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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-19265 Date AUGUST 3, 1990
THIS CERTIFIES that the building ACCESSORY
Location of Property 11080 SOUND AVENUE MATTITUCK N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 142 Block 1 Lot 18
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 23, 1990 pursuant to which
Building Permit No. 19294-2 dated AUGUST 3, 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 ACCESSORY SHED AS APPLIED FOR.
The certificate is issued to EDGAR AUGUST & ANO.
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
l
~v
Bu' ding In ector
Rev. 1/81
F(?Sffi NO. S '
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTWOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
' COMPLETION OF THE WORK AUTHORIZED)
N ; 2 ~ Z Dnte X9..90
Permission is hereb~route/d to: ~y
Ge~~~
~i irl ~1~...... ~ ~C'`~r.~G''
' of premises located at .......ld 0~~......~..___"--"'
County Tax Map No. 1000 Section .......1~,~....~..-... Block ..........1........ Lot No.......
1
{ pursuant to applicotinn dated 19~, and approved by the
Building Inspector. /
or
Fee S.•~,~
. g
dfn I for
Rev. 6/30/80
~ _
r
Form No. 6
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 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 ly, lead. r
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 Certifica e of Occupancy - Residential $15/00, Commercial $15.00
Date .....:°./,y:'~.,9.4
New Construction.....1...... Old Or Pre-exist g Building
Location of Property.12~gfC~ .............~~:41F~..~:£,............. :h-:`:`:...........
House No. Street Hamlet
Onwer or Owners of Property........GPI/ALL..~~~n.~WY/,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
County Tax Map No 1000, Section... .,{00 ~
:....Bulock......~..........Lot...~.~
Subdivision .Filed Map............Lot.............._.......
Permit No.~l.~g~'.'C.~..Date Of Permit"?...~:C?.......Applicant.......
Health Dept. Approval......,,~/.~~.......~........Underwriters Approval...~/!~:`
Planning Board Approval.... v ~
tequest for: Temporary Certificate...... Final Certicate...~'.
?ee Submitted: ~J: ~
Q.(rC~ ~0~ 1~ .
C O ~ q a 6~ ~ APPL CANT
~~c~~FfOLK~OGy
VICTOR LESSARD ~ L Town Hall, 53095 Main Road
PRINCIPAL BUILDING INSPECTOR = z P.O. Box 1179
(s 16) 76s-isoz tOf~ ~ Southold, New York 11971
FAX (516) 765-1823 ~~0~
1
OFFICE OF BUILDING INSPECTOR
TOWN OF SOUTHOLD
July 10, 1990
Nassau Suffolk Permit Processing, Inc.
25 North Hamilton Avenue
Lindenhurst, New York 11757
Attn: Sheila:
RE: Premises: 11080 Sound Avenue
Mattituck, N.Y.
Suffolk Co. Tax Map #1000-142-1-18
Owner: Edgar August
pear Sheila:
Pursuant to our telephone conversation of today, enclosed
please find your check #1685 in the amount of $225.00 marked
void.
The inspection has been rescheduled for Thursday
July 12, 1990 at 10:30 am.
Very truly yours,
SOUTHOLD TOWN BUILDING DEPT.
Georgia Rudder,
Secretary
t
THE NEW YORK BOARD OF FIRE l1NDERYYRITERS ''"'~t 1
100(1062 EIUREAU OF ELECTRICITY
55 JOHN STREET, NEW YORK, NEW YORK 10085
Tl1NE t1, 1990 69('15B64pJ4D N 13G~222
Date Application No. on file
THIS CERTIFIES THAT
only eM eMetrical egrtiptnettt M dsserilred below end ineroducd by the applicant nand on tM ofwoe applicatbn nuaeMr in the prontiwt of
F..OOAR AUGUST, 1108tl SOl1ND AVFNUP, MAYiTTI1CK_, N. Y.
OUi
in thefollowin%locotionl ? ement ? let FL ? Ynd Fl. Section 81ock Lot
MAY 22,1990
wn e.TOmined on and found to be in compliance with the rvyuirementt of Chit heard.
tnCllS SYIITORlS R%T RANOK CODKIIlO DECKS O w T
OttT1RTYt INCANDltClNT tlUOKEEClNT OTHER NAT. K. W. AMT. K. W. AMT. K.W. AMT. k. W. AMT. N. t.
