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Home My WebLink About26989-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27673 Date: 05/14/01 THIS CERTIFIES that the building ALTERATION Location of Property: 1330 NORTH SEA DR SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 54 Block 5 Lot 9.3 Su~divislon Filed Map No. __ Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 26, 2000 pursuant to which Building Permit No. 26989-Z dated DECEMBER 26, 2000 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 ALTERATIONS TO BASEMENT OF EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to CONSTAMTINE GEORGIOPOULOS (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF }~%LTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 N/A PENDING 05/04/01 ut or~ize~ mg~at~ FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMBNT Town Hall Southold, N.Y. (THIS BUILDING PERMIT PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 26989 Z Date DECEMBER 26, 2000 Permission is hereby granted to: CONSTANTINE GEORGIOPOULOS 156 READ AVE CRESTWOOD,NY 10707 for : CONSTRUCT ALTERATIONS TO BASEMENT OF EXISTING ONE FAMILY DWELLING AS APPLIED FOR. THIS PERMIT REPLACES BP#24239. at premises located at County Tax Map No. 473889 Section 054 pursuant to application dated DECEMBER Building Inspector. 1330 NORTH SEA DR SOUTHOLD Block 0005 Lot No. 009.003 26, 2000 and approved by the Fee $ 75.00 horized ~~e ORIGINAL Rev. 2/19/98 tn thg'followtng i iTHE NEW YORK BOARD 'OF FlEE BUREAU OF 40 FULTON STREET NEW YORK, NY 10038 ,~Iow ahd l~tt~odub~d by the apRiCOt ~ed on ' ' ~¢lfO.~ iO be tn Oo~p~nce ,with th.~ SWITCHES MOTORS elect g~ORelOPO'Oi~OS'; , , NY, :[~975 i be dltered ln.~trw mal~ner', return lo the office of the Board I~ Incorrect. Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board o~ Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% 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. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and Ppre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a 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 Buildin~ - $100.00 3. Copy of Certificate of Occupancy - ~ 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date New Construction .... / Or Pre-existing Bu n ................. ....... Old ildi g Location of Property ..... House No. Street Ha~et O~wer or O~er8 of .~.~ ................ ';... .............................................. County T~ Map No 1000, Section .............. Block ....... Lot ........... Subdivision Filed Map Lot . Permit No.~.~ ........... Date Of Permit ............. cant.~f !O~ . .. Appli .......................... Health Dept. a~ro, =~ ~ ~ Z I ~ ~ ~- ..... Underwriters Approval ............ Fee Sub itted: $ ~'OO ~.~ o .-:?.: ~. ~q S~ APPLICANT HENRY .J. SMITH & SON, PLUMBING, HEATING & FUEL OIL MAIN ROAD SOUTHOLD. N.Y, 11971 (516) 765--3690 CERTI*FIC InC, Dat.e April 18, 1991 Building Permit No. 181'01Z Owner ConstantSne Plumber Henr I system certify that the solder used in the water supply contains less than 2/10 of 17. lead. "*' __- ~ '~: §~' Sworn to before me this ~9_2!_' - mo~ary ruo±z Notary Public, Suffolk County BERNAD~'TTE L. HOTARY PUBLIC ~844893 State of New York R~lding in Surfak C~Y Commis~ofl ~pires Sep~ Pleas'e note that this plumbing certificate is to cover the plumbing pipes in the basement only. Upstairs plumbing was done by house manufacturer. The New York Board of Fire Underwriters Bureau of Electricity is in the process of issuing a certificate of coropliance for the electrical installation as provided for in the application for inspection ./ New York Board of Fire Underwriters Bureau of Electricity Inspection activity pu~u~t to npp~tion has been completed and a certificate of compliance setting forth the detail of the ~al system is b~eing prepared., Inspector ~ Date Form O0 (Rev. 06/00) · Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971-0959 · BUILDING DEPARTMENT TOWN OF SOUTI-IOLD Fax (631) 765-i823 Telephone (631) 765-1802 January 11, 2001 Constantine Georgiopoulos 156 Read Ave. Crestwood, NY 10707 RE: 1330 North Sea Dr., Southold To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: XX XX XX An application for Certificate of Occupancy is ~tMCto~ not on file. (Enclosed) No Underwriters Certificate on file. The check is (not on file.)