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Home My WebLink About12050-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificnte Ot Occupancy No..Z11.7.96 ......... Date .......... July..20 ............... 1983. THIS CERTIFIES that the building ....... one:-£.amily..dwe&.Ling ................... Location of Property .... 380 ............ Th~. St..and ............ E~.st. M~.=ion ....... House No. Street Ham/et County Tax Map No. 1000 Section ... 0.21 ..... Block .... 1].5 ........ Lot ... 0D.4 .......... Subdivision.. tVel~ble..Boach..F, arms- ....... Filed Map No... 62.66 .Lot No .... 136 ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated November 12 1982. pursuant to which Building Permit No.. I,Z050 Z. dated ..... D..e.c.e.m.b..e.r..2. ...........1982., 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 ......... ....... pr iva.t.e · one- fam.i, ty. dwe t 1.in.q, ....................................... The certificate is issued to SPIRO & JOAN BELETSlS (owner, ............ ~ of the aforesaid building. Suffolk County Department of Health Approval .... s. 6. ......7/.7./.8. 3. .... v.i..Ll.a. .... UNDERWRITERS CERTIFICATE NO. N 60 7538 Rev. 1/81 Building Inspector TOW~ oF BUILDING DEPAR'rMI~N~ TOWN HALL , SOUTHOlaD, N. Y.: BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PRE/~ISES COMPLL~I'ION OF THE WORK AUTHORIZED) : UNTIL EULL N? 2050 Z Permissiori is hereby granted~to~. ~ ................................. ~ ............. ~ ................. ~ ......r'"'"'P ff~"~'"'P'"r'""~'~'""'~'~ ........................ ............... coua~ ,~ u~p ~o. ~ooo 's.~,~o~ ................... ,...~ 8~k .?....:L...,...,...:~ }t ~o.. ....................... ...... ~ ~I~P~ . .. 1 a~: -'~pprov~ by the pu~uant ~o appl cot on aat~ ......... .................. ~ ............ .~;...~ .., B~lldlng ~sPector. Rev. ~1301'80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with 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. Final 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 building. 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 pete ..... ........ New Building ......... Old or Pre-existing Building ............ Vacant Land ............. Location of Property O ~ ~. .~ Lo House No, Street Ham/et Owner or Owners of Property ~~...~j.~ ..... ~ ~.~.~5 .................. cou.t M.p No. 000 S c ion ........ ......... Subdivision .~.~..~ ~ ~..~ .... Filed Map No. ~ .... Lot No ....//. ~'~ ...... Permit No.l~.~. ~ Date of Permit/.~ ~.Applicant~.. ~.~;.. ~ ~; ...... Health Dept. Approval :~. ~.~. ~ ~ ............ Labor Dept. Approval ........................ Unde~riters Approval.~ ~..~.~ ......... Planni.~ Board ~pproval ...................... ~equest for Temporarg Certificate ..................... Final ~ertificate .. Fee Submitted $ .............................. Construction on above described building and permit meets all applicable codes and regulations. Applicant...,~..~. ~".~.... / Rev. 10-10-78 FIELD INS ~EC T I~ON 1. FOUNDATION (1st) COMMENTS FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL z6s-z8o2 BUILDING DEPT. INSPECTION [] FOUNDATION 1ST ~ RoUGH i PLBG.· [ ] FOUNDATION ZND [ ] INSULATION ~FRAM,NG /~'/~, [ ~FINAL REMAR ,,, , ,,~ ~r DATE 7/4~~ INSpEcToR FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL File No ................................ To . .'~.' · '(~.7: ./'. ~.....~. · .'~..~/7...~.~--q..~... · ~ .... ~z~. ~ ........ , for p~it to construct.. ~.../~.(~.. ~/~-- ................. ~at Lo~o~ o~ ~o~ ...~ .... ~/~e..~C~., ........... ~7/~e:O ~. County Tax~p No. 1000 S~tion .. ~. .. ~lock . .~.~ ...... Lot .~ ...... is ~tum~d ~t~ ~nd d~s~pp;o~d on the ~o]]o~]n~ ·~ Bufl~m~nspector RV 1/80 FORM NO. 1 TOWN OF 80uTHoLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 76~180~ ~pp~v '~.. .... ~.. ..... l~.