HomeMy WebLinkAbout12351-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Buildin§ Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. z-16870 May I6, 1988
Date ................................
THIS CERTIFIES that the building ONE FAMILY DWELL ING
Location of Property 145 Budds Pond Road Southold, New York
h3~s~ hal ............. ·
Street Ham/et
County Tax Map No. 1000 Section . . .5.6. ....... Block . .5 ............. Lot 4
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this' office dated
May 20, 1983 pursuant to which Buitding Pennit No. 12351 Z
dated ...~.a ¥..2.7.: i .1.9.8. 3. ........... 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 .........
ONE FAMILY DWELLING WITH GARAGE AND ATTACHED DECK
The certificate is issued to ALPHONSE & CARMELA SCHIAVONI
..................... [o~n'o'r, ~e~o'X'~e~'X .....................
of the aforesaid building.
Suffolk County Department of Health Approval 13-80-73 - ,lan 28, 988
UNDERWRITERS CERTIFICATE NO. . . N836144 - October 6, 987
PLUMBERS CERTIFICATION DATED: N/A
Rev. 1/81
FOR~ NO. ~
TOWN OF ~OUTH0:
BUILDING DI:PARTM
TOWN HALL
$OUTHOLD; N. ¥.
BUILDING PEI~I~
(THIS PERMIT MUST BE KEPT ON THE PRE~I~ES UNTIL FULL
COMPLY'ION OF THE WORK AUTHORIZED)
m.o 12351 2[ D,~te..:..!i...,!....;.........~./~...~:..~.~,~9..~...~
Pe~ission is hereby granted to:
............. ~..{~ ....... ~.~J ........ ~.~;~.~,..,: ~.~...; .
...~ ......
.................................................................... ~ ................. , ......... p...t.~ ....... t....,t..,..~ .............................
at premises located at .......... .~ ............... ~..~-:.:.*..-. ..........................
" .. .... i.~ ~k~.~. ~..d
C°U~ty TaX Mop No. 1000 ~ction ..... ~.~ ........... BI~E ~....~ ....... ~., ~Lm No. ~ ........ ~ ............
Bulldl~ Inspector.
~,e ~ ......
...... ~LLO~IN~ iNSPECTIONS:
/~ 1. FOUN~ATION ' TWO REQUIRED
~ ~ FOR pOURED cONCRETE
L 2. RougH - FRAMING & pLUM~ING
3. iNcULATION
4.' FIN~I - CON'STRUCTION MuST
BE ~'~aP~ ;:TE FOR C.O.
FORM NO. 6
TOWN OF $OUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
765- 1802
TOWN OF SOUTHOLD
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
This application must be filled in typewriter OR ink, and submitted .= ~----=-=- to the Building Inspec-
tor with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal-(S~9 form or equal).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa-
tions, a certificate of Code compliance from the Architect or Engineer responsible for the building.
5. Submit Planning Board approval of completed site plan requirements where applicable.
For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1, Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or
topographic features.
2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings.
3. Date of any housing code or safety inspectio,n of buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
C. Fees:
1. Certif[cate of occupancy New Dwell'in~o,$25.00, Accessory ,$10,00 Business $50.00
2. Certificate of occupancy on pre-existing dwelling $ 50.00
3. Copy of certificate of occupancy $ 5.00, over 5 years $]0.00
4.Vacant Land C.O. $ 20.00
5.Uodated C.O. $ 50.00 Date ..........................
6. Alteration $25.00
NewCons truc tion Old or Pre-existing Building Vacant Land
Location of Property .. ~. ~. ,,~.... ~'. (.~. ~x~. ,-q,..-~..~:~./.V. ~)..~, ~ ,... ~-z~? .~.' .~'../~..~..Zc.Z~. .........
House IVo. Street Ham/et
Owner or Owners of Property 4~.fC, gC,A,(C. ~..~,.~..~'.~,3 g. fR..,~.~ a .~',~. ~ ................
County Tax Map No, 1000 Section ,O,~, ~ ,*,O,O,, Block , ~,.~.,,O, ,O.,,,, Lot, ,~,, ,~, ,-~, ,,, ,O. ~
Subdivision, ~'~,~ ,~ 2,(2, ,c~,, , ,,~,¢ ~/V:~., .... Filed Map No, z~, g ,~',~, ,Lot No .... f~, .......
Permit No./.~.~.~,~/.~' Date of Permit ~.~.~ ~?,-¢~Appticant ..,~,,,~,/,~/tf,.~'.~'.~,,C,~,l.~.,~,,,~.~.~/.
