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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-23896 Date SEPTEMBER 19, 1995
THIS CERTIFIES that the building ADDITION & ALTERATION
Location of Property 3075 OREGON ROAD NATTITUCK NY
House No. Street Hamlet
County Tax Map No. 1000 Section 100 Block 2 Lot 7
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 3, 1995 pursuant to which
Building Permit No. 22709-Z dated APRIL 28, 1995
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 ALTERATION & ADDITION TO AN EXISTING ONE FAMILY DWELLING
AS APPLIED FOR.
The certificate is issued to RALPH & ANN BADAGLICCA
(owner's)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N362856 SEPTEMBER 7, 1995
PLUMBERS CERTIFICATION DATED SEPTEMBER 11, 1995 PERFECTION PLUMB & HEAT
? t
B din Inspector
Rev. 1/81
N
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-23897 Date SEPTEMBER 19, 1995
THIS CERTIFIES that the building ALTERATION TO ACCESSORY
Location of Property 3075 OREGON ROAD MATTITUCK NY
House No. Street Hamlet
County Tax Map No. 1000 Section 100 Block 2 Lot 7
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 3, 1995 pursuant to which
Building Permit No. 22709-Z dated APRIL 28, 1995
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 ALTERATION TO AN EXISTING ACCESSORY GARAGE AS APPLIED FOR.
The certificate is issued to RALPH & ANN BADAGLICCA
(owner's)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N362856 SEPTEMBER 7, 1995
PLUMBERS CERTIFICATION DATED N/A
Bu lding 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) pp
N2 22709 Z Date .......4......4 ............!!77:'Q........................, 19F~./
Permission Is hereby grante T p
/ ~ s.....r x
to
~.~J,...........~......1......`.... ......,/1(.. e......
44
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a fIwp. 9.5~ ~.........C-....~'...........
.....k...................
~s
e. . .
1
a's.....,-................,.,............
at premises located at........ ~~4•5 G?y•••1..~.••••
?'I.., c..,. '.S G,........................
County Tax Map No. 1000 Section .....(...Q..4/....... Block Lot No....
pursuant to application dated ...............~~/L(.0.... 19..J.:.~and approved by the
Buildirlg_Insspector.
Fee $.....L.. Z..
Building Inspe r
Rev. 6/30/80
3>q
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT SEP - 8 ~9g5
TOWN }TALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OR ink and submitted 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, L'uildine - $100.00
3. Copy of Certificate of Occupancy - $20.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Reside a1 $15.00., Commercial $15.00
Date
'dew Construction........... Old Or Pre-existing Building ...............~q.,.~
Location of Property.1~7..........2~F3h..,_ ..............!:lIt,/ .t/C .C.......
House No. Street Hamlet
Inwer or Owners of Property./. 6 N 1;&K. Ali N 10GIw
7ounty Tax Map No 1000, Section.. Block ~.,........Lot ~
>ubdivisi.on ....................................Filed Map............ Lot......................
;,ermit No..~ Z?b. r.. Z..Date Of Permit ................Applicant.............................
lealth Dept. Approval ..........................Underwriters Approval.........................
'lanning Board Approval
tequest for: Temporary Certificate........... Final Ce~-late
-ee Submitted: '
Rwir-150l U3 ,
1 /-a
, Wf, s ~~389t~ .3$q7
TEL. 765-1802
~vaamr
0 S~FFULkCpGy~ TOWN Or SOUTIIOIA)
OfTICE 01" BUILDING INSPI'sCM
o a P.O. BOX 728
u°, r^ TOWN HALL
+0 t SOU'I'I TOLD, N.Y. 11971
C E R T I P I C A T 1 0 N
Dat62~
Building Permit No.
