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Home My WebLink About12624-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall $outhold, N.Y. Cerli[icate O[ Occupancy No. Z15791 Date May 29, 1987 THIS CERTIFIES that the building ..... .n.e.w...one-family dwelling Location of Property 680 Sta~s Road East Marir~n County Tax Map No. 1000 Section ..... 3. 1. ..... Block .... 4 .Lot 7 Subdivision.. $9.u.n.d..c.r.~.s.~...W.o. qd..s..S.e.c. :..1..Filed Map No. 5315 .Lot No. 2 conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... $.e~.t.¢ .m~.e.r.. 9,,..1,983 ,. pnrsuant to which Building Permit No ..... 12624Z dated ...... $~p.t;.¢¢b.e.r...2.1.,...1.9.8.3. , . was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... .... Ne~..o~e:-.f~mi~,Y.. 0w.e.1%i~g .v.i.t.h...a.t.%.a.q .h.e.d..t. Vpr.qa..r' .g.a.r..ag.e' .a..n.d..d.e. 9.k.... The certificate is issued to ............. A~.I~A~N~.%Q$..&..S..T.E.L.~A.. p.R.E.N..I.S ............... (owner, ~r.:)X ~~ of tile aforesaid building. 13-SO-113 Suffolk County Department of Health Approval .......................................... UNDERWRI'rERS CERTIFICATE NO... ~. - .... N797209 4/25/87 PLUMBERS CERTIFICATION DATED: Rev, 1/81 FOEM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12624 Z Permission is hereby grantS'p: i / , _ ......... o, premises located at ...~.~...(~. .......... ..~.~.....-~ ........ ~.-~.~ .................. County Tax Map No. 1000 Section ....... ..~....~...1 ....... Block ...... .~..~. ........ Lot No .....,g.9..'~. .......... pursuant to application dated ..................... ....~.~~ ~ .............. , 19.~.~., and opprovod by the Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY ~ Instructions ~ (~}~l A. This application must be filled in typewriter OR ink, and submitted m~ 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 u, nusual 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. B. For existing buildings (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 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: Additions $25.00 1. Certificate of occupancy New Dwelling $25.Q0, Accessory,S10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $]0.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date .,,5/.~//.~7. ................. · .~... Old or Pre-existing Building ............ Vacant Land ............. NewCOnstruction. Location of Property . ~O. St oc$. gd, ,, , . f ct~t . Ecsc ;oo. -,. ly,,¥,,. ~ ~ ?.35 .......................... House No, Street Hamlet Owner or Owners of Property .. ~bczl~(~$/o$. &. $t¢!/ct. 0C~o]$ ................................ County Tax Map No. 1000 Section .. 03;/ .......... Block .. z/ ............ Lot.. ~' ............. ,Subdivision ~'~2U./~.~.~/~.~:'.~.../F~'~'~. ¢ ...... Filed Map No ........... Lot No .............. Permit No.. 726~.~.~7.. Date of Permit . ~/~7/~,3. ·Applicant .. J$bqo~370~. Dceo73 ............... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ../V. 79720~ .............. Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ 25,~D. J.~. .~,l~. ............. Construction on above described building and perrl~t meets all applicable codes and r~gulations. ... ...... /' ' ......... Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY , 0'1.071 85 JOHN STREET. NEW YORK. NEW YORK 1OO3:~B THIS CERTIFIES THAT only the electrical equipment ~ ~scrlbed belo~ and int~uced by t~ applicant ~med on the a~ application flu tuber in the prem~es of Tom Drenis~ Sta'~s R~. Ea~% Side~ 700' n/o Main Rd., East M~rio~ N~Y~ in the following location; ~ Basement ~ Ist FI. ~ 2nd ~7. Section Bilk ~t t~s exatnined off ~C~ ~ ~ ~ ~ ~ 7 and foaTtd to be in compllar*ce u'ith the require.tents ~f this Board. FIXTURES RANGES OVENS DISH WASHERS FANS FIXTURE SWITCHES 32 35 27 32 DRYERS ~ FURNACE MOTORS APPLIANCE FEEOERS TIMECIOCKS UNiTNEAI[E~RS MULTI.OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT S E R V I C OTHER APPARATUS: Motors-l-3/4H. P. Panelboards; ~-12 (car°) 1,~ 5amps. G.F.C,I.