HomeMy WebLinkAbout23688-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-25021 Date MAY 6, 1997
THIS CERTIFIES that the building ACCESSORY
Location of Property 4960 HORTONS LANE SOUTHOLD, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 54 Block 3 Lot 21.4
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 29, 1996 pursuant to which
Building Permit No. 23688-Z dated SEPTEMBER 19, 1996
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 ACCESSORY INGROUND SWIMMING POOL WITH FENCE TO CODE IN
REQUIRED READ YARD AS APPLIED FOR.
The certificate is issued to CHRISTOS & CHRISTINA VERVENIOTIS
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-403788 - NOVEMBER 21, 1996
PLUMBERS CERTIFICATION DATED N/A
Bui ding Inspe 110r
Rev. 1/81
FORM NO. 3
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)
N? 23688 Z Date .. . ....l...f......................
Permission is hereby grante
�-lqlrae
.. .,�.�... ... .. .... . .. .................. .....
..... . .. .............. ................ .: � '
. ....: .... .... ...
. ,, .. . . . . . . . . . ..............
...................
., -
at premises located at ............................ .... ...�p..��.... .. .... ..............................
............................................................... ..,-?�✓f7.... t . .........................................................
..................................................................................................................................................................
County Tax Map No. 1000 Section ....=K...... Block .........�2....... Lot No. .. ,l.... .....
pursuant to application dated ...................... .. OZ., 19...1.$'A'?and approved by the
Building Inspector.
Fee S••F••��C.<.. .....�
.... . . ...................:. .... .............. ....... .................
Bwlding Inspec r
Rev. 6/30/80
Form No. 6
jr TOWN OF SOUTHOLD
i 2 O BUILDING DEPARTMENT
_ . TOWN HALL
765-1802 t � �
"--'APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. 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 of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of 1% lead.
s,. 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.
B. 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.
C. Fees
1 . 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 S50.00.
2. Certificate of Occupancy on Pre-existing Building - $100.00
3. Copy of Certificate of Occupancy - .25¢.
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date . . . . .9. . . . . . . . . . . . . . . . . . . . . . . . . . .
New Construction. [: . . . . Old Or Pre-existing Building. . . . . . . . . . . . . . . . .
Location of Property. . . . .�.�.v . J7 D Q70I. . . . . . . Al.. . . . . . . . . . . .. . ®L�. . . . . . . . . . . . . . . . . . .
House No. Street Hamlet
Onwer or Owners of Property. .. . .. .. . . . �.�./lZI S'T/.s✓f�. . . .Y�f?(i L '/ 10 i 5. . . . . . . . . . . . . .
County Tax Map No 1000, Section. . . . . . .?.`.� . . .Block. . . . . . . . . . . . .Lot. . . :3 .1 . a.l.� . . . . . . . . .
Subdivision. . . . .c.. .p./. . . . . . . . . . . . . . . . . . . . . . . . . . . .Filled Map. . . . . . . . . . . .
'Lot. . . . . . . . . . . . . . . . . . . . . .
Permit No. 3�.�? .a .Z. . .Date Of Permit. . /��/% . . . .Applicant. 07J71!s)0 x P) (A'!?.
HealthDept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . .
Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . .
Request for: Temporary llCertificate. . . . . . . . . . . Final Certicate. . . . . . . . . . .
Fee Submitted: $. . . . . .?S' . . . . . . . . . . . . . . . . . . .
testi ' APPLICAN
II rl,�,..11l 1!t, � �„ ,111`IiI_.�g1'�+,�f1=l3l-'^i”{ilii.-.�- ..,.{�I.,. SII(,..;.!i I�I.':��,� Tyy�► tll ..#i�111�—�—'��� 1=11='1 I .}1l=) Nt=111_:! ��� 7
t i�li �+ ~' �• i.`, 1_.II. ..##I�:i+11�1itl l`l.:
E11 NEIN, YQ . SITFROARDj�OFI�I�i�� 1,-.1ND��R, R� 'ERt11 f'1185077 1;Eli sl! 111=lil ,j1tl lli=i(( .III IIS-!!1 ?'1-;
' 1 �[?i:,_,,.BUREAU OF ELECTRIC' �hL YI}? 114. illw{{Mme ; ill X111=1iI aIIM41 ill.:.+is i! .. ,1;.; I,.
! 11 ill IM i,l II BSI:JQ N, STREET, NEW,-YOA "i' .p38111=111 =�Ii1=;11=Ii
�... +1� �=?' I1,10 mil=-� I I til, , i i
1 lil..
