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' FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-18581 Date NOVEMBER 21 1989
THIS CERTIFIES that the building ADDITION
Location of Property 100 PARK AVENUE MATTITUCK, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 123 Block 07 Lot 5.3
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 9, 1988 pursuant to which
Building Permit No. 17061-Z dated 3UNE 6, 1988
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 ADDITION TO EXISTING ACCESSORY BUILDING AS APPLIED FOR.
The certificate is issued to THOMAS & PATRICIA CAREY
{owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL, N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
uilding Inspector
Rev. 1/81
Foaas 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 0 ~ 17 ~ 61 Z Date ......Sd.°°..la 19. c~,~U
Permission is hereby gront~:
...Ss'~n.~~....~~~®~
%~,•~~.,~-,~..~,~.dry-.......--..........~,~9,Sa-
.~~~~,?~~-........cam
of premises located at ..1...~~?........./~oirE,,,,~fiY%,,,....G.~!/`~~
e
Block Lot No................:.-~~.....
Caunty Tax Map No. 1000 Section
pursuant to application dated,y~~~~ ~ 19........, and approved by the
Building Inspector. J °
e7
Fee
uitdln ctor
Rev. 6/30/80
p~
TOG7N OF SOUTIIOLD
BUILDING DEPARTNEIIT
TONN HALL ~
.~J
SOUTIIOLD, NE41 YORK 11971 TOWNUF,SOU HOLD
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCIIPANCY ~j
DATE.. ~~~4/
KEN CONSTRUCTION .......OLD OR~PRE-E%ISTING BUZLDING_~...VACANT LAND........
Location of Property..~~(~.,~.Cf~~l!~2..........!l::T1~1/a~...
HOUSE NO. STREET HAMLET
Ovner or Ovners of Property....~~;~~`S~~'~~2/cA.C_,fi(/E~~~...__-..-...
County Taz Map No. 1000 Section Block Lo C'
Subdivision._........ Filed Map ........Lot_
Permit No. U~?~~jDate of•Permit ~~..~0",_Applicant~'r`;'"!'D.'S~~~~/
Health Dept. Approval Undcrvritcrs Approval..._..........
Planning Board Approval
Request for Temporary Certificate Final Certificate
Pee Submitted: ~v
APPLICANT. ~
reV• 10/14/88
~~c.• 38G4S
co ~l$s$(
FORM NO. 6 Y ~
TOWN OF SOUTIIOLD
s ~ ~ ~ BIIILDING DEPARTMENT
TOWN DALL
765 - 1802
it
APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS
A. This application must belfiled in typewriter OR ink and submitted to the Building
Inspector with the following; for new buildings 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 Dea th 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 chat solder used in system contains less
than 2/10 of 1Z lead.,
5~. Commercial buildings,',iindustrial buildings, multiple residences and similar.
buildings and installations, a certificate of code compliance from the Architect
or Engineer responsib~.e for the building.
fi. Submit Planning BoardliApproval of completed site plan requirements.
B. F'or existing buildings (~rior to April 9, 1957] non-conforming uses, or buildings
and "pre-existing" land pses:
11. Accurate survey of property showing all property lines, streets, buildings 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 Occupancy is denied, the Building Inspector shall state the
reasons Lherefor in whiting to the applicant.
:3. Date of any housing code or safety inspection of buildings or premises, or other
pertinent information!, required to prepare a certificate.
C. For Vacant Land Certificate of Occupancy: _
1. Aa application for vacant land Certificate of Occupancy shall be submitted,
and a certified abstract of title issued by a title company showing single and
separate ownership o£ the entire lot prior to April 9, 1957 shall also accompany
the application. If 'a Certificate of Occupancy is denied, the Building Inspector
shall state the reasons therefor in writing to the applicant.
D. FEES:
1. CERTIFICATE OF OCCUPANCY - New Dwelling $25.00, Additions to Dwelling $25.00,
Alteration to Dwelling $25.00, Swimming Pool, $25.00, Accessory building $25.00
Addition to Accessory buildings, $25.00 - Businesses $50.00.
2, Certificate of Occupancy on pre-existing dwelling - $100.00.
3. Copy of Certificajte of Occupancy - $5.00 - over S years - $10.00
4. Vacant Land Certificate of Occupancy - $20.00
5. Dpdated Certificate of Occupancy - $50.00 "
6, Temporary Certificate of Occupancy - $25.00 Residential
j $50.00 Commercial ~
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I1dSULATI0P1 PER N. Y. y
STATE ENERGY
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ADDITIONAL COMMENTS:
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APPROVED AS NOT/ED ~f~~`~ g ~Raf~,~i,,
gATE:~B.P.tlf ?OBI /2•X8 ~p~id,~¢E~f}
FEE. S~ BY: f~.~ ~
NOTIFY U L ING DEPAR NT A7
7~i5-1802 8 AM TO 4 PM FAR 7HE
FOLLOWING INSPECTIONS:
i. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING ffi PLUMBING
3. INSULATION
b. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALl CONSTRUCTION SHALL MEET
7HE REQUIREMENTS OF THE N.Y.
STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
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FtlnM N0.3
TOWN OI: 50UTHOLD
llUILDiNG DZPAI2TMCN'I'
TOwN CLIiRIK'S OI'['ICi
SOUTIIOLD, N.Y.