~.Permit APPLICATION FOR BUILDING PERMIT ll-H- Date ............... INSTRUCTIONS a. This application must be completely titled in by typewriter or in ink and submitted in triplicate to lite ~ Inspector, with 3 sets of phms, accurate plot ~ Co scale. Fee ac~ io schedule. b. Plot plan showing location of lot and of buildings on premiss, relationship, to adjoining ~ or lalblic streets or areas, and ~iving a detailed description of layout of property most be drawn on the dia~, whidl is p~tof this appli- cation. ~' c. The work covered by this application may not be commenced before issuance of Buildin~ Permit. d. Upon 'approval of this al~plication, the Building Inspector will ~ a Building Permit to the spplic~nt. Such permit shall be kept on the Premises available for inspection throughout the w~i'k. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certtfi~te of Oc, oupan~y shall have been ~anted by the Building Inspector. APPLICATION IS HEREBY MADE to the ~g Dep~hhent for the issuance of a Building Permit purmant to the Buildtns Zon~ Ordinance of the Town of Sonthold, Suffolk County, New York, and other ~pplie~ble Laws, Osdi~? or .~. Re~lsiians, for the construction of buildings, add,ions or ~dlev~ions, or.for removal or d~molitioa, ~s h~,~l~ ~ :~ The applie, ant s~-es to comply with all applicabis &~, o~linano~s, ~ding code, honsing co~, and r~p~aions, and ~o admit authorized inspectors an premises and in buildings for neCe~aty it~poctions. W'~..~ .~..~.~.~. ~...~...~.,.: ....................... (Signature of applicant, or name, if a corporation) (Mailing address of applk~t) State whether applicant is owner, lessee, agent, architect, en~neer, Senerai contractor, electrician, plumber or builder. ~j~ ~.~..~.~.e...~. ............................................................................... · Name of owner of premiscs $ ~1 ~0 ~' ~.~. ~. .?.o. o~.~. .~ .~.L..~.~.'.~ .I ~~. (as on the tax roil or latest deed) Plumber's License No..~.0. ~.... ?. .............. ~e~.an's I. ic,~ ~o. ~'lr..~.. ............. Other Tr~le'~ License No ...................... :~t~..~'O t~ ~t 1. Location ofland on which proposed work will be done. O1° '~"~-~--' ST~A~ t~ t ~./.-~.~ ~;~..~c~...~.~...~...a-.....~..~.. ~ .................... .~..r.. ~5 ~o..u ................. tuber Street Hamlet county ~'~ ~ap ~. 1000 r~c.o~ . .O~-.. I .......... ~lock. ~. ............ tot.. ~.~. .......... : (lq~ne) 2. State existing u~ and occupancy of premiss and intended u~ and o~upancy of proPO~l const~fion: a. Existing use and occupancy ~ ~ .~.~. ~ ~-' i 9~¢..~..~,~ ~.~:?? b Intanded-use and occupancy ':u'~vt 3. Nature 'of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Remoyal .............. Demolition .............. Other Work ............... (D ipti 4. Estimated Co ......................... . Fee ....................... : (to be paid on filing this application) 5. If dwelling, number of dwelling ~nits... 0 .~. ?.~. ..... Number o f dwelling units on each floor ................ If garage, number of cars . . . 6~ i.1~.~7. ........................... ................................... 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 .................... ... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front . .~'.X..~'~ ...... Rear . ?.~:~.~.g'[ ....... Depth .~,~,~.~..~ ........ Heaght .../. ~.: ..... ' 't' Number of Stories ...'~..o4~ ...... , ........................... I.. .............. Size of lot: Front . .7.~ ...... ........... Rear ...7.5'. ............... Depth ' ~. ~.~..P...~ ........... Date of Purchase . . ./t,] :~. ?*... i .................. Name of Former Owner ~.~6/~kgT.. ~.~..47.. ' .