1 i
OWYS R/Rt1ACE MOTORS tUTURE M/!IAlICE IElDDIS SrECIAI REC?T TIMl GOOKS IItIR IIEAINE f1elN~Yf DftAMNS _
AMT. K. w. at N. r. cAS N t. AMT. NG. A. W. G. AMT. NM. AMT. AMn. TRAM. AMT. N. e. ~ RR AMT. WAlit
SER1flCE DISCONNECT lW.Of 5 E R V 1 C E
AMr. AMr. TTte c r zw 1 r ew t r sw a r .w icoNO. cc
i:~i+o. No. of N4ue ~ a No. or NeurtAta a l
eunAt
OtMNt Ae?/IRATUS:
G. F'.f,.I:~l
*(SWIMMIH6 fOULl Thix r.trl:i~ticwate /(i r„
roves r;awpliance at the date oT ~ l
inaner.tion on1r. Because of un ut,l /'7
environments it i advisable .o
have frequent teat nndJar repRir!.
Bade hr n qualified nersnn.
-
GUSIAV BAftfRA
R.R R1
227 E. BRE:AKNATER ROAL1 Of~tMAEIAEIER
MA'fTI'IUCK, NY. 11957 11
Per
Thit uflilitah mutt not be altered in any manner; rNUrn to tM office of IIIS Eoard if itN:orrecl. t b idtltMi<iRll. chair cndlfMiak.
eoPY Fgt tdIL~IMIB bEPAR'TMENT. TIME COPY OF'CER'fIFICJtT! ASST ~la? ~a ~W~nr Mwlyeie. ,
BDAf~O OF HEF,LTtI
~ SETS OF PL.\a5
' FORPANO.1 SURVEY ~ . , .
TOWN OF50UTHOLp CUECK .~~.j~~-r~.~.........
DUILDING DEPARTMENT SEPTIC Foitrt .
TOWN HALL
$OUTHOLD,N.Y.11rJ71 NOTIFY!
~ I,I~U TEL..7GG•1B0< CALL
Exasnincd 19 NAIL T0.. ' • • .
Approved f?. 19Permit Nol..~OZ~T ~ •
Disapproved a c . . ~ n c'
,r,r,.,.~ ~ MAY 2 31990,
uil o ~pector) • _ . ~~'I_.
~.~E3d_iyt~. i)~:d'7
APPLIC ION FOR Bl1lLDlNU PERPAIT TOlr~c~ t~F~fJUfliC)L17...,~,.
Date ..:..~':-/s=
....1~~ 90
INSTRUCTIONS
ri
a. Tlus applicati must be cor>~pletcly filled in by typewriter or in ink and submitted to the Building inspector, wit
sets of plans, aceutate 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 strr
or areas, and giving a detailed description of layout of property mast be drawn on the diagram which is part of this ap;
cation. ~ ,
w c. The work covered by this appjication may not be commenced before issuance of Building Permit.
' d. Upon approval of this application, the Building Inspector will issued a building Peirrsit to the applicant. Such pcrr
shall be kept on the premises available far inspection throughout the work.
^ e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certifiate of Occupant,
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 t
'Building Zone Ordinance of the Towir of Southold, Suffolk County, New York, and other applicable Laws, Ordinances
Regulations, for the construction of buildings, additions or alterations, or fore,rcmoq l or demolition, as herein describe
The applicant agrees to egyt~ ~th~~~i~atile laws, ordinances, buildin cod . ` ~usinr code, and rco
:fations, and
``d~~~'f,~' g ,
a mil authorized inspe¢foss n pre`mis~ s nd in s
• ~buiidin, for necessary inspections.
`1- . a' S (Signature~oi applicant, or name, if a corporazson)
to Y'~'sN?r421'{'Ci .„tLiSlfJlsi2T
iit~ 4als~i A,fl%. tr `'Vi'i 0h~ v`,- .4~ ~ ~.,_.~.~-.~..~..r
t # „IJII~~t a 's t y~.t, ~ y _a (Mailing address of applicant)
State whether applicant is owrj~r^'l~~tseg.' a~ rit arcl~jtect, etigirieer, geneial cr1''lract~r, electrician, plumber or buihic~
yg~ f
i
..~~14*..F t'S ^ i ~ ~r' k4u~ ~y~
Name of owner of premises t'' ° ` ~ s h;:,tl , , , , , , , , , , , , ,
-9'34 _q'~'jp~ i"'~~~'~~r'i~\ ~ ~ (as on the ax roll or latest dec{1)~
t tt ittl' ~Lk ;?!'L'1 bd~i1!t1L2 z5' ~r~.
If applicant is a corggfAltlRB, ~aggDfes flEI1tFy~authbttztd oCticer.
••.••••+ii;~)1gri31sNf7l~'Sft:i.~s:~,s:~„i.'::.`:....
(Name and title of corporate officer) '
- ~ I
Builder's Liccnsc No. , .
