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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-22333 Date MAY 17, 1993
THIS CERTIFIES that the building ADDITION & ALTERATION
Location of Property 3865 GRAND AVENUE MATTITUCK, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 107 Block 1 Lot 4.1
Subdivision Filed Map No. Lot No,
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 17, 1992 pursuant to which
Building Permit No. 20894-Z dated AUGUST 17, 1992
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 PORCH ADDITION & ALTERATION TO EXISTING ONE FAMILY DWELLING
AS APPLIED FOR.
The certificate is issued to THOMAS J. WILLIAMS, JR.
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. PENDING - APRIL 26, 1993
PLUMBERS CERTIFICATION DATED N/A
ild'ng Inspector
Rev. 1/81
"19M NO. 2
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)
NMI 208942 Date !eV I9...9y
Permission is hereby granted to:
rV
......4.11
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. 4g,.e...
to ftp miles 1 ted at .../......~.:5
i
~s........~i~~ ...s.... ?-...r
County Tax Map No. 1000 Section .....&.7.......... Block o/ Lot No....... 2,4Z
pursuant to application dated .7 and approved by the
Building Inspector.
Fee ~
uilding Inspector
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT Y Q
TOWN HALL Q<
i 7 t'.r•-'" 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).
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 2110 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 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 $15.00
Date
New Construction.......... Old Or Pre-existing Building.....
Location of Property....,... IQl.P~............ C!-...!`?I>.?LV tk.! t:.
House No. Street Hamlet
Onwer or Owners of Property..lJ,i~~~d$~ ~I~1 !,5. ~i ....................(.f................
Oounty Tax Map No 1000, Section Block I......... Lot.....
Subdivision ....................................Filed Map............ Lot......................
;7 ~~yy t~
'ermit No.. R ...Date Of Permit..Q..1.I.7• q.LApplicant... .,d 4KG
Iealth Dept. Approval........ ...............Underwriters Approval.
'lanning Board Approval..........
tequest for: Temporary Certificate........... Final Certicate...........
,ee Submitted:
`f Sq St
-APPLICANT
r''ri-;* X7222 _ .
~MME
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
8035699 BUREAU OF ELECTRICITY
88 JOHN STREET, NEW YORK, NEW YORK 10038
Date MAY 14,1993 N. tionNo.on//-rle 78546392/92 H 034859
THIS CERTIFIES THAT A?(RNIT N0. 2 H8942
only the electrical equipment ar dercribed below and introduced by the applicant nomad on the show application number in thepramiras of
THOMAS WILLIAMS, 38~6~yy5 GRAND AVENUE, POLE/NYT 2, MATTITUCK, N.Y.
in thefoltowinq location; L7 Basement C3 IAt Ft. ? Ysd F1. OUT Section 107 Black1 Lot 4.1
sous examined un APRIL 26,1993 andjoand to be in compliance with the National Electrical Code.
RXTURE ~vavrr RXTURB RANGES COOKING MCKf OVENS DISH WASHERS EXHAUST FANS
Ounus; ACIA5 SWITCHES NCANDESCENT FLUORESCENT OTHER AMT. K. W. NAT. K. W. AMT. K.W. AMT. K. W. AMT. M. P.
14 21 16 14
DRYERS PURNACI MOTORS PRIME APRIANCS NIMURS SNICIALREC?T TIMECIOCKS ~ UNRHEATERS WAT1AUTIET DIMMERS
AMT. K. W. Olt N. P. OAS N. P. AMT. NO. A. W. 0. AMT. AMP. AMT. AMTS. TRANS. AMT. N. P, SYfTEMS NO. OF till AMT. WATTS
1 F
SERVICE DISCONNICT Mon S E R V 1 C E
AMT. AMI. IRTE b111P IX tW I jr 3W 3 AT 3W 3X AW WNR%COND. Of A. .0.. NO.OF H4IE0 OF-~W L O MO. OF NEIntAle • W. t
1 100 C8 1 % 1 4 1 4
OTHER APPARATUS:
MOTORStl-F H.P.
G.F.C.II-7
SMOKE DETECTOR r L
THOMAS J. WILLIAMS, JR.
P.O.HO% 879
MATTITUCK, NY, 11952 ODOM MANAGER
11
Per This certificate must not be altered in any manner; return to the office of the Board if incorrect, impactors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
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6130 SOUND AVE. • P.O. BOX 325
MATTITUCK, NEW YORK 11952
(516) 734-7171
May 5, 1993
Mr. Thomas Williams
P.O. Box 879
Mattituck, NY 11952
RE: House on Grand Avenue
Mattituck
Insulation
The above home on Grand Avenue has been insulated
to building code by our company.
