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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-24424 Date JUNE 12, 1996
THIS CERTIFIES that the building ACCESSORY
Location of Property 565 OLD MAIN ROAD MATTITUCK NY
House No. Street Hamlet
County Tax Map No. 1000 Section 122 Block 7 Lot 2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 25, 1995 pursuant to which
Building Permit No. 22695-Z dated APRIL 24, 1995
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 AN ACCESSORY BUILDING AS APPLIED FOR AND TO CONDITIONS OF
ZBA APPEAL #4303.
The certificate is issued to STANLEY FLISS JR.
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N354841 JUNE 13, 1995
PLUMBERS CERTIFICATION DATED N/A
t
ilding inspector
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)
Date 19.9.,!'
N2 22695 Z
Permission Is hereby granted to:
.
. ~...f.
........451t"rT. Y .
ce,
..0.................................
at premises located at..~ir.,
.
County Tax Map No. 1000 Section .,./•~..Z......... Block.......~~.,...,...... Lot No.
pursuanttoapplication dated.........'~4/?•.••.....•••.19 and approved by the
Building Inspector. 'y~/f~?®
Fee
ng Inspector
Rev. 6/30/80
~ Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL MN
765-1802
BLDG. DEPT.
TOwN nn Cni Mini D
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, Droperty 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 17 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. -
3. 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
1. Certificate of Occupancy - New dwelling 525.00, Additions to dwelling 525.00,
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 Buildins - $100.00
3. Copy of Certificate of Occupancy - .25s
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date .......~i
dew Construction.. X Old Or Pre-existing Building N~
,ocation of Property....S
House No..C Street Hamlet
)nwer or Owners of Property... J. C, , ...ell S .
'ounty Tax Map No 1000, Section ...l....... Block ...........Lot...
;ubdivision.....l!...............................Filed Map............ Lot......................
'ermi t No.. .uC.W q.-5. ZDate Of Permit. y/Q 9-./9.S .....Appli cant.~Znn ./p.~ Fl i.4i. Jb .
-iealth Dept. Approval ..........................Underwriters Approva'_..y...................
Tanning Board Approval..Y.'°5
request for: Temporary Certificate........... Final Certicate
-ee Submitted: $.O o U /
. /_V~r
Cruz _244. AP ~iGAri~
~OgOFFO(,~cp
o~O Gyp
w x
Town Hall, 53095 Main Road p • Fax (516) 765-1823
Telephone (516) 765-1802
P. 0. Box ewvork 9 11971
Southold, N
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
April 30, 1996
Mr. Stanley Fliss
565 Old Main Road
Laurel, NY 11948
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.
xx 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.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 22695-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
1\
1cLD i;:S. C:;UtJ II'J i Ii OaYMLNT° A~.
1. ~ In
FOUNDATION w (1st)
FOUNDATION (2nd)
2. T /lv qS _
z
0
ROUGH FRAME &
'PLUMBING P
i co
3. y
n
I14SULATION PER N. Y.
STATE ENERGY
CODE
x~
4.
FINAL
o
ADDITIONAL COMMENTS: x
H
a
m
• r
m
^o '
H
m z
APPEALS BOARD MEMBERS ~o~OSUfFO(~ ~D
~ Gy Southold Town Hall
Gerard P. Goehringer, Chairman c 53095 Main Road
Serge Doyen, Jr. y x P.O. Box 1179
James Dinizio, Jr. O Southold, New York 11971
Robert A. Villa d~ol ~a0~ Fax (516) 765-1823
Lydia A. Tortora Telephone (516) 765-1809
BOARD OF APPEALS
TOWN OF SOUTHOLDe`
i
ACTION OF THE BOARD OF APPEALS t,! €r OR 2 01995
DATE OF ACTION: April 11, 1995 APPL. #4303.-{
y 6J P.(I{e Yx. 47~~ei
APPLICANT: STANLEY J. FLISS
LOCATION OF PROPERTY: 565 Old Main Road, Mattituck, NY
COUNTY TAX DISTRICT 1000, SECT. 122, BLOCK 7, LOT 2.
