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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 8-24020 Date NOVEMBER 6, 1995
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property 775 HARVEST LANE MATTITUCR NY
House No. Street Hamlet
County Tax Map No. 1000 Section 120 Block 3 Lot 8.33
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. 22786-5 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 A NEW TWO STORY SINGLE FAMILY DWELLING WITH ATTACHED TWO
CAR GARAGE AND COVERED PORCH AS APPLIED FOR.
The certificate is issued to THOMAS 8 MARY LENTINI
(owner's)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVALRIO-95-0047 NOVEMBER 3, 1995
ELECTRICAL INSPECTION SERV. 8696 SEPTEMBER 20, 1995
PLUMBERS CERTIFICATION DATED NOVEMBER 7, 1995 JOHN DEACY
di Inspector
Rev. 1/81
C
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.
IVG 22786 Z
Permission Is hereb rant d to:
A
..:..............r
r-
.I..~......y...
to.. ~ u...
....77
.........................................................r.^.............................„.... ~.....y...
at premises located at.....,......7..7^.J............~..'/°..°'^......!~.
lea
County Tax Map No. 1000 Section Block ........3............ Lot No.
and approved by the
pursuant to application dated ............~!~.l.....•l..® 19./.
Building Inspector. a
Fee $.."'..7...
Buildin Inspe or
Rev. 6/30/80
't
J
Town Hall, 53095 Main Road Fax (516) 765-1823
P. O. Box 1179 Telephone (516) 765-1802
Southold, New York 11971 ?
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
C E R T I F I C A T I O N J 9
DATE: /r
Building Permit No.
Owner:
(please /print)
Plumber: ' y / Aj V ~ c
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead..
(Plumbers Signatur
Sworn to before me this
DEBRA AML SEACY
~p day of A[0t? , 19 Qf RY PUBLIC, State of New YOTIT
14a. 4818621, Suffolk CourttY
Commission Expires March 30'19-9.
Notary Public, J?~=r~Ut-~• County
t~~e._ c----
Form No. 6 /
TOWN OF SOUTHOLD
BUILDING DEPARTMENT 66
TOWN HALL
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 Buildine - $100.00
3. Copy of Certificate of Occupancy - $20.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.90, Commercial $15.00
Date
New Construction............. Old Or Pre-pe(x'sting Buildin
Location of Property.... / ?JJ
House No. Street Hamlet
~C
Onwer or Owners of Property./.....
/p~a ~y
County Tax Map No 1000, Section Block .....p ..Lot.......Y.. ~
Subdivision Filed Map.Y.?.D~1....Lot.........
Permit No ................Date Of Permit Applicant
Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate...........
Fee Submitted: $
,ems SO
APPLICANT
o~~gOFF01.t o
c~ Gyp
ti x
Town, Hall, 53095 Main Road p • Fax (516) 765-1623
P. 0. Box 91971 Telephone (516) 765-1802
Southold, New York 1
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
October 2, 1995
North Ray Corp.
Box 655
Shirley, NY 11567
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 # 22206-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
FIELD INSPECTION REPORT DATE COMMENTS
-
L5 I
FOUNDATION (IST)
tt-----{I _ -
q
FOUNDATION (2ND)---~
_________________________1-- -
I 11 ~
ROUGH FRAME &
PLUMBING
ii
I
cell
__11=====---_____________°___---------
T/
INSULATION PER N. Y.
STATE ENERGY
CODE
II II -
II IjjCC~/~c/9lII
FINAL 11
II
_ ADDITIONAL COMMENTS:_
Ntl
W ,e CAA) 1o f
O°
x
t
m
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSU ATION
L l FRAMING INAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE 714vfh1Sf'I
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ INAL
[ ] FIREPLACE & CHIMNEY
~ t
REMARKS: -
d~
DATE INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE _1l 6~ INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] RO PLBG.
[ ] FOUNDATION 2ND [ INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: _
14-
DATE INSPECTOR
M-1802
BUILDING DEPT.
1 NSPECTIO
[ ] FOUNDATION 1ST [ ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ 44RAMING [ ] FINAL
[ 4,--~IREPLACE & CHIMNEY
REMARKS: rD~~~L-wt
6
DATE INSPECTOR
ppp,7
7
765.1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION ~IST- [ ] ROUGH PLBG.
[ ] ;~RAING ON 2ND [ ] INSULATION
[ M[ ]FIN x°07
[ ] FIREPLACE & CHIMNEY
~i et
17
REMARKS: 4
cl/ 01
DATE INSPECTOR
)0- 1
M-1802
BUILDING DEPT. ~b
INSPECTION
[ ] FOUNDATION 1ST [ ROUGH PLBG.
[ ] OUNDATION 2ND [ ] INSULATION
[ FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE INSPECTO e
M-1802
BUILDING DEPT.
INSPECTION..
