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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-17561 Date DECEMBER 1, 1988
THIS CERTIFIES that the building ADDITION
Location of Property 300 BARTLEY ROAD MATTITUCR, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 144 Block 03 Lot 29
SubdivisionPPTY OF LIDA BARTLEYFi1ed Map No. 770 Lot No. 3
conforms substantially to the Apphcataon for Building Peruut heretofore
filed in this office dated NOVEMBER 30, 1988 pursuant to which
Building Permit No.I7655-Z dated DECEMBER 1, 1988
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy far which this certificate is
issued is ADDITION TO EXISTING ONE FAMILY DWELLING
The certificate is issued to GERALD & TERESA SMALDONE
(owner, )
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N/A
PLUMBERS CERTIFICATION DATED N/A
d--t~
Building Inspector
Rev. 1/81
F08ai NO. f
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 o U 1. ~ b 5~ Z Date .......1....?.$.SP..:?r::~~...'..........., 19..~,~
Permission is hereby granted to:
...~1~......~..~.°
~ . s~.~r,.,... ~ . .
A~ ,
to ,a~.ca:' ..A..,ra.....CLrI:I~..F.Y.tS!41,~A,C1 '~"~t ~M....R~....~.....
a~.~.........
ct premises located at 1.~...Akt...K~...... ..~.Ct,r~t,~.C,l,~
.4/C~ A.a..Q.IP..:~.4Q.7'...rS+?4-{Rr.R.4s.......,..~J!'!v„7ti?~-4-??~!tx-
: ........p...............
Caunty Tox Map No 1000 Section I T ~ Block oLot No ..a..l .
pursuant to application doted d't-~~m~ .1~'~. 19. ~ 4., and approved by the
Building Inspector.
Fee S
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Building nspector
Rev 6/30/80
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FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled m typewriter OR ink, and submitted ~ e..... to the Building Inspec-
torwith the following, for new buildings or new use:
1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual
natural or topographic features.
2. Finai approval of Health Dept. of water supply and sewerage disposal-{S-9 form or equal).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa-
tions, a certificate of Code compliance from the Architect or Engineer responsible for the budding.
5. Submit Planning Board approval of completed site plan requirements where applicable.
8. Far existing buddmgs (prior to April 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.
2. Sworn statement of owner or previous owner as to use, occupancy and condition of huddings.
3. Date of any housing code or safety inspection of buddmgs or premises, or other pertinent informa-
tion required to prepare a cert~f~cate.
C. Fees: Additions $25.00 POOLS $25.00 ALTERATION $25.00
1. Certificate of occupancy New Awellino $25.00, Accessory 10.00 Business $50.00
2. Certificate of occupancy on pre-existing dwelling $100.00
3. Copy of certificate of occupancy ~ 5.00, over 5 years $1D.00
4. Vacant Land C.O. $ 20.00 ppttXX
5.Uodated C.O. $ 50.00 Date /.Y(J?.:..~~,~..f.~/.p.S,~,,.
NewConstruction,,,,,,OldorPre-ex~stingBuilding Vacant Land
Location of Property ..............f7.f~.~'i.~. L . , d \ I-2 /~Cl..... „ ! Its I:/.
1, i
/i.G t~
- House No S reef Ham/et
Owner or Owners of Property G~~PR9z.v.~ ~E^-~r~Fl.J~IYJ.r4F.c?P.!V ~ .
County Tax Map No. t000Section ....Jyy...... Block Lot...~.~.........
/7'~ r? P 6 F PR o !°J T a
Subdwision4~14r?. r3.4~P7:4~! .h.4~ 7,~?$~9ZZFiled Map No. .7 7Q...Lot No. 3........ .
Permit No. 4 ? 1..Z.` . Date of Permit . (~I3~:~t? .Applicant .
Health Dept. Approval , ..............Labor Dept. Approval .
Underwriters Approval ......-r ..............Planning Board Approval
Request for Temporary Certificate .....................Final Certificate .
Fee Submitted $ ..~~e ,~'Q .
Construction on above described budding and pe it meets alf ~a7pplicable ccod~es and regul/ations.