Sincerely,
James P. Hunter
President
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INSPECTORS
(516) 7 5- 802 O~pS~FFO(,f CO
hZ` Gy
VICTOR LESSARD, Principal SCOTT L. HARRIS, Supervisor
~
CURTIS HORTON, Senior CIO x Southold Town Hall
VINCENT R. WIECZOREK, Ordinance p P.O. Box 1179, 53095 Main Road
ROBERT FISHER, Assistant Fire 01fi Southold, New York 11971
Oj ~0~y Fax (516) 765-1823
Building Inspectors * Telephone (516) 765-1800
THOMAS FISHER
GARY FISH
OFFICE OF BUILDING INSPECTOR
TOWN OF SOUTHOLD
T1iO1w Wtw~q?u5 V,
P ,0.30)k 87Y STOP WORK ORDER 8//10
W t4Trt Ta -lc g4
P4, THowtNs WL1.41 S GM~-~~
TO: Eugene & Mari 0040 l K 600 l ?i74.1d+770A/. #J 15 9e
46 NE Del Drive awkN-sk4
Sadd rook N. J. 07662 0 VIT 2,_
YOU ARE HEREBY NOTIFIED TO SUSPEND ALL WORK AT:
3865 GRAND AVE. MATTITUCR N.Y. 11952
TAX MAP NUMBER - 1000-107-01-4.1
Pursuant to section 100-281 of the Code of the Town of
Southold, New York, you are notified to immediately suspend all
work and building activities until this order has been rescinded
BASIS OF STOP WORK ORDER:
THE ONE FAMILY DWELLING IS BEING ALTERED WITHOUT
FIRST HAVING OBTAINED A BUILDING PERMIT.
CONDITIONS UNDER WHICH WORK MAY BE RESUMED:
WHEN A BUILDING PERMIT HAS BEEN ISSUED BY
THE BUILDING INSPECTOR.
Failure to remedy the conditions aforesaid and to comply with the
applicable provisions of law may constitute an offense punishable
by fine or imprisonment or both. pp
DATED: AUG. 12, 1992 UL~.+-py,~) ~~/yt
Vincent R. Wieczorel
Ordinance Inspector
(Cert. Mail)
TOWN OF SOUTITOLD
BUILDING DEPARTMENT
SOUTHOLD, NEW YORK
STOP WORK O R D E R
TO: L( s W A b A en Lo ty
Owner, Uwner's Agent or Person Perrorming Work)
KI= Dt- LL F_ C- b f21 VE
076(6 a
Aaaress or above-namea person)
YOU ARE HEREBY NOTIFIED TO SUSPEND ALL WORK AT.
3R 6S GRI~~~ Ave, luar ruct< M. Y. 105"a
(Aaaress wnere work is to be stoppea)
TAX MAP NUMBER /000- /07,6/- Y. l
Pursuant to section /06- 2. $ / of the Code of the Town of Southold, New York you
are notified to immediately suspend all work and building activities until this order has been
rescinded_
BASIS OF STOP WORK ORDER: TNT O ~f. E F ~ tLi t L b qj F-:: f.-L 1 Q 1 5
Re( y(7 Mt.T'r~cg~ h Lul'rNaLLT /rFrL~7- t-tAuIme, a RT?ttxe-:-
ut~.~ruC, L> 7
CONDITIONS UNDER WHICH WORK MAY BE RESUMED: UJ R tz.-- ?.1 A R u 1 L b I At rr,
Rr-_12 W t T ~ Mi S r c= t f 15 S u I~, mss' 7~~f r= !3 u 1 L b?! t e
Failure to remedy the c6nditions aforesaid and to comply with the applicable provisions of
law may constitute an offense punishable by fine or imprisonment or both.
DATED:
BUILDING INSPECTOR / CODE ENFORCEMENT OFFICER
~~t V t Ca e 7' /r .
CYZ~F
38GS
vtl L i Uc-l< IPA,
4& llC S , J M-1802
~C BUILDING DEPT.
INSPECTION
~t
[ ] UN VATIO 1ST [ ] UG PLB .
DO ] ;FO NDA ON 2ND [ ] NS TI
[ ] RAM G ] FI AL
REMARKS: b eU'S e- b1A U S t
e-
" To c-t 4p, LtS,
7- 6 0 i I 2
OF 5'6u i tt0L-lb
DATE 2/1 g2 INSPECTOR Z (;~/c
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST ( ] ROUGH PLBG.
[ j FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [<VINAL
REMARKS-.,
L a
DATE ` INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ I FOUNDATION 1ST [ I ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING FINAL
REMARKS:
DATE 19 -INSPECTOR
1
C
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- y N
OUNDATION (1st)
c
'OUNDATION (2nd) n
o
:OUCH FRAIME & 0
-PLUMBING I L
3 . I ~ +1
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:NSULATION AN.Y.
