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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-23809 Date AUGUST 9, 1995
THIS CERTIFIES that the building NEW DWELLING
Location of Property 935 FARNVEU ROAD MATTITUCK, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 121 Block 7 Lot 6
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVEMBER 22, 1994 pursuant to which
Building Permit No. 22509-Z dated DECEMBER 2, 1994
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 GARAGE & DECK AS APPLIED FOR
The certificate is issued to FARMVEU ASSOCIATES
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL-RIO-94-0090-JULY 27, 1995
UNDERWRITERS CERTIFICATE NO. PENDING - JUNE 5, 1995
PLUMBERS CERTIFICATION DATED JUNE 22, 1995-DEACY PLUMBING & HEATING.
ild'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 /..4? . C~2 199
NQ 22509 Z
Permission Is hereby granted To;~x~ A f.
P.... , -
' ............w........ ,
/
to......
..e L.~.,.c..r ..........C ~..r. z,. . ~`fe4 <
lea- .r 1.-.s ..l..r.-Q. .I--o f? .
at premises located at............ 3,5......... V// //err..........
........................................................Y""""..!... 6.../.../.......(...~k:..(.`~.....r...... U.••A..y..~............
County Tax Map No. 1000 Section „~`.t...... Block Lot No. ....6..................
pursuant to application dated /..?/.u.v..... ;?n2........... 19... .~f.., and approved by the
Building Inspector.
Fee $...7`3.....
. .......1..:.... M • . r....... p..•
Building Inspector
Rev. 6/30/80
3T -3,
0 C 0 V N Form No. 6
P~1 TOWN OF SOUTUOLD
ii +JUL~t28 BUILDING DE-PA RTNFNT
TOwN HALL
D1. . DGP765-1802
TOWN OF &0UTA0LD
AP 111,1CATI0N FOR CERTIFICATE- 01' OCCUPANCY
A. This application must be, filled in by typewriter OR ink and submitted to the building
.inspector with the folloW111g: 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 llealth Dept. of water supply and sewerage-disposal(S-9 form)
3. Approval of electrical. installation from Board of Fire Underwriters.
4. Sworn statement from1plumber certifying that the solder used in system contairs
less than 2/10 of 1% lead.
5. Commercial buildinindustrial 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 0 0 (,tuner :al $15.00
Date . l(/
New Construction........... Old Or Pre-ex'
lllg iuilding..
Location of Property..... 11, 3 S
...................................iouse No. .
Street
'eLc. am...
Onwer or owners ICE Property. Q . . . . . //v
County Tax Nap No 1000, Section.... ~
......llluck...... Lot.. X/
Subdivision..
~~l-•- 44.. .Filed M: p..FFA,
A .Lot..
Permit No..•••••••0,!.„Date Of Permit.•F!~
Applicant. -
•
'.Iealth Dept. Approval ..........................Underwriters Approval..................
' arming Board Approval............,..
tequest for: Temporary Certificate........... Final Certicate...........
'ee Submitted: $
~9 a Z01
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T2077 PER N. Y. II J/ m
STATE E77ERCY I
CODE
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Town Hall, 53095 Main Road Fax (516) 765-1823
P. O. Box 1179 Telephone (516) 765-1802
Southold, New York 11971
' S
OFFICE OF THE BUILDING INSPECTOR.
TOWN OF SOUTHOLD
C E R T I F I C A T I O N
DATE:
Building Permit No.
Owner:
(please print)
Plumber: ~c~u.~Jw51~t Sat•~~ey",
(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
N, day of Ju,< 19~i4- DEBRA ANNE I)EACY
NOTARY PU31-I0, Slate cf Nmv York
Notary Public, S.~FG County No. 48'8621, Suffolk count;
Commission EzpnPS March 36, 19E(
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765-1802
BUILDING DEPT.
SPECTl N
(FOUNDATION 1ST [ ] ROUGH PLEG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ 7 FRAMING``' [ l FINAL
REMARKS: a
a
DATE L INSPECTO
M-1802
BUILDING DEPT.
INSPECTION
[ ] F UNDATION 1ST [ ] ROUGH PLBG.
[ FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ J FINAL
REMARKS: C
DATE ~V ~v I INSPECTOR
`1v
M-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ROUGH PLBG.
