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i
FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 2-18231 Date AUGUST 1, 1989
THIS CERTIFIES that the building ACCESSORY
Location of Property 575 EASTWARD COURT MATTITUCK N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 115 Block 07 Lot 08
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 10 1989 pursuant to which
Building Permit No. 18300-Z dated JULY 12 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 ACCESSORY SHED AS APPLIED FOR.
The certificate is issued to THOMAS & JOYCE REMPE
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL NfA
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Building Inspector
Rev. 1/81
gos~ xa 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°- $ 3 Cl 0 Z Date ~.....1. ,9
~..Y
Permission is hereby granted
4':i:{~
to
nn
at premises located at ~7 ~ S.:AJ-~41.~
County Tox Map No. 1000 Section 5~....... Block Lot No.......~..~.........
pursuant to application doted 19.x.9.., and approved by the
Building Inspector.
i
Fee $...w~J
Building Inspector
Rev. 6!30/80
co
• - ,
TOWN OF SOUTIIOLD D ~ U° LS O
BUILDING DEPART?LENT flnpp 2
TOWN HALL JUL
SOUTIIOLD, NEW YORK II971
TOWN OF
SOEIp
765 - 5802
APPLICATION FOR CERTIFICATE OF OCCDPANCY
DATE. ~/~~~~J
NEW CONSTRUCTION .......OLD OR PRE-E%ISTING.BUILDING......VACANT LAND........
C
Location of Property.. ~~'~.......a^5."^;~~.S.,O,c~r;,,,,,,,,mC~;~'}~,~~.
~ HOUSE NO. ~S~T'REET HAMLET
Cvner or Ovners of Property~~~1.g.,c~, J6~{~,~ ~~rn~~
County Taa Map No. 1000 Section ,~1~, Bloclc Lot-..`."
Subdivision Filed Mapq........Lot..........
Permit No. ~Q,~Qa„Date of Permit ~~Ia~ `,,Applicant
Health Dept. Approval Underwriters Approval..........__..
Planning Board Approval
Request for Temporary/Certificate ......,Final Certificate
Fee Submitted: g., ",~,5,,,(~-!?,,,_...__
APPLICANT
rev. 10/14/88
C~„~.~, 3756-7
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?OUt7DATI0:7 H
?OUIJDATI0:7 (2nd) _ _ m
` . ~ _ ~ N,
°OUGH FRAME & 'J
h
PLUPIBING p~
. d
ti
3. m
n
IIJSULATION PER N. Y.
STATE ENERGY
CODE
7 ~ ~ d
4 . t ~ J `
/J X04
FZ;IAL
o
ADDITIOf7AL COMMENTS: m~
x
4
m
x
'a ~
H
A
A
H
H -O
~ 1
~
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r
~ H
O
m
_ ,9
H
1 distaMes to wolls and ceucools ore
' ~ - by kcallon from hnmo rnmon and field
. /'N.~/5.''R~~-•.~~~~ ptlOll oatro nofrrv'to'.iblozthazaz dimensions
- ~ MQ/n/ ROAD ~ _ cannot ba certified.
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C~" e
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N,, _ LOT" . 3 i
4 k•, s
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M.. i ? ','fir IIt s
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ur °4" +Y-hi , ~ ~ f{ BY °.7104 d 0 ~ - ~~•.:re.i• rr i :1 . ~ ~ a.
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t J .Or +A4. '.r ~/~rt '3 ~ ~ .
~ K~.~ 9Y L ~ ~ i ~
VQQ? FV~ O o s ~
~g~,1 C~R~(~~C~ ~ <<~. ; $ , .r Era y c t 5-f~k~ual~r;~~
~ ~ '!ice ~ '`~w~ ~ i~
. 3 i
' ~ Z - - ~ , , , -
- APR~iOVED AS NDTED _ o - ~ , fl - ' .
/ ~ ~ ~ s .
DATE: B.P.lI
FEE.: BY:~ ~ ~~'~'s ' Ls. Qr-y,~~C~ of
NgTIFY BUILDING DEPARTMENT AT
765.1802 9 AM Tp 4 PI1A FOR THE '
FOLLOWING INSPECTIONS:
i. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE -
2. ROUGH • FRAMING & PLUMBING
3. INSULATION 4
4. FINAL - CONSTRUCTION MUST ~ 3
BE COMPLETE FOR C.O. a ~
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y. e
STATE CONSTRUCTION aD ENERGY o
CODES. NOR RESPONSIBLE FOR e`' °
DESIGN OR OONSRRLICTION ERRORS ~ ~
y
e~
naufhorized aiteration or addition So chit survey is a~violallon of _ 1,
,or.,.,.
oction 7^^<'J9 of .So P7v .c Edu;ntfm Lcri,. -
•urcryo~ z fnkod ~ .
~!.A
in 4P~
r
/ 765-1802
G BUILDING DEPT.
1NSPECTtAN
[ ]FOUNDATION 1ST ~ ] ROUGH PLBG.
