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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 2-25016 Date MAY 6, 1997
THIS CERTIFIES that the building NEW DWELLING
Location of Property 385 OLD FIELD COURT MATTITUCK, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 120 Block 3 Lot 19
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 10, 1995 pursuant to which
Building Permit No. 22789-Z dated MAY 24, 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 ONE FAMILY DWELLING WITH ATTACHED 2 CAR GARAGE AS APPLIED FOR
The certificate is issued to EMIL & ALBINA BORRUSO
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL-RIO-95-0048-APRIL 25, 1997
ELECTRICAL CERTIFICATE DATED DECEMBER 1, 1995 - #9061
PLUMBERS CERTIFICATION DATED OCTOBER 4, 1997-JOHN A. DEACY
it ng 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)
Date C........ 19../
NP 22789 Z
Permission Is hereby grant d to:
....P
~
to..4., erl~.......
,At..>~ ........~..ecz2 4......C....
1194.
.....................................................................................I.~./.
at premises located at...,..... . p..J.......cn4 • • • •..(..../...?~~GG/~ ....i
~..L!.t.... y..............,.............
County Tax Map No. 1000 Section ®~..~~~.yyyBlock ........q..... Lot No. .
pursuant to application dated r./to.•. 19...(...~ and approved by the
Building Inspector.~
Fee $..6.w...
* Building Inspector
Rev. 6/30/80
C9 T~,
.o„~ 0= soy .HOB k k,
p
TOWN OR 281997 44
TOWN
65_18C2
r BLDG. DEPT.
TOWN OF SOUTHOLD
000L? ..1C`_'
D.__.O\ ?0$ OF
_._es aoo__c suss be by 7-"Dew :.::a=, OP. laic and ssbm_:=-_ :o :,a bucic_a=
-nsnec:or w_:h :he :oi!o._ =or new ouzic_ag or new use:
i-.a_ survev Of 7rcoer:7 w_=a accurate location o= all buiid;rgs, roper=v -_nes,
sr==_e:s, and urusua'_ nanura_ or :opoeraphic =eacures.
-_,al 2DDrova_ __om Heal:- Danz:. of weer sL•Dnly and Setae=age-Q1SDCSaI ;C_C = --MN.
3DDr^ova_ of -__-=__cal _as:a__z=icn r:om Boa-` 04 Under- --Zze=s
Sworn s==amen: =rom 7iumber czar =he solder used v_sn_ con=accts
less chin 2110 of lead.
Comae:c=al Indus=rial OL'_idi=g, mL'1:=71e =es_dences and s:L3=_ar ou=C"223
and ns:a_iaL1Cn5, a cer7_=cca:e of Code Comoilance =ram or engcneer
r resDOns=018 =0r =he 'au_41 d-ng.- of _ _
Sub, z P- --n2 Board 2pp:cv` c= compi azed set: -j-,an reou_:~ena.
t. .,r _.:iscing cui~c cgs (7-_o_ :w pr=- 9, 1957? Hon-con=Orsiag uses, bu__ccag_= and
r ---eacs~_ g land uses:
accurate survev o_ ,roper=-,- show-gig ail -roper:- -imes, s:ree=s, bu_icng anc
unusual na=oral or -opograDnic =aa:uras.
j% D=ooerly comDla=ad aav icacion and c consan: =o =nsvec: signed ov :he aDD-icanc.
c Car:__.._a=. CC uzenC7 denied, :_-le 3u:.-d----g -nspeC:0. snap s:a:e =he
reasons _aer°_O_ 4-- :w tae
Occuaaacv - New dwe_lzng. S-_3.00, Add-=ions :o dwei. mg
Gwe_--..> >.-CC: S"^.,ZIl1ng 700_ 523-00, CCeSSO_; OL__.._ng
3ddi:ions accessory build ig 525.00. 3us'nesses 550.00.
Car____ca:a^o= OccuDancv on Pre-=_c_sciaa 3u_'c_as - 5100.00
Copy O= Cer=c:__d:_ of Occupanev - .25c
undated Cer:-_ica=a Or Occuza=7 - 550.00
-amporary of Occupancc - Res. en:_e_ 515.00, Commexca_ 5'_5.00
iew Cons=rucc_on....". ~i 0_c Or Pr-ea_st_ng 3u_1c_ag .1
oca=ioD or ?raper=y. 3'85' OLD iy-l d C r 1fY? ~~.K A I l q~ Z
House No.Screel namier
of LAM t C 4 f)L 3/ N ii 13 o R R z+ S o
iawer or Owners o --oiler:y .
,our.:y x ail No 000, Sec=lea.. .......3iock ..........Loc....!.
uocaviscon i_ad ~,a7............ loc......................
~ar=-: NO...... Of ?e-
Deo:. pproval .....Umde=-w-t:ers :ova..........................
