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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-23801 y, Date JULY 27, 1995
THIS CERTIFIES that the building NEW DWELLING
Location of Property 1445 GLENN ROAD SOUTHOLD, NEW YORK
House No. Street Hamlet
County Tax Map No. 1000 Section 78 Block 1 Lot 23
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated FEBRUARY 14, 1995 pursuant to which
Building Permit No. 22603-Z dated FEBRUARY 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 AS APPLIED FOR.
The certificate is issued to JOHN & CATHERINE D'ALESSANDRO
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL JULY 13, 1995-RIO-95-0017
UNDERWRITERS CERTIFICATE NO. N-355846 - JUNE 22, 1995
PLUMBERS CERTIFICATION DATED APRIL 14, 1995- ROBERT BERTORILLO
2v A
Building Inspect,
Rev. 1/B1
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)
N2 22603 Z Date.v/ 19< .
Permisslon Is hereby granted to:
~
I~
to...C`...~ G4......f?? ....G% ~ t .,r......... 11
.y5`5....(1..
atpremiseslocated aT....
County Tax Map No. 1000 Secttllon.. 7.& Block Lot No. . ~2
pursuant to applicatlon d d 19.j.., and approved by the
Building Inspector.
Fee $..Ef
.
Building Inspector
Rev. 6/30/80
i _
FORM NO.6
TOWN OF SOUTHOLD i k
Building Department JUL 14
j
Town Hall
Southold, N.Y. 11971 - - -
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted = w ~ to the Building Inspec-
J for with the following; for new buildings or new use:
1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual
J natural or topographic features.
Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal).
A. Approval of electrical installation from Board of Fire Underwriters.
4. -Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa-
tions, a certificate of Code compliance from the Architect or Engineer responsible for the building.
,-Z.-Submit Planning Board approval of completed site plan requirements where applicable.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or
topographic features.
2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
C. Fees:
1. Certificate of occupancy $25.00 BUSINESS $50.00
2. Certificate of occupancy on pre-existing dwelling $ 50.00
3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00
4.Vacant Land C.O. $ 20.00 c~
5. Updated C.O. $ 50.00 Date ............7~i."~'. f .
NewCOnstruction „g,,.Old or Pre-e-xistingBuilding Vacant Land
Location of Property .e/$.G1earl.Boad% w/o. Grissom Lane,, Southold, ,
House No. Street Hamlet
Owner or Owners of Property ..74hn, t . Cet:herine,D'.Alessandro ( was. Mary. Ellen Frederick)
County Tax Map No. 1000 Section 7$......... Block qk Lot 23
Subdivision West, Cgeek, Estates, , , , , , ,Filed Map No. .3848 .....Lot No. , , , 36
Permit No........... Date of Permit ........../applicant . Jgq] SIDE HOMES,, q , , , , _ . .
Health Dept. Approval ...Ynn`.: N :qs , e ol7 ?/Labor Dept. Approval
Underwriters Approval ........................Planning Board Approval
Request for Temporary Certificate .....................Final Certificate .
Fee Submitted 25 .
Construction on above described building and per t mee p lic code; and regulations.
dean
Applicant .
S. rdo S1?residerit /RIVERSIDE HOMES, INC.
Rw. 10.10.78 '
co 2d3100,0
~O~OgOFFO(,~-CO
Print Key t Gym Page 1
5738SS1 V2R2M0 920925 rn Lip D 07/26/95 10:12:59
Town Hall, 53095 Main Road p • ~ Fax (516) 765-1823
Telephone (516) 765-1802
DiSP11 N9~ Y116b 971
ld
NYSRPS ASSESSMENT INQUIRY DATE 7/26/95
473889 SOUTHOLD SCHOOL SODUTHOCLD~SCHOOL ROLL SEC TAXABLE
OFFICEPOHOF THE BUILDIN IG INSPECTOR TOTAL REM SITE
78.-1-23 TOTAL COM SITE
1445 GLENN RD TOWN OF SOUTHOLD ACCT NO 42
OWNER & MAILING INFO ===1=MISC ASSESSMENT DATA
D'ALESSANDRO JOHN & !RS-SS ! **CURRENT** RES PERCENT
CATHERINE M ! 1 !LAND 800 **TAXABLE**
116 SOUTH SNEDCOR ! BANK !TOTAL 800 COUNTY 800
BAYPORT NY 11705 **PRIOR** TOWN 800
1 !LAND 800 SCHOOL 800
! !TOTAL 800
==DIMENSIONS SALES INFORMATION
ACRES .53 !BOOK 11722 SALE DATE 04/11/95 SALE PRICE 53,000
!PAGE 608 PR OWNER FREDERICK MARY ELLEN
=======TOTAL EXEMPTIONS 0 TOTAL SPECIAL DISTRICTS 5
CODE AMOUNT PCT INIT TERM VLG HC OWN CODE UNITS PCT TYPE VALUE
!FD028
!PK070
!WW020
!WC001
F1=NEXT PARCEL F3=NEXT EXEMPT/SPEC F4=PREV EXEMPT/SPEC
75.10- 03-011 F6=G0 TO INVENTORY F9=G0 TO XREF F10=G0 TO MENU
w
Date April 14, 1995
Building Department
Town of Southold JUL 1 4 1995
Town Hall
Southold, New York 11971
Re: Building Permit No.: 226032
Owner: D,ALESSANDRO
Gentlemen:
I hereby certify that the solder used in the water supply system
for the captioned job contains less than 2/10 of 1% lead.
