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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-24428 Date JUNE 13, 1996
THIS CERTIFIES that the building NNW DWELLING
90 BAYHAVEN LANE &
Location of Property 10870 MAIN BAYVIRW ROAD SOUTHOLD NY
House No. Street Hamlet
County Tax Map No. 1000 Section 88 Block 4 Lot 26
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 12, 1995 pursuant to which
Building Permit No. 22794-Z dated JUNE 1, 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 A ONE FAMILY DWELLING WITH ATTACHED GARAGE, DECK AND OPEN
FRONT PORCH AS APPLIED FOR.
The certificate is issued to JULIA, JOHN L. & JOHN M. MCCORMICK
(owner's)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL-RIO-95-0023 JUNE 5, 1996
UNDERWRITERS CERTIFICATE NO. N365478 OCTOBER 4, 1995
PLUMBERS CERTIFICATION DATED OCTOBER 4, 1995 LARRY LISO PLUMB & HEAT
Building Inspec r
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)
Date 19.
Na 22794 Z
Permission Is hereby granted to,
.Q:..... 15.va
17
to z: ~/w - W. Ilia
../....c.-.....?.t
at premises located at.....'o......xz `Gl~rt 1....,~ l~ Z (
County Tax Map No. 1000 Section CF9....... Block ...T Lot No. ~v.................
pursuant to application dated ..........1/ and approved bythe
Building Inspector.
Fee "d i.(14 !u~e-
......1.....
Building Inspector
Rev. 6/30/60 .
Form No. 6
TOWN OF SOUTHOLD ~
f~ D
TOWN
BUILDING
HALL
~JUI~ 765-1802
BLDG.DEPT
TOWN OF SMOLD
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 1% 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 Buildin¢ - $100.00
3. Copy of Certificate of Occupancy - $20.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date Q ..30.. 1. 22 S
New Construction........ Old Or Pre-existing Building
2.4..... :.....3.IV r~. Sa fF~~
Location of Property........
House No. Street Hamlet
Onwer or Owners of Property..........
County Tax Map No 1000, Secction.... .~jj f~ ~......Block...... ./..f Lot.... Zj°
Subdivision.. ~9Yft}4/Y~(! Kl Filed Map............ Lot......................
Permit No..Z2~ 9 • .2--.Date Of Permit.., /.%r • .Applicant.g..(.Ch1;r 4 • • +
Health Dept. Approval ..........................Underwriters Approval...`
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate.;Ik .
ac
Fee Submitted: '
?2 ° SI ~f33 . . .
/pry APPLIC ANT
INSPPCTORS
l~gSUFFe(
CI
0
SCOTT L. HARRIS, Supervisor
Southold Town Hall
Thomas Fisher w • ^i P.O. Box 1179, 53095 Main Road
Building Inspector W
Gary Fish Southold, New York 11971
i ~O Fax (516) 765-1823
Building Inspector Telephone (516) 765-1800
i
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
C E R T I F I C A T I O N
DATE:
Building Permit No.
Owner: ///-Z-O/W..z 6'n4lo
(please print)
Plumber: lffl//Lfy4&-&Ve V- 17E 741K'
please print)
I certify that the solder used in the water supply system
contains less than 2/10 of Iz lead.
Plumbers SP n turd e
Sworn to before me this
q day of 04*xe5 Z 19'?
Notary Public, -r4l,5zv /#-IC County
DOLORES L LISO Notary Public
Norwy PuWA Stab of NW York
Suffolk County • No. 4841022
CommISSlon Wray Oot 31,
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1135021 BUREAU OF ELECTRICITY
85 JOHN STREET. NEW YORK. NEW YORK 10038
Date OCTOBER 04,1995 Application No. on file 88798395/95 N 365478
THIS CERTIFIES THAT
only the electrical equipment m described below and introduced by the applicant n unedon the above application number in the premises of
MICHAEL PISACANO, MAIN BAYVIEW & BAY HAVEN, POLE LIL 13, SOUTHOLD, N.X.
in thefollowing location; ® Basement ® Ist Fl. ? 2nd Fl. OUT Section Block Lot
was examined on SEPTEMBER 22,1995 and found to be in compliance with the National Electrical Code.
