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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-18973 Date APRIL 18, 1990
THIS CERTIFIES that the building ALTERATION & REPAIR
Location of Property 12500 ROUTE 48 MATTITUCK N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 108 Block 2 Lot 7
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 23, 1989 pursuant to which
Building Permit No. 18254-Z dated JUNE 28, 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 & REPAIR TO EXISTING ONE FAMILY DWELLING
The certificate is issued to JOHN C. TUTHILL
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N-112958 - FEBRUARY 6, 1990
PLUMBERS CERTIFICATION DATED APRIL 16, 1990 - DAVID STEELE
ilding Inspector
Rev. 1/81
arosas xo. s
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)
N° ~ 8 2~ 4 z Date C~/~~~ •!A/J'~.~.......~.....G7........., 19.~. y
Permission is hereby granted to:
1.... ~....T.~~
to ~.........f .....................~~ll'7::.......~..............
y~
ct premises located at ....l..p~.~x...~.-1~1.~...........J.•......~...~..... ..:...1./..1.
•L• /.../.rt~l/•
.........................................................................mm.............................qq........................................................
County Tox Map No. 1000 Section U..Q......... Block .....~l.1........... Lot No.......~~.,
pursuant to application doted ..C~.......~..~ 19..~~ond approved by the
Buildx/i~ng I,n/spector,
Fee $.~Y.r.O U...
Building Inspector
Rev. 6/30/80
Form No. 6
4 TOWN OF SOUTHOLD ~ S~.'.9 C C1 CU/ i_`°::;m .
.,.,..,...m... a.=,.~.. _ i
' BUILDING DEPARTMENT f
765N1802L r~ ~ ~ 6 ~ ~ ~ } I=
BLDG, DEPT, ~
APPLICATION FOR CERTIFICATE OF OCCUPANCY TUW~V UP SUUTHU_~~L17
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 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. I
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 - Residentia~/lJ$15.00, Commercial $15.00
Date ,1/f~9~
New Construction........... Old Or Pre-existing,~B,1ui_/ld)ing.....~...........
Location of Property... 4 ~.J
UD 1 .~.~.~'l N QF~............. ~Fk'~'T.~~:::~~....... .
House No. Street Harniet
i--
Onwer or Owners of Property.......JG+~:',+;t;.~.~..~;/'~~J'.!
County Tax Map No 1000, Section...l~ ~......B1ock.....~.........Lot....'
Subdivision ....................................Filed Map............Lot......................
Permit No.. , l of
~ . Date Of Permit.ip/.Z?,(.~~, , , , , .Applicant.. ~~.af~ L, ;5~~,~(~, , , , , , , , ,
Health Dept. Approval .../..Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate...........
Fee Submitted: 0. 't/Y.`^ / ,~1 ~ ,
cp ~,~Yj`y 7,j APPLICANT
O~~F F Q[/i~`, TEL. 7G5- l II02
TO'4YlN OF SOY7TgOLD
~ 't" : < OFFICE OF BUILDIPIG INSPECTOR
~ .
,°r, E ti, `3~-~; P.O. BOX 728
c??i ~ TO6VN HgLL r,=
SOUTHOLD, N.Y. 11971 ~ ~ ~
i 't3t.cG~: ;~t::l~t.
C E R T I F I "t..~P,,. TC1V'diV C~f=~~'> F't'°if'~):..'.....
C A T I O N
Date I~
Huildirg IIPermit No. ~ 0 Z ?~LI
Owner JU` h,h ~ T~~-~t it ~ ( ~ t°
j~(please print)
Plu^.ber I/G~~~-S `~'-e~e" ~-E
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of to lead.