NGTIC); Ori' DISAPPI20VAL
t=ile Nc7 . Date .Q?-......, 19
__~pp ,
. / v.-o..~°-4~ ~ .
PLfiASfi'I'AKE NOTICE that you,r~anptp~lication date(d~ ~ ~1~•'~.. 19 .
for pcmiit to construct .cv~n..G~~.:n.~-ra ..oLcv~:...4~~!-t :v........(.~.......... at
Location of I'ropcrty ~ Q-<<~...~F•~ a Cam.... .
Hou;a No. Straat Fl~mlet
County "fax Map No. 1000 Section 131ock Lot .
Subdivision Filed 11ap No. Lpot Nn. .
is returned hep_rewnith and disapproved on the followin~gtgr/ounds !??~.~3L
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BOARD OF HEALTH /
• 3 SETS OF P ANS ..1/..--
FORM NO. 1 SURVEY .
TOWN OF SOUTHOLD CHECK • • •
BUILDING DEPARTMENT sar~TYC FoRm
TOWN HALL NOTIFY
SOUTHOLD, N.Y. 11971
TEL.: 765-1802 CALL
MAIL TO:~ ~ Qo X ~ $O
Examined .rP,/. Si.........., 19 5
rn lq 7. IIWs~
Approved . ~ 1~~Permit No~7~ <-;
Disapproved a/c ~ D ~
MAY ~ ~
' J
C--~.. ~ ~ ~ TOWN
OF SOUTHOLD
' ~ (Bu' ng Inspector)
APPLICATION FOR BUILDING PERMIT
Date . 19o P.
INSTRUCTIONS
a. This 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
oar 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 vtill issued a Building Permit to the applicant. Such permit
' shall be kept on the premises available for inspection throughout the work. a:
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 ot" a Building Permit pursuant to the
Building Zone Ordinance of the Town of Sguthold, Suffolk County, New York, and other applicable Laws, Ordinances oz
Regulations, for the construction of buildigs, additions or alterations, or for removal or demolition, as herein described.
The appiicani agrees to cmnply with all applicable laws; ordinan~as, building code, ous±nQ code; and regulations, and to
admit authorized inspectors on premises and in building for necessary i ections~
..T7.:
(Signature of applica~~name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises T~y~~ '
(as on the tax roll,or latest deed)
If applicant is a corporation, signature of duly authorized officer.
X13 C
(Name and title of corporate officer)
ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENS ~ ~^®0~
Builder's License No. e.~y'Y~ • • . • • . • . • . • • • • • A~° 96,dA
Plumber's License No . ~(1~ i~
Electrician's License No .
Other Trade's License No.
1. Location of land on which proposed work will be done . .
AYe
House Number Street ~y Hamlet
County Tax Map No. 1000 Section Block Lot .
Subdivision Filed Map'No. Lot...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ..~'.4.`~N~~
b. Intended use and occupancy .~,~•~'°f~~.~'"• • ~iOt~..v f/al~s~t?~ ~yt~'~~P.~rv9
3. Nature of work (check which applicable): New Building Addition . Alteration .
Repair Removal Demolition ..............Other Work , , . .
(Description)
4. Estimated Cost.....~~ Fee.........
' (to be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on each floor .
If garage, number of cars .
6. If business, commercial or mixed occupancy, specify nature and extent of each t pe of use
g , . g es, if any: Front ~a .......Rear • .Depth 8..... • . , .
7 Hemh~srons ~existin stru Number of Stories p~!~ .
Dimensions of same structure w
Depth . , , , , , ith alterations or additions: Front ,Z Rear . i$:'?- .
,''.`'r
8. Dimensions o~ er~trre h'ew const 'Height c~ Number of Stories ...4!~!''g- .
" ruction: Front .....~4....... Rear ~d........ Depth ..8........... .
g mb r of Stories b'~!~ .
9. ,Size of lot: Front ~ ~ Rear /~5.,`j.~ D th ~S4• ~ J' ~ ~ • • .
10. Date of Purchase ....'6~ ' ...................Name of Former Owner ~ • • .
NhT .
1 1. Zone or use district in which premises are situated .
12. Does proposed construction violate any zoning law, ordinance or regulation : .
13. Will lot be regraded ....................Will excess fill be removed from premises: Yes No
14. Name of Owner of premises ..................Address ...................Phone No............... .
Name of Architect .Address ...................Phone No............... .
Name of Contractor ...........................Address ....:..............Phone No............... .
15. Is this property located'', within 300 feet of a tigidal wetland? *Yes No
*If yes, Southold Town Trustees PermitPLO~ DIAGILAM ed.
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from
propf;rty lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
~:~-'~S
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F
STATE OF NEW y~RLC..~. _ ~ S.S t
f.~~~0~ ~-+^.!Q'~~ being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named. ~
He is the.. QLL/~!~'..~......'
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
application; that all statements contained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manner. set forth in the application filed therewith.
Sworn to before me this
7Y~
Notary Public, ,M ..1.[.. L/t/.2~.i/G:G:....... County
r ~i~s-~-
HELENK.DEVDE
-NOTARY PUDU ,State ai New,York (Sign ure of applicant)
' Na.476787~, Sutfotk Cuun
Term Expires ~taruh 30,19