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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-14098 Date DECEMBER 17~ 1985 THIS CERTIFIES that the building. NEW DW~JJ.ING Location of Property 1380 JACKSON'S LANDING ~ATTITUCK~ N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 106 Block 09 Lot 017 Subdivision JACKSON'S LANDING Filed Map No. 5280 Lot No. 12 conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 17~ 1985 pursuant to which Building Permit No. i3974Z dated MAY 23~ 1985 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 NEW PRIVATE ONE FAMILY DW~.rJ.INGWITH ATTACHED DECK. The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED RIVERSIDE HOMES~ INC. 85-SO-65 N725489 ~'-"B{~ilding Inspector" Rev. 1/81 ltOB3J NO. 9 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) 13974 Z Permission is hereby gra~teef-~: , ~ ...~..~.~..~.....~.....~..:... .....~...o..~.....~ ............................................. ..~..~.~~.....~.~' · , ...... .u.~.....~.~ ........... ,o ~.:.. ...................................... :.~.......~. ........ ;......~ ...... at prem,$es located at .!..~...~..~....~..o:..c~,..~.~...(~.~....~.. ...... .~..~~ ............... County Tax Map No. 1000 Section ...]...?.....~. ........ Block ...... ...(~....~.. ....... Lot No.....?...J...'] .......... ,o opp,,~ot,on dot,d .........--.~..~....m .................. , ,,.~.~:.,-- ~ ~,ov~ ~ pursuont Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 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 instatla- 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 property showing all property lines, streets, buildings and unusual natural or topographic featu res. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 $15.00 Date .......................... New Building ....x.x ........ Old or Pre-existing Building ............ Vacant Land ............. Location of Property 1380 Jacksons Landing Mattituck House No, Street Ham/et Riverside Hemes Inc. Owner or Owners of Property ..................................................... County Tax Map No. 1000 Section 106 Block 9 Lot.. 17 Subdivision..M.ap..o.f..J.a.c.k.s.o.n.s..L.a.n.d.i.n.g ......... Filed Map No. %2.8.0. ...... Lot No .... 1.2. ........ Permit No...1.3.9.7.4.Z... Date of Permit ,5./.2.3/.8.4. , .Applicant . Rive.r.sid.e Home. s, .Inc. Health Dept. Approval ...................... Labor Dept. Approval ........................ Underwriters Approval .~"~ ............ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ... ~/ .................. Fee Submitted $....5...0.0 .................... " Construction on above described building an~ ~?~s~ticabl~gu lations. e. ~.'C~C[C~ ~ ~ q~li~eth A. Canngz'aro, Agent / FI~E LD '~NSPECTION DA COIdMENTS FOUNDATION (1st) FOUNDATION ( 2nd ) i~ PLUMBING INSULATION PER N. Y. STATE ENERGY ~ODE - ~. ~'/~: F~_~ ~,~ .....,~ TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR - P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 Deceraber 23, 1985 TEL. 765-1802 Mr. Wayne Davis Bos 768 Sound Ave. Mattituck, N.y. 11952 RE: B.P.#13974Z New Dwelling 1380 Jackson's Landing, Mattituck, N.Y. Dear Mr. Davis: This is to confirm that the drywell installed in the driveway of your new home was not a req- uirement of this department or a request of a Building Inspector at any time during the req- uired scheduled inspections. Yours truly, Edward Hindermann EH:hdv Building Inspector Riverside Homes, Inc. P. O. BOX 274 1159 West M. ein Street Riverhead, N. Y. Phone: 516 - 727-3395 O~tober 16, 1985 Building Department Main Street Southold, New York 11971 Permit No. 13974Z Gentlemen: Per your request, we enclose herewith a letter from 9ur insulator indi~ating that the house was insulated to ~ode. / Eliz aro Enclosure ~981-2363 - Office 147 Hawkins Avenue C & M SPACKLING CO. Inc. SHEETROCK INSTALLATION & FINISHING STEEL STUDDING · SUSPENDED CEILINGS RESIDENTIAL & COMMERCIAL Lake Ronkonkoma, N.Y. 11779 Oct. 14, 1985 To Whom It May Concern, We, C & M Spackling Co., Inc.,~state that Riverside Homes Job #1028 located on the E/S jackson Landing, 388.27' N/W/0 Mill Rd., Mattituck, New Y6rk has been insulated to code. Sincerely, C & M SPACKLING CO., INC. Michael Mas~roddi, Sec. