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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-23393 Date DECEMBER 6, 1994
THIS CERTIFIES that the building REPAIR
Location of Property 1075 NAVY STREET ORIENT, NEW YORK
House No. Street Hamlet
County Tax Map No. 1000 Section 25 Block 3 Lot 6
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 12, 1994 pursuant to which
Building Permit No. 22253-Z dated AUGUST 12, 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 REPAIR FIRE DAMAGE TO EXISTING ONE FAMILY DWELLING AS
APPLIED FOR..
The certificate is issued to SHIRLEY A. REITER
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-325769 - SEPTEMBER 1, 1994 6
N-334155 - NOVEMBER 21, 1994
PLUMBERS CERTIFICATION DATED DEC. 5, 1994-BERTSAND PLUMB. & HEATING
a,-
Building Inspect
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 ..~~r.r 19
N2 22253 Z /
Permisslon Is hereby a ted to:
f r
Q
/.1..
t r......... , .../..1..
r
to.
at premises located at.../025~
................................b K..! /
County Tax Map No. 1000 Section Block Lot No. .....4...............
pursuant to application dated .`...°L 19 Fl......, and approved by the
Bullding Inspector.
?eaj_
Fee
j >
Building Inspector
Rev. 6/30/80
J JIO~ Form No. 6 D a
TOWN OF SOUTHOLD p
" 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.
i 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 Building - $100.00
3. Copy of Certificate of Occupancy - $20.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $(h4.00, pC~~ommercial $15.00
Date !G...?.( i ~ .
New Construction........... Old Or Pre-existin Building.,
Location of Property 7 ) t °Ae '
House No. (1J tre``et Hamlet
Onwer or Owners of Property ......JKt~~!~e ~,,1 TL°6(
County Tax Map No 1000, Section... . Block 0......... Lot.... 6
Subdivision ......................................p Filed Map............ Lot......................
Permit No..;IP;~53.. .Date Of Permit.... 2,,~t ,Applicant... Q ?d ~~M'ecl1/...
Health Dept. Approval ..........................Underwriters Approval......
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate,.'„•
Fee Submitted: $......M) 0
JOHNSEN, P.E.
J(~ ~I.Cr2-RJ ;ormorontDr,
n Bays, N.Y. 11946
Design r/w NJJ Tel/Fox (516) 728-5095
UU0
September 26, 1994
Peter DeNicola Professional Builder
P.O. Box 841
1695 Chablis Path
Southold, New York 11971
Re: 1075 Navy St., Orient
Build. Permit # 22253
Dear Mr. DeNicola;
Per your request, I have inspected and evaluated the three double 12 inch
'Microlam' beams which support part of the roof system at the above refer-
enced one story dwelling. The beams are of sufficient strength to support
the dead and live loads as per the respective New York State Building Code.
This letter may be presented to the Southold Town Building Department and
shall serve as my certification that the subject beams have been properly installed
and comply with the structural building code.
If there are any questions or if I can be of further assistance in this matter,
please let me know.
Res ectfully submitted,
Jo n I. Jo nsen, P.E.
e 8
l DEPT
TOWN B3LDG SOUTPi--o--L--.D p 41
smnn11dY6~
s
I
c~~FFOtkI` T" 70-1~A2
~O D TOWN OF SOUTHOLD...
OFFICI: OF BUILDING INVIXTOR
j P.O. BOX 728
O TOWN HALL,
SOUTHOLD, N.Y. 11971
C E R T I F I C A T I O N
Date December 5, 1994
building Permit No.
Owner 2e`1'Fci(~ •
(please print)
Plumber Bertsand Plumbing & Heating, Inc.
(please print)
I certify that the solder used in the water
contains less than 2/10 of lit lead. "
81.~1ier'B ri9natvxe)
Sworn to before me this
5thh„_day of December ,
1994
Notary Public
Notary Public, Suffolk County
EILEEN M. HOACNE -
Notary Public, State of New York
No.482694P-
Qualified in Suffolk County
Commission Expires Junuan/ 39, L9_y,oo .
Town Hall, 53095 Main Road Fax (516) 765-1823
P. 0. Box 1179 Telephone (516) 765-1802
Southold, NewYork 11971
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
November 30, 1994
Mr. Peter DiNicola
P.O. Box 841
1695 Chablis Path
Southold, NY 11971
Re: Shirley Reiter
Prem: 1075 Navy Street, Orient NY
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)
No Underwriters Certificate on file.
xx The check is 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 # 22253-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
Hfn~ ``1,,
F0 U14DATION (1st)
FOUNDATION (2nd) _
_ o
ROUGH FRAME &
-PLUMBING Gy\
i y
3. x
INSULATION PER N
STATE ENERGY I2
CODE
x
a
y
FINAL
ti\
ADDITIONAL COMMENTS: n
x
c
H
x
a
y N
o ~
• z
M
A
1
•n
H
i
M-1202
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSU ON
[ ] FRAMING [ INAL
REMARKS: 6gle
4)
DATE 11.4 INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ) ROU H PLBG.
