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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
No Z-24511 Date JULY 22, 1996
THIS CERTIFIES that the building ADDITION & ALTERATION
Location of Property 180 NO. RILEY AVE. MATTITUCK, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 122 Block 3 Lot 38
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 1, 1994 pursuant to which
Building Permit No. 22286—Z dated AUGUST 28, 1994
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 REPLACE SIDE ENTRANCE STOOP OF EXISTING ONE FAMILY DWELLING
WITH OPEN PORCHES AS APPLIED FOR.
The certificate is issued to JEANNE WHATNOUGH
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Building inspector
Rev. 1/81
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)
Date.... .......................................... 199 .
N2 . 22266 Z
Permission is hereby granted to;
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to A. 4 .. . .. ..4=G...... .. ... .....IOL71-C'...
�. ...... .. .�...... ,� ... ..
.00
.... ................................................................................................................................................
..................................................................................................................................................................
.................................................................................. ... .......................................................................
a
at premises located at......If ........ ...!�w...f�................................................
f ., ........................................................
County Tax Map No, 1000 Section ..../r Z.g....... Block................... Lot No. ........
pursuant to application dated ........®./Z ...................................... 19.. ..... and approved by the
Building Inspector.
�Fee$.. -1, 2,
�..... . ...:.. ......
Building Inspector
Rev. 6/30/80
r"o rm L4 6. 6
t TOVN OF SOUTHOLD
BUILDING DEPART2�NT
TO N HALL
765-1802
APPLICATION FOR. CERTIFICATE OF OCCUPANC''
A. This application must be filled in by typewriter OR ink and submitted to the building
inspector with the following: for new building or •ne-w 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-dispcsal(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.
a. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
"pre-existing" land uses:
1 . Accurate survey of property show-ng .all property lines, streets, building and
9 unusual natural or topographic features.
2. A properly completed application and a 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 cc -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 Buildins - $100.00
3. Copy of Certificate of Occupancy - _ .25<�.
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15 00, Pommercial $15.00
Date . . . . . .� .1. . . .1D . . . . . . . . . . . . . . . . . . . . . .
New Construction. . . . . . . . Old Or eYistiBuilding. . . . . ,p_/
Location of Prop erty. . .� Q. . . ./4� . . .1!L�. . . . . ��ceLXit�[. 4C�.�. - -Yet
. . .
House House No. Street H
Onwer or Owners of Property. . . .�1 .CJ. /.v/.': . . .(�1,! ! :::Q�!�` . �. . . . . . ..... . . . . . .. . . . . . . . . . .
County Tax Map No 1000, Section. . 22. . . . . . .Block. . .` . . . . . . . . . . .Lot. . .��. . . . . . . . . . . . . . .
Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . `:. . . . . . .F led Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . .
Permit No. � . . .Date Of Permit. .. . . .Applicant. ! . - �/ . ... =�=`• c�
• •lJ- O
Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Under+writers Approval. . . ' . . . . . . . . . . . . . .
Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . .
Reauest for: Temporary Certificate. . . . . . . Final Certicate. . . .
Fee Submitted: . . . ".`" V . . . . . . . . . . . . . .
APPLICANT
coZdLISH
f
765-1802
BUILDING DE".
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: r �
DATE f l INSPECTOR /
j �
765-1802
BUILDING DEFT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ vFRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
ox—
DATE 0` `r INSPECTO .c�j
765-1802
BUILDING DEFT.
INSPECTION
[ ] FOUNDATION iST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ FRAMING [ ] FINAL
[ ] FIREPLACE 8 CHIMNEY
REMARKS: � E�
DATE 'S� INSPECTOR
I::S. E C: 0, Il ai jl '' K 1E N a
FOUNDATION
FOUNDATION ( 2nd ) _ C,
2 .
o
ROUGH FRAME &
•PLUMBING ' Q -
3 . I I y
114SULATION PER N . Y. I y
STATE ENERGY
CODE .
4 .
FINAL
I71
0
z
I-� ADDITIONAL 'COMMENTS :
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I�D ILL .
ply Ago 00S,
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H
D FORM NO _� BOARD OF HEALTH
3 SETS OF PLANS
E F ; TOWN OF SOUTHOLD SURVEY . . . . . - - . . . . . . . . .