$25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (Ail permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 26989-alteration"" Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. Building Department Town of Southold P. O. Box 1179 Southold NY 11971 CONSTANTINE P. GEORGIOPouLos 156 READ AVENUE CrestwOOd, NY 10707 Monday January 15, 2001 Re.: Building Permit No. 26989 Alteration Dear Ladies and Gentlemen: I enclose the following documents requested in your letter dated January 11, 2001; 1. Application for Certificate of Occupancy; 2. Check in the amount of $25.00. I cannot send you a Plumber Solder Certificate because the alteration in the basement was for the purpose of constructing walls to partition the basement from the garage. No plumbing was installed in connection with the alteration. A certificate is on file with respect to all the plumbing in the premises which was filed by Henry Smith several years ago. Very tm_~ly yours, /~. Page 1 of 1 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATIONIST [ ] ROUG/~LBG. [ ] FOUNDATION2ND [ ] I~ULATION [ ] FRAMING ~'I~INAL REMARKS: ./ ~// Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Fax (631) 765-I823 Telephone (631) 765-1802 January 11, 2001 Constantine Georgiopoulos 156 Read Ave. Crestwood, NY 10707 RE: 1330 North Sea Dr., Southold To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: XX An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. The check is (not on file.)$25.00 No Health Department Approval on file. No final inspection has been made. . XX No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 26989-alteration Please contact our office on this matter. cooperation. SOUTHOLD TOWN BUILDING DEPT. Thank you for 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]/INSULATION ,~/ [ ] FRAMING [//~ FINAL []FIREPLACE&CHIMNEY DATE I NSPECTO~~-.~ FOUNDA'TION (1st) FOUNDATION (2nd) ROUGH FRAME & .PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL I N,q'I'I{UCT I ONfi ,SIIRVI'~ ¥ ........................ NOT I IZ¥: c^,., .... ~.(,;., ..... ~::.~:.- HA I I. TO: .................... b. Plot phlll ~ds~inll I(~nti~l of lot nisl of I~lihlinB~i on pr~,i~;e:~, rehttion~fidp to ~ljoinJnB pi(~linea or i~lblie c. 'ihe i~)rk c(N~l'ed iii Ihia Jlj~)J Jf~ilLJOll I~ly I~)l, J~ (:(~m~la:ed I~fore i~ml;uate of l~dhling o. ~) JxlJJ(lJll~ l~l;llJ J~ ix'C~ljlj~] (}f tl~(~{J ill ~lole or ill I~lrt for all~ Iilllglfi~l ~l}l[(~ve[' IllllJJ ~1 (~rtifi('~lle o[ I~lil(JJilj~ ~X)IK~ OidJl~llx:e of Ihe *l~l of ~xllJlohl, ~rfoll( (~xlnly, ~ York, ~uKJ olher al)pi Jeabl~ I~s, ()ldJnniK~efl Ol de~icrJixtd. 'lhe nppJJ(:nnL illyria Io c(~,~ly ~ilh all api)licnhle I~.~c;. orllJnance8, I.dlding (-(~le, i~J~lJilj~ c(xlo, aiKI '"" ; Li;,; (,Iii,Ii'II,lie Of nppl J(';llll , 0 I ' ' ' ' ' ) 'l " ' ; C.6...~.?.. ~.Y% ..... .~. ~.~7.~9.~.k~.... ~ ~ ......................................................... 765480~ g AM ~ -......~_~PM FOR THE (N;,l~ ;u~l lille o1' (oqx)lale ol fleer) ~,,rS~,~'{~'' ~'~ FOLLOWING INSPECTIONS: , , ~ ,., ~. FOUNDATION - '~OREQUIRED ~"'<, ~,~, ~" s,?~'~ ~,~, FOR POU~ED CONCRETE I~,i hie,,, I.ice,me ~, .......................... t..~.:~ '~'~ ~ ~ ~.~,~V~'~'~ ~. ROUGH ~ FRAMING ~ PLUMBING I'h~l~l~ l.iumme No .......................... 0~ gggg~ 4. F:H~AL" CONSTRUCTION MUST AL,L CO~;TRUCT~ON ~I~,ALL MEET Olhel' '1'~[~'[I l,i('en[~(~ ~) ...................... ~NE R[~O~fiREfViE:NT~ O~ THE I(). II, 12. I~. ~6. 5xamined..~., [pproved ... 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ..... ...... 19 .~Permit No.. ~..~.~./. )isapproved a/c ..................................... Received ........... ,]9... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ets 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 )r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ,htion. 