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fFt!(,f•04dG . Town of Southold 6/3/2016
P.O.Box 1179
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t 53095 Main Rd
�l � Southold,New York 11971
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CERTIFICATE OF OCCUPANCY
No: 38328 Date: 6/3/2016
THIS CERTIFIES that the building OTHER
Location of Property: 2200 Grand Ave, Mattituck
SCTM#: 473889 Sec/Block/Lot: 107.-2-10.2
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
10/14/2015 pursuant to which Building Permit No. 40210 dated 10/26/2015
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:
SWIMMING POOL FENCE AS APPLIED FOR
The certificate is issued to Norkelun,Kim
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
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Autho ': Signature
:w TOWN OF SOUTHOLD
'o4SUFEn- eoG : BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
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'�" SOUTHOLD, NY
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BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 40210 Date: 10/26/2015
Permission is hereby granted to:
Norkelun, Kim
2200 Grand Ave
Mattituck, NY 119521240
To:
replace an existing g pool fence as applied for.
At premises located at:
2200 Grand Ave, Mattituck
SCTM # 473889
Sec/Block/Lot# 107.-2-10.2
Pursuant to application dated 10/14/2015 and approved by the Building Inspector.
To expire on 4/26/2017.
Fees:
ACCESSORY $100.00
CO - SWIMMING POOL $50.00
Total: $150.00
1.
Building Inspector
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
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 1% 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:
1. 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$50.00,Additions to dwelling$50.00, Alterations to dwelling$50.00,
Swimming pool $50.00, Accessory building$50.00, Additions to accessory building$50.00,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 $15.00, Commercial $15.00
Date. Ia 1
New Construction: //�� Old or Pre-existing Building: (check one)
Location of Property: i7O0 OP-MJ AVZ M P1TE'tVci
House No. Street Hamlet
Owner or Owners of Property: O P GR-- d 1-W i /
Suffolk County Tax Map No 1000, Section tO7 Block 02-- Lot 10i Z
Subdivision Filed Map. Lot:
Permit No. L1 of 0 Date of Permit. Applicant:
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted. $ 50 �%
in.1, udivzr,
Applicant Signature
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%--(ItC010, 01.1
, TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION • -
, , FOUNDATION 1ST [ ] ROUGH MBING
[ ] FOUNDATION 2ND [ ] IN ATION
[ ] FRAMING / STRAPPING [ INAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE Ve ATION [ ] CAULKING
REMARK -4511. ° le Ailidx_. ,..., - r ill •i&.1.__.
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DATE "57/3/4 INSPECTOR /4 :
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TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLUMBING
[ ] FOUNDATION 2ND [ ] 1 ULATION
[ ] FRAMING /STRAPPING [ FINAL Clea.)
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS: LR a
DATE d�,7,/, INSPECTOR
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TOWN OF SOUTHOLD ' BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health '
SOUTHOLD, NY 11971 - 4 sets,of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 _ Survey '
SoutholdTown.NorthFork.net_ PERMIT NO. C� L(� Check
• r ;_. , •,.j . , . . : Septic Form • ,
. N.Y.S.D.E.C.
-Trustees
C.O.Application
-, _ Flood Permit
Examined 20 Single&Separate
- Storm-Water Assessment Form
Contact: - -
Approved ,20 . .. Mail to:
Disapproved a/c
Phone: ° ' —52/6
ExpirationII- 20jPIP c:13 714«a ^) g
_ -_-----,,-, ,,, \ , , ;uilding Ins$ek or DAT- 2-67/LB.F.1,.
3.
L f APPLICATION FOR BUILDING'PERK TIi:Y BichIn i;_; ; �h r< N AT
L OCT 1 4 201 �' - - --1-• -` ,, . 7t;54802 ,,,l !, PM r oR l i-iF.
Dato_owiNi ; si•i_ ic)Ns. , 20 l:
_ - INSTRUCTIONS-- -t. FOUNDATION, i:q0 F1 :01_, I-ED
—_- -- FOR i-OU�iE0 e;e'i'1l'.•RE- J
- BLDG DEPT
a. This a5 'Dleati'or' [LIS--k�e"completely filled in by'typewr-iter or'iii.ink;arid_subriItt't'ed;tb thelB'Uilding&Idspectb ith 4
p ans, accurate plot plan to scale. Fee according to schedule. INSULATION
b. Plot plan showing location of lot and of buildings on premises;:relationship to.adjoining p?el use aipubliclsttreets or
areas, and waterways. RF COMiPLL'i E. FOR c 1. ,
c. The work covered by this application may,;not,be.commenced,before issuanc,glof Buildings pgrdit. „L:Ei Ti-'"
d.Upon approval of this application,the Building Inspector will issue a Butldi ggPermiYto}he;appliicarit: Such": :permit i '
shall be kept on the premises-available for inspection throughout the work. YORK STi;i ii, /I''1 'c ;,'31.`= 1: -,
e.No building shall be occupied"o'r'used in whole or iri'rith'for'ati purpose wham,vatintitlCtMaildirliAn§pector..-
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•int'erim,the Building-Inspector may authorize, in writing,the extension of the permit for an
addition six months. Thereafter, a new permit shall be required.
APPLICATION IS HEREBY MADE:to_the B,uilding;D.epartment for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town,pf Southold;Suffolk County;:New York,-and other.applicable•Laws,prdinances,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 inspections.
1444
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, % ''�O G®®� (S nature of applicant or name,if a corporation)
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loon ' ' • • • _ ' ' (Mailing address of applicant
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises I '+•. ' err V1
'(A" 'on the tax roll•or-latest deed)
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer) a •
Builders License No.
Plumbers License No. '
Electricians License No. `
Other Trade's License No. •
1. Location of land on which proposed work will be done: •
a0 6140 Af// , 0A I1 ►4-,
House Number Street Hamlet
i`t .r°,u i.0 _friar;,f.