FIxTURE ECEP7AClE5 SWITCHES NXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS ±
OUTLETS INCANDESCENT FlUptESCENT OTHER .VAT K.W. AMT K.W pai K.W nMi K.W. AMT. H.P
27 36 29 26 1 1 6.8 1 1.4 3.. F
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS '
AMT. K. w. OIL H. P GAS H. P AMT NO A W G AMT AMP. AMT. AMPS. TRANS. AMT. H. P. SYSTEMS
NO. OF FEET "I. WATTS
1 F 2 - 1
SERVICE DISCONNECT 140. OF S E R V I C E
METER NO. OF CC COND. A W. G. - A. W. G ' A W G
MAT. AMP. TYPE GOUIP iA1W 103W 3%3W 3% W f CC Of CG COND NO. Of NI-lEG t OF HIAEG NO OF NEUiRAt3 O NEUTRAL
1 200 CB 1 X 1 2/0 1 2/0
OTHER APPARATUS:
WELL PUMP-1
MOTORS:1-F H.P.,1-2.0 H.P.,1-F H.P.
PANELBOARDS:1-1 CIR. 60
G.F.C.I:-3
SMOKE DETECTOR:-1
THREE "C" ELECTRIC LIC.#3327 E
RT. #1, BOX 45M
SOUND AVENUE G RAt M$NAQER
RIVERHEAD, NY, 11901 11 <
' Per
This certificate must not be altered in any manner; return to the office of the Board if incorrect. inspectors may be identified b'. it ciedentiulS.`
Y 'the
O~OgOFFO(kco
o~ Gym
y x
Town Hall, 53095 Main Road p • Fax (516) 765-1823
P. 0. Box 91971 yjhOl ~aO~ Telephone (516) 765-1802
Southold, New York 1
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
October 30, 1995
Mr. Michael Pisacano
P.O. Box 40
Jamesport, NY 11947
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
not on file. (Enclosed)**
No Underwriters Certificate on file.
xx The check is not on file. $25.00
xx 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 # 22794-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
- NEED $48.00 FOR AMENDED DECK PLANS. ALSOO DETERMINE WHICH
SIDE & REAR YARD.
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] WLATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] I ULATION
[ ] FRAMING ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: me)
DATE INSPECTO
765.1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] 1 LATION
[ ] F G [ --FINAL
[ FIREPLACE A CHIMNEN
REMARKS: sbm_~~ -
_ o e3 '-'o 0,o, 4~g
DATE INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ J RO PLBG-
[ ] FOUNDATION 2ND [ INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLAC HIMNEY
REMARKS:
G_ "2 V DATE INSPECTOR
M-1802
BUILDING DEPT.
I NSPECTIO
[ ] FOUNDATION 1ST [ ROUGH PLBG.
[ ] F DATION 2ND [ ] INSULATION
FRAMING [ ] FINAL
[ ] FIREPL CE S CHIMNEY ~'o'~'/o~5~oec.
REMARKS: 6daa&-P,~ (o. y
DATE f INSPECTO
M-1802
BUILDING DEPT.
INSPECTION
[ ] F UNDAT{ON 1ST [ )ROUGH PLBG.
[ FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLAC CHIMNEY
REMARKS-
r
DATE INSPECTO
7~4
M-1802
BUILDING DEPT.
INSPECTION
[ ]L FOJJNDATION 1ST [ ]ROUGH PLBG.
[ OOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLAC 8 CHIMNEY
REMARKS:
DATE INSPECTOR y
2"
7C~5-180
BUILDING DEPT.
NSPECTION
[ FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
G.
