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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-25968 Date: 09/11/98
THIS CERTIFIES that the building ADDITION
Location of Property: 50 BREAKWATER ROAD MATTITUCK
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 113 Block 3 Lot 7.2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated FEBRUARY 27, 1992 pursuant to which
Building Permit No. 20462-Z dated MARCH 3, 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 INGROUND SWIMMING POOL ADDITION TO AN EXISTING ONE FAMILY DWELLING
WITH FENCE TO CODE AS APPLIED FOR.
The certificate is issued to MICHAEL & JOYCE MATTES
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N 235805 05/18/92
PLUMBERS CERTIFICATION DATED N/A
Bui ing Inspe for
Rev. 1/81
roast NO. a
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)
N2 2 0 4 6 2 Z Date .......I ..QAf, i.....'3 1991J .
Permission is hereby granted to,
......l.l.c.... ..12:X~1~{..:~:... a.?ti......~..Sr.:........
-PI-30- x 4 8 J
.................~..yy...~~..........................................................
a11~'u....~....
/.~n.4. ~3r.......
to.... Ser... ilr,...AM~?{,Jle04lrki&!.. f..... R.ane~.q......S3rm7............
. . .
at premises located at i ....17. ? R-1d.................. 9 r~t fcLC.~
.
~...v~.l q .14..Lazz
1l Q.... . < ~
County Tax Map No. 1000 Section Block Lot No.....~.
pursuant to application dated ....1.) 19(b7:, and approved by the
Building Inspector. 1
Fee S. t
Building Inspector
Rev. 6/30/80
Form No. b ,p
Ql~~JO TOWN OF SOUTHOLD
BUILDING DEPARTMENT,
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OR ink and submitted to the buil(
inspector with the following: for new building or new use:
1. Final survey of property with accurate location of all buildings, property lir
streets, and unusual natural or topographic features.
2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 for
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contain
less than 2/10 of 1% lead.
5. Commercial building, industrial building, multiple residences and similar buil
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
'!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 applic:
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 $25.0(
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 - .25~,.
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
[1/ Date .11Cn1Xr
New Construction..&&-... Old Or Pre-existing Building ...............~.9.
Location of Property..... .%.Tj.7cl%e!`
House No. Street T6_.,5 C Hamlet
Onwer or Owners of Property. 'txj ljq. ..1M.7.T(..,5
County Tax Map No 1000, Section ...11. 3......Block..............Lot...~7(A
Subdivision. ....Filed Map............ Loott.........
Permit No. AQ./ (V.,;Z-.Date Of Permit.*?? ........Applicant./.ltdk/Y~
Health Dept. Approval .....................//.....Underwriters Approval.......................
Planning Board Approval 14 L
Request for: Temporary CCertificate........... Final Certicate...........
Fee Submitted: $.0255
cif l~ 60
G 5 ~j IS • APPLICANT .
Af;k,
THE NEW YORK BOARD OF FIRE UNDERWRITERS
r10@0744 BUREAU OF ELECTRICITY
I 85 JOHN STREET. NEW YORK, NEW YORK 10038
Dote NAY 18,1992 Application No. on file 02996392/92 N 235805
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
NICHM NATTS, BREAK WATER RD,, (CO.NBCK RD, 37), NATTITUCK, N.Y,
in thefollowing location; ff] Basement ? IRE Fl. ? 2nd Fl. 0 U7' Section Block Lot
NA.Y i1,t992
was examined on and found to be in compliance with the rwtuiremen[s of this Board.
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS ECEPTACLES SWITCHES INCANDESCENT FLUORESCENT OTHER AMT. K.W. AMT. K W PMi NW, AMT. K.W. AMT. RP
I 2 1 1
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNI7 HEATERS MULTI-OUTLET DIMMERS
AMT. K. W. 01 H. P GAS H. P AMT. NO. A. W. G. AMT AMP. AMT. AMPS TRANS. AMT. H P SYSTEMS AMT. WATTS
NO. OF FEET
1 A~
SERVICE DISCONNECT NO. OF S E R V I C E
AMT. AMP T1YPE METER I 2W I1 A 3W 8 d 3W 9,0' 4W N0. Of C0. COED A. W. G. NO OF HbLEG A G NO. OF NEUTRALS A. W. G.
EQUIP, PER 9' Of CC.COND OF H1 LEG OF NEUTRAL
OTHER APPARATUS:
SWINNING POOL-1
SPECIAL RBCBM20A-1/03V-T.°1°2
*(SWIf9NING POOL) This cettif.icate
cov("rs eomp.)..lance It 0'1(a chtf" of
insper,t.ion only, Decaufm of mitisual
envItonment5 it Is advisable to
have frequent test/arid or refaiis p
spade by a qualified person. ® "'l
RICHARD G. RGLYRA LLC.ft2L46-N
P.O. BOX 372 GENERAL MANAGER
LAUREL, NY, 11948 f ,s'
Pef~~~. y
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.
