HomeMy WebLinkAbout17555-z FORM NO. 4
TOWN OF SOUTHOLD
BUILBING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 219482 Date OCT. 31, 1990
THIS CERTIFIES that the building ADDITIONS
Location of Property 755 SOUNDVIEW AVE. MATTITUCK
House No. Street Hamlet
County Tax Map No. 1000 Section 94 Block O1 Lot 06
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 19, 1988 pursuant to which
Building Permit No. 175552 dated OCTOBER 25, 1988
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 DECK ADDITIONS TO EXISTING DWELLING
Z.B.A. APPEAL #3735 and D.E.C. PERMIT #10-88-0798
The certificate is issued to DINO AND LYNN ROSSINI
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. H018704 OCT. 17 1990
PLUMBERS CERTIFICATION DATED N/A
Building Inspector
Rev. 1/81
r~oaai xo. s
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)
Nfl X17555 Z Date ......l..~~2:? Is.......
Permission is hereby g~raynted/to: Q
~~1~ Y .!l~ /t ~'~Gr1.G
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4~~ ...??~rr..~.ca~,c.,...-~~"-~-~~ ...............7„x.5. ,~..Gc,~r--..
County Tox Map No. 1000 Section .....l.T........... Block .........,1......... Lot No..........ya...........
pursuant to application doted `J,l~~ 1~~, and approved by the
6uildfng Inspector, ~/~~6 g
O~
Fee $.uTO...o~l......
x:.......l~........
~~%%A'~~ilding for
Rev. 6/30/80
Form No. 6 ~~I~Q 0SSIV1~ U'~'
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` ~ TOWN OF SOUTHOLD J 1~,~~~
BUILDING DEPARTMENT n _p
~ G ~ TOWN HALL `4~'Y~? `OJ' ~
L 765-1802 / ~ ~ Spa
BLDG. DEPT. ;
70WN UF5OUTNt)LD APPLICATION FOR.CERTIFICATE OF OCCUPANCY '
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 19, lead.
` S. 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.
3. For existing buildings (prior to April 9, 1457) 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.
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 or Occupancy - $50.00
5. Temporary Certificate of Occupancy - Resident...i~,a-lam~ $15.0/0, Commercial $15.00
Date .`:'!Q!G~. JK.I.~~o
:;ew Construction....... Old Or Pre-existingdBuilding. ~t~~
;.ucation of Property....l~.,~.~dua~~{/~.r~.t~.^Jv~.- ..................~ft:l.~.~.~~.~.........
House No. pStzeet Ramlet
nnwcr .~lsV~ ~~jtliJ ~CO~SSI.~/(
or Owners of Property.
.
County Tax Map No 1000, Section.....,. L..~,~....Block........~.......Lot........~4:...........
Subdivision..//.........'..................//.....Filed
M~a ..........//.~~.Lot -
Permit No....(~,~~s~..Date Of Permit..F~..~~~Y.°. .Applicant,y.~~J... ~:5.~.~~~........
{(ealth Dept. Approval.. .Underwriters Approval... "
?
Planning Board Approval /
Request for: Temporary Certif~q~in,c/~at~e'.~. Final Certicate..../.......
fee Submitted: $,.,,,,~5, '1Me'~'`~~d,/~¢,t..'
~
~ec.. ~F077 !
ld~~ Ergo APPLICANT ~ ' .
CO Sj
~~~'O/a
- TOWN OP SOUTIIOLD ~191A1~
r A BUILDING DEPART?LENT
~1 TOWN HALL
BLDG, DEPT. SOUTDOLD, NEW YORK 1 197 1
TOWN OF 50UTHOLO
7b5 - 1802
~ APPLICATION FOR CERTIFICATE OF OCCIIPANCY
~ j~
DATE . _ J . , .
NEW CONSTRUCTION .......OLD OR PRE-E%ZSTING BUILDING.. ...VACANT LAND.....
t~ ~
Location of Property..... ~v. _ , ~ ~ ~~t:°.. ~Cr~1.Ll. J.v~r'K.
HOU5E NO. STREET .HAMLET jf"'o
Ovner or Ovners of Praperty.~~~_17.. ~'~C/.,~-~~..~~;5~~(n~_,,,_,,,,_.,
County Taa Map No. 1000 Ser.tioavv .~1~.. Block Lot ..Y/.....
Subdivision) Filed jJM//ap ~......Lot........._
Permit No. ~~~ate of Permit ~~.C~44kpplicant '~ti~L1.~.~ _
.
Health Dept. Approval Undcrvri/tn/ers Approval.....J......_
Planning Board Approval ...,~':':'Y`:! ~
Request for Temporary Certificate Final Certificate
Pee Submitted: $ 5~......._...
APPLICANT..
-7-~.p. (s-~~~ yg~-~~1~~
rev. 10/14/88
h 'I
FORM N0. 6
TOWN OF SOUTDOLD _ ~ »
BUILDING DEPARTMENT
TOWN AALL
765 - 1802
APPLICATION FOR RERTIFICATE OF OCCUPANCY INSTRUCTIONS
A. 'This application must be filed in typewriter OR ink and submitted to the Building ~
Inspector with the folloiwing; for new buildings or new use:
1. Final survey of prope'rtp with accurate location of all buildings, property lines,
streets, and unusual natural or topographic features,
2. Final approval of Health Dept, of water supply and sewerage-disposal~S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4_ Swotn statement from plumber certifying that solder used in system contains less
than 2/10 of 1Z lead.,
5. Commercial buildings,'industrial buildings, mulCiple residences and similar.
buildings and installations, a certificate of code compliance from the Architect
or Engineer responsible for Che boil"ding,
6. Submit Planning Board~,Approval of completed site plan requirements.
B. For existing buildings (prior to April 4, 1957] non-conforming uses, or buildings
and "pre-existing" land Vises:
Accurate survey of property showing all property lines, streets, buildings and
unusual natural or topographic features.
2. A properly completed application, a consent to inspect signed by the applicant
and a cerCified 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 O~cupancy is denied, the Building Inspector shall state the
reasons therefor in vr~iting Co the applicant.
3. Date of any housing cgde or safety inspection of buildings or premises, or other
pertinent informationltequired to prepare a certificate.