3carc oprova_
e~ueSL _amocrar_ ..2_- a........... _=1~ Ce °_:a--...........
STATE OF NEW YORK )
) SS.t
COUb'TY OF SUFFOLK )
I. Jou,Sa ~(aGC•1 being duly sworn. depose
and say that I am licensed as a MASTER PLUMBER in accordance with the Occupational. .
Licensing Law of Suffolk County. New York, and have been issued License Number
having an expiration date of
That the material and work installed in conjunction with Building Permit Number
"l, Z issued by the Town of SOV'TJ-WChAS Building Department for the
structure located at'J1umber N S E W side
Distance N S E W of
Village . State of New York, is in
full compliance with the State Building Construction Code and all other applicable
laws.
That this affidavit is made pursuant to the requirements of the Town•of S00-V OLD.
Building Department in connection with the issuance of, Certificate of Occupancy/
Compliance for this structure.
Print Name
(Signature)
Sworn to before me this ,
day of 199
Notary Public
CAROL L, 1RVTN0
Notary Pubtie, State of New York '
No. 4867673
alified in Suffolk County
'WOO Expires Apr. 24 1
s 1
i
c e (516) 286-6642 ELECTRICAL INSPECTION SERVICE INC,' ' " .
375 DUNTONAVENUE ,
• c _ EAST 1?ATCHOGUE NSW YORK 1172
9d6,'
,APPLICA'T'ION NO ON FILE
I - c DATE: -12-1-95
ADDRESS: Lot #19 Farm Veu Develop. VILLAGE: Mattituck TOWN: Southold
ISSUED TO: Ray Hartman
INTRODUCED BY: De Lane Electric LIC. NO. 4354
c ° AREAS LISTED WERE INSPECTED ON: AND WERE FOUND TO BE IN COMPLIANCE WITH THE
' =aQ~~ r k• i ~T~k~,~ONf~G,ELEGTIAI~ CO7?~x~,,,.( ,v , - r
LOCATION. SASE got IST -2E -2ND 3RD ?2 ATTIC -POOL
c ° OUTSIDE, RES.
32 SWITCHES 2 SMOKE DETECTOR -DETACHED GARAGE
c° 54 RECEPTACLES 1-RANGE 3#8
c° 26 FIXTURE/OUTLETS 1-DISHWASHER 2412
2 EXHAUSTS I-OIL BURNER 2014
3 G)FI
1-209iP,WASHER11-~OAMP DRYER
- SERVICE DISCONNECT ' v
s ° EITERS, 2,1 S AMPS P - SE - ' tt s >
w s f 1 4 11 j .4 1! " `t'
1. 200m,
n
THIS CERTIFICA' i MUST NOT BE ALTERED IN ANY"MANNER ' HUGO $,.SURDI
c INSPECTORS MAY BE IDENTIFIED BY T)IEIR CREDENTIALS, ' ' pRESIDENT
a"Ogo "Og
° ° t
N V V V Y V V
` 1. ..i t a 4 t w f t
_ ~ .t -a.. .i-..c. .....i n'.-. n n ,.a.. )L. nl.-w .-.u ..tea .<..a_- .
o~gOFF011r
c~ G~2
CAR x
Town Hall, 53095 Main Road p • Fax (516) 765-1823
P. 0. Box 91971 Telephone (516) 765-1802
Southold, New York 11971
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
June 6, 1996
Mr. & Mrs. Emil Borruso
P.O. Box 921
Mattituck, NY 11952
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 is not on file. $25.00
xx 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 # 22789-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] IN LATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
II
DATE INSPECTOR
765.1802
BUILDING DEPT. G~
INSPECTIO '
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
/ck<-
[ ]FOUNDATION 2ND [ ] INSULATtO
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
i
REMARKS:
3
- hs T
DATE ZY INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] IN ATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: - T `
,
DATE i INSPECTOR .
~J C
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ I R H PLBG.
[ ] FOUNDATION 2ND [ INSULATION
[ ] VFFINAL
ACE & CHIM Y j~
REMARK
Vol, 64~
00,4
DATE / INSPECTOR
el !
~G 1 r
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [t,]lF(OUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
DdIFRAMING [ ] FINAL
[ . ] FIREPL E,A CHIMNEYS
ti ~r A WS
/ _
DATE c'3 INSPECTOR i
765-1802
BUILDING DEPT.
INSPECTION
[ vF UNDATION iST [ ] ROUGH PLBG.
[ FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
IZ-O y
-
a
DATE / 4"d'~ INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY ~s
REMARKS:
e
G
DATE /5~1 5e' INSPECTOR
FIELD INSPECTION REPORT DATE COMMENTS
- - - -
_ n(~ H
FOUNDATION (IST)
rr----
1) .001
a
~i it CIA"
rr~ cya _
FOUNDATION ----(2ND)-----
ROUGH FRAME 6 n
PLUMBING i '
INSULATION PER N. Y.