BASIS OF APPEAL: Notice of Disapproval issued by the Building Inspector on
February 15, 1995. "Accessory buildings shall be located in the required rear
Byrd"
PROVISIONS APPEALED FROM: Article X, Section 100-10IC(1).
RELIEF REQUESTED: Accessory building locate partly in the westerly side yard
area (and partly in the required rear yard).
MOTION MADE BY: Gerard P. Goehringer, Chairman
SECONDED BY: James Dinizio, Jr., Member
ACTION/ RESOLUTION ADOPTED: Granted building located 66' from the front
property line and 6' from the westerly property line, with the condition that the
building is "accessory and incidental to the resident-owner's use of the building
as a woodworking shop business."
REASONS/FACTS: The principal use on the premises is single-family dwelling.
In addition, the owner-resident of the dwelling operates a woodworking shop in
separate buildings in the rear yard. The proposed building will also be used
incidental to the business use of the premises as a woodworking shop for drying
of lumber products. The subject premises is zoned "B" General Business.
Section 100-33 provides that buildings which are not the principal building, or
accessory buildings, shall be located in the required rear yard. Approximately
one-half of this 20' x 36' building is located outside the required rear yard,
and the remaining one-half shows the building to be located in the rear near the
northerly yard area. Accessory buildings are permitted to a height of 18 feet.
No undesirable change will result from the location of this building -
particularly since the adjoining land to the west is vacant and the building is
proposed near the circular end of the existing driveway area. There will be no
adverse effect or impact on the physical or environmental conditions of the
neighborhood.
VOTE OF THE BOARD: Ayes: Serge J. Doyen, Member
James Dinizio, Jr., Member
Robert A. Villa, Member
Lydia A. Tortora, Member
Gerard P. Goehringer, Chairman-Member
This resolution was unanimously adopted.
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N.Y.
NOTICE OF DISAPPROVAL
Date .2?<r . 19
PLEASE TAKE NOTICE that your application dated 12- 19
for permit to e.. AF??.. a~
at
Location of Property SJr(ii SJ.......~` , _ , , _ , , . kv j G sL~/
House No. Street Hamlet
County Tax Map No. 1000 Section !Z. ?r... Block ~;F Lot ...2
Subdivision Filed Map No. Lot No.
is returned herewith and disapproved on the following grounds
`
. . . . . . . . . . . . . . . . . . . . . . . . . . . . Y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
uild 9 Inspector
RV 1/80
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PROPERTY OF:
STANLEY & JANICE FLISS JRt MAIN STATE RoA.p
565 OLD MAIN RD.
MATTITUCK N.Y. 11952
R01)DEhi
N. 52° I3 40 E. I91. Sl
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Co. TAX MAP D ATA )000- 122-2 2 v s,•: n
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765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: ,
A LA-1
DATE INSPECTOR,.C
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ j INSULATION
[ ] FRAMING [AI41NAL
[ } FIREPLACE & CHIMNEY
REMARKS:
A d-19
DATE ~ f9 r INSPECTOR
765-1802
BUILDING DEPT.
SPECTION
[ FOUNDATION iST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ~FMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
2r~~
,
DATE INSPECTOR
LEM
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1000121 BUREAU OF ELECTRICITY
F 85 JOHN STREET, NEW YORK, NEW YORK 10038
Date JUNE 13,1995 Application No. on file 07275595/95 N 354841
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
STANLEY PLISS, 565 OLD MAIN RIr~TOy~AD, HATTITUCK, N.Y.
in thefotlowing location, . ? Basement 11 Ist Fl. El 2nd Fl. OUT Section Block Lot
was examined on JULIE 06,1995 and found to be in compliance with the National Electrical Code.
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS ECEPTACLES SWITCHES INCANDESCENT FLUORESCENT OTHER MAT K. W. AMT. K W, MIT KW. AMT K. W. AMT. H.P
4 4 4 2 2
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'/T TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
AMT. K. W. OIL H. P. GAS N. P. AMT. NO. A. W. G. AML AMP. WT AMPS. TRANS. AMT, N P SYSTEMS AMT. WATTS
NO.OF FEET
SERVICE DISCONNECT NO. OF S E R V I C E
W G.D NO. OF HILEG A.