C. For Vacant Land CertificaCe of Occupancy:
1. An application for va4ant land Certificate of Occupancy shall be submitted,
and a cerCified abstract of title issued by a title company showing single and
separate ownership of~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 reasogs therefor in writing to Che applicant.
D. FEES:
I. CERTIFICATE OF OC~UPANCY - New Dwelling $25.00, Additions Co Dwelling $25.00,
Alteration to Dwelling $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 gears - $10.00
4. Vacant Land Certificate of Occupancy - $20.00
5. Bpdated CertificaCe of Occupancy - $50.00
6. Temporary Certificate of Occupancy - $25.00 Residential
$50.00 Commercial
eo. 10/14/S8
TEL. 7G5-t 802
5~F F ~L
~ SOUTIIOLD
~o , o~ ~ owrr or
~ OFFICE OP BUILDING INSPECTOR
~ .4i1
~ { k r} P.O. BOX 728
~ ~ TO1YN FIALL
,y~ol ~ Y~a~~ SOUTHOLp, N.Y. 11971
July 10, 1990
DING ROSSINI
151 HEMPSTEAD TURNPIKE
WEST HEMPSTEAD, N.Y. 11552
To Whom This,May Concern,
We are unable to complete your Certificate
oL- Occupancy because of the following reasons.
J~ 11n application for Certificate of Occupancy
is not on file. (ENCLOSED)
No [Jnderwriters Certificate on file.
The check is (oMt~~~lt&'~/not on file. ) $25.00
No tlcalth Dept. P:pproval on file.
No final inspection has been made.
Please contact our office on this matter.
Thank you for your cooperation.
Bui]di.ng Permit it 1 7 5 5 S Z
Building Dept.
No Plumber Solder Certificate on file.
( all permits involving plumbing being
issued afL-cr Rpril 1,1984 )
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IIJSULATIOPI PER N. Y.
STATE ENERGY
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ADDITIONAL COMMENTS: T~
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1
o~ ~r ~ Southold Town Board of Appeals
,~~1® MAIN ROAD - STATE ROAD 25 SOUTHOLD, L.I., N.Y. 17971
TELEPHONE (516) 765-1809
APPEALS BOARD
MEMBERS ~ 2 c
GERARD P. GOEHRINGER, CHAIRMAN
CHARLES GRIGONIS, JR.
SERGE DOYEN, JR. ACTION OF THE BOARD OF APPEALS ~ L
JOSEPH H. SAWICKI
Appeal No. 3735:
At a Meeting of the Zoning Board of Appeals held on
July 14, 1988, the above appeal was considered, and the Action
indicated below was taken on your Request for a Variance to the
Zoning Ordinance, Article XI, Section 100-119.2A:
Upon application of DINO AND LYNN ROSSINI for a Variance to
the Zoning Ordinance, Article XI, Section 100-119.2 for
permission to construct deck addition, landing and stairs near
and along bluff of the L.I. Sound, at premises known as 755
Soundview Avenue, Mattituck, NY; County Tax Map Parcel No.
1000-94-1-6.
WHEREAS, a public hearing was held and concluded on
July 14, 1988 in the Matter of the Application of DING AND LYNN
ROSSINI under Appeal No. 3735; and
WHEREAS, at said hearing all those who desired to be heard
were heard and their testimony recorded; and
WHEREAS, the Board has carefully considered all testimony
and documentation submitted concerning this application; and
WHEREAS, the Board Members have personally viewed and are
familiar with the premises in question, its present zoning, and
the surrounding areas; and
WHEREAS, the Board made the following findings of fact:
1. The property in question is identified on the Suffolk
County Tax Maps as District 1000, Section 94, Block 1, Lot 6, and
is a described parcel of land containing a total area of
approximately 40,000 sq. ft. with frontage of 100.56 feet along
the north side of Sound View Avenue, depth of 364.0 feet, and
frontage along the Long Island Sound mean highwater mark of 99.13
feet.
2. The subject premises is improved with a single-family,
one-story framed house as more particularly shown on the copy of
a 1981 survey prepared by Robert A. Kart, Land Surveyor.
gage 2 - Appl. No. 3735
Matter of DING AND LYNN ROSSINI
Decision Rendered August 18, 1988
3. By this application, appellants propose to construct
accessory stairs and platform structures as shown by the sketch
submitted, extending from the area of the existing deck at the
rear of the dwelling, along the bluff toward the bulkhead at the
bottom of the bluff.
4. Article XI, Section 100-119.2, subparagraph A(1)
requires all buildings and structures proposed on lots adjacent
to the Long Island Sound to be set back not less than one-hundred
(100) feet from the top of the bluff, or bank. No other sections
of the Zoning Code appears to provide for the type of
construction proposed herein, with the exception of 100-119.2A.
5. In considering this appeal, the Board finds and
determines: (a) the activities required for the placement of
this structure will be constructed on piers without disturbance
to the vegetation of the bluff or be adverse to the character of
the immediate area; fb) the percentage of relief in relation
to the requirement is substantial; however, there is no other
alternative for appellants to pursue other than a variance; (c)
the practical difficulties are related to the land and are not
personal in nature; (d) the grant of this variance will not in
turn be adverse to the safety, health, welfare, comfort,
convenience, or order of the town; (e) in considering all the
above factors, the interests of justice will be served by
granting the application, as conditionally noted below.
Accordingly, on motion by Mr. Grigonis, seconded by
Mr. Sawicki, it was
RESOLVED, to GRANT a Variance from Article XI, Section
100-119.2A of the Zoning Code for the placement of an accessory
stairway and platform in the Matter of
Appeal. No. 3735 - DINO AND LYNN ROSSINI, SLSBJECT TO THE FOLLOWING
CONDITIONS:
1. Stairs must be detached from-the top platform (although ,
it may be near same - not physically attached);
2. Deck platform and all related construction must remain
open and unroofed (except for railings);
3. Structures must be constructed in the best way possible
to avoid disturbance to the existing vegetation within this bluff
and immediate surrounding area;
4. Area around the "stringers" or poles which will hold the
stairs must be replanted, if necessary, with additional ground
cover as recommended by the N.Y.S. Department of Environmental
Conservation (and Suffolk County Soil and Water Conservation
District);
gage 3 - Appl. No. 3735
Matter of DING AND LYNN ROSSINI
Decision Rendered August 18, 1988
5. The soil areas shall not be disturbed, except for the
placement of the poles (piers) necessary for safe construction.
vote of the Board: Ryes: Messrs. Goehringer, Grigonis, and
Sawicki. (Member Doyen was absent due to weather conditions.)