BUILDING DEPARTMENT CHECI:
TOWN HALL SEPTIC FORK - . . . . . - -
_
BLDG.DEFT
i; SOUTHOLD, N.Y. 11971
u
WN TEL.: 765-1802 t:OT I F'f
p F SOUTHOLD�,-/ C A L L � - tQ
Examined . ,: 19 � . . . . . .
.�. . . . . . . ., � t•IA I L TO :
. . . . . .
Approve
. . _ . . . . ..
d . . . . ., 19� Permit No. .sZa��''. . . . .
Disapproved.arc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . - - - . . . . . .
. . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . .
A��9�
. . . . .. .� �.. . . .
_ (Building Spector)
APPLICATION FOR BUILDING PERMIT
Date . !. . . . . . . . . . . :. 19
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
or 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 will issued a Building Permit to the applicant. 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 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 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 c e, and regulations, and to
admit authorized inspectors on premises and in building for necessa inspections.
ibnature of applicant, or name, if a corpttron
• . . • • • -(Mailing address of applicant)'
State whether applicant is owner, lessee, "agent, architect, engineer, general contractor, electrician, plumber or builder.
. . . . . . . . . . . . . .� 1. . . . . . : . .. . . . . . . . . . . . . . . . . . . . : . :.. . . . . : . . . . . . . . . . . . . . . . .
.
Name of owner of premises . . . .
(as on the tax roll or latest deed)
If applicant is a corporation,signature of duly authorised officer.
.. . . (Name and title of corporate officer)
Builder's License No.
Plumber's License No. . . . . . .... . . • , , , • .
Electrician's License No. . . . . . . • , . , . .
Other Trade's License No.
I. Location of land on which proposed work will be done. . :�C/.�! . ,!(, ;•�1.� 1 , . .
Strcet
Hamlet
County Tax Map No. ]000 Section •. . . �Q��•,� • , , , : • ; • .
Block . Lot . ' .C,. . . . . . . . . . . .
Subdivision . . . . . . . ... . . . . . . . . ... . . . . . . . . . . .. . . . . . ... Filed Map No. Lot . . . . . . . . . . . . . .
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy . . , <.✓, �' 1 � G2. _
; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...
b. Intended use and occupancy
•3. Nature of work (check which applicable A j
Repair . . . . . . . . . . . }Zc ): New Building . . . . . . . . . . Additio`n ;Vf3 i. m ., „'Alte�ati !/
moval on . . .
( . .• - . . . . . . . . . . . Demolition . . . . . Other Work s. , • • , , • • • , ,
4. Estimated Cost . . . . . (.�rDl:v l/ (Description)
. . . . . . . . . . . . . . . . . . . . Fee . . . . . . : . . . . . . .
(to'b'c-pal'i'd!ori'"filing.this application)
S. If dwelling,number of dwelling units . . . . Number of dwellin --units onleact1 If garage,number of cars . . .,. ���1. �; g floor . . � . . , . .
6.• If business, commercial or mixed occupancy, s•ecif • . • • • • _ • • - ' ' ' ' ' ' ' ' ' '
7. Dimension of existing structures i rp y . t�src and extent of ea Atzp1 of use ,
Height . . . . . . . . . r f any: Front . . . . _ Rear . . . . . . . DI . . • . . .
Numbcr Depth _ ,
of Stories . �• Qf C/�
Dimensions of same structure with alterations r additions: From" . . . . • . . . . . . %. ' ' ' ' . ' '
Depth . . . . .3�. Height
. . .��. p � .. . . . . . . . . . . Rear ' . .
8. Dim ' • • - Number of Stories . ./ .,�� . • .
Re-
Dimensions of entire new construction: Frontj, �? n : . . . ..Height . . . . . . . Number o Storics - 'l:�.Q: G . . . r . . . . . . . . . . . . . . Depth . . . . . . . . . .
9. Size of lot: Front . . . . . . . . . . . . . . • • • - • • . . .
Date of Pu .1 ( lq,-
10. . a : ear . . . . . . . . . ... . . . . . . . Depth . . . . • . . . . . .
rchase .. N ame F' . . .
11. Zone or use district in whichpremises • Owner- .�(,1•Q;�,C;f , • , ,
are situated :(`._ �Q
12. Does proposed construction violate any zoninglaw, o am 0, • . . . . • • • ' ' ' ' ' ' ' ' ' '
13. Will lot be regraded rdinance or regulation: �, , , , , , • - , , , , , • . • • _ .
Will excess fill be r ved from premises: Yes •Bo
. 14. Name of Owner of pre• ises :�� gj�
Name of Architect ,(°, � (��`.� Address �. r l'�L pone No. p�.�Z y . .