REMARKS:
OLr ~ ~Grr '
DATE 15 INSPECTOR
FIELD INSPECTION REPORT DATE COMMENTS
-------III==----- i Q- -
r
y
FOUNDATION
FOUNDATION ( 2
~I
11f X
ROUGH FRAME fi
PLUMBING II ii
I~ it Y
II y
"I 140
c
INSULATION PER N. Y.
yl n,,~
STATE ENERGY
CODE u
u it
-~I II'' / ~.CS O I~
2
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6ve
FINAL n -"I
11
ADDITIONAL COMMENTS:
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BOARO.OF HEALTH
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FORM NO.1 3 SETS OF PLANS
" TOWN OFSOUTHOLD SURVEY
MAY BUILDING DEPARTMENT CHECK . .
2 {995 TOWN HALL SEPTIC FORK
- SOUTHOLD, N.Y. 11971
TEL.: 765.1802 t:OT I FY ;
tCALL
Examined! , , , , , , , , , 19 MAIL TO
79
Approved / l rmit No.
Disapproved a/c
( ild' a nspector)
APPLICATION FOR BUILDING PERMIT
Date f.?......., 19 q1s
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 19cation 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-
s- cation.
c. The w Wk 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 inspectio ' .
- (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.
Grvw~14
Name of owner of premises ...1 !4(C fI.CtS AGA?~G9
(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. .3.3r2.. 7 . F......... .
Other Trade's License No .
~19~/Ul~y{
1. Location of land on which proposed work will be done. W OF
House Number Street Hamlet
County Tax Map No. 1000 Section ...:.?r Block .....7 Lot a ~
A h
-Subdivision . . . .
. Filed Map No. Lot
(Name) ,
state existing use and occupancy of premises and intended use and occupancy of proposed construction:
.IaC~-
,Existing use and occupancy
V .
. .
\Eended use and occupancy
3. Nature of work (check which applicable): New Building Addition Alteration
Repair Removal , Demolition Other Work .
(1?escription)
4. Estimated Cost . Fee . i
5. If dwellinn (to be paid on filing this application)
g, number of dwelliIts , . , Number of dwelling units on each floor .
If garage, number of cars ....~/,y,,,,,,,,,,......................................................
mixe
6. If businessHeight commercial or Nud occupancy, specify nature and extent of.each type of use .
7. Dimensions of existing structures, if any: Front Rear Depth
.
mber of Stories /11 .
Dimensions of same structure with alterations or additions: Front .,?2r Rear .
Depth Height /-01 ; _ Number of Stories .
8. Dimensions of entire new construction: Front ....7. , Rear . Depth F
.Height /7. Number of Stories • .
9. Size of lot: Front .....I79, Rear.... l$ ~i De th .
10. Date of Purchase Name of Former Owner .:?.!7t W ~
11. Zone or use district in which premises are situated . . • .
13. Will Does proposed construction violate any zoning law, ordinance or regulation: . . . .
Owner e . , i • ' ' • • . • • Will excess fill be removed from premises: Yes 40
14. Name of f regraded
Pr ises Address . Phone No. 7, f~37
Name of Architect z!uK?/ , 14-wraw?: , . • , , , Address Phone No. V?.? <,,y4:
Name of Contractor . , "aW f~- , , , • , • • , , , . Address Phone No.
15. Is this property within 300 feet of a tidal wetland? *Yes........ No.?.0
*If yes, Southold town Trustees Permit may be required. 1
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from 1
property lines. Give street and blockjnumber or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF NEW YORK, !S S
COUNTY F .
C-,~Pfz • • • ! , 9• • . • ~ being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the .....OW NrsY1. AC",.............. .
(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
?......dayofl...°.\ .........,191.
Notary Public, .
County
JOYCE M. WILKINS , , . .
