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Home My WebLink About24283-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-26308 Date: 03/02/99 THIS CERTIFIES that the building ADDITION Location of Property: 555 SOUND BEACH DR MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 99 Block 1 Lot 23 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 1, 1997 pursuant to which Building Permit No. 24283-Z dated AUGUST 4, 1997 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 SECOND STORY ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to GEORGE & MADELINE LIVANOS (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N-471665 11/16/98 PLUMBERS CERTIFICATION DATED 02/26/99 GREENPORT PLUMS.&HEATING VA"I Building In ector Rev. 1/81 7011M NO. $ 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) rT° 24283 Z Date ....................... ......14.r/.................. Permission is hereby gronte to: �� < ...t ........................................... ..........�Q.. :NY........�� .. ro / . ......... ...1 . .. ... ...................`. x .... ................ .. 9 �1. . .. ................................................................................ ..................... ...... ............ at premises located at...= ......... ..... ............. 9 . ........................ County Tax Map No. 1000 Section ......... .r ....... Block ........../........ �Lot No. ..4;'( ......... pursuant to application dated 1............... 19f....../.., and approved by the Building //Inspector. ;20- Fee . ........... ... .... ... ................. ... . ..... .. . ... .. Building Inspector Rev. 6/30/80 M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] F NDATION 2ND [ ] INSULATION [ FRAMING [ ] FINAL [ ] FIREPLACE A CHIMNEY REMARKS: co7y�=� DATE �� INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ RQO GH PLBG. [ ] FOUNDATION 2ND [ ]v INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: • DATE h-7 INSPECTOR M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLGG. [ ] FOUNDATION 2ND [ ] INSULATION [ FMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE � a INSPECTOR Afft-u'�3-4 M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ L.,�FRAMING / .) [ ] FINAL [ ] FIREPLACE irk CHIMNEY REMARKS: ^ DATE / INSPECTOR I 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. ( ] FOUNDATION 2ND [ ] 1 ULATION [ ] FRAMING [/ FINAL ( ] FIREPLACE A CHIMNEY REMARKS: ml-477:zt4 DATE INSPECTOR i M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 SOLATION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY REMARKS: 1 co r/ DATE INSPECTOR /�/^ BUILDING DEPARTMENT 'L EN HALL TOWN 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: lines, 1. Final survey of .property with accurate location of all buildings, property 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 of 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 '!pre-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. Fees Iling 1. Certificate of Alterations to dwelling Y$25x00,dSwimming$pool $25.00, Accessory building25.00, Additions to dwelling $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildine - $100.00 3. Copy of Certificate of Occupancy - , 45c- 4. Updated Certificate of Occupancy - .$50.00 5. Temporary Certificate of Occupancy - Residential $15.090, Commercial $15.00 Date - /• ... . . . . . . . .. . .. . . . . . . . . . . . . . . .a Construction........... Old Or Pre-existing Building... ...... .. . .. . . . .. . . . . . .. . . . . . . ,cation. of Property............ .. .. .... ................ ..... . . ... . . .. . .. .Hamlet House No. Street vs t. . I`�� i.h:� .. . Ua�o.. . � ,ver or Owners of Property. . . . . .. . . . . . .. ,linty Tax Map No 1000, Section. .. . .. . . ......Block. .. .. ....... ... .Lot. . .. .. . . . . . . . . . . . . . . . . Nibdivision. . . . .. . . . . . . . . . . .. . . . . . . . . . .. .. .. .Filed Map. . .. . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . ,emit No.F�`rla 9" : . . . ..Date Of Permit. . .. . ... . . . . . . . .Applicant. . . . . . . . . . . . . . . . . . . . . . . . . . . . ,alth Dept. Approval. . .. . . . . . . . . . .. .. .. . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . .arming Board Approval. . . .. . . . . . . . . . . . . . . . . . . . ,quest for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . . :e Submitted: $. . .. .. .. . . . . . . .. .. . . .. . . .. . . :�ii�(..GtX„�� APPLICANT ENERGY CODE CALCULATIONS (For Non-Electric neat) Design CriL•eria G , UDU Ueyree'.Days O.A. lUQr S .A. 70OF FOR: //C'b U11 PER: if 7 f N y if/,yo I 7 fi u�y , a4 UA'1'liU: 17 DESIGN '111PRMEL REMARKS SUBSYSTEM AREA "U" RA'Z'ING f;xteriot: Walls lO6>a(411el 6 gl, , f1 �" 7-7 Glazing 2 • � B z, ''fD .i 2 ' q0 Doors Ceiliny/Roof (Opaque) -75,6 d O SkyliyhLs $ rloor roundation Walls Slab Insulation TOTAL } 3 Notes: Bulldj.ny Lnvelope Systems to meet requil:emenLs of 7U15. 2 ❑VAC Lquipement to meeL requirements of 7015. 11 11VAC Systems to meet requirements of 7015. 12 Duct Systems to meeL requiremenLs of 701.5 . 1.3 Ventilations Systems to meeL requirements of 7015 . 14 lnsulaL•lou of 1'ipiny Systems to meet requirements of: 7015. 15 Service Water Heating Systems & Equipment to meet requiremeuL-s of '1915 . 21 Electrl.cal & LighL•ing SysL•ems & Equipment to meet requiremenLs of 7UJ.5 . 31 To the best of my knowledge, ��OFNEI�y� belief:, & professional Co lz� judgemenL• , these plans are 1.11 �Q compliance with the code. 1 i'r 032254.1 �V r pq�FE3S10NP� ��o�OgpFFO(,��oGy Town Hall,53095 Main Road y' x Fax(516)765-1823 P. O. Box 1179 iC Telephone(516)765-1802 Southold,New York 11971 y�ol � dao OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD C E R T I F I C A T I O N DATE: 6 Building Permit No. Owner: (please print) Plumber: (o v^ cn poJ4 /d�nf�i i",9 _ t*�a �7 ro z cws/moi (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (Plumbers Signat e) Sworn to before me this 0 day of 1999 Not Public, County M1 i i HELENE D.HORNE l FEB a 6 Notary Public,State of Now York I No.4961364 — -- Qualified in Suffolk County ] i '.DG. Di; T. Commission Expires May 22, 19_L T4 ' 6t%iiia D o��gUFF0jjf 0 o� Gym Town Hall,53095 Main Roadyy. Fax(516)765-1823 P.O.Box 1179 �� O�� Telephone(516)765-1802 Southold,New York 11971 BUILDING DEPARTMENT TOWN OF SOUTHOLD February 23, 1999 Clement Charnews P.O. Box 1299 Southold, New York 11971 RE: Gus & Madeline Livanos, 555 Sound Beach Dr. , Mattituck. 1000-99-1-23 . 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 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 # 24283-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. I Ilt l.11 I lli I.tit;11(111 Iltrult'1' IM 1'1: rvllUlill117 `� l llnlmn'I'Ilul 1:1 I.1 TI n 1�� I:ulRillnfl011Tnn^( 211U)n _.z 1111111:11 YllAlll: A 1•I 1111111 Nu _nn.•-----------nn_nr.•mw•n. nnm.^ r mm m�_ n CT II;;IILn'I'11111 I'ii ll 11 P.111!111 f Y 1;11111! .------------mm-nnn__---- ....mnm....,_ --------------..---------- - ...,..m ...N'2�ji....n.n. n1111 i'I'11111A 1. --- II I[]"! . .. _m.. e __.. —___mn_nm � -- ----_nmn r__ ----- ` - , `Z In ; S N N O pt o a 0 ° ° o ° ° M ( CD n n f o s < N 7 N N - Z ----•--•--- --•- o m = n ° � m lj i S w Q a 0 0 F p0 N w q CD l m _ � x o INCo V � -a ks El cr ° 7 ID �.