Health Dept. Approval ........................ Lab~i Dept. Approval ........................
Underwriters Approval ........................ Ptall/fifi~j-Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $ .............................
Construction on above described building and permit meets all applicable codes and regulations.
Rev. 10-10-78
3 0
Memorandum from....
BUILDING INSPECTORS OFFICE
TOWN OF SO!JTHOLD
Town HALL, SOUTHOLD, Iq. Y. 11971
765-1802
~IELD INSPECT~O~T ~
1.
FOUNDATION (1st)
FOUNDATION (2nd)
ROUGH FRAME &
PLUMBING
COMMENTS
INSULATION PER N.
STATE ENERGY
qODE
FINAL
ADDITIONAL COMMENTS:
THE NEW YORK BOARD OF FIRE UNDERWRITERS
1001071 BUREAU OF ELECTRICITY
~l~c~ 85 JOHN STREET. NEW YORK. NEW YORK 10038
0ct. o~er 06, 1987 245522/83
Jo~ ~ade, Budd'~ ~oad ~ad, ~ou~oi~, ~
thefolmwmg t~atlon: ~ B~ement ~ Ist Fl. ~ 2~ ~. .~rion Bilk
Se~mne~ ~2, 1987
RXTURE [~EC~TACL~S I H RXTURES RANGES COOKING DECKS I OVENS DISH WASHERS EXHAUST FANS
DR~RS ~RNAC~ ~T6RS ~TURE A~kNCE ~ SP~ALREC'~ TIMECt~S BE~ UNIT HEATERS MULTI~T~ ~ERS
i~.F.C.%.
2-~e de,et:ors .
G & $ ~lectrical
Sox 215
Sou=hold, NY 11971
39.35
Lic$578E
AMOUNT
4P4.EASE REMIT BY CHECK OR MONEY
ORDER TO THE ORDER OF THE NEW
t,r /// ,~
KINGSWOOD 56' x 24' K52C3H
KINGSWOOD 60' x
K58C3D
E145 EAST BAIN ,ST.
RIVERHEAD, L I., N.Y. 11901
516-727-2950
TOWN OF $OUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N,Y, 11971
TEL. 765-1802
This is to advise you that the job under building
permit no. 12351Z issued to Alphonse Schiavoni
5J~__7L83 for New Dwelling is completed
lima] inspection has ( ~ has not (' X ) been done.
and
In order to complete this file, it is necessary that
a Ccrtificato of Occupancy be issued. Please fill out the
enclosed form, return same to the above office with a cheek
for .$25.00 payable to the Town of Southold. Please indicate
to Whom the Certificate of Occupancy is to be mailed, and
arrange with this office for an inspection date
Occupancy or use is unlawful without a
Occupancy. Please help us to clear up this
legal action does not have to be taken. .:
Certificate of
matter so that
Thank you for your prompt attention.
~'~Very trul)~,~
Victor Lessard
Executive Administrator
VL:gar
encl.
THE NEW YORK BOARD OF FIRE UNDERWRITERS:
BUREAU OF ELECTRICITY
],,9~j~B5 JOHN STREET, NEW YORK, NE
THIS CERTIFIES THAT
in the following location; ~ Bo~semenE U I st Ft.
wasexaminedon ~ ~ 1~
FIXTURE ~ SWITCHES FIXTURES
OUTLETS
3~
[] 2nd F/. ,%ction Block Lot
and found to be in cotnpl once with the requirements of this Board.
RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
DRYERS FURNACE MOTORS
FUTURE APPLIANCE FEEDERS
sERViCE I S E R V I
C
NO. OF HI-LEG
O~ HI-LEG OF NEUTRAL
aox 115
Sou~hold, ~Y 11971
This certificate must not be altered in any manner; return to the office of the Board
,~, ~qe¥ Fo~,BUmmaO ~Ee, e~EaT. TH~S cop~
may
credentials.
ANY ~ANNER.
k
I.?~{c)
RD
Pond
2.5A (c)
~)
22 3A(c)
1.4
MhTCH ~. 03-Or 5
Legend
76S.1802
BUILDING DEPT.
INSPECTIOns,
]FOUNDATION ZST ~ ] ROUGH PL~G.
] FOUNDATION ZND [ ] INSULATION~'~
] FRAMING ~FINAL
REMARKS:
/ /-
INSPECTOR
/--~ 76S-1802
~ BUILDING DEPT.
INSPECTION
] FOUNDATION 1ST [ ] ROUGH PLBG.