? is Date >n a NQ A licat(on'No.;u►i'' i(p ?I{ i �6:I � �Ik�1iUll��lll� III ! 7 J1Y1„ Iljli I° 11111:
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iTHIS ,CERTIFIES ';i111
'. ;1-
only the electric.!equip eo w described below t4 introduced by the applkagtl 0 i nl Rl,,?..,,II IiI -ill 111111 Il jli t,'
!. a ePPI Atb ;fi4+lab rtn the premiaef of
-11>ee{I 11f Ii, it Ill Ill=p1-111=1 -i1i-111 i' I f' i' I . ,+i
sCHRIS'NERENIO ; +,,�- .,!
�, ' 111 L�111= :111 1"I Ilf�lil==Ill-�111�11l=Iii
x. 149060 HORTONS iat+AN', SQUTHOLA,'I:N '1=ifi 111- dN ril {l# 111 I -IiI-til=ill Tll=1511=
f t Ij) �jxr�lif lil�lll"=;lL 111 ill_11f 1'1_11=II1
in the fo(lotrtng locotion; ;y O;Basement'I"' (s Fl �]:Ynd Fl Ilf..lil I,�t{u�l Ill,:$lock 'ij? !. Lot s+ 1'I
fl. IHI cl�l �l) III=111-11f.^Itl (l-,+,i: tll' !I
.was examined on NOVFI�BER 1$,1996{! ill li' nand found to be to coat llama w l thdll� nal Elea 'cal.Cods
;• SLI iiln,li, 4; EI ,i.;111 rti13 111„ l Piz 11...1:111 l i Ilt"I� III= ;1 f ill {(� Ill!iil IPl i1 111 it
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FIXTURE 1" "I`° 'E+ '°" ��RXiURES "� RANGES Ill ;CO1 1fi S --ii'OV NS ! i DISHWASHERS 'EXHAUST°FANS
OUTLETS s IICNTActs SWITCHES: INCANDESCENT PIUORESCENT OTHER'EF1 "AMT:` 'Ei1K:W. w_S �", 1K.W{,7+-'AMT., ..,K:.W., '. ":AMT.'`' +"M.P."
T1111 1 jiiN � if- k.
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DRYERS '' FURNACE'MOTORS FUTURE APPUANC!'FEEDERS 5►ECIACRE TT ':TIME t1 ,� UNIT HEATERS' MULTI-OUTLET �DIMMERS
AMT. K.W. oft M.P. OAS 1. M.P. AMT,` ::" NO. -1i A.W.0. AMT.' :C AMP,. i1AMT'i ANSi j FAM,;{_i ,M P.,;I'NO.ST FILET II AMT. ` ,WATTS''
1 F 2 20
SERVICE DISCONNECT NO.OFS E R VV , " I" C „ E
METER _ _
.` ,+ + AM►:. TYPE ' EOUI► 1,8`nv 1 jr 3W /SW 7X♦W ,: ERC.!' D .1•; CC OND 1' NOt(Dt:'MI-lEC T...Of MWI lEb'�! ai NEUTRAUi
' AMT..
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OTNER APPARATUS: A.
777: :r
SWIMMING POOL-1
TIME CLOCK-AMP.40-1
G.F.C.I-1
*(SWIMMING POOL) This certificate
covers compliance at' the`date of
inspegtion only.' Because of unusual
--6nvironments, it is advisable to
have frequent test/and or repairs
made,,by a qualified person.
J
<<< Continued on Page 2 >>>
GENERMI MANAGER
Azao'Per
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may fbe identified by their credentials.
ll, l 'THE NEW ' YORK , BOARD 'OF FIRE UNDERWRITERS PACE:2
'1185077 " I%I
BUREAU OF ELECTRICITY
,.
I' 85 MORN STREET NEW YORK NY „10038
r
Date ' I ' NOVEMBEIR ,21,1996Appultcation No.on file_ 12843296/96 N;403788
THIS CEeRTIF1ES'THAT u
only the electrical equipment as described below,and introduced by the applicant named on the above application number in the premises of
I• ,, ii� Ill ,II r I,
CHRIS VERENIOTIS, �49060 �:HORTONS 'LANE, SOtlTHOLD, N.Y.
in the following location; ❑ Basement ❑ /st,Fl. ❑ Ynd Ft. OUT Section I ', Block Lot
was examined on NOVEMBER 18,1996 'and found to be in compliance with the National Electrical Code.
11
RXTURE. FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS '' RECEPTACLES SWITCHES INCANDESCENT FLUORESCENT OTHER AMT. " K.W. 1 AMT.' K.W. AML K.W AMT. K.W. AML H.P.
