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Home My WebLink About12107-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildin§ Inspector Town Halt $outhold, N.Y. Certificate Of OcCupancy No. Zl1923 Date September 15 1983 THIS CERTIFIES that the building -.-new dwelling. 235 .............. Azalea ~o~ ............................. Location of Property 655 Cardinal .Drive Mattituck County Tax Map No. 1000 Section . . .1 .1.5 ....... Block . .0..6 ........... Lo* . .. 0. .1.3 ....... :... Subdivision Mattituck Estates . . .Filed Map No. 4453 .Lot No. 8 conforms substantially to the Application for Building Permit heretofore filed in this office dated .... J.a..n.u.a.r.y...6 ........ 19.8.3. pursuant to which Building Permit No....1.2.1.0..7..Z. .......... dated ..... J..a .n.u.a.r.¥..1.4 ............19.8.3., 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 ......... a private one-family dwelling. The certificate is issued to PETER SCOUTELIS fowner,-le~,~' of the aforesaid building. Suffolk County Department of Health Approval .. 13 - S O- 01 , 6 / 9 / 83 ~ R o b t. A. V 5.11 a, 601949 UNDERWRITERS CERTIFICATE NO ........... .iN ...................................... P.E. Building Inspector Rev. 1/81 ToW'H~,OF BUIJ $OUTHO~D,N. BUILOIHG (THIS PERMIT MU~T BE KEPT COMPLETION OF 3~HE WOR!~ ~.o 12107 Z tO ai piemlseb located a"~...' ............................ ,....,~ end approve~ by the FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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 oi~ 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 features. 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 land use ~/ 5,00 3. Copy of certificate of occupancy $1.00 ./... o.t ...... ¢¢zx .......... New Building ....... Old or Pre-existing Building ...... ...... Vacant Land .............. Location of Property .~.,~..~,r~/. ~Z~.. · House No. Street Ham/et Owner or Owners of Property ...... f .~.... 0~.(~:~ .~..-Z~./"/.J..i .............................. County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision .... ~')//,~'.~. z.¥.~.. ......... Filed Map No ...... Lot No. Permit No ........... Date of Permit .......... Applicant Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described bu ilding and per~t~m~a~c~e ~r~J;~lat Ap ,,cant ....... ........... 1000771 BUREAU OF ELECTRI~ITY~ 85 JOHN STREET, NEW YORK, NEW ~:~ORK 10038 ..,. N 60%949 only the electrical equipment ~ ~scribed bel~ and int~duced by t~ applicant nam~d on the ab~e application number in tl~ premises of and found to be in cornpliahce with the requlrerrter~ts of this Board. wasexaminedon ~y ~ ~j~ FIXTURE FIXTURES RANGES OVENS OUTLETE SWITCHES FLUORESCENT DRYERS DISH WASHERS EXHAUST FANS SYSTEMS NO. OF FEET NO, OF CC COND, OTHER APPARATUS: AWG OF CC, CQND NO. OF HI*LEG AW.G OF Hi-LEG NO OF NEUTRALS I~uland ~lec%r£c P.O. Box 143 ~L%tti~ucl% N.Y~ 11952 'Lf~242 This certificate rqust not,be altered in any manner; return fo the off~ce of the 8oard 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST ~ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ] FRAMING [ ]FINAL RE;MARKS: /, . 4~ t .1i , -" ,, 765-~.802 BUILDING DEPT~ INSPECTION·' ,~ · FOUNDATION ZST [ ] ROUGH F'Li FOUNDATION ZND [ ] INSULATI0! FRAMING [ ] FiNAL FIELD INSPECt%ION COMMENTS FOUNDATION ( 1 s t) FOUNDATION ( 2nd ) 2. ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: TOWH OF $OUTHOLD BUILDING DEPARTMEHT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y, [x~mined ............................... ............. , ....... Application No ............ ~:..~ .............. Disapproved o/c ............................... -~:;~.~7~ ..................................... i ........ .............................................. :: ....... ........... i ............................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .......................... ........ ,, ..... INSTRUCTIONS a, This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the Building Inspector, with 3 sete 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 o~ areas, and giving o detailed description of layout ofproperty must be drown on the diagram which is port of this application. 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 issue o Building Permit to the appJicant. 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 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, o~ 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 buildings for necessary inspections. ? (Address of applicant) J State whether appl~nt is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................... ~.;/~rZ~.~ ................................................................................................................................................ If opplican~'~corporat~e~ ~ignatu, r~ o,~uly auth~iz~d officer. r/ (Name and title of co~orate officer) Builder's Lic~se No ..................................................... Electrician's License No...~....~:~.f~.~ Other Trade's License No ............................................... 1. Location of land on wh~ch/~Droposed work will be done. Map No: .... .~... Lot No ................... Street and Number ..... (~'T-~,/'~4~t .~.~. ...... ~...~.fi....(~,...~..~....4L....~../~l ................. ..4~...~//...~ .(/~, ................