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FORM N0. 4
TOWN OF SOUTHOLB
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 218553 Date NOVEMBER 9, 1989
THIS CERTIFIES that the building ADDITION
Location of Property 460 PVT. RD. #8 EAST MARION
House No. Street Hamlet
County Tax Map No. 1000 Section 023 Block O1 Lot 03.2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated FEB. 3, 1989 pursuant to which
Building Permit No. 178132 dated FEB. 9, 1989
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 MR. & MRS. SEYMOUR LEVINE
(owner, xxxxxxxxxxxxxxxx)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N074359 NNE 1, 1989
PLUMBERS CERTIFICATION DATED MATTITUCK PLUMBING & HEATING 10/16/89
Building Inspector
Rev. 1/81
Fosai xo. s
TOWN OF SOUTHALD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
ffHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N o 017 813 Z Date .....z7..R~'~:......1 19 ~ 1
Permission is hereby granted t
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ct premises located at ......,....~...........4).....~.~p..........~ .....................N.r.~r.............
Counhj Tox Map No. 1000 Section .....0 Z..~...... Block Q. Lot No......~.:
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pursuant to application doted .~:~-~F~-......~ 19.a'..9.., and approved by the
Building Inspector.
Fee $..1.+~..1:....<.D...
Bw ng Inspector
Rev. 6/30/80
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.e TOWN OP SOUTHOLD ~ ~
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BUILDING DEPART2IENT ~ ~
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TOWN HALL pp__ maal_~S>f
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SOUTIIOLD, NHW YORK 1 197 1 T~S'.'eP~; tJF~.S)41'fF1t3LC~
765 - 1802 p, nN_..,._.~.,.u., ~.~...N. _,~.a _
APPLICATION FOR CERTIFICATE OF OCCIIPANCY
DATE_.fl...
NEW CONSTRUCTION ._.../~O/L'D PRE-E%ISTI ~ UILDING....._VACANT LAND........
Location of Property..:/..vo,.,, ~,~~~d ___._~~~J _-~~U`/J n/
HOUSE NOh,.,n STREET , / .l HAMLET • -
Ovner or Owners of Property./!!,`d`~~S So ~El/~P~t~
County Taa Map No. 1000 Section Block Lot- ~
subdivision Filed Map ........Lot.../.......
Permit No.~!7=•/~~.Date of Permit ..pp ~G -~/f r~
f-~•-9•-APPlicant C ...C®N~'
Health Dept. Approval Underwriters Approval..............
Planniag Board Approval
Request for Temporary Certificate Final Certificate
t~
Pee Submitted:
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rep- (0/14/88
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i ~ i FORM NO, 6 ~ "
! ~ ~ TOWN OF SOUTBOLD r
Yb~N BIIILDING DEPARTMENT
TOWN BALL
765 - 1802
APPLICATION FOR CERTIFICATE OIL' OCCUPANCY INSTRUCTIONS
A- 'This application must b~ filed in typewriter OR ink and submitted to the Building
Inspector with the follgwing; for new buildings or new use:
1. Final survey of properrty with accurate location of all buildings, property lines,
streets, and unusuallinatural or topographic features.
2_ Final approval of Eie~lth 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 solder used in system contains less
than 2/10 of 1Z lead.:,
5. Commercial buildings,,! industrial buildings, multiple residences and similar
buildings and installations, a certificate of code compliance from the 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, buildings and
unusual natural or topographic features. i
2. A properly completed application, a consent to inspect signed by the applicant
and a certified abstract of title issued by a title company which shall
show single and separate ownership of the entire lot prior to April 9, 1957.
If a Certificate of Occupancy is denied, the Building Inspector sha21 state the
reasons therefor in wilting to the applicant.
3. Date of any housing code or safety inspection of buildings or premises, or other
pertinent information, required to prepare a certificate.
C. For Vacant Land Certificate of Occupancy:
1. An application for valiant land Certificate of Occupancy shall be submitted,
and a certified abstract of title issued by a title company showing single and
separate ownership ofl,the entire lot prior to April 9, 1957 shall also accompany
the application. If a Certificate of Occupancy is denied, the Building Inspector
shall state the reasons therefor in writing to the applicant.
