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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
Date: 11/13/07
NO: Z-32717
THIS CERTIFIES that the bui1ding ADDITION/ALTERATION
Location of Property: 1160 NORTH
(HOUSE NO.)
COUnty Tax Map No. 473889 section 71
PARISH DR
(STREET)
Block 1
SOUTHOLD
(HAMLET)
Lot 28
Subdivision
FUed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
fi1ed in this office dated
FEBRUARY 9, 2007 pursuant to which
Bui1ding Permit No. 32718-Z
dated
FEBRUARY 13, 2007
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 ADDITION & ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to HARRY & RUTH FIUMARO
(OWNER)
of the aforesaid building.
N/A
SUFFOLK (:uwrn DBPARTMBlIIT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
07-1015
08/04/07
N/A
PLUMBERS CERTIFICATION DATED
~ri~
Rev. 1/81
,.
'00 ~ ~ n w ~ . rn'"', 1 TOWN ~~~~JruOLD
~._- ~'I BUILDING DEPARTMENT
,,' 'S 30 20n7!j. TOWN HALL
u" 765-1802
T W~cQ(:'!~~~~O~D PLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
A. For new building or new use:
I. 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 ofFice Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of I % 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:
. I. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic
features.
2. A properly completed application and 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.
C. Fees
I. 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 - $.25
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date. & bo ( 6 7
(
New Construction:
~ol. ~EA/?E
Old or Pre-existing Building:
(check one)
Location of Property: II (, d /Up~rJ.-l ,0....#2 (sA j) e...
House No. , Street
,
Owner or Owners of Property: e.o:tIr. ,J:.- #~
Suffolk County Tax Map No 1000, Section . Block
Sb~ ----n, 0 L- 0
Hamlet
Lot
Subdivision
Date of Permit.
Filed Map.
Applicant:
Lot:
Permit No.
Health Dept. Approval:
VA
Underwriters Approval:
Plmming Board Approval: ,f/ p
Request for: Temporary Certificate
Fee Submitted: $
~eI1i~
(check one)
~
Applicant Signature
&'J.<. 1 J 38!
coi: 3;l7f7
r.~
--- I
FORM NO. 3
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)
PERMIT NO.
32718 Z
Date FEBRUARY 13, 2007
Permission is hereby granted to:
HARRY & RUTH FIUMARO
116 MIDWOOD STREET
VALLEY STREAM,NY 11580
for :
ADDITION/ALTERATION TO AN EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR
at premises located at
1160 NORTH PARISH DR
SOUTHOLD
County Tax Map No. 473889 Section 071
Block 0001
Lot No. 028
pursuant to application dated FEBRUARY
9, 2007 and approved by the
Building Inspector to expire on AUGUST
13, 2008.
Fee $
200.00
ORIGINAL
Rev. 5/8/02
3;}-7/T7
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING I STRAPPING 6><(FINAL
[ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION
[ ] RRE RESISTANT CONSTRUCT1ON [ ] RRE RESISTANT PENETRATION
REMARKS:
r~- , .-11-- -
r- _ L--v-7 Q~
.
~ 0 .
E~ L-.-''JPI?~
~~~ct~
DATE
Z'.-'J-f-tJ7
INSPECTOR ~~
3), 7/?'i;
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1ST [.] R..9tfCH PLBG.
[ ] FOUNDATION 2ND [ 4NSULATION
[ ] FRAMING I STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS: :z;; ~ eYe-
7() {?~
,
DATE
~/~~ #7
, I ,.
INSPECTOR
3Z-7l?~
~
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [
[ ] F~TION 2ND [
[ /"FRAMING I STRAPPING [
[ ] FIREPLACE & CHIMNEY [
[ ] FIRE RESISTANT CONSTRUCTION [
] ROUGH PLBG.
] INSULATION
] FINAL
] FIRE SAFETY INSPECTION
] FIRE RESISTANT PENETRATION
REMARKS:
~'f ~.Jt4.A:; ~
DATE
INSPECTOR
- .. ... ._..,...~_ . ..:--.,"IIOF.., .~"'"
J~71l z.
TOWN OF SOUTH OLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
l)<f FRAMING J STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] RAE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
REMARKS: ~
AJo ~ I
(~I) t) / ~)
----
~ {~>>- ~-r--'"
~~~I~o7
DATE
INSPECTOR ~~
. ,
.
