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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-26804 Date: 11/29/99 THIS CERTIFIES that the building ADDITION Location of Property: 555 SMITH RD PECONIC (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 98 Block 4 Lot 6 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 20, 1998 pursuant to which Building Permit No. 24676-Z dated FEBRUARY 13, 1998 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 SCREEN PORCH & DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to FRANCIS E & JOAN RAIA (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N-465126 09/15/98 PLUMBERS CERTIFICATION DATED N/A 'Bui ing Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT �' j'G� Q ! �'t TOWN HALL i 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A •-, ;This applicatipn-must be filled in by typewriter OR, ink ,and aubmitted_to-,the-building-inspector:'with` the following: 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 17 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 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 to 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 Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. . Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . . �� . . . . . . . . . . . . . . . . . . . . . . . . . . . . New Construction. . . . . . . . . . . Old Or Pre-exist in Building. . . . . . Location of Property. . . S ? �. . . . . . . . . . . . . . . . . . . . .` . ! /. . . . . . . . . . . . .V.F.CB riJI.� / . . . . .. . . . . House No. •Street Hamlet Onwer or Owners of Property. . .IR:J�l.� ��. . . d. �<?u J lr 3 . . . . . . . . . . . . . . . .. . . . . . . . . . . County Tax Map No 1000, Section. . . 1 . . . . . . .Block. . . . . . . .tl . .pp. . . .Lot. . . . j�a. . . . . . . . . . . . . . . Subdivision. \ ...\ o, �2,U( �3�{7 jC , , , ,, ,Filed Map. . J. . . .Lot. . . . . . . ` j , Permit No. . .(0.q , , .Date Of Permit. . . . �-,�13/y' P. . .Applicant J�P, C3 uJ 'Pj� Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . .. . Planning Board Approval. . . . . . . . . .. . . . . . . .. . . . . . . / Request for: Temporary Certificate. . . . . . . . . . , AinaCeef . . . . . . . .Fee Submitted: $ ,. . . . . . . . . . . . . . . . . . . . . . . . . . PPLICANT CoEd `l w•� : a LD INSPECTION J(UATE COMMENTS S� m 3 H H FOUNDATION ( 1st) c FOUNDATION ( 2nd ) 2 . U� ROUGH FRAME & .PLUMBING m H 3 . m m INSULATION PER N . Y. y STATE ENERGY CODE �b 4 . t " FINAL rD z m ADDITIONAL COMMENTS : m x • op H 9 H s H O 2 1 _ m a • r H ' T d ' m ^o H 4' Timm Id Pat 'N OR 2 0 L VVIV a, i Environment East, Inc. 2885 Indian Neck Lane P.O.Box 190 Peconic,New York 11958-0190 Raul x2a&d&1 q 516-734-7474 Fax: 516-734-5812 KO'd ILI a TITLE NO. 72S- 02361 & S INDIAN, NE K RQAD...__._ ..._ LOT 10 120.03' ATM. fiN SIS°QOt E a T109 C14 fm ■ y — r Y. .•.:r..' 7A p PM10 P, n Y. rl �. NE`s t 1 A_ LOT 14 .'!.`•Unoedsorized alteration ' .. .'.' . ��-{eiClbsi�r209 alt he °,addition'io this sumoy is a violation of Now York.Slate @decotlae la, :.Ccolas OF this survey or embemop 'no' b"4011 the land survbyor's inked • ?