Very truly yours,
BERTSAND PLUMBING AND HEATING
By e.(CCzr
Sworn tD,,before me this
14th day, of AIy ; , 199,5.
Notary Public
j EILEEN M. noACHE
Notary Public. State of Now York
/ Qualified in Suffolk County
Commission Expires January 31, 986
d
FIELD INSPECTION REPORT- - D)ATE - COMMENTS
o 1) 1
+ II II H
FOUNDATION (iST) n ~
n
I \
II II Ct t\`~N~\,,
FOUNDATION (2ND) m v
ROUGH FRAMES i il,:57
PLUMBING
n n
It II
I II
__$__=====O=O°e==s==c==a°======°.ell o~_=====s===a=es===a°==O===vees==e=°-----c==°s---_-
~1 ~ I U ~ H
INSULATION PER N. Y. In ii y~
STATE ENERGY
CODE
ii n 11
FINAL n n
_ ~y------
L COMMENTS:
n
°x
H
i
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INS TION
[ ] FRAMING FINAL
( ] FIREPLACE & CHIMNEY
REMARKS:
DATE INSPECTOR
765_1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST ( ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INS TION
[ ] FRAMING [ INAL
[ ] FIREPLACE & CHIMNEY `
REMARKS : F~
^ ,
~,t?a
DATE INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ INSULATION
[ ] FRAMING [ ] FINAL
[ ) FIREPLACE & CHIMNEY
REMARKS:
DATE _~INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [rROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
U,-YfiAMING [FINAL
REMARKS:
I
DATE ~~s 9S INSPECTOR
i
765-1802
BUILDING DEPT.
INSPECTION
[ FOU ATION 1ST [ ] ROUGH PLBG.
[ -FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ FOUNDATION 1ST [ ] ROUGH PLBG-
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
C.t~A
c
DATE Zllo,)21fr INSPECTOR
~1 - - 3 2120
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
r1035018 BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
Date `TUNE 22,1995 Application No. on file 87945695/95 N 355846
THIS CERTIFIES THAT
equipment as described below and introduced by the applicant named on the above application number in the premises of
only " the eehictrice!l
D'ALESSANDRO, MIS GLENN ROAD,, SOUTHOLD, N.Y.
in the following location, r1~ L'J Basement L'J 1st Fl. ? 2nd Ft. OUT Section Block Lot 1195
nwsexaminedon JUNE 19,1995 and./•ound to be in compliance with the National Electrical Code.
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS ECEPTACLE$ SWITCHES INCANDESCENT FLUORESCENT OTHER AMT K W AMT K.W T. K.W. AMT. K.W AMT H P
11 29 14 11
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
AMT. c W. Oll H. P. GAS H. P. AMT NO. A. W G AMT. AMP. AMT. AMPS. 7RAN5. AMT N. P SY$TEM$ AMi. WAITS
NO.OF FEET
1 F 1 DW 12- 3 -
SERVICE DISCONNECT NO. OF S E R V I C E
MT. AMP. TYPE METER tW T,6 3W t %3W 3,e• 4W NO. OF CC COND. A. W. G. NO. OF M4lEG A. W. G. NO OF NEUTRALS A W G.
EQUIP. PER % OF CC.COND. OF NV OF NEUTRAL
1 100 Ca 1 x 1 4 1 4
OTHER APPARATUS:
MOTORS;I-F H.P.
G.F.C.II-2
SMOKE; DETECTOR t -1
PETER CHAREONNEAU LIC.#2697-E
35 SHEPPARD LANE
SMITHTOWN, NY, 11787 GENERAL MANAGER
11
1
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 ALTEREDIN ANY MANNER.
