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FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-19839 Date APRIL 5, 1991
THIS CERTIFIES that the building ADDITION
Location of Property 455 SOUND BEACH DRIVE MATTITUCK N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 94 Block 1 Lot 21
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVEMBER 7, 1990 pursuant to which
Building Permit No. 19513-Z dated NOVEMBER 9, 1990
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 2ND STORY ADDITION TO EXISTING ONE FAMILY DWELLING
The certificate is issued to FLORENCE ALFANO
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N-173500 - FEB. 8, 1991
PLUMBERS CERTIFICATION DATED APRIL 5 1991 - FRANK S. MEYER
uilding Inspector
Rev. 1/81
IOHD[ NO
TOWN OP SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BU{LDlNG PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Na 1 9 51 3 Z Date ....N t9..~:.o
Permission Is hereby granted to: 1/ ~ ~ ~p~
.....~.~~.~.--finn
-.~L~~......:~.~...~::~.:..
at premises loeoted ot ...~S..y~.....~''.`~".^..~s°.5.....°`.~.....f~?~r4~R.......~.Q slS
County Tox Map No. 1000 Section .......Sa.~1~..... Block ......C,?. ~.......qq. Lot No... °1.l
pursuant to application doted ........~..5~'l:~:'? 19..1. and opproved by the
Building Inspector.
fee 5... . ~ s...........
~ .:t!Jl...~:
Building Inspector
Rev. 6/30/80
. ~
(~/7~~~- g3 ~s4 av~~ ~
~ ~ ~ 1J L~~~ Form No. 6 ~2.Q~i.Da.¢.i~~+-,~y . lJ~c~/p
` ~ TOWN OF SOUTHOLD "`~f ~
~ BUILDING DEPARTMENT o
~~''S ~ TOWN HALL
765-1802
BLDG. [1P
N7.
7QW[u GlF iitSES"t"tit3P_Ti
"'"""""'°""""'~°~°^^-~e~ 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 £rom plumber certifying that the solder used in system contains
less than 2/10 of 17 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. 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 Cherefor 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`$115.00, Commercial $15.00
Date ..y,/~!•~/
::ew Censtruction..t'........ Oid Or Pre existing Building,.pf
Location of Property.. . ,1~,~i~`zd~:..~'.r,/; . /L;~..~~t7%E_''~?
House No. Street Hamlet
Cnwer or Owners of Property.....1~.
~i.~~c~.4-~:... .7~.'A~' /Q
~n
County Tax Map No 1000, Section.....~.~ .....Block......~~./..,....Lot..,.`
Subdivision Filed Map..........'~.._L'Jot......................
i'ermit No.~,~~5/......Date Of Permit...~~~~~~~..Applicant.d~/F~'~~j.~E~l{~.j~~i~.~Q~.,~F.....
!iealth Dept. Approval.... ~l~ .............Underwriters Approval.. Y,~:..................
Planning Board Approval... J
Request for: Temporary Certificate........... Final Certicate.
fee Submitted: /$......!-b:
f~szt Nay ~ ~ ~ ..........-.,,..APPLICANT...=: .._._,_r
C~ 1983
F
' TEL. 765-1802
~oc~~FF~C/~cpG TOWN OF SOUTHOLD
j4"" OFFICE OF BUILDING INSPECTOR
z P.O. BOX 728
u~', .r TOWN HALL
"0~~0~ SOUTHOLD, N.Y. 11971
C E R T I F I C A T I O N
Date
Building Permit No.
Owner /~C? ~ ~
(please prin )
Plumber ~
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
~ A
(plumber's~re1
Sworn to before me this
1991 ~ Notary Public
HRROID T. CARR
Notary Public, ,S County NOTARYPURLIG STATE OF NEW YORK
NO 52-D5784~5-SUFfOi.K COUIV?Y
C~NMiSSIUN EXPIRES JAN91, 19~
THE NEW YORK BOARD OF FLRE UNDERWRfTERS ~f~~~~xr a
] (}(}O S BUREAU OF ELEGTRIGITY
8S JOHN STREET, NEW YORK, NEW YORK 10038
Date k~:RR.LIARY (I$,f9'3,i APPlicationNo.unfile ~3_Pi~Eva~~LTf!%~1t3 PI '~7~?~~kU
THIS CERTIFIES THAT
only the electrical equipment as deacrihed below and introduced 6y the applicant Homed on the shove application numher in the premiaea of
FJ,C~RI%NC'k.', 4~h SOi7~lU }tFIACTi LrR7:v~~;+ P~tL'~"Y"1'.I"t'r,S~'h, N, v,
in lhefoliuwinq location; Basement L~*J 1x1 FL 2nd FT. AEI"h3 Sertion Block Lot
was exomtned on J13NUARY i I + I to r17, arulfound to 6e in carnplianre uith the requirements q~ this Board.
FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCANDESCENT FLUORESCENT OTHEH AMT. K W. AMT. K.W AMT KW qMi K.W. AMT. H P
' DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS ggLL UNIT HEATERS MULTI.OUTLET DIMMERS
AMT. K. W. Oll H. P. GAS H. P AMT NO. A. W. G. AMT. AMP AMT. AMPS. TRANS. AMi H. P. SYSTEMS pMT. WARS
NO.OF FEET
3 E' I
SERVICE DISCONNECT NO.OF S E R V I C E
AMT. AMP. TYPE METER 1,6'tW 1 ,R 3W 3.9 3W ~ $ 4W NO. OF CC COND. A. W. G. NO OF HI-LEG A W' G' NO OF NEUTRALS A W G.
EQUIP. p 5 PER % OF CC.COND. OF HbLEG 9 OF NEUTRAL
I ~ '~~~i {r~ } .O d- ~ S
OTHER APPARATUS:
h.F,C.T7-'.t
~ -c'~
rl.w.p. cu~errRnr.~Ytrr~, f+t~.~•~~ra'~~
x,r~nr p~t,ax~rffx
34.38 T,4"ki1,A1V I) Rl,~il GENERAL MANAGER
RAY2i~[t?Rkit NV, :1,3'1i3fi i.]
Per V-z-=y, y,-~ "t
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.
t COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT $E ALTERED IN ANY MANNER.
~ ' ~
• ~ TEL.', GS-1 SO'
~FO~.
o~ n ~c~~ 4 ~ro~~rr or sour~oL~
,?'~x,:~~~:~~ ' orl~rce or >suIL~JNC tNSrrcTOlt
a~r,~,f" = I'.o. Doi t 1 ~ 9
1"',",'i. jt ~ TOV~N IIALL
'~~4,y SOUTIiOLD, N.Y. 11971
February 26, 1991
Donald W. Palahnulc
DSiP Building Contractors
112 Sound Ave.
Riverhead, N.Y. 11901
R13: FLORENCE ALFANO
'to LVhcm This May Concern,
4Je are unable r.o complete your Certificate
of~Occuoancy because •of the folloc•ring reasons.
/"V/ An application for Certificate of Occupancy
~is not nn file. (ENCLOSED) '
ate' J?/ Dto tJndcr~•rritcrs Certificate on file.
't'he c;hec:}: .i:;( 1/nut on file.) $25.00
D:o Itra].th Dept. Approval on file.
P:o final insl'~r_c:t:ion has becu made.
Pleaso contact our office on this matter. -
Thank you foz your cooperation.
Jhc.ilc]ir,cJ Permit. 1! 1 9_5 1 3_ Z
DuilQir q Dept.
hhk/?/ tla Plumber :;o ldcr Certificate on file. '
_
( all permiL•:: involving plumbing being
iesucd after April 1,1984 )
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765-1802
BUILDING DEPT.
INSPECTIOI~I
[ ]FOUNDATION 18T OUGN PLBG.
[ ] FO ATION 2ND [ ]INSULATION
[ FRAMING [ ]FINAL
REMAR S: ~ -Q.~-Q _
DATE ~C ~ ~ INSPECTOR ..~%y~
765-1$02
BU{LD{NG DEPT.
t NSPECTION
[ ]FOUNDATION 1ST [ ROUGH PLBG.
[)FOUNDATION 2ND INSULAT{ON
[ ]FRAMING [ ]FINAL
REMARKS: D~,~-~
t
4 \
DATE J INSPECTOR
i
n BOARD OF.HEALTII•::::::::•
'U` 3 SETS OF PL.1N5
FORM NO. t StIRVSY
.r'r~l TOWN OF SOUTHOLD CI1ECK .
BUILDING DEPARTMENT SEPTIC FORM
_ ~ p~pg TOWN HALL
F $ iiTl10?.b $OUTHQLR„ I~LIC„ 11271 t..'c`YT i FY
?,1 l. q TEL.:7G5~1II02 GALL
Examined 1~."' . lq.. 199 MAIL TO
approved ~ `h~?'wvl~e... L, 194. Permit No..~.~.~.1.~•~ . .
DisaPProvedaic
(Bui ding Inspector)
APPLICATION FOR BUILDING PERMIT ~f~~
Date . . . IS . .
