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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-18922 Date MARCH 27, 1990
THIS CERTIFIES that the building ALTERATION
Location of Property 440 PARK AVENUE EXT. MATTITUCK, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section I23 Block 8 Lot 28.3
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVEMBER 1, 1989 pursuant to which
Building Permit No. 18636-Z dated NOVEMBER 9, 1989
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 ALTERATION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to BRENDA HELIES
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N/A
PLUMBERS CERTIFICATION DATED N/A
.I~~/~C~
Building Inspector
Rev. 1/81
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TOWN OP 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)
N ~ .L cQJ ~ ~ ~ Z Date ....1/~~ 19P...!.
Permission is hereby r n ed to: ,
to ..G~~X/~y~.~7'f~Gl.....~~.~f"/~J..... ..f~Ar~,~r......<Q......1~'~-~~r~yr•~!.?. ....a.~..
t
of premises locoted at ........~~Q.f...~~~j../~,1.~....
................................................................................................................G................................................
County Tox Map No. 1000 Section ~!~..3.... Block .............tf....... Lot No...... Z.~t..:3...
pursuant to application doted 19.~.I~.., and approved by the
Building Inspector.
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Fee ~ .
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B ding I for
Rev. 6/30/80
a~~~-1~. TOAN OF SOIITIIOLD
EUILDI27C DEPARTaC2iT
' ~,~m.~~v_u ~ TONN kiALL
I~'~ SOUTIIOLD, NEN YOttK 11971 i
BLDG. Dlwl~l'. ~ 765 - III02
TOWN OF SOUTMOLO
APPLICATION FOR CERTIFICATE OF OCCIIPAttCY CC
y+DATE.~.z7.d0....
HEH CO2iSTRUCTION .......OLCD/ OR PRE-E%ISTZ2IC BUILDING?:...VACA27T L//AND_...._..
Location of Property.../ ~......_~~~__~v~°..........b.~~.~.~~D_~~
DOUSE NO_ / /S~TRCEJT DAMLET
Owner ar Ovncrs of Property.. ~~~":`may ~U~~~p".::. /~-~~~.~:r.._.,...~_.,..~_~
County Tax Hap No. 1000 Section ~23. 81ock Lot ..L.~.~....
.
Subdivision Filed Map ..Loc._.__...__
3G
Pcrnit Do. /~~......I]aCe of Permit ..~~~9Applicant /'~~J1;~z~.wr/~mrxo.'~'
Dcalth DepC. Approval Underwriters Approval._._........__
Planning IIoard Approval
Request for Temporary Certificate Final Certificate
S '
Pcc Submitted:
APPLICAtiT.. ~
10/14/88 ~'J/~~ ~ ~~'h'
0~G,~3`i~O6 ' IIB~'
~ o z~- i B y a ~ x(11 e,2, e-G~ s~-c~~ / ~'J~~ ~ cu`~^w,r, y . I ~ q 3 s
Form No. 6
TOWN OF SOUTHOLD ~~Y ~
BUILDING DEPARTMENT '
TOWN HALL
765-1802
APPLICATION FOR 4ERTIFICATE OF OCCUPANCY INSTRUCTIONS
A. This application must be ',filed in 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 of 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 solder used in system contains less
than 2/10 of 1% lead.l
5. Commercial building, ,industrial building, multiple residences and similar
- buildings and installations, a certificate of code compliance from the architect
or engineer responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
B. For existing buildings (P;,rior 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, a consent to inspect signed by the applicant
and a certified abstract of title issued by a title company which shall
show single and separate ownership of the entire lot prior to April 9, 1957.
If a Certificate of O'~ccupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
3. Date of any housing code or safety inspection of building or premises, or other
pertinent information required to prepare a certificate.
D. FEES
1. CERTIFICATE OF OCCUPANCY - New Dwelling $25.00, Addidtions to Dwelling $25.00
Alteration to Dwelling $25.00, Swimming Pool, $25.00. Accessory Building $25.00
Addition to Accessory Building, $25.00 - Businesses $50.00
2. Certificate of Occupancy on pre-existing dwelling - $100.00
Copy of Certificate of Occupancy - $5.00 - over 5 years - $10.00
4. Updated Certificate o',f Occupancy - $5.00 Residential
5. Temporary Certificate of Occupancy - $15.00 Commercial
I
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oc~~EFOIK~OGy
VICTOR LESSARD ~ L Town Hall, 53095 Main Road
PRINCIPAL BUILDING INSPECTOR = z P.O. Box 1 179
(516) 765-1802 N ~ Southold, New York 1 1971
FAX (516) 765-1823 yQ~~O ~~0~"
1 ,Y.