SII (. i f :w.�1 t t (d; '� f` r r,: I !1 � I I r•. r r j� f f� 11 11 I � �r I �:
DRYERS,"' ' ' I' FURNACE MOTORS' 'I' FUTURE APPUANCE FEEDERS SPECIAL REC'PT TIME CLOCKS SEL UNIT HEATERS MULTI-OUTLET DIMMERS
'AMT. K.W. II OIL' H.P. GAS H.P. AMT.' NO. A.W.G. AMT. !,AMP. +AMT.' TRANS. EMS
AMT. H.►. •NO.ST FEET AMT. WATTS
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SERVICE DISCONNECT, NO.'OFS -ni E+rrr�irrc :R y.:;.;' I C E
AMT. ..AMP; TypE METER 1�• 1 A 7W 3 X IW NO.Of CC.COND. A.W.G. plp,Of HI•lEG A.W G. NO. NEUTRALS A.W.G.
EQUIP. P R N Of C.COND. OF HIAEG OF NEUTRAL
I,.j.�
OTHER APPARATUS:
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76S-iso2
suiLDiNc DE".
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] I CATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY J
REMARKS: D� {�c-i c U
DATE � 17 INSPECTOR
BUILDING DEPT.
INSPECTION
[ j FOUNDATION IST [ ] ROUGH G.
[ ] FOUNDATION 2ND [ ] 1 CATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
L 41)
J
DATE o` INSPECTOR `,/
Xi
f 1 lil,l) I rr;;l'I C f ION Rlir'Olt 1' DATr (:UNHI;N I S
dW
F UI IIJI)A'I'i ON
FOUNDATION (2ND) t
Rf)111:11 PRAM?
r�1.U1nr 1 r►c II Q
1 N>III.AT I ON PEAt N• Y . E�1
STATE P.NP.RRY
1:0111?
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FI FIAT.
nun t•1 I ONAt. c c)rlcrl N► �`
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til
'd
FOnMNO. 1 • 3 SETS OF PLANS . . . . . . . . . .
TOWN OFSOUTHOLD Su RV EY . . . . . . . . . . . . . . . . . . .
BUILDING DEPARTMENT 1 C11GCK . . . . . . . . . . . . . . . . . . . .
AUG 2 9 ia�
TOWN HALL SEPTIC Folia . . . . . . . . . . . . . .
y4 SOUTHOLD, N.Y. 11971 tt OT 1 FY ;
f gLpG F� , TEL.: 765 1$02
.TOWN 0 OUT OLD: 9 ALL : .��3•y:• �` • • . . . .
Examined , 19 /. . MAIL TO :
Approved elf : ., 1#/ Permit No
. . . . . . . . . .
Disapproved a/c
i
(Building Inspector
PLICATION FOR BUILDING PERMIT
Date .. � . . ., 19"'96
► INS'T'RUCTIONS
a. 'I'liis 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
sliall be kept on the premises available for inspection throughout the work.
e. No buildingsliall 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, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections.
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Name of owner of premises .� r�� �v�-� . .4. � � �� �✓ ✓� 26
(as on the tax roll or latest deed)
If applicat t is a corporation, sigi tur of duly authorized officer.
errs-R . . . ! • f: . .
(Name and title of corporate officer)
Builder's License No. . .��j./.�J . /��-+ • • • • . • • •
Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . .
Electrician's License No. . . . . . . . . . . . . . . . . . . . . . .
Other Trade's License No. . . . . . . . . . . . . . . . . . . . . .
1 . Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . 0 °.u,5 / ! . . . . . . . . � � .. . . . . . . . . . . . . . . . .
Ilouse Number Street Hamlet
County Tax Map No. 1000 Section . . PZ?.7. . . . . . . . . Block : �s . : , : : . . Lot . , .�• . . • • . . • • • -
Subdivision % j�74}5 5. . . Filed Map No. . . . . . . . . ,'. . . . , Lot . . . . . . . . . . . . . . .
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction;
a. Existing use and occupancy . G?`. . . U?.`1. ./'?� .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Intended use and occupancy . . . Y . . � • ••'i � , : � v,1 `�'` �'
3. Nature of work (check which.applicable): New Building . . . . . . .
. . , Addition
Repair . . . . . . . . . . . . . . Removal . . . . , . , . Demolition . . . . ,Pti 'on . . . . . . . . . . `
. ..... .
. . . . Other Wor . Jl ,'mirt�nS `P>ro
(Description)
4. Estimated Cost . . . . , . . . . . . . . ... . . . . . . . . . . Feel�'�.c1U
(to be paid on filing tills application)
5. If dwelling,number of dwelling units . . . . . . . . . . . . . . . Number of dwelling units on each floor . , . . . . . . . . . .
If garage,number of cars ,
6. If business, commercial or mixed occupancy, specify nature and extent tof each type of use .
7. Dimensions of existing structures, if any: Front . . .'C1. . . . . . . . Rear . .,�D,j . . . . . . . . Depth . . . . . . . . . .
