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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF 0CCUPAI3CY
No Z-21189 Date DECEMBER 3, 1992
THIS CERTIFIES that the building NEW DWELLING
Location of Property CENTRAL AVE. & MUNNATAWKET AVE. FISHERS ISLAND NY
House No. Street Hamlet
County Tax Map No. 1000 Section 6 Block 3 Lot 6.2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 18, 1991 pursuant to which
Building Permit No. 20177-Z dated SEPTEMBER 27, 1991
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 & DECKS AS APPLIED FOR
The certificate is issued to PHILIP & JANICE OPALENSKI
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 91-SO-52 NOV. 27, 1992
UNDERWRITERS CERTIFICATE N0. N-255546 - NOV. 2, 1992
PLUMBERS CERTIFICATION DATED JULY 7, 1992 - T. BUEHLER
Building Inspector
Rev. 1/81
108M N0. ~
TOWN OP 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° 20177 Z Date ....~~.~'...~....`..~:~::...~.1........, X9.41..
Permission is hereby grouted to:
..~............u I.....a..p......'~1.
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Y ~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
at premises located ot .l~ktt!1:44.4~.1t~.k!5..~:~:4k~~f!?.!~:!:.`.~~..~~!4~4....~...
County Tox Map No. 1000 Section .......~..~Y........ Blockp......Q..~...... Lot No...~'
.W.:
pursuant to applieotion doted ...~?~:!^.~!.^.:~......~..4..........., 19.9...., and approved by the
Building Inspector.
Fee 3..710; QO....
..eS ~11:: 5~..
Building Inspector
Rev. 6/30/80
1~ . ,
TOWN OF SOUTHOLO
BUILDING DEPARTMENT
U~~ _ I TOWN HALL
r,!
- SOUTHOLD, NEW YORK II971
765 - 1802
APPLICATION-FOR CERTIFICATE-OF OCCIIPANCY 9 p~
DATE, y.. ZG1 .
NEW CONSTRUCTION .~1.....OLD OR PRE-E%ISTING BUILDING......VACANT LAND........
Location of Property.. ~~1. ~~I.! .:~1~:6~,~~Pi'~~7~4....~15!'iY%'~.g .~~~~-,~(.o('
HOUSE N0. STREET HAMLET
e
Owner or Owners of Property... ~ v~n?~. :~`QM~~~....^.~...'.'...
County Tax Map No. 1000 Section .~Cl. Block ~ Lot ~/L.l~g.. v
Subdivision Filed Map ........Lot..........
Permit No.r~:.l~(„Date of PeSrmit .Y~ ~t.....ApplicanC •1.~`~~~~~~
Health DepC. Approval .....~~'i/ Underwriters Approval... eS......
r,,
Planning Board Approval
Request for Temporary Certificate Final Certificate ......~.t/d......
Fee Submitted:
` ~ APPLICANT..
rev. 10/14/88
Cam' ~c, y~aryo y
- New York State Department of Environmertal Conservation
Building 40-SUNY, Stony Brook, New York 11794 II
`P~I~I~ ~~QIenS~i DATE: MQy Iq~ 4-
.~Ivnl drove. A~Pet~~te- - Re: f~P(~~Ic~.~ioh~ 1-473~'-ov3o9 f -
~~~c,~evlce~~'T oa~06 - oooai -c~
o~~r -Ph.1. P Q ~alzi~s ~ i Thomas C. Joriing
Commissioner
Dear I`1~- D~Glens~i o `
- - A-review- has been made of -your proposal to:-~C3t~13°~-fv.G'~ -Q' -$`'r'~}` ~~`rv`~~~ -
dt.~e.lllnqq.?sani}Gry_syS~tm ~ gara~~~ cQ~'r~iew~Y ~ 0(ec.ki~.~ a~ ~p~,r Plan
- - f~re:pa~~dl by ~Zicl~ara~ S~'-t-rQ~se ar 3 ~i8-191 -~o,~-~h-e ~~~e.T'ty tac~.tec~
q'~- eevri~f ~1 f~~~-~'~n~ ~tv~~ Munn~itawke.'} Prve~~~ i F<sY,cr~s ' ~s1aNd a
Based on the info-rmation you have submitted, the New York State Department
of 'E vironmental Conservation has determined that the parcel
- - - - "
- project is:
- -
- Greater-than--300'. from inventoried tidal wetlands:- ~
Landward of a substantial man-made structure ,SeAWG~I~ Gn(f pQG''~(A IOQUfS1
greater than 100'- in length which was constricted prior t 9/20 77.
