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,
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z-
31746
Date: 08/10/06
THIS CERTIFIES that the building
DWELLING
(STREET)
Block 0004
ORIENT
(HAMLET)
Lot 023
Location of Property 21955 MAIN RD
(HOUSE NO.)
County Tax Map No. 473889 Section 017
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Requirements for a ONE FAMILY DWELLING
built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF
OCCUPANCY NUMBER Z-
31746
dated AUGUST
10, 2006
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
ONE FAMILY DWELLING WITH ATTACHED TWO CAR GARAGE*
The certificate is issued to LAWRENCE REYBINE
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
N/A
PLUMBERS CERTIFICATION DATED
N/A
*PLEASE SEE ATTACHED INSPECTION REPORT.
~:L:t'"""~
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATIOB:
21955 MAIN RD
ORIENT
SUBDIVISION :
MAP RO. :
LOT (S)
NAME OP Ow.HBR (S): LAWRENCE REYBINE
OCCUPAHCY: SINGLE FAMILY DWELLING
LAWRENCE REYBINE
ADMITTED BY: ROBERT HUGHES
ACCOMPAHIED BY: SAME
KEY AVAILABLE:
SUFF. CO. TAX MAP HO.: 17.-4-23
SOURCE OF REQUEST: ROBERT HUGHES, ATTY 7/11/06
DATE: 08/10/06
DWELLING:
TYPE OF CQHSTRUCTIOIl:
WOOD FRAME
# STORIES: -L..Q # EXITS: ~
FOUNDATION:
CEMENT BLOCK
CELLAR: 1/2
CRAWL SPACE: 1/2
TOTAL ROOMS: 1ST FLR.: -1
2l!ID PLR..: ~
3RD FLR..: ~
BATHROOM(S); ---2....J! TOILET ROOM(S): ~
UTILITY ROOM(S):
PORCH TYPE: ENCLOSED SIDE PORCH DECK TYPE:
PATIO TYPE:
BREEZEWAY:
FIREPLACE:
ONE
GARAGE: 2 CAR
DOMESTIC HOTWATER: YES
TYPE BEATER: OIL FIRED
AIRCQRDITIOBDlG:
TYPE HEAT:
OIL
WARM AIR:
HOTWATRR :
xx
OTHER: ENCLOSED FRONT ENTRY, DRESSING ROOM
ACCESSORY STRUCTURES:
GARAGB. TYPE OF COIlST.:
STORAGE, TYPE CQlliIST. :
SWIMMDlG POOL:
GUEST, TYPE CORST.:
OTHER ,
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION
DESCRIPTION
ART.
SEC.
REIIl\RKS ,
DlSPBCTIID BY:
~j(. ;7;-f
GARY J. SH /
DATE Oil DlSPECTIOB: 07/13/06
TIME START: 9: 45 AM
END: 10: 10 AM
~w 1-\3-O~
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY JUL I I
This application must be filled in by typewriter or ink and submitted to the Building Depanrnent~1~~_t~e_~1~6~~~I:I)J
A. 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 I % 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.
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:
I. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic
features.
2. A properly completed application and 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 - $.25
4. Updated Certificate of Occupancy - $5000
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date.
7/ I/O 6
,
New Construction:
Old or Pre-existing Building:
v
( check one)
D~0
Location of Property:
;) I '1 5 ~ f20J::<.
House No.
Owner or Owners of Property:
/;UIf;];
o~
,,-
01':,
Street
lfw~r-Yv('~ (2Gyg/r"z.
4
Hamlet
Suffolk County Tax Map No I 000, Section
/1
Block
Lot
~?
Subdivision
Filed Map.
Lot:
Permit No.
Date of Penn it.
Applicant:
Health Dept. Approval:
Planning Board Approval:
Underwriters Approval:
Final Certificate:
v
Request for:
Temporary Certificate
u-&
Fee Submitted: $ I 00 ~
~'l\)I('()
CONSENT TO INSPECTION
;; S/t!/I;;'" 0 P J.1f...utl-c w c<€ e Y.lh\&the undersigned, do(es) hereby state:
Owner(s) Name(s)
That the undersigned (is) ( e owner(s) ofth~ premises in the Town of
Southold, located at ' -- ';/l- 2- ~ IC-I fSrJ ;- It c;
which is shown and designated on the Suffolk ounty Tax Map as District 1000,
Section I, ' Block ~ , Lot 2.] .
n
That the undersigned (has) (have) filed, or cause to be file~ application in the
Southold Town Building Inspector's Office for the following: C. _ F 0;2-
p~b-e>r/~rIAJt: 8olt.t!)lIvr, .
That the undersigned doe es) hereby give conSent to the Building Inspectors of the
Town of Southold to enter upon the above described property, including any and all
buildings loc.ated thereon, to conduct such inspections as they may deem necessary with
respect to the aforesaid application, including inspections to determine that said premises
comply with all of the laws, ordinances, rules and regulations of the Town of Southold.