Notary Pugtlo, to of New York (Signature of applican
No. 495248, Suffolk Cou
Term fxOreaJune 12,15
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Unausw,,.e, w,,,auon or add'nion
to this survey is a violation of
Section 7208 of the New York State WGIG~ A
EdueWon law. W"4
M~ISnO~irasryori Inkb wl or~n0 .
emhoated eeY NaN rglMmrwldered ~ ;
to be atMd awOW. ~
auerMeeee Yrda:ele0 hwwn a1W rue
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=g=and ~rwM
990 4 VINNIay, 901AMMenOl agnay and
lendktp Newd Iaswon W
b M ndYraeesMtkutionof M lardnp krtlaNon.
Guarantees we not aansWW*
to additional institutions or subsequent ~gE 0 LAN O
owners. 4& S
vG LE G'9d•
S~vY,S:.~CV. r.: ,1YdY.» /h>dLL Lat.V)iwv Yr~iaye"•v~ .py.',y p,~ Jrs:y~;mS E'
_n/rr rte' Ui~ s ^ /6? ° m. of o Q
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4uga~.vv~ea Tv•T/com? Tires ~~v_ , 9~cECo, 9 F ~~9g
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pro SUFFOLK CO11NYY WARTMEW OF WAIN $EAMES
-f MR APPRWA6 OF CONU NlCTION OF
APR
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N8 REF.
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SUSJECY YO COVENANTS R AESTNOTICNS LIS R.»j... 4
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I am familar'with the Standards for' WV-44.
Approval and Construction of Subsurface w
Sewage Disposal Systems for SingLaPamily
Residences and will abide by the conditions;
set forth therein and on the permit to
construct.
,ED LANO`pG
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PLUMBER CERTIFICATION
ON LEAD CONTENT BEFORE
CERTIFICATE OF OCCUPANCY
SOLDER USED IN WATER
SUPPLY SYSTEM CANNOT
- EXCEED 2/10 OF 1% LEAD.
C1 N eeppw tWnO k ussd
Mh"C WWoO NWI be .
- ohYrKa
I~
1E, I LE
AEGIIIRFDIr+RE ELEVATE HEATING ~c
APPLIANCES IS" AS MAY 12 199.5
AS NOTED REQUIRED BY PART.
DATE: 717.3 (d (4) OF E: M S.P. 4 N.Y. STATE BUILDING CODE. -
OCCUPANCY OR fEE.
cFe. y nsF IS IINLAWFUL .57X2 -
NUIltY WY MUILVIMU VcrnVKLI ~-Nv "
WITHOUT CERTIFICATE 765.1802 9 DUILVIMUAM T[ -1802 9 AM TO 4 PM FOR THE P7L~
OF OCCUPANCY FOLLOWING INSFEI 'E. FOUNDATION - LOWING INSPECTIONS: 'OUNDATION - TWO REQUIRED
FOR POURED CC 'OR POURED CONCRETE ENMEIR7 IMM AS
2. ROUGH - FRAM'. TOUGH - FRAMING & PLUMBING KIK9 NY N1~K 714 of
$ MSULATION NSULATIf7'~ N.Y. STAIE MIWK cool.
a3. F1hEtn1 - COR RE COMPLETE F, CE FOR t -0- MUST ;e C OSViT _ C-0-
' - ALL G;ONSTRUCTI( CONSTRUCTION UCTIOM1f SHALL ME=ET
. TRr REOiIIREPu]EN REOUIREMENTS OF THE N.Y.
FATE CONSTRUC ,TE CONSTRUCTION & ENERGY one 477.0400 Mni1r Road
-.0 NOT. RF 5. HOT RFSPONSIBLE FOR
08 CONSf .o OR COJVs(-RUCTION ERRORS DO NOT FROCEEO WITH iSREFNPEtk-T[ N.Y:. 11944 - I
FRAMING UNm SURVEY
OF FOUNDATION LOCATION 1 kk~l ~ti 1i 93
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BPPl111NCE518"AS
NEQDINED BY PANE. erees tiw
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