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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-23496 Date FEBRUARY 15, 1995
THIS CERTIFIES that the building ADDITION
Location of Property 282 NORTH SEA DRIVE SOUTHOLD, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 54 Block 5 Lot 51
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 16, 1994 pursuant to which
Building Permit No. 21955-Z dated MARCH 22, 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 2ND STORY NON-HABITABLE ADDITION OVER EXISTING DECK ON AN
EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to MICHAEL J. & DEBRA ACQUAVIVA
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. PENDING - FEB. 10, 1995
PLUMBERS CERTIFICATION DATED N/A
4"~/' A"~
Building Infector
Rev. 1/81
FORM NO.3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
70YM HALL
SOUTHOLD, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED) 9
N2 21955 Z Date 19..
Permisslon Is hereby granted to:
1~~....~9.r.V
7......f?,° s3.
......lhs
~ ? .......5~.~i..................
to...~-rP~?s:.......~~......
lrrc~l'!~?~x ...?d ...c........... d...~``..`"~ ~x%1'i
I
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at premises located at
.r~ .
County Tax Map No. 1000 Section..y/.// Block 4`.5.......... Lot No. .....,J,...r.................
pursuant to application dated ......../.!.fT.~... I..~O 19....,x, and approved by the
Building Inspector.
Fee S..-7
B Ilding Inspector
Rev. 6/30/80
Form No. 6 -
TOWN OF SOUTHOLD
7 G' BUILDING DEPARTMENT
T01M HALL
765-1802 I-i sr 2 9 iog-i i BLDG. DEPT
APPLICATION FOR CERTIFICATE OF OCCUPANCY TOWN OF-SOUTHOLD
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_.ar-chiteet-or-engineer
responsible for the building, t _
6. Submit Planning Board Approval of completed site plan requirements.
i 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 $15.00, Commercial $15.00
Date
New Construction....... {Old Or Pre- xistinpl Building. Location of Property... •„,.,,,,c~_,_;
House No. Str /Hamlet
Onwer or Owners of Property„ .
County Tax Map No 1000, Section...'41u Block....J:..........Lot...l~'.,•............
17
i Subdivision. File M p.. .Lot..
Permit No. ate Of Permit.. ~f%
Applicant 4 C
Health Dept. Approval ..........................Underwriters Approval................~......
Planning Board Approval
Request for: Temporary Ce tificate........... Final Certicate „
Fee Submitted:
?.l /yLl(/~ _
(R, `1161 APPLICANT
e~~~3496
64- 5-5 1 a
Ell
mil
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1001071 BUREAU OF ELECTRICITY
F- 83 JOHN STREET. NEW YORK, NEW YORK 10038
Date FEBRUARY 15,1995 Application No. on file 84766794 / 94 N 342721
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
DEBBIE AQUAVIVA, NORTH SEA DRIVE, SOUTHOLD, N.Y.
in thefollowing location; ? Basement ? lAt FI. ® 2nd Fl. Section Block Lot
was examined on FEBRUARY 10 , 1995 and found to be in compliance with the National Electrical Code.
NXTURE ACl6 SWITCHES RXTUIt RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCANDESCENT FLUORESCENT OTHER HAT. K. W. AMT. K. W. ANT. K.W. AMT. K. W. AMT. N.P.
1 5 1 1
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS RBl UNIT HEATERS MULTI-OUTLET DIMMERS
AMT. K. W. OIL H. P. GAS H. P. AMT. NO. A. W. G. AMT. P. AMT. AMPS. TRANS. AMT. N. P. SYSTEMS
NO. OF FRY AMT. WATTS
SERVICE DISCONNECT NO.OF S E R V I C E
AMT. AMP. TN•! METER 1 / TW I F 3W 3 L 3 0 AW NO.Of CC COND. A. W. O. NO. OF HI.LEG A. W' G. NO. OF NEUTRALS A. W.G.
EQUIP. NR 1 OF CC. COND. OF NI~UG OF NEUTRAL
OTHER APPARATUS.
