN & LAURIE MORREL
(owner's)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N317496 JUNE 16, 1994
PLUMBERS CERTIFICATION DATED N/A
Buil ing I Spector
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)
Date /1.?~ 19..l..~.
N2 . 21714 Z
Permisslon Is hereby granted to:
/y191i~/~°.....~~~' .~~.i..°t."'~,i.~. fir....... ~~,?€~7 ~Oc~s2F_L,
°i~..v....-
to !3.......~&e.......1e*l)........
f............... .......p o......... ..~.~..J:...... ~i~d....
~tL
,
at premises located at r•..........f..??~ d uG/.........(a°i..............
................9...../..? ~ z
County Tax Map No. 1000 Section /0............ Block .......1 Lot No. .....`..p.......
pursuant to application dated 19.../......., and approved by the
Building Inspector.
Fee $...zolz?..iA!
PERMIT AMENDED TO INCLUDE POOL HOUSE 11/19/93 ti
PFE PAID $35.00
2 SEPARATE COs.REQUIRED Buildin Inspector
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD~
D BUILDING DEPARTMENT
TOWN HALL
I 765-1802 Poo hbi_ j
st)EPT.
APPLICATION FOR CERTIFICATE OF OCCUPANCY
TOW" OFSOUTHOLA. is 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
M 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 $15.00, Commercial $15.00
Date ~z a
New Construction....!!..Old Or Pre-existing Building
Location of Property ........................Ya6GK
House No. Street / - Hamlet 1
Onwer or Owners of Property.... 0. ..~L~ L
County Tax Map No 1000, Secction... ....Block...... Lot...... ~J...... Z.10
Subdivision.. Ou - PCT..t l~.S ......Filed Map............ Lot
Permit No ................Date Of Permit Applicant
Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate...........
Fee Submitted:
Fol. tt
APPLICANT
INSPECTORS rye;,,
SCOTT L. HARRIS, Supervisor
d _;7e r{
en Southold `town Hall
Thomas Fisher w ° .yz P.O. Box 1179, 53095 Main Road
Building Inspector 0:'
Southold, New York 11971
Crary Fish !'"[I[taZ? Fax (516) 7654823
Building Inspector Telephone (516) 765-1800
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
C E R T I P I C A T 1 0 N
liq m
DATE.
Building Permit No. _
Owner
(please riot)
Plumber: 11, I~ U eCec~o.
please print
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
w
(P ers S
Sworn to before me this
day ofG f/ a 19
Notary Public,, County
Notary Publi
Edf11f.JRCKSON
pa" h Sd* New YoAc
Tam Exptree Feb, ft"
6
"Aw
dq~ M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] IN LATION
[ ] FRAMING [ FINAL
REMARKS:
i
DATE INSPECTOR '
i
f _
M-1802
BUILDING DEPT.
INSPECTION
[ ) FOUNDATION 1ST ( ) ROUGH PLBG.
FOUNDATION 2ND [ ) INSULATION
[ ) FRAMING [ FINAL
ftT-
REMARKS:
t
DATE INSPECTOR
aRmk+,n' - *y; L
TINIR
4 Ve'=4.v1! J ;L..w i~+t/F f. II~A ~~RL .I:;; r.l#""L U2/kI 5'f, t2„"~iV 1~•t 1r P
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i ••'[~V a idF• I i 4 r i w• n r fl, r ~ ~ y r
%OnNDATIO*I f 1st
'OUNDATION
(2nd
) m.
ZOUGH FRAME &
.PLUMBING
y
I n
IISULATION PER N. Y.
H
STATE ENrRGY II
CODE
m
. i
• / I 7a~e;
FINAL
' SOY 9~ c~pt.~
•
ADDITIONAL C MMF.NTS:
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37
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FOLI(
Town Hall, 53095 Main Road C2
CA Fax (516) 765-1823
P. 0. Box 1179 W- Telephone (516) 765-1802
Southold, New York 11971
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
June 30, 1994
Matrix Pool & Spa
43 Lovell Road
Hampton Bays, NY 11946
Re: Owen & Laurie Morrel
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)
xx No Underwriters Certificate on file. IU6
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.Poolhouse
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 21714-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
I
BOARD OF HEALTH
FORM NO.1 3 SETS OF PLANS
TOWN OF SOUTHOLD SURVEY
I } BUILDING DEPARTMENT CHECK . . . .
TOWN HALL SEPTIC FORM _
'TO" SOUTHOLD, N.Y. 11971
TEL.: 765-1802 NDIIFY ? ~7
CALL 1'717
Examined 19rr~~ TO: /
Approved 19 (3 Permit No. ,P 21 7 .