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 ;hall 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 g Certificate of Occupancy ;hall 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 demolitions,as herein described. the applicant agrees to comply with all applicable laws, ordinances, building code, housing code, aria regulations, and to admit authorized inspectors on premises and in building for necessary insolent. ..... ........ (Signature of applicant, or n'Mne, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~ueer, general contractor, electrician, plumber or builder. ........... .O.c.o t-L~,~- .................................................................. Name of owner of premises Qot,4~Tta ~-r~ . .: ...... o. (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 ..... ~ ~-x ............ Plumber's ~icense No .... Electrician s License No..~~.,07~ ..... 1. Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section ..... [ ~ ......... Block .... ~ ........... Lot...5 .............. Subdivision ..................................... Filed,Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: h. Existing use and occupancy ...~.~g ~.Q~[q~ ~8 t3E~ use an occupancy ................................................................. N ..... .Addition .......... Alteration . .t~... ature of work (check winch apphcable): New Building ......... Repair .............. Removal .............. Demolition ' c~th~, w,,~t- ff~'r¢~o~ $,~c- (Description) Estimated Cost .... ~..~..0.0..,.0..0 ...................... Fee ...................................... (t) be paid on filing this application) $. If dwelling, number of dwell.lng units ..... [ .......... Number of dwellin units on each floor../ .............. If garage, number of cars : ~ ............... 6. If business, commercial or mixed occupancy, specify natgre and extent of eec ~t type of use ..................... 7. Dimensions of existing structures, ifany:Front...*4.(~,,..J~..~... .... Rear .~l~.~ Depth . 3 9. £. ........ Height ....... Number of Stories ! t ... Dimensions of same structure with alterations or additions: Front . .~..~.~'.I ........ Rear ...~..~?..q ......... Depth ....... ~'..~.~..'~ ........ Height ..~..~.a..~.. ',2 .......... NumbSr of ,Stories .. ~.~../!. C-, ....... , ...... 8. Dimensions of entire new construction: Front . .~ ~ .dT.~ Rear g ~, ~q <~ Depth ...~.,./~..~. ~ .. Height ...~.0 ?..~. ..... Num.)er of Stories., .~..~..r~. ¢ ................ 4 .................................. 9. Sizeoflot: Front . .]..0..O. ~ ......... Rear ................... l.. Depth .: .................... 10. Date of Purchase ................. Name of Former Ow-~ 11. Zove or use dj, strict in which premises are situared .................................................... 12. Does proposed constluction violate any zoning law, ordinance or regulation: .~.0 ........................ 13. Will lot be regraded .......... : ........ . ......... Will ex,,cess fill be ret, roved from premises: ~ F~No, 14. NameofOwnerofnremisesC,O.6-c. oe-c~oeo,~o,~ Aaar,,,~ 1~6 g¢~l~ ,,~u~'- qt' ~ .......................................... Phone No. ¢ [c~s-o.ooo'0 ~ )(. Phone No Name of Architect ........................... Address ............................ ,,. . Name of Contractor .......................... Address .................. Phone No .............. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, an indicate all set-back dimensions from property lines, Give street and block number or descnphon according to deed, and Jhow street names and indicate whether interior or corner lot. ~PP 0 ~D AS FIOTED ~t:,.-IBOZ 9 AM TO 4 PM FOR THE FOLLOWII IG ~NSPECTIONS: 1, FOUNt: FOR PC 2. ROUG~- 3. INSUL,~ 4. FINAL BE COI~ ALL CONI THE REQ STATE C( CODES. DESIGN I STATE OF NEW YORK,, , COUNTY OF J~¢..c9.....'/.~..g'.~.~... S.S Coo(~wt~tq'~ cp. ................................................. being duly sworn, d ATION TWO REQUIRED URED CONCRETE ~ FRAMING & PLUMBING rION - CONSTRUCTION MUST iPLETE FOR C.O. ;TRUC'I'ION SHALL MEET IIREMENT8 OF I~IE N.Y. ~ISTRUCTION & ENERGY lOT RESPONSIBLE FOR CONSTRUCTION ERRORS ,,poses ancl says that he is the applicant (Name of individual signing contract) above named. He is the ........................................ ~,., ............. (Contractor, agent, corporate officer, e~c.) ~..e&:a~ c;'.'ner er ewners, and is duly authorized to perform or have performed t~ e said work and to make and file this application; that all statements contained in this application are true to the best ol 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 otarY Publi~r~.....~. · · ............ ::; .~ t, uualtEIod In 'New York County ~'ommisalon EXpires May 30, TOWN OF Sou'rHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING pERMiT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~.o 24239 Z Dote. ..~ ....................... · ' ' by granted~/o: / ~ ~.~..~..~.....~...~i~.~ '...../..~......~.~.~~.... ....... ~,. ...................................................................................................................................... at premises located at ................ County Tax Mop No. lO00 Section ........ ~. Block .......... ~ .... Lot No...~... ................. pursuant to application doted ............... ~...~.....,//J~' j 19..~....~, and approved by the / - Building Inspector. ~ n~. ~,~ ~~--~..~ ...... Building Inspector Rev. 6/30/80 CONSTANTINE P. GEORGIOPOUIOS I 56 READ AVENUE CRESTWOOD, NY 10707 TELEPHONE: (9 I 4) 793-6 144 Thursday, December 21, 2000 Building Department Town of Southold Town Hall Southold NY 11971 Ref.: Building Permit 24239 Premises: 1330 North Sea Drive, Southold, NY Dear Ladies and Gentlemen: I understand that the above referenced Building Permit issued for a basement alteration at the above premises expired. Please renew the Permit. My check to the order of the Southold Building Department in the amount of $75.00 is enclosed. Very truly yours, [ Constantine P. Georgiopoulos Page 1 of 1 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION2ND [ ] INSULATION [ ] FRAMING [~FINAL~ [ ] FIREPLACE & CHIMNEY DATE~/~~ INSPECTOR OFTNF. AJ2~'~0kJ OF F'A~TFFIONI WALLS VF~Tb~OUT C£R F~F iCA ~£ OF 0CCUPANC7 ~x£ O~IOPOUL O$ JUDITH T. TERRY TOWN CLERI{ REGISTRAR OF VI'lAb STATI~rlCS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER Town Hall, 53095 Mam Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1801 OFFICE OF THE TOWN CLERK TOWN OF SOUTI-tOLD THIS IS TO CERTIFY TItAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 1993: RESOLVED that the Town Board of the Town of Southold hereby adopts two (2) new forms to be used under the Flood Damage Prevent regulations of the Code of the Town of Southold: Application" [FDP(93)], and "Certificate Special Flood Hazard Area [C/C(93)]. "Floodplain Development Permit of Compliance for Development in BL~SG, DF:Pr, TOWN ,OF SOUTHO[ Southold Town Clerk August 25, 1993 TOWN OF SOUTHOLD APPLICATION # PAGE 1 of 4 FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. SECTION I: GENERAL PROVISIONS (APPLICANT to read and si~n'l: 1. No work may start until a permit ia issued. 2. The permit may be revoked if any false statements are made herein. 3. If revoked, all work must cease until permit ia re-issued. 4. Development shall not be used or occupied until a Certificate of Compliance is issued. 5. The permit will expire if no work is commenced within six months of issuance. 6. Applicant is hereby informed that other permits may be required to fulfill local, state and federal regulatory requirements. 7. AppLicant hereby gives consent to the Local Administrator or his/her representative to make ieasonable inspections required to verify compliance. - 8. I, THE APPLICANT, CERTIFY THAT ALL STATEMENTS HEREIN ~AND IN ATTACHMENTS TO _ THIS APPLICATION ARE, TO THE~ BES~T OF MY KNOWLEDGE, TRUE AND ACCURATE. SECTION 2: PROPOSED DEVELOPMENT (To be comtfleted by APPLICANT) NAME ADDRESS TELEPHONE APPLICANT BUILDER ENGINEER PROJECT LOCATION_ To avoid delay in processing the application, please provide enough information to easily identify the project location. Provide the street address, lot number or legal description (attach) and, outside urban areas, the distance to the nearest intersecting road or well-known landmark. A sketch attached to this application showing the project location would be helpful. FDP(93) APPLICATION # PAGE 2 OF 4 DESCRIPTION OF