[ ] F UNDATION 2ND [ ] INSULATION
[ FRAMING [ ] FINAL
REMARKS:
Gs t
Ai~
C
DATE INSPECTOR
=I
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLOD.
[ ] FOUNDATION 2ND [ ] IN ATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
a
DATE (S? INSPECTO
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ I ROUGH PLBG.
FOUNDATION 2ND [ INSULATION
[ ] FRAMING FINAL
REMARKS:
DATE 1111 AT INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] RO GH PLBG.
[ ] FOUNDATION 2ND [ INSULATION
[ ] FRAMING FINAL
R RKS-
G
DATE _INSPECTO
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ R~OUGH PLBG.
FOUNDATION ZND [ ] INSULATION
FRAMING [ ] FINAL
DATE
INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ) IN ATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE /A CHIMNEY
REMARKS:
4 4
AEC
DATE INSPECTOR
765.1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] IN LATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: cgp
DATE INSPECTOR,,--"4
-ter---
BOARD OF HEALTH
(I { FORM NO. 1
( 3 SETS OF PLANS
TOWN OF SOUTHOLD SURVEY • • "
BUILDING DEPARTMENT CHECK
NOV 2 2 1994 TOWN HALL SEPTIC FORM
SOUTHOLD, N.Y. 11971
TEL.: 765-1802 t:0i i FY _
iOW C ..y =t 1. 9
t U CALL`.
Examined . ~ 19 Q MAIL T0: • . • •
kpproved .:P~ , I9 ,wennit No. D/ . .
Disapproved a/c _ .
(Building nspecto
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
ets 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 streets
r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
ition.
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
call 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
.tall 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
uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
:egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
he applicant agiees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
dmit authorized inspectors on premises and in building for necessary inspec i ns.
P..
(Signature of aP1' ant, r name, if a corporation)
.4101
s "
(Mailing address of app cant)
,tale ther applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
-v.~/1~.... ,~j~(./j
lame of owner of premises 0. . rT ; : I1.~ .
(as on the tax roll or latest deed)
applicant ' co oration, signature o duly a thorized officer.
(Na and title of corporate officer)
Builder's License No .
Plumber's License No. • • • • • • •
Electrician's License No .
Other Trade's License No. , • , • • • • • • •
Location of land on which proposed work will be done .
* N ~Qr~NVr-U-ev{- fYlGlst~.
.ube; m ber Street H.a.m . let " " " " " "
House '
County Tax Map No. 1000 Section 1~(........ Block Lot .
Subdivision n,. t- Filed Map No ~ Lot .
' ! (/(Name)
State existing use and occupancy of premises and into ded iLIS d occupancy of proposed construction:
a. Existing use and occupancy . V -~1'
. . .
. . . .
b. Intended use and occupancy 1~ t ?,.7
3. Nature of work (check which applicable): New Building ....Addition Alteration
Repair Removal . Demolition . Other Work .
` ! Q (Description) .
number of dwellin Fee
(to be paid on filing this application)
5. If dwelling, Estimated Cost • • • • ' ' amts / Number of dwelling "nits on each floor .
S
If garage, number of cars, , , , ,
6. If business, commercial or mixed occupancy, specify nature and extent of each t .
Ypeof use
7. Dimensions of existing structures, if any: Front Rear Depth
Height . . Number of Stories . .
Dimensions of same structure with alterations or ditions: Front Rear .
Depth Height Num of Stories . .
8, Dimensions of entire new construction: Front Rear , ~O , . Depths
. 71 Height u~nber of Stories ..'Z , . ,
9. Size of lot: Front . .j . Rear
~ ~ . , , eptl; 43.
11. Zone or use district in which u • • ' ' ' ' • • Name of Former owner tau', ~e<y~~
premises are situated
.
12. Does proposed construction vio~ate any zoning law, ordinance or re ulation:
13. Will lot be regraded g ' .1 " " is " " " '
• • 1 • • , • • • • • • • . • .......Will excess till be removed from premises: Yes
14. Name of Owner of premises i . Address , , Phone No. .
Name of Architect Address !Phone No.. • . . . . . . . . . . . .
Name of Contractor Address . ..ne No. .