-~ 1, Smoke 'Dete. ctor~- 1 · 2/o A W C* NO OF NEUTRALS A W.O. OF HI-LEO OF NEUTRAL , 1 2/0 G & S Elec. BOX 215 Southo]d, N,Y., 11971 lic.9578E~ This certificate must not be ohered in any manner; return to the office of the Board. if incbrrect. GENERAL may be identified by iheir credentials, ALI~ tI,L~AN¥ ~ANNER. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN tIALL SOUTltOLD, N.Y. 11971 TEL. 765-1802 To Whom This May Concern, We are unable to complete your Certificate of Occupancy because.of the following reasons. _ An application for Certificate of Occupancy is not on /~_~ No Underwriters Certificate on file. ( ~ NO Ilealth Dept. Approval on fi~ Please contact our office on this matter. Thank you for your cooperation. .Building Permit # .~/ A ~ ~'~Z~ Z Building Dept. ***/_/~No Plumber Solder Certificate on f~le.~E~c/' ( all permits involving plumbing being issued after April 1,1984 ) TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 Date #/25/87 Building Permit No. 1262~7 , Owner ~., & ~. DREN[$ (please print) Plumber ATHANASIQS DRENI$ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. ~P 1 umb e r ~s~s i~i g~ a~~ sworn to before me this ~day of /~/~,19 ' ' f / Notary Public, C0un~y Notary Public-~ ~IEL~ INSPECTION 1. FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING 3. INSULATION PER N. Y. STATE ENERGY ODE 4. FINAL ADDITIONAL COMMENTS. TOWN OF SOUTEIOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN ttALL $OUTHOLD, N.¥. ! 1971 TEL, 765-1802 Thls i~ to advise you that the tob under building per,nit no. 126243 issued to Athana~los Drenis on 9~21~_83 for New Dweli~ng is ¢0~pleted end ;, f'~7,;;¥ i~p--e-~ion h=~ ( ) has no~ '( X )"'been done. fn order to complete this file, it is necessary that a Certificate of Occupaucy be ~aaued. Please fill out the enclosed form, return smme to the above office with a check for $25.00 payable to tbs Town of Southold. Please indicate to Whom the Certificate of Occupancy ia to be mailed, and arrange with thin office for an inspection date Occupancy or use is unlawfol without e Certificate of Occ,lpnncy. l'leaae, help ua to clear up this,, matter so that action does not have to be taken. Thank you for your prompt attention. Very truly _y~, Victor Lessard Executive Administrator VL:gar 765-1802 BUILDING DEPT. ,~ INSPECTION [ ]'FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION AND [ ] INsuLATION [ ] FRAMING [ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.; 765-1803 Approved .....~. ?...7. \.., 19 ~..~. Permit No.)..~. ~ ....... Disapproved a/c ..................................... Received .......... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 available for inspection throug~aout 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 Department 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 builjling code housing code, and regulati,,o_ns, and to admit authorized inspectors on premises and in building for necessary i~ns. ~. , "~}~- (Signhture of applicant, or name, if a co:rptSration) . Lq( . 4'. g ?: ::."(.. ./-,/.,5! . .x.,:..,/.' . ./. .z./. q. . . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Name of owner of premises . ,0 [.[f .~.~.J./).-5 ! ().5. . ~'?5/..57/.".~./-../' f~ .... .~,, ~'~..~../,5. .............................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .... .~) .% ................ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ..... ¢. ?..q ................... a.:... ................... ............ House Number Street Hamlet County Tax Map No. 1000 Section . ¢27.3[ ............. Block ...O./ff ............. Lot...~).O..'7 ........... Subdivision.,~.6?