(plumber's signature)
Sworn to before me this
~ ~ day of --e
C~~
Notary Public
Rotary Public, , O County '
HELEN w DE tl0E
NOTARY PUBLIC, State of New YoAI
No. 4707878, Suffolk Co"unty,~~
Term Expires tAwch 30.1x..-.cc
'c'1c:LD±I::d~ECTiU,J ~~UATE ~ COMMENT° ~
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ItJSULATION PER N. Y/ • •
STATE ENERGY
CODE
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BUILDING DEPT~~~"~~~'~`~~' ligsz
INSPECTION
[ ] OUNDAT ON 1ST OUG LBG.
[ ] FO ATION 2ND [ ] 1 ULATION
FRAMI G, ~ ] FINA
REMARKS: ~i, ~ i.c.~_~-, i~~-~ i.~.t_ i T
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DATE _~2~`~~INSPECTOR ~i~~~
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765-1802
BUILDING DEPT.
.INSPECTION
[ ]FOUNDATION 15T [ ] ROUGH PLBC.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [~INAL
REMARKS: ~~~,~,c.,._ ~
DATE ~7 INSPECTO
G ~LS / 765-1802
BUILDING DEPT.
INSI~ECTION
[ ]FOUNDATION 1ST ( ] ROUGH PLBG.
(]FOUNDATION 2ND (INSULATION
[~RAMING (]FINAL
REMARKS: 1=
DATE ~ dZ ~2 INSPECTOR
1~277r~-
~EFUtk~^ TEL.7G5-Ifi01.
'f;i}`'~?~`~,?=.~~~ T'Ott PI t)I' S()UTII~L~3
r r ~,~r14~.~r~~t orrlcr•, or nulLDlrrc IlasrrcTOR
-~a~~~j~'r~; ~ , P.O. iJnh 728
11 w V' cT, » ~ `c. "('Ol:'IJ I !ALL '
'o'w"n" c~'- SOUI'IIOLi), N. ;'.11971
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April 6, 1990
John C. Tuthill
Elijahs Lane
RFD Box ]06A
14attituck, N.Y. 11952
To 47hom This May Concern,
t•Ie ire unable r_o complete your Certificate
o~f~occupnncy because of the folloo-~ing reason:,.
An :cnplicat.ion for Certificate of Occupancy
.is not nn file. CENCLOSED)
`!o ilnderoritcrs Certificate on file.
/~'1'hc check .is ( /not mr file.) 525.00
t:n lfe~lth Dept. Approval on file.
P:o final inspection ha; been made.
P)en:;e conlar_L• our office on this matter.
Thank yoc.1 for your cooperation.
auildinr, Permit II 1 s 2 5 4~ Z
Builclinsl I)epL-.
do Plumber Solder Certificate on file.
( all Permits involving Plumbing being
issuc<1 after April 1,19II9 )
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7£<r+ tR02 4! F.-,~ `t 4 PflA FOH .:+C
~ FC7L4Cfv'JlNC+ tNSFc"CRONS
j 1. fOUNDATiON - TWO REQUIRED
7 FOR POURED CONC TE
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c, ~ FINAL CONSTRU(:TION Mtr>~1' 4/
~ ALl CdNSTRUCTIO R SHALL MEE?
THE REQUIREME dF THE N.Y.
STATE CON ON rh ENERGv
L~ CODES. NpT PON318L`1 FOR
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THE NEW YORK BOARD OF FIRE UNDERWRITERS YACF:
1444711 BUREAU OF ELECTRICITY
83 JOHN STREET, NEW YORK, NEW YORK f003B
Date F$BRl1ARY 46,1990 ApplicotionNo.onfile 6447$289/fl9 N 11a95R
THIS CERTIFIES THAT
only the dectriea! pulpment u deurihed 6ebw and introduced 6y the opplitwrt named on. the oltooe oppBeattoa number in the pnnwses of ~
DAV[D STEEIIB, S/S/C RT'6.48, Ctl'CCNt)GUS, N. Y. ~
in thefolbminq lacotion; ®Baaement ® /xt Fl. ? Ynd Fl, OUT Section Block Lot
rDes examined on DECENBER as r 19$9 and found to 6e in rnmplianre erith the reyuiremenes of this Boord. i
i
RXTVE! ~ RXTURES RANGES l'ODKING REtlls OVRNS qSH WASHERS EXHAUST FANS
~yMyS Adlf SWITCHES INCANDE]CENT PIUORFSCENT OTHER AMT. K. W. AMT. K. W. AMt. K.W. AMT. K. W. AMT. N. P.
