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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-22457 Date JULY 20, 1993
THIS CERTIFIES that the building ADDITION & ALTERATION
Location of Property 1225 INLET DR. & 500 MIRIAM RD. MATTITUCK, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 99 Block 2 Lot 9
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 21, 1992 pursuant to which
Building Permit No. 20446-Z dated FEBRUARY 25, 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 REPAIRS, SECOND FLOOR AND DECK ADDITION TO
EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to JOHN & JOANNE CALABRESE
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-270150 - MARCH 23, 1993
PLUMBERS CERTIFICATION DATED JULY 19, 1993 - JOHN CALABRESE
Building Inspector
Rev. 1/81
FORM 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)
No 20446 Z Dare ..~°.ts.....................................
. t9~
Permission is hereby granted to:
/ v s M12
at premises located of .~°~./2 ~..Jaw......
1~(...................................................................
.........................................................................q.....................................................................................
County Tax Map No. 1000 Section Block Lot No..,5~
pursuant to application dated and approved by the
Building Inspector..
Fee S•'~.~'lXi
Buil g Ir~.tpeetor
Rev. 6/30/80
THE NEW YORK BOARD OF FIRE UNDERWRITERS PPA00V It
1.00G822 BUREAU OF ELECTRICITY
F 85 JOHN STREET, NEW YORK, NEW YORK 10038
Date HARCf1 I ,:f ~7 R:i Application No. onfile 771. fiall9L~~'1 2) Ian
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number in thepremises of
J.CALABRNSK, WO NtRLAR ROAD, MATTIl''ISC9, R,Y,
in thefollowinR' location; 71 Basement 1 1st FL ® 2nd Fl. ONT Section Block Lot
wasexaminedon I?tA.Reff 19ti393 andfound to be in compliance with the requirements of this Board.
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS ECEPTACLES SWITCHES INCANMscENT FLUORESCENT OTHER MAT, K W. AMT K.W AMT K.W. AMT KW
AMT. H P
,I a 40 30 41 1 , 30.6 2 T
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIALREC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
AMT K. W. OIL H. P GAS H. P. AMi. NO. A W. G AML AMP. AMi. AMPS TRANS. AMT. SYSTEMS
H P. NO. OF FEET AMT WATTS
I I Dsf ~.zrz a 1,
SERVICE DISCONNECT NO.OF S E R V I C E
AMT. AMP TYPE METER 10 9W I A H 3X CW No OF CC COND. A. W G. NO. Of HbLEG A W. C' NO OF NEUTRALS A W. G.
EQUIP. PER.e OF CC. COND. OF HI-LEG OF NEUTRAL
a cu ~ x z z 1, a
OTHER APPARATUS:
NOTOR3:2' f' I{. P.
{i . It . C...7 L - .f
2ROV i I1f'iT['(1 TI)R i -2
JOHN CALLA.I3R@1519 t17:C:.flt.3t~7
25 OAK DRIVE
C''REAT NECK , PIY, 11021. GENERAL MANAGER
7.i
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.
~VF F ~L{ TEL. 765-1802
~O .of `D~i
T0V?N Or SOJT 10LD
OFFICE OF '
IIUILDII•IC INSPECTOR
P-0- BOX 1179
TOWN HALL
~1 ~b0 SOUTHOLD, N.y. 11971 JUL 191993
• TOWN CEv.. OUN p9C.r.i;....,.., .
C E R T I F I C A T I O N
Date
Building Permit No. 433 I 2
Owner y ®4(~. (f
(phase print)
Plur,ber fly e®9-Lfj/3/L _
(please ~f
Print)
I certify that the
contains l solder used in the water supply system
less than 2/l0 of to lead.
( umber s- ture)
Sworn to befor: me this
-t=~daY
of _2(h % ,
19 Q3
Notary p Notar
County __...._._.__._l._Pub, ~G___-----
RO® L SCM. Rt
i o.4NOTARY 089 Seffo; ~N Y
Iwo Term Expires May ppl~yy
3I,19T$
INSPECTORS
Victor Lessard
Principal Building Inspector
Curtis Horton SCOTT L. HARRIS, Supervisor
Senior Building Inspector
Southold Town Hall
Thomas Fisher ` v
Building Inspector ,V P.O. Box 1179, 53095 MainRoad
yl ; Southold, New York 11971
Buildn R Inspector Fax (516) 765-1823
Telephone (516) 765-1800
Vincent R. Wieczorek
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
JDLY'16, 1993
JOHN CALABRESE
25 OAK DRIVE
GREAT NECK, NY 11021
To Whom This May Concern:
We are unable to complete your certificate of occupancy
because of the following reasons:
7//~ ? KZx An application for Certificate of occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
/XXX The check is not on file.)$25.00
No Health Department Approval on file.