This resolution was duly adopted.
* ~
lk GERARD P. GOEHRINGER
CHAIRMAN
New York State Department of Environmental Conservation
Regulatory Affairs Unit
Bldg. 40, SUNY, Rm. 219
Stony Brook, NY 1 1794 Thomas G Jorling
(516) 751-7900 Commissloner
August 19, ]988 D
q IJ~70
Dino Rossini 8 .DEPT,
15 1 Hempstead Tpke. fOwN O~ OUTNOIp
West Hempstead, NY 11552
Re: 10-88-0798
Dear Mr. Rossini:
In conformance with the requirements of the State Uniform Procedures
Act (Article 70, ECL) and its implementing regulations (6NYCRR, Part 621)
we are enclosing your permit. Please read all conditions carefully. If
you are unable to comply with any conditions, please contact us at the
above address.
Also enclosed is a permit sign which is to be conspicuously posted
at the project site and protected from the weather.
Very truly yours,
Katy Muzphy
Environmental Analyst
enclosure
k
E
95-20.6 (9)86)-25c NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
DEC PERMIT NUMBER ~ EFFECTIVE DATE
10-88-0798 8/19/88
FACILITYIPROGRAM NUMBER(S) PERMIT E%PIRATION DATE(S) ,
Under the Environmental Conservation Law ~ '
N/A 8/3]/90
328Ci 329: Aquat c Pest tides 27 ~ Water Oua~y~ Certification ~ Tidal Wetlands
Article 15, Title 5: Article 17, Titles 7, 8: Article 27, Title 7; 6NYCRR 360:
Protection of Water ~ SPDES ~ Solid Waste Management*
Wateles~5Pp
~tle 15: ~ AirlPolluton Control* ~ Hazardous Walste rManagement3~
Article 15, Title 15: ~ Article 23, Title 27: ~ Article 34:
Water Transport Mined Land Reclamation Coastal Erosion Management
Lonlgelsland IWellsS~ ~ Frelshwat
~r Wetlands ~ Floodplaio Management
Article 15, Title 27: N-New, R-Renewal, M-Modification, Articles 1, 3, 17, 19, 27, 37;
Wild, Scenic and Recreational C-Construct (*only), 0-Operate (*only) ~ 6NYCRR 380: Radiation Control
Rivers
PERMIT ISSUED TO
Dino Rossini
ADDRESS OF PERMITTEE
151 Hempstead Tpke., West Hempstead, NY 11552
AGENT FOR PERMITTE EjCONTACT PERSON TELEPHONE NUMBER
NAME AND ADDRESS OF PROIECTfFACILITY (If different from Permittee)
755 Soundview Ave., Mattituck SCTM ll 1000-094-01-006
LOCATION OF PROIECTfFACILITY COUNTY TOWNjCITYIVILLAGE UTM COORDINATES
Mattituck Suffolk Southold
DESCRIPTION OF AUTHORIZE D. ACTIVITY _
Construct 12'x20' deck and 4'124' linear ft. staircase with a 5'x5' platform.
All work shall be in accordance with the attached NYSDEC approved plans.
I . ~ , - _ -
GENERAL CONDITIONS
By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compli-
ance with the ECL, all applicable regulations and the conditions specified herein or attached hereto.
1. The permit[ee shall file intheoffice of the appropriate regional permit administrator, or other office designated in the speaal conditions,a note of intention to commence
work at least 48 hours in advance of the time of commencement and shall also notify himfher promptly in writing of the completion of the work
2 The permitted work shall be subject to inspection by an authorized representative of the Department of Environmental Conservation which may order the work suspended if
the public interest so requires pursuant to ECL §71-0301 and SAPA §401(3)
3 The permittee has accepted expressly, by the execution of the application, the full legal responsibility for all damages, direct or indirect, of whatever nature, and by whomever
suffered, arising out of the protect described herein and has agreed to indemnify and save harmless the State from suits, actions, damages and costs of every name and descrip~
[ion resulting from the said Oroiect.
~ 4 The Department reserves the right to modify, suspend or revoke this permit at any time after due nonce, and, if requested, hold a hearing when:
a) the scope of the protect rs exceeded or a violation of any condition of the permit or provisions of the ECL and pertinent regulations are found; or
b) the permit was obtained by misrepresentation or failure to disclose relevent facts; or
c) newly discovered information or significant physical changes are discovered since the permit was issued
5 The permittee is responsible for keeping the permit active by submitting a renewal apphcatiom including any forms, fees or supplemental information which may be required
by the Department, no later than 30 days (180 days for SPDES or Solid or Hazarduous Waste Management permits) prior to [he expiration date.
6 This permit shall not be construed as conveyin8 to the applicant any right to trespass upon the lands or interfere with the riparian rights of others m order to perform the
permitted work or as authorising the impairment of any rights, title or interest in real or personal property held or vested in a person not a party to the permit.
7 The permittee is responsible for obtaining any other permits, approvals, lands, easements and rights-of-way which may he required for this project.
B Issuance of this permit by the Department does not, unless expressly provided for, modify, supersede or rescind an order on consent or determination by the Commissioner
issued heretofore by the Department or any of the terms, conditions, or requirements contained in such order or determination.