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY "350-]-~ 85 JOHN STREET, NEW YORK, NEW YORK 'leo:~l~l . ".,~ December 9,1985 '.P'i,;.'i.,,N-..-f'.342609/S5 N725489 THIS CERTIFIES THAT , only lite etec trical equipment ~ ~scribed below a~d in~r~.c~d by the oppllcent ~r~d O. ~lf~ e~vy ap~l~ati~ ~Ser in the pren[i~es of Davis, e/s Jackson's Landing 388.27' ~/w/0~ Mill ~d,'~ M ttituck, N.Y. i.~/om,,.~.~,.~.~..~ ~..,~,.e., ~ I~,Ft. ~ ~.d F~. S~t~.~'. .~,~,~ Lo~1028 ,~.sex.,,,i.ed..November 25,1985 a"dfou"dt°beincompliancewi~t~'ther~q~'ire"~""~s°ftl~i~H°ard' FIXTUR~ FIXTURES RANGES FANS OU~/ETS SWITCHES 16 45 20 DRYERS FUTURE APPUANCE FEEDERS TIME CLOCKS UNIT H~ATERS DIMMERS SYSTEMS FEET SERVICE DISCONNECT $ E R V I C E [ NO OF ~ APPARATUS; Special Rec'pt.- 1-30amp., 1-50amp. Motors- 1-F H.P., G.F.C.I.-1, Smoke Peter ' CCha~b~nneau 35 Sheppard Lane must ~o~ be ~llered in ~y m~nner; retur~ ~o lhe office TOWN OF SOUTHOLD OFFICE dF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No. 13974Z Owner Riverside Hemes (please print) Plumber~q~ ~2)~R,~/M..~ ~ ~ ~--? (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to bef~me this //~ day of Notary _~_~(plumber' s siqnature~) Public BUILDING DEPT. INSPECTION FOUNDATION ~.ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION FRAMING ~/FINAL ~REM/~RKs: · 7GS.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FRAMING [ ] FOUNDATION 2ND [ ] INSULATION £~FINAL REMARKS: FORM NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. t -' BLDG, DE?F, ~t~o_uT~oLD ~'~ , Application No ................................. <amined .......... ~ .................. 19..~...b.d pproved ............... ....'~...~ ..~...~...., 19~..~... Permit No...~..~...?..?...~.....~... ....... isapproved a/c ............................................................................................ ~'~ ..................................................................................... ................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .............................. , INSTRUCTIONS o. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building ,spector, 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 cas, 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 applicant. Such permit ~all be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used Jn whole or Jn part for any purpose whatever until a Certificate of Occupancy ,all 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 ~ilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ;gulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ~e applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to ]mit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Ceneral contractor, Builder ~me of owner of premises ............ applicant is a corporate, signature of duly authorized officer. ,. Go~don-.$ee¢. T~ea~u~er (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No..2...0..L}.9.7..?. ................................. Electrician's License No. .2.~.9.7..J~ ............................ Other Trode's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ..... ~.f.~.2..,8..0. ........................ Lot No. 1 2 I , · ' 0 M' Street and Number .... ]~./.~...~r%C~.~..~,,~...~...L.~.~.~;z,~.,...3.~.~..,.~,.7.....~.Z.~./. ....... .~..Z.i....,D.~,~., ............................... I-0%© ''~ ~L J~ Municipal ity 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ...... Y.~R~I.~...~.;O.¢~ ................................................................................................ b. Intended use and occupancy ...... O.