WORK (Check all applicable boxes): A. STRUCTURAL DEVELOPMENT ACTIVITY T~CTURE TYPE [] New Structure [] Addition [] Alteration [] Relocation [] Demolition [] Replacement [] Residential (1~4 Family) [] Residential (More than 4 Family) [] Non-residential (FloodprooFmg? [] Yes) [] Combined Use (Residential & Commercial) [] Manufactured (Mobile) Home (In Manu- factured Home Park? [] Yes) ESTIMATED COST OF PROJECT $ OTHER DEVELOPMENT ACTIVITIES: [] Fill [] Mining [] Drilling [] Grading [] Excavation (Except for Structural Development Checked Above) · [] Watercourse Alteration (Including Dredging and Channel Modifications) [] Drainage Improvements (Including Culvert Work) [] Road, Street or Bridge Construction [] Subdivision (New or Expansion) [] Individual Water or Sewer System El Other (Please Specify). After completing SECTION 2, APPLICANT should submit form to Local Administrator for review. SECTION 3: FLOODPLAIN DETERMINATION (To be completed by LOCAL ADMINISTRATOR) The proposed development is located on FIRM Panel No. , Dated The Proposed Development: [] Is NOT located in a Special Flood Hazard Area (Noti[y thc applicant that the application review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED). [] Is located in a Special Flood Hazard Area. FIRM zone designation is 100-Year flood elevation at the site is: Ft. NGVD (MSL) [] Unavailable [] The proposed development is located in a floodway. FBFM Panel No. Dated [] See Section 4 for additional instructions. SIGNED DATE APPLICATION ~ PAGE 3 OF 4 SECTION 4: ADDITIONAL INFORMATION REQUIRED (To be completed by LOCAL ADMINISTRATOR_). The applicant must submit the documents checked below before the application can be processed: El A site plan showing the location of all existing structures, water bodies, adjacent roads, lot dimensions and proposed development. [] Development plans, drawn to scale, and specifications, including where applicable: details for anc. horing structures, proposed elevation of lowest floor (including basement), types of water resistant materials used below the first floor, details of floodproo£mg of utilities located below the first floor and details of enclosures below the first floor. Also, Subdivision or other development plans (If the subdivision or other development exceeds 50 lots or 5 acres, whichever is the lesser, the applicant muir; provide 100-year flood elevations if they are not otherwise available). [] Plans showing the extent of watercourse relocation and/or landform alterations. [] Top of new fill elevation Ft. NGVD (MSL). [] Floodproofing protection level (non-residential only) Ft. NGVD (MSL). For floodproofed structures, applicant must attach certification from registered engineer or architect. FI Certification from a registered engineer that the proposed activity in a regulatory floodway will not result hi a_~ increase in the height of the t00-year flood. A copy of all data and calculations supporting this Finding must also be submitted. [] Other: SECTION 5: PERMIT DETERMINATION (To be completed by LOCAL ADMINISTRATOR) I have determined that the proposed activity: A. [] Is B. [] Is not in conformance with provisions of Local Law # , 19 . The permit is issued subject to the conditions attached to and made part of this permit. SIGNED , D~.TE If BOX A iS checke~d, the Local Administrator may issue a Development Permit upon payment of desigaaated fee, If BOX B is checked~ the Local Administrator wifl provide a written summary of deficiencies, Applicant may revise and resubmit an application to the Local Administrator or may request a hearing from the Board of Appeals. APPEAL.S: Appealed to Board of Appeals? [] Yes [] No Hearing date: Appeals Board Decision --- Approved? [] Yes Conditions [] No APPLICATION # PAGE 4 OF 4 SECTION 6: AS-BUILT ELEVATIONS (To be submitted by APPLICiNT gefore Certitlcate of Compliance is issued) The following information must be provided for project structures. This section must be completed by a registered professional engineer or a licensed land sttrveyor (or attach a certification to this application). Complete 1 or 2 below. ' Actual (As-Built) Elevation of the top of the lowest floor, including basement (in Coastal Hi~;h Hazard ' ..Areas, bottom of lowest structural member of the lowest floor, excluding piling and columns) is: FT. NGVD (MSL). 