ALTERED IN ANY MANNER.
O~~gUFFO(,~Co
o~ Gyre
ry Fax (516) 765-1823
Town Hall, 53095 Main Road y 2
P.O. Box 1179 Oy • Telephone (516) 765-1802
Southold, New York 11971
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
September 8, 1998
Michael Mattes
P.O. Box 831
Mattituck, New York 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 (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 # 20462-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
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765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION iST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] 1 ULATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE INSPECTOR
1. 0
FOUNDATION
FOUNDATION (2nd)
2.
POUCH FRAME $ d
PLUMBING
3. y
m
m
INSULATION PER N. Y.
STATE ENERGY
CODE
4. m
FINAL `
a
ADD f MMENTS:
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BOARD OF HEALTH
FORM NO. 1 3 SETS OF PLAYS
TOWN OF SOUTHOLD SURVEY . .
BUILDING DEPARTMENT CHECK
TOWN HALL SEPTIC FORM
SOUTHOLD, N.Y. 11971
TEL.: 765-1802 t:OT I PY S
1,,,~ f1 CALL
Examined ....y . Q,t,~(/yl, 19 ).4- ,1 MAIL TO:
Approved ...J A0- c.Yt .3 199?- Permit No. A44laa-5,L. • . .
Disapproved a/c
(Building Inspector)
APPLICATION FOR BUILDING PERMIT W,3
Date 9/,?. 7 19.4cr-
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
iuilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
tegulations, 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
dmit authorized inspectors on premises and in building for necessary, iinspections.
~.•.a(- 44 Y. t.. JOh! S,, Vv
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
hate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.....................(J.G?i/D?~f~c 1}?!?;~/'~l2
Jame of owner of premises /yl4C 2..M..)9:% 77~s Q....1 .
(as on the tax roll or latest deed)
f app cant ' corporationWaluof authorized office r.
anr)
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. 477 / C
S~ .......................RE?3K!~ iZ .rZZPa rJ...............!~?.'~} k#-Gj
House Number Street Hamlet
County Tax Map No. 1000 Section 13 Block
Lot..... .A 42.
Subdivision Filed Map No. Lot...............
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy /.Z.~~ (d} t
b. Intended use and occupancy ...........!:./v%`,-.--
3. Nature of work (check which applicable): New Building Addition Alteration
Repair Remo val Demolition Other Work S~+/r?v tivG Ad<)
(De4 ptlo )
4. Estimated Cost .........,~r~!,f38Z? Fee
(to be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on each floor
If garage, number of cars .
mixed 6. If business, occupancy, specify nature and extent of each type of use .
7. Dimensions of existing lstru t$, if any: Front Rear Depth'
Height Number of Stories .
imensionsofsamestructure with alterations or additions: Front Rear
• • • Height Number of Stories
8. Dimensions of entire new construction: Front . . . Rear Depth Height Number of Stories
. DateofPurchase Rear Depth
9. Size o t
I .................NameofF rmer Owner
11. Zone 12. Does proposed miser are situated !19(A!T( If -
construction rs in which Ppl 'to any zoning law, ordinance or regulation: A-0
13. Will lot be regraded ~v~
• • • • • • • Will excess f 1 be removed from premises: es No
14. Name of Owner of premises . . • , • • , , Address . ~ 1.!TJ.'J.7, 3W , • , . Phone No.
Name of Architect Address Phone No....q~.p
Name of Contractor ' . • Address
/2~' jLC y a' lh em. Vq~• • Phone No.. -AIX .~a6 .
15. Is this ryes, t within 3• • • • ' ' C1
00 feet of a tidal wetland? *yes........ ~
*If 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.
I
~!I
tt
i
;TATE OW2. S S
:OUNTY • • . .&.C. ~,F 0 • • • • being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
bove named.
(e is the 6?1 TJ2 /9t7~1Z .
(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 this
nplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the
ork will be performed in the manner set forth in the application filed therewith.
worn to before me this
ayo r- 192--
otary Pub County
CLAIRE L GL vS®L-
Notary Public, State of l ew York • • • • •
No.4879505 %gCf applicant)
Quelltied In Suffolk CpuMy (Z - -
Commission Expiros December 8,18.... w
• Lli~xly _
%
OCCUPANCY OR
OF OCCUPANCY
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