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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-23705 Date JUNE 14, 1995
THIS CERTIFIES that the building ALTERATION
Location of Property 3140 GREAT PECONIC BAY BLVD. LAUREL, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 128 Block 6 Lot 9.1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated -AUGUST 20, 1993 pursuant to which
Building Permit No. 21640-Z dated AUGUST 20, 1993
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 ALTERATION TO EXISTING ACCESSORY GARAGE AS APPLIED FOR
The certificate is issued to LODA ROMANELLI
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-323286 - AUGUST 10, 1994
PLUMBERS CERTIFICATION DATED N/A
Building Inspect 2~7
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)
/...3..
N Date D) f{.. 19Q
21640 Z /
Permission Is hereby granted to:
c,J~Nas ...........................(..L.d..~..~.r~.....~~.
o.......
~~?n,.,.....
to .......,Z. T v3 F
s.......... /~.°i°~ .Ed........
.
- .
at premises located at .............3~'1'< ..............5.'~~rE oe i. <</
t~ .C:.............~..J.........................................................
County Tax Map No. 1000 Section ..,1 /d............ Block 4144 Lot No. /
pursuant to application dated ............e./.~/.14f 19../...Q .3....., and approved by the
Building Inspector. /
Fee $....3...
-'f IIBInspector
U
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TO[JN HALL
765-1802
APPLICATION FOC CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter OR ink and submitted to the building
inspector with the tollowfng: for new build'_n5 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. Approyul 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.
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 properle 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 therofcr in writint; to the applicant.
Fees
1. Certificate of Occuoancy - New dwr lling $25.00, additions to dwellinc 525.00,
Alterations to dwelling $25.00, Swimming pool $25.00, accessory building $25.00,
Additions to accessor'; 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.O$15.00., Commercial ;15.00
Date I .9.../.y
.ew Construction.... Old Or Pre-exisnting Building Xn
.ocation of Property.....t3~.~P??...~rt..:..! .I.J`.~ .cos;'a.Ft~^•!. ......`..y............
House No. Strut Hamlet
rower or Owners of Property....~~-!:Tl-...
.ounty Tax Map No 1000, Section 1.2.8...... Block. .4............ Lot. .gl V
subdivision ....................................Filed Map............ Lot.
'ermit No.. JZ.'J*. < •.Ddtc OZ Permit ................Applicant.............................
Iealth Dept. Approval ..........................Underwriters Approval.........................
'lanning Board Approval
'.equest for: Temporary Certificate........... Final Certicate...........
ee Submitted: $
C~c•'tgb3y
Co ~:2:,23 70_5 :.1 Pi_TCA,'7
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 Y
lUllJl? BUREAU OF ELECTRICITY k
F 65 JOHN STREET. NEW YORK. NEW YORK 10038
Date AUGUST 10, 19q4 Application No. on file 82551093/93 N 32123E.
THIS CERTIFIES THAT
F
only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of R
Li,10 ROILIANEI.LI, 3140 PECONIC BAY BLVD. , LAUREL, N.Y.
in thefollowin;t location; ?X Basement M Is( Fl. M 2nd Fl. GAR/OUT Section Block Lot
was examined on AUGUST 08 , 1994 and found to be in compliance with the National Electrical Code.
T`
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WA' ERS EXHAUST FANS "
OUTLETS ECEPTACLES SWITCHES INCANDESCENT FLUORESCENT OTHER WT KW AMC K W WT. FW /JAT KW AMT. H.P
R
`s3 73 82 1 4.6 1 h.3 1 1.4 2 F P
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS EELI UNIT HEATERS MULTI-OUTLET DIMMERS
AMT K. W OIL H. P. GAS H. P. AMT. NO. A. W G AMi W. AMT AMPS. TRANS. AMT. H. P SYSTEMS AML. WAITS E
NO. OF FEET
I / - 1
SERVICE DISCONNECT NO. OF S E R V I C E
METER NG OF CC. COND. A. W G A -.0 A. w. c
'W'T' AAUP EQUIP. 1 A 1 / 1W l R lW ) / IW PER 8 OF CC CONp NO HiIFG OF HI LEG NO Of NEUTRALS OF NEUTRAL
_ l7u r'H 1 X 2 1/0 2 l;iT
OTHER APPARATUS:
JAi'U:"Sr 1
I1iITGP.;:4-3.5 H.P. ,4-F H.P. ,5-F H.P.