9. Any modification of this permit granted by the Department must be in writing and attached hereto. R/S(itn
PERMBI~I$9U(sB
IICE DATE pR MINI A ADDRESS REGION i HUILDINl3
1I David DeRidder 40
STATE UNiV
AUTHORIZED SIGNATURE gTtti'Vy Rq()r~K, F,W V(1R t( t17o• 3
~ Page 1 of
cc: BMHP
95-20fia (1186)-25c
ADDITIONAL GENERAL CONDITIONS FOR ARi1CLE5 75 (Title 5), 24, 25, 34, 36 and 6 NYCRR Part 608 ( )
10. That if future operations by the State of New York require an al- other environmentally deleterious materials associated with [he
teration in the position of the structure or work herein authorized, or project.
if, in the opinion of the Department of Environmental Conservation 14. Any material dredged in the prosecution of the work herein permitted
it shall cause unreasonable obstruction to the free navigation of said shall be removed evenly, without leaving large refuse piles, ridges across
waters or flood flows or endanger the health, safety or welfare of the bed of a waterway or floodplain or deep holes that may have a
the people of the State, or cause loss or destruction of the natural tendency to cause damage to navigable channels or to the banks of
resources of the State, the owner may be ordered by the Department to a waterway.
remove or alter the structural work, obstructions, or hazards caused 16. There shall be no unreasonable interference with navigation by the work
thereby without expense to the State, and if, upon the expiration or herein authorized.
revocation of tfiis permit, the structure, till, excavation, or other 16 If upon the expiration or revocation of this permit, the project hereby
modification of the watercourse hereby authorized shall not be com- authorized has not been completed, the applicant shall, without expense
pleted, the owners, Shall, without expense to the State, and to such to the State, and to such extent and in such time and manner as the
extent and in such time and manner as the Department of Environmental pepartment of Environmental Conservation may require, remove all or
Conservation may require, remove all or any portion of the uncompleted any portion of the uncompleted structure or fill and restore the site
structure or fill and restore to its former condition the navigable to its former condition. No claim shall be made against the State of
and flood capacity of the watercourse. No claim shall be made against New York on account of any such removal or alteration.
the State of New York on account of any such removal or alteration. 17 If granted under Article 36, this permit does not signify in any way
11 : That the State of New York shall in no case be liable for any damage that the protect will be free from flooding.
or injury to the structure or work herein authorized which may be caused 18. If granted under 6 NYCRR Part 608, the NVS Department of Environ-
by or result from future operations undertaken by the State for the mental Conservation hereby certifies that the subject proect will not
conservation or improvement of navigation, or for other purposes, and contravene effluent limitations or other limitations or standards under
no claim or right to compensation shat! accrue from any such damage. Sections 301, 302, 303, 306 and 307 of the Clean Water Act of 9977
12. Granting of this permit does not relieve the applicant of the responsi- (PL 95-217) provided that all of the conditions listed herein are met.
bility of obtaining any other permission, consent or approval from 79. All activities authorized by this permit must be in strict conformance
the U.S. Army Corps of Engineers, U.S. Coast Guard, New York State with the approved plans submitted by the applicant or his agent as part
Office of General Services or local government which may be required. of the permit application.
13. All necessary precautions shall be taken to preclude contamination Such approved plans were prepared by Dino Rossini P.E.
of any wetland or waterway by suspended solids, sediments, fuels,
solvents, lubricants, epoxy coatings, paints, concrete, leachate or any Revised on 8/ 9/88 , ,
SPECIAL CONDITICPNS
1. Verticle support son seaward side of deck to be set back a minimum of 5'
from cliff.
2. All areas of disturbance shall be immediately stabilized by plantings.
Supplementary Special Conditions (A) thru CJ) attached.
DEC PERMIT NUMBER
]0-88-0798
PROGRAM/FACILITY NUMBER
N/A Page 2 of 3
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FORM N0.3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N.Y.
NOTICE OF DISAPPROVAL
c~1 / .,p Date 19
PLEASE TAK~E~NO~TI~CE that yo~ur~~'appliv//canon dated Y/~U 19~`~. .
for permit to G~?c!v/.'.r~
+~~9y'~~`G~ .GZa~G~xi"`.' at
Location of Property .......1.~~'•..~~'U~~~~••~~~•~••~~••••••••••••••••••
House No. Street Hamlet
County Tax Map No. 1000 Section .......gT • • • • Block f .......Lot .
Subdivision Filed Map No. Lot No. .
is returned herewith and disapproved on the following grounds . ~u.u~.Ll.-• ~/~•Z
'Bui]~ing ~~spector
RV 1/80
FORM3 THE NEW YORK BOARD OF FIRE UNDERWRITERS
- ELECTRICAL DEPARTMENT
' A.J. REED, GENERAL MANAGER
R~E/SPOND T~~:
WEW YORKQNY 10038 I ~ ALBANY,SNY 12207 I ? BUFFALO aNY 14202 I ~ ROCHESTERnNY 14608 I ~ SYRACUSE, NY 413206
THIS IS A REPORT OF (SEE BOX CHECKED HEREUNDER)
? NON-lNSPECI RCN SPECTlO!'J ? ELECTRICAL SURVEY
JOB LOCATION:
APPLICATION NO.: PERMIT NO.:
TO: OWNERI
TENANT
ADDRESS
NON-INSPECTION: We have received your application for an inspection of the electrical installation made by you at the
premises named herein but we have been unable to make the inspection for the following reason:
? Floor location and name of tenant not furnished ? Premises locked, no entry possible.
? Floor location of building not furnished ? Other
Inspector's Signature Date
Please provide the necessary information or suggest arrangements for our access to the premises on the green form
attached and return it to this office.
Applicant's Signature Date
- - - - RarAk
INSPECTION OR ELECTRICAL SURVEY: We have attended at the premises named herein to inspect the electrical
installation and regret that we can not issue a certificate of compliance for the reason(s) listed hereunder;
? Concealed work nqt exposed sufficiently ? Additional electrical work found for which no application
for inspection. - for inspection has been received.
? Installation not completed sufficiently ? Electrical installation does not comply with National
for inspection. Electrical Code for reasons listed hereunder.
(see reverse side for explanation of coding)
KEY TO FORM: Code numb~rinted under BLACK column listed below combined with code number printed under RED column listed Delow
indicates condition. EXAMP BCAGK 1dED =Service Conductor not of proper capacity.
n.,. T8 45
BLACK(. RED.., FLOOR BLACK RED FLOOR BLACK RED FLOOR BLACK RED FLOOR
v "7
J f: ~i~
r
Inspector's Signature ~ - - Uate
fJOTICE TO APPLICANT: Please sign, date and return green copy of this
form to request re-inspection when modifications have been made. ARRUCnnrs SIGNATURE DnrE
NOTE: IF THIS IS A REPORT OF ELECTRICAL SURVEY, A NEW APPLICATION MUST BE MADE FOR RE-INSPECTION.
