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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
Date: 06/19/08
No: Z-33111
THIS CERTIFIES that the building AIR CONDITIONING SYSTEM
Location of property: 1040
(HOUSE NO.)
County Tax Map No. 473889 Section 38
GILLETTE DR
(STREET)
Block 2
EAST MARION
(HAMLET)
Lot 11
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
APRIL 17, 2008 pursuant to which
Building Permit No. 33839-Z
dated
APRIL 22, 2008
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 CENTRAL AIR CONDITIONING FOR AN EXISTING ONE FAMILY DWELLING AS APPLIED
FOR.
The certificate is issued to MATTHEW C WEBER
(OWNER)
of the aforesaid building.
SUFFOLK COWlTY DEPAR'l14BNT OF HEALTH APPROVAL
N/A
05/01/08
ELECTRICAL CERTIFICATE 11IO.
3064489
N/A
PLUMBERS CERTIFICATION DATED
Rev. 1/81
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
6.Lf.
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75"/- /~'8D
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APPLICATION FOR CERTIFICATE OF OCCUPANCY
Tills application must be filled in by typewriter or ink and submitted to the Building Department with the following:
A. Fo r new building or new nse:
I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or
topographic features.
2. Flllal Approval from Health Dept. of water supply and sewerage-disposal (S-9 fonn).
3. Approval of electrical installation from Board ofPire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of I % lead.
5. Conunercial 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, AJterations to dwelling $25.00,
Swuwning 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 - $50.00
5. Temporary Certificate of Occupancy - Residential $ t 5.00, Commercial $1500
Date.
Old or Pre-,xisting Building: /
Location ofPrope'iy /Oc.;O G/{[c/!f.., )),e/J'i.,
'House No Street
Owner 01 Owners ofPrope'1y _//J/fll)1~tJ (? ~.!:f3cR.
L/7J829 Block 000.:1..
New Construction:
6 -//- oS
C'd-,v74L I'1IC"""~'N ;c,,,:...i/' .
(check one) . 'I1'-'S.>C.47;:".,
c5ts r /IJ/'Ii/ D;J
Hamlet
Suffolk Coullty Tax Map No 1000, Section
Subch vision
03~
J 3 &392.- ~a-=-~fPermit
Lot_Oil ~_
_ Ftled Map Lot
t/-.:l.:2-~(Je,3 Applicant fflt<l;;;;;e"~ p ~LJ~~
Underwriters ApprovalCeer# :5 0 (,JLCL'39
Af'~# 30 '- S'~i'~
Fmal Certificate --./ _ (check olle)
Permit No
Health Dept Approval__
Plal1Jling Board Approval
Request Cor
TemporalY Ce,iificale
Fee Submitted $
(1v -h '33> /II
R..u C 7 L{ S7:JV
~aJ'edL~
Appllcant Signature
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BY THIS CERTIFICATE OF COMPLIANCE THE
NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
40 FULTON STREET - NEW YORK, NY 10038
CERTIFIES THAT
? '(,
"
Upon the application of
upon premises owned by
MATTHEW WEBER
1040 GILLETTE DRIVE
EAST MARION, NY 11939
MATTHEW WEBER
1040 GILLETTE DRIVE
EAST MARION, NY 11939
1040 GILLETTE DRIVE EAST MARION, NY 11939
3064489
Certificate Number:
3064489
Section: Block: Lot: Building permit~? ~ 3q BDC: n511
Described as a occupancy, wherein the premises electrical system consisting of
electrical devices and wiring, described below, located in/on the premises at:
Basement, First Floor, Outside,
A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed
herein, was conducted in accordance with the requirements of the applicable code and/or standard
promulgated by the State of New York, Department of State Code Enforcement and Administration, or other
authority having jurisdiction, and found to be in compliance therewith on the 1st Day of May, 2008.
Name OTY Rate Ratin. Circuit ~
Appliances and Accessories
Air Conditioner
Wiring and Devices
Outlet
Fixture
Outlet
Receptacle
Switch
Dimmers
Disconnect
o
30.000
BTU
22 0
22 0
4 0
2 0
I 0
2 0
I 0
Fixture
Incandescent
General Purpose
General Purpose
General Purpose
60a
Air Conditioner
An as built inspection, of the delineated electrical installation, determined that an obvious hazard is not present and the installation is believed to
be in comformance with the applicable reference standard for the estimated period of construction of the premises wiring system.
seal
of I
This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated.
FORM NO. 3
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)
PERMIT NO.
33839 Z
Date APRIL
22, 2008
permission is hereby granted to:
MATT WEBER
1040 GILLETTE DR
E MARION,NY
for :
INSTALLATION OF AIR CONDITIONING SYSTEM AS APPLIED FOR
at premises located at
1040 GILLETTE DR
EAST MARION
County Tax Map No. 473889 Section 038
Block 0002
Lot No. 011
pursuant to application dated APRIL 17, 2008 and approved by the
Building Inspector to expire on OCTOBER 22, 2009.
