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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-22983 Date MAY 4, 1994
THIS CERTIFIES that the building ACCESSORY
Location of Property 5950 NEW SUFFOLK LANE MATTITUCK, NEW YORK
House No. Street Hamlet
County Tax Map No. 1000 Section 115 Block 12 Lot 2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVEMBER 19, 1993 pursuant to which
Building Permit No. 21819-Z dated DECEMBER 4, 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 TWO CAR GARAGE AS APPLIED FOR
The certificate is issued to GRACE NELSON
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-308756 - MARCH 28, 1994
PLUMBERS CERTIFICATION DATED N/A
ja~ - ; I a
B ild' g Inspector
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)
f ) C~
Date /P-A....c............................. 19,...
N® 21819 Z
i
Permission is hereby granted to;
4111.. Aezy .
{ to ......4rV..ST!2cC-.....,...~............ .
a ./~~..s........ <
f
( at premises located at `~Q..........~ w, 4 E........... dl<l;x~
i rrr.- 4c e....... r.!e
County Tax Map No. 1000 Section I/,.~ Block L.......... Lot No....... ~J
pursuant to application dated .............a................... , 19.....1. and approved by the
Building Inspector.
Fee $.....(a
(
ui8 i ing Inspector
Rev. 6/30/80
R y Form No. 6
OF SOUTHOLDBIIILDI DEPARTMENT
TOW OWN HALL
SL'ED TOWN
765-1802
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).
A 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
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 ...yIA
New Construction 01AV Old Or Pre-existing Building...
Location of Property...6'g-,I ...............V a_,si -lk4 U JX,- .4.ere ~ c4 Q?1.... .
House Noo./.YY Street Hamlet
Onwer or Owners of Property.. 4. p.... /Vo Lea
County Tax Map No 1000, Section... Block..../......... Lot.... 2r
Subdivision ....................................Filed Map............ Lot......................
~j
Permit No...~~ .~~.T?..Date Of Permit. Applicant~. . i.~%~.~
Health Dept. Approval ..........................Underwriters Approval. -Q
Planning Board Approval /
Request for: Temporary Certificate........... Final Certicate:.. J el
Fee Submitted: ~
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`C '1v-APPLICANT
FIELD If:S!;Z0Tl0N JJDATZE I~ OtYMENT° _
1.
FOUNDATION (1st)
c
FOUNDATION (2nd)
2.
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ROUGH FRAME &
PLUMBING p
ti
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INSULATION PER N. Y.
y~
STATE ENERGY
CODE
4.
^ ~ H
FINAL
_:c L
ADDITIONAL COMMENTS:"
cn
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31
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Town Hall, 53095 Main Road Fax (516) 765-1823
P. O. Box 1179 , • Na•% p~ Telephone (516) 765-1802
Southold, New York 11971 n
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
April 25, 1994
Mr. Edward C. Nelson
48 Wilmarth Ave.
Greenport, NY 11944
To Whom This May Concern:
we are unable to complete your certificate of occupancy
because of the following reasons:
x%% An application for Certificate of occupancy is
not on file. (Enclosed)
XXR No Underwriters Certificate on file.
XXX The check is not on file. ($25.00)
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 # _BP# 21819Z
Please contact our office on this matter. Thank you for
your cooperation.
SOUTHOLD TOWN BUILDING DEPT.
h~o~OS~FFO(,~~OGy
Town Hall, 53095 Main Road °y = Fax (516) 765-1823
P. O. Box 1179 10 Telephone (516) 765-1802
Southold, New York 11971 if~~ ~~O!
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
April 25, 1994
Mr. Edward C. Nelson
48 Wilmarth Ave.
Greenport, NY 11944
To Whom This may Concern:
We are unable to complete your certificate of occupancy
because of the fol Wing reasons:
XXX An application for Certificate of occupancy is
/ not on file. (Enclosed)
XX% /A%/ No Underwriters Certificate on file.
RxX The check is not on file. ($25.00)
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 # _BP# 21819Z
Please contact our office on this matter. Thank you for
your cooperation.
SOUTHOLD TOWN BUILDING DEPT.
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BOARD OF HEALTH
3 SETS OF PLANS
FORM NO. 1 SURVEY .
I 01 993 TOWN OF SOUTHOLD CIIECK .
g BUILDING DEPARTMENT SEPTIC FORhI
~.k F TOWN HALL
i~, iV $OUTIiOLD, N.Y. 17971 NOT Y
7
TEL.: 765.1II02 CALL C ,Z...` J7
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Exanrincrl h., 19. r/ h L T0:
Approved 19 ( Permit No.
Disapproved a/c 7 C=
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(Build n Inspector)
D
APPLIC.
. ATION FOR BUILDING PERMIT
TOWN O SOUfgO, Date 19...
INSTRUCTIONS
-,sets a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
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
ror areas, and giving a detailed description of layout of property must be drawn on the diagram whichispart 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 applicauL 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 cl-
admit authorized inspectors on premises and in building _fornecessnry ins .ctionsode, housin code, and regulations, and to
- - -
S' na.tu -o? applicant, or name,
(Mailing address o applican"t)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
jJ Ui L d e~
Name of owner of premises F~.014, gel , &-~sON AA.4 (1940- AM, acy ,
(as on the tax roll or latest deed) -
!f 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. ,.I S BLS ~~R,.4?
Other Trade's License No. pr'an/
1• Location of land on which proposed work will be done:
~ f£9 11.21V v olL fi/ew. F,o4K ALr-e
Mgy~GC~•
er p ~aL~ ORt(/ o Hanilct House Number Street
County Tax Map No. 1000 Section ter........... Block , . , , , .
Lot Subdt'v' .
ision Filed Map No.
Millie)
cj Lot
State ecisting use and occupancy of premises and intended use and occupancy of proposed construction-
a. Existing r ` _ 1
use and occupancy K.g,Z, lAt~ .
b ga fit.+'v ° fl;" a .
Intended use and occu anc :N;cYv;.i,,,,'
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UNDERWRITERS CERTIFICATE REQUIRED
s 1 Q ~g~® /'off/
q~~s
a i i ~FNG 4i G 0~ ~,dCUP/i3Y ~ C.~
a t . S c I W MOE7 10 1 MIN MAIM 11
U S D ~f
P~ , G 4 ~I P
I i ~ i 60 ~N. WITHOUT CERTIFICATE
ry
I y ! I r I ~c, OF OCCUPANCY
`Yt' >
" a I ion' ~ I i
APPROVED AS NOTED -
i; DA. B.P, 2l
BY:
NU IFY BUILDING OEPARTM NT T
/ 314 ~nh 3~ 765.1802 9 AM TO 4 PM FOR THE
S d 1 FOLLOWING INSPECTIONS:
> rn _ 1 _ q a A/ 1. FOUNDATION - EOUIREd FOR POURED CONCRETE
- - G- 2. ROUGH • FRAMING M PLUMBING
' 3. INSULATION
4. FINAL CONSTRUCTION MUST
k r `i n '1 BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET '
/ THE REQUIREMENTS OFY~ THE N.Y
STATE CONSTRUCTION & ENERGY
J E CODES. NOT RESPONSIBLE FOR
g~ 4 I~ DESIGN OR CONSTRUCTION ERRORS
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