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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-20960 Date AUGUST 20, 1992
THIS CERTIFIES that the building ALTERATIONS
Location of Property 1355 DEEP HOLE DRIVE MATTITUCK N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 115 Block 13 Lot 12.1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated FEBRUARY 2, 1992 pursuant to which
Building Permit No. 20428-Z dated FEBRUARY 13, 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 ALTERATIONS TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to ANTHONY & ANGELA LEONE
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-239237 - JUNE 16, 1992
PLUMBERS CERTIFICATION DATED N/A
Building Inspector
Rev. 1/81
FORK N069
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 2 0 4 2 8 Z Date 3 19.E
Permission is hereby granted t
.....g 5.......YM.
.::......t~.~. n
to 11wC(.t....!1?AsF ..C3.Rt .....0+.b4,QSp~!!... C.......................
y.......................................
at premises located of..A.5499....:I?--a°
........../C.... ....V.'. .,.J::i..... +t~S rn
County Tax Map No. 1000 Section/......111i Block Lot No....~..c3~:.
pursuant to application doted i.-A"n . 19.9.3-:, and approved by the
Building Inspector. v
Fee 5..1'x.:..
Building Inspector
Rev. 6/30/80
i
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT {~gg;;r~~
TOWN HALL AW 2 V ;0912
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.
r
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 - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date
New Construction........... Old Or Pr existing Building.
7 r
.rCI
Location of Property../.~t~.~ .Q ...~d?4 .....(..L.......
House No.' Street Hamlet
Onwer or Owners of Property../. 1 WR-p N~ . :~(V 6 ~~e e. , , ,L~(Vr-
County Tax Map No 1000, Section 1.1.`r:..... Block ~ ........Lot..( ° Z
Subdivision.... ./................................Filed Map............ Lot......................
Permit No D L.Z~ Z...Date Of Permit Applicant CT .r (:t ~ 6? FrfP C`dN~
Health Dept. Approval ..........................Underwriters Approval.° 4v,...........
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate..,:_:~
Fee Submitted: $ a S
CO 0960
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1195017 BUREAU OF ELECTRICITY
F 85 JOHN STREET. NEW YORK, NEW YORK 10038
Date JUNE 16,1992 Application No. onfile 76418992/92 N 239237
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
ANTHONY LEONE, 1355 DEEPHOLE DRIVE, MATTITUCK, N.Y.
in thefollowinq location: ? Basement ® lst Fl. ? 2nd Fl. OUT Section Block Luc
wasexarninedon JUNE 05,1992 andfound to be in compliance with the requirements or this Board.
FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS INCANDESCE NL FLUORESCENT OTHER AMT. K W AMT. K W. AMi K W AMT. K W AMT. H P.
8 2 8
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIALRECPT TIMECLOCKS BELL UNITHEATERS MULTI-OUTLET DIMMERS
AMT. K. W. OIL H. P. GAS N, P. AMT. NO. A. W. G. AMT. AMP AMT AMPS. TRANS. AMT. N. P N O SY. OF STE FEEMS T AMT. WATTS
2 600
SERVICE DISCONNECT NO.OF S E R V 1 C E
AMI. AMP. TYPE METER 102 W T s' JW 3 9 3W 3,0' 4W NO.OF CC COND A. W G. NO. Of HFAEG A. W' G. NO.OF NEVTRAlS A. W G.
EQUIP. PER % OF CC. COND. Of MI IEG OF NEUTRAL
OTHER APPARATUS:
SKINNER WILLIAM LIC.#1712-E
1439 BROOKLYN BLVD
BAYSHORE, NY, 11706 GENERAL MANAGER
11 S~~
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.
INSPECTORS
Victor Lessard a" ~vFFa(Y
Principal Building Inspector
ti~/,.
Curtis Horton a SCOTT L. HARRIS, Supervtisar
Senior Building Inspector Southold Town Hall
Thomas Fisher
Building Inspector k, P.O. Box 1179, 53095 Main Road
~ ter ~ G.
y4
Gary Fish Southold, New York 11971
IJd r rY~ Fax (516) 765-1823
Building Inspector ~zm
Vincent R. Wieczorek Telephone (516) 765-1800
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
MARCH 13, 1992
SIG APPLE REMODELING
895 MONTAUK HIGHWAY
SHIRLEY, NY 11967
RE: ANTHONY s ANGELA LEONE
To Whom This May Concern:
We are unable to complete your Certificate of occupancy
because of the following reasons:
%RIC An application for Certificate of Occupancy is
not on file. (Enclosed)
XXX No Underwriters Certificate on file.
XXX 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 #20428-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
CC: ANTHONY a ANGELA LEONE
INSPECTORS
Victor Lessard "~~FFiIIpr F,
I,s t'Q 4
Principal Building Inspector
Curtis Horton SCOTT L. HARRIS, Supervisor
Senior Building Inspector Ye~a
`YTJ cn • -~;.r t''~'~'si-;. Southold Town Hall
Thomas Fisher P.O. Box 1179, 53095 Main Road
Building Inspector x, a,rtt!
