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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-23467 Date JANUARY 23, 1995
THIS CERTIFIES that the building ADDITION
Location of Property 4244 GRAND AVENUE 14ATTITUCK NY
House No. Street Hamlet
County Tax Map No. 1000 Section 107 Block 2 Lot 2.3
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVEMBER 5, 1993 pursuant to which
Building Permit No. 21785-Z dated NOVEMBER 18, 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 A GARAGE ADDITION WITH NON HABITABLE STORAGE AREA ABOVE
TO AN EXISTING GARAGE ADDITION AS APPLIED FOR.
The certificate is issued to EUGENE & MARIE VANDEN BOSCH
(owner's)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
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uil ng Inspector
Rev. 1/81
FORM NO.3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y.
BUILDING PERMIT
ITHiS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Date .////If 19.F
N® 21785 Z
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( Permission Is hereby granted to:
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to
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I at premiseslocated at..,rlr7~T..•.. .....4`.F~.G9' ll~
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County Tax Map No. 1000 Section ......../o.7....... Block ....A7 Lot No...e`~.t..
pursuant to application dated 19..q.,d~........ and approved by the
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Building Inspector.
i Fee $ ....liq
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` Building Inspector
Rev. 6/30/60
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'A aa-b @ o Svc 36~
p n ~~-~y Form No. 6 ~Ang 1Jy
JC!! TOWN OF SOUTHOLD
JAN 1 3f995 F BUILDING DEPARTMENT
TOWN HALL
BLDG.pEP7 765-1802
TOWN FS UPHOLD
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:
A 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 Buildinn - $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 $15.00
Date JI? /5
New Construction.:......... Old Or Pre-existing Building...
Location of Property..4.2-44.... ..~v' ............U SS ~ c
House No. Street Hamlet
Onwer or Owners of Property...4~?,~i~, Vy~p t •~sS
County Tax Map No 1000, Section ....~d 7 ......Block.. 4............ Lot. Z° A
Subdivision... ~.Y."..~4y..AAJeq& .............Filled Map............ Lot...2.................
Permit No.. Z.~ Q§: -:2-..Date Of Permit U jJ$! ,3 Applicant U :t _Wrn Vk,%c yfcX4M
Health Dept. Approval V
...................Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate. _ .
rew 9ubn,* "'ed: Z5^~ . .
ac 1903 ,
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ I ROUGH PLEG.
FO NDATION 2ND [ ) INSULATION
[ FRAMING ( ) FINAL
REMARKS: L~l~/G /CAL/
S,c r ZZ
DATE < INSPECTOJ
M-1802
BUILDING DEPT.
I SPECTION
[ FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING t ] FINAL
REMARKS:
G~~
DATE !l ?INSPECTOR
h~o~OSpFFO(,~~OGy
o ~
Town Hall, 53095 Main Road y x Fax (516) 765-1823
P. O. Box 1179 • Telephone (516) 765-1802
Southold, New York 11971
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
January 11, 1995
Mr. Euguene Vanden Bosch
Box 362
Cutchogue, NY 11935
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.
xx The check is 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 # 21785-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
1ELD S1;EC ION JIDAi ~ OaYMLNT°
C
FOUNDATION (1st) a
c
FOUNDATION (2nd)
2.
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ROUGH FRAME & o
PLUMBING
a
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3. "N,
INSULATION PER N. Y. y
d
STATE ENERGY
CO"DE
Ell
FINAL VUC
ADDITIONAL COMMENTS:
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~ ` )I \f' i ' ~ ~ r BOARD OF HE LTH .
FORM NO. t 3 SETS 0 PL.177S .
NOV TOWN OF SOUTHOLD SURVEY
- 5M3
BUILDING DEPARTMENT C I I E C K .1[58
TOWN HALL SEPTIC FORM
SOUTHOLD, N.Y. 11971
TEL.: 765-1802 NOTIFY
, . .
Examined .l?/. /('f • • 19~ CALL
MAIL TO:
8 (3:4-(.~4 e2
Approved . 197U. Permit No.19).1
Disapproved a//cc . . a i le.
Xl9'3.5
3uil g Inspector)
APPLICATION FOR BUILDING PERMIT Q
Date , 19 15
a'
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
ets 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
>r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
:ation.
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
hall 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
hall 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
3uil ding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
?egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
Ite applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
dmit authorized inspectors on premises and is building for necessary inspections.
(Sign ur-c 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.
dame of owner of remises .'uGf~l V P
PM..IJ,,sc
(as on the tax roll or latest deed)
,:!'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 . . . .
Location of land on which proposed work will be done.
a G~ ts~i2/FN/~ a lT/ TG
at /
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liottse Nuntbcr t......<
Street Hamlet
County Tax Map No. 1000 Section Block ...2 Lot .
Subdivision ..&Yt~4. ~ '!~a S Filed Map No p Lot
..(Name)
Statc existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy r~S{GfLGL7-(yam(, , , ;
b. Intended use and occupancy t P .l.......... .
%
3. Nature of work (check which applicable): New Building
Repair Addition Alteration
Removal Demolition
Other Work
4. Estimated Cost pvO (Description)
f+,. Fee....................................
5. If dwelling (to be paid on filing this application)
S. number of dwelling units , , , , • , • • , , , , , Number of dwelling units on each floor
If garage, number of cars ..I
6. If business, commercial or mixed occupancy, specify nature and extent of eAch type of use . .
7. Dimensions of ex'st' structures, if any: Front ...'240 ~-b
Height Number of Stories Rear Depth ..0...... .