KEY TO FORM: Code number printed under BLACK column, combined with code number printed
under RED column indicates condition:
EXAMPLE: BLACK RED .SERVICE CONDUCTOR NOT OF PROPER CAPACITY
76 45
BLACK COLUMN
1. AIR CON DITIONER 23. FITTINGS 16. MOTOR BRAN CH CIRCUIT 68. RECEPTACLE PLATES 90. SPLICE 80%ES
2. APPLIANCE 24. FIXTU qE CANOPIES 47. MOTOfl CONTROLS 69. RECEPTACLES 91. SURFACE METAL flACEWAV
3. APPLIANCE CIflCUlTS 25. FIXTU RE OUTLET BOXES 46. MOTOR DISCONNECT MEANS 70. RECEPTACLE OUTLET BO% 92. SUfl FACE METAL flACEWAV
9. APPLIANCE RECEPTACLES 26. FI%TU qES 49. TEMPO gAflILV OE LETEO 71. RECESSED FIXTURES CON OUCTO RS
S. BONDING BUSHING 27.'FIXTU RESOCKETS:_ 50. MOTOfl EQUIPMENT' 72. RHEOSTAT 93. SWIMMING POOI MOTORS
6. BRANCH CIRCUITS 28. FIXTU flE~EON DUCTO RS 51. MOTORS 73. SEALING FITTINGS -94. SWIMMING POOL JUNCTION BOXES
7. BRASS SHEILSOCKETS 29. FLEXIBLE CORDS 52. MOTOR TEgMINAL BOX 74. MORE THAN ONE SERVICE 95. SWIMMING POOL GROUNDING
B. BUSWAVS 30. FLUOgESCENT FI%TQRE$ 53. MOTOfl WIRING 75, SERVICE 96. SWIMMING POOI LIGHTING
9. CABINETS 31. FU RNACE CONTROLS 54. MULTI OUTLET ASSEM BLV 76. SE RVILRE CON OUCTOflS 97. SWIMMING POOL RECEPTACIES
10. CABLEBUS 32. GENERATORS 55. NEUTRAL CON OUCTOfl 77. SE RVILE CONDUIT 96. SWIMMING POOL
11. CABLE BUSN ING 33. GROUND FAU LT IN TEq RUPTER 5fi. NON-METAL LIC CABLE 78. SERVFCE OISCONMECT MEANS TRANSEOAMEq
12. CABLES 34. GROUNDING ELECTRODE CLAMP FITTINGS 79. SERVICE DROP 9y. SWIMMING POOL WIRING
13. CON OU CTOR ASSEMBLIES 35. GROUNDING ELECTRODE CONDUCTOR 57. NON METALLIC CABLES - B0. SERVICE ENTRANCE CABLE IOq. SWITCHBOARDS
I4. CONDUCTORS 3fi. GROUNDING ELECTgOQ6S 58. OPEN WIRING CONDUCTORS 81, SERVICE EQUIPMENT 101. SWITCHES
15. CON QUIT 37. HEATERS 59. DU TLET BO%CO VE RS 82. SE RVICE HEAD 102. SWI iCH OUTLET BOXES
I6. CONDUIT FITTING_5 38. INSU LATEO BUSHING 60. OUTLET BOx FITTINGS 83. SHOWCASES 103. SWITCH PLATES
17. CONTROLS J9. JUNCTION BOX COVERS 61. OUTLET BO%ES ~ 61. SIGN LON OUCTORS 104. SWITCH WIRING
16. CUTOUT BO%E5 40. LAMP 6UAR05 EC. OVERCUfl RENT OEtlICE9--' 8~. SIGN @ISCONNECT MEANS 105. TEMPOflAgY WIRING
19. ELECTRIC METq LLIC TUBING 41. LOW VpITAGE EQUIPMENT 63. PANELBOARO COVER 86. SIGN FRAME 106. Tfl ANSFO RMEflS
20. EMERGENCY SYSTEM ~ 42 NAGHINE TOOLS ~ 64. PANELBOARQ$ $7. SIGN-HIGH VOLTAGE 107. U, F. CABLE
21. EQUIPMENT Gfl OUNOING 47.~METAL CLAD CABIE 65. RACEWAY LON DOCTORS EQUIPMENT "108. UkOEPFLOOR gACEWAV
CONDUCTOR 49. METAL CLAD CABIE FITTINGS 6fi, gACEWAV FITTINGS , 88. SIGNS 108. WIREWAYS
22. FEEDERS 45. METEq EQUIPMENT 61. flALEWAYS 69. SMOKE DETECTORS I10. WIRING METHODS
REO COLUMN
L OE FEL TIVE 23. NOT EkPLOSION PROOF 11. hUI DF A 1YFE LISTED 66. NOT PROPERLY JUINEU C6. NOT Pfl OViDEO WITH
2. OETERIORAFEU 24. NOT EXTERNALLY OPERABLE FOR RNDERGRUIINO G7. NUTPROPEkLV LOCATED PROPER SEALING
3. DOf:S NOT OISCONNEC7 25. N07 FASTENED ATYflOPEP 15. PJ;JT OF PROPER CAPACIT'i BB NOT PROPERLY LOCATF.U COMPOUND
Ail-'CONDUCTORS - INTERVALS SG. NOT OF PROPER GAUGE IN CLOTRES CLOSET A7. NDT PROVIDED WITH THE
4, DOES NOT DISCONN EGl ALL 26. N03 FLUSH 47. N@T OF PRDPEF POLQ RI; r B9. NOT PR OPE qLY MOUNT.E O., PROPEfl UVE RC LIRRENi
UN GR OIINOEO - 21. NOT IN'ACCOR pANCE WITH 49' NpT OF PR OPER RAl1tt7S- 70. NOT4ROPE RLV SEALED PROTECTION
L ON OUCTi)R$ AHiILLE 4687 Al RENDS ll. NUT PRGYEfl LV SECURED xR NOT RAIN FIGHT
S L`uES NGI HOVE 4MPI I'SPACF 28. NUT IN 4CI:ORUANCE WITH .:19. NO7 OF PROPER TYPE - TO FITTINGS '?9 NOT PEAOIIPAffESSIBIE
v IiUkh NUI dAVE NARIL Pl4FG CIIUE `,i:+NU,:NO~ ' or UI TYPE:, r!U`. PRUPE F'IVSFFa FAIEU ID NOFTU RE f, fINNEC TED
' ORf SNOLHAVE -E9. NOT•fMUYERA81,E - ~ :'~Id IHE GR9UNOCU I':PE -tt NPT PPHPEkty 9HPPORIEU - ANJVF 4EHV1lE HERO--
°ROFFH~_..~1HiJLLF CONCH FIIJN _ ~~~~II pFi'cEPI J',",F$EMh. FIr ?ui PH:iF'I'I. '"L'G'l~'.'Ei' 'E`LF L'IIryN"~FF Fir'
" UOF A;JUI UH.L ~If VPER JV. NU UIU, j.GMfA 4H qAL[+J i,r '+u r oi'ER L'~ FIiH LCJ. LN JFpI r 4 -V;.r r rPnrtl CE f.
