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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: 07/01/08
No: Z-33131
THIS CERTIFIES that the building ACCESSORY
Location of Property: 250 KRAUS
(HOUSE NO.)
County Tax Map No. 473889 Section 122
RD
(STREET)
Block 4
MATTI TUCK
(HAMLET)
Lot 36
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in tbis office dated
JUNE 18, 2008 pursuant to which
Building Permit Bo. 33991-Z
dated
JUNE 18, 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 ACCESSORY SHED AS APPLIED FOR.
The certificate is issued to MARY WALLRAFF
(OWNER)
of the aforesaid building.
N/A
SUFFOLK COUNTY DBPAR'DIBHT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE 11IO.
N/A
PLUMBERS CERTIFICATION DATED
~d1::!:::
Rev. 1/81
L-._.
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-~_ .i.~-!~"
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Form No, 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
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This application must be filled in by typewriter or 1I1k and submitted to the:Building Department with the following
A. For new building or new use:
I. Final survey of propet1y with accurate locatIOn of all buildings, proper1y lines, streets, and unusual natural or
topographic features. ,,'
2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 fom1).
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 2/1 0 of I % lead
5. Commercial building, ir.dustrial building, multiple residences and sinlllar buildings and installations, a certIficate
of Code Compliance from architect or engmeer responsible for the buildmg.
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
L 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 ofOcclIpancy on Pre-existing Building - $100.00
3. Copy of Certificate of Occupancy - $25
4. Updated Cer11ficate of Occupancy - $50.00
5. Temporary..CerCtllicate of Occupancy - Residential $1500, Commercial $15.00
Date. June 12. 2008
Building Pe~t~ #7432Z)
New Constructron: X d Old or Pre-existmg Building: (check one)
Location ofProper1y: 250 Kraus Road, Mattituck
House No. Street
Hamlet
Owner or Owners of Property: Linda E. Mills
Lot 11>
Lot.
Suffolk County Tax Map No 1000, SectIOn 1 ?? .
Block h.
Subdivision f C3(',J)'VJ{ tf---- Filed Map.
Pennit N03~''1<:j_1-_~ Date of Pe1l11lt "-f 6, D>i' Applicant
Health Dept. Approval:
Underwriters Approval:
Plalming Board Approval:
Request for:
Temporary Certificate
Fmal Cel1ificate:
OLSEN & OLSEN llP
32495 MAIN ROAD
PO BOX 706
CUTCHOGUE, NY 11935
Fee Submitted $ 25.00
CA/ 2~3 \~ ,
~G --NSIo3
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.
33991 Z
Date JUNE
18, 2008
permission is hereby granted to:
MARY WALLRAFF
250 KRAUS ROAD
MATTITUCK,NY 11952
for :
ERECT NEW ACCESSORY BUILDING. THIS PERMIT REPLACES 7472.
at premises located at
250 KRAUS RD
MATTITUCK
County Tax Map No. 473889 Section 122
Block 0004
Lot No. 036
pursuant to application dated JUNE 18, 2008 and approved by the
Building Inspector to expire on DECEMBER 18, 2009.
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,
Fee $
100.00
(
ed Signature
ORIGINAL
Rev. 5/8/02
3391/ 'Z-
TOWN OF SOUTHOlD BUilDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PlBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING I STRAPPING [] FINAL
[ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
REMARKS: M.. ~ ~f: A-
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I _ 3o~ 0 ~
DATE /0
INSPECTOR ~~
FOaM NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE '
SOUTHOLD, N,. Y.
BUILDING PERMIT
<THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
3399 l (~/q
Nt! 7472 Z Date ..........................Auguzt........1.3-..., 19..7-~~..
Permission is hereby granted to:
D.'-"...l:!Uls................................. ............... ...........
..............;.:..t.t:i.tuck.............................. ........ ......
................................................................................
to ..G/.r.@oQ:l;...ne-w..o/iloeQ&elOOl'y...1Hrl.:!.(l,in-g......... ..........................................................................,..
.................................................................................................................................................................
at premises Ioc:ated at ...... .Ole ..J.ule. .i.. ..j(.r-a:usQ.. .Rd......................................................................
............................................................lla.tt:i.tuck... ..~.:l...................................................................
.................................................................................................................................................................
pursuant to application dated ........................Alolg......1.3..............., 1994...., and approved by the
Building Inspector.
Fee $:1.0...QO............
h ~-'\c."k~[~m
f.~ Building Inspectar (
.
FIELD INSPECTION REPORT DATE I COMMENTS ,tJ
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STREET Z5D VILLAGE DISTRICT SUB.
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N E ~EAGE
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S W TYPE OF BUILDING
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VL. FARM COMM. I IND. I CB. I MISe.
TOTAL DATE REMARKS
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FORMER OWNER
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RES '..</0 SEAS.
LAND IMP.
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Tillable 2
Tillable. 3
Woodland
Swampland
Brushland
House Plot
Total
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Fire Place
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Porch
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Roof Type
Rooms 1 st Floor
Rooms 2nd Floor
Dormer
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II'OBM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
....~6...1...~........, 19..7.1 339Cf {r~~Plication No. ..2..Y...?..~.......