2. Actual (As-Built) Elevation of floodproofing protection is Fr. NGVD (MSL). NOTE: Any work performed prior to submittal of the above information is at the risk of the Applicant. SECTION 7: COMPLIANCE ACTION (To be comp!.eted bv LOCAL ADMINISTRATOR) The LOCAL ADMINISTRATOR will complete this section as applicable based on inspection of the project to ensure compliance with the community's local law for flood damage prevention. INSPECTIONS: DATE BY DEFICIENCIES? [] YES [] NO DATE BY DEFICIENCIES7 [] YES [] NO DATE BY DEFICIENCIES? [] YES [] NO SECTION 8: CERTIFICATE OF COMPLIANCE(To be cQmv eted bv LOCAL ADMINISTRATOR) Certificate of Compliance issued: DATE: BY: Attachment B SAMPLE CERTIFICATE OF COMPLIANCE for Development in a Special Flood Hazard Area TOWN OF SOUTNOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD HAZARD AREA (OWNER MUST RETAIN THIS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO. PERMIT DATE_. OWNERS NAME AND ADDRESS: CHECK ONE: ', [] NEW BUILDING [] EXISTING BUILDING [] VACANT LAND THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: A. COMPLIANCE IS HEREBY CERTIFIED WITIt THE REQUIREMENTS OF LOCAL LAW # ~ 19,,. . · SIGNED: .... DATED: B. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW #~., 19 , AS MODIFIED BY VARIANCE # DATED -- , SIGNED: DATED: C/C(93) IN,qTRUCTI ONS BOAIU) OF IIEAI,TII ............... 3 ,ql~'l',q ()1~ Iq,^H8 ............... · qURVI~Y ........................ CIIICCK ......................... SICPI'I (; FORH ........ ; .......... itOTIFY: HRII, TO: .................... n. 'lhi.q al~plicatkm ~]st be c¢~qdetely filled in by tyl~riler or in ink a~gl sullnltted to the Ihdhling hml~clor wilh b. Plot plan sl~ing l~ati~ of IcL asxl of Ia~ihlinga on pronises, relatlonahip to mljolnh~g pr~,i~es or ixd~lie this appl icnti~. c. 'lhe ~rk c(~rc~l by this all~lication T,v]y ~K)I I~ c(xme[~l I~fore issuatme off ]k~ilding Pe~it. d. Illx~ alEPh.al of this application, the l~Jildlng lnslmCtor will issue a Ikiilding Permit to the appllcaut. Such [~unlt Mmll 1~ kep~ ~ tim proni~s available for insl~Cki~l thrtx~¢x~t the x~rk. e. ~) Ndhlin8 rJtall Im ~oqfi~l or u~l in ~ole or (kx-ul~nx:y ~t~atl ha~e Ix~n grnnt~l by lira Ikllhling hmlmctor. affffl. ICA'l'l(~ lB IflCl~Cl~ ~l~ lo tim Ik~ilding lkq~lrt,ent For the issuance of a lkJild[ng Pe~it D]r~mnL Lo the Ikdhllng 7~m Ordimmx:e or tim 'lk~m of ~tl~ld, ~ffolk (~mcy, ~ York, mxl other a~llcable l~s, Ordlno~es or lWgulatitms, for tie c~stn~ti~ of la~ildings, ~kliti~m or alterations, or for ~al or d~olition, as herein ¢~aerilx~l. 'llm applicant ngr~s ~o co,l~ly with all al~fllcable ..... ............ (Signature of appl icanl, or~a~e, if a ('orl~rnl ion) State wl~ther apl)licmll 19 ~a-,er, le.q~e, agent, architect, engineer, general contractor, electrician, ph~d~,r or la]ihler. ............ ~.~.~.~.g .................................... _ .......................... ~e~w~as.aoT~a......... , . NOTWY ~UILDING DE(~T AT Ir ?ppllt:nut- is a eorl~ratt(m, siglmLure of duly aul.l~)rizel officer. 78[~-1802 9 AM ~ 4 ~ FOR THE FOLLOWING INSPECTIONS: '"i ...................................................... ~, FOUNDATION ~ '5~0 REQUIRED (~,~I n~xl Iii le or (,()tjx)late oJTJt'(,r) fO~ POL8EDCONORETE OCCBPANCY O~ a. ~aouc~ .. ~:a~M~ ~ ~UM~NG ......................... F, ./:,~. ~/;x,.,. ~F~,JCLON MUST ~;~,:,-~i~i,,,,,, ~,i~,,~ a,. 0F OCCUPANCY ~T6ZE CONSTRUC"T~ONc,,,e~ ENER~3Y CODES. NO] R~ ,ON,)IBLE FO~ UNDERWRITERS CERTIFICATE I. la:aLi¢~ o¢ h.xl ~ ~lcl~ prol~l ~nk will i~ do~ .... REO~REO ............. ~ ~ .... ~¢.~r ~..5 ~.~...~.~.~ ................... ~. ~.~.~:'5> ....................... Ikx.m ~dmr Street lk~nl et ,~.,,,~ ',',~ ~,, ~. ,,~ ~,.i~, ...~.~ ....... ,,,~ .... .~..P7... ,,,t ...2 ........... ~flxlivision ...................................... FilCM ~il~ E~ ................ lot ............... (~e) .. ,;~i,ti,,g ,,,~, ,,,.~ ,~o,~...:y .... '~b.~PE.~.~.%.