PANELBUARDS:4-1 CIR. 60
I-.. F. C. T: --Is
PAUL R. BUR145 LIC.#282-E
P.O.BOX 1061
SoUTHOLD, NY, 11971--09 32 GENERAL MANAGER
it
Pe
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be en ified by their credentials.
FO(/(~OGy
y Z Fax (516) 765-1823
Town Hall, 53095 Main Road co
P. O. Box 1179 .r0 • Telephone (516) 765-1802
Southold, New York 11971 .f. 0!
poi ~ ~a
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
March 16, 1995
Windsway Building Corp.
1020 Glen Road
Southold, NY 11971
Re: Loda Romanelli - BP#21640-Z
Prem: 3140 Gt. Peconic Bay Bouldevard, Laurel
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)
xx 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.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 21640-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
FIELD IN3ftCTION REPORT DATE COMMENTS \v
n
II
II~_ ~llA H
c
FOUNDATION (1ST)
n „
n
R- -11
n _
II C
FOUNDATION (2ND)
it
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II I
II
O
ROUGH FRAME 6
PLUMBING i it
ii
INSULATION PER N. Y. M
n
STATE ENERGY a
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CODE u
ii
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I II li Ntv
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II j
II
FINAL III- iii
_ II II
_ ADDITIONAL CO S:
mac,
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5 7
NOTES A n
L = MONUME IONS NT FOUND • =STAKE FOUND S
2 ELEVATIONS cRE REFS REw:EG TO IN G.V 0
.v G _ s~ \ \2B G.9\
I MSL X929) \p00" \Og26
• E `N
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0
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.ELLTM OCPL R'YENT -DLTL FOR LR9 R' ~ TO CONSTRUCT
• L4+C.RA aA;N-W ! .+0a.ft OR u'l. FR.PR-t Z.Jl•C _ e
IF 1MtL .1Q m P tl""s reu loo ',IT or TN+..:PERT. 1 \ 00. D
OF-E. T.AN T.O+t f-D- -I CO. D. r.t rU ZK , YC BE .4E a Vf1.- nt-u rJ I'S .0 CIE RCZ
nul 11" TO T•( IT.-W OF Twt f./T1. CeJT, DvL.ra.T p6
w.tL.r. t .CEII y\ o
u.LlCrr-
.DD.{O P \ w..n.
t V aN 9
SURVEY FOR
N
LODAVICA ROMANELLI
AT LAUREL 0 \ TM1> >3 hr,
TOWN OF SOUTHOLD i~P
SUFFOLK COUNTY, f1.Y.
NE
h g~ w. y9~ y
,r
45695 y
r p S~~ ~ ~
AUG 9,1993 hnw-A- e y
JUL 16,1993
JUN 18.1990 YOUNG aYCrtlN
DATE MAY 14, 1990 400 OSTRANDER AVENUE, RIVERHEAD, N.Y ta• '
SCALE. I'=40' ALDENw YOUNG,NYS. PE B L S LIC N0.12841 a°
110. 90-0312 HOWARD W YOUNG,N Y5 L.S LIC. NO 45893 /4`P
BOARD OF HEALTH
FORM NO.1 3 SETS OF PLANS
TOWN OFSOUTHOLD SURVEY
BUILDING DEPARTMENT CHECK
TOWN HALL SEPTIC FORM
SOUTHOLD, N.Y. 11971
TEL.: 765-1802 t:oC
CALL ALL . . .7~1- 1! h . ) l a
- C?.?.