G & S CONTRACTOR LIC.#578
BOX 215
SOUTHOLD, NY, 11971 0104111M MANAGH
11
Per This certificate must not be altered in any manner; return to the office of the Board if incorrect. Impactors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIRCATE MUST NOT BE AL7EW IN ANY MANNER.
~~o~OSpFFO(~COGy
o ~
Town Hall, 53095 Main Road C4 Z Fax (516) 765-1823
P. O. Box 1179 • Telephone (516) 765-1802
Southold, New York 11971
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
January 23, 1995
Ms. Debra Acquaviva
76 Juniper Street
Islip, NY 11751
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.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 21955-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
4
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST ( ) ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING FINAL
REMARKS:
C DATE INSPECTO
i
70-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ /IR UGHPLBG.
FOUNDATION 2ND [ ULATION
FRAMING [ ] FINAL
REMARKS: drl
DATE % INSPECTOR
i
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] RO H PLBG.
FOUNDATION 2ND [ INSULATION
[l
[ ] FRAMING [ ] FINAL
REMARKS:
t
i
f
~r
4
DATE -INSPECTOR
i
M-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ]ROU H PLBG.
[ ] FOUNDATION 2ND [ INSULATION
C ] FRAMING [ ] FINAL
I~
~ REMARKS:
G
DATE CU INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
( ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] F DATION 2ND [ ] INSULATION
[ FRAMING [ ] FINAL
REMARKS: C"-~----
/Lrrti9zr/l ~
DATE C17A~ INSPECTOR
~'~dla'LD ll..Ci:•. H. ~U ~ r. I .....a..caa• ^^l•'f~ ~ ~ ~Y° _ .~.~a. R"~~
:7 IWh•E t COMMENTS
7OU11DATION (1st) yv
a~
FOUNDATION tiG
(2nd) mp
2. v G:
Ed• ' /i' ~J Z
ROUGH FRAME
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PLUhiB2NG
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b
INSULATION PER N. Y. _ y6
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS: v
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- 079 ' ~ ; -
m TOWNLDG. DOTI -
OF SOUTH lD,
f
- BOARD OF HEALTH
FORM NO.1 3 SETS OF PLANS
TOWN OF SOUTHOLD SURVEY . . .
p;frh' 6 r9l BUILDING DEPARTMENT CIIECR _ _ . _ .
TOWN HALL SEPTIC FOR:I
SOUTHOLD, N.Y. 11971 5"- SOOQ.
TEL.: 765-1802 t:OT I FY 2
Examined ......~jr1r 19~ CALL
q 9 MAILn TO:
Approved 199VPermit No.~f.
tif-
Disapproved a/c '76 Ja. i~G (f
14/
B ~ In /ecr ,
APPLICATION 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 location of lot and of buildings on premises, relationship to adjoining premises or public stre
ets
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 art for an t
shall have been granted by the Building Inspector. P Y Purpose whatever until a Certificate of Occupancy
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 Lws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, aas 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)
i
- °~6•Jsc,~~ Fit• Jl..:-'~La;L...L.- 1./.~'.s~
(Mailing addres of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises e ~j~C,Glf9~j%~
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No. l/Cl1!CL°w~~L/Q~LG/~/-Gf~_ y/
Plum ber'slicense ?,*l J-,
Electrician's License No..
~72`~ ~GEt7/y2jty
Other Trade's License No.
1. Location of land'on which proposed work will be done. .
House Numbcr Street
Hamlc
County Tax blap No. 1000 Section • • , • , • , Block ,
5 Lot.... r./...........
Subdivision Filed Map No.
Lot ......1.......
(Name)
3. State existing use and Occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy (f% ti" I'a tt ; e;,
• . Y.ti . f
b. Intended use and occupancy ! r r„~
3. Nature of work (check which applicable): new Building Addition ...tom .
Repair Removal , , Alteration .
Demolition Other Work escrip .
4. Estimated Cost . , . (Description)
Fee
5. If dwelling, number of dwelling (to be paid on filing this application)
If garage, units , Number of dwelling units on each door .
g 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 ' ' ' ' ' ' ' ' ' ' • • • • • •
Height Rear Depth...............