OFFICE OF BUILDING INSPECTOR
TOWN OF SOUTHOLD
March 28, 1990
Mr. & Mrs. Anthony M. Helies
45 Shady Hill Rd.
Weston, Ma 02193
Re: Building Permit #18636-Z & #18522-Z
Premises: 440 Park Ave. Ext. Mattituck, N.Y. j
Suff. Co. Tax Map #1000-123-08-28.3
Dear Mr. & Mrs. Helies:
We return herewith your checks #2421 & #2422 each in the
amount of $25.00 representing the fee for the Certificates of
Occupancy with reference to the above numbered building permits.
Certificates of Occupancy for both permits were applied for
and sent to Mr. Patrick Sweeney of Bay East Construction at P.O.
Box #1188, Cutchogue, New York 11935 on March 27, 1990.
Very truly yours,
SOUTHOLD TOWN BUILDING DEPT.
Victor Lessard,
Principal Building Inspector
VL:gar
cc to: Bay East Construction
encl.
~~FF~U(C TEL. 765-1802
0~4 O~ TOWN Ot~ SOUTIIOLD
~ ~ OFFiCE OF BUILDING INSPECTOR
v, }aY~~ rn P.O. BOX 728
~ b' ~ TOWN HALL
~~01 SOUTHOLD, N.Y. 11971
Aiarch 21, 1990
ANTHONY ~ BRENDA HELIES
45 SHADY HILL RD.
WESTON, aA. 02193
To Whom This May Concern,
We are unable to complete your Certificate _
of Occupancy because of• the following reasons.
An application for Certificate of occupancy
is not on file.
`No Underwriters Certificate on file.
/BRI The check is( /not on file.)$25.00
No health Dept. Approval on file.
No final inspection has been made.
Please contact our office on this matter.
Thank you for your cooperation.
Building Permit I! 1S636Z _ _ _ Z ALTERATION
Building Dept.
No Plumber Solder Certificate on file..
( all permits involving plumbing being
issued after April 1,1984 )
c'lELD I1;S:':;CTiU1J ~~UATE ~ i;OMMENT° ~
ro
[TJ ~
1. ~ ~
3
FOUIJDATION ( 1st ) \'(1,(~
FOUNDATIOIJ (2nd) ~
- a
2.
o
O
ROUGH FRAME &
PLUMBING
N ',O
H
3 . ~ .
c~
H
IIJSULATION PER N. Y.
STATE ENERGY
CODE
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4 . ~ y
FIiJAL
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ADDITIONAL COMMENTS: ~`f~
.
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y
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O
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• x
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[+7
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H
BOARD OF HEALTH
3 SETS OF PLANS
,~FORMN0.1 SURVEY
TOW'V OF SOUTHOLD CHECK .oZS
BUII:D.INGDEPARTMENT SEPTIC FO .t
TOWN HALL ~7 ~J c
. EOUTHOLD,N.Y.11971 NOCALL •-../.~.7 .:-s`.~~~
' TEL.: 765.1802
MAIL T0:
Examined , , , • • • , , 1 ,~(~!q / /
Approved . l/,/.~........., 19V1. Permit No/~tP.~~?.~ p~,~
Disapprove AY~J F7 DASiV01'EO ~y
...DATE;II~C~B.R.B IIA I L
O
IIf p
FEE: BY: ~ BLDG. DEPT.
NOTIFY BUILD NG DEPA ETA • • • • TOWN OF SOUTHOLD
785.1802 g AM TO 4 PM FOR THE (,>3uild' o Ins ector)
FOLLOWING INSPECTIONS: `pppLICATION FOR BUILDING PERMIT
1. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE Date 19 .
2. ROUGH • FRAMING & PLUMBING
3. INSULATION INSTRUCTIONS
4. FINAL - CONSTRUCTION MUST
a• ~ co ely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
setsbTH la~i~ t Fee according to schedule.
SS tt and of buildings on premises, relationship to adjoining premises or public streets
or az~~~., 5U o ~ ~ ~n of layout of property must be drawn on the diagram which is part of this appli,-
catio !,n1 r~ tto~ ppi~p S
c~: `1tti8 vYbY)C ~"2'ppTR3tion may not be commenced before issuance of Building Permit.
d.D,{Itgorl aDDrQya)
Qf13t~i~~ applicatiQp,,the Building Inspector will issued a Building Permit to the applicant. Such permit
shall beeps on the prem' es available for inspection throughout the work.
F
e. N )t4-~u~ ~H F~ sed in whole or in part for any purpose whatever until a Certificate of Occupancy
shall h~~ ~ s~2glta~,~FiY ~X ~Y ,u _ pector.
A16~~~.~'T~T,~'~3~'~EIIQf)!~~' b1ADE to the Building Depaztment for the issuance of a Building Permit pursuant to the
Buildiig f~~h~f~~ncb o~~e~F~~~i~ Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulatic~~ ~~~7~7c~~~~~rt of buildings, additions or alterations, or for removal, or demolition, as herein described.