] FOUNDATION 2ND [ ]/~SULATION
] FRAMING [ '~ FINAL '(~'~Z
O
IFI;I)LI( COUNTY BEI'AI~T?¥~[~51T C~; HEALTH SERVICES
[,'O[I~.,~, ~, ~'~o~,: .._'. L (~. C,,~.,~., ~ ,~,1 ~ON ONt~Y
FAMILY DWELLING ON,
LOT 3
MA P OF
"WIllOW POINT
AT ARSHAMOMAQUE
TOWN OF $OUTHOLD
SUFFOLK CO.,N.
FILED JUN
FI£E Na
GERT/F/ED TO '
USLIFE TITLE INS.
AL PHONSE S~HIA VONI
~ CARMEL'LA
donack associates
:513 west main street
riverhead, new york 11901
[516) 369~1717 (2:12)746-3020
April 2Z,l,983 Job Ns 8~-240
1000-056-05"04 Scale: I"=$0'
/~,IVIUUI~/I U'~ t~")0,. ~ J IgATE ,~ ('~'~ 19~'i~~.
PROVIDING SERVICE
R6FERENCE NO.
FROM
[] HEALTH CENTER [] HHS [] MH CENTER
ENVIRONMENTAL--[] DA [] TB
PHCP [] ~P [] OPR
OTHER
FORM OF PAYMENT
COPY 1 PAYER COPY 2,~DMINISTRATION COPY 3 PAYEE
COUNTY OF SUFFOLK
~ETER F. COHALAN
5iJFFOL.K COUNTY EXECUTIVE
FACt SHEET
LEAD IN DRINKING WATER SUPPLIES
Sources o._~_f Lead Concentrations in Drinking Water Systems
Use of lead solder in new plumbing or in plumbing modifications to existing
water supply piping.
Lead is not a naturally occurring element in Long ~sland groundwater.
Oc, ourrenfes
Lead is present in drinking water as a product of corrosion. The natural
corrosiveness of Long Island groundwaters contributes to this process. Most
public water supplies in Suffolk provide chemical treatment to increase the
water's natural pH, and minimize corrosion products, but no amount of treat-
ment can produce a totally non-corrosive water. -
Studies indicate that after prolonged periods of water non-use, lead con-
centrations can be found in excess of Drinking Water Standards. This problem
appears to be limited to newly installed internal water piping systems, or
recently modified systems, in which lead-based solder is used.
Lead is rarely detected in routine water supply surveillance. This fact is
seen as indicating that, at a particular location plumbed with lead solder,
this problem will diminish with time. The New York State Health Department
concurs with this evaluation.
Hea. lth Conside____.~rations
Lead is a compound which is accumulated in the body. Human intake can be
expected to occur through many environmental sources, including water.
Recommended Action
In order to minimize lead occurences, the following steps are recommended:
Particularly in new or recently modified olumbing systems, users should be
encouraged so flush the water line for a period of ac leas: two minuces
prior ~o consumptive water use. This is par~icuiariy necessary after pro-
longed water non-use, such as the overnight period.
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
Examined.·..~0~ .~....~L.~)., 19.
Approved ·..~ .~.. ~..-)., 19 ..~. Permit No. [ ¢. ~. ~.~ ]..~.
Disapproved a/c .....................................
( raiding Inspector)
APPLICATION FOR BUILDING PERMIT
Application No... [ .~ .'~..S~. (..~7...
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 ~uthorized inspectors on premises and in building for necessary inspedtions.
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.................... ..................................................................
Name of owner of premises . ./~...X../~..~.~ .~.~.~... ~..A/.~....~.~.~..~.~.Z. ~....~'~ ]jTf).l~. O..A/. ~. (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 LicenseNo .........................
Electrician's License No .......................
Other Trade's License No ......................
1. Location of land on which proposed work will be done ..................................................
· ................. ....... o-+h .............
House Number Street Hamlet
Count a a o. 000s . ..... .... .............
Subdivision..~.l.,.~.~..~.~..~.~.. .......... Fil dMapNo..~.w.~...;,:.. Lot ....... -. .......
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ff~ ~M ~ ~
b. Intended use and occupancy ........ '~ ~'~ · ' ~ ~'7. · · 0 ~.~:/~ .P~ .....................
3. Nature of work (check which applicable): New Building ....... Addition .......... Alteration ..........
Repair .............. Removal .............. Demolition .............. Other Work ...............
¢.~..~ i 1~.~ 70. (Description)
4. Estimated Cost .......................... Fee.. .. ...............................
(to be paid on filing this application)
/
5. 1t; dwelling, number of dwelling Units .............. Number of dwelling units on each floor ................