Fee $
200.00
"'~ ~~
( Authorized S1gnature
ORIGINAL
Rev. 5/8/02
3s~31-C
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
] FOUNDATION 1 ST [
] FOUNDATION 2ND [
] FRAMING I STRAPPING [
] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION
] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
REMARKS:
DATE ~//I/t7?
INSPECTOR
33 ?~l t:--.
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] IN~TION
[ ] FRAMING/STRAPPING [~NAL
[ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
REMARKS: CI~ f!rf #- d- 7/1:0
~c- ~~ \
DATE
S-/I r; /0 f
/ !
INSPECTOR ~~
FIELD INSPECTION REPORT DATE I
COMMENTS
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FOUNDATION (1ST)
-------------------------------------
FOUNDATION (2ND)
ROUGH FRAMING &
PLUMBING
LNSULATION PER N. Y.
STATE ENERGY CODE
FINAL
.
.
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ADDITIONAL COMMENTS
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TOWN OF SOUTHOLD IiJ .!~?!:, t.J--rRXCJM_&
BUILDING DEPARTMENT .d ~_y n n t::L
TOWN HALLR o-<--~) -DC> LA.:.J
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www.northfork.net/Southold! PERMIT NO. 33 fJ37 6
BUILDING PERMIT APPLICA nON CHECKLIST
Do you have or need the following, before applymg?
Board of Health
4 sets of Building Plans
Planning Board approval
Survey ,;/
!i ^' if'
Check "" <>0-
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
Mailto:!41</"G';Cf6lf( ?J..P.
~"'5fJ"Y/I/.4r;,v ,v-'(. 1/ 'lJf
Phone: r; 1 'J. 7:; 1- /02. i? 0
&,20 cJf'
P./}/2O(2Y
Examined
Approved
Disapproved ale
Expiration
(tJ/~d20.J?,L
~
Building Inspector
_~ ...-1
APP~ICATION FOR BUILDING PERMIT
17
Date
,20_
I
a. This application MUST be call1jl1dbly filled in by typewriter or in ink and submitted to the Building Inspector with 4
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location oflot and of buildings on premises, relationship to adjoining premises or public streets or
areas, and waterways.
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 issue a Building Permit to the applicant. Such a 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 what so ever until the Building Inspector
issues a Certificate of Occupancy.
f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of
issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the
property have been enacted in the interim, the Building Inspector may authorize, in writing, th~ exten,ion of the r~rmit for an
addition six months. Thereafter, a new permit shall be required.
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 South old, 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 inspecl1ons.
. )~CUPANCY OR -4'=of.;,~...f."o"",o,"'OO)
.,,3E IS UNLAWFUL /fJ1eJ t1/UG7Tt /J~. tAg-rI1,q~/oJ Al,e.;:
-HOUT CERTIFICATE (Mailing address of applicant) /1'13'1
INSTRUCTIONS
State whether applicant is owner, lessee\ag~,;'ll~vt, engineer, general contractor, elec~~ moer
OiJAiz..R DATE: t~!~ B.p,#;3g-j"~1C-
vVI I . . I FEE' b.~' . 8v./~
Nameofownerofpremises /'Ii11/II!.fw C l-Ie/$-r,,/'rIEe w&I.5,t.,<!" NOTIF~ BU'LD' ~'-'.i"'.':::"T '.r
(As on the tax roll or latest deed~65-1802 8 f.:" - ..' 'ii' THE
Ifapplicant is a corporation, signature of duly authorized officer FOlL(JI!:;~I~ "i':~t.. . "'~
(Name and title of corporate officer)
lINocnv~ITERS CERTIFICATE
REQUIRED
1. F~""~ "~:-:-:'J ...,
'-- ".r"' Ilfq::.::~
Builders License No_
Plumbers License No.
Electricians License No.
Other Trade's License No.
FO~:. r:-;<JH[C; , ,1: i;:
2. ROUGH - Flit,,:,'L ,'. PLUN:8iNG
3. INSULAT,CrJ.
4. FINAL.- eOI ". '-. .:.; e'eN MUST
3187 IV.? .s-.;l"I.eE-dSI.~LETL ,c, c.o.
All r.()NSTliL,' N SHIll ALL CONSTRUCTIXJ SHAl.L MEE:T THE
~FI=T THI= RmUIH . OF THEREQUIREMENTS OFTHE CODES OF NEW
CODES OF NEW YD,::< STATE. YORK STATE. NOT RESPONSIBLE FOR
1. Location ofland on which proposed work will be done: PE&IGN 9R ONSTRUCTION ERRORS.
/tJy'O -/Ut..7TL ;j,eicJt.. CI/SII17/JI2/o,J ;V., 1/939
House Number Street Hamlet
County Tax Map No. 1000 Section j 'iJ
Subdivision /l1A ,f~",J /YJ 11 ,Joe.
(Name)
Block ~
Filed Map No. CjCj-3; 3
!icStJrJ.6(03'2
JAy. fYI fll'ity 73 ~.g9
Lot / /
Lot eX 3
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a, Existing use and occupancy /',('/17''111-<' '/ /'.6.~' /IQ &".J( e
b. Intended use and occupancy I) /,Ce.:. ~")I iJ/v1 Le.../ rlf I} L ANIJ e.u:c:rA!fe~t ~o.el(
J
5. If dwelling, number of dwelling units
If garage, number of ears
Addition Alteration
Other Work e./:"'~~IIL ~/C f,IJ.'crw.e)(
.fI #oj . C (! (Description)
Fee , .D'<;.otb iJ -....:.