[)FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING FINAL
REMARKS: ~~C CO
DATE ~ INSPECTOR
r
B0.1RD OF HE.ILTH ,.J,,,,,,,,
3 SETS OF PL.1NS
FORM NO. 1 SURVEY 'r ~ ~ ~ ,
TOWN OF SOUTHOLD CHECK . . , , , , ,
BUILDINGDEPARTMENT SEPTIC r•oarl
TOWN HALL
SOUTHOLD,N.Y.11~J71 NOTIFY
• TEL.:7G5-1802 CALL
Gsaminud ~ 19$9. MAIL T .
~~f/ f-ir
Approved ~~.(,1,.. 19$9. Permit No~.p.r3.'~. „ ~
Disapproved a/c ~ i p~ ritit
Vl
8 DEPT~UU
~1WN OF SOt1TF10tD
~0.:~- .
(Building Inspector)
APPLICATION FOR BUILDING PERMIT ` p
Date . J.~ 15 f~ y,
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 or public streets
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
shall 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
Building 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 for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
,admit authorized inspectors on premises and in building for necessary inspect-
(Signature of applicant, or name, t a
co~~~.
' ,36x _ poi ~ .M . ~,.~:..~.1.~ ~a
' (Mailing address of applicant)
State whether applicant is owner, lessee, agent, azchitect, engineer, general contractor, electrician, plumber or builder.
W n e~r AA (l
Name of owner of premises ....I!.W)'~A-5...~:v.~cl'l1~~.....~..r-4-?i."l-.~
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate of&cer) '
Builder's License No.
Plumber's License No.
Electrician's License No. ^ .
Other Trade's License No . .
I, Location of land on which proposed work wnnill"_
be done. , '
House Number Street. Hamlet ~ ~ ~ ~ ~ ~
County Tax Map No. 1000 Suction Block Lot...................
Subdivision Filed flap No. , , , Lot .
..(Name)
Stale existing use and occupancy. ofpremises and intended use and occupancy of proposed construction:
a. Existing use and occupancy Y~Le ; • • • • , ,
b. Intended use and occupancy .....LCS-l~!f.~...1.'.:~.W.~';'1;,,••••.•.,.•..•........•...-••....•..•--.
3. Nature oCwork (check whiah~pplicable): New Uuilding . ,
Repair , , ~ • • • Addition .Utcration . .
• oval Demolition ~ • ~ • • • •
OthcrlVork.
4. Estimated Cost . ~ , ~,~,~,,,O,d, , , . • (Description)
Fee
g (to be paid on filing this application)
dwelhn~ number of dwellin
° units Number oC dwelling units on each floor....... • .
6• Hcb 1,mess, commercial or mrx bs if any: Front , • • • • • .
7, Dtmens ons of extsotmc~ structurd occupancy, specify nature and extent of each type of use.....r........
° .Rear
.....NumberofStories. ~ Depth.
Dime f(S tructurewithaltcrationsorad~~~~~~~~~~~~~~~~~~~~"""""""""•
Depth . ditions: Front Rear .
. height , . Number of Stories .
' 8. Dimensions of entire nri-w cc~rtsti'uction: Front , , p~ ~ ~ ~ ~ ~ ~ ' ' • • • • • : ~ : •
Height •1 Rear .....,jc~....... Depth
9. Size oflof:Front ~ "NuinbcrofStories„...,,,~,,,,,,;,.
. L .
' P
10. Date of Purchase ~e;~,'tlet' Rear Depth ~ .
P P „ ..Name of Former Owner ; .
1 1. Zone or use district in which remises are situated . , , ' ' ' ' ' ' • •
oes ro ose construction violate any zoning law, ordinance or regulation: N.~, , , , , , , , , , • • ,
13, iVill lot be regraded , . Nill excess fill be removed from premises: Ycs • .
14. Name of Owner of premises :~e~rnaS,G,,,
}~~F~Address ~.~,SEa~~wu;ct(,t:.0;~(`Igff.f"+~tone No..~`~8"- • No
Name of Architect ,Address . •
Name of Contractor. "•••••••••••••••.PhoneNo..
.........................Address...................Phone No.
IS.Is this property located within 300 feet of a tidal wetland? *YES..,.NO.
*If yes, 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 comer lot.
iT,1 TG O F \ E1V~0I~
-OUtiTY OF • •f• ,I S.S
~ ~ " "tt~'~`•• • • • • • • • • • • • being duly sworn, deposes and says that he is the applicant
(Aamc of individual si~nin~• contract)
bovc named.
iC 1S tI1C ..........4-/. Y1-3{~~~..
y
f said owner or owners, and is del apthorizodttocperformnor lotvc performtcd the said work and to make and Gle•this
iplica[ion; that all statements contained in this application arc true to the best of Itis knotvlcdge and belief; and that the
ork wdl be performed in the manner set forth in the application filed therewith.
vom to before me this
........lad`........dayof...s.)1a.!~........... ~ /
County ,
nary Public, • ,
• • nature oC applicant)