D. FEES: ~
1, CERTIFICATE OF OCCUPANCY - New Dwelling $25.00, Additions to Dwelling $25.00,
Alteration to Dwe}ling $25.00, Swimming Pool, $25.00. Accessory building $25.00
Addition to Accessory buildings,- $25.00 - Businesses $50.00.
2. Certificate of Occupancy on pre-existing dwelling - $100.00.
3. Copy of Certificate of Occupancy - $5.00 - over 5 years - $10.00
4. Vacant Land Certi€icate of Occupancy - $20.00
S. IIpda[ed Certificate of Occupancy - $50.00
6. Temporary Certificate of Occupancy - $25.00 Residential
$50.00 Commercial
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FOUNDATION ( 2nd ) _ _ ~ yJ
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IIJSULATIOf1 PER N. Y. • • p
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STATE ENERGY
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F 0~~~ TEL. 7 GS-1802
~O O,, TOWN OF SO'UTBOL~
< OFFICE OF BUILDIPIG INSPEC'T'OR
`.+~~~~,f P.O. BOX 728 t
~ TOWN HALL , i,': ~ ; , ` j l ~ ~4
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O~M01 r~~~ SOUTHOLD, N.Y. 11971 ~ it ~ u 'i ~ ippi
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~ TGWU C1F SOUTHOLp
C E R T I F I C A T I O N
Date `~J
Buildiyn~g/~ PermAit Nco~. g~
Owner////'~ J , "
(please print) 1
Plumber a vc,~ I ue~ ~r ~'~~I:,~~ ~r-.
(please print) ~
I certify that the solder used in the water supply system
contains less than 2/10 of l; lead.
~LltlL.Sd ~
(plumber's si urel
Sworn to before me this
JfXZ~FTday of ~n"J~~.~,E
19~. g
Notary Pub
notary Public, ~S'C1~~UL/~ County
EuirH f'.uNCKSON
N4Imy Publk, State of flare York
No. 4920756
tlualified In SuNalk (:ounty
Torm £xpire~ Feb. 16,159i!
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ass-18o2
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION i5T [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND INSULATION
[ ]FRAMING p [ ]FINAL
REMARKS:
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DATE 3 / INSPECTOR
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765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST ~OUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING FIN/~AL
REMARKS: d' /~--Q~
DATE I D INSPECTOR
l~
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION i5T ( ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[~RAMING ( ]FINAL
REMARKS: f-~~r~
DATE /r INSPECTOR / Y
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765.1802
BUILDING DEPT.
1 NSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING FINAL,~~"
REMARKS:
s~~~~
DATE ~ INSPECTOR
~ _ ~
THE NEW YORK BOARD OF FIRE UNDERWRITERS r•~;4;r; ~
3. i)U! O%.1, BUREAU OF ELECTRICITY
y~y 85 JOHN STREET, NEW YORK, N,[E, /W YORK //10038 ( 94
UI}lVl'~ ~lAY A{Y ~~Y~ 4).A 1. 41.n~~i ~i!!~~ 39 A41'`.k J~T.t
Data Application No. on file
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced 6y the applicant named on the above application number in the premises of
r.,;;~r:LrrF:, a ~a1u ~ta~l~ <s, t~Yx~~~~€~~; F)£t~l~'k;} , ~t,~`I` r;~~~.1~~3{ s~,Y,
in the following locotion> ? Basement ? lst Fl. ~ 2nd P'l. eJ£F`~ Sertion Bloek Lat
woe examined on I~TtY " T "I r`{4} and foand to be in conrplianee with the rvYluirentenRc v/this Daard.