III ^
STATE ENERGY
CODE
n
# &A- - q~
H
n &AI
FINAL
S : oo ?
NAL COMME _S:_
_
-
-
r 0
~ I
0
BOARO OF HEALTH
FORM NO.1 3 SETS OF PLANS
TOWN OF SOUTHOLD SURVEY
MAY I BUILDING DEPARTMENT CHECK;
TOWN HALL SEPTIC FORM _ .
SOUTHOLD, N.Y. 11971
TGt'fN 3d'SL( ~ksgLCx TEL.: 765-1802 ADT`<FY
`CALL
Examined , 191.! p~ MAIL TO: 3
Approved . 10 P it No4;^!`:~~O l
Disapproved a/c .
Bui
(lding Inspector)
P (CATION FOR BUILDING PERMIT
Date 19
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
sgts of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing l9cation 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 authorized inspectors on premises and in building for necessary inspections.
(Signature of applicant, or name, if a corporation)
-X,/./ i967....
0 S
(Mailing address of applicant)
State whether applicant is owner essee,'agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises
(as on the tax roll or latest deed)
If applicant issaa~corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No .
Plumber's License No. a so/-
Electrician's License No .
Other Trade's License No .
1. Location of land on which proposed work will be done . .
.................o
House Number ..Srrtreet Hamlet
County Tax Map No. 1000 Section A~ b....... Block Lot . F.... /
Subdivision Filed Map No. . ~ 8 Q...... Lot ~17
(Name) ,
1 State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ...U/k!q!n!! .
b. Intended use and occupancy . .
O'a• rvature of work (check which applicable): New Building Y.. , : Addition Alteration , . , "
Repair Removal , . , Demolition Other Work .
4~ (Description)
4. Estimated Cost i.: /OYb Fee .
I (to be paid on filing this application)
5. If
'
garage, dwelling, number of dwelling units , Number of dwelling units on each floor
If number of cars 11
6. If business commercial or mixed 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 with alterations or additions: Front Rear .
Depth . ....I... Height Y. .N...:.: Numbs ofrS#o~es .
8. Dimensions of entire new construction: Front . .6.. , r! Rear . 4~ !i Depth .
.Height N tuber of Stories . .
9, Size of lot: Front lag Rear.... 47.44 . ....Depth Q .
10. Date of Purchase S .I. S... , • • , • • , , , , Name of Former Owner .fe';tI?w~• .0&-wr ~ ? ,
11. Zone or use district in which premises are situated . . . .
12. Does proposed construction violate any zoning law, ordinance or regulation: .:h!C5.
13. Will lot be regraded y~~ Will excess fill be r oved from premises: Yes
14. Name of Owner of premises It . Address ~!a?~ , , , ,phone No.3Jf
Name of Architect . Address Phone No..... .
.4.
•d Address Yhqne No.
15. Is this PryPese;tY Southold within 300 feet o of a tidal wetland?
Name o contractor • • ' ' ',Town Trustees Permit may be required.
If *yos....... No.........
PLOT DIAGRAM
Locate clearly and distinctly all 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.
I
STATE OF NEW
COUNTY OF..
' " " " ' ' . • • • • being duly sworn, deposes and says that he is the applicant
(Name individual signing contract)
above named.
He is the . ~k_124_41 .
(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 befomme this
nA
e, LIday of .i. (.I!(. d,~.......... 19L
Notary ublic,...ntAMT County Yt% 1 :J............
nlta NEVIh(Signature of applicant)
No,-, uj, riera?in, Stmeof P.'-vv York
R7o. a~?-C1: 5fr~C2, NUi`re9k. Cot
Ter6 Expires October 31, 1 .
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as CMCnded, e;Feckive- March I, 1991
Part 5-,Je6fi(on 7814, ~Idg.77esign be~~4cceptable Pracf~ce
Source _oF_Nca{ in for fhj's bld ' Non-FIccfric-
4 g:- 1=lcclric ?
ram Tables 5 2 0 Parf 3 {or 5,600-(p, ooo Ue ree Da
l=nve(ope- flan-elec. E1cc•qq In uIAOn
Component , Neanr u7a ro Re nd' =n a)led• Remarks
t. W-0 I R-IS - R- Iq
-W.F Cci)FI R-Iq 6 R - lq
F~Ioor 117 19 R- I
11 \1
Found all* R-lo
o" R Nl~ _
R-10 R 1 R- NR
lazin R i•T ® R-2.6 R (07 _
r. Doors a -2•~ R-2• b- •S
imum Grass /l-!/oor Area; 5,ooo SF; T/rrs bldg. _AA.., 2,ooo_ :7-F-
* Req'd. dcp t c olvgra e; iiicics;orb}ofoofinc -
Z• 11 11 11 S 84 11
(2) ail glazing shay) not eXeeed 177^ oFcross wnllareci.