s 5 s 1 z.a
DRYERS FURNACE MOTORS FUTURE APPLIANCE NlDERS SPECIAL RK'?T TIM! ClOCR4 EBL UNIT HEATERS MIXTI.OUTIET gMMERS
AMT. K. W. Oll H. P. GAS N. P. AMi. NO. A W. G. AMT. AMP. AMT. AAVS. TRANS. AMT. N. P. ~ ~a
~T AMT. WAITS
1. 14 ER
SlRVICE gSCONNECT NO.OP s E R V I C E
AMT. AMP. TYPE p~ 1/TV 1/7W ]/3W ]/lW NO.O~pCrCOND. OF CC. COND. NO.Oi 114HG Oi~NI
~lEGO NO. OP NEUTKAIS Oi ~NWEVTGIIAL ~
1 1D(I CS 1 X 1 4 4
OTHER APPARATUS:
SERVICE GRANGE &KiTCNEN AI,TERATIt)N°I
G.F.C.I:-1
TRACK LIGHTING:°4
RULANU f;LEC/il,B. RULANA 11IC.f24a E
BOX 143
NATTITUCK, NY, 1.1952 OEFIERAI M .EAGER
1]
Per
This certificate must rat bs altered in any manner; return to tM offiw of the Board if irHOrreN. Inspectors may bs id~IMfied~ by thek tiols. .
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFIGTE MUST NOT !E ALTERlD IN IAN MANNER.
B0.1aD OF HEALTH
3 SETS OF PL.1NS
FORM N0.1 SURVEY
TOWN OF SOUTHOLD CtiECK .
BUILDINGDEPARTMENT SEPTIC r•oart
TOUVN HALL
SOUTHOLD, N.Y. 11D71 NOT FY ~~ryry
' TEL.: 765.1802 CALL ..~Y.~.~..~`~~~. , , , , ,
Examined 19 .yy dd pp~~ ~ L T0: .
\pproved 19LZ~Pcrmit No.R.C~Q~~ 7
Disapproved a/c : [ ~ C ~
~E~ ~.~G~~, u - w f ~ ,
di m I
~.stiv~:.~~,1 JUN 2 3 i9~9
(Building Inspector t3i.gG. DEPT.
TOWN OF SOUTHOLp
APPLICATION FOR BUILDING PERMIT
. Date IS .
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 plot plan to scale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining- premises qr public-streers -
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
cation.
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
stall 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
3uilding Zone 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 far removal or demolition, as herein described.
Tite applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and fo
admit authorized inspectors on premises and in building for necessary inspecti s. jj,~, 00// 11
(Signature of applicant, or name, if a corporatton)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
C1U-~-e~.... .
.
~
/V
:v'ame of owner of premises .....l .
(as on the tax or laces[ deed)
[f applicant is a corporation, signature of duly authorized office ' ~
• (Name and title of corpocra-te officer)
Builder's License No. - -
~ ~ p~ ~ - - - - ~ - -
Plumbcr's I_iccnse No. ,J.-~!J .
Electrician's License Na . .
Other Trade's License No .
Location of land on which proposed work will be done. f; ~ ,r"~~t ~~~t,~a,O~
IfouseNumber p Street. •.~~•~~••.•~..Hamiet,•,••,,,,,,,,,•,..•,...,
CountyTaz+\fapNo. IOOOScction .I~D Bluck Lot..,,.(.,,,,,,,,,••..
Subdivision Filed flap No. .Lot .