STATE ECODE
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FI:1AL I -
ADDITIONAL COMMENTS:
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q r ROAnD OF HEALTH
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° FORM NO.I SET'S OF PLANS
y 1%2 TOWN OF SOUTHOLD I SURVEY .~oZ 5 = - .
1 BUILDING DEPARTMENT CHCCI
w-- TOWN HALL SEPTIC FOR:I
SOUTHOLD, N.Y. 11971
TEL.: 7651802 tTT I F'f
CALL a?:...
Examined d /4? , 191L. y MAIL TO:
Xpproved .L~? 199,k.-Permit No. . .
Disapproved a/c
.
Budding Inspector)
APPLICATION FOR BUILDING PERMIT
Date 19
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
As 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-
rtion.
c. Tlie 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
iatl 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
call 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
uitding 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.
he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
unit authorized inspectors on premises and in building for necessary inspections.
(Signature of applicant, or name, if a corporation)
UNDERNR CERSfflCAFE ~Q ~ 2?. e - 4 l~% w ll ~
REQUIRED • • • • • f
(Mailing address of applicant)
;ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
vw-e..... APPROVED AS NOTED
G'
ame of owner of premises `a'.'Y,. F ~ BY.
(as on the tax roll or latest de E DEPARTMENT BUILDING D PA ENT AT
a licant is a cor oration, si nature of d 765.1802 9 AM TO 4 PM FOR THE
pp p g CCAf OR FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRED
. . . . (N . ame . and . title .
. of corporate.
. of>E.UNLAV1FU FORPOURED N
2. ROUGH - • FRAMING G & & PLUMBING
Builder's License No. ITHOUT CERTI IFICATE 3. INSULATION
4. FINAL - CONSTRUCTION MUST
Plumber's License No. ..P!•!/!~_ BE COMPLETE FOR C.O.
/~~CU~A(~ ii!!Y ALL CONSTRUCTION SHALL MEET
Electrician's License No. . , yr 'o THE REQUIREMENTS OF THE N.Y,
• " • " . . . , rt STATE CONSTRUCTION & ENERGY
Other Trade's License No. CODES. NOT RESPONSIBLE FOR
• • • • • • • • • ' • ' • • • • DESIGN OR CONSTRUCTION ERRORS
Location of land on which proposed work will be done. .
(louse Number Street Hamlet
County Tax Map No. 1000 Section ~
Block Lot
Subdivision Filed Ma No. Lot
(Name)
State existing use and occupancy of premises and in,t('ej}pded use and occupancy of proposed construction:
a. Existing use and occupancy ..~el , , , , . ,
:
b. Intended use and occupancy 'p--
Nature of wor (check which applicable): New Building Addition Alteration .
Repair Removal Demolition Other Work
(Description:
4. Estimated Cost ...S_ 6b Fee .
(to be paid on filing this application)
S. If dwelling, number of dwelling units Number of dwelling units on each floor
If garage, number of cars
6. If business, commercial or mixed occupancy, specify nature and extent of each jyge of use .
7. Dimensions of existing structures, if any: Front Rear Depth . 38
Height ..,2P 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 ofStories
9. Size of lot: Front Rear Depth
10. Date of Purchase ...7~/. yy~~Nam-/ of Former Owner i~Kr
11. Zone or use district in which premises are situated . , f5~°l.!C~P+2~7Gt~-
. . .
12. Does proposed construction violate any zoning law, ordinance or regulation: . .
13. Will lot be regraded ....~1 t) Will excess fill be removed from premises:.~t? Y ?&V. lv
14. Name of Owner of premises f~l![/.~ CMS. Address Phone No,,2 iFr .
Name of Architect ...........................Address W. OM- Phone No. 7..l..?..L.....
Name of Contractor Address Phone 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 fret
property tines. Give street and block number or description according to deed, and show street names and indicate wheth;
interior or comer lot.
STATE OF N ORJ~(, ( . SS
COUNTY T~( ' n J J /
1 ~S. ~ being duly sworn, deposes and says that he is the applican
(Name of individual signing contract)
ibove named.
.~i
leis the
(Contractor, 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 thi
pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that th,
Vork will be performed in the manner set forth in the application filed therewith.
;worn to before me this { {
day a f . . . . . ' Y. . ...119
dotary Public, L . ounty
CLAIRE L GLEW
tlopry PoNo 4878NewYork .
QueHfied in Suffolk County 9~ ( ignat o applicant
Cmemisslon ftires Decemb S. I*.
_