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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-25141 Date JULY 18, 1997 THIS CERTIFIES that the building ALTERATION Location of Property 775 LEGION AVENUE MATTITIICR, N.Y. House No. Street Hamlet County Tax,Map No. 1000 Section 142 Block 2 Lot 2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 7, 1994 pursuant to which Building Permit No. 22355-Z dated SEPTEMBER 26, 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 ALTER EXISTING KITCHEN & DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to GERARD & JOHANNA WELLS (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. H-049096 - MARCH 14, 1996 PLUMBERS CERTIFICATION DATED N/A Build' g Inspec r Rev. 1/81 7 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.................. .............................. 19.. E Na® 22355 Z Permission is hereby granted to; . ...... .... ...6;0"04)...........'%'�......................... f? rri.Tjrc ...... . ......... ... ............ to ... fz;.. -e........... ........ . ..... R�17... .G-......... � 1 - �........... .............. ........................I............ ...................................................................... .................................................................................................................................................................. .................................................................................................................................................................. ................................................................ ..............� l -s......................................I...............I...... at premises located at............................. /�` ..... � .U.. .... :................................. ....................................I........................ ......................... ................................................ Coun Tax Ma No. 1000 Section �.... Block...... :........... Lot No. ...... ............. ty p ............. r pursuant to application dated ........... ....... ................... 19... .. pp y......., and approved b the Building Inspector. Fee$..... . .�........ Building Inspector Rev. 6/30/80 I orm No. G / TOWN OF SOU`1-1101,J) / BUILDING I)l;l' I nZItILt`)C TOWN IIALL 765-11102_ API'LICATION FOR CUT H'ICATIi OF OCCUPANCY A. This application must be filled in by typewriter OR ink and.i submitted to the building inspector with the fvllvw.(ng: for nc:w bui.J.d.ing or new nse: 1 • Final survey of property with accurate locatiOrl of all buildings prop streets, and unusual natural or � ci"t}� .lines, topogr.apll.i.c features. Final Approval Er.om lie, "tet. of wa r.te supply and scc•rerage-di.sposal(S-4 form) . . Approval of electricatl.cinit Dept. from Board of Fire Underwrite J rs. 11. Sworn statement from Iplumber certifying; that the solder used in system contain, .less than 2/10 of 1% lead. 5. C011nnercia.l buildill :industrial bu:i.lditlg, multiple residencesr-and similar builcling�s and installativtts,{a certificate of Code Compliance from arclvitect or engineer responsible for the building• G. Submit Planning Board Approval of completed sate plan tequiremeitts. B. For existing buildings (pt:ior. to April 9, 1957) non-confvrmitt g; uses, or buiJ.di.ngs and ' pre-existing" land uses: 1 • Accurate survey of property showing all property litles, streets, building and unusual natural or topographic features. 2• A properly completed app.licatiotl and a consent to inspect. signed by the applicant. If a CerLificate of Occupancy is denied , reasons therefor in writing to tile IIui.ldi.ng inspector.' shall stale the the appJ-icant. C. Fees •1 . Certificate Or Occupancy - New dwell.ilig, $2.5.00, Additions to dwelling; $25 .00, Alterations to dwelling $25.00' Swinlrn Additions i.rlg pool. $7_.5.00, .Accessory building $25_00, to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing; Buildine - $100.00 3• COPY of Certificate of Occupancy - $20 ()() 4. Updated Certificate of Occupancy - $50.00 5. T'ernporary Certificate of Occupancy - Residential $.t' .00, Commercial $15.00 Date . 101? New Construction. �. . . . Old Or Pt" e-e�}ting IIui.lding. . . . .�,� 7 �(�:aV • Location of Property. . . . .(:"l . . . . . . . • , del?! , . House No. . . . . .` . . . . . . . . . . . . . . . . 1 Street hamlet: Onwer or Owners �,.f Property. . . . G��Rrz-D � ��hG�Pi � e LC5, / . . . . . . . . . . . . . . . . . . . . . . . . . . . . . County Tax llap No . I000, Section. 1.