• P CL C _EH S 0 w ° m m a0 o - •i SCO LANO LES �6& �O so ` �aUt�TD BEAC}-i`tD( I V r � " ; 1's y'• -; 1TMBEit CUR�M r r 3'Q�rrA fE U7NIJ;- saes .5�;�7Q. :yr.� ,!�1 f►� �1' '{s' i lt7� '~~.._,. 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TERRY ) " - Town Hall. 53095 Main Road TOWN CLERK '. �;'; ys _rn P.O Box 1179 ` REGISTRAR OF VITAL STA7151lCS �' �✓ •1C�E*�. r Southold, New York 11971 MARRIAGE OFFICER �'✓-y,, m �� Fax (516) 765-181-3 RECORDS MANAGEMENT OFFICER �� 1j� Telephone (516) 765-1801 FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD THIS IS TO CERTIFY THAT 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: "Floodplain Development Permit Application" [FDP(93) ] , and "Certificate of Compliance for Development in Special Flood Hazard Area [C/C(93) ) . Sf/t i �LJ1J. . -a ' TOWN OF SOi17f+OLD �h T. Terry Southold Town Clerk August 25, 1993 APPLICATION #_ PAGE 1 of 4 TOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be riled out in duplicate. SECTION 1: GENERAL PROVISIONS (APPLICANT to read and sign): 1. No work may start until a permit is issued. 2. The permit may be revoked if any false statements are made herein. 3. If revoked, all work must cease until permit is 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 reasonable inspections required to verify compliance. S. I,THE APPLICANT,CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO /" THIS APPLICATION ARE, TO THE BEST OF MY KNOWLEDGE, TRUE AND ACCURATE. �7 �--t..vrPLICANT'S SIGNATURE) l "tet°1� U� ' �$�"^' k- DATE 11T S / ✓fSECTION 2: PROPOSED DEVELOPMENT (To be completed 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 STRUCTURE TYPE ❑ New Structure ❑ Residential (1-4 Family) ❑ Addition ❑ Residential (More than 4 Family) ❑ Alteration ❑ Non-residential (Floodproofing? ❑ Yes) ❑ Relocation ❑ Combined Use (Residential & Commercial) ❑ Demolition ❑ Manufactured (Mobile) Home (In Manu- ❑ Replacement factured Home Park? ❑ Yes) ESTIMATED COST OF PROJECT $ B. 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 ❑ 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 (Notify the 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: ❑ 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 anchoring structures,proposed elevation of lowest floor(including basement), types of water resistant materials used below the fust floor,details of floodproofing of utilities located below the fust 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 must 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). ❑ Floodprooflng protection level (uon-residential only) Ft. NGVD (MSL). For floodproofed structures, applicant must attach certification from registered engineer or architect. ❑ Certification from a registered engineer that the proposed activity in a regulatory floodway will not result in any increase in the height of the 100-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 DATE If BOX A is checked, the Local Administrator may issue a Development Permit upon payment of designated fee. If SOX B is checked, the Local Administrator will 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. APPLICATION # _ PAGE 4 OF 4 APPEALS: Appealed to Board of Appeals? O Yes O No Hearing date:_ Appeals Board Decision --- Approved? O Yes O No Conditions SECTION 6: AS-BUILT ELEVATIONS (To be submitted by APPLICANT before Certificate 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 surveyor (or attach a certification to this application). Complete 1 or 2 below. 1. Actual (As-Built) Elevation of the top of the lowest floor, including basement (in Coastal High 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 floodproofmg protection is Ff. 