INSTRUCTIONS
' a. Tltis application must be completely fined in by typewriter or in ink and submitted to the Building Inspector, with
sets of plans, accurate plot plan to state. Fee according to schedute.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stree
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appl
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 perm.
shall be kept on the premises available for inspection throu?hout the work.
e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupant
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 th
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o
Rcculations, for the construction of buildings, additions or alterations, or for r oval or demolition, as herein described
The applicant agrees to comply with all applicable laws, ordinances, building de, houstn~ a and regulations, and tc
admit authorized inspectors on premises and in building for necessary inspect'
Z~ _
j~l ~j~' G~,{~' / (S t.appli : or name, if a corporation)
• j~h~' l/~d"~ a dress ~~fiJih.~~i~
State whether applicant is owner, lessee, agent, azchitect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ...~G~~c.'-:d!df 1. • . • • • • . • .
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer. '
(Dame and titlepf corpor~at~e officer) ~a,~/`~~
Builder's License No_~.. /G1./.. .`•^•f:~:'• : ,y~`7~~
Plumber's License No~7.1~.~5~.~..~~. • f .~U""' i?
Electrician's License No~`~~~.~`..... •
Other Trade's Liccnsc No. l Y/.~........ .
1. Location of land on which proposed work ~vi1t be done;
Etouse Number Street. Hamlet
County Tax Atop No. 1000 Section • Block , ~ , , , , , , , , , , , Lot , , , , , , ' , _
Subdivision Filed Atap No. Lot
• ~(Namej
State existing use and occupancy of premises and intended usernd occupancy of roposed construction:
A. Existing use and occupancy........
B. Intended use and occupancy... I ~s k
~i1~~ ~'L.r~
- ~ -
3. Nature of work (check which app'icable): New building Addition . Alteration .
Repair Removal Demolition W~P~ .
Tennis Court•...~~/. AAccessory Building..........Fence ..Other Work:.
4. Estimated Cost .....~`.'~::4~' Fee .
c
,(Lp hc'~ditl oii
~Fi9i~i~^tht •on~
5, If dwelling, number of dwelling units • Number of dwelling units on each Moor • .
If garage. number of cars .
7. Dintcnsions of c.cisti
ralstructures'occupancy, specify nature and extent of each type of use . .
,iCanY: Front Rear Depth.............. .
Height ...............NuntbcraCStorics............................................. .
Dimensions of same structure wiyh alterations or additions: Front Rear , .
Depth .Height Number oC Stories .
8. Dimensions of entire new constnjction: Front Rear Depth .
Height ........NumberofStories
9. Size of tot: Front Rear Depth .
10. Date of Purchsse . ...Name of Former Owner .
11. Zone or use district in witiclt premises are•situated .
I2. Does ro osed construction violate any zoning law, ordinance or regulation: • • • • • • • • • • •
l3. 1Vill lot be regraded . .will excess fill be removed from premises: Yr.... • , '
14. Name of Owner of premises . Address , _ , .......Phone No...............
Name of Architect .........Address , .......Phone No.. • •
Name of Contractor , . • ...Address . .Phone No..... .
tS.Zs this property locaCed•crithin•30p feet of•a tidal•vetland? ^YgS....NO....
*If yes, Southold Tocrn; Trustees Permit may be required.
PLOT DIAGRAM
Locate cleazly and distinctly all, buildings, whether existing or proposed, and. indicate all set-back dimension; tr
property lines. Give street and block number or description according to deed, and show street names and indicate Zvi:°::'
interior or corner lot.
! .
sTATS or-1:E~v YoRI:, I s S
COUNTY OF
• • • • ~ • • • • • • • ; • • • • • • • • • • • • • • • • • • • • being duly sworn, deposes and says that he is the applica;;
(Aamc oCindivtdual si ping contract) ,
above named.
Hcistltc
(Contractor, agent, corporate officer, ere.) • • • • • ~ • •
oC said owner or owners, and is drily authorized to perform or have performed the said work and to make and file tln
application; that all statements contained in this application arc true to the best of his knowledge and belief; and that th
work will be perfomtcd in the manricr set forth in the application Rlcd therewith.
Swom to before me thirys I '
Notary Public, ...1:1.•..: ~ Q*•t/• QQ....... County
• j.
HEIENK.DEVOE pp.. ,
NOTARY PUBLIC, State of New York
No.A167878,Su0olk,CcuntYrs~ Si,namreofa limn
Teem Expires March 30,;19.--==ll++~t