80ARD OF REALTII
~i(f FORM NO.1 3 SETS OF PL,\.[S
TOWN OFSOUTHOLD SURVEY
BUILDING DEPARTMENT CIIECK _ . _ _ .
TOWN HALL SEPTIC romi
SOUTHOLD, N.Y. 11971 '
TEL.: 765-1802 ttor I F'f
Examined . . 1995- CALL _ , .
rtniL TO:
Approved , 1 J, Permit No. A
. t .
Disapproved a/c _ _ .
~i•i
. ~
APPLICATION FOR BUILDING PERMIT
Date J,~P l;y .24,...., 19 95.
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 location of lot and of buildings on premises, relationship to adjoining premises or public sheets
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.
NOTE: ALL CORRESPONDENCE TO RZV,ER= HOM) S.. IA1G . .
IVERSIDE HOMES, INC. PLEASE (Signature of applicant, or name, if a corporation)
P..f_l.. BAX. 274,. RIVerbe4L41i .NY.. .11901
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Builder
Name of owner of premises Xaxy, Ellen Frederick
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
S..GO> dRn . President.'
(Name and title of corporate officer)
Builder's License No . .
Plumber's License No. ....1487P
Electrician's License No. • , 2697E
Other Trade's License No.
Location of land on which proposed work will be done. F,/S. G1ann. Road, , 858;041
o Grissom Lane.
......Squthold
House Number Street " " " "
Hamlet
County Tax Map No. 1000 Section ...:...78......... Block Lot 23...•,,,.,•,.
Subdivision ...West Creek Estakes Filed Map No. 3848........... Lot , .36, .
(Name) ;
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy vecent, 1400• • , • , •
b. Intended use and occupancy PPP,9j:ruCtioq.9;a _sin le famil dwellin
3. Nature of work (check which applicable): New Building 'X
Repair Re Addition Alteration
Removal Demolition Other Work .
4. Estimated Cost $6815QQ%Q01 (Description)
Fee
(to be paid on filing this application)
5. If dwelling, number of dwelling units 3........... Number of dwelling units on each floor ..3........... .
If number of cars .
garage, P9 garage, , • , . .
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . .
7. Dimensions of existing structures, if any: Front . ' ' ' ' ' ' ' ' ' ' ' • •
S Number of Stories .
Dimensions of same structure % ith alterations or additions; Front ' ' ' . ' ' ' ' ' ' '
Depth . Rear
8. Dimensions of entire new con Height .
stl . A..:: ' ' • • , • • Number of Stories Depth , , , , ,
ruction: Front . Rear . ,~4 ,
Height .lb.'............ Number of Stories . one .
9. Size of lot: Front .110!.j. Rear . . llp; , , ; • • ....?10' " "
10. Date of Purchase ;.l/g4/94 . Depth , . .
IL Zone or use . e cris t rict . i„ which 1 Name of Former Owrar Mary. Ellen. Frederick ....which premises are situated one, family', ,
12. Does proposed construction violate any zoning law, ordinance or regulation: . no . . . . . .
13.
Will lot be regraded yes. ; , , , , , Will excess fill be removed from premises: Yes
14. Name of Owner of premises Mary, Ellen.$>:edgdglS Address c?o.13uil~ec.... Phone No. 7?7;3395
Name of Architect Richard WaOdOlQyski , , , , . , , , , Addres$ox 971, Ri verhead,:"i Phone No. 727-§Q~ ,
Name of Contractor Rivers]fl , Homesi Inc; AddressPR ls. ! . hone No. 737.
ss
15. Is this property within )30 274 Riverhea yes, X00 feet of a tidal wetland? *yeS........ No..$,,,,,.
*If Southold frown 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
see attached survey
I
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> _'IRfba' e.Vl ":G Ff3ri THE
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~~J ETitl ria 69U0~+~~4'ACI4n 4~llJ~~ Cpl f:.f441ti\.~~~
NoT -RE'Sp ata ll~c . FOR
rt'4ltat :OR 1TfpN~`fRUCT1()rd ERRC9ft~a
TATE OF NEW YORK
$
'OUNTY OF.. $[TF .....FOLI S•
.