FOUNDATION 2ND [ NSULATION
[ ] FRAMING [ ] FINAL
REMARKS CV
-w`7
mom c
ti
DATE 1o~ INSPECTO
r
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ 4~4OUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ a-F~RAMING [ ] FINAL
REMARKS:
DATE ?`1V INSPECTO -
~na.n co .
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1'065081 BUREAU OF ELECTRICITY
F 88 JOHN STREET, NEW YORK, NEW YORK 10038
Date NOVNUBER 21,1994 Application No. on file 85707794/94 N 334155
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
3SI3IRLY RIOTER, 1.071.1 NAVY STREET, ORIENT POINT, N.Y.
in thefollowinglocation; ® Basement 11 Ist Fl. ? 2nd Fl. ATT1C/BtlT Section Block Lot
uws examined on NOVEMBER 17 , 1994 and found to be in compliance with the National Electrical Code.
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS ECEPTACLES SWITCHES INCANDESCENT FIUORESCENi OTHER AMT K. W. AMT. K W. AMT K.W AMi K.W. AMT. H P
28 31. 27 2R 1 F
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL RECPT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
AMT. K. W. OIL H. P. GAS H. P. AMT N0. A. W. G. AMT AMP. AMT AMPS TRANS. AMT H P. SYSTEMS
NO. OF FEET pMT. WATTS
1 F 1 2/16 HOtr) 1.
SERVICE DISCONNECT NO. OF S E R V I C E
AMT. AMP TYPE METER I 4W L R 3W 3,R 3W 3B 4W NO. OF CC COND A W G. NO OF HbIEG A W G. NO. OF NEUTRALS A. W. G.
EQUIP. PER a OF CC. COND. OF HI-LEG OF NEUTRAL
1 180 C.8 9 % 1 4 1 4
OTHER APPARATUS:
MOTBRSi4--F H. P.
G.F,C.I:-•9
SMOKE DETECTORi-3
E'RW ELECTRICAL IIZC. #4405-E
SERVICES, INC..
P, O. BOX 1.154 GENERAL MANAGER
RONKONKOMA, NY, 11773 I1
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.
IF a~LS -6
THE NEW YORK BOARD OF FIRE UNDERWRITERS PACE 1
1000955 BUREAU OF ELECTRICITY
F 85 JOHN STREET, NEW YORK, NEW YORK 10038
Date SEPTEMBER 01,3994 Application No, on file 85363899194 N 325769
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
REI:TER, 1075 NAVY ~SryTREET, ORIENT VILLAGE, N.Y.
in the following location-- CJ Basement [I Ist Ff. El 2nd Fl. Ot" Section Bock Lot
wasexaminedon AtJGrUST 29 , 1994 andfound to be in compliance with the National Electrical Code.
FIXTURE FIXTURES RANGES COOKING DECKS OVENS OISHWASHERS EXHAUST FANS
OUTLETS lItECIP11 ACLES SW17CHE$ INCANDESCENT FLUORESCENT OTHER AMT. K W. AMT. K, W. WT K.W AMT. K W AMT. H. P..
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMER$
T. N. W. OIL H. P. GAS H. P. AMT, NO. A. W. G. AMT AMP AMT. AMPS TRANS. AMT H -P SYSTEMS
AM AMT. WATTS
NO. ST FEET
SERVICE DISCONNECT NO.OF S E R V I C E
METER NO-OF CC COND A. W. G. A W. G. A. W. G.
AMT. AMP. TYPE EQUIV. 1,e' ]W 1 ,e' 3W 39 3W 3,e' 4W pER % OF CC. COND. NO. OF MIdEG W HIdEG NO.OF NEUTRALS OF
1 100 CB I x T 4 1 4
OTHER APPARATUS:
TEMPORARY EIRE RE--COONECT ONLY-4
BT-COUNTY ELEC'TRIC CORP. T;TC,#I330
2279 JERUSALEM AVENUE
NORTH BELLMORE, NY, 11710 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.
U V BOARD OF HEALTH
FORM NO.1 3 SETS OF PLANS
TOWN OFSOUTHOLD SURVEY
BUILDING DEPARTMENT CHECK _ . . . . . . .
TOWN HALL SEPTIC rORN
~ BLDG. DEFE r SOUTHOLD, N.Y. 11971
OLA TEL.: 765.1802 t: oT I P'f
EXatllincn CALL 9 ^ MAIL TO: _ _ . •
Approved •/•~r., 19 Permit No,2.,5. _ .