'
! Landward of the 10' above mean sea level elevation contour an a
gradual, natural slope.
' - Landward of the topographic crest of a bluff, cliff or dune which is
j greater than 10''3n elevation above mean-sea level.`
Therefore, no permit is required-under the Tidal Wetlands Act (Article 25
of the Environmental Conservation Law). -'Please be advised, however, that
no construction, sedimentation or disturbance o-~any kind may take place
seaward of the 10' contour or topographic crest without a permit. It is
your responsibility to ensure"that all necessary precautions are taken. to
prevent any sedimentation or other alteration or disturbance to the
'
ground surface or vegetation in this area-as a resulG.of your project.. _
Such precautions may-include providing adequate work area between the
j 10' contour or topographic crest and the project'(i.e. a 15' to 20' wide
' -const-ruction area)'or'erection of a.temporary fence, barrier, or hay -
' bale berm.
I _
I Please note that any additional work, or modification to the project as
'-descr~.bed, may reau-ire 'ailthorization by this Department.- Pleasi=_ contact-` - -
' this office if such are contemplated. - - -
Please. be further advised that this letter does not relieve you of the
responsibility oi= obtaining any necessary permits or approvals from other
agencies. _
s~
-
GI~-h~ -sus-1-15M,U. ~ovP;u(`~'!/Iq. Very truly,~yl~o~jrs,
~.C , ,~~~~9
tom. ~~1L ,
- ~avld ~R~doler
- - ~ - Deputy Regional Permit Administrator
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=1ELD I1:S:`EC:'_U;1 ~IJe,: ~ i;OHi`1LNT~
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FOUIIDATION (1st) y J
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FOUNDATIOtJ (2nd) ~
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P,OUGH FRAME &
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PLUMBING
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ItJSULATI0t7 PER N. Y. y
STATE ENERGY
CODE ,Q
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ADDITIOtIAL COMMENTS: m
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TEL. 7GS-1802
~p ~ O~ TOWN OF SO~JTB[OILD
< OFFICE OF BUILDIIQG INSPECTOR
~ ~ ~ P.O. BOX 728
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O ~ ~ `r SOUTHOLD, N Y 11971
y~~l ~ ~~p
C E R T I F I CAT I O N
OCT - I Iv~i{~ \
Date v~ ~
Building Pellrmit No.{~~u-~-E-~-~
Owner d1~ _ C'j~~,~.v,_ ,
(please rant)
Plumber ~ Z ~~zf~c°.~
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of lg lead.
c~iZ-~!~.lC _ " "
' (plumber's signature)
Sworn to before e this
<'~!S "day of ~Cr
~ ~
NQnrte~~mBSPrfotaryic
Notary Public, (Ai~e,7 ~~ounty My Commission Expires3-81.95
THE NEW YORK BOARD OF FIRE UNDERWRITERS PA(;fi ~
1235~~3 BUREAU OF ELECTRICITY
65 JOHN STREET, NEW YORK, NEW YORK 10038 _
# Date NOVEH}3ER 02,1992 APPlioationNo.onfile 039301'32f9;? I9 355'.196
THIS CERTIFIES THAT
only the electrical equipment as deacri6ed 6eIota and introduced 6y the applicant named on the o6ove application number in the premises of
PHTGZP QPAGTNuKI: , PUT, ROADS F 7rTSfIFR9 T;;,,ANp I H. X'.
in thefollau•inq locotiong ®Basement ® /st Fl. ~ 2nd F1, 4+AR tOUT .Sertinn Block Lot
uns examined on OCTOfl@iR 29,1992 andfourtdto be in cornplianee u~irh the reyuireTnenGr q(this Board.
FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS -
OUTLETS INCANDESCENT FLUORESCENT OTHER AMi K W AMT. K W qMT. K.W AMT. K.W. AMi N P.
65 50 D0 6O 5 1 73.& t 1.4 # P
a
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS gEU UNIT HEATERS MULTI-OUTLET DIMMERS
} AMT. K. W. Oll N. P. GAS N. P. AMT NO. A. W. G AMT AMP. AMT. AMPS TRANS. AMT H P SYSTEMS AMT. WAiiS
NO.OF FEET
3 a 2 s 600
SERVICE DISCONNECT NO.OF S E R V I C E
AMT AMP TYPE METER I ]W I ~ ~W S ~ 3W K~ 4W NO. OF CC COND. A W G. NO. OF MI-LEG A W G. NO OF NEUTRALS A W G.
EQUIP. PER b' Oh CC. COND. OF MI-LEG OF NEUTRAL
1 200 CB 1 X 1 3/0 1 3(0
OTHER APPARA7U5:
z HOTOR5:7-F fI.A,.,1.4,61 H.P.
G,P.C.It-9
SH(JKM; IIETPSCTORe •3
~ TRACK D76fiTTHGi-8
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L2y~
~,FlAG$H,$ERVICE GTC.#92~-U C/~~~
MOHTA~IK AVG.
}FISHERS I5LANf1E HY, 06390 GENERAL MANAGER
~ 11 i
! Per ~
This certificate must not be altered in any manner; return to the office of }he Board if incorrect. Inspectors may be identified by their credentials.
t
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. '
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Zupan Building Contractors Inc. `'f`~``~~R
GENERAL BUILDING CONTRACTOR 47 CHURCH HILL ROAD HADDAM, CONNECTICUT 0643~~~:,„, k`
(203) 345-8849
c~ ~n s ~S ~ ,1 ~ ~ e
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BOe1RD OF HEALIa
FORMNO.t 3 SETS OF )~.',bS1N5 7!,,,,,,,.-,
• SURVEY N'' .
TOWN OFSOUTHOLD CHECK •
,..BUILDINGDFPARTMENT SEPTIC FORt•t
' TOWN HALL ~ ~ -
• $OUTH~t„61., CV,oY~ i,tUZ1: 4tPP F F Y I
( TEL.:765•it302 CALL
Examined.~4-g?~•?+a't~t.°~,~,19~~, MAIL TO :
Approved ~`t~~. ~Z 19~). Permit No..~.~ .
DisapprovedaJc '
(Building Inspector}
APPLICATION FOR BUILDING PERMtT `
INSTRUCTIONS.
a. Tltis application muss be completely filled in by typewriter or in ink and submitted to the BuildinE Inspector, with 3
sets of places, accurate plot plan to scale. Fee accrording to schedule.
b, Plot plan shotiving location of tot and of buildings on premises, relationship to adjoining premises or public streets
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 inspeciion throughout the work.
e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancl•
shall have been granted by the Building Inspector.
APPLICATION IS IiEREBY MADE to the Building Department for the issuance of a Building Permit gursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lativs, Ordinances or
Regulaiions, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all appiicatile laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors an premises and in building for necess~ inspections.
( gnature of cep tic , or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, azchitect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ~!'4~ ~ 1 ~.....1...1. tik~'k:.~ ~ ~ i .
P (as on the tax roll or latest deed)
If a t is a corporation, signature of duty authorized officer.