If garage, number of cars '
6. If business, commercial or mixe~ 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 wi'th alterations or additions: Front ... Rear
Depth ..................... ,.. Height ......... . ............ Number of Stories ......................
8. Dimensions of entire new construction: Front ... ~ I Rear Depth ~/.
Height ............... Numlber of Stories /' .........................................
9. Sizeoflot'Front [~l~'OOj Rear .lOb ~. . "~'e t{~" ~
........................ q .......... p .! ....... . ......
10. Date of Purchase ..... ~..[.I.~.].l~.~. .............. Name of Former Owner ~&~)v..~.~..~.o. ot~I~/J~,0~. ........
11. Zone or use district in which promises are situated .....................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: .............................
13: Will lot be regraded ........ 1~.~$ .... , ......~ .....~ill ems fill ~,removed from. premises: ~Yes
14. Name of Owner of premises ~.~p~'~O/~.~ g..~0~h .O0~ress-~-~. '5' .(-q.-~one No..92.7... lr/~. · · ·
Name of Architect ............... Address Phone No ............
Name of Contractor ........................... Address ................... Phone No
PLOT DIAGRAM
Locate clearly and distinctly alll 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 ~ORK, o o
COUNTY OF.. ~tF~ ~0 ~-~ ~'~
........ ....
'(Name of individual signing contract)
......... bein ~ says that he is the applicant
above named.
(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
............ ~ .c:~..~ · · .~.~j~day o f · · ~.~:~'. ..... 19...~
Notary Public,/~.'~ '~'~-~ '~--~~. ~.~County .~. ~ ~.~j~
Notary Public, S~ate of New York
No. 52-0344963 Suliolk COuntyj:~l~ '' ' ~'' '.:.~ ................
Commission Expires Merch'30, 19~.~ x.j ~gna*.ure of applicant)
SUFFOLK CO. HEALTH DEPT. APPROVAL
H.S. NO. /-~-SO
....... MAP O~ PROPERTY
THE WATER SU~LY AND SEWAGE DIS~SAL
AT SYSTEMS FOR THIS RESIDENCE WiLL
........ ~RS~ANO~A~E CONFORM TO THE STANDARDS OF THE
SUFFOLK CO. DEPT. OF HEALTH SERVICES.
/7~1~
....... ~ i, SUFFOLK COUNTY DEPT. OF HEALTH
--~ m~.~*~3, ,, - ~' - · · ~ I/ SERVICES -- FOR APPROVAL Of~
. ~ ~00' ~ - ..... //%// CONSTRUCTION ONLY
DATE:
~ ,~.~ / ~ . ~ APPROVED:
~ ', ~::: . ~ //
~ + ~ ~ ~IST. SECT. B~OCK PCL.
, ~ ' ~ Z , ~ .J ~ DEED: L. P.
¢ .................. The sewage d~s~osal and waLer si~po~y facilities for ~ % s,~,.t¢ ~,o -
Iocabon have been ms~sctsd Dy ~n~s D~a[tn~ms~ i '
Chi~ ~ Bur~u of Was~v~f ~anage~
~ ·
LOT NO'S, ~EFE~ TO "~P OF EILLOWPOIMT u R~ERICK VAN F_UYL, P.¢
FILED ~NTHE ~F~ CO.~R~ OF~I~ AS/4AP~0.465~, ~. ~ ~ ...... " ~'~ ' ~~',
ELEV4TIO~ RE~ TO ~EAN ~ ~VEL. LICENSED LAND SURVEYORS '%¢~-~75
GREEN~RT NEW YORK
F
olaf.
~ FIREI
-OPT.
LATTICE
ROOM
GiREAT. ROQPI
I~&TH
I~DI~QOIM
WI,C
L£C1END ~. 5HEAI~ WALL
I PANEL IBQX
O WALL OPENINGI
] I
CKT. ~V/OPT, ~'IICRO°W&V= OVEN
/
A
\ 1
\ /
\ / lo
\
K,tGTE$:
APPLIANCE LI~T IN
AND BREAKEK/WIRE SIZES.
C~RCUIT a ~,
4. THIS RECEPTACLE
WITHIN 1'4 IN. OIr WATEI~
SUPPLY INLE'T,
INSTALL FURNACE SWITCH
~ITHIH $1~i~tT OF FURNACE
I1=' FURNACE HAS NO INT~:~RAL
SWITCH.
PE~. ~NER~Y CODE
PR'ESENTATIONj ALL CKT$, HOT
SHO'N'H TER~qlIdA"I'-I~ AT
ARROW-~. ,~