Applicant CYC>~~^.'?_.~.~. .f.:t`~'wY~'....lr~S /~~r~vi~.. .
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FOUtIDATI0;7 ( 1st )
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FOUIJDATI0:1 (2nd) m
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P,OUGH FRAME &
PLUMBING
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IidSULATI0h1 PER N. Y.
STATE ENERGY
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BOARD OF HEALTH
3 SETS OF PLANS
FORM NO. 1 SURVEY .
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL
SOUTHOLD, N Y 11971 NOTIFY
TEL.. 765-1802 CALL
Eeamme~d-~1-I?S~^^~•.1...., 19~~. MAIL T0:
Approved 19~?~ Permit No ~ bSS
Disapproved a/c .
. ~ r~~ .
(Buildmg Inspector)
APPLICATION FOR BUILDING PERMIT
Date [YO 1:
INSTRUCTIONS
a Tlus application must be completely filled m by typewriter or m ink and submitted to the Building Inspector, w
sets 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 adloming premises or public st
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of t}us r
cation.
c. The work covered by this application may not be commenced before issuance of Buildmg Permit.
d. Upon approval of this application, the Buildmg Inspector will issued a Buildmg Permit to the applicant Such p~_
shall 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 Occup
shall have been granted by the Building Inspector
APPLICATION IS HEREBY MADE to the Buildmg Department for the issuance of a Building Permit pursuant t~
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordmanc
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descn
The applicant agrees to comply with all applicable laws, ordinances, budding code, housing code, and regulations, an
admit authorized inspectors on premises and m building for necessary pections.,
.~S.~GE;`u{
(Signat e of applicant, or ame, if a corporation)
PO..t3.P?X. x'17 . ~vjC~~vFuc rl./~!~9
(Mailing address of appiicant)
State whether applicant is owpner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bull
t?'1A Ri hk vt1. ~ F:. tl cA!-.i. .R,S . t~.G.G
nJ 7-
Name of owner of premises .GF!P~~ p. ~ T.
X1.2 ~S.A..~C'
!'i?'`t`4 oo,Y ~'q;ppRgy~p•g$ J,lOT~p , . ,
(as on the tar roll or~€t deed) 1 , g p ~ . 1 ~
If applicant is a corporation, signature of duly authorized officer FEE ,S•-~ , ~ By ~ (z',~,• ,
NOTIFY 8111LOMG DFPARTMENT AT
765.1802 9 AM TO n fOR T4E
(Name and Utle of corporate officer) FOLLOWING INSPECTi(}~t~,
pR i. FOUNDATION - TWO REQUIRED
Builder's License No VQ~'~~ FOfl POUREf1CONCRETE
~(•,C N~ w~'~„ 2. ROUGH • FRAMING & PLUMBING
Plumber's License No ~tCJV. ~i~~ INSULATION
V
~~Y~ CE 4. FINAL CONSTRUCTION MUST
Electrician's License No V BE COMPLETE FOfl C.O.
Q~.... ALL CONSTRUCTION SHALL MEET
Other Trade's License No. Tll# OF THE N Y.
sl'f~QE ODIIIdTRUCTION ~ ENERGY
1. Location of land on wluch proposed worl. will'be done (1QpSS, • FOR
M OIU CONtTM1CilON S
House Number Stree/t Hamle[
County Tai hiap No ! 000 Section ~~`7 • . • Block Q,-~ • , , , , , • • Lot .....~9 • . • • ,
mAA oFp~o nC~
r)/ o,C .
Subdiviswn L/oq ~f1.IT.bE~.~'44t~.T~z.7,-/922 Filed Map No .'770.... ,Lot..........
(Name)
2 State e~istuig use and occupancy of premises and Kntended use,a/rid accupanc y of proposed construction
a Existing use and occupancy'~• urr/rr/t•~ ~~C'• y•~e~T°. N~ ~~'.-s'p-
• ,
b Intended use and occupancy • • S~~ '
3. Nature of work (check which applicable) New Building Addition Alteration .
Repair Removal . . . Demolition .Other Work . .