~.q. ~.'1~/i ..... Zone or use district in which premises am situated .... (/~ I .~.~.'~..~:'~ ¢.'-~.: ............................... Does proposed construction violate any zoning law, ordinance or regulation: . ¥?.."~. .......................... Will lot be regraded . .~. (9..~ ..................... Will excess fill be removed from premises: Yes Name of Owner of premises ., ,~,.~-~c.%*.T.~. I.): ...... Address .iq:. £.~:~..~. '~.~-~. .... Phone No. ~.r~.. Name of Architect . ~'lg~... ?.°.'?...u:?.~: ......... Address ~.~a'.*~. ~-x~. ....... Phone No..~..~.'~'.~ .~.?./..~'.. Name of Contractor . .~.~.'~..(~. P?: .~:-. Co .. ~ :... Address (~:. ~ff.' (t0~c.g'Y~f~hone mog~-B.)z.~"/.I ........ 10. 11. 12. 13. 14. PLOT DIAGRAM Locate clearly and distinctly all' buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block humber or description according to deed, and show street names and indicate whether interior or corner lot. ~ )'~ ~ STATE OF NEW Y~P~,~-/ , COUNTY OF...~ff.~.. ...,~.~.~..~././~.C. l ~ ~ .... 3 ................ being duly sworn, deposes and says that he is the applicant (Name of individual si~ffing contract) abgve named. ....... .............................................................. (Contractor, agent, corporate officer, etc.) of said owner or owne~, ~d is duly authorized to perform or have perfo~ed the ~id work and to m~e and file this application; that all statements contained ~ this application are true to the best of his ~owledge and belief; and that the work w~l b~ perfomed in the m~nCr set fo~h in the application filed therewith. Sworn to before me this .......... , / .... ............. ' qu~l~o'~a ,n aa~s~ ~ ~// (Si~ature of applicant) &' ,/// su~Y FOR I ~ ~ ~ o-/~ ~ ',]~L~ ,, ~"7'~ ~~ ~' ~' ~' ~-~~ LOT NO, 134, PEBBLE ~E4CH FRHMS " ~ ~, /~ raoilities to~ t~).ia looatien h~e been SuFfOLK COUNTY, NEW ~RK NO. B2-61~ HEAL~ OEPARTM[NT-DATAF~APPROVALTOC~STRUCT ~E ~R~ FORWNO~ ~.~ Su~eY IS PREPAREO AmLIC~' ~l ~ ~ ~T~~ ~ P~PE~TY LINES OR FOR THE ERECTION ~ FENCES . . RIVER~AD, NEW YORK NOTE. It : MONUmeNT ' . SUB~/VIS/OflM4P F/LED Iff r~ O~/C~ OF r~g CL~RK OF ~ J AN~ND SURVEYOR N.Y.S..~CENSE NO. 12845 ' ;i I/'HO~RDW. YOUNG, LAND SURVEYOR ~ L~T~ W~iWI,~ICTANKiS~aCE~OL$(~) ~N HERE~ ~ lj N.~, LICENSE N0,45893 ~E m~ FtE~ ~TI~S MD OR DATA ,OITNNED F~ OTHERS , ~ )EXCAVATION IHSPECTiOH REQUIR su~y ~ ~FFOLK COUNTY DEPARTMENT OF H~LTH SERVICES LO~ ~0. /~, ' P[~L[ B~CH ~M~ ' FOR APPROVAL OF CONSTRUCTION ONlY ~W~ ~ SOUTHOLD SCALE: / ': 50' HEAL~ OEPAflTM~T-PATA F~ APPROV~ TO C~STRUCT ' ~ ~a~ ~e wH~ THE $U~EY IS PREPAeED NOT~ ~ I : MONUMENT SUBDIVIE~N MAP FI~O IN THE O~IC~ OF THE C~[ffK OF ALDEN W. Y~NG~ PROFESSIONAL ENGINE ER SUP~LK COUN~ ON JUNE/I, 19~5 AS FI~ENO, E~E AND ~ND SURVEYOR N.Y.S, UCENSE NO, 12845 HOWARD W, YOUNG~ LAND SURVEYOR ~ ~ L~T~ ~ W~L(W),~IC TANKISt}a CES~OLS(~) ~H HERE~ N.~ S, LICENSE NO, 45895 I~C copper tubing is used NOTIPY E JII-DIN( 765-1802 9 AM TO 4 PM FOR THE for water distributing FOLIJOWING INSPECTIONS: system; piping shall be I. FOUNDATION - TWO REQUIRED of types K or L only FOR POURED CONCRETE '~, 2. ROUGH - FRA~tING & PLUMBING 3~ INSULA?ION 4, FINAL ON MUST 'BE COMPLETE FOR C. O. ALL CONSTRUCTION SHALL MEET :THE;REQUIREMENTS OF THE N, Y. STATE ,CONSTRUCTION 8, ENERGY , C-.ODES,~ NOT RESPONSIBLE FOR '.:'. DEsJGfir OR CONSTRUCTION ERRORS, t ate¢ c~tst ~i'outlng ~ ' ng shall be types ~ Ifcoppee tubing is 0sed for water distributing system; piping shall be of types K or L only t ,q, Ot..,O ~, If copper tubing is used for water distributing sys em; piping shall be of types K or L only ,I for Water distrlbuting Syslem; piping shall be of types K or L only 4----,I II ,?-o' 4'-o" L U-o" # 1//.4° 'z~ q,. /¢* '" o,C_.,, --