-/7- No final inspection has been made.
ffi No Plumber Solder Certificate on file.
47 (All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT 4 20446-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
:1F1 D CUXMLU
?OUI7DATION (1st)
I
?OUNDATION (2n d)
_ • I o G~ 4J
-OUGH FRAME & O
093`
PLUMBING (t\
40
3. y
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x U~
LNSULATIO;I PER N. Y. m
H
STATE ENERGY
CODE I ,
113 el
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FZ:7AL -
o
ADDITIONA OMMENTS: m`
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M-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [0//INSULATION
FRAMING [ ] FINAL
REMARKS: ,rm V- c~
DATE Jr INSPECTOR,
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
DATE 6 L INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
FKMINQ [ ] FINAL
-Ao
REM KS-
DATE INSPECTOR
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BOARD OF HEALTH
FORM NO. 1
j3 SETS PLANS . .
TOWN OFSOUTHOLD /SURVEY . . . . . . .
' P BUILDING DEPARTMENT HECI:
FEB 2 11992 - . ' ' ' `
J~ TOWN HALL SEPTIC FORt1
SOUTHOLD, N.Y. 11971
TOWN'ol TEL.: 765-1802 NOTIFY;
Examined `P.-. //gyp 19~ CALL
• MAIL TO.... .
Approved -Y-W 19 ...Permit No. 6 . .
Disapproved a/c . .
. o
5....
(Buil ng In ctor)
APPLICATION FOR BUILDING PERMIT /
Date 2.~........., 19 n-
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
cis 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
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
hall 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
hall 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
Wilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
tegulations, 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
dmit authorized inspectors on premises and in building for necessary inT ectio~rs.
:
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
Rate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
k.lx!NE2
Vame of owner of premises .J. ow.t4 N. , .111Z~k71..h/.~C'k.. x/(f //UZ )
(as on the tax roll or latest deed)
f applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No.
Plumber's License No. . .
Electrician's License No. .
Other Trade's License No. f/
Location of land on which proposed work will be done. r ~ f E . . . . . . .
J. l`f ~.~.%..l~.t2........~J o........
House Number Street Hamlet
County Tax Map No. 1000 Section G/
Al Block 2 , Lot. q
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
b. Intended use and occupancy . , , , , , ,
3. Nature of work (check which applicable)* New Building Addition . Alteration
Repair . Removal............ Demolition Other Work .
ZT (Description)
4. Estimated Cost . 1. Q .O,paQ Fee
(to be paid on filing this application)
5. If dwelling, number of dwelling u' pits • • • • • : • Number of dwelling units on each floor. , t ,
If garage, number of cars 11 . .
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .
7 Dimensions of existing strutoes Number any: Front ..<6 .V. • . • . , , , , . Rear Z$ Depth
He Z /
'er of Stories
Dimensions of same structure with alterations or additions: Front , , . :f 1~ (1. E:..... Rear , • , , , ,
Depth •••.'I.Height Number of Stories.........
8. Dimensions of entire new construction: Front Rear Depth
Height
. , • . , , . . . • . . Number of Stories
9. Size of lot: Front Rear . . Depth
1101- .
10. Date of Purchase . . . . . . . . ....Name of Former Owner .13! 4L.,,0..-2. r4~f.~H.><~FIT/!,? LtV
11. Zone or use district in which premises are situated
12. Does proposed construction viola~e any zoning law, ordinance or regulation: /V.O .
13. Will lot be regraded . X1.4 , • • • • • • • , Will excess fill be removed from premises: Yes )NO
14. Name of Owner of premises,lo#4 , r.,4GAa16;b eF. AddressZi Od~A, • • • • Phone No. 7.].?410 .
Name of Architect Address . . . . . . Phone No .
Name of Contractor
15. Is this within 30 • ~ ~ " of a " • • Address Phone No............... .
property
0 feet of a tidal wetland? *Yes No~ '
If 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.
I
~I
i
M
;TATE OF NEW YORK,
S.$
'OUNTY OF .
' ' 'J v (~~Z •6 • • • • • • • • being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
bove named.
(Contract , agent corporate officer, etc.)
f said owner or owners, and is duly authorized to pc or have performed the said work and to make and file this
1plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the
ork will be performed in the manner set forth in the application filed therewith.
worn to before me thi
b
otary Public,! County
CLAIii E ~ ~
Notary Public, State f New York
No.48796 6 . , G.. .
Qualified in 8uffol~C Counryr G~
Commission Expires December 8,18! (Signature of applicant)
I w.