Disapproved a/c _ _ .
(B ilc Inspector)
APPLICATION FOR BUILDING PERMIT
e Date ...~Q 7.! 19 93
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 code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections. A -in- V
(Sig ture of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber builder
B.u~ K.
Name of owner of premises N1G . e.., . l_
(as on the tax roll or latest deed)APPR VE AS NOTED
If applicant is a corporation, si nature(oJf duly authorized officer. DA % ~P #
f \ J-9~ ' FEE: 4V- BY:
( ame and title of corporate officer) ZGSS ^ Su~+C C~ T1FY BUILDING DEPARTMENT AT
7 5-1802 8 AM TO 4 PM FOR THE
Builder's License No....2SS.. u~, . StnR FOLLOWING INSPECTIONS:
1. 'FOUNDATION - TWO REQUIRED
Plumber's License No. FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
Electrician's License No. 3. INSULAT)ON
4. FINF+f. - Cf?N;^TR.T,ICTIC;N MUST
Other Trade's License No. BE COMPLETE FOR C.0.
ALL CONSTRUCTION SHALL MEET
1. Location of land on which proposed work will be done. 0146r ??L~DDOG W RFt $RUCTUCTS OF THE N.Y.
• • • • • • • • •ST.4I~ •fl.'.t7Ai$IgP!• aRt • gNEpG:Y..
CODES. NOT RESPONSIBLE FOR
.......OFSIGN OR. CONSTRUCTION.BRROH4..
House Number Street Hamlet
County Tax Map No. 1000 Section Block ....4.4 Lot z.- a.
Subdivision Filed Map No. Lot
(Na.m.e)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy 5~Y4Lf_... ~r • , RCS tD(w ~UF
b. Intended use and occupancy
4c an~~4a !~t+! .$w!?~!«.A4 r
:.s•PCOt_
applicable): New Building Addition Alteration .
(Description)
• ar of Dimensions of work . existmg strtrcheck which .ucto Removal . . Demolition Other Work
stimated Cost ~~.640.G is ~Q Fee
(to be paid on filing this application)
If dwelling, number of dwelling units Number of dwelling units on each floor .
If garage, number of cars .
F7. eoccupancy, specify nature and extent of•each type of use
.
es, if any: Front Rear,.............. Depth
If beight ..usiness.. . ..commercial or mix Number of Stories .
Dimensions of same structure with alterations or additions: Front Rear
Depth . . Height . . . . . : . . Number of Stories
8. Dimensions of entire new construction: Front Rear . Depth
Height Number of Stories .
9. Size of lot: Front Rear Depth
10. Date of Purchase .
1. Zone or use district in which , . ' • • • Name of Former Owner .
1
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 .
15. Is this property within 1300 feet of a tidal wetland? *Yes N hone 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 blocklnumber or description according to deed, and show street names and indicate whether
interior or corner lot.
.
STATE OF NEW YO I
COUNTY OF... O.Q,\k, S.S T-
?.L1AM~
"p• • • • •s • I• A • • • • • • , being duly sworn, deposes and says that he is the applicant
(Name of individual si mng contract)
above named.
He is the PW.N-&....................................... (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 contained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manner pet forth in the application filed therewith.
Sworn to before me this
Notary Public, SV\~
tBLIC, unty
R . (Signature of a licant
RWRY
Nountv,,
Term EXpires May 81;19
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SURVEY FOR
OW EN MORREL & LAURIE JEWELL
LOT NO. II , " WOLF PIT POND ESTATES"
AT MATTITUCK
TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
N UNAUTHORIZED ALTERATION OR ADD 111. To THIS
SURVEY IS A VIOLATION OF SECTION 7209 OF THE
MEW YORK STATE EDVCATIOM LAN
+COPIES OF THIS SURVEY NOT SEARING THE LAND
SUAVEYORS INKED SEAL OR EMBOSSED SEAL SMALL V~
NOT BE CON SID. RED TO BE A VAL10 TRUE COPY
MGUARANTEES INDICATED HEREON SHALL RUM ONLY TO
HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT THE PERSON FOR WHOM THE SURVEY 1S PREPARED
AND OR HIS BEHALF TO THE TITLE COMPANY, GOVERN- co
NEAREST WATER •AIN-MI ! *SOURCE OF WATER PRIATE -PUBLIC _ MENTAL AGENCY AND LENDING INSTITUTION LISTED c!