Disapproved a/c x _ .
( ilding specto`rr
APPLICATION FOR BUILDING PERMIT )
Date . l 2 19!.y
INSTRUCTIONS
r a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with
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 stieet
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 permi
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 rem'ses and in building for necessary inspecti s.
~TlC~1Y4iii
p3111 % :~l~
(Signat r'o
f applicant, or nam , if a corporation) /
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
7~ TXag 0 .
Name of owner of premises Re- 5~'t f?_('e
(as on the ax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No. . r~ 14M
Plumber's License No. , ,
Electrician's License No.
Other Trade's License No. .
I. Location of land on which proposed work will be done.
l.e`?........ av (940 m ^
I Ouse Nu ber
Street Hatttlct
County Tax Map No. 1000 Section ...t Block ...1;Z
Subdivision Filed Map No. Lot
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy (Fp Er>Cs .....F !-rl. r `':"i<ll
b. Intende use and occupancy ........F ~p tt~
3. Nature
Rehr ofwor heck which Rcpplicable): New Lluilding , , , • • 31
Addition te ' ration , e:
Removal , , , • „ • • • . , • . • Demolition O 117
"
. t?cr fk~-:.J.
4. Estimated Cost knQ b~ (Descrip°tion)
/ Fee ......r,.,~, ~w..~-
i tt t_
g g p, number of dwellin units . (
S. Ifgarag," a Number of dwelling ni P CN tson\cac1,Sp laa}a~t+ion)
If ara e, number of cars 6. If business, commercial or mi .
7 xed occupancy, specify nature and extent of.each type of use .
, Dimensions of existing structures, if any: Front , , , • , • • , , , , Rear • . • • • '
Height Nliml ber of Stories ...Depth .
Depth Dimensions of same structure with alterations or addition . . .
s: Front
. ; Height . Rear . . .
H
8. Dimensions of e?~t fe new construction: Front o...:., • • , , . RearNumber of Stories . : . . Height . , , , • , , , Number of Stories . • • • • • • • Depth ...yp , , 16 . 9. Size of lot: Front Rear•
10. Date of Purchase
Depth
Name of Former Owner "
1 1. Zone or use district in which premises are situated
' " "
"
premises ate any zoning taw, ordinance or regulation: r1b 13. Will lot be regraded Will . premises: .
Name proposed construction viol` , • • .Address ../.a7 (`Flit/
14. Name of Owner of excess fill be removed from premises: Yes
of Architect Sow • • Phone No .
Name of Contractor jQy{r~ Ortt. C-Pi`rddress Phone No t'
Yes ' err y within 3 Address , No. • • A • ,
15.* Is this pro • S /j(' Phone No, 7k T. 1
300 fe t of a tidal wetland? d? d~
tIf es Southold Town Trustees Permit may be required. " 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.
@5'~0A'C 4`IC_.dt;°'A`' ~('0 ..y4'<t,.fic.l. ~`~b~'~••w5 ~.~Onl`
13>4~v~~ .~an~t~`tn4g tp 'n.a~e/.1 ~Xr9}tt^1
GG'..tN-rced~ ~'lp~It ".$orS'T^ ~•0 It•.~,(.c.l~ G1('IS'~-r~^q
~ w w V,i'>0rriS
o >7 f 1 AV~ # III `nNOTEQ)
Ce ~c 1~lATEs:- / ~1T 17r a Z53
' M419y' BUIL I. : 13'EPA THE A.
i6648(12 g AM: TO 4 PM' FOR THE
FOLLOWING INSPECT(ONS:
1. FO
UNDATION, • TWO REQUIRED
FOR PRED CONCRETE
OCCUPANCY OR 2, ROUGH FRAMING & PLUMBING
USE IS UNLAWFUL S. INSULATION
WITHOUT CERTIFICII E d. BEE
O FINAL - CONSTRUCTPONMUST
ALL CONSTRUCTION SHALL MEET
OCCUPANCY THE REQUIREMENTS OF THE N.y,
STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR
TATE OF NMV DESIGN OR CONSTRUCTION ERRORS
OUNTY ~ . ~dK L~ S.S,
• h 1.4.OJII , , , , , • • • • , • being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
)ove named.
is the
Contractor agent, corporate officer, etc.)
said owner or owners, and is duly author _d
o perform or have perfonned the said work and to n
plication; that all statements contained in this application are true to the best of his knowledge and belief; and I lat hie
)rk will be performed in the manner set,forth in the application fled therewith.
om to before me this
.............1. ay of ......s 1Q?
91
tary Pu ic, County
CLAIRE L• GLEUII
Nry P No 4879506NehrYork
Qualified In Suffolk County (Signature of applicant)
Commission Expires December 8,10
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