�2. . ,0 . . . d2. O 0 G Block. . . . . . . .Lot. �0Z' 0C) . . . . . . . . 7ubdivic,ion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .FiI.ec1 M-11). . . . . . . . . . . .Lot . . . . . . . . . . . . . . . . . . ... . . :'errnit Ilv. . . . . . . . . . . . . . . .Date 0 f Permit. . Appli.can t . . . . . . . . . 'lealtll Dept. Approval. . . . . . . . lJndcrwri.ters Approval . . . . . . . . . . . . . . . . . 'lanr'lllg Board Approval. . . . . . . . . . . . . . . . . . . . . . . . terlucst for: Temporary Certifi.c-1te. . . . . . . . . . . Filial CerLic:ttc. . . . . ;ce Submitted: S. . C �• S-3 � .,� � 141 ���. . . . . .. . . . • . . . . . . . . . . . . . . . . . . THE NEW YORK BOARD OF FIRE UNDERWRITERS PACE 1 8050974 BUREAU OF ELECTRICITY F 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date MARCH 14,1996 Application No.on file 86410894/9 q H 049096 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of .7ERARD tJNLLS, 775 LEGION ffiTNUE, MATTITUCK, N.Y. in the following location; ❑ Basement EP Ist Ff. ❑ 2nd Fl. Section Block Lot was examined on 14ARCi1 11,199G and found to be in compliance with the National Electrical Code. FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT.FLUORESCENT OTHER AMT. K.W. T. K.W. AMT. K.W. AMT. K.W. AMT.I H.P. 7 4 4 1 1.2 1 r DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI.OUTLET DIMMERS SYSTEMS OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. I H.P. NO.OF FEET AMT. WATTS 1 600 SERVICE DISCONNECT NO.OF S E R V I C E METER NO.OF CC.COND. A.W.G. A.W.G. A.W.G. n AMP. TYPE EOUIP 1,e'sW 1.0 3W 3 0 3W 3,0'4W PER OF CC.C � NO.OF HI-LEG OF LEG NO.OF NEUTRALS OF NEUTRAL OTHER APPARATUS: PADDLE' FAN-1 Y-LnTORs:1-F IT,P. G.F.C.I:-1 LC7 ELLS ON AVENUE 'I{, Ny, 1195ZGENERAL MANAGER Petered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. 1 , Town Hall, 53095 Main Road y Z Fax(516)765-1823 P. 0. Box 1179 %�5 ® Telephone (516)765-1802 Southold, New York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD July 11, 1997 Gerard & Johanna Wells 775 Legion Avenue Mattituck, N.Y. 11952 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons : XX An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. / XX The check is (not on file. ) $25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984) . BUILDING PERMIT # 22355-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. Town Hall, 53095 Main Road y Z Fax (516)765-1823 P. 0. Box 1179 �y • Telephone (516)765-1802 Southold, New York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD July 11, 1997 Gerard & Johanna Wells 775 Legion Avenue Mattituck, N.Y. 11952 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons : c.// XX An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. XX The check is (not on file. )$25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984 ) . BUILDING PERMIT # 22355-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. rss-isos BUILDING DEFT. INSPECTION [ ] FOUNDATION iST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1N ULATION l FRAMING [ FINAL [ ] FIREPLACE 8 CHIMNEY REMARKS• DATE �O / l � INSPECTOR 70-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ] FRAMING [ ] FINAL REMARKS: r d DATE INSPECTOR �°=- 765-1802 BUILDING DEFT. INSPECTION [ ] FOUNDATION iST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ /], F, SULATION FRAMING [ INAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE INSPECTOR ,� � 235s � T65-1802 BUILDING DEFT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]�IULATION [ ] FRAMING [ FINAL��,evr�� J i [ ] FIREPLACE & CRIMNEY REMARKS: DATE INSPECTOR ' ��� JIIDATIOV ,( 1 s tLA ) 111DATIOII (2nd ) tri 1GH FRAME `.,...PLUMBING ;ULATION PER N. Y. STATE ENERGY I j CODE FINAL _ I .. o ADDITIONAL COMMENTS C'7 .`•0�.�_•r"e1'^'L►1.1-iy.+.wsl:- "r.+a�a.•1 l�v.ice:. �.1.•.� ;. .•, w .. . ,. .. . .. � ^ ..� ... ..• .., .. � •.r/'s.�!/d. n�7 BOARD OF HEALTH FORM NO. 1 3 SETS OF PLANS . . , . . , TOWN OFSOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . ... f SFP _ �gg� ); BUILDING DEPARTMENT CHECK . . . . . . _ . . . . . . . . . . . . is TOWN HALL SEPTIC F0R&H _ . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 TOWHNOFSOUTF. TEL.: 765-1802 r:or�Fy Q CALL � Examine . a_�, d . . . . . C! SO. ., 19 . ! / MAIL TO : . • . Approved . . . . . . . . .l�?� 19 Permit No.oLv�ASS . . . . . . . . . . . . . . . . . . . . Disapproved a/c . . :. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A e' (lil7d b Inspector) APPLICATION FOR BUILDING PERMIT Date . . . . ./. .�. . . . . . . .. 