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1 FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20060 Date 3i3LY 8, 1991
THIS CERTIFIES that the building ADDITION
Location of Property 650 BAY AVENUE MATTITUCK N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 143 Block 3 Lot 12
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 20, 1990 pursuant to which
Building Permit No. 19417-Z dated SEPTEMBER 25 1990
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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to BALE D. & STACEY MOVER
(owner)
of the aforesaid building.
BUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N~A _
UNDERWRITERS CERTIFICATE N0. N/A
PLUMBERS CERTIFICATION DATED_ N/A a
~e~
Building Inspector
Rev. 1/81
roans rro. s
TOWN OF SOU7'HALD
BUILDING DEPARTMENT
TOWN FYALL
SOUTNOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N g 9 ~ 1 ; ~ Z Date 19.9D
Permission is hereby g
of premises located a~ ...~yi~~........~~...Q,,`~..'.....t~:~i
.............................................a.~~.~............................................................................
County Tox Map No. 1000 Section///~~~.././~,~1..-,'~.......... Block ..........:3...... Lot No......~
pursuant to application dated ....:/,(..~~..r-~ 19.~, and approved by the
Building Inspector. /
OO
Fee .X.:SI ,
i `~'~~~G~~
ding I for
i
Rev. 6/30/80
Porn No. ~i
TOWN OF SOUTIIOLD ate,
BUILDING DEPARTMENT D
TOWN BALL ~ ~ ~ `
765-1802
F3i.U;~.;. w)cb'I'
APPLICATION POR CERTIFICATE OP OCCUP:1 ~-1Ft~~'a`~O"~.5~,~,1~OE[m~
This application must be filled in by typewriter OF, inlc and submitted to the building
inspector with the folloeaing: for new building or neca 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. o£ water supply and sewerage-disposal<S-9 form).
3. Approval of electrical installation from Board of Pire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains
less Chan 2/10 of 17 lead.
~ S. Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Compliance from archi'_ect or engineer
responsible for the building.
" 6. Submit Planning Board Approval of completed site plan requirer.:ents.
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 Luilding Inspector shall state the
reasons therefor in writing to the applicant.
Fees '
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations co dwcllinB 525.00, 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 - 510.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial S15.00
r
~ . / .
Date -
ew Construction...... r q!.~_. OLd Pre- rxJisting Building..... ry~~ ~~~~vfv~`~•
ocation of Property.. „Y~l!~ :I1M~~~1i1:':..................
House No~ //p ~ ~ ~)~"'7/~St//r~~gge~/e//t ~~j~ /~/(}1/~ '{//~,j~ Hamlet
twer or Owners o£ Property..:.4!~~LVf. ~I,t..~ •~~jj• % ~ t~/t•'Y • • • • • • • • •
>unty Talc htap No 1000, Section..../•'~:~......Block.......+/........Lot.....64.
;bdivisionjj. • Fi/lied Tiap... • , . • . Lorpt...~...../~...... /r. .p.~.~
rmit No. f.~.~.1. Z....Date Of Pcrmi.r.~~~~/~~tt.....AppliCants~{,,.i~(.4. ~ ~~~vk~~~iJ~~!~:
alth Dept. Approval ..........................Underwriters Approval.........................
inning Board Approval ~ ,
quest for: Temporary Certificate........... Final Certicate.,.........
¢ 0
i
Submitted:
. .
l ~ I a ~ / APPL I ANT •
nrr9 ~nt1f_l'1
mmz,~ TEL~,7G5-180?
S~FFa~kc
o~p , , OGy TOWN OF SOUTIIOLLD
:Sa ~ Opi'ICE OE BUILDING INSPECTOR
o ~i1"~S~ ,z„ P.O. BOY 728
cn j- " ~~4:>>~ i
~ l(l~sa ~ TOLVN fIALL
,~OI ~ ~a~~ SOUT[iOLp, N.Y. 1 171
June 28, 1991
Dale Moyer
650 Bay Avenue
Mattituck, N.Y. 11952
To P7hom This May Concern,
We arc unable to complete your Certificate
of Occupancy because ,of the following reasons.
An application for Certificate of Occupancy
is not on file. (ENCLOSED)
/ / No Underwriters Certificate on file.
'L'Ite check is (X74Y#~/not on file.) $25.00
No Ilcalt-h Dept. Approval on file.
No final inspection has been made.
Please contact our office on this matter.
Thattk you f-or your cooperation.
Buildi.nq Permit It ~ -9-- 4-1___7_ Z'
Uutldi.ncl Dept.
/ No Pluml~cr Solder Certificate on Eile.
( all permits involving plumbing being
.i^,succl after April 1,1984 )
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a~ ~gyr7 iy.~ _ ~ _;a
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C
BY THIS CERTIFICATE OF COMPLIANCE THE r_].
5 NEW YORK BOARD OF FIRE UNDERWRITERS 5
5 BUREAU OF ELECTRICITY 5
5 40 FULTON STREET - NEW YORK, NY 10038 5
CERTIFIES THAT 5
CSJ. Upon the application of upon premises owned by ~5
5 JOHN LUDEMANN DALE MOYER ~5
L5U P.O. BOX 621 650 BAY AVENUE 5
NEW SUFFOLK, NY 11956 MATTITUCK, NY 11952 c
5 Located at 650 BAY AVENUE MATTITUCK, NY 11952 5
55
C5 Application Number: 2089589 Certificate Number: 2089589 ~5
Section: Block: Lot: Building Permit: BDC: ns11 r~
Described as a Residential 0-599 square ft. occupancy, wherein the premises electrical system consisting of
5 electrical devices and wiring, described below, located in/on the premises at: 5
5 Detached Garage,
5 A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed 5
5 herein, was conducted in accordance with the requirements of the applicable code and/or standard
5 promulgated by the State of New York, Department of State Code Enforcement and Administration, or other 5
authority having jurisdiction, and found to be in compliance therewith on the 24th Day of February, 2006. 5
5 Name ~ Rate Ratine Circuit ~ 5
5 Wiring and Devices 5
5 Outlet 3 0 Fixture
5 Fixture 3 0 Incandescent 5
5 Outlet 7 0 General Purpose 5
5 Receptacle 2 0 General Purpose 5
5 Switch 4 0 General Purpose
5 Receptacle 3 0 GFCI 5
5
5 5
5 5
5 5
5 5ea~ 5
~~5 1 of I 55
r~ This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. ~j
5 5
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FORMN0.1 SURVEY U-15.........