FI%TURE ECEPTACLE$ SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS INCANDESCENT FIVORESCENi OTHER AMi K W AMT K.W. AMT KW. AMT. K.W AMT. H P
.l ~l F. ~ 1 hU
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS gEll UNIT HEATERS MULTI-OUTLET DIMMERS
AMT. K. W Oll H. P GAS H. P AMT. NO. A. W. G. AMi qMP. AMT. AMPS. TRANS. nMT. H P SYSTEMS AMS WPBS
NO.OF FEET
SERVICE DISCONNECT NO.OF 5 E R V 1 C E
METER NO. OF CC COND. A W G AWG. A W G
AMi. AMP. TYPE EOUIP 1 ~ 4W 1 ,e' 3W 3 W 3W 3.e 4W pER % OF CC. COND NO. Of H4lEG OF HI"LEG NO OF NEUTRALS OF NEUTRAL
- r'tl i. X ~lGr 2 iFit
OTHER APPARATUS:
Ell}Si'. ft00i~7 tx"~~ti"F'[:k2S.5°i.°,1".1 K,~£„fir°l. It.,b!_
F~hS1I!1S2S:"t -'i3 +Y t31k.,E;iS~N'E Ti) e'.Nbl )~'F,tltrl{
h'h;Y31tEk$:1."'<~ 1f R. F311"@;r4A~9F'Y y£i t~1" L{'iii)(5}~
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iibfl`Ci3O(,l), i~lY, 1 LN`7) GENERAL MANAGER
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Per j'
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.
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BOARD OF .HEALTH .
3 SETS OF PLANS . L~?-~~;~8~ , .
FORM NO. 1
SURVEY !J• K; , , , '
i ~ ~ BUIOLD NG DEPARTMENT SEPTIC Fo~. 3l5~ ~ ~ '
~ ~ FEB 3 1989 ~ 1
[ ~ TOWN HALL
C:"„ ~ J'~ SOUTHOLD, N.Y. 11971 NOTIFY
I rtn,~~.,,~~~r,,;. -•,:.7 ~ TEL.: 765-1802 CALL ....~3`/....Z~7G,
,
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Examined ~~~.~!":`?^"~..p1,., 19g~. p MAIL T0:
Approved~.¢~^°~?~(,, . ;1, 19~~. Pcrmit No.L P.~ .3.Z~. .
Disapproved a/c
................................:••y.~~.~ ~ n
Y S~ (Building Inspectord)(-
APPLICATION FOR BUILDING PERMIT
Date ~?:.T..."~~........, I .
t
INSTRUCTIONS
a. Tlus application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
sets of plans, accurate plot plan to scale. Pee according to schedule.
b. Plot plan showing location of lot 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
shalt be kept o~ tte premises available for inspection throughout the work.
e. No building call be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy
shall have been granted tty\e Building Inspector.
APPLICATION IS HER);BY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Re,ulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
Tlie applicant agrees to comply with all applicable laws, ordinances, buildin code, ousing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspe ~ s. / -
~~cr""• PPIi~~~ P
C~~f~
(S' nature of a nt, or na , if a cox oratton)
~..~~2~. cr~~c~,c,,~ Nf /1~.~J~"
' (Mailing address of app iFcant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
~~/.`!.E~.~..C~r~~
i?~GT~ .
y~
Name of owner of premises ./.~~iP ~'~~G-S S LGL .
(as on the tax roll or latest deed)
If applicant is a corporation, signature of du]y authorized officer.
(Name and title of corporate officer
Builder's License No. ~ ~~.~J...........
Plumber's License No . .
Electrician's License No . .
Other Trade's License No . y6 D
I. Location of land on which proposed work will be done. !./J,'; i~
G
~~~.~.~,~i~~l`(U.~
HouseNumbcr Street. ~
Hamlet
County Tax i\tap No. f 000 Section ~r~......... Block ....O , , , , , , , , , , , , Lot a'
Subdivision Filed A1ap No. Lot...............
(Name)
Stale existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy C.. .
b. Intended use and occupancy . ~ •~'<~.~G~ .L'.'~.~: - `
. :~e
; C. e. o w .
ar.
+~s„~; _ _
3. Nature of work (check which applicable): New Building Addition . Z~ Alteration
Repair Removal • , Demolition 'Oth U.rk .
~k;Q
° (Description)
4. Estimated Cost ....~~I',• Q~~r. .
. Fee .
5. If dtvellin number of dwell (to be paid on Filing this application)
g,
If ara e, number of cars ng units Number of dwelling units on each floor , , ,
S g
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 ...............Number of Stories . .
