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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-18690 Date JANUARY 3, 1990
THIS CERTIFIES that the building ADDITIONS
Location of Property 825 KIMBERLY ROAD SOUTHOLD, N.Y.
Nouse No. Street Hamlet
County Tax Map No. 1000 Section 70 Block 13 Lot 20.5
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 18, 1988- pursuant to which
Building Permit No. 17262-Z dated JULY 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 ATTACHED GARAGE & DECK ADDITION TO EXISTING ONE FAMILY
DWELLING AS APPLIED FOR.
The certificate is issued to JOSEPH & VIVIAN CORNACCHIA
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-107036 - DECEMBER 13, 1989
PLUMBERS CERTIFICATION DATED OCT. 3D, 1989 - MICHAEL DAWSON
Building Inspector
Rev. 1/81
mows xo. a
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)
NQ Z Date 19~
Permission is hereby granted to: ~
......~',~...s.....~1..~.~~~~
to
cY premises located at ......Z~r~.41........~ .$rr~~l••-.....~~
.....................................................................~-.-.77.........................................................................................
County Tax Map No. 1000 Section Block .......f.`.~.......~Logt No....°I~!~...
pursuant to opplication doted ........./,1.~ 19..Q~, and approved by the
B u i l d i n g7~ I n~sp ectojr.
Fee $...(I./..!..~
~.rj(.~ll...
...~••••.r.•ai'• • • •.4~~~~~}
Bui ~ g Inspector
Rev. 6/30/80
f
' TOWN OF SOUTIIOLD
BUILDING DCPARTMENT ~ ~ (~~/J(~
_ TOWN HALL t`
~l'~ UV°~I~_~~~
SOUTHOLD, NEW YORK 11971 D 1
765 - 1802
BLOG.OEPT
APPLICATION FOR CERTIFICATE OF OCCIIPANCY
"vw0~"®U7HOL0
DATE...'.
NEW CONSTRUCTION
OLD OR PRE-E%II~STINpG BUILDING. _pACANT LAND........
Location of Property. ~,~,~__.,_~Grn/j.~i,_~yj ~qil~..._...~?JLC~YlG~'L':1..__....
DOUSE NO. ($/IREET UAMLET
Ovncr or Owners of Property.~(~SP~,~~,~iU.brCwv~..,_.~~~~~,,~C~~~~_•.'-.•.'.-
County Taa Map No. 1000 Section Block . Lot d
Subdivisio~~'~c~:14~:5.¢,:ry.~'~•:.~`':~. Filed Map ~'`~1`$,G:~,~,Lot~:s
,
Pcrmi[ ao~ / ~~..,Date of Permi_^®~~~.r~~, /
. App 1 i c a n t , ~ ;f\CtCC..lt i C~,._
Health Dept. Approval Underwriters Approval..
PlanninC Board Approval
Request For Temporary Certificate
Final Certificate „
Pee Submitted: `
.J.t............
_ 9
APPLICANT. _ , _4.It: ]/4L~C/~'~~;`ti-~~
rC4. 10/14/88
Co ~-is'64o
L' v
FOEFS N0. 6
TOWN OF SOUTIIOLD
BUILDING DEPARTMENT
TOWN IIALL
765 - 1802
AP,$LIG~~1?ION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS
A. 'This application must bG filed in typewriter OR ink and submitted to the Building
Inspector with the follgving; for new buildings or new use:
1. Final survey of property vith accurate location of all buildings, property lines,
streets, and unusual 'natural or topographic features.
2. Final approval of IIealth Dept, of vater supply and sewerage-disposal(S-9 form).
3. Approval of electrical installation from Soard of Fire Underwriters.
4. Sworn statement fromjplumber certifying that solder used in system contains less
than 2/10 of IZ lead,l
5. Commercial buildings,~'i industrial buildings, multiple residences and similar
buildings and installiations, a certificate of code compliance from the Architect
or Engineer responsib~;le for the building.
li. Submit Planning Boardl,Approval of completed site plan requirements.
B. For existing buildings (prior to April 9, 1957] non-conforming uses, or buildings
~aad "pre-existing" land uses:
1. 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 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 shall state the
reasons therefor in vciting to the applicant.
:i. Date of any housing cede or safety inspection of buildings or premises, or other
pertinent informationirequired to prepare a certificate.
C. For Vacant Land Certificate of Occupancy:
1. An application for vaunt land Certificate of Occupancy shall be submitted,
and a certified abstract of title issued by a title company showing single and
separate ownership ofjthe entire lot prior to Aptil 9, 1957 shall also accompany
the application. If a Certificate of Occupancy is denied, the Building Inspector
shall state the reasons therefor in veiling to the applicant.