(Descnpti~
4. Estimated Cost . Fee .
(to be paid on ?ling this application)
5. If dwellm„number of dwelling units Number of dwelfmg units on each floor .
If garage, number of cars . .
6. If business, commercial or mixed occupancy, specffy nature and extent of each type of use .
7. Dunensions of existing structures, if any Front Rear Depth .
Height ...............NumberofStones
Dimensions of same structure with alterations or additions Front . Rear . .
Depth . . Ileight , .Number of Stones . .
.
8. Dimensions of entire new constructron Front 3..`1..r Rear ..J,3., `J: Depth ~'c U..`.. .
Height . Number of Stones .
9. Size of lot. Front ...~'O.. ~ , Rear . ,~P.c ..°.6. Depth f.7Oe ~iO
10 Date of Purchase S , Name of Former Owner :~.4Hn1.~.`.~{iYlq.re~ A, , o v,
1 I. Zone or use district in whic}i premises are situated .
12. Does proposed construction violate any zoning law, ordinance or regulation .
13. Will lot be regraded ...~ekq~Acs;..r-~R .Will excess fill b~ remo~d from premises. Yes
14. Name of Owner of premises m.,g f..°.~ n:~.... Address `~,cZ r.~~r l~b.J Phone No.~: ~ 7 y,
Name of Architect . . . .Address , .....Phone No........... .
Name of Contractor .............Address ...................Phone No.......... , ,
15.Is this property located within 300 feet of a tidal wetland? *YES....NO.k,
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate cleazly and distinctly all buildings, whether existing or proposed, and.mdicate all set-back dimensions 1
property hues. Give street and block number or descnption according to deed, and show street names and indicate whc
intenor or corner lot.
riPUPaS~~ ~Ot~rT"lprV /tvTERio(~
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STATE OF NEW YORK„~;~,,;~„!i-' - t~ "~v9,~~zs ra n/ Q gaTG a ~ R~ A D
COUNT~'O;F,:,su~-~ryr:~(<. a ~ S ~'~~s~ r -.a PR~vAr~ /~r,.~u
j e uly`sworn, deposes and says that he is the apple
-C~~n ~ Sri contract)
aboJ'Et9aiti~li . ~
Yc7A~13 • MN?~
He i~'fP~
8Af??AI11~ pt'J RO 1+t~+;.4," .
(Contractor, agent, corporate officer, etc )
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file
apphcation, that all statements contained ut this apphcation are true to the best of his knowledge and belief, and than
work will be performed in the manner se[ forth m the apphcation filed therewith.
Sworn to before me this ~
t~ . .day of / l/(l.~!C!., 19 l~~
Notary Public, ounty
AS
AERALYN GERLE ~ ~.``.f. Alr t;+
NOTARY PUBLIC, State of New (S gnattire
of applic
.•Ma •!750631, So-ffatk Coin
?aim Exgres Mmeh-3p;49
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AN10"'° eA 6~ j' SURVEY OF
"/°~F „ E 6°° MoN - l PR ®PER T Y
N 69 26LILLn P°`E.9 A T MA T TI TUCK
TOWN OF SOUTHOLD
p4W W
SUFFOLK COUNTY, N Y.
- 0 1000 - 144 - 03 - 29
Nov. 3, 1988
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CERTIFIED TOE
LONG ISLAND MOR ]"GAGE CORPORA T/ON
SCT1C, INC,
MATTHEW R. MA URO
BARBARA E. MAURO
NOTE, LCT NUMBERS REFER TO "MAP OF PROPERTY
OF LlOA BARTL EY FJL ED JULY 27, i922 qS MAP # LANpf,U
770.
~y5 bed A. I,yCF. ~'~L
~w ~°y ~ZO~o
Prepared !n accordance wllh fhe minlmum ~ L/ NO. 49668
rlandords /ar 111/e surveys os eslobllshed ~ +
Dy fhe L.LA.L.S. and approved and adop/ed
!Dr such use by The New York Slcle Land ~ ONIL" p~ E , P
Tllle As:DCIellon. f 6J 76S - u 49666 OQ•
MAIN ROAD ~OF iJF'".1
SOUTHOLD, N. Y. 147%
88 - 669