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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-24056 Date DECEMBER 4, 1995
THIS CERTIFIES that the building ALTERATION
Location of Property 1728 ARSHAMOMAQUE AVENUE SOUTHOLD NY
House No. Street Hamlet
County Tax Map No. 1000 Section 66 Block 2 Lot 45
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVEMBER 25, 1994 pursuant to which
Building Permit No. 22512-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 A DORMER ALTERATION TO AN EXISTING ONE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to BRUNO ILIBASSI & WIFE
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. PENDING DECEMBER 1, 1995
PLUMBERS CERTIFICATION DATED 10/26/95 H. SMITH PLUMBING & HEATING INC.
Suildin spector
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)
N° 22512 Z Date 19../...
Permission Is hereby grand t '
/ 3 rv.~.ad. . 4C
-old /.~~7../.........
to r
.ll~r!~ ,T~.~,, r .
at premises located at.........1../., ..SQ....~~. i?../7 •••~c• c ~/°<•rz• C• ce.........
~ .~1AL.a1........... :7
County Tax Map No. 1000 Section /`,F,3.... Block rn..... Lot No.
pursuant to application dated ............../..l,~.l~.[!...... . i~ 195,.'./Cz-..., and approved by the
Building Inspector. .
Fee
.....................9............
Building Inspecto
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
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 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.
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 Building - $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 QC~t . C_24 _13.q S
ew Construction..:........ Old Or /Pre-existing Building..................
p
'ocation of Property....
. J.~Jg...?.:rSliChj~l~D/))Ct .r..cJl~lLlf.'Q.~......
House No, y~ St eet Hamlet `
nwer or Owners of Property
r r. 1,.
ounty Tax Map No 1000, Section ...(P..~'....... Block 9 ..........Lot....
ubdivision .Filed Map............ Lot....................
rn7nn vv~~ iL--1- f~
_rmit No...go~ ~p Date Of Permit...... .l..7....Applicant.'John.lcj2~~ ;~~e< Trv
.alth Dept. Approval ..........................Underwriters Approval.........................
fanning Board Approval
.quest for.: Temporary Certificate........... Final Certicate..~....
e Submitted: $..~~6,0
~C n elf...`.... .
APPLICANT
INSPECTORS
UFFO( .
KC~G2i SCOTT L. HARRIS, Supervisor
° Southold Town Hall
N r? 2
Thomas Fisher id ^r P.O. Box 1179, 53095 Main Road
971
Building Fish for Southold, New
Gary
Fax (56) 765-1823
Building Inspector a Telephone (516) 765-1800
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: October 26, 1995
Building Permit No. 22512-Z
[ C L r
Owner: Bruno Ilibassi S
• (please print) ° '"A€Pi
Plumber: H. Smith Plumbing & Heating Inc. Off
(please print)
MIX- 'Y -f
I certify that the solder used in the water supply system
contains.less than 2/10 of 1% lead. for the work performed
under this building permit.
4
umbers Signature)
H ry P. Smith, Pres.
Sworn to before me this
26th day of October 19 95
Notary Public, Suffolk County
Notary Public
CLAIRE L. GL.EW
Notary Public, State of New York
No.4879505
Qualified in Suffolk County
Commission Expires December 8,19--'j
s: ~
o~OgOFFO(,~C
O
ti Z
Town Hall, 53095 Main Road p • Fax (516) 765-1823
Telephone (516) 765-1802
P. 0. ewVork 9 11971
Southold,
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
October 24, 1995
Mr. John Bertani
1380 Oakwood Drive
Southold, NY 11971
Re: Bruno Ilibassi - SCTM#1000-66-2-45
Prem: 1728 Arshamomaque Avenue, Southold
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
An application for Certificate of Occupancy is
not on file. (Enclosed)
xx No Underwriters Certificate on file.
The check is (outdated/not on file.)$25.00
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 # 22512-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
COHMLNT::
7DATI0II
(2nd)
ii FRAME t, /
,,,_,'•PLUi•IBING .
?t~zt
L;,TI0:1 PER N. X• M
STdTE ENERGY
CODE II
r
'FI:LAL
ADDITIONAL COPSmFiITS.
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765.1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND ( ] INS TION
[ } FRAMING FINAL
[ ] FIREPLACE & C IMNEY
REMARKS:
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I
DATE //4rlNSPECT0
7 4(/
I'
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] ,INSULATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
c~
REMARKS : J
DATE INSPECTO
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ } ROUGH PLBG-
[ ] FOUNDATION 2ND [ ] IN ULATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: /n,,z
DATE J/ INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 7ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:/yt
DATE ~ZJJ~INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] RO GH PLBG.
[ ] FOUNDATION 2ND [ INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
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DATE <~376 k INSPECTOR
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ss-1802
BUILDING DEPT.
INSPECTIO w
[ ] FOU ATION 1ST [ OUCH PLBG.
[ ] UNDATION 2ND [ I INSULATION
FRAMING [ I FINAL
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REMARKS: fw tla
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DATE INSPECTOR
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THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1001071 BUREAU OF ELECTRICITY
88 JOHN STREET. NEW YORK, NEW YORK 10038
Date DECEMBER 08,1995 Application No. on file 9.0758495/95 N 372393
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant namedon the above application number in the premises of
A.ILIDASSI, 1726 ARSHAMOHACUE AVE., SOUTHOLD, N.Y.
inthefollowinglocatin- El R 01 Basement a Ist Fl. In 2nd Fl. -Section Block Lot
was examined on D ' and found to be in compliance with the National Electrical Code.