D. FEES:
1. CERTIFICATE OF OCCUPANCY - New Dwelling $25.00, Additions to 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 years - $10.00
4. Vacant Land Certificate of Occupancy - $20.00
S. IIpdated Certificate of Occupancy - $50.00
6. Temporary Certificate of Occupancy -'$25.00 Residential
$50.00 Commercial
i~~
ceo• 11)/14/58
TEL. 765-1802
~Oc~~FFUL!(CpG TOWI~i OF SOUTIIOLD
y~ OFFICE OF BUILDING INSPECTOR ~1=w4 ~
~a~~-~.;~~r~;,h~ ~
a ~ P.O. BOX 728 I 1~~ ~ 1::=:
~ TOWN HALL ~ ~ I ~ I
`~Q S ~0~ SOUTHOLD, N.Y. 11971 ~ e ~R
~i01 ~ f ~ " JAN - 21990 Y ~7
lJ 1~
si_oo. vs~r.
TOVtIlV OF 50UTHOLIY
C E R T I F I C A T I O N
Date - ~l ~ ~ S l
Building Permit No.l~ ~ ~z
Owner (~C~ 4a ~ nv'v~acG%~`~
(pl ase print)
Plumber /~j/Gff!$~L,. ~l3~°~J`d r`~
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1~ lead.
---«~-~cs,~~
(plumber's signature)
Sworn to before me this
30th day of October
1989 Notary Public
Notary Public, Suffolk County Linda K. Dawson
Notary Public State of New York
#4694688
Qualified in Suffolk County
Commission expires 3/30/91
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91_CG. DEPT.
TOWN OF SOUTHOLD
c'lELD; Ii:SPc TiON ~~llATF. I COMMENTS
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BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST ( ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ F{NAL
RJF.MARKS: p ~.c~.
- -
DATE I~ INSPECTOR
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BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST f`i] R UGH PLBG.
[ ]FOUNDATION 2ND [INSULATION
[ ]FRAMING [ ]FINAL
REMARKS:
DATE ~ ~D INSPECTOR
l
765-1802
BUILDING DEPT.
INSPECTION
[FOUNDATION 1ST [ ] ROUGH PLBG.
[FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ]FINAL
REMARKS: .~~l,
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BOARD OF HEALTH
3 SETS OF PLANS
FORM NO. 1 SURVEY . .
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL NOTIFY
SOUTHOLD, N.Y. 11971 CALL ,~~5; :~,tr~8, • • -
TEL.: 765-1802
MAIL T0:
19 . r
Examined .yr "
19 Fermit No..... °,.~'~^.~°.,°•..°.°°,.,,®^,P«~
Approved . ~ . ~r... L~C! ~ ~ ~A~.
~~~c~~~c~~
Disapproved a/c 1
~ JUL 1 $1988
- - ~ - f3l.l7G. DEf`T. - -
(B ing Inspector) TOWN OF SOUTHOLO
APPLICATION FOR BUILDING PERMIT ~
Date 14 ~8
} 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 issued a Building Permit to the applicant. Such permit
shall be kept on the premises avaIIable 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
admii authorized inspectors on premises and in building for necessary 1 -spectio" " .
...~!Z'1~?
gnature of applica t, or name~if~ cPrpo a ' n)
` X ~~`aZ~. ~ .
ding address of applicant)
Stat/e'~whether applicant .ids owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
pCy~,~C'uZG
Name of owner of premises ; ~~~~2`L-i'~~Gv--
(as on the tax roll or latest deed)
If applicant is a corporation, sig3rature of duly authorized officer.
(Name and title of corporate officer)
ALL CONTRACTOR'S MUST BE FFOLK COUNTY LICENSED
Builder's License No. .....(,S~t~~/ .
Plumber's License No. ....~/Fd?t~t f~t!~........ .
Electrician's License No.
Other Trade's License No . .
1. Location of land on which proposed work will be done
. .
....~.a.s
...................k.'~:~~~~..~~.~.................~~~d~r
House Number S reet Hamlet
County Tax M/a~p No. 1000 Section ........7b Block ...~:3, , , , , , , Lot-:.:~~?.~.~~...... .
Subdivision . D.a.&a~lsx....~~ . ~~...1?.w.y Filed Map No. !~:~!<r.~ Lot .
(Name)
2. State existing use and occupancy of/p//r~e~miseps and intended use and occupancy of proposed construction:
a. Existing use and occupancy ...:r!.'~9F~??~J .
b. Intended use and occupancy
3. Nature of work (check whine ovlicable): New Building Addition Alteration .
Repair , al . Demolition Other Work .
/ ~ (Description)
4. Estimated Cost ~oo.~ I Fee . .
` (to be paid on filing this application)
5. If dwelling, number of dwelling units , Number of dwelling units on each floor .
If garage, number of cars ~2 .