..Number of Stories _
Dimensions of same structum with alterations or additions: Front • ' ' ' ' ' ' ' ' '
Depth Height Number of Stories Rear
8. Dimensions of entire new construction: Front Rear .
Height Depth
••••••••••••..,Number ofStories
9, Size of lot: Front..
10. Date of Purchase Rear...................... Depth
Name of Former Owner .
11. Zone or use district in which premises are situated • • • '
I2. Does proposed construction violate any zoning law, ordinance or regulation:
3. Will lot be regraded Will excess fill be removed from premises: Yes No
14, Name of owner of premises Address Phone No............... .
Name of Architect Address • •
Name of Contractor . Address • • • , ' . ' ' ' • • Phone No............... .
15. Is this property within 300 feet of a tidal wetland?. * • " " " .Phone
o......No....
*If yes, Southold Town Trustees Permit may be required. NoPLOT 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.
STATE
COUNTYFNEl<1O$ZK /L S.S
(Name of individual signifi; contract) being duly sworn, deposes and says that he is the applicant
above named.
lie is the.........
(Contractor, agen , orporate officer, etc.
of said owner or owners, and is duly authorized to per or have performed the said work and to make and 61e 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 met is
y
l
Votary PubliCounty
(XNRE L QI.EVII
Notary Public. State of New York.
Na 4879606 .
chm% d in Suffolk County (Signature of applicant)
Coerei won Bow Dicsmbfrr
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3. ALL NBNII SHALL OOM/LY N CURBBNT NXN YOBX /!tATB BUILDING CODB/~ UNIFiI~I 3"YRB ON, AND LOCAL 1t'BBULIITION/.
2. -•r•'i OON /HALL VBRIFY ALL DIVSN/ION/
BRQjB 'so =/v=mm
3• ;&4M;.QUX DBANINU/. NRITTBN DINBN/ION/ ARM To BE
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4. ALL BIOP331ION NAl7Le /MALL BB 2"Xi" 0011 VSVCTION , ALL U
INTBBIQB PA1D!Ii"ION$ TO BB 2"X4" CONSTRUCTION UNLass
wmp~ z S. ALL BBADBRS AT'''llIB Oft NAUJ /HALL BE (3) 2"XYO" UNLB// f.1
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6. ALL lLO08 4OI/ti'i TO BB D00/LSD /SLUM PARALLBL PARTITIONS, ~-I
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7. PROPYDE BBIyDO~yno AT KID POINT OF FLOOB JOIST SPAN ON
V-0" O.,C. XAX. IN ALL FLOOR BYSTBNS.
S. ALL WINDOWS TO BB 11XOXR/BN NANUTACTUBSR UNLBSS NOTBD ^ oTB~Bpa/
9. ALL DOOR HBIOBT/ TO BX AT S'-S" MISS NOTSO OTRX WSX.
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M V K I me' APPS rED AS NOTED 11_
Di DATE: --113 ~ B.P. q .ss~ O
FEE~_BY: NOTIFY BUILDING DE ART ENT T
7E 765-1802 9 AM TO 4 PM FOR THE
FOLI.OINING INSPECTIONS: /
O > - 211%Fyn IZLt7~ R 1. C`i';ND :TV1"' TWO REQUIRED I.7 Q
" ' i,Uf i,-C0,NCRETE ILy
& PLUMBING O
211xF~l IZOOp a I V 4 4 TEFO i,^•L~CT ON MUST
u` AL Fd: CO S FLUTE FOR C O
k!.t CONSI RUCTIQN SHALL MEET
Tr: THE REOIIIREMENTS OF THE N.Y STATE CONSTRUCTION & ENERGY F-1
DE CSCT. CODES. NOT RESPONSIBLE FOR
-,I I uE DESIGN OR CONSTRUCTION ERRORS {~I
A
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Lo 1011 OCCUPANCY OR
USE 1~ UNLAWFUL
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