Owner.Gt 1- 1
tplea. ((mint)
1'lUntbel~~t-{_eC.IOA "Y'Vrw6~Y+ ~-~?a.1~?wj'
(please print) 11
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
(plumber's signature
Sworn to before me this ~
day of - -
1951-~- Notary Public
Notary Public, ~1o u n t y
Ybok
No. 49441508
OMMINW EO" t N,~
o~o~~gpFFO~~-~ y~
G
N x
Town Hall, 53095 Main Road p • Fax (516) 765-1823
Telephone (516) 765-1802
P. 0. Box New York 9 11971
Southold, N
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
August 29 1995
Burger Construction Inc.
P.O. Box 934
Cutchogue, NY 11935
Re: Ralph Badagliacca - SCTM#1000-100-2-7
Prem: 3075 Oregon Road, Mattituck NY
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)
xx No Underwriters Certificate on file.
?xx The check's are not on file. $25.00 each.
No Health Department Approval on file.
No final inspection has been made.
?xx No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT #22709-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
- 2 CO'S REQUIRED FOR THIS PERMIT. ONE FOR ALTERATIONS AND
ADDITION TO HOUSE & ONE FOR ALTERATION TO ACCESSORY
GARAGE. PLEASE SUBMIT $50.00 FOR BOTH.
FIELD INSPECTION REPORT - - II DATE II
COMMENTS
77
FOUNDATION IST9' _ _ i it Q _ y!
o n ~
II II
II it\
II II 1
FOUNDATION (2ND)
l
"Zoe
ROUGH FRAME 6
PLUMBING
n
{I~9S czc
INSULATION PER N. Y. N If y
STATE ENERGY
CODE ii II
ii II
0 II
It ii
II II y
Ii II
II II
II II
FINAL Ii II
11
I II
O
ADDITIONAL COMMENTS:
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M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] UGH PLBG.
[ ] FOUNDATION 2ND [ INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: 0-/C-
S""`~
DATE INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ F MIND [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE INSPECTOR
765-1802
BUILDING DEPT.
NSPECTION
[ FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:.21af
DATE INSPECTOR
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1001071 BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
pate SEPTEMBER 07,1995 Application No. on file 88503095/95 N 362856
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
RALPH BADAGLIACCA, 3305 OREGON ROAD, MATTITUCK, N.Y.
in thefollowing location; ? Basement ® Ist Fl. ? 2nd Fl. OUT Section Black Lot
was examined on SEPTEMBER 01,1995 and found to be in compliance with the National Electrical Code.
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS ECEPTACLES SWITCHES INCANDESCENT FLUORESCENT OTHER AMT. K W. AMT. K. W. PMT. K W, T. K W T. N. P.
3 11 7 3 1 6,8 1 1.5
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIALREC'PT TIMECLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
AMT K. W. OIL H. P OAS M. P. A. NO. A. W. G. AMT. AMP AMT, AMPS. TRANS. AMT H P SYSTEMS AMT. WATTS
NO. OF FEET
2
SERVICE DISCONNECT NO. OF S E R V I C E
AMT. MAP. TYPE METER T R 3W13 %3W 13X 4W NO. OF CC COND A W. G. NO. OF Hl- NO OF NEUTRALS A W G'
EQUIP. PER % OF CC. COND. OF MIIEG OF NEUTRAL
OTHER APPARATUS:
PADDLE FAN-1
MOTORSEI-F H.P.
G.F.C.II-11
TRACK LIGHTING:-24
G & S CONTRACTOR LIC.#578-E
BOX 215
SOUTHOLD, NY, 11971 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 DUILDIN6 DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1001071 BUREAU OF ELECTRICITY
F 83 JOHN STREET. NEW YORK. NEW YORK 10038
Date SEPTEMBER 9.3,1995 Application No. on file 10094295/95 N 363359
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
RALPH HADAGUACCA, 3305 OREGON ROAD, MATTTTUCK, N.Y.
in thefollowing location; ? Basement ® lat Fl. ® 2nd Fl. OUT Section Bloek Lot
was examined on SEPTEMBER 05,1995 and found to be in compliance with the National Electrical Code.