Dimensions o ame structure ~~ith alterations or additions: Front `Lb • ' • ~ ' ' ' ~ ~ ' ' ' ' ' ' ' ' '
Rear 4.la............
De di t g......... n Height f Number of Stories ..R,...................
8. Dimensions of entire new construction: Front ...'0 ,
Hei• T Rear Depth) _
9. Size of lot: Front rpber 9 ~o (nes Rear . t '
,q...
10. Date of Purchase • • • • • • . . . . Depth ! f....... .
Mme of Po ° "
11. Zone or use district in which pr rmer Owner cmises are situated 9.E. ~ik, L, . . . . . . '
12. Does proposed construction, ryt~olate any zoning law, ordinance or rem
13. Will lot be regraded ; I`kt~l . oulation: , • , . , • • ' ' '
14. Name of Owner of premisesE 1 .~e~N#a1• Will ex9sss fill be removed from premises: N
Name of Architect
Address C Gt ~.p MII.z , , , Phone No.:?qe . •a3-?.
Name of Contractor -e Address 6:k",4 . Phone No. .
F I~ 1 4~ IaaAddress . .
15. Is this property within $00 feet of a tidal wetland? *Y ' Phon No.
es..... No
*If yes, Southold 'down Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back ditnensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
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• • • • • being duly sworn, deposes and says that he is the a
(NAhc of signing contract) applicant
ove named.
is the yb'P;r...
(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
irk will be performed in the manner set, forth in the application filed therewith.
orn to before me tlµs !
day f /V
....,192
tary PubliOej/-WJ County
Notary Public, State olN v I brk , , • , . qy..
No. 4878606 /
Duslifled in Suffolk Courtly (Signature of applicant)
Commission Expires December % 192f
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PIGOi Q NOV 3, 1987 .
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- y Of JAN. 21, 1987
SURVEY FOR
EUGENE VANDEN BOSCH B MARIE VANDEN BOSCH
AUG. 13, /984
AT MATT/TUCK DATE JULY 26, /984
TOWN OF SOUTHOLD SCALE: It " > /oo'
SUFFOLK COUNTY, NEW YORK NO. 84 - 740
N UNAUTHORIZED ALTERATION OR ADDITION TO THIS CERTIFIED 70E
SURVEY R.A VIOLATION OF SECTION 7209 OF THE
NEW YORK ,STATE EDUCATION LAW CHICAGO T/T CE CO. -
*COPIES OF THIS SURVEY NOT SEARING THE LANG FOREMO ';i f;'
SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SMALL =p~
NOT BE CppN SIDER¢D TO BE A VALID TRUE COPY SRIDG HA M04 BANK
NGUARANTEES INDICATED HEREON SHALL RUN ONLY TO 3\ Y
HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT THEANOAN HISPERSOM FOR BEHALF WHOM TO THE THE TITLE SURVEY IS COMPANV,< PREPARED GOVERN- a l OZ
M NEARElT W MAINpiTMI. 7 NSOURCE Of WATER- IVaTE aGPUfLIC_ MENTAL AGENCY AND LENDING INSTITUTION LISTED g0
N fIXF CO. TAX %M ~ECT10N^/°7 BLOCK A LOT MEREONi,"o TO THE-AISIONEES OF THE LENDING
NTMER[ ARE (ID DW[LLIIMf WITHIN 100 FEET Of THIS PROPERTY IMSTJYUTIqp'GUARANTEES ARE NOT TRANSFERABLE
TO AERS ,NAL INSTITUTIONS OR'9UBSEDUENT
OTHER THAN THOSE SHOWN HEREON. OWNERS
% THE WATER SUPPLY ANSSEWASE DISPOSAL SYSTEM FOR THIS REf IDENCE
PROPERTY LINES
WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT TO *DISTANCES EKISTHIG _STRUCTURES A RES RE FOR FROM A SPECIFIC
,
OF MEALT'N. SERVICES. PURPOSE ;AND ARE NOT TO BE USED TO ESTABLISH 'TFO OQ'
APPLICANT. PROP,ERTYI` LIMES OR FOR THE ERECTION OF FENCES IAN UEV
AgITRESS
TEL. YOUNG YOU NG ~ RHEAD, NEW YORK AVENUE
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NOTE a 3.038 AWs a = MONUMENT <S7AKE
,ALOEN,W;YOUNG,PROFESSIONAL ENGINEER
RE: LO NO. 2, "MINOR SV801WSIOM FOR LYNN' AND LAND SURVEYOR N.Y.S. LICENSE NO. 12845
SAN AN04S." HOWARD W. YOUNG, LAND SURVEYOR
N THE LOCATION OF WELL(W),SEPTIC TANK(STIG CESSPOOLSICP) lMOWN'IKREON N,Y: LICWSk' NO.4,5893
ARE PROM FIELD Q6KR0t1,"S.AND OR DATA OBTAINED FROM OYMERS , - -
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ALL d;o}P'ITRUCTIC44 514AUL ?Ad ET
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f`.e'.MSTRUQ:IION & ENERGY PIOT RESPONSIBLE FOR"
fT4_SIt9CJ OR F;ON;3I'RUCTION ERRORS
" 4)6 UNDERWRITERS CERTIFICATE. p REQUIRED
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