The a~p~~~~~~gteFe~'~~I~n~lyp~applicable laws, ordinances, building cod/e~housing code, and regulations, and to
admih u4M:~4~~@'dl~rl ectors on premises and in building for necessary inspections.
4. FINAL ~ CONSTRUCTION MUST d/j"-
BE COMPLETE FOR C.O. (Sls.... ....Pp p )
ALL CONSTRUCTION SHALL MEET nature of a licant, or name, if a cor oration
THE REQUIREMENTS OF THE N.Y,
STATE CONSTRUCTION & ENERGY ~ ~D l}~/~-as-?s~ ~
~ N~ ///r,7S
CODES. NOT RESPONSIBL'~ FOR (Mailing address of applicant
DESIGN OR CONSTRUCTION ERRORS
State whether app]icant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Nam: of owner of premises .../1L~!?!/~9n~/, . s
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
ALBui ~eris L censa No. MUS % ~ 32~FP~l COUNTY LICENSED~~
Plumber's License No. , , , , • , • , , , • ~~~G~~~
Electrician's License No. ''~i , , , , ~
Otltcr Trade's License No. ,
1. Location of land on wftich proposed work will be done . .
House Number Street Hamlet
County Tax M1lap No. 1000 Section ~ Block Lot Z~m•3, • • • .
Subdivision Filed \1ap No. Lot .
•(Name)
State existing use and occupancy oC premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ........=t+~.~.~R
b. Intended use and occupancy 4~'.'~
I
3. Nature oC work (check which applicable): New Building , Addition Alteration . , , , , .
Repair Removal , Demolition Other 1ti'ork .
~ / S o o (Description) .
4. Estimated Cost....l....... Fee....................................
' (to be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on each floor ...,l
If garage, number of cars , j
' ~accupancy, specify nature and extent of each type of use .
7. Dimensions of ex stmalstruct res'' if any: Front Rear Depth .
g
Height IVun?~gr'of Stories .
Dimensions of same structure sVit~t~a)tcrations or additions: Front Rear
Depth . .'Height Number of Sto'{~~~~ ~~S!t~~ti(?~'t a......... .
8. Dimensions of ' e~newstryFction: Front Rear ~„:.,gAF{)th ,
Height Numb~e:r of Stories r
9. Size of lot: Front Rear • ~ f . .
0. Date of Purchase • r;~' ~A,~';~,v~trt• ~,,.~r;•t:.......... .
....Name of Former Owner„t.Wrs~•t~ca. •.•:~:r.'..-.............
l . 'Lone or use district in which premises are situated
.
. ~s•.6 .
2. Does proposed construction viola}e any zoning law, ordinance or regulation: t ~y;. s+t
3. will lot be regraded ...~JP..'...... 1Vill excess fill be rem~wed from;p>t8riti~es: ' ` Yes N~o
4. Name of Owner of.premises ~9~+~~ony,r~/;'~o;., ~!%'es Address . 3!r . ?"~~-:~X. ?r~~4~~~ franc NoO~~ ~
13'x' ~ff'~~, ,
flame of Architect i, , .Address .Bone No.
Name of Contractor ...~°`~~:~:'~.S:w~~~>„ , , , , ,Address l:n.~~?37d~!.~U'~~Q;'": Phone No.' ~~y s-~'3•
. .
5. Is this property located within 300 feet of a tidal wetland? *Yes ..2~.:' 'Nb
*If yes, Southold Town Trustees Permit may be reqyuired.
. PLOTDIAG1tAM ,=lF 'tkir
c ..~d :F~ ,
Locate clearly and distinctly all buildings, whether existing or proposed, and.~indicat4,-plhset•back dimensions from
roperty lines. Give street and block n(<mber or description according to deed, and shgwrst;ee~tmarnes and indicate whether
f zterior or corner lot.
Ply' lns~~t six
p
~~aMR ' , - _ - . ~ EIS
~I
~lev
rATE OF NEw YORE, S
~G\TY OF S' ) '
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(tiame of individual signing contract) ~ ' • ' ' • being duly sworn, deposes and says that he is the applicant
-ovc named.
:isthc
(Contractor, agent, corporate officer, etc.)
said owner or owners, and is duly authorized to perform or have perfonned the said work and to make and file this
alication: that all statements contained in this application are true to the best of ltis knowledge and belief; and that the
xk will be performed in the manner sat forth in the application filed therewith.
:orn to before me this
Mary Public, ~..l.Y•... :U~ County
NELEN DEVOE ~----r; re of applicant)
NOTARY PUBLIC, State of New York
Na. A707878, Suffolk Countyr~~
Term Expires M1rch 30,19._._..