R SUFF CO TA%MAP DIST 1000 SECTION 107 BLOCK 4 LOT 2.10 HEREON, AND TO THE ASSIGNEES OF THE LENDING yy
IETHUR ARE NO DWELLINGS WITHIN 100 FEET OF TIMES PROPERTY INSTITUTION GUARANTEES ARE NOT TRANSFERABLE T
OTHER THAN THOSE SHOWN HEREON TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT
M THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FOR THIS AESIDENCE OWNERS C•
ERTY
WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT R DISTANCES SHOWN HEREON FROM A LINES
OF WEALTH SERVICE? TOE%If TIMG fTkUC TURES ARE FOR A SPEPCCT FI C ~}Y
PURPOSE- AND ARE NOT TO BE USED TO ESTABLISH L•j~,
} t._=
_ L=341.21' ~OJI
9
I : s.ss°D
'I o OCT - 1 1993
260 9 ,A` S 22 F 4
--~«.Fd...: 'rah. C4u~r. = - ~P~, QQ Sph4 :3\
TOWN OF ,JQUIIIOL1D Op p° NsS°O CCk Lr R4VFM
o p 22 2gs FA r
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of 13 r~f , w ~'H'qy ~ y oMOQ
~ o zgs?;. tie.
w Lu
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o b2 O
U 0I O O
NO 00 pN~
00 U
z ; _ N OCCUPANCY OR 0
NLAW
o6' \ i U E IS U
ao 09 m ~o S O
dr L J
UNDERWRITERS CWFICATE y ~ $ fN • ` otpl9 .0 ' p Tl CTE
REQUIRED 9 0l.o WITHOUT CERI
o 'oo s0' ~a
CCIJPANCY
''-?==1036 ~o/
/
"IMMEDIATELY"
coos
0 111;
sP
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O~~~Qf• 4~v Bpi ip°yp3 V / "C/
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SURVEY FOR
OWEW M.PRREL 8 LAURIE JEWELL AUG. 31, 1993
LOT NO. it , WOLF PIT POND ESTATES" JUG: 122
51, 1591
AT MATTI+UCK RATE. JUN 25, 1991
TOWN OF SOUTHOLD SCALE I IDo,
SUFFOLK dOUNTY, NEW YORK NO 91 0528
N UNAUTHORIZED ALTERATION OR AOOITION TO THIS
SURVEY B A VIOLATION OF SECTION 7209 OF THE
NEW YORK STATE,, EDUCATION LAW
*COPIES OF THIS SURVEY NOT BEARING THE LAND
SURVEYORS IMKE D. SEAL OR EMBOSSED SEAL SHALL ,I
NOT Of CONSIDQ'REO TO BE A VALID TRUE COPY I
KGUARANTEES INDICATED HEREON SMALL RUN ONLY 70
/h
HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT THE PERSON FOR WHOM THE SURVEY IS PREPARED W.
AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERN- lA "jT-~(L~`)
R NEAREST WATER BAIN_MI - NSOVRCE OF WATER PRIIRTE-PUBLIC _ MENTAL AGENCY'ANO LENDING INSTITUTION LISTED °J ^
M SIRF CO TAXSAA? DIST 1000 SECTION 107 BLOCK 4 LOT .210 HEREON, AND TO ',THE ASSIGNEES OF THE LENDING Ty .yL
RTHEIIE ARE NO DWELLINGS WITHIN 100 FEET OF THIS PROPERTY INSTITUTION GU4RANTEES ARE NOT TRANSFERABLE
OTHER THAN THOSE SHOWN HEREON TO ADDITIONAL iN STITUTIONS OR SUBSEQUENT
M THE WATER SUPPLY AND SEWAGE DISMAL SYSTEM FOR THIS RESIDENCE OWNERS
WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT N DISTANCES SHOWN HEREON
S A FROM PROPERTY LINES FOR OF WEALTH SERVICES PURPOSE AND 1TE ARE A 3PEC1?I S
C
AAPLICAMT PROPERTY LIN INEAS `OT TO BE USSE ED TO OF FENCES M
, OR N O FOR THE ERECTION OF EN[S
ADDRESS
TI` YOUNG a YOUNG RRIIVOERHIINDER EAD,NEWAYORKE
NOTE: • = MONUMENT FOUND A -STAKEFOUND ALDEN W YOUNG, PROFESSIONAL ENGINEER
COUNTAPY ON FILED JIUNNE THE 21, 1 1OFFICE 990 990 AS OF FILE THE NO. 696CLERK3. AND LAND SURVEYOR N Y.S. LICENSE NO 12845
OF US SUFFOLK FFOLK MAP
O
HOWARD W. YOUNG, LAND SURVEYOR
m LATHE LOCATION OF WELL(W), SEPTIC TAMK1STH% CESSPOOLS(C?) SHOWN HEREON N Y S. LICENSE NO 45893
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