.Address . .� � .d (
Name of Contractor . . . . ��;U,U; • • . Phone No. / ,� ,
15. Is this propertywithin . . . . . . Address . . . . . . . . . ' .Phone 1No. . . . . . . . . . . . .300 feet of a tidal wetland. ,�
Yes. . . . . . . .. No. . . . . . .
*If yes,- Southold Town Trustees Permit may be required. ' •
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and.indicate all set-back dimensions frii,m
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner Iot.
;TATE OF NEW YORK,
:O Y OF S.S
.. . . . . . . . . being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
bove named. . .
e is the . ... . . . . . . . . . . . . . . . . . . .�. • Aj. C::. . . . .
Contractor, agent, corporate officer, etc:)
said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
)plication; that all statements contained in this application are true to the best of his knowledge and belief;and that the
ark will be performed in the manner set forth in tlse application filed therewith.
torn to before me this
. . . . . . . .day of. . . . . . 19 .
Mary Public, . . . . . . _ . F' Lux,
JOYCE M.WILKINS .GK.
Notary Public,State of!Now York • • • • • • • .
No. 4952246,Suffolk Coun (Signs a of a licant)
Term Expires June 12,19—%
a YOUNG
400' 0$,rRAuoER Avfi'NVC,, , , R1VfRHfAO# N- Y
A4,00V W. YOUNO NOWAX W. YOUNO-
PIPOeaS'IONAL fNOINUR•ANO LAND SURVEYOR
LAAID SURVEYOR, ff.Y-S,L/0 M 11 lKY$.4/C/Ella
SURVEY FOR
i. V/8,FR IF fYm 4 Vo/7•IA.� MI Ft—®RW 8 'i' •I `.^M Y XER
i"o9't F INSURANCE Ca
w up; .oo.d N.®. 1 t1/7.ihGl/,{6 s 7r,
SCAL F 1�r� r7 ?, I�'��f FR ?1� POGO Na
r
• . __-.,._. .._._......_.�:..r.�..._,w �... ,�„�.,.....+....:.e...._. .r. .,�..:.,�..�ar.-,,.,s... _ _ .....� ..4��.• � � "'T.:.1"4 F GT'.^l:�v'^y y:u:T� �1�5".�.'.its., .. � .... .. .....� {r.�T•U-a":u"'
11 J llu Jf-1-1.:.,..1.1—--- .. . .. r1 ....,..— ...1
,ontracl shall be deemed cancelled and thereafter neither subd. 5 of Section 13 of the Lien 1� �
..
- �w"o4'N�,�'i,'`J�'�3'%Y,i,•�:i.tc,... ir:_is:.us�a+Ayewi�4f..e ;�;31o'h1.+y;x,i.s�:,'".
SCHEDULE A
J
ALL that certain plot, piece or parcel of land, with the buildings and improvements thereon erected, situate,
lying and being3nKdiKx at Ma.ttituck, in the Town .of Southold, County of
Suffolk and State of New York, bounded and described as follows :
BEGINNING at a point on the easterly side ' of- "Riley Avenue"
distant the following 2 courses and distances from the intersection
of the northerly side of East Legion Avenue with thecnsterly side of
Riley Avenue: (1) South 77 degrees 35 minutes East 52.93 feet; (2)
South 06 degrees 45 minutes East 156.93 feet to the point at which
Riley Avenue is intersected by the southerly line of land now or
formerly of James Wasson; thence, along said land, South 77 degrees
35 minutes East 142.46 feet; thence, along land now or formerly of
Julius Zebroski, South 07 degrees 55 minutes Ea..st 66.82 feet; thence
along land now or formerly of Elvira Travell, North 77 degrees 35
minutes West 145 feet to the easterly side of Riley Avenue; thence,
along the easterly side of Riley Avenue: (1) Northerly along a curve -
which bears to the left and has a radius of 234 feet a distance of 22
feet and (2) North 06 degrees 45 minutes West 44 feet to the point
of .place of BEGINNING.
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Al 9..1994
TOWN�pp SDEPT.
UTFIOLD
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