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS ECEPTAGLES SWITCHES INCANDESCENT FLUORESCENT OTHER AMT K. W. AMT K. W. AMT. K.W. AMT. K. W. AMT. H P
5 A 5
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL RECTT TIME CLOCKS EEII 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. MAT H. P. NO. OF FEET AMT. WATTS
SERVICE DISCONNECT METER S E R V I C E _ NO. OF
AMT AMP TYPE METER 1 /s 3W 1 0 3W 3 a 3W 3.0 4W NO. OF CC COND. A. W.O. NO. OF HI LEG A. W G
NO. OF NEUTRALS A. W G.
EQUIP. PERK OF CC. COND. OF HI-LEG Of NEUTRAL
OTHER APPARATUS:
G. P.C.It^1
t9" t
G & S CONTRACTOR LIC.#57II•-E
HOX 215
SOUTHOLD, NY, 11971 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.
apwaiimou Fyh l nwcs "t y!~' jr°
644111101 m ~n7y0lr C6001A
BOARD OF HEALTH
1411)'•13\1202
WWA6WI!iC' G-"46010611M 3 SETS OF PLANS
Bfvibif CIDA FORMNO.1 SURVEY
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL
SOUTHOLD, N.Y. 11971 N o
TEL.: 765-1802 CALL In~r• 7J~ J ./7.
Examined 19 j MA L T0:
Approved 2.d 19 5. Permit No.
Disapproved a/c ; j
I~ « 11
(Buildin. • , ~ BLDG. DEPT. L
Spector) k TOVity OF SOUTHOLD 2
A P ICATION FOR BUILDING PERMIT ~~F K V
Date .`3J /
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 accotding 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 Countyi New York, and other applicable Laws, Ordinances or
ReVI ions, 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, build' de, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary ins t' s.
(Signature of a p scant, or e, if)a corporaIwn)
(Mailing address of applicant)
State whether applicant is owneellessee,aageent, architect, engineer, general contractor, electrician, plumber or builder.
/..1
Name of owner of premises ~~/,/1~}?• • f~(j L/GC
(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 ddone:
house Number . S! .........1/..
Hamlet
County Tax Map No. 1000 Section /op Block 2 -
Lot........
Subdivision Filed Nlap No. .
.(N~~ncj~ Lot
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing
use and occupancy C__ S! . , , •
.
b. Intended use
use and occupancy •
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~G„' F fl CERTIFICATE DATEB.P.# 70
VVI THOUT FEE Sis~ BY
pp[~.~~.+~~pngpgapq9~y NOTIFY BUILOAG DEPA
' u 0'."CU i-YA CY 76$-1802,9 AM TO a RIBA FOR THE
EGLLOLM9IVG INwPp{; i f(,}iua.
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- (7,6Ia3:}!1fF BW"a~ix~iC4 lfiT Ow-w4k lance, 5r' zµ ~ ~ MEW' - - BE COMPLETE Gil-. I; U -
ALL CONSTRUCTION <,HAI L MEET TIME REQUIREMENTS Or ME N Y
STATE CONSTRUCTION 1L ENERGY
uN~E~'~~N k~ ' CODES. NOT RESPONSIBLE MR
' - - FY+~va~ Hsi- xDl4rxY-"? ul+NCt+ul " ' 3).ST rwi DESIGN OR CONSTRUCTION £RROF
NO W PLUMBING
ALL PLUMBING BASTE
_ $KI4t'Nk~ & WATER LINES NEED
- ( - TESTING 13EFoRE COVERING
PLUMBER CERTIFICATION
rt3" : ON LEAD CONTENT BEFORE
rrs CERTIFICATE OF OCCUPANCY
1:t' I SOLDER USED IN WATER
r6~ ~ i' ,,i}.' ~ r?bsoMabtr~'f"rrl~,5 SUPPLY SYSTEM CANNOT
EXCEED 2110 of 1% LEAD.
If COPPSr tubing is used
fOr water distributing
Tom` -'totem: Dieing Shall6e of types K or l only
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