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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-21044 Date SEPTEMBER 28, 1992
THIS CERTIFIES that the building NEW DWELLING
Location of Property 395 BURGUNDY COURT SOUTHOLD NEW YORK
House No. Street Hamlet
County Tax Map No. 1000 Section 51 Block 3 Lot 3.13
Subdivision CHARDONNAY WOODS Filed Map No. 8822 Lot No. 13
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 13, 1992 Pursuant to which
Building Permit No. 2GS64-Z dated APRIL 20, 1992
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 AS APPLIED FOR.
The certificate is issued to BRUCE & BARBARA PETRUCCI
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 92-SO-25-SEPT. 3, 1992
UNDERWRITERS CERTIFICATE NO. PENDING - 753259 - SEPT. 25, 1992
PLUMBERS CERTIFICATION DATED SEPT. 9 1992 - K&K PLUMBING
Building Inspector
Rev. 1/81
I' 1
YORK NO. a
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)
.
19Q.z°
N°-N° 20564Z Date .........-00 .
Permission is hereby granted to.
`i<U........ .Y4.....1 ~
'
r...:1411 .1?G.+..
ses located at 120,4.4.4 .........C
County Tax Map No. 1000 Sectio Block . y~......... Lot No......3l. R .o...
pursuant to application doted ....'4ti'tirX 19.9.:?-, and approved by the
Building Inspector, v
Fee ti!.~..l..s...........
Building Inspector
Rev. 6/30/80
Form No. 6 ~4~5` 937
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.'
3. 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 - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $115.00, Commercial $15.00
Date ....L'
'ew Construction.... Old Or Pre-existing Building
L 1
ocation of Property:..:*'***.........L24rY
House No. Street
Hamlet
L- }
ewer or Owners of Property...-~ vc. C~n9 .....~~Ca bCiYCL.. .~LCI
I,)unty Tax Map No 1000, Section.... ~j ......Block..... 0..,~.•••••Lot.... ,1 ) _
ibdivision.~~q~CwY) ............Filed Map.6Z;.,?..... Lot: 3
!rmit No.~Q5h9.ZDate' Of Permit.PV.Y.)'IN) TItc .Applicant.. Y1544.SR~)4$.. { -LY~1 ~ c,•
!alth Dept. Approval...... \\Sf 5 ...............Underwriters Approval.. ....7,e 5
anning Board Approval
quest for: Temporary Certificate........... Final Certicate...V...... '
e Submitted: ?
~I ~1~6z l? ,{4vb y:... al.l ki•C...
,
co alQ~l't APPLICANT
CO ib Z -;z f~
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1001 i 90 BUREAU OF ELECTRICITY
83 JOHN STREET, NEW YORK, NEW YORK 10038
Date SEPTFHAER 28,1992 Application No. on file 77525992192 N 251971
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
BRACE POTRUCCT, 395 BURGANOY CT,, .10UTTIOL0, N.Y,
in lhefollowing location; ® Basement ?X l.st FL 11 2nd FL GARIOUT Section Block Lot -
wasexaminedon 89t?T9Hl1RR 25,1992 andfound to be in compliance with the requirements of this Board.
ECEPTACLES SWITCHES FIXTURES RANGES COOKINGDECKS OVENS DISHWASHERS EXHAUST FANS
FIXTURE
OUTLETS INCANDESCENT FLUORESCENT OTHER AMT K.W AMT KW pMi KW AMT. K W AMi. N P.
iIt1
34 44 35 34 1 d,2
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REVPT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
AMT. K. W. OIL H. P. GAS H. P AMT. NO. A. W. G. AMT. AMP AMT. AMPS TRANS. AMT H P NO. OF YSTEMS FEET AMT. WATTS i
3 3 3.' 2
SERVICE DISCONNECT NO. OF S E R V I C E
PMT. AMP. rypE METER I 4W , ,e' 3W 3 R 3W 3,e' AW NO OF CC COND. A W. G NO OF -EG A' W. G. NO. OF NEUTRALS A W G.
EQUIP. PER % OF CC. COND OF HI LEG OF NEUTRAL
i 3(0
1 X00 CB 1 Y 1 310
OTHER APPARATUS:
NOTORSIT 4,0 ff.P.,34 11,P,
G,P.C.Iz -7
SPOKE HETECTORr 2
TRACK LIGNTINGc_y w
TED CH9811TRN JR, CO, LTC,#953-0
P.O. BOX 255A
9280 ROUND AVE. GENERAL MANAGER
HATTTTUCR, NY, 11952 L1 'p
Peri.~..
This certificate must not be altered in any manner; retvrn to the office of the Board if incorrect. Inspectors may be identified by heir credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
i 5 't,'
r. • ~UI~'~, TEL. 765.1802,
v n 1.14
TOWN OF SOUTHOLD
1 OFFICC OF BUILDING INSPECTOtt
P.O. BOA 72$
t?? TOWN HALL „
SOUTHOLD, N.Y. 11971
i n 9
I{. it
C E-11 T I F I CAT I O N +
Ali,
It .