� Ossed•seal shall not be Cnnticlerod TO be o valid copy, 1 j a GvaranMes Of ceulfisar'*As tMkorod hereon shall run only to the : Poroon fat whom the wrvo� Is Proposed,and an his behalf to the tllfe company, 13 Mfnentol agency and landing Instilutlon listed het?4n,and to the cmign.443:ot the 14w to institut on• 4uarontees I or.ce,tillcations aro tat.trooi(aiable! addin iSbsequjnl arners. . •,• oral institution, or , SURVEY FOR REFERENCE? FRANCIS a• JOAN.; d''iAIA. INDIAN NECK PARK MAP NO. 551, FILED AfAY 27, 1913 TOWN OF SOUTHOLO GUARANTEED TO: " SUFFOLK COUNTYt N.Y.: '�'; ?, 'CHICAGO TITLE INSURANCE COMPANY SAVINGS & LOAN ASSOCIATION OF RICHMOND HILL SCALE r f"i 30' FRANCIS & JOAN RATA JUNE 2, 1972 JUNE 13,1972 LAND SURVEYOR ., . N.Y,S.LIC.N0.20726 h,l/r Mill An e, v ' UU✓UA.G � I ��r p � °" MAY 15 ! rL e =" Environment East, Inc. 2885 Indian Neck Lane P.O.Box 190 _ Peconic,New York 11958-0190 'A RESl DF1V(ce f 516-734-7474 Fax:516-734-5812 6�Vl el, Aoll� O e loc z, (o b'lb THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1001093 BUREAU OF ELECTRICITY F 40 FULTON STREET, NEW YORK, NY 10038 Date SEPTEMBER 15,1998 Application No. onfile 15975198/98 N 465126 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of DR. & MRS RATS, 555 SMITH ROAD, PECONTE, NY in the following location• El Basement IN Ist Fl. El 2nd Fl. OUT Section Block Lot was examined on SEPTEMBER 10,1998 and found to be in compliance with the National Electrical Code. FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESC 71 FLUORESCENT I OTHER AMT. K.W. AMT. I K.W. I AMT. I K.W. AMT. K.W. AMT. H.P. 1 2 1 DRYERS FURNACE MOTORS I FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. I H.P. NO.OF FEET AMT. I WATTS SERVICE DISCONNECT NO.OF S E R V I C E METERCC COND. A.W.G. A W G A.W.G. AMT. AMP. TYPE EQUIP. 1 0 2W 1 0 3W 3 0 3W 3 0 4W 40.01 PER 0 OF CC.COND. NO OF HI-LEG OF HI-LEG NO.OF NEUTRALS OF NEUTRAL OTHER APPARATUS: SCREEN PORCH-1 PADDLE FAN-1 G.F.C.IF-1 DOROSKI ELEC. INC. LIC.#2991— L 425 MONSELL LANE L CUTCHOGUE, NY, 11935 GENERAL MANAGER 11 Per This certificate must not be altered 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. 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] F UNDATION 2ND [ ] INSULATION [FRRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE ` �� INSPECTOR s� � Y�o7 � M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY REMARKS: -- ---fes DATE l Y INSPECTOR FORM NO. 1 to ff U r TOWN OF SOUTHOLD BUILDING DEPARTMENT f TOWN HALL JAN 2 SOUTHOLD, N.Y. 11971 TEL.: 765-1802 SLOGt TOW '� /� C� NOF SO+JotiOtt} � ' Examined . . . . . . ��/''ho!.. . . ., 1) l�J.�� Received . . . . . . . . . . , 19 . . . Approved . . . . . . .. 191.. Permit No. . . . . . . . . . . . Disapproved a/c :. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ;e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . oil ing Inspector) APPLICATIO FOR BUILDING PERMIT u t Date r INSTRUC'T'IONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plmis 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 dfawn on the diagram which is part of this appli- cation. 11 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 necessa inspections. 'EAST INC (Signature of applicant, or name, if a corporation) T. C).