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 completed by 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? DYES ONO DATE BY DEFICIENCIES? DYES ONO DATE BY DEFICIENCIES? DYES ONO SECTION 8: CERTIFICATE OF COMPLIANCE(To be completed by LOCAL ADMINISTRATOR,) Certificate of Compliance issued: DATE: BY: Attachment B SAMPLE CERTIFICATE OF COMPLIANCE for Development in a Special Flood Hazard Area TOWN OF SOUTHOLD 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: O NEW BUILDING 0 EXISTING BUILDING ❑ VACANT LAND THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: A. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW #_, 19 SIGNED: DATED: B. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19_1 AS MODIFIED BY VARIANCE # DATED ' SIGNED: DATED: C/C(93) t3%D LA&40 %C* y1. 0 LEW, A. A T 5o SOUND BEACH DoVE =BE12 CORO .L - 0 1 52 00 E. 50, rATJN�ET C41VE live QkAv'EL KA LE,-Klj 0 0 AREA:7�C�3SF O'Nu HEW at L WWO ?CH. via 'Tt MAP OF Pr2QEE t LLVLNgS orlc-e (17) ui MATT)TUCk- MI is TDWN OF GOOTHOL.0 NY, S.52 Q0 50.0 U thin �su"' In].a n R�014YMAP!1000-99-4-?� Eloollon 730 ele.W,k M. Lax.flon c:Plqs Of this survey map not bear"If JI the land surmyDesinkod seat or o-3y to the person forwhand the survey It pimated.and on his behalf to ft VI;,,cmpany,governmental ager ,S,1v ,ig WSW,di.i,11s:Gd 110M.6 I'd I, as otoG Cd IIL Ito,""2 u.rItf�I t NOTE! T. I R?Ayi�L) OC WTNO`5,,,REFE-U TO MAP OF CAPT. 0 PV 'A RODEP 1CW VAN TUYL PC A —LE 6 THE 14PTATeS71 tIFM -61" APNO,1672, d, W. HOMEOWNERS POLICY PAWTUCKF,T MUTUAL INSURANCE COMPANY 25 MAPLE STREET POLICY #: HX31 -347561 -09 PAWTUCKET, RI 02860.2104 EFFECTIVE DATE: 1/09/1997 MUTUAL COMPANY of I1i5�7N •;� 1+IM!M1FIh+kp ".I; NON-ASSESSABLEPOLtCY AMENDED POLICY CONTRACT Incorporated 1848 ADDRESS & POLICY FORM CHANGED, COVERAGES "A-E" & DEDUCTIBLE N GEORGE GUS *LIVANOS INCREASED, HO 216 ALARM CR. & s MADELINE *LIVANOS, H/W HO 290 REPL COST CONTENT ADDED U 208-12 30TH AVENUE R BAYSIDE, NY 11360-0000 E Agent: D 01305 D ( J'_II BRISOTTI & SILKWORTH INC. 8400 MAIN ROAD P. 0. BOX 1448 d',._.. MATTITUCK, NY 11952-0925 Customer#: 000027899 N --- Phone: (516) 298-4747 TOTAL POLICY PREMIUM $524 . 00 ENDORSEMENT PREMIUM $57 .00 4A) II)k,g'A7 pp bb�� oo yy atthe Q 4 S7. 17 SOUND BEACH DRIVESe CAPT r KIDDIE3T -Y,s MATT I UCK NY 1e952dress unless otherwise stated: rll p;tRl W11i pf,,;;,1�I91#ItK i l 11 ,1 IIS It1 li rfY Czs tIF9 111V 11f �+b�ltd 11yWlttf 4lf�M1{�IF 1., pMdAY1NtY lh,l.l,l POLICY PER�IODp from 7/02/1996to 7/02/1997 at 12:01 AM Standard Time at the Residence Premises. k`nl i':#pl, 1. ±� I .,•;, 1.. li 9i to IlhKill $Ini'go"i4H0,1101:11 is i I!I14', 11 •ry,•a A. DWELLING $120,000.00 $544.00 B. OTHERSTRUCTURES $123000.00 C. PERSONAL PROPERTY $60,000.00 D. LOSS OF USE §24,000.00 i fi I.. r qhw rrial kkl 11 \lI(k5 J �'l ok,,u. I( Xyll^l •,w3§ I, •^rP��,.:y. A I' +it k iu'I"Il�i"'r4 u.. �j yl D hII SIV Irl 1 k ^l4y IV >Ik P �''I r\� gll"gh,,n Rl 'y�.� I�lyhi�l!�!.'rl ,1,�•oJI'1A'� H yt .^ Ih'F54\i li 112P ALL PERILS $500.00 WINDSTORM THEFT 1 k lllr Fl I l ,'ll;'I Ill IL�WJ11=e4 1AI�kl yi.41 �. 1 ,yy 14 h" ICllk k 4.0 1 l ij1 a 11r �' FPi�4.l I1 t1.p 1 ry1'I; , § IpllrH tiJ'kh l� ya+� y� g IPI I ^ .ht t IIS 1 141 I � A� :i. , '. Isl rrn I � �AYI'IMJ�r's • ..� 4J17•k{b,l ,rt t,:a 1� , ,71 ,1 .,a lu,,,.•I kll IA � t III I ;�11 I E. PERSONAL LIABILITY $300)000 .00 J Each Occurrence F. MEDICAL PAYMENTS TO OTHERS $15000.00 Each Person Forms,Endorsements,and Exceptions to Conditions following Rage f this policy at time of issuance are prin1/22/199 DATE SIGNED YAUTH EDREPRESEN THE Page 1 of 2 IID. VIIIIIIIIIIIIIeode2ldeed11lv . 