(Name and t' too c~+o^rp~orate oppfficer)
Builder's License Na..-..,~. q_ , , `bri~
Plumber's License No . . . . . . . . . . . • •IIJm ~U'C ~t4.~L
Electrician's License No. ~:0~-7 ~ , , , , ,~~5~ t~(;'~'i,C
Other Trade`s License No . •
I, Location of land on which proposed work will be done; '
. Ce+~-t~~... ~:u.4... ~`-:./.'1'1'l
~w??~tc~ s~.l~.e ~:u?t,t . ..~.~skarts..';~s ~~w?;~
House Number Street. Hamlet ~ ~ " "
County Tax Alap No. 1000 S¢ction ~ , Block ~
Lot.. s.~-"A!'.. '
Subdivision Filed !<}ap No. ~ . .
..(Name) Lot...
State existing use and occupancy of premises and intended us\\e and occupancy of proposed construction: .
A. );xisting use and occupancy..... . , ~';t~~y~% ,
t t ys; t~
B. Intended use and occupancy......... .
' PF el;% 'rd~'.F
1.~s~%R~........
l
3. Nature of work (check which applicable): New Building Y....... Additicn , Alteration .
Repair Rpmov~l . Demolition ..............Siaimning pool .
Tennis Court . Apcessory Building....... Fence .......Other Work:.
4. Estimated Cost .}.r.~ Fe~ ..47.9 d ,
' (ta hc,paid on filing this aQplicationl
I
5. 1f dwelling, number of dwelling un~ts Number of dwelling units on each Cloor
If gars^c, number of cars j. ....a4 . .
6. if business, commercial or mixed occupancy, specify nature and extent of each type of use .
7. Dimensions of existing structures, if
any: Front . Rear Depth .
Height . . . Numbcr~of Storics ..............y......................................... . .
Dimensions of same structure with alterations or additions: Frant Rear .
Depth . . }',Scight , Number of Stories • • • • . . - .
8. Dimensions oft}re new constn~ctipn: Front 1~~.:~ Rear ,,~f. , Depth , , , , , ,
Hcigltt Nu ber of Stories h............... s~,, , , , , , , ,
9. Size of lot: Front ....ol.o?.ti~t7 - Rear . t J.~7i.g~~....... Depth .....~8'6.! ~J.... , .
10. Date of Purchase . .........~'i Nn of Former Owner , .
11. Zone ar use district in which premises are situated .
12, Does proposed construction violate any zoning law, ordinance or regulation:
13. FVill lot be regraded ~ .....'.Fill exc s fill be remav f om premises• Ycs ~ Naf
lA. Name of Owner of g ices ~}~.li .Q Cd ..Address S~?tli~k~..Ft~~~ Phone No -
Name of Architect t"AR~'t. Kb`'!'sS.. .Address .','ER?.~... IN!~$.... Phone No 36~r:
Name of Contractor Qk1. .....Address ..k}~C4h..4tl6k\ ..Phone N
.
15~Ls this property orated ~`ithin gQp feet of a tidal wetland? *YIiS....NO....
*Tf yes, Southold Town Trullstees 1pLOTDIAGRAM a required.
Locate cieazly and distinctly all buildings, whether existing or proposed, and• indicate all set-back dimensions from
property lines. Give street and block numbs; or description according to deed, and show street names and indicate whether
interior or corner lot. '
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STATE OF NEk1-Y~itf~-zj ~ ,
OF~~ S.S I
c~r,~.4~...7 ..~`:~.p.~°"-:...~. , being duly sworn, deposes and says that he is the applicant
(R'amc oCindividual 9i,ning contract) I
about named.
Ht: istltc
Contras ,agent, corpprate officer, etc.)
of said owner or' owners, and is duly authorized toy 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 thk application filed therewith.
Sworn to before m ~t}y~, ,
, C 1-4.-....day of 19
Notary Pu6~~~°~.P.-. (.~1..P.. ~s~•-~,t ,County.,.
•
~YDuW~S~1~EINN~York I . • . • - •i;nature•ofapplicant)
QtNfNlad
ill
BuNdk~County Q
fan Ekpirer Deoomber 8.18.;;,1.---'