Height .11-01_1-1. . . . . . . , . , Number of Stories . . .cz? . . . .
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 j ' ' '
9. Size of lot: Front . . .5/5 . . . . . . . .
. . . . . . Rear . . lyloG ' . . . . . . . . . . . . . . . . . . � . . . . . .
10. Date of Purchase Depth �, �. . . • . . , . • • • , , , , ,
Nameof F.on er 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
• • •;�5• • • • • • • • • • . . . . . . . , . . . . WII1 excess fill be removed from premises: Yes
14. Name of Owner of premisesaw6&s. . . Address / ,?4 A%4-, -�"A Phone No. 74S7.
Name of Architect , , . , , . , Address . , . . Phone No.
At
, iaN ?cul , fit; .. . . , ,
Name of Contractor K Address`P,u,�x jc�Ac pilo a No. ,7,35!;.??c�L
15. Is this property within 300 feet of a tidal wetland? * " " '
Yes. . . . . . . .
* No. , . , . . .
If yea, Southold Town Trustees Permit may be required.
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 show street names and indicate whether
interior or corner lot.
dr
;TATE OF NEW YI S.S
:OE1NT OF . . . /.w.F�:1��.
. .C�!`r/.Tty . . . . . . . . . . . . . . . . . . . . . . . being duly sworn, deposes and says that he '
p y �s the applicant
(Name of individual signing contract)
hove named. _ L
le is the . . . . . . . . . . . . . . . . . 1���. ... . . . . . . . . . . . . . . . . . . . .
(Contractor, a ent, corporate officer, etc.)
if said owner or owners, and is duly aut ' ed to perform or have performed the said work and to make and file this
pplication; that all statements contained in this application are true to the best of his knowledge and belief;and that the
York will be performed in the manner set forth in the application filed therewith.
;worn to before me this
. . . . . . . .2:. , . ay of, . . . . . . 19
4otary Public, . . . . . . . . , , , County
fiUtitR`i�i�SCo
NOTARY PUBLIC,S to N.Y.
No.4725089.SuH Cou� " " " '`�- • • • • • • • • • • • • • • • •
Term Expires y 31. 19 (Signature of a1plicant)
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THE; RE0111ENT'S OF N Y a aia,
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Now
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VSUFFOLK CO. H p PT. APPROVAL
F SWEA 0oulm t 9(T OF fd 3m OCT 28 1ge�
— SINQU FAMILY OWELUNG Nd —
:t ' ATAw H.S. Kf,K0. xS--Q:W i
!n' The sewage disposal and wafer supply boililie6 for ft DEPT. OF
location have been inspected by this Oeparbwt and/or ft 1 INTgNTe
other1101011 and f tA—kAdd THE WATER SUPPLY AND SEWAGE DISPOSAL:.*
SYSTEMS FOR THIS . RESIDENCE WILL
f�hief of 4rreeu of Wastew& Management CONFORM TO THE STANDARDS OF THE
1 SUFFOLK CO. DEPT. OF HEALTH SERVICES
APPLICANT
SUFFOLK •
�y COUNTY DEPT.' . OF HEALTH .;
4 SERVICES — FOR APPROVAL 0
LL CONSTRUCTION ONLY
O ;'> DATE: I
r/ H. S. REF. NO.; BS-50-80
APPROVED:
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SUFFOLK CO. TAX MAP:DESIG.NATIQN: #`
`/ , it
DIST. SECT. BLOCK
FCL.
1 Z54
OWNERS ADDRESS:
..41:' W,
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..a.0-ALE -'60'9 14
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DEED:
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TEST HOLE STAMP
? of 1.119NsvY York Statc
•!:n lnw. .
LOAM
, '�Y�no!txtarinp
2 <. ogor's IraceG sae!a
' t not be consideru+d
t-C ✓P.T}+���—(c.k-f-:t�'iG �D Mf-:/'•.�.: �".�!"f'� f E iffy —.___.. .,, � s9��sh��t
i_,cc true copy.
.;sss indicet9.here-in sh.?,runt
7^lh;,nerson tar whom the sural ti
t•l`•'��� _ •.•J.end nn his l'v'h3if to tc;a 1 ".
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_ .. �,t�n 6re not tranz;trahie
• _f'sf'ft'AMENilE ,,)7AUG.7 2 nttitutic+ns or sut,""Uent
_
OCT14 198SEAL !
pF AiEy�
RODERICK VAN TUYL, P.C.
Irt,
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41
LICENSED LAND SURVEYORSv<S 25
GREENPORT NEW YORK ; i ~�L•�►v. Dsv
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