110.m"IIIIunasialPTHPDI MEMORANDUM COPY PAWTUCKET MUTUAL INSURANCE COMPANY HOMEOWNERS POLICY POLICY #: HX31 -347561 -09 MEMOMUTUAL COMPANY NON-ASSESSABLE POLICY Incorporated 1848 0,llvl"!wwlWOW "'.!l HO 3 0484 HOMEOWNERS 3 SPECIAL FORM $ N/C HO 300 0892 SPECIAL PROVISIONS - NEW YORK N/C HO 322 0985 DAY CARE- NO SECTION II & LIMITED SECTION I COVERAGE N/C HO 350 0987 SUPPLEMENTAL PROVISIONS N/C PMI 101 0485 COVERAGE B - APPURTENANT STRUCTURE LIMIT ADDED TO COVERAGE A N/C HO 216 0484 PREMISES ALARM OR FIRE PROTECTION SYSTEM 11 .00 CR HO 290 0187 PERSONAL PROPERTY REPLACEMENT COST 54.00 HO 295 0484 OFF PREMISES THEFT EXCLUSION - NEW YORK N/C HIGHER DEDUCTIBLE CREDIT 54.00 CR HO 90 0986 WORKERS COMPENSATION-CERTAIN RESIDENCE EMPLOYEES-NY 3.00 INCREASED SECTION II LIABILITY 16.00 RENEWAL CREDIT 28.00 CR TOTAL ADDITIONAL PREMIUMS AND CREDITS $ 20.00 CR BASIC PREMIUM (From Page 1) $ 544.00 TOTAL POLICY PREMIUM $ 524.00 Up 1901 FRAME, I FOILY DWELLING, PRIMARY RESIDENCE, FIRE DISTRICT MATTITUCK PROTECTION CLASS( , MORE THAN 1000 FT. TO HYDRANT, LESS THAN 5 MI. TO FIRE STATION _ TERRITORY QDF 46 PTDQT INSURED DATE' 07/0918A FD CODE 4A4A MORTGAGEE(S): 1 ) ESTATE OF THEOFANIS KYVERNITIS-390 SOUND BEACH DRIVE, MATTITUCK, NY 11952 ADDITIONAL MESSAGES: CHANGES WERE MADE TO YOUR HOMEOWNERS POLICY Page 2 of 2 PTHPD2 MEMORANDUM COPY reel $6.01 0*03IM09.651W ONO HOU76110901309 rR :r .34 q{ gNy��Ytr' i Y C 1'K l C f it *+`f ��Ve t ' i3 br i jt K 51'1, g�� ivl' kv` V�'i b+Yc4�g��` ( ��+a•d% i'! � a i � - u�< 't +e !/ ( bsgk $a`. Moo F 's�j ytkt9 qxe f '�A,Y,'n�U�Px t- } � ; F 3C1) 2 1GI R`(ltl�I °�f�llr( Ali 6 zttq1q , 'Ar jwLT PRiy w ,� x �t it, " tXNf All �}C h ��1�� dy E,Z✓t r 5 )�� h ! ci. s t,Ri u t T P M n S a �+Rta� 4 y y ''�� 1 1 l Y F'" ;�, 2 � may. ♦ ' � F,�'�,y�r }�� } r �II4` j f I I UCI&I lowR � 1 ��1�1 E } kir h jL ttyl n d � k, 1 1000 /�� 4,p,; it- r r i c ,11115 V�� dit � ei � it . . NOS.'I��F�I��?�MehP t�F' � r1�'T, !�'��te t � (�t)[)(�I21r1! 1JAP�# rn yrwp d 1 rte+ V014r IJ* t/`c` THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1000314 BUREAU OF ELECTRICITY F 40 FULTON STREET, NEW YORK, NY 10038 Date NOVEMBER 16,1998 Application No. on file 14704197/97 N 471665 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of GUS LIVANOS, INLET DRIVE, POLE 8 5, HATTITUCK, NY in the following location; ® Basement ❑ Ist Fl. ® 2nd Fl. GAR/ATTIC/OUT Section Block Lot - was examined on NOXIE14BER 11,1998 and found to be in compliance with the National Electrical Code. FIXTURE RECEPTACLES SWITCHESFIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT FLUORESCENT I OTHER I AMT. I K.W. I AMT. I K.W. AMT. I K.W. AMT. I K.W. AMT. I H.P. 26 1 126 28 26 ;77 DRYERSFURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. SYSTEMS AMT. WAITS NO.OF FEET 3 F 2 — SERVICE DISCONNECT NO,OF S E R V I C E - METER NO.OF CC COND. AWG. A.W G. AMT. AMP. TYPE E6UIP. 1 0 2W 1 0 3W 3 0 3W 3 0 4W PER 0 OF CC.CONO NO.OF HI-LEG OF HILEG NO.OF NEUTRALS OF NEUTRAL 1 200 CES OTHER APPARATUS: WIRL POOL TUB--1 PADDLE FATN_F.-3 3 1/2 TON AIR CONDITION-1 PANELBOARDS:1-•13 CTR. 100 G.F.C.T:-8 SMOKE DETECTOR:-4 B.J.ELEC. CO. GENERAL MANAGER BOX 16,STILLWATER AVE. �\ CUTCI{OGUE, NY, 11935 Eper This certificate must not be altered In any manner; return to the office of the Board If Incorrect. Inspectors may be Id¢Qtlfled by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BF, ALTERED IN ANY MANNER. BOARD OF NRAU111 . . . . . . . . . . . . . . . PORN No. 1 J SETS OF PLANS . . . . . . . . . . . . . . . _ TOWN OF SOUT110M) Si1RVEY .5 . . . . . . . . . . . . . . . . . . . . . . J U U iCK . . . . . . . ::: : : :: :: :: ::::: ::RI MING DEPARTMENT C TOWN HALL FRCTIc PORN . f �R�il ti011'I'1I01.0, N.Y . 