5. .Gordon sl. being duly sworn, deposes and says that he is the applicant
(Name of individual si nin 'contract)
iove named.
eis the ,,,,.President of applicant/builder
(Contractor, agent, corporate officer, etc:)
said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the
xk will be performed in the manner se forth in the application filed therewith.
nom to before me this
..........24th ........day of ...(....January......., 1995
tary Public, ~Q~yti l t~~iVf~
(vf" ~ • • • 64folk.. County •
PAMAW KWC, SO% of Nw rat .
f. 6t+4504470, tamps CV-4 ~ *Presi ,
cbm6sim jWM mod 84,~ ~ (Signature of applicant)
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Cvmpliance_with MY•5PA. Fncrgg Conservab2in Consfrdc~ion Code, .
as arncndecl, efFective Narch I,1991-
Par} 5- SecPion '1814, Sldg•z7esign bey~4ccepl'able S'rac~ic~
• Non-!?lcctriG
56 wre oFNeal my far this bldg:- Elcctr•ie ?
tom Tables 5-2 or Part- 5 for V ooa-fo,ooo Ve rce 170
o e - f lon- Lim lee
l=nvel , q rF, upla1i~,
eomponen~ Neaninj a io Re nd" sn~stalled• Remarks
t. W-0 I R-18 - R- 19
RaoF Cci1R R-19 G R 38
oar R-I 19 R• )
F=ound a) * R to * o" 1' Nfl
R-io R-1 R-
R I.7 -
rlazi~- ~zq 0 R- Vt (6) R-24
Doors -2.5 Z• 5
F
_ a irndm toss ~/oo~ ArcQ= 5,000 FF.; is b/d a•FA.: J l0
* Req'd• jcpffj c vVj gra e: incRcs;orT-a Top or Talmo
:84 "
#lt u u u n
® VYall glazing shall nvF eXceed 17f- of gross Wall wren .
Inc udes lskglifIIt of rkgF UgWe sho 11 be, no mee
® Re 'd depth: a4 inches below grade, or below top of slab,
w :chever is greater- or From {-op oFslab to bo4urn of slao,
't17ert a horizontal:ASFapre of 24lnchc5 berreoftl thesiab_
his Su,ldirrg: -
4r,ll 1,Area: I, l2o ~S,F; ~/l Glaz•flrea: 99 NSF; y~ 45~~nr q~°
" Ir t o y 5F • d` E ~.Iligfi~ " ?~5tr:.l : ,1. e
)Poof'
Curd-r) ruction of* tris bldg. sfrall eonfvrrn jo all pcrfrnerf/
Seclrogs of Por/ 5, o~ specif°ier! :r~ the obo?e_idenfi~'re~
SF of MEIG ~
NaclSc for: f=f1~5T -SLo n • o
t,l ~9, u
G e e
a 5• No ~
vM.• 1
v
fo w8ta tubing is
Ulged system. water distributree -r.
Of tyivin ® D Of tyt~sB K or ~ ONT he p~
' ~vxiT~.+.,o us F~nye Ve.ar - -
~-II(!+" r~icGe V~~T I V -0 s
r
_ =4b ~ A•s~~rAr:ry" 3 ~
PLUMBING
ALLMMMBING WASTE S WATER LINES NEED I
TESTING BEFORE COVERING d~
I~ I
I ~ 4L 27" ie s
I
I
I X I Wlnn-wvl ~
~pnp
I ON LEAL i ON LEAD CONTENT BEFORFq- @ V
CERTIFIC CERTIFICATE OF OCCUPANCYI'I ~T;
SOLDL SOLDER USED IN WATER sJr-6 SUppLy SYSTEM CANNOT
SUPPL
EXCEEL EXCEED 2110 OF 1 % LEAD%,,r_
i IZ~~I Sro i -
TiN ~ovs (2..tsvArr. vepr x UNDERW UNDERWRITERS CERTIFICATE
,,VP-1r U w.. REQUIRED
r1l
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G 4'STd V'4 .''rte ris CIE
F IBynCIDPAFdaaY
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LL.-
~f 11-1Yt. SI G1~.J4 ~
I •I i ~ 9(P I
i
xili:rl o-^r iarsi,llaz anialy i fryI rle n. r DO NOT PROCEED WITH
~7;'-Fhi C1n4:r5'Gh;ICtVf3Pa .L;r FIBkr^Fv
FRAMING UNTIL SURVEY
! "r~, ~.-n! 2,W r:(?ri;?rG4SLi~'~I"7Q74! ER~C9r;F OF FOUNDATION LOCATION
i
HAS BE APPROVED.
PROVIDE OP PROVIDE OPENINGS FOR
EMERGENCY ESCAPE AS
its - - - - - - - - - - -REQUIRED BY REQUIRED BY PART. 714 OF
N.Y. ~TIEr 81114DING CODE:
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