70WN OF SOUTHOLD CHECK ....:#Io.? S~, ,
BUILDING DEPARTMENT SEPTIC FO[ZPf ,
T04VN HALL
EOUTHOLD, N. Y. 11071 NOTIFY ~ ~5
~ TEL.: 765.1802 CALL
[~amincd..l~°~~~1,~........,,19~~1~y~ MAIL T0:
.\pProved ....G/~:~.T~, 197.&'' Permit No. >i9Y."~T .
Disapproved a/c
uildin nsp ctor)
APPLICATION F R BUILDING PERMIT
Date .~.r...,, 1~~.
INSTRUCTIONS
a. Tltis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
sets of plans, accurate plat 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
ar 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
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 hfADE to the Building Department for the issuance of a Building Permit pursuant to the
Il3uilding Zpne 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.
iTite applicant agrees to comely with all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building fot necessary inspections.
{Signature of applicant, or name, if a corporauon)
• (Ivfailing address of applicant) ~ . •
!State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician; plumber or builder.
.
. . ...................QV~.Y.1GY : .
'~`ameofownerofpremises .......~~~'I:I~J~..:~.:.~.~G{ ..~:~:r~c;~=. 1'~'~^,.`..J"1~~!i!'..•...........
(as on the tax~ol! or latest. eed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of c//o^^~~r''p'' /orat~~JJe,,~~o-fficer) •
Builder's License No. ....~luV~4!Y •
Plumber's Liccnsc No . .
Electrician's License No . . .
OtlterTradc's License No .
Location of land on which proposed work will be done. . . .
house Number Strcc~ Hamlet ~ ~ ~ • ~ •
r
County Tax lfap No. 1000 Section ....../.1.~ , Block , , ~ , , , , , , , , , Lot , , , , , , , ,
. Subdivision F.iIcJ lifap No. Lot
(Name)
State existing use and occupancy of premises and intended use andl occupancy ofproposed construction:
a. Existin ,'~Cr',.`..~~~.~~.~1~:~~.~a~'l l ~~1
use and occupancy .
b. Intended use and occupancy ••-•--1'~..~1•~u1~"'~' ~~~.~I ~~.,,,?~~?~,,,,aLe~',oP.tr~"f
qx~;
3. Aaturc of wort, checl, a•ntch
( aPPlicable): New Iluilding Addition ~Utcrati
Repair , RerrSoval Demolition Othe Park .4.1~v1~-:... .
~•I~~V I~D (D.scriPtionl
4. Estimated Cost....l t!V Fee
~ (to be Paid on filing this application)
I
5. If dwcllin^, number of dwcllin& units . . Number of dwelling units an each floor...............
If;ara_c.numbcrofcars ....I
6. if business, commercial or mixdd occupancy, specify nahtre and extent of each Cype of use .
7. Dimensions of existing structures, iC any: Front Rear . Depth .
Hci;Itt Nutjrber of Stories ,
-
Dimensions of same structure With alterations or additions: Front . Rear .
epth : . Ilcight , ...........Number of Stories
Dimensions of entire new construction: Front Rear Depth
Height , , , Nuiribcr of Stories . • • • • • •
9. Size of lot: Front Rear Depth
10. Date of Purchase , , , , , , , , .Name of Former Owner , , .
11. Zone or use district in tvhiclt premises arc situated . . . • , , .
11. Dees proposed construction violate any zoning law, ordinance or regulation : . , .
l3. l~'ill lot be regraded , , . . . . . . . Nill excess fill be removed Gom premises: , Ycs No
l4. Name of Owner of premises . - .I,, , , , , , , , , , , , , , , , ,Address , -Phone No............... .
Name of Architect , ,I . . .Address ...................Phone No............... .
Name of Contractor . ,Address . . ..Phone No.. . .
15,Is this property loca~ed•within X00 feet of a tidal wetland? *YES....NO.~C..•
*If yes, SouChold 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 Sines. Give street and block number of description according to decd, and show street names and indicate whether
interior or comer Sot. ~
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T,tTEOFtiE~S'YORI:, 5$
OU~iTY OF .
••••••••••••••••••••••••••••••Ir••••••••,•••••... 6cingdulysworn,deposcsandsaysthatheistheapplicant
(Name of individual s~gnmo''icontract)
:ovc named. ,
•isthc
(Contractor, agent, corporate officer, etcJ'
said owner or owners, and is duly at~tltorized to perform or have performed the said work and to make and•fSie this
~lication; that all staterttems containud in this application arc true to the best of his knowledge and belief; and that the
rk wdl be performed in the manner set Cortlt in the application Glcd Ihcrcwith.
orn to bciorc me thryryis I
• ............~l U ..day of . , .''i , „ 19 ,~Q
'ary Public, ~~`e;ea^~:.:1 r.,~•~VUU . County
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Nt:IEN IC DE Y0E f~ • • • J y,~
N01MNpl18lIC, otNewYatk ~I (Si;naIUrr of pplicani)
Na A707870, Suffolk Ceunly
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