[ ] FOUNDATION iST [ ROUGH PLBG.
[ ] FO~INDATION 2ND [ ] INSULATION
[ Imo]' FFRAMING [ ]FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: _
e
B
DATE (a y3,INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
4 Z-- Z12 keh
zu~
DATE / INSPECTOR /
o ; ~c
? 0d
I1
vAG.'j G.\ s V
- U Z
Sr=PTi G iN ~r~ONT, VA
eiEL.l. IN 2F:>,f ~P20P.1 ~U J
~
4 ~ I N W
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r
I
i% NA2VE5T' LANE d~ SO
N.?Q"!9 3{i E. !25.Q I
350 TO C'JT-QF- AT A L)QK-H LA,
i
I I 5Q7 ex9m.
> I ` i vaoP. u
~4 I ~ ! ;,i SEPTIC. / ~ c`J
1 -
r I6A2. 1-. __t
I 38'
i PLEASE NOTE
1 Minimum distance bet,
i
~i C-Ind cesspool is
~R
o -.43
45 O 1! n
P20P- WEL:.,
~C9(7~ r rt~
NQTE~
OT NG_
5U PF.
\44;
11.7 REV C
i
~y m
m ~
V.+ P
~ ~ 2EVf5~tV oL:OP. t_1f~tE_ ~ lh ,
5.70.1$ W. 125.0 I p
- 5.69°37 W ~F!L-ED M.40 125.0!
N/P IGUUA~'Si<,!
VAC.)
I
TEUDYNE POST N81]29
BOARD Of HEALTH
FORM NO.1 3 SETS OF PLANS
TOWN OF SOUTHOLD SURVEY
MAY 10 1995 BUILDING DEPARTMENT' CHECK .
TOWN HALL SEPTIC FORM
SOUTHOLD, N.Y. 11971
TEL.: 765-1802 NOTIFYp 1~~7iv
c~
TO: ~ .
Examined . . . ,191 CALL L
ila~ p ,F0~ .
..I... 19 Permit No
Disapproved, a/c
(Building Inspector)
AP LICATION 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
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing ]pcation of lot and of buildings on premises, relationship to adjoining premises or public stieets
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.
~~~~p:..............
V - (Signature of appli ant, r name, if a corporation)
4A . . .
(Mailing address of ap licant)
State whether applicant i owner essee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises
(as on he tax roll or latest deed)
If applicant is rporation, signature of duly authorized officer.
(Name nd 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 done. ~ .
House Number Street Hamlet
County Tax Map No. 1000 Section ~J Block Lot... 3. . .
Subdivision Filed Map No. . xA. L~-? Lot .
(Name) '
1 State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ..~p~ H!~ .
b. Intended use and occupancy .."4, a
3. Nature of work (check which applicable): New Building .:Y . , , .Addition Alteration .
Repair Removal . . , , , , . , Demolition . , Other Work .
4. Estimated Cost , , , , , , , , , , Fee , , , , , , (Description)
5. If dwelling, number of dwellin / (to be paid on filing this application)
units Number of dwelling units on each floor . . . . . .
If garage, number of cars
• , , , , , , , , ,
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 . . NuItber of Stories .
Dimensions of same structure with alterations or additions: Front Rear .
Depth . Height ; . i,....:.: Nu Ilel~Stories .
8. Dimensions of entire new construction: Front ...~".y . , , ; Rear ......Depth 3... , , .
Height Nu bXr of Stories .
9, Size of lot: Front Rear Depth p. r .
10. Date of Purchase . Name of Former Owner . / ,
11. Zone or use district in which premises are situated .
12. Does proposed construction violate any zoning law, ordinance or regulation: F , , , , ,
13. Will lot be regraded Will excess fill be removed from premises: Yes No
14. Name of Owner of premises , Address Phone No.,3q.q3&~ . ; '
Name of Architect . Address Phone No. .
Name of Contractor . . . Address . ne No . .
15. Is this within i fee
property X30 00 feet of a tidal wetland? *yes....... No
*If yes, Southold Town Trustees Permit may, be required.
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
I
III ~
i
STATE OF NE ORK
Y....S.._
COUNT
• • • . • • • B • • • • • • • • • • being duly sworn, deposes and says that he is the applicant
NN e of individu si ning contract)
above named.
I
He is the..,.. •~~,tf~ y~
• (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 wilf be performed in the manner, set forth in the application filed therewith.
Sworn to before me this
U
j....dayof............,1y4J.
Nota Pu~bvli~c. County
. • . • .
Et.I AOE .1 AWR Nrviut,F. (Signature of applicant)
Nctnry rablir, S'mtetof F: uvY®rN
No. g2aS12.fjb50, Syoffo1k Couy3"pp~
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,pI !^mrr
y OCCUPANCY OR
1
USE IS UNLAWFUL
WITHOUT CERTIFICATE
` r
1. E+ OF OCCUPANCY
!