(Name)
State ex+sting use and occupancy of premises~njand intended use and occup-(a•~ncy of proposed construction:
a. Existing use and occupancy U.~ tCr 4a.~...FJ:~~ . ~,;~5'•eJ, l . ~ 1~~~ y~~.... .
t
b. Intended use and r • • ~ • . • • .
occupancy . ~X.~~.+!~ o-r~.... t ~4=~inJ
.9.,
..a.~,..~ti ...,.w.~•-
ii
3. Nature of work (check which applicable): New Building
Repair Re~rtoval Addition tcrat'on~!`~ OIZ
Demolition Other IVork ./Gt.(', Qp}¢A~
4. Estirnatcd Cost , ~d CO,d~, , , , , , , , • • • • . • , • . • • , • • • • . esu~4 ~ • • ~ p q~''~ (Description) •
. I CCee o R, r~.ST~'~~uR.e
.
5. IC dwelling, nurnbcr oC dwcllin~,g units , (to c pard on filing this application)
If gars^c, number of cars " " " " " Number of dwelling units on each floor.. •
6. IC business, commercral or mined occupancy, s ccif ~ ~ • • • ' ~ ' ' ' ' ' ' ' ' ' ' ' ' ' ' • • • • • • • • • • •
7. Dimensions oC existin^ p Y natt3f and extent of tacit type of use .
Height structui~cs, if any: Front . , [.1../ , , , , Rcar r
• .4...... Number of Stones . ' • • • • • • • • • Depth :'7, , , ,
Dimensions of saps structure with alterations or additions: Front /.~,r,~ 31Y, , , ~ • • • •
Depth ~ , .Heigh[ ....l O o, Rcar . ,
8. Dimensions of enti c new construction: Fro ' • • • • • • • • Number of Stories , • • ~ • •
Height l f nt J/..~.`.`...... Rear . .Depth .7•~~•y.......
. c-......... Number of Stories . .
9. Sizcoflot:Front
10. Date of Purchase Rear................ Depth
~ p"""•••••••••....NamcofFormcrOwner
p p , ? emiscs are situated „ " " " " " • • • • • • • • • • • . .
11. Does ~ ou oseddsconstructhontvio'late any zonin law, • ' ' ' ' ' ' ' ' ' ' ' ' ' • • '
l3. Nill lot be re,raded S ordinance or regulation: . G, " "
Name of Owner of remises . ' ' ' • • Nill excess (ill be removed from premises: yes No
Name of Architect P ~ ~
• Address ...................Phone No.. .
Name of Contractor , .S.R,(~ , ~ % • Address ...................Phony. No.. , • .
IS.Is this propertq looted wi[hin ' Address ..Phone No.. ~ •
*If yes, Southold Town Trustees POrmitemay bearequiredetland? *YES....NO.tl., •
- _ PLOT DIAGRAh1
Locate clearly and distinctly all~l buildings, whether existing or proposed, and. indicate all set-back dimensions from
property lines. Give street and block'number or description according to decd, and show street names and indicate whether
interior or corner lot. y
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T,1TL• OF \ER' Y'ORfi,
OUNTY OF .
S.~
. (Name of individual signingicontract) ' ' ' bei°g duly sworn, deposes and says that he is the applicant
~ovc named.
M
~IS the
said owner or atvners, and is dul (Contractor, agent, corporate officer, c[c.) • • • •
nlication; that all statements containeitlin tltisapplicauon a~e !true toctl o best of h saknowlcdge and belief; and that tlhe
uk will be performed in the manner se4 forth in the application thud therewith.
om to before me this i p
................?T3 ..day of.. ~,L~
J• „d~:~•(....... ~
-~f ~ y U 19 f
,ary Public, ....!~rx?;t;,.. !L-.. ~,t+ County
• ~
- NEIEN K. DE YOE • • .
NOTARY PUBLIC,ShteofN~wYMk (Signature of a• •lrcant)
Na4701878 ~ut~_k ~ pP •
Teen Ergren k/ireh 30, /
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