-.Sox 10.0 ecoty�,C- N`E • (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. GEpfJt�" -. . . .C-DOT-2 cro 2: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises tSCI,S E . . �b w, ,-.�k A—: . . - .1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (as on the tax roll'or latest deed) !Cap.p1&iciM1,E afore ofduly authorized officer.cand tile of corporate officer) Builder's License No. . . . . .�. ..5.. . . . . . . . . . . . Plumber's License No. 't �yat•� , Electrician's License No. . . . . . . . . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . ,iliiat ' I. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . !41t . . SJ�J� SIf�� CE� _bZ1� �l=Cf�7�11C . . . . . . . . . . .. House Number Street Hamlet _ 6•+•., + County 'fax Map No, 1000 Section . . :. . . ta. . . . . . . . Block . . . . . . . . . . . . . . Lot . . . . .`F1. . . . . I N Int/1 N N t✓�t PA EZ.�- �J S Subdivision . . . . . . . . . . . . . . . . . Piled Map No. Lot . . (Name) >.. Slate existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . . �. . . . �,.^� . .U , ,�.: • :.. T:.lr:-::.1 . . . . . . . . . . . • . J\VJJ aaubt r eir a?. .a+i.i b. Intended use and occupancy �� dWCt�l :teirQQy1QG� (Jb(C� v ll i �raa� e�:av CI Nature of work (check which applicabll'c): New Building . . . . . . . . . . Addition . . . . . . . . . . Alteration • i • CSCR( d Repair . . . . . . . . . . . . . . Removal . .i . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . (Description) Estimated Cost . . . . . ?.. . . . . Pee (to be paid on filing this application) If dwelling, number of dwelling units . . . . . . . . . . . . . Number of dwelling units on each floor . . . .�. . . . . . . . . . . . ifgarage, number of cars �. . . . . . . . . . . . . . . . . • . . . y . . . . . If business, conrrnercial or mixed occu4iancy,specify nature and extent of ca9h ty1 of use y Dimensions\gf exis ing structures, if any: Front . 4r.•7 . . . . . . . Rear . . f�.$. l. . . . . . , Depth . . �s . • !`r. . Number of Stories . . . . 721. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • . . . . . . . . • . titer. . . . . . . . Rear . .s�!�'YVI . . . . . . . . Dimensions of same structure with nit rations or additions: Front . . !E. Depth . . . . . . .Si'tt)! i. . . . . . . . . ilc ht . . . .s$�t!t . . . . . . . . . . . NumberofStories . . . . iS/ n1r:. . „ . . . . ' 1 g �r�. . . . . . . . Depot . . . . ... . ... . . . Dimensions of enlite new construction: Front . . .. - . . Rear Height . . . ... . ��.:�{<. . . Numbcrol Stories . . . . . . �.-,Sc-(leer eC)r ,PotZct� : q . . . . . . Ig0.o0 , . . . . . ; . . . . . . Rear . . . . . ._. . . m. .. . . . . . . . Depth ... [ O r DS . . . . . . . . . . . . i Size of lot: Front Date of Purchase . . . . . . . . . . . . Name of Former Owner . . . . . . . . . . � e itu . . . . . . . . . . . . . . . . . . . Zone or use district in which premiseslare situated . . . . .�'.!�� : . . . . . . . . . . . . . 0 b . • • . • • • • • • • • . Does proposed construction violate any zoning law, ordinance or regulation: . . . . . . . . . . . . . . . . . . . . . . . . • . . • . • • • • • Will lot be regraded 1�.c? . . . . . . Will excess fill be removed from premises: OYes!7 tQ' Name of Owner of premises ,�2hNu$ Ill i.