Nam I
APPROVED AS NOTED
#aa7~~ ; DATE zY IL B.P.
I u B
I, NOFEE: TIFY f7 Zk 6UILbiNG D
--I i! 768.1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRED !
rwwe~lw i I FOR POURED CONCRETE DD ( rgwcw SIN 2. ROUGH - FRAMING & PLUMBING
- j FRAMING UNM SURVEY 8. INSULATION 4. FINAL - CONSTRUCTION MUST
OF FOUNDATION tIKAT= BE COMPLETE FOR C.O.
:I I F Let! _ i' n ALL CONSTRUCTION SHALL MEET WS 00 ARA I 1 THE REQUIREMENT'S OF THE N.Y.
STATE CONSTRUCTION & ENERGY
4 CODES. NOT RESPONSIBLE FOR
j f DESIGN OR CONSTRUC 10111 SIRORB . i
I. ~ _1 ~ COPS I O dJ ~ it
^--6
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1 PLUMBERCER"AlICAT/ON I
r. ON LEAD CONTENT BEFORE
CERTIFICATE OF 'PANCY'
F,r /6` SOLDER US& IN WATER ;
; " SUPPLY SYSTEM CANNOT I
I~ v EXCEED 2190 of I% LEAD, i
ALL
PLUMBING q ! f TETNWa ONESNEED
BEFORE COVERING
i
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or tubing Is und HOW
for wster disbrlbut ~ B I
sysam; Piping shell be
Of types K or L only III r„ ~
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PROVIDE ~i NR. FIRE
--f - RATED SEPARIITtOIF'Nt-~
I PART. 717.3 (1) (1) OF~t - - - j
N.Y. STATE BUILDING CO .5
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PROVIDE OPENINGS FOR' FOR!
{ - - ~4 EMERGENCY ESCAPE AS I v PROVIDE OPENINGS FOR AS
J EMERGENCY ESCAPE AS REQUIRED BY PART. 714 .1, ; I O`; I t4-F~_I
i alD N.Y. STATE BUILDING COr) . n3 ;pn a
I~ \REQUIRED BY PART. 714 OF M1, 6 sG a . G
N.Y. STATE BUILDING CO sL '
! I x3~ i
I
PRI _ ppp -I , PROVIDE OPENINGS FOR
EM PROVIDE OPENINGS FOIL 7 6-~ " FFF--- REQI EMERGENCY ESCAPE AS I~!
1 I c EMERGENCY ESCAPE AS I REQUIRED BY PART. 714 OF "
N.Y. REQUIRED BY PART. 714 OF m If = N.Y. STATE BUILDING CODE.
:~'N.Y. STATE BUILDING CODE.
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Part SCG1'1•on 7814; ~Id ',~esi~n bel ~hcceptable T'rac;~-ICC :
5owre oFNeo}ing for this bid g Non c-ri FiccY-G ?
j i rom Tab)~s ~ ti-2 0l= Parr ~ for' 5,000-6,000 Ue ree 17auS:
! nVt)ope-- flon-elec. ~Icc• qq s~ Sbula}lo„
Componen{-' T 1.5 to Rei Sn5~°Yo)led• Remarks
19 Eix t. Vra -R-)B
RooF Ccilrt R-19 - ~ l9
oor R 1 19 R Iq
Found a)I* R to o" F- NA _
R-to R 1 R 1JA
IaZllz R-1.7 ® R-2.~ R-
r. Doors -2.5 _ R_2• g_.5 -
o imum Gross door ArSq: 5,000 sF; r/ris 6/dg. FA ?.180__ r
Req'd• depth 6eloW gra e: I~icics, orb op o -Foofing
*it „ ,Q4 I G l (r
®~all g)azing sha{I notercced 17~° o} dross vVnllCirecy
Includes skyleghi-s - 5kyUghl-.s shO U YIe, 770 Mb) -C tFran 1°f~ o-F 'fo{n) rooF areLl '~r 4C rJ:x .r~'p~`~f- 2a'~ C<,?rr.r _J~- ~ - ~/5 ~~17 ~7`_
f j ®Rr. d depth: 24 inches below groJc, or below i-op o qq lab,
nrhlcl7cY" is area}cr• or fro,n(~)-op oFJlnb }o bo4o„7 of
H en a horizontal d'Is_ {arlre of 24 Inches berreo-I1t ~-he slab.
T,51s $u;ldlrlg: -
lYall E~i~ssh~rea: 2,Z8~ v,F; YilIJC~lar.ff~~O. 275 SF; ~Yvf2•bX ( -
/?00 Jr v
I C~;u~ruc,tio of ftrls b%g--shall con/a,m f0--nll- pi-r~X~i/ 4 ~y__J, ,-'~.~~,U`~•<,<= I~
' sec fogs oF Fart 5ass ec%, °iecl lrr fhc - aGove-%cle,~
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