.SPAi:ING 31 NOTIN SIGHT OF OF s4 ^'Dr P.rdPNl r:BtiFHFO"~ 15 ~rVLr p9gPEHEV TFRM'HATFfF IN l'u -rIH
v. UUt>NUI M1'EFI61,LINE LJi..I"I F1 FE '1 (dl'.PI F', t': La+.Fb ra:; of OP`~1 In4:.1 E.; AI Jil l~'r 'I!'N`I4J Eli iY
MEM1LiF ~HIn,E x560 -37 NOTINSFALLEU. - 55. NfITPRfIPFRLYfASTENEU'. :&JX85 ~ GM1IALL 41MF9AM.F --C I'.
I U. DUE$NGI IERM~NAIE IN 33. NUT ISDCATEL p01 PHUFE11ur Ni.LU - 17uI CF:yiEf 1,JiE.. ~,dHEh'~N GENCPAL'.'~'
LI"IED FIPIN G.`. 74~NOT IIRII1D TIhFT '~N OT Fa11FF NIY ~;R ]!'NOF? ~ 76 .rygi hRlS~cF~OrPOM - '^4 NPT'FO'P.E MORE THAN SI++
°OaEO'T 11C ;Ifr: :5 fap li°I[11 ELIIP4: ~ ~I E?nP:-- ~ 114':%- .~,.N r '_.'-1~:
eL'•, •.!vE NUMeFd {n NI,i LI'IfU FUi Ubb~ It'~nl-1 ,i' ~t hull"alp ryl-P(
OF HRJIn kIFWAI M1uF PRJF{H.: dJ:.:AI.LFU PHY'.'LAL J:dJ A:.E~~. JuNC1iJN Eb:.
. •I/.IE UP~4 xa DCF .T^P~ :f Nu: LIS1I li FiPt HA,: nODU' Eli +T'vE 'u f111,1C- riclE ^J:'"I .
..r~ilh.n,~`Jt.L'..D _ AREA'.I`.AI,F "--FI', ~i NHI PC:n~_{,-.. _ ..ENr
' : NnFLI`iFL E~IV U:.u.,r. rATr;'u'.F i :i~ 1•.,.C4Kpr h e~. r, .~..I~~, .I
r.. IV iN:.uF NiIENI 'W:dJ TIT: , ~FPUC- -t ~ RW'i v7
i+SJFF1i IFN: 39. NOI Lq IEL'F~i' oC i P` ~ liE_ A2. NOi rf."n. ;Ci. :'.:'Iq g"v qe r.T ic-'F^:.-
Lnc; PF-. InaN .,,nnu nE Enlll:raEmrr A~:eL -r n.: n~;.~~ ;ve,., I~ Ilna ~.a.-- r - +
SfRANNFp WHEN INa NI. N01 L!SrEL'MPrFRIn'_` ~'i.,q"'+:~~ \,iI YFUVUGd WI'N n- 'plr n.FF~I'nY
NAC.FIN,:' 41. NUi OFANOh ~NT[H c~b 'R IUi' b F;FH I c..;~
i3. MI.SIFJC LHAI.LiABL~::: P~ - :uU;;I.Ul LI... .Lei+.L[d a+. NO+HW.:ULU B..n ,u.. .~YU....u ue,.tLY.L:.tA'
20. NOTATPOIN7UF~9:94NCE AL TEMPRRAPoLY pELCIEU ~cL.gTIVE IOV..=:CH At, PROPER ORAINALU -4i ':++:„HAyr_~vF~E Fib
21. NOTLAr'PEL 13. NDF OFA TYPE II:FF" _ ,FE.'.M PIPE;
b5. N7TPflUVIUEG WITH TnE 104. ULEL IN YLALE OF AN
22. N07 CONTRJUVUS FOq OUTDOORS 65. FIOTPgOPEPCl INGULATFU PgOPER FI7TINGS ACCEPTED WIRING METHOC
FORM 3IREV. 4/63) a - ,
r
. ~ ~~~~~1
~ ~~A~
r,
l M o-'3 k~s~x'^ LL
VICTOR LBSSARD ~
EXECUTIVE ADMINISTRATOR 81'~ ~ - ~ Town Hall, 53095 Main Road
tfr, ~ P.O. Box 1179
(516) 765-1802
~~~~~'°'y. Southold, New YOrk 11971
OFFICE OF BUILDING INSPECTOR
TOWN OF SOUTHOLD
September 27, 1988
Mr. Dino Rossini
151 Hempstead Turnpike
West Hempstead, N.Y. 11552
Dear Mr. Rossini:
I am returning the set of plans you submitted to our
office Sept. 23, 1988.
Please submit 3 sets of plans, all alike. They must
be more detailed regarding structural design. Please note
my marks in red on the plans of Sept.23rd.
Thank you for your attention to this.
Yours truly,
Thomas Fisher
TF:hdv Building Inspector
[ .
FORM N0.3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N.Y.
NOTICE OF DISAPPROVAL
~1 / ~ Date 19
PLEASE TAK~E~NO~TI~CE that yo~ur/application dated ~~~4 19ca.~ .
for permit to L ~x!yl.!ztt
e~L?~ . G?4~~~F~.~/~r'.!.~' at
Location of Property .~~~.Y?~t!.J..4~L.~L~.
House No. Street Hamlet
County Tax Map No. 1000 Section .......g7:.... Block , l....... Lot ....4.( .
Subdivision Filed Map No. Lot No. .
is returned herewith and disapproved on the following grounds . w!'~.. x/92
...~`~P':1. .
r ` .
'Puilyd'ing~~Spector
RV 1/80
765-1802
BUILDING DEPT.