�. . • • • Address 555�ml77t, ,RQ; , , Phone No. . . . -Architect . Address Phone No. . r ;'.:;ue of Contractor �rh)i/iRQNrn ;V7 ,Frfl¢'T; . /NG. Address pP. .l.`«,� . o . . • :phone PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and,indicate all set-back dimensions from,. arty lines. Give street and block numb�r or description according to deed, and show street names and.3ln,!licate whether rior or corner lot. •/• � , `[t it I, � 1 { I, r i TE OF NEW Y [ S.S II' INTXQF ' �} y applicant (Name Of iridivt� d i mtrS cov r. . . . . beingduly sworn, deposes and says that he is the g �itracR) c named. ' { ; . . . . . . . . . . . . . . . . . . . . . . . . :. . . . . . . . . . .. the . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , (Contractor, ag'tit, corporate officer, etc.) Id owner or owners, and is duly autljorize o per orm or have performed the said work and to make and file this [cation; that all statements contained in this application are true to the best of)tis knowledge and belief;and that the will be performed in the mawler— et forth in the application filed therewith. m to before me this % it 2c9A y of. . iry Public, , . . . County ROBERT SCOTT JR. r. . Notary Puglia tote of ew York re of applicant) puslNisd in uffolk Courtly Tim1 Nitrpkeell ri !!V u Z�tw�uv, W7.1 tt�, rr j It j 44, t ot! 41 A 4 V 17- 'it t' 7t 7 to f i 4P ,l—Mw,AA,. I k 1�zl t 4 t7 if TO PON WO, A.4 it ts (*tAp4t-,A L)N a�s it F A% O.Omzt4 UM -, 'Imm 4 7 I� A�' L to I Jll C 41 7 T, fr.&Ft r444-Soll'0-0 A16V�r 7 Qjo w Z Ito tl *M, AA wvlw 107 'it A ANN j I-, I � "`:,� 777 lAr- 40" T o 7 7 f , y . , Pfw yb T`(�F , • b — _ . t SC tip wr f \ i � VwT, ,,rJs" e 4 ,1 i� �1uN' .i. ` . 5 t tq Ov A vim} c K Dy} r y'�LLTe a\ h _. ' - - V �1♦ '' "-wr�.w+r. 5'.Lz 3+�. �:5." y..,,i +�._4,:...! z;Z:E a iMIMY�JwJJ•wlr u1n1•.-' + - • 4MIM w•1' _ Moowiw J J i. y.� �,�* F ��\'�l` V fs'(A'�"'�.i � 4-^�.�n��^"".i� F 4'�^r, 1b•�1'T^1 Tw�'f„ 41 . .� Its t2 . 097 APP RA • SCALE: BY: -. 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' v , �. �.,. ti.,.r_.,.�..._u.._ -,s . :., ,. „_.._-.._. x,xlwar,.,.,,..,..e..-.tet_�.:. ," y.. ,'�'_ „.. -:.,. ,,.,, ..,�. _,_. „ ,. kms``' ^a:.',N_,,...�'�.•_N,,,..,_.._,�.x.•_., < . , a „�_..�v, _.,k,.,,-.7 _ sa: __fir:- .,.,-._ ...,.,-�--'....._ �.,.,,___-...��_...,,,_��.�_.,.�w._.,,w�r..'4..u`�,_..3.+�"..�......ur,,.ry„rs_„��,..s.. :..,:_,c._l�,$.�.,.. __...,,e-,�#' vm�,_,'tr-�5 rw: .�,ri�. F a r• _ r ex2,8 i�lD6E T exi�'�', �. � © ' `+� ► .._., hit C N C:E 5 -- # "1't F Nrl r _ *t i2 , CLIfS Ty?, Ar 4 _ . . . .x0400C>eN 6r- W Su��T-tN 1514. R —141 t � C � �` '' ice'L.1NC� a l__4 • •Sw['i' . f !, --.—+ ,a.�-r ^ .....u.... «..,..-t+ '''j} ...f... -..iw,+Mni.rfe'} { 1 i fl_.k 4.e \ 1 G's t"+ e 7 CCA Ns COA "f .. t w 4 I I ► il " s:.+-t ' 6 A' t i t r �° F'C "! UNDERWRITERS CERTIFICATE REQUIRED OCCUPANCY OR USE IS UNLAWFUL r. WITHOUT CERTIFICATE, - OF OCCUPANCY N AM 1M i !M !M M.. , FOUVAUS PON 2. Mow 3. INSUL,�ON 4 _BE COMMfTE FOR C�O� MUiT �► : ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. r STATE CONSTRUCTION t ENERGY CODES. NOT RESPONSIBLE FOR I S DESIGN OR _ON ERRORS rol ,...rte. -•�= , t� C-TUfke Res<mLv 1 P c,r�.•.t t ."': _150 AMP RA $CAL.-g: �� 't t� r �tr �,�� tflliK�IP� Af TA } I At40A - - _