6. If business, commercial or mixed occupancy, specify na~ure and extent of each type of use .
7. Dimensions f existi g structures, if any: Front , ,S~a.`a , .....Rear ~P.'.~' Depth ~S"~V...... .
Height .S'~~ i~~ Numper`of Stories / ~ .
De th . , „ , , . . ~h alterations or additions: Front:...5 0.'. , . Rear d~U.' : f? .
p do o ~ ..Height ,/.6, : f ,.~~w....... Numberof Stories .
8, Dimensions of ~ii,'tg'4 st ~wtstruction: Front a'i,1~-4....... Rear ~ :a .......Depth ~~-Q....... .
Height Number of Stories .
9.' Size of lot: Front Rear Dep~ .
10. Date of Purchase X.... , 's .................Name of Former Owner ....~/Y(e~e~(c~.: ~!lotie.%rJ.:::::::
Zone or use district in which premises are situated .
12. Does proposed constructio~yyiolate any zoning law, ordinance or regulation:
13. Will lot be regraded ...~j , ) , ,Will excess fill be re oved~rom premises: Yes
14. Name of Owner of remises [ra.t2f?R-rr~.~f!`k-.....Address !y.Q!~l~~,p;~; /~~~++fephone No..~ar . 7/,f'~o2 .
f
Name of Co tractor ~ ~ ~ ~ ~ ~ ~ • ~ ~ • ' ' ~ Address !!...........Phone No
.3"0.~~......... Address P,,l(one No .
15. Ira th3,s property located within 300 feet of a tidal wetland? *Yes No
*I£ yes, Southold Town Tru$tees Permit ma be re uired.
1 r PLOXI' DIAGRAM
/G'o ~z~t,ui/' Rcb~ink~ ~ ~'Ro~'- ~,y. Q1eo K Hn•+2M+-a~, 7S"l~ 7900 Fxf: ~N7 3~as~f
Locate clearly and drstinctly all ;buildings, whether exishng~or proposed, and, indicate all setback dimensions from
property lines. Give street and block dumber or description according to deed, and show street names and indicate whether
interior or ebrner lot.
~i
i
•
STAT OF NEW YO K, S
COli ~jl OF '
~ • • ! . • • ~ ~ • . • • • • ~ ~C-C' being duly sworn, deposes and says that he is the applicant
(Na e of indivi ual signing contrac )
above med. ~ y I
He is the...D~.~lx2 .-..G aNl~.ks 7v1~
(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 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 the application filed therewith.
Sworn to before me this da of 'll
................l.~ y 196
Notary Public . 2~a5 County
~MA~~ q of Nbv+ Mark
No. 52 -
5.8 ounty ~q (Signature of applicant)
1 Quolified in Suffolk C~1 I~,dp!''~
Commission Ex a¢s May, /~,'Jlf('',Y~/J
E N ER~Y CODE CALCUL.gTI0N.5 ~Foa NON-EL EGT/i/G 1JEA
Fo.a : C /'7 2 , e u N PE,o. ~ ~vv s : r'en Nti .C.., dv S°3 F
/ ~f ~ ~ - ~E-siy,~ CnirEa.,, 600 ~EyQEE ~e:s
d ~i7<i~^ ! ~ DATES .7,y~~ ~ _ O.r1. ~ O'F S. A. ' 70~F
~UBSYSTEn\ AQEA Q ~esiyn~ .ALLOWED DES/y.U AGLO\VEp Q n\,4R.kS
"U' U BTU-N BTUH
EXTE,Q/~Q \VALLS (l,QOSS~ O /7
EXTE,d/pq \VALLS ~pGdQUE~ 3~t ,p o.os IIZc~°
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SNF/LTA.AT/pN /v„/,„-> 2u~9~ O.oiB 31 1 u
TOTALS I 7 /
/ b 1
HEATING EQUIPMEN'P 4T7 MEET 7813.23 - 75$ EFF. x60F NE{y yo
HEATING CONTROLS TO MEET 7813.13 TO THE BEST OF MY KNOWLEDGE, r ~
BELIEFi AND PROFESSIONAL '(`P~,ee nv ti
RANGE 45 TO 75 DEGREES FAHRENHEIT. ,IUDGENENT THESE PLANS ARE
WATER HEATING PER 7813.31 THRU .38. ~ w
PIPE INSULATION 7813.19 IN COMPLIANCE WITH THE CODE. _
WINDOWS -DOUBLE GLASS. ^.y ~ _
0]2[54-1
CONSTRUCTION TO MEET N.Y.S. ENERGY CODE.
' - I~pq FESSIONP'y~
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