INSPECTI~JN
[ ]FOUNDATION 1ST ( ] !ROUGH PLBG.
[ ] FOUNDATION 2ND [ ~ INSULATION
[ ]FRAMING [ INAL
REMARKS:
DATE ~ ~O INSPECTO
. ,
T65-1802
BUILDING DEPT.
INSPECTION
[ ) FOUNDATION 1ST ( } ROUGH PLBG.
[)FOUNDATION 2ND [ ]INSULATION
[ ~RAMING [ ]FINAL
REMARKS:
DATE ~ INSPECTOR
~
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAFE '
sD2nsve I
BUREAU OF ELECTRICITY -
85 JOHN STREET. NEW YORK, NEW YORK 10038
;x~a °OC.7UBER 17,1990 69970640/4f1 H b1R7D4
~b ~ Application No. on file e'
THIS CEFtTIF1E3 THAT
only the electrleel equipment M described 6sbm and introduced 6y the uppHcent nomad on the a6ooe spplicetian number in the promises of
DING k LYNN ROSSINI, 755 SOIlNDV1 EW AVENUE, MATTI FUCK, N. Y. eT-
in the follominR kteatton • n b ll T
OCTI~BF.R 11, 1Y9~ ? Ixt Fl. ? Ynd FI. Sertiun Blork Lot
mss examined un and found to 6e in cornplianre mith the reyuirementx of this Board.
pItTUR! At]ES fYVITCXlS RXTWES RANOES CODKINO D[t:KS OVENS DISH WASXERS EXHAUST FANS
ODTIET{ INGNaltCEt1T nU(MIEEClNT OTHER AMT. K. W. AMT. K. W. AMT. K.W. NAT. K. W. AMf. N. P.
15 2 15
of
DRYERS FURNACE MOTORS FU111RE AFFUANCE FEEDERS SFlGAt REC'?T TIME CLOCKS ENL UNIT HEATERS MUITI-0IITIR DIMMERS
AMT. K. W. Oll, n P. GAS M. P. AMT. NO. A. W. G. AMT. AMP. AMT. AMPS. TRANS. AMT. N. P. ~
W~IEFi AMT. WATTS
RRet
fppVlC! DISCONNECT. NO.OF ~5 E R V 1 C E
AMT. AIN. TTPE METH 1 / TW 1 A tW S / 3W ~ / AW NO.OF CC COND. A. W. G. NO. OF Nb1EG A. W. G. NO.OF NEUTRALS A. W. G.
EOINF. PERT a cc. coNO. oP NI-1!G OF NEGTUI
OTHER AF!'ARATUS:
fi,P.f,.I:-1
1~
D=
~R
DING RDSSINT P. t.
155 SOUNDVIEW AVE.
MATTITl1CK, NY, 1195? OEIIERAtMANAOMt
1 1
Per
Thi/ certificaH moA rlOf be ahsrod in any manner; returTl to Nle oXia of the Eoard if incorrect. Inspectoro may be identified by IMir cTedsMbls.
A
~ _ _ _
~ ,
CIIARLES T. IIAT:ILTOT?
Chi€f, TiAi2IIdE REGULATOP.Y S~^~'?'.~T?
TTYS DEC, Bureau of T:arine Ilz:bita.t Protection
Bldg. 40, SUT]Y, P.m. 225
Stony Brook, PI. Y. 11794
Res Perm9.t Ito.
Issued To,
Contractor`s Addres~. _
Contractor's Phone 41
Dear Sirs Contractor°s Tlame
Pursuant to General Condition t?o. I of the abo~°s refzrerced permit you
are hereby notified that the authorized activity anall ccruncaca
This T?etice is to be sent at laust tc~o days zs a:'
vance of commencement of the project. The Permit sign e7i11 be poet:;;:. c.t
the site and copy of Permit will be available ac site for inspect~e~n.
Submitted by
DATE:
FAtt.TTRE TO TIOTIFY OR POST SIGT? [TILL LEAVE OIIP?ER/AND/OR COIITPAC~02: SUB
JECT TO APPLICABLE PETIALTIES FOR NOT?-COPIl'LIAPTCE I?ITII PEPSIIT COT?DITIOI:S.
CIIARLEB T. IIAIIILTOTd
Chief, I;arine Regulatory Section
IIYS DEC, Bureau of ITarine Y.abitat Protection
Bldg. 40, SUDTY, Rm. 225
Stony Brook, N. Y. 11794
Res Permit TIo.
Issued To.
Contractor°s Address,
Contractor°s Phone ;l
Dear Sir: Contractor°s Tlame
Pursuant to General Condition Tdo. 1 of the above referenced Permit, you
are Hereby notified that the authorized activity c•7as completed on
Submitted by
DATE;
THIS TTOTICE, 61ITII PIIOTOS OF COTSPLETI:D 6?OPR ATTD/OR COT'PLETED SURVEY, IS
TO BE SEPdT TO ABOVE ADDRESS Pli'JT~TLY UPCTT COT~LETIODT OF PROJECT. PAILORE
TO NOTIP`I (?"zLL LEP_VE OTR?ER ATTD/O^, CCT'.TRACTOR SUBJECT TO APPLICABLE
PEidALTIES FOR TdON-COTIPLIATTCE LdITH PEPSIIT COT•IDITIOTv'S.
SUPPLLML:NTARY SPECIAh CONDITIONS
The following conditions apply to all permits:
A. If any of the permit. conditions are unclear the permittee shall con-
tact the Division of Regulatory Affairs at the address and telephone
noted below.
B. A copy of this; permit or approval and supplemerrtary conditions shall
be available at the project site whenever authorized work is in
progress.
C. The permit sign enclosed with the permit or a copy of letter of
approval shall be protected from the weather and posted in a con-
spicuous i.ocation at the work site until completion of authorized work.
D. At Seast 48 hours prior to commencement of the project, the permittee
shall complete and return the top portion of the enclosed receipt form
certifying that he is fully aware of and understands all provisions and
conditions of this permit. Within one week of completion of the
permitted work, the bottom portion of that form shall also be com-
pleted and returned.
E. For projects involving activities to be accomplished over a period of
more than one year, the permittee shall notify the Regional Permit
Administrator irr writing at least 48 hours prior to the commencement
of resumption of work each ,year.