Date Sept. 9, 1992
1
r•,
Building Permit No. 20564-z
. Owner
r`# 1
(P ease rint
P
147nJeY M Plumbing
(P ease print)
ccsrtifY that the satdpr uged it, the water supply syvtem
' .''contains less than 2/10 of 1% lead. ,t.
i
t.~ r gym:
(Plumber's signature)
xf,
1 sworn to before me this
y
` i day of tt„ Notary Public
I{:1, 11akary publ i
County
,r :tJj%tY.
HELENE D `
HORNE
NOWryPu6do,State ofofho
oyYork r+`="
No 4951364 ~r•.a
m olk Counttyy
' Com~suasion 11fled In Exp(ces Suff May 22
t•` . 19 ij41
Zdj
T'1
CAICU ATIOAl'o
(FOR NON+rELECTAIC HEAT) DESTCN CRITERIA 6,000 Degree Mys
O.A. 100F Y.A. 70OF
1 OR ?d~cU; _ Au p d?WS a % ehhy /~v3/
3 f z3/~L-
P h T4 F))
13 5 YS yr_
j' AeE .u/tAriNG REMI,Rlt S
Exterior Walll+ (Opaque) ~~~vaU U~ ; /-76
01atinq 133 r3
N"re U 1 J
CA11111 Roof (Onagne) J oS O
?kv11v1,te ,v''l y' 9d • ~ vo / ~ _
Flnndation Walla
Slab Npulation
TOTAL a 9 3
Noteal
RailAing Envelope Sjeteae to Meet require>Aenta of 761+x4
HVAC Equi"00 to meet regvitementn of 791.5.11
,
HVAC Eyeteme to meet reg4tremente of 7A15.11,
Duct systems to meet requitementm of 7615.11
Vkntilations•Eystemh to meet,regniremehte of 7A15.14
Tnnalatien of Pipinv Syetemn to reet regrtiremente of 7813.15
Service Water ueatina Eyntemn and Egnipmpnt to meet Asquirekents of 761541
Electrical and Lighting 5retemn and Equipment to meet requirements of 7H1501
Te t-e beet of my KnowleAae, pf Nf
Telfet, and rrofeMMlonal Pet ~Yd
JMvement, theme plans are in z~ew~°E r~r9t
J a
compliance with the code. + s~
m ~ w
• Nt~~ 032251.1
~AQFfSSiDNt'~~.
fib ~ti
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----I H.
FOUNDATION (1st) I a
'OUNDATION -0 m1z
(2nd)
9,4
OUGH FRAME
-PLUMBING ~a
3, 7 d
'11SULATION PER N. Y. w-,n
STATE ENERGY
CODE ly 3 ~ r
i, .
An.
FINAL
r s w"-C.~~ • F
ADDITIONAL COMMEPJTS: m }
x
,ell
x
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M-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ROUGH PLBG.
FOUNDATION 2ND [ ) INSULATION
RAMING FINAL
REMARKS: !J r~
it ~11
DATE _y% INSPECTOR Ald a
765-1802
BUILDING DEPT.
INSPECTION
[ FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING t I FINAL
REMARKS:
S
V
I
DATE 1l INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ FOUNDATION 2ND [ ] INSULATION
C 7 FRAMING [ ] FINAL
REMARKS:-e4,
I
t
s
[°TE C ! INSPECTOR -
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ } FOUNDATION 2ND [4f-(WSULATION
[ 7 FRAMING [ ] FINAL
REMARKS: / O
" v!
r
4.
C
DATE INSPECTOR f 167
r
M-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ I INSULATION
[ 1 FRAMING [ INAL
REMARKS: z2
r
DATE 6 INSPECTOR
i
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ FINAL
REMARKS:
X) 0-
DATE INSPECTOR
v
f
BOARD OF HEALTII
FORM NO. 1
3 SETS OF PL,kaS .1.. •
it APR 1 31992 TOWN OF SOUTHOLD SURVEY
,
BUILDING DEPARTMENT CIIECR
'h
TOWN HALL SEPTIC FORPt _
TOWN SOUTHOLD, N,Y. 11971
TEL.: 7651802
Examined CALL ...q. -
19 .
MAIL TO:
Approved , O. , 199A . Permit No.--A'? .1a . .
Disapproved a/c
(Building Inspcctorr
APPLICATION FOR BUILDING PERMIT
Date
191..
ti 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-
ation.
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
call 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 agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
imit authorized inspectors on premises and in building for necessary inspections.
(Signature of applicant, or name, if a corporation)
).)yo f1 YS~fa2/r fzn C~z( , /!4V
y
(Mailing address of applicant)
tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
~?w/V z
~ameof owner of promises -~CT A V0 ~.~2,7 /~a 0 0~'T2 G cC /
.