Plumber's Liccnsc No. ~ ~ i '
a
Electrician's License No. , . , "`'~~~u~#
.i.. ,
Olhcr Trade's License No. .....~/.~,Flf ' ,
F~ ~E S:
Location of land on which ro os •d',work ll be done; -
(louse Number Street, Hamlet
County Tax i\tap No. 1000 Section ..I7:QS.'.Q.Q..: Block ..~.1; , Q, ,41,', , , , , Lot , . ~ f ~t ~Q,IQ. ,
Subdivision I~ Rilud Nfap No. Lot "
~(Nnm'cj ~
State rxistin~ use and occupancy of premises and intended use and occupancy of proposed construction: `
P
a. Existing use and occupancy , i • • • • • ` .
b. Intended use and occupancy t j ....1. •~~Y.. .
.
3. cJ~tu.% ~ s.',;:., ~ ~~Lw C3urldu,5 ~ addiucn • • ~~;;cratron .
ReparY RFrnoval Demo on .Swimnin; pool.
Tennis Cuurt Accessory Buildin t~ „
8• •"v• • • • .Fence . , .....Other tJork.7C~~/~ j~~...
~4. EstimatcdCost .............3~~~......,......,...Fce.. ..~!/.~~/././.I.~G
• .J
(to be paid on Cilini, this applica:ron)
5, ICdwellin^, number of dwcllin~ u its . • ~ g~/t-jr~
Number of dwelling units on each floor .
If daracc, number of cars ..~,ft r~ .
6, IC business, commercial or mixed occupancy, specify nahire ~,pd extent of •ac(t type of se ...dK~. ,
7. Dimensions of c.``~~isting structures, iC any: Front t Rcar,~t~ j. Depth , ~ , .
Hci_lu s~. Tr .......Number of Stories j„^--`; .
Dimensions of same structure with alterations or editions: Front , , Rcar ,i y, i~ , ,
Depth ~".:.T..~. ,
Ilcigh[ Nu,nbcr of-Storics .
S. Dimensions oCentirc ncty constmction: Front Rcar . Depth .
Hcigltt ........Number of Stories .
9. Size of lot: Front r'
Rcar U p'tt , "'~-e..~•,t'
l0. Date of Purch~±se , • , , , , , • • . _ . , . am of Former Owner ~ .
I I. Zone or use district in which premises arc situated .~j~~• • •
1 Does proposed construction violate ~~}}iI sing law, ordinance or regulation: N/~ .
l3. Will lot be regraded /.K z~, , , , , , , , , , ,Will excess Fill hc,rcmovcd from premises: Ycs , N
L}, Name of Owner of premises .........Address t ..Phone No .
Name of Architect ~ : • • , , , , , , , ,Address f Fi ..Phone No.............. .
Name of Contractor ~Y
.....Address ~'9„ , ..Phone No..... ; vv... .
15.Zs this property located within 100 feet of a tidal ia`~~,t:land? ^YES._._NO..r~.
*If yes, Southold Town TrusCees Permit may be required:'a
PLOT DIAGRAb1
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions fro, ~
property Lines. Give street and block number or description according to deed, and avow street names and indicate whcthr
interior or ccrncr lot.
~,~ry ; 'v;z+,~-:
o ~x
~ ~ = 1~ .
. r c ns~to~a
OATE•b~9.P. M
FEE: ~2~8Y:.....
NOTIFY 8U1 NV OEPARTM A
766.1802 8 AM`TO 4 PAA FOR THE
FOt-L~NCa ~N$~~~TIpNS:
. ~ NO1l~'AON! TWO REQUIRED
pO'q ppED.~bNCRETE
2. RQAIGH+~ ' ~ , ~G 8i; p1 UMBING
b. FINAL CfSN '~}UC'hON WWST
BE COMP4ETE>R`~~•O•
~ ~ ALl CONSTRUCf1~N:°'SHA~ME~
tHE REQUIREMENTS OF
STATE CONSTRU~N b ENERGY
j CboES. Ndf.. ~SPON818LE FOR
IDESIGN OR CONSTRUCTION ERRORS
STATE OF \E1V OR S.S
~OUNTY OF,
• . being duly sworna xieposd~ anFi says that he is the applican
~ L~
• (Name of individual signing contract
ihovc named. .
is is the ..'i . .
(Contractor, agent, corporate officer, etc.)
if sail owner or owners, and is duly autltorizcd to pc~form or have performed the said work and to make and file thi- ,
pplication; that alt statements contained in this application arc true to the best of his knowledge and belief; and that thr
rork will be prrfornred in the manner set forth in fife application filed therewith.
wom to hciorc me this
.........•^....dayof...../~~......19~
'otary Puhlic, , , • , Y.~::...... County
L.., . .
• (Si;nature of applicant)
tR~~t~jEN K pE Y0E
~j~4Tp7878;~ulkC~o
h~
. , Term Expires Marsh 311,19..-~