FIELD INSPECTION REPORT DATE COMMENTS .
\P
~~
FOUNDATION (1ST) -~
.oQ::j
NJ""
--------------.-----------------
FOUNDATION (2ND) ~~
Z
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INSULATION PER N. Y. t;J
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STATE ENERGY CODE
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ADDmONAL COMMENTS :'J
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_ 2.? TOWN OF SOUTHOLD PROPERTY _I!!CORD CARD
OWNER STREET VILLAGE DIST. SUB.
LOT
FORMER OWNER
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TYPE OF BUILDING
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RES.;!/ I) SEAS.
VL.
COMM. CB. MICS.
Mkt. Value
LAND
IMP.
TOTAL
DATE
REMARKS
00
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Tillable FRONTAGE ON WATER
Woodland FRONT AGE ON ROAD If.9 c..)
Meadowland DEPTH ..I t
House Plot BULKHEAD *
~
i Total :~
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I ~~ / COLOR /IA74nL wt~
I . TRIM
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extension :srr' ~ .<<'/7 ?~ IIQ ?I
/i./'/9 "- ., il
Extension
Extension I R.I4<!'
Foundation ?Ic. Both 2. Dinette
Porch .fVJ..9,7n- Basement hJl Floors GAl( K.
Porch )f!" If?- /.5"2. .., ..J,f<! :,t:J /9'2- Ext. Walls bJ d. S 4. L... Interior Finish $k LR.
Breezeway Fire Place 2,. Heat Ilf'8 Ii 6J. DR.
Garage -' 7 0('1</ " .~-.l 0 I~ f..(A Type Roof 9", UP Rooms 1 st Floor BR.
Patio Recreation Room Rooms 2nd Floor FIN. B
O. B. /1. f/l-J:.. sa Dormer Driveway
Total S'717
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TOWN OF SOUTHOLD
BUILDING DEPARTME~
TOWN BALL
1 . SOUTHOLIi, NY 11971
I TEL: (631) 765-1802
FAX: (631) 7~02
I www.nol1lafOrk.netlSoutholdl
PERMIT NO. <38':1/ r e
i
BUILDING PERMIT APPLICATION CHECKLIST ~
Do you have or ~.the following, before applying? .~
Board ofHea11h /
4 aets ofBuildiog Plans ,/
:::;hI~approva1
~. ,<il.fC; ~
Septic Form
N.Y:SJ;>.E.C.
Trustees
Contact:
I Examined
Approved
! Disapproved alc
20 -'t-
20
Mail to:
Phone: ?~.5 - /111
of'
lL___.~....",:,=,,::=:y.::;'__-:-.'-
!',~~~.~..,...
rro\/:,:': ~i~'~~!~____.
-.-...-,
'Y
,\ I' ,.\APPLICATION FOR BUILDING PERMIT
'. II
I J "
\-)
Date
;/2-2-
I
20t??
'-
INSTRUCTIONS
~l::u~applica:ti~~ill letely filled in by typewriter or in ink and submitted to the Building Inspector with 3
sets OUlt:;j A~.':]llot-plan to scale. Fee according to schedule.
,b. ot pian showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or ,..'1-.
I areas, and waterways.
I · dC' ThU e work COva1Veredftbisb~ this aliPp~catiothcn mauil~ ~~eInscommenwill~ ~ofore iBssuilll;llI1din~e ofB~dingthPermi1icantt: S h . I
I . pon appro 0 app cation, B pector iSSUe a g Penmt to e app . uc a penmt III'
shall be kept on the premises available for inspection throughout the work. '
'1' e. No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector I
issues a Certificate of Occupancy.
f. .Eyery building permit shall expire if the work authorized has not commenced within 12 months after the date of 1
I issuance or bas IIQt been completed within 18 months from such date. If no zoning amllnclments or other reguljltions affecting the 1_._.,...':
. property hare been enacted in the interim, the Building Inspector may authorize, in writing, the extension of thc penpit for an I
I addition ~;inn..tI1~, Thereafter, a new permit shaIl be required. '. . I.'....
t\:rr'LICATI()N IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
1 Building Zone ~ce of the Town of South old, SuffOlk County, New York, and other applicable Laws, QrrI~~QI'
. Regulations, for tb.e cOnstruction of buildings, additions, or alterations or for removal or demolition as herein~.' 1'be . Ii
I applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations; aDd to admit
. authorized inspectors on premises and in building for necessary inspections. r
I ~~Z:-xr I.' I!