11971 if m ��Q.W�•GH"f' �h hbl CALK _ j p I'yucatbn 1 :..s'r' .� permit �Apt)rwetl I lermuC Ntr. ) ��y.� NAii. 1'0: . . . . . . . . . . .�. . . . . . . r�k1..... r...., 1 . 4 $vv 07� IIS.. 093 to Ig S.. .... ..... ..-...�.f�..i........... u,-�,.,.,1...._..,.. ..e L'LOG. OG4'T .......�........�.................. Dirsappn(rve<I a/c ................................. I'{)tn/a: OF . ^' ('1 tilling Inspector) API' . ;A'1')ON 1'OIt 111I11.U1NG PIr.RMI'I' Q'7 Date.1�.� 1. . . . . . . . . , 19(1. . 1 NSTRUC1'I ONO a. 'Jilin nppaliention uatnt Its cogileteiy .filled in Ly lypmariror or In ink and sul>tmitted to lite lAtilding Inspector with l Sets of: plans, accurate plot plan to scale. Pee accordial, to schedule. h. Plot plan showing location of lot mxl of Imildings on preoisen, relationship to adjoining premises or imblic streets or arena, and giving a detailed description of layrxat: of property must be drmma (nit the diagram which is part: of this abpalicalion. c. 'lite work covered by this application vvty not, Ile costetx:ed before issuance of. Iuilding Permit. d. Upon approval of this slprlication, the IAauldmg Inspector will isme a lAtilding Permit to the applicant. Such lennit shalt be kept on the premises available for iorpection thrxigltaat the wrtrk. . e, No Ixdlding shall be occupied or uned litrltobe or in part for any purpose whatever until a Certificate of occupancy shall have leen granted by Lite Building Inspector. A11113C/VI NI 15 11I;111111Y HNIM to the )Atilding DeporlwnL for the inmtnnce of n Milling 1'er'mit purmmnt to Lite Building Zone Ordinance of Lite 'i'rxan of Southold, %iFrolk 0xmty, Net; York, and other applicable laws, Ordinances or Regulations, for Lite const:rnedon of Ixaildings, wMiLims or alterations, or for rettoval or dertxrlition, as herein described. ills applicant agrees to comply with all applicable laws, ordinattcen, building code, lttxusing code, and regnintions, six] to admit auliwrized inspectors on preatisea and in Ixtilding for necessary inspections. . `1 ` (Signature of Applicant, or nate., if a�corporat i0n) lc/ /V (MtiIing m1drenn of applicant) r ila a wlte 1 r applicant is agent, uwner, leasee, orchilect, engineer, genernt contractor, electrician, pludrer or Ixailder. u� i �-............. ....................................................................:4................. Mxme of: Satter of prenlaes ..Gu ( Vrt.t'1.o.s ............. ..... . ................................................................ (as on the tax roll or latest deed) If apptlIcant is a corlxarstion,.aignaahne of dulY aulborized officer. ......................................................... (Mmie and title of corporate officer) Rnilders License No. .�/. �y...:!.!... Pludera License No. ......................... Electricians License No. ..................... Other Tuxle's license No. .................. I. Location of land on whtidt proposed work will be dome.... .. . ..�..I�..�.......Ov ... . .,eR.L. . (:P v ...i ..... a. '�i t! .1C .....�U'.y''........................................................ house N'ni)erSCreeCHarlet Cxinty Tax Map No. 1000 Section ....!(�.1p......... ]Nock ...I............ int .......... Sulxlivislon ......:............................... Piled PUtp No. ............... Int .:......;:..... (Nage) / 2. State existing use six] occapanxy of precise.