15. Is this property within 300 feet of a tidal wetland? eyes,,,,,,,, No
" '
*If Yes, Southold ')'own Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly alt 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.
it
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STATE OF NEW YORK, S~ S
-0UNTY OF,./
being duly sworn, deposes and says that he is the applicant
(Name individual signing contract)
ibove named. ,
le is the d!!L .
(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
pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the
ork will be performed in the manner set forth in the application filed therewith.
worn to before me this
. ....dayq of . li 19 elf
otary Public, County
H£LENE D. HORNE
i A.
Notary Publoio, State 49511364of New
dl York (Signature of applicant)
Qualified in Suffolk Cou ttyy pp~
Commission Expires May 22, 1S L
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From: Joseph Fschet9 P.E. To: Ray Hartman Date: 016195 Time: 14:01109 Pape 1 of 1
Joseph Fischetti
PROFESSIONAL ENGINEER
HOBART ROAD SOUTHOLD, NEW YORK 11971 (516) 765-2954
Date: August 6, 1995
Reference: 935 Farmveu Road
Southold, NY 11971
SCTM 121-7-6
'qd<?~}
Building Department
Town of Southold
Main Road
Southold, NY 11971
Dear Sir,
An inspection of the above referenced premises was done on August 3, 1995. Both the interior
of the foundation and the exterior grading was inspected. The builder gave me a copy of the original
subdivision soil core tests. The builder informed me that the sanitary system which was installed in the
front yard within 15 feet from the foundation encountered sand and gravel during its excavation.
The-following _information.is_beingused _to determine whether-waterwill-enter the basement
through the foundation.
I. The foundation was damp-proofed and inspected by the Building Department
2. The soil test indicate that groundwater was not encountered to 17 feet below grade and that the
soil conditions indicate sand and gravel.
3. While the grading adjacent to the foundation has a marginal pitch, their is still a positive pitch
away from the foundation to take any surface water away from the basement.
The foundation has been built to normal practices for this area. With no indications of ground
water from the soil tests and with a positive pitch from the adjacent foundation grade the basement
should not encounter water penetration,under any normal conditions.
It is recommended that any future landscaping take into consideration that a positive pitch
away from the foundation should be maintained and that an exit for any runoff must be maintained,
especially in the rear yard.
Very truly ,yours,
CFU~, Pe
Joseph/ Fischetti, Y.E.
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PL.IfIA/1I?ERCERTIPICATIOAI - --+{'i n - -
,'~~`~II~•~ . 1:'n .T Jett ON LEAD CONTENT BEFORE G3~Ina3uO;w. n,vi.IaNnc. 1 N I~+t
CERTIFICr'aTEOF 000IJPAIVCY sNOUa3JSNIJI~uJ1Cn.e7d ! ~ +ijQ , ' ~O" r I----~ I r I I
;q.'-"L HOH i7Ol Wtf S SOLDER USED IN WATER ~ d~3G JNUnIIys n3oloua ~ ; ' ~ ~ 3 >~t~ p"> I^~
SUPPLYSYSTEA1 CANNOT
EXCEED 2110 of I% LEAD ~j x a e 3~o I ~
03SGN $V A08d o \ f f ` 1 - I• o
C
PLUMBING
M ALL PLUMBING WASTE DO NOT RRDCEEO WITH
i & WATER LINES NEED TESTING BEFORE COVERING FRAMING UNTILSURYET I I _~i f z x29_"-' \ Ft
- --1 I OF FOUNDATION LOCATION
HAS BEEN APPROVE& t 71 u r 3/B Fc.. ? A f I. .f - tY ; V':. ~j•.lC G~ /IJLY~ [l~~[:G~/r (h
If copper tubing is used 0 '0 { o v L
for water distributing Oo s ~ t PAY I ^L~ tW
system; piping shall be
y • of types K or L only 1 ' - - ! { ! I _ . _ v I {
Plrnf 2 21994
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l'GWTq fJ OF S06TNOL'1 ~ Ih • Q ~ I ~
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PROVIDE % NR. FIRE
RATED SEPARATION TO
L 14NCe-/r ?7 T oG 2'4'x- yhy< Z4'! a' T='ll C_
PART. 717.3 M (1) OF -
N.T. STATE BUILDING CODE. IN j
14
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