The undersigned, in consenting to such inspections, doe es) so with the knowledge
and understanding that any information obtained in the conduct of such inspections may
be used in subsequent prosecutions for violations of the laws, ordinances, rules or
regulations of the Town of Southold.
Dated:
711t t
v
e (Signatur~ Ii
o {l,e71;- ~... ur; /7cJ
(Print Name)
(Signature)
(Print Name)
/ (JOO - 17. Lj. 2] -
OWNER ~'~/9Sb VILLAGE DIST. , SUB. LOT i
Mil"''' iC' . MAIII / rfj~J c" -I D4<5"(" ,
. / kw//;)t ~.'5' c-z.
.F'/' eel,,!. '.( r~Z- i ,
.' E . J)ooll AlIO
FORMER OWNER (./ N ~.(c.\ or h e~ ACR. IS""
[\1\, WC:Il_ ' J,71.
S, . / CL;= ~, W TYPE OF BUILDING
14', f ~:-t- 'Ru-N \I-\I\..\..' LL .
./ :' :s?~l:)r '~,
. .
~ES..1 J 0 SEAS. VL. FARM i COMM. CB. MISe. Mkt. Value
LAND IMP. TOTAL DATE REMARKS ,
/~OO 9000 7700 4/1 = C); L- .p,. re,J !AJa/e.,. )..Je"jl!v'fc-~
rs--"BP e:?;;u'o."i;)' - T..,sl-,,-II
'. .;;. ,'l-tJ f' II t /?,! i:'; idt q/QS ~"-v " .
-- . ...' ", ~}-1) 6 0 \'>.c,
/ . ~-0fk.e.J; ~ 'f--.fNJ ~ .
. -
~ .
AGE BUILDING CONDITION W\ <t>O (\/ ^ I,' ?
ABOVE r O\~ l~
NEW NORMAL BELOW
FARM Acre Value Per Value
Acre
rillable 1
rillable 2
.
iillable 3
.
'v'oodland / 7/ / r-t'"l' /70 0
;wampland FRONTAGE ON WATER
lrushland FRONTAGE ON ROAD 3<::n
iouse Plot / !J r I i~ ' , DEPTH .~<"^ 11"
o-v ' :'7 (r'( -'
--,,~,,-
. U? BULKHEAD
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'otol DOCK
TOWN OF SOUTHOLD PROPERTY RECORD CARD
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\, Bldg, '17)(.27: ut:.<? ~ao 03~.s-' Foundation G8. Bath z..-- Dinette
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~tension / R )/ I.... , ,:J 71'1 ~M t78 Basement Floors o ri 1(. K,
,
:tensian Ext, Walls t,Jp S.#./ ,\' ~ Interior Finish tUF)LL B D LR
~tension Fire Place j[S Heat /I VU DR,
Type Roof /.:p l?L F Rooms 1 st Floor BR,
.rch / '/ )f 2A:J , .2?O\' Recreation Roam Roams 2nd Floor FiN, B,
.rch 6-XIP', "JtJ! -370 ,;( ",-,1 '7 'I d Dormer .
--
eezeway Driveway
!rage c:< d. X ~S : 55() /0" S-S'O
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SURVEY OF PROPERTY
SllUA TE: ORIENT
TO......N: SOUTHOLD
SUFFOLK COUNTY, NY
SURVEYED JUNE 26, 2006
SUFFOLK COUNTY TAX #
1000 - 11 - 4 - 23
CBRTIFIBD TO:
~ ofLawmlCe H. ReybiDe
N
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NOTES,
.
MONUMENT FOUND
PARCEL ALSO APPEARS AS LOT 1 ON A SURVEY
MADE BY OTTO V'l. VAN TUYL ~ SON, DATED JULY 2, 1"154.
A COPY OF V'lHICH SURVEY IS ANNEXED TO AND FORMS
A PART OF A CERTAIN DECLARATION DATED APRIL 23, 1"155,
AND RECORDED IN THE SUFFOLK COUNTY CLERK'S OFFICE
IN UBER 38"12 OF DEEDS AT PAGE 202-210
""I'.t.
AREA; 118,264 SF or 2.115 Acres
,;,,,, "'I""
';""'".-' ",,-'
",1;,.,1
'I"',,""
JOHN C. EHLERS LAND SURVEYOR
GRAPHIC SCALE
~-
1"= 50'
I
""J"",,""",
-,.11,
"-',,,,,.,-',,
.",..".
'-"-',
,1',-.....,'., ".,h,
6 EAST MAIN STREET
RIVERHEAD, N.Y. 11901
369 8288 Fax 369-8287
N.Y.S. LIC. NO. 50202
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REF.\\Compaqserver\pros\06\06-197.pro