(To be paid on filing this application)
Number of dwelling units on each floor l' fL.ro..e .. t>A 'f M C ".}'I
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
4. Estimated Cost /I (oJ 9 ~o -.,~
/
6. Ifbusiness, commercial or mixed occupancy, specify nature and extent of each type ofuse.
/! /, (II L(5~ r 30 ~ 3"
7. Dimensions of existing structures, if any: Front '1 ~ Rear Depth
Height Number of Stories
D. , f t t 'th It t' dd't' F t ND '" ~~"'r;" ,<1
ImenSlons 0 same s rue ure WI a era Ions or a I Ions: ran .
Depth Height Number of Stories
Rear
JJ cJ ,:j!>() ,''''IJ ,,,s
8. Dimensions of entire new construction: Front
Height Number of Stories I
~ r oj"
9. Size oflot: Front I 00 I (;'l)'~ Rear /00' Co' " Depth / ('I C)
.
10. Date of Purchase ,5---/7- (. ? Name of Former Owner Jltf. fAJ,1'o e';l1l1tJo~ (PlANA ,('O:;'[':ih)
11. Zone or use district in which premises are situated S'C D 1-1 S /? f 1';$ ;f/ 0 ~ u' . cc '3'7
Rear
Depth
12. Does proposed construction violate any zoning law, ordinance or regulation? YES_NO ~
13, Will lot be re-graded? YES_NO L Will excess fill be removed from premises? YES_NO_
14. Names of Owner of premises (it/1'1r Ifb) l,Jf.&t-R Address /oL/~ r;;U6r'i..- :,,e, Phone No. Plr.]5i,/ ~Jo
Name of Architect Address Phone No
Name of Contractor D:nL 1-1/:",:"'\" C...C.I..J([ Address 1'.0 C.....d.Lfl Phone No. '3/- 433 -/30,/
C,J'f'c..".cr."e.."'.'-!.I'HS"-o";l.L.\'1
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES ~ NO ,/
* IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES ~ NO ~
* IF YES, D.E.C. PERMITS MAY BE REQUIRED.
16. Provide survey, to scale, with accurate foundation plan and distances to property lines.
17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey.
STATE OF NEW YORK)
SS:
COUNTYOF~
{Y\ "'T~ W~ being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the
(Contractor, Agent; CotpOOttll',Of{lcer, 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 b" efore me this;;- ~. y
t7 A day of ~ 20 0 If / t1 / I
~ t ({<0~::/Z)' . 4-~ c ;J~
/ Notary Public..;:, '_ _ ' _,,-A._ ......'10. Signature of Applicant
k1iif' ~
~ ~ GAIL L A88ETTO
, ' NolIry PublIc. _ oI_'Ibrk
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e)j "',"<'"~J1foIkOOlrllV, ID
. ~ Illn - f8, 10...'; 1"-.,
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TOWN OF SOUTHOLD PROPERTY RECORD CARD
· M~ Yd
,1':,
3
ACR.
.3
TYPE OF BUILDING
<JtrL~'!S \OML
DIST. SUB.
E
W
FARM COMM. CB. MISe. Mkt. Value
". p~
"",0.-:>
12co
BUILDING C
...
Co 23(Yfl./ '-I
LAND
IMP.
TOTAL
DATE
~
0'"
J.,
S-CJ()
Goo
71!X)~~
A
i ~EW
Acre Value Per
"500
~\OO~V~ ~
'ARM
7ro
liable 1
liable 2
lable 3
)odlond
amp land
FRONTAGE ON WATER
FRONTAGE ON ROAD
DEPTH
BULKHEAD
c1 r1
J
Jshland
,
I use Plot
01
DOCK
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I",...,~g. 30 K. "''''', (';500 .3"""'" If 12~ Iruur,dation ~C Bath \ Dinette
I ~_._- -----
Extension Basement C.J\ \ Floors K. /
---._~'"--
Extensian Ext. Walls g~cc.o Interiar Finish <3R LR. ~
-~---
Extension , ./
Fire Place - Heat y -..s DR.
Type Roof ~ t\\ \' ,\-e Rooms 1 st Floor BR. ./
Porch Recreation Room Rooms 2nd Floor FIN. B.
pnrrh I
h:~r u.1' ('2.\ e 1<.\"2-' \ll~ l~ 4~ 'Dormer
--------- _m_.__~___
Breezeway Driveway
,-~-- ---"
Garage
--- -------
~ M.. s~ -<,<b ~
O. B. If q 7"2> 4'1'73 r 4<<;0 A. '\
,.Ki -/ / I ---
Total - 2.>ll-~ 7 0 ./
\,.S~ 00 ~~O~. 0" .., ..... ....-/ ,.(
-. ~ ;:~' ~.
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38 2 11 3/03
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