(as on the tax roll or latest deed)
applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer.).
fficer)
Builder's License No. .
Plumber's License No. o y
5- IF
Electrician's License No.
Other Trade's License No.
Location of land on which proposed work will be done . .
.
.//...............?3 v~ GV ?0 y C0w,y
SooTHa~~
(louse Number
Street Hamlet
County Tax Map No. 1000 Section . S:? 5;.)• C1 . , , , , , Block C) 0 0 • • . • , • • Lot . ~ ~ • U 1 3
Subdivision ..C,~~ 7~ ~,o( NA In Oo ~S ~gsfPlrxS~ piled btap No.
a Lot t.
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
t. Existing use and occupancy N ~N
.Intended use and occupancy 1 .i1 C F
3. Nature of work (check which applicable): New Building
• • • • • Addition Vteration
Repair i Demolition Other Work
4. Estimated Cost )/0> o, 0 (Description)
• Fee
5. If dwelling, number of dwellim• (to be paid on filing this application)
If garage, number of cars ° u0s Number of dwelling units on each floor ,
6. If business, commercial or mixed occupancy, specify nature and extent of each type,of use • .
Dimensions of existing structures if an Front , , , , ,
Rear , , , , , , , , , , , , , , Depth , . ,
g Numberof of Stories
Dimensions of same structure . N with alterations or additions: ' ' ' • '
Depth......... Front`........ Rear....:.
Height
• Number of Stories .
8. Dimensions of entire new construction: Front .....7 '
Height Number;of Stories , Rear ......Depth y .
9. Size of lot: Front ' % ov Rear 1 .
10. Date of Purchase `f t i Depth ,a 7 9 6
Name of Former Owner n! El ~ f2,,Gp
It. Zone or use district in which rcnu..sl
p es are situated ....d~~4s'In~~r.a~
12, Does proposed construction violat('any zoning law ordinance or rem N D • ' • ' ' ' ' ' ' ' '
13, Will lot be regraded Yr S emulation: • • . .
14, Name of Owner of /3;ro`r Dn??~R9 <~Tuc.. • ' Will excess fill be removed from premises: Yes No
premises Address en r
Name of Architect • Phone No.
Name of • ¢ • . • Address ti6.. Phone No.....
.
Contractor cF9w Address a gA ..~.;,toeiq&r, k 9 S s j '
'.5. Phone No.. , .
property within 300'feet of a tidal wetland? *
Is this ray~r, *If yes, Southold Towp Trustees Permit may be required. Yo• X
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
nterior or corner lot.
5 4 ~ ~ l 9 c-r eA etr
LOT )3
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isa~~ (c} 0 l7S ~ `
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'ATE OF NEW YORK,
)UNTY OF .~p ~lGd'oLt S.S
r,- 7, V eP
N • ' ' ,being duly sworn, deposes
contract) y
(Name of individual signing "I'd says that he is the applicant
We named. ontract)
is the QCvItJEC'
(Contractor, agent, corporate officer, etc.)
said owner or owners, and is duly au}horized to perform or have performed the said work and to make and file this
lication; that all statements contained in this application are true to the best of his knowledge and belief; and that the
'k will be performed in the manner set forth in the application filed therewith.
)m to before me this
day of/~..../ 19~
ary Public, ?/~~r~~<a4 , . .
. County
ra a~1a1 tat'ntw
rer v ruBuc, sic ec n4 r1
W.
Suffotk County
York,
C'.emmis~inu (.Signature of applicant)
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APPROVED AS NOTED 1
3 ; DATE: A '1° - B.P. H 3DSG7 4 BY,
FEE: AEM.
\8 Q , ~ IUOUFY BUILDING DEPARTMENT AT 705-1802 9 AM TO h PM FOR THE
t FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REOLIIRED' ?4pF NEW Y04,_
FOR POUREDCONCRETE cE 2. ROUGH - FRAMIING F PLUMBING 3- INSULATION fi
A. FINAL CONSTRUCTION MUST r u w
6F. COMPLETE FOR C,O
fW 3 41I CONSTRUCTION SHALL MEET
I WE REQUIREMENTS OF THE NY. p 41 7I
I STATE CONSTRUCTION & ENERGY ^90fEsva*t~
- - - CODES. V'dOT RESPONSIBLE FOR
_ _ ~I Lil I I - DESIGN OR CONSTRUCTION ERRORS
_ l 7
PLUMBER CERTIFICATION ' Phone 477-0400 ,~.maol Road
ON LEAD CONTENT BEFORE GRF.ENPORT. \ Y. 1I9~4
CERTIFICATE OF OCCUPANCY
SOLDER USED IN WATER r[~ c c pE Ell M ; ~n z Y zz~s- F
SUPPLY SYSTEM CANNOT
EXCEED 2110 OF 1% LEAD.
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GRFIEN (?R'F. N.Y. 11944
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s GRLENPORT. N Y. 11944
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