Includes skyligLhts - Sky light's shu II be. no mDrc
Phan fp- of rVtal rooF area.
® Req'd depth. 24 inches below grad c, or below }op of slob,
of ichcver is Brea}crr- or From }oy oFsln6 }o boilofrr OF 5106
` H7en a horizontal d isIaaCe o)' 24 inches; bcrreo4h mhe -IDV.
This Building: -
I4rall (Imss 1lrca-, 2, 506 v.F; lVT/) ~jlaz•f~rra. 286 sr; IJ
Cvir-sl•rvc&n of' his bldg. shall con,~Qorrn ~o nll pcrfr,~cvrl
secho,7s of Per/ 5, av specified in the above-iden/iAe.:/Co-/
,WD is Hi rfrnan
c ~ ~-may
~ufe, /-/prrj 199..'' S~/ MAS .rA
it ~ ~ 1
G
f PLUMBER CERTIF/CAT/ON p
! Isj ON LEAD CONTENT BEFORE OCCUPANCY OR
CERTIFICATE OF OCCUPANCY USE IS UNLAWFUL
SOLDER USED IN WATER It copper tubing is used SUPPLY SYSTEM CANNOT WITHOUT CERTIFICATE
pf~~or~ water distributing EXCEED 2110 of 1 % LEAD. CE OCCUPANCY
aWaR1; Piping shall be I of types K or L only PLUMBING
_.__ALLPLUMBING WASTE__
& WATER LINES NEED
TF TWG BEFORE COVERING
/7
- - /s-
9 6 b
- - , 3
~ -rya I I'
i I ( ~y
t ! I n 1 I;
61,u rx c ITY./ p -r PL) I
` r
r i ~-.._.~__.~z-L~Al, j _//~bu ~15/i•1dr,Y /1~._.~~ ~----eft,`` y~~
! i / \ ~eJP/tl~ T~ f~nriCCi j/
/ r ! rY ~ w 7 r DO NOT PROCEED WITH
FRAMING UNTIL SURVEY
T J 1 l OF FOUNDATION LOCATION.
:ro j I . HAS BEEN APPROVED. I
V I
Y. I I UNDMITERSCERTIRUTE i
I _ _ _ Psi t REQUIREQ .I -
Is ~ ( r
' AP RU EO S NOTED
f
NOTIFY BUILDINI AT
J~Ix B.P. # 7 1 785-1802 9 AM 4 FOR THE
FOLLOWING INSPECTIONS: I t. FOUNDAIION - TWO REQUIRED
I rl I ! FOR POURED CONCRETE
' ^1 `v G~xJ C' v GII i,l.-~ r` G 1~ 1 2- ROUGH - FRAM NG & PLUMBING 3. INSULATION
k ! Y- - . L I- - I agll~ P~'! 4. FINAL - CONSTRUCTION MUST ~7 I f ! I BE COMPLETE FOR C.O.
r _ - '.~Ir I I { I ALL CONSTRUCTION SHALL MEET
U i THE REQUIREMENTS OF THE N.Y.
` I I I ! STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
is F't u y a- i i
`v I ~ 'Q ~i I 1
N 4, f
3 0,;L y I
- - -
I
-
j
I t~PS
41- ~~91
i
I "
i
-
f
1
s s ~
{
- s c a a s~ !i d' PR DEr(mk,N fORt
EMERGENCY ESCI~PE AS 1N
REQUIRED BY PARt 714 0K
t PROVIDE OPENINGS FOR % a SN.Y.STATE BUILDI~ CODCI
EMERGENCY ESCAPE AS M y REQUIRED BY PART. 714 OF h•
l i
N.Y. STATE BUILDING CODE.
O ' 'I V
f
~~__S =N I I ' I II ; _2rizh'A`.1_ IfA(2 1/ A z4r,T P,".t9
? 4~ i 4 - /
Z4 li,
rr
t„
F.
F~.3..,.~...., S ' I ,-_..._.~.'YY , ~ . ~Y.rp_ NG J( Y.---~-•.- -~-----.-.may
ski _ I PROVIDE OPENINGS FOR
EMERGENCY ESCAPE AS
2 14 / r i REQUIRED BY PART. 714 0F.'. tj {.i tl l:: '
N.Y. STATE BUILDING CODE.
- f~9 ~ r ~ nll .ti 'ql~ ~ - • ~ J 2~-z3~R
C.'te -..`T t II i
A k7 T1 -
v
j ! i
0
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i ell PROVIDE % HR. 'W NR.IIRE c.
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r 'PART. 717.3 (f) (1) OF
N.Y. STATE BUILDING CODE 31fl(l)OF I << a~ J UILDING CODE:
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