~)~J~.C/~ ~,5~j.. 'lkf. dJ..~.])..~,...('.~-~.-,~... Filed Map No. ~5.,~f,O.' ........ Lot... J~ .......... (Name) 2, State existing use and occupancy of premises and inten, ded use and occupancy of proposed construction: ' a Existing use and occupancy '-~- 3~ ~/q'-/kY ~---' ' b. Intended use and occupancy ...':~.: · . / .... "~.V..mO.. , !,.~ . .e..~. ..................... 3. Nature of Work (check which applicable): New Building ...... Addition .......... Alteration .......... Repair .............. Removal ....... Demolition Other Work ..... ~ _.~ (Description) 4 Estimated Cost :~l),a ~ Fee - (to be paid on filing this apFlicatinn) 5. If dwelling, number of dwelling unitsr7 ..... 1. ........ Number of dwelling units on each floor If garage, number of cars -/-4 ............................................................. ' 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 .......... ; ..... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Sizeoflot: Front ...................... Rear ...................... Depth ...................... 10. Date. of. Purchase ............................. Name of Former Owner .... . ............... 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .... Address ................... Phone No ................ Nmne of Architect ......... .................. Address ................... Phone No ................ Name of Contractor ........ ' .................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly al! buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW ~, / ~ S S ', (Name of individual signing contract above named. being duly sworn, deposes and says that he is t'he applicant ~or ~gent 'corporate officer He is the.. , 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 ............. ~..day"~': ..... 19 .~ Fill t SUFFOLK COUNTY HEALTH DEPARTMEN,'J' _ SINGLE FAMILY DWELLING ONLY H.D. REF. NO.. ~'~-,vo DATE HAY 1.q lg 7 . THE SEWAGE DiSPO~AL AND WATER SH ~pI.y FACILITIES FOR THIS LOCATION HAVE BEEN INSPECTED BY THIS DEEA~RT_~MENT AND FOUND TO BE SATISFACTORY. Cl~lef[of Wastewater Management Suction 1987 SC D:?~. OF RODERICK VAN TUYL, P.C, LICENSED LAND SURVEYORS GREENPORT NEW YORK SUFFOLK CO, HEALTH DEPT. APPROVAL H.S. NO.,;~.~'~O-!L~ .......... S_TA .T,E_ .ME~ OF INTENT THE W~TER SUPPLY AND SEWAGE DISPOSAL 'SYSTEI~IS- FORff',.T~IS, RESIDENCE WILL CO, t~.~?I~.M 70 THE STANDARDS OF THE ~d~EK ~O. ,D~P,T:~OF HEALTH SERVICES. ,' ' AEPLICANT SUFFOLK' 'CbU~T-~ -, DEPT, O~ HEALTH S E~R~-I C~"S'~'' F~R APPROVAL OF CONSTRUCTION ONLY DATE: H. S. REF. NO.. APPROVED: SUFFOLK CO. TAX MAP DESIGNATION: DIST· SECT. BLOCK PCL. OWNERS ADDRESS: ~ ,~', ~' ~-~ ]'~ DEED: L. ~J/~ ' 'YEsT HOLE Ii STAMP RODERICK VAN TUYL, P.C. GREENPORT NEW YORK SUFFOLK CO. HEALTH DEPT. APPROVAL H.S. NO. /2 ~C)*l,~"'~ STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAl SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO ThE STANDARDS OF the SUFFOLK CO. DEPT. OF HEALTH SERVICES. APPLICANT SUFFOLK COUNTY DEPT, OF HEALTH SERVICES -- FOR APPROVAL OF CONSTRUCTION ONLY DATE: H. S, REF. NO.. APPROVED: SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK PCL. /0~0 ,0'3/ 4 DEED: L, ~J/~ TEST HOLE 6TAMP SEAL HEALTH .,' STATEMENT OF' INTENT j.~ (',~U.~t~'O,LE. ~'OC~'7'Y /y~c, J~/O. ~5'~/.~'~) THE WATER SUPPLY AND SEWAGE DISPOSA[ A? SYSTEMS FOR THIS RESIDENCE WILL ---~-~ ~ ? CONFORM TO THE STANDARDS OF THE ~, APPLICANT" // SUFFOLK COUNTY DEPT. OF HEALTH ~ SERVICES -- FOR APPROVAL OF ] CONSTRUCTION ONLY ' / ,... ~ DATE: .-- 2, , APPROVED: ~ = r ~C SUPFOLI< CO. TAX MAP DESIGNATION: ~ DIST. SECT. BLOCK PCL. ~ ~~~-~ q ;~ t~ E A : 2 0 , ~ 5' 9 ,.5',.~,'~' . ~ OWNEES ADDRESS: ! ~' DEED: L. ~/,~ P. : u~ :~_ YEST HOt~E ~TAMP " 2~"~.06 ~o~ ^ vAu~ ~ co.. SEAL ROOERICK VAN TUYL, P.C. LICENSED LAND SUf~VEYORS GREENPORT NEW YORK