Dimensions of same structure' with alterations or additions: Front Rear . ~ ~ •
' Depth . i .Height . .Number of Stories , • .
8. Dimensions of entire new co struction: Front . ~ , , , Rear , a:Z ,Depth r~p,
; , , ,
Height .~Q, , , , , , , , , N~mber of Stories... ..z, . ' ' ' ' •
9. Size of lot: Front Rear , .:..............Depth .
10. Date of Purchase . ......Name of Former Owner •
12. Does ~ ou osed construction vpremises are situated . .
P P
iolate any zoning law, ordinance or regulation:
13. Will lot bere~raded
° P ' ' ' ' ' • ' • • • • • • • • • • • • • • . • • Will excess fill be removed from premises: ,Yes Nc
14. Name of Owner of remises .Address .
Name of Architect '•••••••••••••••••PhoneNo
Name of Contractor ~ . , , ~ • • ~ ~ • ~ ~ • ' ' ' ' ' • • • Address . ..............Phone No............. ,
• • • ..Address . ..Phone No. /jt
IS.Is this property located within 300 feet of a tidal wetland? *YES Y..NO....•~
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate cleazly 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.
. l
STATE OF NEW YORK, ~ S.S
COUNTY OF
(Name of individual sip ~ • • ~ ' ' ' ' ' ' ' ' • • • being duly sworn, deposes and says that he is the applicant
°rjing contract)
above named.
He is the
•~I'•
(Contractor, agent, corporate officer, etc.) ~ ~ • ~ • • ~ ' '
of said owner or owners, and is duly authorized to pe~rfgffm or have performed the said work and to make and file this
application; that all statements contained in this applicgtjron are true to the best of his knowledge and belief; and that the
work will be perforned in the manner set forth in the application filed therowith.
Sworn to before me this ~
Notary Public, !'~~?t!, . /J,., U,ik-; , , , , , County
NEIEL,N K. DE VOE
NDTARY PUB' SuKa~k Countyt'q .
TeNm~Exp~iegs?C, State of New lbrk .
March 30,19,...=./
( ',nature of applicant)
E N ER~Y CODE CALCU~ATI ONS (FDA NpN-ELEGT2/G ~/E.ar,
j?
FpA ~ 9~y1~~ PE1 0Vvhl lyS 1~"-'19uS ~v>?I /Ll~ /~I~ % QES/lyN ~C/2EPl~ : 000 ~ES+6FE ~ds
- ~ATE~ /Z+", ~;/'3 S - O.o4. ~ /O F S. A- : 70~F
~UBSYSTEh\ AREA Q DES/4yu ,4~owce DES/4.u Actowee ,Q-6n\.4,QKS -
' U' U STU-1a IITUH
EXTE2/DA. AVALLS (!~/~~55) ~b-~' o l~ t4t~'/~~
EXTEA./~Q WdLLS ~OPdQUE) y? / I o.os / 7~'
CpGAZ/Nl,+ ~ ~ l .33 0.58 5"3'~O iJyi(~PrSo- ~~r~~a,r,<;Ce.
0
~~~25 oqo
1~ GE/L/NC~S~QGbF ~Zi.3 19 O.'D3 2_/n~ Z/c5U
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/U~TES TcT6L5 iS ,~b'D 1%i.~`30
~ 1) HEATING EQUIFME0.T TO MEET 7813.23 - 75$ EFF. TO THE BEST OF MY KNOWLEDGE, ~ , ~
BELIEF, AND PROFESSIONAL ~ /
~ c) HEATING CO[v^.ROLS TCJ MEET 7813.13 JUDGEMENT THESE PLANS ARE /
`)9~ 5.
RANGE 45 7LD 75 DEGREES F.AfIRENHEIT. / ~ ~
IN COMPLIANCE WITH TEE CODE.
WATP:R rnnTING PER 7813.31 THRO .3E. ,~~~C"~~~0 i
S) PIPE INSULATION 7813.19 ~ -----i
5) WINDaaS -DOUBLE GLASS. , ~ r~
~ 6) CONSTRUCTION 7D NEET N.Y.S. ENERGY CODE. - - ~~~~/'/L5;'.il~~~;,r
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