Examined a...... 19 D, y HA I L TO:
Approved 0 , 1973 Permit No..d ~~a21 _ .
Disapproved a/c . . . . . . . . . . . . . . . . . .
ildi /Inpectore)
APPLICATION FOR BUILDING PERMIT
Date 45?10.., 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 stieets
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 inspect'
I Nn..S G~VWw'c., .M .
(Signature of appliicpcann~t,~br name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
lh.
.
Name of owner of premises . (0ai4 q. N 6r1 t o
(as on the tax roll or latest deed)
If applicant is o t/0 nn ss ture of d~ul~y auth~oriz officer.
(Name and title of corporate officer)
Builder's License No .
Plumber's License No.
Electrician's License No .
Other Trade's License No .
1. Location of land on which proposed work will be done.
House Num er Street Hamlet
County Tax Map No. 1000 Section 6 Block Lot I: Nil f
Subdivision Filed Map No. Lot
(Name)
3: State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .
b. Intended use and occupancy
3. Nature of work (check which applicable): New Building Addition Alteration
Repair Removal Demolition . .l6~r....... Other Work
~ WA .5
(Description)
4. Estimated Cost A•-O...057:° 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, commercial or mixed occupancy, specify nature and extent of each type of use .
7. Dimensions of existing structures, if any: Front ~.'.nt..... Rear ~.'.5 Depth . , !
Height Number of Stories ....4........ .
Dimensions of same structure with alterations or additions: Front y Rear ..4
Depth 1?0) Height `f Number of Stories P. -L
8. Dimensions of entire new construction: Front Rear Depth
Height Number ofStories
5. Size of10L:Front Rear...................... Depth
10. Date of Purchase Name of Fortner Owner
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation:
13. Will lot be regraded ' Will excess fill be removed from premises: Yes No
14. Name of Owner of premises .440. !*I*rA`... Address . F* .d.~ tom....... Phone No. yfY.-)4-V~ .
Name of Architect Address Phone No .
-el D1 ! 1.. . Gtr" r'a
Name of Contractor !`7.:^•::~.... ...Address . I^~? Phone No. 3"E?.. !
15. Is this property within 300 feet of a tidal wetland? *Yes........ No.........
*If yes, Southold Town 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.
STATE OF NEW Y1 S.S
COUNTY OF ti a
? d . I being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the
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
Qj ..day of. . 19
G/~•
Nota PuWiui~/I.... County
.
ELIZABETH ANN N ILLE (Signature of applicant)
Notary Public, State of . 9w York
No. 5 -8125850, Suffolk Coyeaq/
: Term E Expires xpires October 31, 19~
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DA ILP _ }'`(H SIVItC GYIn~LC \>aLn.Y li 1 ~1140GIEY 560
NOTIFY BUILDI I t. FEE; ~BY' NOTIFY BUILDING DEPARTMENT
_ 785-1802 8 Al 785-1802 8 AM TO 4 PM FOR THE
FOLLOWING IN'i. FOUNDATIOI FOLLOWING INSPECTIONS:
I . FOUNDATION - TWO REQUIRED
FOR POUREI 2. ROUGH - FF FOR POURED 2. ROUGH GH - • FRAMING G & & PLUMBING OCCUPANCY OR
3. INSULATION 3. INSULATION ,
4. FINAL - C 4. FINAL - CONSTRUCTION MUST
BE COMPLEI BE COMPLETE E FOR FOR C. C.O. ' USE IS UNLAWFUL
ALL CONSTRU THE REQUIRED ALL CONSTRUCTION SHALL MEET WITHOUT CERTIFICATE THE REQUIREMENTS OF THE N.Y. UNDERWRITERS RTIRGTE
STATE CONSTI STATE CONSTRUCTION R ENERGY REQUIRED
CODES. NOT CODES. NOT RESPONSIBLE FOR OF OCCUPANCY
DESIGN OR COI DESIGN OR CONSTRUCTION ERRORS