^, and innttenxled use and occullsx�y of: proposed construction: n. 6xi9tittg use and rx:cnputtx:y ..:!F I,h ci 1�. .. T�Y`/.....r' ....... . ... ............ .................................. b. Inleaxled use and occupancy ...TwR S t� 2................ . N 1 R (11: ,lwu {xf ,k (ol xfek Id,ichlallld irublu): IAa, Iw,i ldlug ..... ... . . lvklll ion .,. ....,, , j.Ilt/3l�_ul lon'i.;'.�.... ... . IGllx,ir ............ Ita„ovol ��, ..:....... . .. Ikalrlli1.loll ... ...... . .. OIliac Ika k ... ...... ........ .......... . .. .. .. Uklac�r-�l>Ill�rh •:-°� It.1 I: LI, aIWteit Guic :?. . ...... I ....: ... .. ,i} 117 !� ;f:u'. .:.... ........... ... ... ..... .................. Ino Ix: loud oo flling Ibla applicalloxo) !i. If oAxallnq, ,xnlx:r of o1ael1 Inly units ..fir•:;{. .,"`!. Ilwlxfr of LhxII Ina {ma itox, aach floor .... . . ...... . ... Iflyuruga, Ixnl,ur of caro ...... .. ....... ..... ... . . .. .. ... . .. . 6. If IxtallxaH, ourmlfarpial or 14,ixel mcolwlwy, wiclfy a@nlwra ,,,xl axtanl of eurh lylxf of wise... .... . ...... .. . .. ... ' 1S :loran, If ally: huxlt.H.o,�.s. ... ... . Ilam '.�. j U ). ❑iux.nolrxu, of exluch, acnrf / ... ..... Ikfpth .... .... . ...... (linrfuuirxla of .... dlnMUrr,�..., Rull,ar of ,it or!an ..... J. .. ..... . .... o Willi r Ittir"�{{axon or ,xA,it'innH: lion(: .Z'0', •1^.... IG:ar ..Z.��.'� ...... Willis ............ 1kalyiu: f35l�... Mahar of lylurinn ..��......... Il. Ilhlxa,aloxlfi pf entire slow e(7Wil'o(AArxl: FfOol ?!v:.�7.. .. . . Riser 2'78 .. ... ... balsill 3 .. . . .. ..... .. . Wilyhl: ..........I......... N,ulxfr of Him iall . .... .... . . . .. .: .. .. . I), Hi4a of loft Verrone .....:.I, .... ...... . . Maar ....... .... .. .. ... .. Dolls .................... Ill. Ik,le of 11,roJwae ..........�,...... ..... ILnr: of 14nur:r fkV,x:r .. ... .... . . .........:...... ..... . ... .... IIor uue dlalrlcc In wltl4:h u primilua nru all wated ..... ..... . ... •. ...... .....,........ ... ..,...,.. ..... . ... .. ... . l+x x. � 12. Wall prnlxlaed Cnwatllx:Ll(xl ylolml'a ally laxnioll law, ordlnnoce or ludoluclont ..,,............... ..... Ilwill lot: 1x7 relyrail L(I L............• VIII axrana PIII 1x7 romr,ved from pr"M mea: YES 14. 1k,nx.0 of O.Vlxlr of. pmaltxaa 4h IV�..7t��nR�d,C�l,h ..... MAheao J7.. 5(]VND ycvC(i (�V: 1'llood M). )4f.&.jTX1 N,wxf of Architec:4 1:... K„'.:\ .t...0... .. A1AlIL'HII t�C„w ., 111o,w tJn.y.. y .N;n�e of 1.onrra<:tor� I^'1'l tJ � � r �� !� 06 h� �',�8. ”. ..... �?� 5.. ....... Ailklraau .��.Rl .(y2.2�. �Pv � .:...mode Il•.776j'.11.0 la this prollerty within 300, feat of a 1:111al watialxl't x Yf1i . U) *Il+ YES, fXXIII1(1111 'ICAM 'I1Ul llifli l'IEI41I.1' IIAY IA.. kCSS +katl 3.04)' ¢pew Suvwc{, PLOT MAGRAH Irx:fica elearly,iaxl dificilx:fly all Ixrll(liolla, rd,elhar exffifioly or prolxlaed, rail IndlCaCe, all fief-back dl,reouiona frnn pu,lx rl'y ll,xa. OivE utreata ulxl ,blrx:k 111411wr or deficrilli loo accnrdinil fo lkad, and allow utreel naoen find (rxlival'e {d,alhor lo(arior or corrxlr loc. ISI t I r nil ' 51A'Ili lMr tJI:1J MGC, �� t71XIN1Y lMr �?� � f �^,...• � /� . (Nalrl u1 i,xlividwal alllnlul lr C/ ! " • "• 'lallog duly lxxw'n, dlawaea anon anya that: ho IH this applicant: „ncl.) ,dxwu uulV:d, IA6fu Ila ...... ...... ....... ....... ........ .......... . . ... .. (lkn Nn'Hclnr a assn:, corlx,rola officer, enc.) of maid mlor or tmoord, taxi III ololy nwlhorim.Yl u, lxrloom nr hnvo lxw'1'ooloil Il,e assist wollr a,xl In 11Vnka aril fila Ihin ,q,plir:al.ian; th,d: all alrltaiiit?aON ;pminirual In lltia application era tax: la lite !stall: of lila klwwledllol mol fxlliaf; rail that, ilia work will 1x7 perfoluiutl Ill% 1110 mamnxfr' met. I'Mil, ill Ilia applicnflun 111CA (herewith, tAx,n, to� I//xl``fnra ury Ihlfi q � 65 r 1... .. .day o�U.I hYFr.l.. ...., ELIZABETH sl NN h1EVII.l.E (tlll;oniwa (il Appllruul ) ((� No4my PlAblic,SUAP 06 No'- "mom El em"m PLUMBER CERTIFICATION OCCUPANCY OR (' ON LEAD CONTENT BEFORE USE IS UNLAWFUL k7 ` CERTIFICATE OF OCCUPANCY WITHOUT CERTIFICATE AAPPPRRO�ED AS NOTED SOLDER USED IN WATER OF OCCUPANCY OAT E:`/ -eROFOR T_ SUPPLY SYSTEM CANNOT FEE: A e - EXCEED 2/10 O/ 1% LEAD. NOTIFY BUILDING DEP 766-180'2 9 AM TO 4 l`Cl RNNIDNE-0ETECTINB FOLLOWING INSPECTIONS: AMU DES 1. FOUNDATION - TWO REQUIRED O FOR POURED CONCRETE R capper tubing is used ASIOML72LI 2. ROUGH - FRAMING & PLUMBING for water distributing N.1<SW NNOCOOE 3. :NSULATION o m aYetenl; piping shell be 4. FINAL - CONSTRUCTION MUST Of types K or L only BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET _ THE REQUIREMENTS OF THE N.Y. PLUMBING FU NNEANO-MALOAND/OR STATE CONSTRUCTION & ENERGY ALL PLUMBING WASTE 11411mramm, no CODES. NOT RESPONSIBLE FOR &WATER LINES NEED 0 Is mieMKwo(K) I DESIGN OR CONSTRUCTION ERRORS TESTING BEFORE COVERING /66 r 'w MFr T1 Lir 2ca�v- S 1- 'q Ic Q IL � ' � 7 W n n � yyCC .11 Aq 0 n Y J , r. Y .+ I L N G+ eySSf 7T Ir�10, t UnTI - Stop NEW), , " 5tiQ'�NGE . TLS*p LII e f a' ' � Opq�FES510NP� 1 - q ..,xu.vFY.�-..w.,�_. -_... ._ m . ,- xT .S� t r r "ING 4F4 gry P? w lith - T�1R :��yiSrT ' aki � ., I F1. � (� , ,� ��. .� 2'trynSG�`O`Xit r ,� � �qy �*-;s�� _-,. ,� ��•-'`. �: � ,.y FZ 17 TI , Poll od j y r s �I _ - .. �AAFEOSIOPW NP� i 37 - -, ,, �3.? ,, .e,. .. - .. •,, 1 t ..d h ee-t:r 'x _ ,. �:- i:;li.,�rtix m.�, 'h.:°. .Y �.r d `.�'-•sJt �.� 4. , .,�Ys E}_. .. . L _ J.u,. g r 5� i } I• CD - x ar y , It AN s�a�r as t¢�,to icrc t.. AlI 4 xJ r j 21 r ' 4 is 1}�i l�i1JM J OF NEW -- .� 032250.1 Ess 0A _ a � .., "„ .v.r, rti"_. 1 Y �� ..r, i�" .4. � � ,a' v� 1 - �'rm .�' ,-air➢ :r� ..r• 5, 2w{� " nPr12a 2iclo' +r- t2° 1th� Io'GG /atl Cort Pp, ML ?P� f✓11C{4IS � " ME '-T11L 126Lf3' f�K: 9R /ZVIOYela+a x aFte erc�A-_ I QVI LI�u Q ? Ira � r�9I«qi �+J > erIto'mN"a,c- 10 " q tr 2ic[o " ®, Ito, Qc ''Gr rLYWa�I� Ate+ I¢ r -I�i Ira e �ou Leo- mall t�arvi� FlooK'- o „7C q�2° GPI '05 G1)1Co"G'Cw M. 11£ Don' P P[J:� f(2" SU13 FLoc e- SCk fn k WA :°. I "k "x5'/ "E 4PY 25>� 7Crt QG, - � ,^` '' '* a SFLF- Q'Pkll�.frtl�N,'u 'f�►.rsYR. � paC7F -M .Ql>t.1>~ - � 'pf . (" C TP !S Mars"TRed7y {-'iTu 4 _ t - - - o . . G i IV gra ILP OOC to"12 po y� J !R' I y DoE NEW J, r � - s _ .. .. O 322544 V IL qi - pq�FE3510NP 1 I W 3 _ no flu ' p. t iA TO ttwur�Tr� --- - u * � �� SF'E � � {" I � I �`JI C.Cf•�'F_f21�1� P.2�L=¢G'� I I 1:41,4p'11511 I - I,41 61Go°0 C7 5, c I 'J �'4xlllyRtz,N _ — �3� 'Yaxl'I Ru�u k x I k " - GtnS .t - g 4K4 oQ -..2 cu ti ¢- to idry 2 s�lC riYa P 4, - >n �Tr, ?017&'( �aTO µ06I ON 6.. ' y f19 m 3 _a BO5f ✓L-2xl Of D... �- + - - � - - -- - - ,6-°S. F,�° - �_ �.\� _ �}�iSi NFI•GI U o '30 C?'►X.iC � � 1 I lee L j2 j ®Ivry I m y _ r C9 ��y�� C AL1 �e Q-QkIQ� - - J 9 54 r-la oe 4 G a , _VT d� � � D 3 OdC •� � - a �� N , a 12-ex'i-pcl 12 li� 6106 U 2-CVr4j46SN— ,C( � �e — 004l�3 �I - 1 c <a•6t-� �q. "c�ivn S�oF NEW . �1F'Q NGE TGTi'(' W is r w W m � F 0322594 @� pR�FESSWNQ• �_.. �t „yr I a u (] uj, , k a T I % + 7r del U"OG AL 14 v e4a r X �jj f (,V OkM 4 904W 4N ,r 43 ......1 04 4 5lip Ito 4101- lee MZ 1 r. !rm 17 L 61, fK % P , p�- cv Ate- A PROIDE OPENINGS FOR of N8W EMER Gf NCY ESCAPE AS REQUIRED BY PART. 714 OF N.Y. STATE BUILDING'CODE. PROVIDE OPENINGS FOR EMERGENCY ESCAPE AS op 032254-1 REQUIRED By PART. 714 OF gOFEsswNP N.Y. STATE BUILDING CODE. 0 A A"