¢ ,"i i s'-r?:. ?i
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County Tax Map No. 1000 Section 107 $lock - Lot 10 ►)i
'sic, ,:`:°.i rli,,8 09 is-z.,Of
;, ..s - - !not;+,•,-lit -,;71)4 '''_)..
•
Subdivision Filed Map No. Lot
2. State existing use and occupancy of premises andntended usT an occupancy of proposed construction:
a. Existing use and occupancy f IV j MAI T'l,C<; ..
b. Intended use and occupancy SW i , VW4: c6O V - t'1c
x+71 :':,I ' ' •'
3. Nature of work(check which applicable): Nev Building X Addition Alteration
Repair Removal', X Demolition 64641 Alte)Other Work 'P--
�Qt4 fg4 ,,) (Description)
4. Estimated Cost 4 ��O Fee
(To be paid on filing this application)
5. If dwelling, number of dwelling units Number o_f dwelling units on each floor
If garage, number'of cars
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front dpi f Rear PO ` Depth 69'
Height 'Number of Stories
Dimensions of same structure with alterations or additions: Front Rear
Depth Height s,,z.,.,r:, . - , s: Number of Stories
C / 6
8. Dimensions o ent ie new construction:Front..,.:,,2 ,- :",,.Rear's.-i-:2.5;' Depth `"Ti
Height - Number of Stories
i,' n, x ",'''ir',,
9. Size of lot: Front -152' Rear •2,.,�., i . • ; Depth
10. Date of Purchase ,, COU :r =a Name'of Former.Owner ;a ilgltR, '
11. Zone or use districtin which'premises are tsituated�:�`"'.- ' ' ''''. '
12. Does proposed construction',VZolate any•zoriinglaw;;ordinatiCe'or'regulation? YES- ' ' -NOX
13. Will lot be re-graded?,YES NO . ,Will excess f 11'be`rgmoved from-premises? YES NO X
14. Names of Owner,of premises Pit NtiZAELVAJ. .Address 2,60.6 .AV :Phone No. 2-6 —, i
Name of Architect, . .,,.,:.,..,•... , .,... Phone No . ;, . r, :
,� ,; Address. ; :�;�, '
Name of Contractor , . • '1'•., • , ' ,ail; Address- _r • a.. :,,, -Phone No.' '
t ) ' 3'J , "-i'! ;,'.
15 a. Is this property within 100 feet of'd tidal wetland or:6freshwater wetland?`*,YES "NO'"
* IF YES, SOUTHOLD TOWN TRUSTEES'&DE•:C: PERIvIITS'IVIAY''BEaEQUIRED ' '
b. is this property'Within',300'feet"o f a tidal wetland?*'Y'E'S!J' . NO" `` ' `
* IF YES, D.E.C. PERMITS MAYBE REQUIRED:'' " '' ' '.••,-" '• ' '
16. Provide survey, to scale, with accurate foundation plan and distances to property lines.,J,
17. If elevation at any point ori property is--at 10 feet or below, must provide topographicalJdNa:on s,ur-vey::, , ', ,:'
18. Are there any covenants and.restrictions with respect to this property? * YES NO 'XI"'
* IF YES, PROVIDE A COPY.
STATE OF NEW YORK) -
SS:
COUNTY OF ) -
_, :,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, 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.
Swo n to before me this Q
--1-11 day of 0C� 20 15r ,
dt_T(N biL4) L jat� , - - /4, k), , , i-
Notary Public CONNIE D. BUNCH Signature of Applicant
Notary Public,State of New York ,
No.01 BU6185050
Qualified In Suffolk County . •
- Commission Expires April 14,2 to
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CERTIFIED TOS 100 ' – 107 - '02; 10
- - - ' SCALE•. '1":- 40.
KIM NORKEL UN JUNE t4, ' 1990 '
BEVERLY NORKEL UN -
• - THE BRIDGEHAMPTON NATIONAL BANK '•` ' `
–COMMONWEALTH LAND TITLE INSURANCE CO. -
•.AREA = 33,588 sq. ft.
•or 0.77.10 ac. - . , - „ C �yi
ANY ALTERATION OR ADDITION TO THIS SURVEY aIS A VIOLATION 1 , �Q�� t MET 0 �y;
OF SECTION 7209' OF THE NEW YORK STATE EDUCATION LAW. - ' - -
- EXCEPT AS PER SECliON 7209 — SUBDIVISION 2. -ALL CEPTIFICATIONS G- ;t 4
IEREOIN ARE V ft' R_BEAR
MAP AND COPIES THEREOF ONLY F i I 'G r ,-4,i,',' ' , �,iY► •. Lila .N` ,- -
SIGNATi SIGNATURE A�PE.dRS HE IMPRESSED SEAL OF THE:SURVEYOR �j�,�,�q j�f `
HEREON, - -,;, Atit• 'VL1�n'f '' .C't � ..,:t .r E 1'>;
ADDITIONALLY ABLY ro COMPLY w1T I sAiI L,d W „ ,1 ' p. 'Tr'-,l'r 07/4:16.7,' ' 'a . .'n, .,, - ♦
T BE AN TERM '"ALTERED Y'' , ' .. - -
MlIS USED EY Y AND AL-L'SURVEYORS'UT1'LIZJNG A COPY ` 1' ( •�` �'Ct �'.`' `
OF TIER SURVEYOR'S MAP TERMS SUCJ4 AS'INSPECTED' AND - . _ . 1°: •' �� �O ' •. Off'' >a., -
73ROUGNT—TO—DATE°ARE NOT IN COMPLIANCE WITH THE LAW. ' I230 Y"`4 I Za �,?_S ' r
Ater
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