~e...~.~mi.].~...Dw~,%.l.J,,~.~ ............................................................................ ~.' Nature of work (check which bpp 'cable) New Building....7,, ............ Addition .................. Alteration .............. Repair .................. Removal .................. Demolition .................... Other Work ................................................... _.~ (Description) 4. Estimated Cost ~ ~ ~ Fee , (to be paid on filing this application) ~.'-'If bWelling, numbe}'~df dwelling units ........... .3. ............... Number of dwelling units on each floor ..2...,.&....! ................ 6. If business, commercial or mixed occupancy, specify nature ~nd extent of each type of use ............................ 7. Dimensions of existing structu!es, if any: Fronl- ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dime'nsions of sQme structureiwith alterations or additions: Front .................................... Rear ............................ Depth ................................ H~ight ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ' ~ ..................... Height .................... Number iof Stories .1.2...~.'9..°....~ .................................................................................................. Jul 19 5 ] 1. Zone: or use district in which I~remises are situated 12 Does proposed construction violate any zoning law, ordinance or regulation: yes 13. Will lot be regraded . ........ :F~S ............ Will excess fill be removed from premises: (×) Yes ( ) No PLOT DIAGRAM Locate, clearly and distinctly ali buildings, whether existing or proposed, and indicate all set-back dimensions from proparty lines. Give street and blohk number or description according to deed, and show street names and indicate ~vhether interior or corner lot. ....... ~.;~.:.....Q..°.Z.~O.~...~./.?~..~.. ................... ..'~...~....~../~..~...be.ng duly sworn, deposes and soys that he is the opplioam (Name of individual sigfi ng contracf) He is the S.~.+. .... ~m~^L .... ~ ~g~ ~ ] (Contractor, ~ent, corporate officer, etc.) of said owner or owners, and is du~y authorized to perform or have performed the said work and to make and file this application; that ~11 statement~ contained in this application ar tr~ to the ~st of Inis knowledge and belief; and tho~ the work will be performed in the manner set fo~h in the o~?fl'l~d th~ .......Sworn to before me this~.~ doy of ~ Nota~ Public,. ............... ~.~r.9.~¢ ................... Cou /~, (Signature o opp icant) ~ No. ~" ~~ SUFFOLK CO. HEALTH DEPT. APPI~OVAL ~--~.-~"~' ~ ~-.~,~,,~ ~o~E - ' ' -'~ , ~Ap OF F4TY ' ............. ~' '~ ' ¢~TEMS FOR ~THIS RESIDENCE WILL ,'-,~ i ~ ¢Z~¢ CONSTRU~N ONLY :5 ¢ , DATE: 3 ~(~- ~ ,,, ~ ~ 1.,~ ~ ..... ~ ..... , ,, ROBER~K V~UYL, LI6ENSED LANB SURVEYORS - , GREEN~RT NEW YORK -- - SUFFOLK CO. HEALTH DEPT. APffROVAL .... H.S. NO. ~5~O I ~ TH[ WATER S~Y AND ~WAGE DI~AL [O ~ SY~E~ FOR THIS RESIDE~E WILL , ¢_ ,~V CONF~M TO THE STANDAR~ OF T~ ~,:] ~ , b'E'L:J L)rN'aCE) ~ ~ ...................... SUFFOLK COUNTY DEPT. OF HEALTH ~ ~ ~~ ~ SE.V~CES - FOe A..aOVXL OF ~ CONST.UCT~ON ONLY r ~ ' J ~ 0 ~ SUFFOLK CO. TAX MAP DESIGNATION: ...................................... - .~_~~ sattstacto~ ~ "-- ~ V~UYL, P~C. ahtef ef gen~al ~aee~i~ LIC~D LA~ ~VEY~S qe~tall G~E~T ~W Y~K 4 Wa~er d!stributlr;g system; pipir~g shall be o~: types K or L Only ' ON LEAD CONTENT BEFORE CERTIFICATE OF OCCUPANCY SOLDER USED IN WATER SUPPLY SYSTEM CANNOT EXCEED 2/10 of 1% LEAD., 1, FouNmATION - TWO REQUIRED FOR Pr~URED CONCRETE ~. ROUGH- FRAMING & PLUMBING 3. INSULATION 4. FINAL - CON'STRUCTION MUST BE C'~'~'*pl ~-E FOR C O. ALL CONSTRUCTION SHALL MEET THE RE©IIIpEMENTS OF THE N ¥'. ~TATE cONSTRUCTION & ENERGY i CODES.,-., NOT RESPONSIBLE FOR DESIGN OR CO_NSTRUCTIbN ERRORS. ,] 4 ./