19 q� 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 code, and regulations, and to admit authorized inspectors on premises and in building for necessary insp tions 4W . . . . . . . . . . . . . . . . . (Si ure of applicant, or name, if a corporation). 7 .*ai &ess . .�/� . . �. . . . g ad applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ,4 . . . �h / / (/t/ ��- • . (as on.the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. . . . . . . . . . . . . . . . . . . . . House Number Str et amlef County Tax Map No. 1000 Section . . . . �`� . . . . . . Block . .� . . . . • , . . . Lot . . . . . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. . . . Lot . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . . . . �. .lY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended p •'`.. .+ N. use and occu ancy . . . . . . , . . ..;. . . . . . . . . . . 3. Nature of work (check which applicable): New Building . . . . . . . . . . Addition . . . . . . . . . . Alteration . . .�!. . . . . . Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition Other Work . . . . . . . . . . . . . . . . (Description) 4. Estimated Cost . . . . . . . . . . . . 31-P..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fee (to be paid on filing this application) S. If dwelling,number of dwelling units . . . . . . . . . . . . . . . Number of 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 . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . ... Depth . .. . . . . . . . Height . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . . . . Depth . . . . . . . . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . 8. Dimensions of entire new construction: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . Depth . . . Height . . . . . . . . . . . . . . . Number of Stories.. . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . 9. Size of lot: Front . . . . . . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . . . . . Depth. . . . . . . . . . . . . . . . . . . . . . . 10. Date of Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of Former Owner 11. Zone or use district in which premises are situated . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: . 13. Will lot be regraded . . . . . . . . . .. . . . . . . . . . . . . . . . . . Will excess fill be removed from premises: Yes • • No 14. Name of Owner of premises . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . .Phone No. . . . . . . . . . . . . . . Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . . . Address : . . . . . . . . . . . . . . . . . .Phone No. . . . . . . . . . Name of Contractor . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . .Phone No. . 15. Is this property within 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 from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF . . . . . . . . . . . . . . . . . — • • • . • • • . • • . . . . . . . . . . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. Heisthe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. Sworn to before me this . . . . . . . . .�� . . . . . . .day of. . . . . . . . . . . 19 . . . Notary Public, . . . . . !l!�! ;. . County. QYCE M.WILKINS . Notary Public,State of NewYork . . . No.4962246,Suffolk CoSignature of applicant) ou Term Expires June 12,tl04 \\ o vto 5,ppR �87 ww; oti� litA X. o , APR z_ g 0 -n •3 t�• 62 -� ? -0 'y T 0 ° O 01 Lp Ao 00. 93,00 s v v'A c p0. c CERTIFIED TO, 00 GERARD S. WELLS -7- ,� ��-� 'o 60� JOHANNA WELLS of e3 �m3' �_ 30 AMERICAN RESIDENTIAL MORTGAGE CORP. SECURITY TITLE 8 GUARANTY CO. to Qm 00 pop . n, � •3000' v m o�d. g9 60 6 / 5• J O1, V SURVEY FOR GERARD S. WELL S & JOHANNA WELL S A T MA T TI TUCK TOWN OF SOUTHOLD SUFFOLK COUNTY, N. Y. 1000 - 142 - 02 - 02 Scale: 1"= 40" AREA= 43,061 sq.ft. Dec. 8, 1992 Q�tOF NEIV jo ��•o�� -1 t«F.rs Prepared in accordance with the minknum N.Y.S. LIC. NO. 49618 standards for title surveys as established 6pNl �eS YORS, P.C. by the L.I.A.L.S. and approved and adopted O for such use by The New York State L and 09 Title Association. MAl AD SOUTHOLD, N.Y. 11971 92-315 he- i y� � � - �. �,,� .�.-.� b I f . � p t i ,p - a L X - f -. K J I - - � - , - - ,,,�, ,,, ; -_ ,, III,, - �KITP - I -— .,_:.*-�,�� __4�_-�'.4. , ,�-"e,."�,�-Y-,�,,,Fl-�'.1,T�-,'�,�l-�w -.., I I _v�,�., I I ",111111 TM��:_ -1- 1-- N__ , M77"__111�71111 IT 77v',�.*WR,71 "�yp nz It,101 , ,,.t�___-7.. .- __�,_. I -,"'I 1-4.�,`i_ "." ,� �,�. ,- ,_r-,;�_ ,,�r�7�77- ,--f!;r_-.-,"�-1�7. ,,--� !; , , �� -�t�,-C,-,?-T-;,,�rio, �,- -.-- _"",',,,i� � - � -- - I�� '.1.., -,�tl. 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