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS ECEPTACLES SWITCHES INCANDESCENT FLUORESCENT OTHER AMT. K. W. AMT. K.W AMT. K.W AMT K.W AMT H P
5 1.2 5 5 1 F
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS SELL UNIT HEATERS MULTI-OUTLET DIMMERS
SYSTEMS AMT. WATTS
AMT. K. W. OIL N. P. GAS N. P. AMT. NO. A. W. G. AMT. AMP. MIT. AMPS TRANS. AMT N. P. NO. Of FEET
SERVICE DISCONNECT NO' OF S E R V I C E
AMT. AMP, 11 TYPE METER 1.02W 1 0 3W 3.e" 3W 3.04W NO. OF CC COND. A. W. G. NO OF HI LEG A ' G' NO Of NEUTRALS A. W G
EQUIP. PER 0 OF CC. COND. OF H W4lEG OF NEUTRAL
OTHER APPARATUS:
G.F.C.I:-1
SMOKE DETECTOR:--2
G & S CONTRACTOR LIC.#578-E
IiOX 215
SOUTHOLD, NY, 11971 GENERAL MANAGER
11
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 ALTERED IN ANY MANNER.
BOARD OF HEALTH
_ FORM N0.1 3 SETS OF PLANt
TOWN OFSOUTHOLD SURVEY
I (1N 7 5 1994 BUILDING DEPARTMENT CIIECK
TOWN HALL SErTIC FORM
SOUTHOLD, N.Y. 11971
ni .r
TOWN f 5 rl3ot D.... TEL.: 765-1802 NOT I
CALL LL
{
Examined . 75. . . . 19 MAIL TO
Approved . 19J.. ermit NoQ.SIlfllf
Disapproved a/c
ui ding Inspector)
A LI ATION FOR BUILDING PERMIT
Date 199.1.`
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 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)
~-,~.~Q CpR11.< w,nto W..O U/0 Y;5:0 c.)44es 44?, .
(Mailing address of applicant) I "5;7e'
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
~Jux1,d5/L
Name of owner of premises M!? s... •..7~G! ~,~.SJ.% .
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer. /J
(Name and title of corporate o7-£ticer)
Builder's License No. 1~4
Plumber's License No.
Electrician's License No. 4f4.~~fX~z/G......
Other Trade's License No. IJ44-fzoV.. 10`e-
I. Locatio2of land on which proposed work will be done . . .
178
r. " M-9WgX.!(e?!2tA~tlE ...1. / .~.'...~~U, o.~0 -
House Number Street Hamlet
County Tax Map No. 1000 Section ......0..4......... Block Lot
Subdivision - Filed Map No. Lot
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy 49teJ5r• • f~t~r~L~r ...dam ~P : .
. .
b. Intended use and occupancy ~GclGlw4 Cr4GI
3. Nature of work (check which
Rempplicable): New Building , . Addition Alteration
Repair , oval . . Demolition Other Work , ,
(Description)
4. Estimated Cost ...4f Fee...........,...,.....,.......,.....,..
(to be paid on filing this application)
5. If dwelling, number of dwelling,
!units Number of dwelling units on each floor .
If garage, number of cars
6. If business, 7. Dimensions of ex st ialstructu emixed occupancy, specify nature and extent of each type of use
s, if any: Front Rear Depth....,..........
Height NutrjberofStories
Dimensions of same structure with alterations or additions: Front Rear , , . .
Depth . . Height . . . Number of Stories , .
8. Dimensions of entire new const ction: Front Rear . , Depth , .
Height Number of Stories , , .
9. Size of lot: Front Rear Depth
0 Zone or use district in which pre . • ' . ' ' ' ' • • Name of Former Owner .
11. .
Z are situated A?" ..d
12. Does 13. Will lot be d construction violate any zoning law, ordinance or regulation: eq o . .
regraded p • . , Will excess fill be removed from premises: Yes X No
1 Name of Owner of remises X4,V44KC'..A1.1 v5s!y , ' • Address 4724..d/ZSNrwaak+d~a0 . Phone No.'1$6-'. z-s 3.Z- .
Name of Architect J .m.Fl.c% . ..c Address 44>~! Phone No.............. , .
Name e of of Contractor
15. Is this property within i ~ 0~ . ' Address /PA Phone No.
00 feet of a tidal wetland? *Ye No.......,.
If yes, Southold Tbwn Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
i
I
ill
STATE OF NEW YQRK,
COUNTY OF ...•'?'vF.~44-4<_. . S.S
• ^ • • ' being duly sworn, deposes and says that he is the applicant
(Name of individual signing c ntract)
above named.
He is the ~DrG~OO Q+q F"rtF m .:f=(.C@5~2 . .
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
application; that all statements contained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
~~yy I
aS.~day of.A140 d M b7m 191?4
Notary Public County
Notary PubliState of New York " " " " " " " " "
No.4879505 (Signature of applicant)
Qualified in Suffolk County
Commission Expires December 8, ~8
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PA I_ CONSTRUCIi ON ;)HALL MEET
- - THE REOUMEMENTS OF THE N.Y. '.l
STATE CONSTRUCTION Rt ENERGY
CODES. NOT RESPONSIBLE FOR - = DESIGN OR CONSTRUCTION ERRORS
PLUMBER CERT;1FIC~TIOl1(
ON LEAD CONTENT BEFORE ff ~ j .i
CERTIFICATE OF OCCUPAIVCY
SOLDER USED IN "TER
SUPPLY SYSTEM CANNOT 2 51998 ~ ~
EXCEED 21I C o I% LEAD- `A
y h TQ 0 ~U~-{yy~l4,~, „ ! 1
If copper tubing is used
for water distributing tM0EI1MIRIfE1Rmdial system; piping shall be AM A[$
of types K or L only t lY'~
1
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PLUMBING
ALL PLUMBING WASTE
& WATER LINES NEED TESTING BEFORE COVERING
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