F. If project design modifications take place after permit issuance, the
permittee shall submit the appropriate plan changes for approval by
the Regional Permit Administrator prior to undertaking any such modi-
fications. The permittee is advised that substantial modification
may require submission of a new application for permit.
G. All necessary precautions shall be taken to preclude contamination of
any wetlands or waterway by suspended solids, sediment, fuels,
solvents, lubricants, epoxy coatings, paints, concrete, leachate or
any other environmentally deleterious materials associated with the
project work.
H. Any failure to comply precisely with all of the terms and conditions
of this permit, unless authorized i.n writing, shall be treated as a
violation of the Environmental Conservation Law.
I. The permittee is advised Co obtain any permits or approvals that may
he required from the U.S. Department of Army Corps of Engineers, NY
District, 26 federal Plaza, New York, NY 10278, (Attention: Requlatory
Functions Branch), prior to commencement of work authorized herein.
J. 7'he granting of this permit does not relieve the permittee of the
responsibility of obtaining a grant, easement, or other necessary
approval from the Division of Land Utilization, Office of General
Services, 'Power Building, L:rnpire State P~~aza, Albany, NY 12242, which
may be required for any encroachment upon State-owned lands underwater.
Regional Permit Administrator
NYS Dept, of Environmental Conservatiun
Bldg. 40, SONY-Room 219
Stony Brook, NY 1]794
(516) 751-7900
DEC # ,p-&~ ~G-795 -
Page 3 of ~
. ~i.•= ~ 7 ' , t~
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~ *~rr pp ~ ,x.
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4, ~ ° ~ ~ yNY~. M
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~
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~ ~
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tlt VJ, h. _ .
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' r~}6'..i .p me / ~r'AW ~ 41w sir
' 'Y.«',.... t. ,_•j °t,ti~. qtr s~
`t 'i ~ ~ IF W y
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T4P~'N J n, 0 ` ~ r k.
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i` ~ ~ ; , J v,, X04.
'"~'S; . v~ 5 s~sb c
~.t~UneutnoritadNteratronwadeitiontothieturwyYRVbte• J\v t'
,~r~: Lon o1 ssgion 7209 of the New York State Etlucetlonlaw. / ~ ~ ~
xi, Copiec of this survey map not beerinp the Iend eurYeyoYe
' ~ Inked seel orembossed seal shall rat beooneldendto be N~ ~ ro ~
. t valid copy. ~ ~ ~
Sh."
~..,',Guarameesaroarrifkatbnsindicatadhsraonslallrunonly ~j~v
''j'"' to„ theparson for whom tha survey h Rrepared, end on h!s '
pehalt io)M tide wmparry, povemmental epencyand len-
` ` .~=fi'.tl;^Y institutbn lined tuueon, end to tha asaiynees of the "'''`y;
' ~IMdiN Imtltution. Guerenteaa ar osrdflcetloro era not, ~ ~ ,r;'..
r1MrfKWMbaddRlWYlinelBUtbMarWflfglMlltOWrors. ~ .
8 !y~`I,~~r NOTE ~t`~,
~ • MONUMENt~ ~4_i
~rl
URVEY~: FOR '
i v,Y~iQ/V .',•~~~IQETrf7 pF NE ~
~~g~''~a rrr rucx ~p'~~
BERT A. ~
4,P
'ZpWN OF,~SOUtHOLO r0 GUAgANTEEp 701 ~ ~ 'r
','S~UFFOLK.;.000NTYa N.Y. * ~ * CMyCAGO Tr7t,E eNSt/RANCf CgMPANY
a • ~ ~ , JEAN LORETTO. ~
z,, r
`fi`r' ' LANO SURVEYOR i; _
N.Y.S LIC.NO.PBTYD
t` _ RIVERNEAD N. Y~'
' BOARD OF HEALTH
„ , .
3 SETS OF PLANS
t: , FORM N0. 1 SURVEY .
-TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL NOTIFY
SOUTHOLD, N.Y. 11971 CALL .5"~b `f ~S' ~ YS^.Z
TEL.: 765-1802 MAIL T0:
0
Examined . . 19 0.~
Approved . ~o~Z..~ 19~Permit No. ~7?xeJJ~~
r~
Disapproved a/c • • • • • • • • • • •
~ ~ 9~ 0
(B ilding sp ctor) ,
APPLICATION F R BUILDING PERMIT
- Date .,APr~-j-..7.$......., 19.$$
INSTRUCTIONS
a. This 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. Fee 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 issaed a Building Permit to the applicant. Such permit
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 Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Depaztment 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
Regulations, for the construction of buildings, additions or alterations, or For removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to.
admit authorized inspectors on premises and in building for necessary inspecti s. ,
(Signature of pplicant, or name, if a corporation)
151,Hempstead, Turnpj_,ke,,,,,,,,,,,,,,,,,,,,
(Mailing addres's of applicant)
West Hempstead, NY 1.1552
State whether applicant is_owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.......Owner
Name of owner of premises Dino, &,Lynn,Rossini,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
ALL CONTRACTOR'S MUST BE_SUFFOLK COUNTY LICENSED
- - °~-Builder's
License No:`_~:-: ° :-,~tv„-.~u~_~,,~~~~~ --~~.~~r.u..~-a,..t~a.P-z_,.-~~~.,-~
Plumber's License No.
Electrician's License No.
Other Trade's License No. . P.E . #b.I7.86........ .
1. Location of land on wlxic,h proposed work will be done . .
7 55 , SoundyieW . Avenue Mattituclc.,. i3Y .
House Number Street Hamlet
~•2.e
County Tax Map No. 1000 Section .09.4 , 9.Q Block ..Q1.4.0........... Lot . , .O.Q6.0.0......... .
Subdivision Filed Map No. Lot...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy RES .
RE S .
b. Intended use and occupancy
~C , ,
II ~Clunojne~ss~aMUlsp~IH~~ h
(;ueotidde 3o azn;euBtS) ~Lt+98LL4•Q6'~1 ti,9~J~1
~NOSNS,I.S~L~~' y~~~ / 1
~ • • d;uno~ . v~ ® ~a nd ~txe;op
" ~
6I ..;o ~iep.......... ~~/I .
i
~ '-•~sttt; atu azo3aq o; u[oml
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