...........I..\............~.:?........, 19..?..Y Permit No. .-:i.J...??:..Z-".......
Examined
Approved
Disapproved a/c ...... .......... .............................
APPLICATION FOR BUILDING PERMIT
Date ........~cf.....f...~............., 19.?y....
INSTRUCTIONS
o. This applicotion must be completely filled in by typewriter or in ink and submitted in triplicate 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 application.
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 applicont. 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 pa rt for any purpose whatever until a Certificate of Occupancy
sholl 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 buildings for necessary inspections.
~.> .
................~~~.................................
(Signoture of applicant, or name, if a corporation)
25" /["4.-11/0 /f".<f'6'#;f~/vCtt AI.,k
.........................................,;....................../................................
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, generol contractor, electrician, plumber or builder.
........................!.f if..f./?:d.1:!... /L. !?({.!ff!d.. C(?!!.1! f.?!.1.f... ?c?,~r..'1.'f.C: [q,1..........................................................................
Name of owner of premises .......p,(.f.f(!.f!....d:..d(f:~....... ................................................ ................................................
If applicant is a corporate, signature of duly authorized officer. /~OJ _ '1-.;';'
(Name and title of corporate officer)
Builder's License No. ....................................................
Plumber's License No. ................................................
Electrician's License No. ............................................
Other Trade's License No. ..............................................
1. Location of land on which proposed work will be done. Mop No.: ........................................ Lot No. ........................
Street and Number ..... ..z.!?.~...({'.l'.-ff(:f...tff.6'.~.......... .............. ........ .......... ............... .. ~--1 t7.(,(J!.~.'J.........................
Municipality
2. Stote existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Exisiting use and occupancy ............6(~~{........................................
...............'................................................
b. Intended use and occupancy ......5...'f.tf.'?....(:::::r...~.7!!.1!i:.":'!...r..~f::~~ ere.
...........................................................,........
Nature of work (check which applicable): New Building .....i........ Addition .................. Alteration .....::.......::-:-~
Repair .................. Removal.................. Demolition.................... Other Work .....................................................
I 0-0 (Description)
Estimated Cost ...... .... .....7.: .?.~........... ....... .... .... .... .... ..Fee .. ../. Q .............. .,. .... .... ....... .... .... ...... ........ .......................
(to be paid on filing this application)
If dwelling, number of dwelling units ............................Number of dwelling units an each floor ............................
I f garage, number of cars ....... ........... ....... .................. ........ .... .... ............. ........... ........... ............ ............. ... ...... .............
If business, commercial or mixed occupancy, specify noture and extent of each type of use ............................
Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth ....................
Height . ......... .... .......... Number of Stories . ........ ...... ..... ............ ....... .... ... .... .... ................ ................ ..... ........... ...........
Dimensions of same structure with alterations or additions: Front .................................... Rear ............................
Depth ................................ Height ............................Number of Stories ................................
Dimensions of entire new construction: Front ....../tf..../?i?.r......... Rear ....../.f:..t."?f.'?!....... Depth (:&..~?!.r.........
Height ....I.~tJ.F.t.. Number of Stories ... ./.... ........ ........ .... ... ..... .... ......... ... ..... ... ........ ........ ..... .... .... ........ .... ... ...... ....,
Size of lot: Front ......7.:.:f:.<?...f.!:::~r............................. Rear ....?~/.....E<:.<!.r............... Depth ..I~f....6:'!:r............
Date of Purchase ...............Lf.'f:.'..............................Name of Former Owner .:r.k:f.e.-!...e.t!..4!.~'?~1'.!....................
Zone or use district in which premises ore situated ...d'd..f.(.~t.~.!?'i~......................................................................
Does proposed construction violate any zoning law, ordinance or regulation: ....1(,-:...............................................
Will lot be regraded ......~'!................. Will excess fill be removed from premises: ( ) Yes () No
Name of Owner of premises ....P./.?t!..t!..:~!f..{-.~.L...................... Address ..~f..~J:1.1.~J..1.~'!.".:"!.1-[; Phone No. .!:1r..:.f1.(f..Y....
Name of Architect .............................................................. Address ................................ Phone No. ......................
Name of Contractor ........P~1?'...&'!!..f......................... Address ?:f.~.((,1.~~.1~.~.::.1.~ Phone No. .1:.r.r...:5'/7.;I...
PLOT DIAGRAM
Locate clearly and distinctly ali buildings, whether existing or proposed, and indicate 011 set-bock dimensions from
property lines. Give street and block number or description according to deed, and show street nomes and indicate
whether interior or corner lot.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
j'f
St'~ t'1/l/1?'''~
STATE OF NEW IS S
COUNTY OF ......... .... ..............f .
............~q. . ..?:~.f...........................................................being duly sworn, deposes and soys that he is the applicant
(No e of individual signing contrad)
above named.
He is the . .... .f?'f!!!!.41.1:::..tf.0/.!'7.-1..-?..<;.[-:'::t..... ....................................... .... ..................... ......... .............................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the soid work and to make and file
this application; that 011 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.
~~~~.~..~~..~:i3;a: t:~s ..........~~..............., 197f...
Notary Public, .................................................... County
(Signature of applicant)