Southold, New York 11971
Gary Fish f~1 a1 Fax (516) 765-1823
Building Inspector `s
Vincent R. Wieczorek Telephone (516) 765-1800
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
MARCH 13, 1992
BIG APPLE REMODELING
895 MONTAUK HIGHWAY
SHIRLEY, NY 11967
RE: ANTHONY & ANGELA LEONE
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
XXX An application for Certificate of Occupancy is
not on file. (Enclosed)
XXX No Underwriters Certificate on file.
XXX 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 #k20428-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
CC: ANTHONY & ANGELA LEONE
T1cLD I;:S:`cCTiU;J Dr E I~ COCiMLNT°
1. °Q
a0
FOUNDATION (13t)
a rp
FOUNDATION (2nd) ti
2. - _ - m 1 12
ROUGH FRAME
"I
PLUMBING
N
3. n
a
m
INSULATION PER N. Y. m
N
STATE ENERGY
CODE
3 y l - .
4, m
H
FINAL
C)
E .
ADDITIONAL COMMENTS: m
x
. `tA
x
H
• H
O
m
r
H
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ l FINAL
REMARKS:
DATE INSPECTO
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST ( ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ RA ING [ ] FINAL
REMARKS:
Z
DATE G" INSPECTOR
B0,\RD OF HEALTH
FORM NO.1 3 SETS OF PLANS
TOWN OF SOUTHOLD SURVEY . . .
BUILDING DEPARTMENT CIICCK
TOWN HALL SEPTIC FORK
SOUTHOLD, N.Y. 11971
TEL.: 765-1802 t: oT Y ;~Ga '
p CAL ~ ,
i.xamincd. M 19ga PIAIL TO.,
'kpproved .l. 10n Permit No.a 0 !a~
Disapproved a/c .
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date 2J'4 19 I.Z.
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
As 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
tall 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 in ections.
Ltode-ll WC
(Signature of applicant, or name, i a cprporation)
(Mailing address of applicant)
:tate//w~~hether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
4.6 n. ~?t t0~
Jame of owner of premises !lNT.f ovy.!t;At?4..6.1,A.•4-~Af~Nth
(as on the tax roll or latest deed)
C ap iZt*s orporatio , ignatur of duly officer.
(Name and title of corporate officer)
Builder's License No. / Z
Plumber's License No .
Electrician's License No .
Other Trade's License No .
Location of land on which propo ed work will be done . . , , , , , , , • , , , , , , ,
TutG(C
~0$~S ....~Dq:gl dtz... .u.........1'?1,~t ~T f.
House Number Street Hamlet
County Tax Map No. 1000 Section J.CJ............ Block Lot . , ..i,a r
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 . . . ,r,~y, ,7 ZI , , , ,
q fd e t . .
b. Intended use and occupancy °
3. Nature of work (check which applicable): New Building . , . , , Addition , Alteration f
Repair . . . . . Removal Demolition Other Work , .
G O (Description)
4. Estimated Cost.
(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 .
Dimensions of existing structures ',if any: Front . . . Rear Dbpth
Height Numb r of Stories .
Dimensions of same structure with alterations or additions: Front
Depth Rear..................
• , , , . , Numbe ion: F. . . .Number of ...........ie Depth
8. Dimensions of entire new construction:
Height
of entire
Yion Front Rear .
of Stories . . . .
9. Size of lot: Front
promises Rear Depth
10. Date of Purchase ,,,,,,,,,,,,,,,,,,Name ofF•ormerOwner
11. Zone or use district in which
12. Does construction vtolate are situated , , ordinance , , , inst.. .
g any zoning law, ordinance or regulation: "
13. Will lot be regraded "
proposed • • • • • • • • • • • • • • , . Will excess fill be removed from premises: Yes No
14. Name of Owner of premises , , , , , , Address , Phone No.......... ,
Name of Architect
within 300i Address Phone No, .
hh iG..
Name of Contractor P.~G ~~I ~ •e~wQ~t=~~ .Address ~t~rv`~
! 5. Is this property No No. ~`(.`~'.tfy , , ,
'
y feet of a tidal wetland? *yes,,,,,,,, No.........
*If es, 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 num';ber or description according to deed, and show street names and indicate whether
interior or corner lot.
I
I
H
h
TATS OF NEW R • 1•~~~1
OUNT~Y,~~~-li(,~f, m'. S.S~ 1 (j
ll~ , t .Il r l
t ~ • • • jkl- being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
3ove named.
I
cisthe............................
(Contractor agent, corporate officer, etc.)
said owner or owners, and is duly authoniZe o perform or have performed the said work and to me and file
plication, that all statements contained in this application are true to the best of his knowledge and belief; and that thte
)rk will be performed in the manner set forth{ in the application filed therewith.
vorn to before me this
~ - 19
day of ,
Mary Public,. County .
CLAIRE L CLEW I IA4N
Notary Public, State of Newyork
No.4878605
Qualified In Suffolk Coumy (Signature of applicant)
Commiaskst Expires December 8,19E
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COYl S. f.IOT RESPONSIBLE FOR C - C o I 14, fl/WZZ RE/JDpEL/.?~ / of /
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