Q Form No. 6 r
i
BUILDING DEPARTMENT 9 1
TOWN OF SOUTHOLD &iSOIJT
993
TOWN HALL 765-1802 FdP9t pp
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.
B. Ftr 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 7$15 00, Commercial $15.00
Date
New Construction........'... Old Or Pre-existing Building
Location of Property.-70a. D,,,,,,,,,,,,, .Y
House No. ( Street Hamlet
Onwer or Owners of Property.
.V.~c((~~. ?G,(Q~3C
County Tax Map No 1000, Section.KI/.......... Block. 2............Lot
Subdivisio .z....... Pil d Map ............Lot.,
~Livisio -
Permit No.4-<.... Date Of Permit...? <Applicant'j G l ~ !GZ
Health Dept. Approval ....................//.....IIIIII.Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate A.........
Fee Submitted: $ 2 ~
a~e.yby~~
APPLICANT'
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{ v tPj ui i I ~A ~-1I 1111 I I r~
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C~ .'p D s s I ~ 11 rI ! ,
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-41
L- - G
UNDERWRITERS CERTIFICATE
REQUIRED GENERAL NOTES.
1-4" x HEADEHS 0,-HALL OPENINGS IJNLL, J
OTHEPP/h(l Sf'd: F 6)
- PLUMBER CERTIFICATION 2-ALL S11WC11J.:, L LUNMER TO BE MIN. 1206
L ON LEAD CONTENT BEFORE kP R
kG R EUASNOTED U LN VIR ci fill UNUIS
CERT;F/CATE OF OCCUPANCY DATE
SOLDER USED IN WATER FEE FF - FEE- BV: '.-P -v 'l L U,;.-N ANI I ~
Ml, 1 J ! SUPPLY SYSTEM CANNOT 765-1802 9 Al NOTIFY BU L G JIVA 7 AT 1
w!. EXCEED 2110 of 1 %LEAD. FOLLOWING IN T65-1802 9 AM TO 4 R PM FOR THE 11 5-11 ,,I .l , ; IOCLI ~
1 FOUNDATIO FOLLOWING INSPECTIONS: JVISIS UNUEkt h;j 6EAH,N- ~A73I - 1 FOUNDATION - TWO REQUIRED p ~ - TIOPIS. J
FOR POURE'-N'r-_, ,-'c. 2, ROUGH - R FOR POURED CONCRETE € - It ee tty"~~ y ! x--NOTEL, DIMENSIONS in lnu~ uRi f-
~ I 2, ROUGH - FRAMING & PLUMBING 1, W%4It A r,PR II?? 'Al
4;,v CEf? tti r .n- J E, INSULATION S, INSULATION y l' ALL CONSTRUCTION SHALL COMPLY
! a h FINAL - 4 FINAL - CONSTRUCTION MUST L F 1nl BE COMPLETE FOR C.O. AWITH NA, ST. AND LOCAL COCES
BE COMP W k n L CONSTLE r - - a- t7P.~l- ~~0d d i ALL GONSTRI ALL CONSTRUCTION SHALL MEET I'pkyf T() PIL USM F31Z - ' °
, THE REQUIRE THE REQUIREMENTS OF THE N.Y. 1
t /X,='„-,nr_~,..-r~ ~:?~Iny^Y:-~O.? 2J,OT - ~ ~~.rY -lll ~ i.-i ..r ~ Y fi R°w~F~ A~ 1 11111 AAAb4rl if SFATF I:ONS7 crnrl CONSTRUCTION & ENERGY CONO STd UC Xim U17LESS ALL EXTERIOR GLA71,N6
UIMLJMV4i1 4,10_ CODES. NOT CODES. NOT RESPONSIBLE FOR APPROVED BY BUIL¢SINU WW'I.)
DESIGN OR CONSTRUCTION ERRORS, PERn F ORMACJ IIIISULATEC GLArii
1,MTHOUT CERTIFICATE DESIGN OR CC
OF OCCUPANCY `j a.
j , ~rYNbINM liE If copper tubing is used
7Et?MO ~`OIIEcowlme for water distributing ised OWNER-k) l 1M,ERRICK DESIGN
- system; Piping shall be Ing ADDRESS - - t"flI ,%+M, F4D-- W. 310 M.m& Avenue
Of types K or LoNy I be SEC. K. ^ ioi M.u;ck, Nu,,, York 11566.
Tel (516) 868-7510 ^"yl
LOCATJON D iE
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ADDRESS - Mik-IN's 3io Merrick Avenue 9
CUF-JL~~'IG~L..I p~..~i~.~ ~ai.~e'~''°I~-9'' _,~~L11 ~ SEC. LK tOT ttid., blew Yo.k 11566
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LOCATlON DATE
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MERRICK DESIGN
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