~ ....................................................... h. Inl Cn~kxl u~ m~l CWCUl~U.;y .......................................... .igc ~l'tU:}~?.t 'l~C~;0~¢ ................ 9. II. 12. IL 14. I,~x'.ate clearly .t~l di~t i~ct ly a ............... ~ ..................... j ..................... i,!irq~ (hily t.'.~,~% (lei×mm; ~)~,i ,n~'~t tiulL he in the ,Iq)i Ihnl iIl(~ ~,l~ will Ix~ IKer[Ollll~(LJll I Ili'llll~r rieL I'orlll ill IJio tljlpI il'ill J()ll liled IIl(~lt~Jl.ll, ................... d'~ . / Examined ..... Approved 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ., 19 ., 19,. _. Permit No.. Disapproved a/c ..................................... ~llildin~spector) APPLICATION FOR BUILDING PERMIT Date . .~..cl~ .... ! ..... , 19 .~.0 INSTRUCTIONS a. Tins 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, ti14¢~!~ ?.o~ C~o ~ ~lK~.~.~o~ b. Plot plan showing location of lot and of buildings on premises, rela lie streets or areas and iving a detailed description of layout of property must be dr~Ce~b~i,t~alt~mo~l~ic~ il~,~8~;[tins appli- . c The work covered by tMs application may not be commenced before mg~a~c~~e~l$~'c (. d Upon approval of tMs application, the Bmld~ng' ' Inspector wall' xssued' a'Bg~d~m[gxtp~[b~'~pHc~t.' ' ' "~ ' ' ' ' Such pemxt' shall be kept on the premises available for inspection throughout the work... e. No bufld~g shall be occupied or used in whole or in p~t for any purpo~ What~g ~tfl a Certificate of Occup~cy shall have been grated by the Building Inspector. . ' APPLICATION IS HEREBY MADE to the Build~g Dep~ment for the issba~C.e 9f a B~lding.~e~)~gant to the B~lding Zone Ordinance of the Town of 8outhold, Suffolk County, New Y6rk ~3'~efapplic~b~' ~ Or~ces or Regulations, for the construction of build,ss, additions or alterations, or for fem0~~ or demgllt}o~a~ ~re~tdescfibed. The a 5cant a tees to comply with all app~cable laws ordinances bu~ding code ~o~sing co~ ~.r~g~l~tiogs, and to admit authohzed ~specto= on premises and m bmldmg for necessaw ~ns~i~ .% ...... ....... (Signatur~ of'applicant, o~ ~'q;7~if g.corporation) ~T ~ ~y to~o~ State whether applicant is owner, lessee, agent, ~chitect, engineer, general contractor, electrician, plumber or builder. 0~¢ .............................. Name of owner of premises Qo~n ~TtN~ ~ .. ~ O~m¢ouCoS - (as on the tax roll or latest deed If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...... . . .e~-f:~....~.. .......... Plumber's License No......~~~ Electrician's License No...///~e~.. ~.y .... 1. Location of land on which proposed work will be done ...................................... '. ........... · ( 3.~. 9.....~. P..~7~..$.e.a...~..~..~?.e7 ............ .$.o..,5.7.~.?..c~. .... .t.'5..~. ........................ House Number Street Hamlet County Tax Map No. 1000 Section ..... .~ .~. ......... Block .... .~. ........... Lot....~. .............. Subdivision ................ (iq'a~)' ............... Filed Map No ............... Lot ............... 2. State existing use and occupancy of premises and intended use and °ccupancy °f pr°p°sed c°nstructi°n: a. Existing use and occupancy ....O..eS..g..' I.~.~..~. %~.., .~..~..S.l.~..~. f'5..C~. ................................. b. Intended use and occupancy . .~..~..~.....~../~..~.~.c~.....~.?.S.~.b. ?: .05..c.~ ................................ 3. 4. 5. 6. 7. ~ 8. Nature of work (check which applicable): New Building ..... ' ..... 'Addition Repair .............. Removal .............. Demolition ........ Estimated Cost . .~..~..0.O. ,O0 Fee ~' (to .......... Alteration J.~.... .... Other Work F~,.'rcr, o,~ Sn~- - .............. (Description) be paid on filing this application) If dwelling, number of dwellj, ng units ..... ! .......... Number of dwelling ~ ~nits on each floor../ ............. '! , arage, number of cars ........................................ , ............................... If business, commercial or mixed occupancy, specify natgre and extent of each type of use o_f existing structures, if any: Front,..~.¢,~..[~.. .... Rear . ~_~.(. '.~'~'~'' '~w,,-~ .Depth..-.-_ .. Dimensions Height ... ,~..O. ....... Number of Stories...~.. (/.~.C. ~..~fl. t?..67.' .t. 0.c .~. ?. 