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..... b. Intended use and occupancy ...... ~./¢/~,....* ' 3. Nature of work (check which'applicable): New Building Addition Alteration Repair .................. Removal. .................Demolitior ..................... Other Work .................................................... ~ (Description) 4. Estimated Cost ...... '-~...b...,~.~.?.~.. ......... -. ........................ Fee ........................................................................... (lo be paid on filing this application) 5. If dwelling, number of dwellihg units ............................ N ~mbcr of dwelling units on each floor ........................... If garage, number at cars ..... ~..,.~ .............................................................................................................................. 6. If business, commercial ar h~ixed eccupancy, specify nature and extent of each type of use ........................... 7, Dimensions of existing sl'ructures, it any: Freest ............................ [),ear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................ Dimensions o~ same structureI with aHerations or additions: Front ....................................Rear ........................... Depth ................................ Height ............................ l'lumher of Stories ................................ 8. Dimensions of entire new construction: Front ....... ,f. ........................... Rear .....~..~ ............ Depth Height ...... l,~.i ........ Number; of Stories ....... ~/~. ....................................................................................................... 9. Size of Iai: Front ......... ~.~.,~ ...................................... Rec,r ..... ..,~-....~..c) ............................ Depth .....~,?.'2.0... ................ 10. Date of Purchase .........J)~,Z,Z.; ...... L~.~.?t,~... ................... Name of Former Owner ...~.,o..(.:.°...I.£.f~L~ .............................. 11. Zone or use district in which premises ore situated .................................................................................................... 12. Does proposed construction viblate any zoning law~ ordinance or regulation: ....................................................... 13. Will lot be regraded ....... .C/.~-..~. ........... Will excess fill be removed from premises: ( ) Yes ( ~"~No , 14. Name of Owner of premise~ ,P~.¢5..~.~.~..~.~-.[.t.'.~,'. ................. Addre]ss~'.(~fi..~/.t:.d..~t~..~':..~.~./.t.~'[}'}~o°~tl~l~ ?.~..~...~....~..~... Nome o~ Archited . ............................................................. Address ................................ Phono ~o ...................... Nome of Contractor ............................................................. Addross ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex s "~ ~g or proposed, and indicate oil set-back dimertsions frar, property lines. Give street and bl6ck number or description according to deed, and show street names and indica~ whether interior or corner .................... C~.,,.~.IO.~..¥...L~..L.v..~...,t~...~...I~..~.,V.'I. ..................... being duly sworn, deposes and says that he is the applicon' (Name of individual signing contract) above named. He is the .................. .~.~.~'~ ........................................................................................................................................ , (Contractor, agent, corporate officer, etc.) of sdd owner or owners, and is dqly authorized ~o perform or have performed the said work and to make and fill this application; thd all statements contained in Ihis application are true to the best of his knowledge and belief; thru' the work will be performed in t'he manner set forth in the application filed therewith. Sworn to before me this ; ~ ............ ..... .................................................................................. ~ Y~ -- ~ / ~) E ~_ ~ ~. ~' (Signature of applicant) .,. RO~ERI(;K VAN TL}yL P.C, .,_: THE WATER SYSTEMS FC SUFFOL .> ,, {si, ../_, SUFFOLK CC SERVICES CONSTRUCTIO DATE: , ~. S. REF. NO.: APPROVED: ~ SUFFOLK Di~. OWNERS ADI~ Soco~ DEED: TEST HOLE SUFFOLK CO. HEALTH DEPT. APPROVAL H.S. NO. STATEMENT OF INTENT JHE WATER SU~LY AN~ SEWAGE ~AL ~EMS FOR THIS R~IDENCE WILL .... ,, "N ~FFOLK COUNTY DEPT. O~ HEALTH ~ ~ SERVICES -- FOR APPROVAL OF ~ - H.S. ~F. ~o.: /3~- ~O- ~FoLK CO. TAX ~ TEST HOLE ~AMP ~o ~ * w,u~ ~r~ ~ +~e .. SEAL RO~RICK VAN T~YL, LICENSED LAND S ORS GREENPORT NEW YORK '~' I SUFFOLK CO. HEALTH DEPT. AI~:~OVAL ,-o',',',',',',','~ H. S, NO, i:~- ' c m ~, .'~ } STATEMENT OF INTENT ~ :~ :,~-c'~ m CONFORM TO THE STANDARDS OF THE ~ .~ . . , SUFFOLK CO. DEPT. OF HEALTH SERVICES. (s} ~ APPliCANt ~ " SUFFOLK COUNTY DEPT, OF HEALTH '~,.~'~'~: ~ ;~ SERVICES ~ FOR APPROVAL OF ~ ~ ._ c~ ~ CONSTRUCTION ONLY . APPROVE D: SUFFOLK CO. TAX MAP DESIGNATION: /~ ~7' OWNERS ADDRESS: 5how~ , ~ ~ TEST HOLE J STAMP [, ~m~ a~ ~*~ :e~.- SEAL LAND SURVEYORS GREEN~RT NEW YORK L)GENSEO L AND GREEN~R~ NEW YORK ~CCU?,~CY IIR V;~[I'I~¥ CD¥1FiCATE ~654802 9 AM FOLLOWING ~ FOR pOURE~ ~. INSULATION ' BE CoMpLETE FOR C.O. ~LL cONSTRUCTiON THE REQUIREME~S OF STATE CoN~RU~ION & ~'~ ffcopper lub/'ng Fs os'e-d for water distributing system; piping shall be ¢~ D/pes K orL only .L A N I 41I