(Signature of applicant or name, if a c()lJlOralitn)
I If!- 0 /lox s-S- ~~.4.4' ~ # V I
I " (Mai1ing~ofapplicant) 11"'fra- I
~, .
State whether applicant is owner, lessee, agent, architect, engineer~eral contra~electrician, pfurober or builder i~
; 't
Name of owner of premises
;:::- I fA .nn ~ tRO
(As on the tax roll or latest deed)
If aPPlican~~~~dulY authorized officer
(Nam lII1d title of corporate officer)
/!;e:1IC/Z-V
,
1
I>
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's.License No.
7 S-~ J I~ I
A?-I-
I. Location ofland on which proposed work will be done:
I / ~t) A/~/2-n.. ~V2I.~ ~ /) R 00 k.7'J,;<Jt-/)
House Number street . JI]I\flA~~~,.
Jii/l wtlI ~a~w~o ,oWl
BIOC~8~ ~\olluZ '" b,illlsuO '~-"-t
U\N" _ l 1111.J ntld:.IJ(tIITlU-a.u
..EiJed. o. .> Lot
I.
I
I'
County Tax Map No. 1000 Section
Subdivision
7/
tJ,p
(Name)
L ~
';"';'-".k.c __.~_
~.___;:i.....",.
~_~_."':~~l...._ c. .
"~...v. -~,,',...-,., ~>.c...c.._.
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... .,_~,__,;.J..;,-,":.:........,..,..:.:..:;.~.",..,....':..L:i,...~.-....;...~~.~_ ~
.~ - ~-~,"~-
- "7--
---IT ., '~, - .~---'.
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2. State existing use and occupancy of premises and intended use and occupancy l,!f proposed construction:
a. Existing use and occupancy / "c:-,P /')? ~tf I) 1(/ rL ~ I/U'
I
b. Intended use and occupancy S~E
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3. Nature of work (check which applicable): New Building
Repair Removal Demolition
Addition
Other Work
/2.-x"S' tJDIh?,"Ei<- (Description)
~a~~
~'
.
4. Estimated Cost
/ rnro
(
Fee
~;
5. If dwelling, number of dwelling units
If garage, number of cars A/A
I
(To be paid on filing this application)
Number of dwelling units on each floor
"
-~
6. Ifbusiness, commercial or mixed occupancy, specifynature and extent of each o/i>e of use, '\p IJt
> \. '- '
Depth
i
1
j
l
i
7. Dimensions of existing structures, if any: Front , _
Height <6 I Number of Stories I ~
Rear
10. Date of Purchase
Name of Former Owner
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Dimensions of same structure with alterations or additions: Front ~
Depth ~ - -. Height S-e... - Number of Stories
8. Dimensions of entire new construction: Front / ~
Height ~ Number of Stories
Rear
J
1,1
P,Slth I 7 )-
,t'~HAt
'1:.;
I
,
9. Size oflot: Front
lIS I
Rear 1"Z..4 /
Depth
/7:5
'~ 11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation? YES~ '
13. Will lot be re-graded? YES c& _Will excess fill be removed from premises? YES~
14. Names of Owner of premises r; t-<-"""A~ Address II'D /./- jY-I./l"~L Phone No.
Name of Architect ,....... Address ' Phone No
:. Name of Contractor ~~~/io/'A/ Address Po;<k,K .r r Phone No. 7bJ lilt:(
, ' pCbtvr"- II"T....- S
.; 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? .YES @)
* IF, YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS ~JE REQUIRED.
r---~'"p. Is this property within 300 feet of a tidal wetland? * YES N
f * IF YES, D.E.C. PERMITS MAY BE REQUIRED.
~,
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.
16. Provide survey, to scale, with accurate foundation plan and distances to property lines.
17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey.
STATE OF NEW YORK)
SS:
COUNTY O~PPo\~
~(I '* ~ being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the r ~(c;..{ .kat
(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 ~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
,.:;)3 dayof~,... Ac::.re}
20.0:1.
0~/~
:- _of- -.....
~".
-
~
Notary Public