5 At...~ ................... Dimensions of same structure with alterations or additions: Front . .~..~.~..~.. ....... Rear ...~.~?..~ ......... Depth ....... ~..~.~.'~ ........ Height . .~[. O.~.q ............. Numbe~ of Stories...~.~..~. ~, ............. Dimensions of entire new construction' Front g ~ .'~.~ Re r ~ ~/~ ~ De~th Heipht .~ O ~¢- Number of Stories 57 r4,,,~ 6. . 9. Siz;oflot:F;ont'.i~.~i~i ../r?'~... ......... "R;~iiiiiiiiiiii.'iiiiiii[i D;~ii~ 1 o. Date of Purchase ............................. Name of Former Owne~ .Ir. P~ .el.~.~.g..a.~.y ............ 1 l. Zone or ~ se d~strict in which premises are situated ...................... [ .............. ~. .............. 12. Does proposed construction violate any zoning law, ordinance or regulation: .1~.0 ........................ 13. Will lot be regraded ............................ Will ex..cess fill be rembved from premises: 14. Nme of Owner of premises ~.: ~..: .6-~yp.~c,:q~.eo.¥ .~.~ .... Address ~(?.6...KF.'~ ~....'~?.~'... Phone No?.~X .~.5..'~. Name of Architect ........................... Address ? .~.~.s .-~..o.o.~... ~.~.... Phone No ................ Name of Contractor .......................... Address .................. Phone No ................ 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 number or description according to deed, and s mw street names and indicate whether interior or corner lot. I PIIOV AS NOTED NOTIffY 8111L~[NG DEPART/t~L~'If A~ 765~1802 9 AM TO 4 PM FOR THE FOLLOWII G INSPECTIONS: 1. FOUNDATION . TWO REQUIRED FOR POURED CONCRETE - FRAMING & PLUMBING 'ION ' CONSTRUCTION MUST ~LETE FOR C.C. 1'RUCTION SHALL MEET IREMENT8 OF THE N.Y. IETRUCIION & [NEI~GY 01' RESPONSIBL8 FOR 2. ROUGH 3. INSUL,~ 4. FINAL BE COM ALL CONE THE REQU STATE COl CODE8. R DESIGN OR ,S.~ATE OF NEW YORK., COUNTY OF s.s C..o.~.? .x'.~.~.~..~... ~ .~...~.~?..~,.~.(?.e.o.? .C.o.~ ........... being duly sworn, d~poses.a!)O~ says that he is the applicant (Name of individual signing contract) above named. He is the ..... O' 'G~' '~' '~'(~" ' (Contractor, agent, corporate officer, elc0 "~ -eS :a.~ cwncr er ?.,nets, and is duly authorized to perform or have performed th 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 ........... LT...,~. ..... day~'..,~..q.~'. ...... Nota Pu' 1'~j~~'~ ~ ~. b l~'~F.,7-. ,'-~'. ................................ ..... ary '?ubl o State of ~ u, wa. .................. ~.'~ ~ ~,2.~._; '} ~ ' ..... . IN0 4~/51798 -e,, -o',n . ~ ' [signature oI applican*- , Qualified n New York Count Commlso on Expirea May 30, THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE I I ~ 95192 BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 Dare JANUARY 29,1992 .4pplic.tlo.~o.o./ile 74602391/91 N 222503 THIS CERTIFIES THAT only the electrical equipment as deserlbed below and introduced by the applicant named oR the above application number in the premises of C.GEORGIOPOULOS, 1330 NORTH SEA DRIVE, SOUTHOLD, N.Y, It.s exanllned on D E C E ~ ~ E R 3 ~ ~ ~ 991 attdfound to be in co.~piiance ~'ith the retlttlremenls qf tbls Board, DRYERS OVENS DISH WASHERS EXHAUST FANS SYSTEMS NO, OF FEET E OTHER APPARATUS: DEFECTS REMOVED AS PER 4-8-91~1 E R V I C NO. OF CC, COND PER ,e' OF NEUTRAL H, SMITH PLUMBING,HEATING MAIN ROAD,P~O,BOX 487 SODTHDLD, MY, 119T~ LIC,~t399E GE~NERAL MANAGER / Per This certificate must not be altered in any manner; return to the office of the Board if incorrect, Inspectors may be identified by their credentials. ~ NO. '~ TOWN OF $OUTNOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. ¥. BUILDING PERMIT (THIS PER~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No 'tc/ll~J Z Permission is hereby granted to: 4.~.,c~...~.....o . ./.~....:~....,~..,......'. ................ ~ '~~"~',, ' '~"'f' .... 7. ........... ~~.~: ...... ,~. ....... ~~......~,~......~....~~........~,. pursuant to oppJicotion dated ..... ..~..../.~. ...................................... , 19..~..~,., and approved by the Building Inspector. Rev. 6/30/80 OFTHF. AJ;~?F/lOfJ OF P4~'~TFllOkl WALLS ....... :: O~ THF. ~UHP,ELOfl,~ UNDEItWRITERS CERTIFICATE ,I use IS'U~AWFU~ OF OCCURq~Cy ~x£ O~'~IOFOULO$