AMT AMP TYPE EQUIP, METER Ate, TW 1 a, 3W I30 9W 3,e' 4W NO. OF CC.B'COND. A OF OF NEUTRAL
OF CC.CGN . NO. OF NEUTRALS A. W. G.
W. HbLEG G
PER
1 200 CB 1 X 1 3/0 1 3/0''.
OTHER APPARATUS: ,
G.E.C.It-1
PAUL R. BURNS LIC.#3897E
P.O.BOX 1061
SOUTHOLD, NY, 11971-0932 GENERAL 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.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
} fs G`s~ L; i BOARD OF HEALTH
yi~ L FORM NO.1 3 SETS OF PLANS
TOWN OF SOUTHOLD SURVEY . . .
~ BUILDING DEPARTMENT CHECK
kid ! + 5 D I 11, 1
TOWN HALL SEPTIC FORM
BLDG. DEPT SOUTHOLD, N.Y. 11971
TOWN OF SOUTHOLD
G~77 TEL.: 765-1802 NOTIFY Examined I9/.:J MAIL TO:
• . .
Approved ..7.,.,J... 19~~P~~ermit No.
Disapproved a/c .5/, . .
4 1 ' g Inspector)
APPLICATION FOR BUILDING PERMIT
Date 10.1. S.
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
cation.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit
shall be kept on the premises available for inspection 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, 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 1 spectio s.
.
- (Signatur of pplicant, or na$fe, if a corporation)
5.65...01.49 ..M4,IA'...R0../Y1A fkc(.c
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
ON. n•e r yy.~ .
Name of owner of premises ..~/c'{/aI(°y..l,..'f f4t,~ .C.(°...L'!r...Flias..,jl
(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. ..L.Z/. ra. I A.tep~ . PT.I
Plumber's License No. .
Electrician's License No. !.7
Other Trade's License No .
1. Location of land on which proposed work will be done .
...................01D. 6.1,h.. ma-7..;t.~C-. k............
House Number ~t et Street Hamlet
County Tax Map No. 1000 Section ...199 Block ......7........... Lot 2
Subdivision 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 Dw e 11lh ~ ..W.. RO.CI. .
b. Intended use and occupancy ......Sam. e ..as...a.>4.?e......................................
3. Nature of work (check which a plicable): New Building ..X Addition Alteration
Repair Remo val Demolition Other Work
Ara d'p (Description)
4. Estimated Cost /lSj. 7P.P Fee ...:,7`............................. .
(to be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on each floor
If garage, number of cars 0A.@......... .
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . .
7. Dimensions of existing structures, if any: Front Rear Depth
Height Number of Stories .
Depth with alterations or additions: Front . . . . . . Rear
Dimensions o same structure w Height i Number of Stories .
8. Dimensions of entire new construction: Front ZQ Rear ...,20......... Depth
ei ht 14 v Number of Stories Q/.9.. ,b . 8t
10. Date ize of of lot: Purchase Front A ` Rear ,/,7~,,,,,,,,,,,,•••pth ..~6C~........•••.•••
er Owner ~~Y.. /V0.GtA.l'OQ ki .
.
premises ........Name of Form 1"
11. Zone or r use district in which
12. Does construction viola are situated .....6 , , , , , , , , , , , , , , , , , , , • , , , • , • , , .
proposed to any zoning law, ordinance or regulation:
.
13. Will lot be regraded ND.. Will excess fill be remgved frgm premises: Yes o
14. Name of Owner of premises S. !Las ..J r........ Address56S. CI/;!7 .,~1'k ..R19 Phone No. 4144t . _ a
Name of Architect Address Phone No............... .
Name of Contractor .....S:4tM. A . Address 540"t Phone o.. 5 AOMA..... .
15. Is this property within 300 feet of a tidal wetland? *yes........ No.
*If yes, Southold TQwn 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.
I
A
~I
~I
STATE OF NE ..R6~ S '
COUNTY OF. .
• • • U • ~[L4~ ~j I. being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
application; that all statements contained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
1
9 .
day of t
Notary Public, n
CLAIRE L. GL.EW
Notary Public, State of New York ' • • • • . • • • • • • • • • • • .
No. 4879506 (Signature of applicant)
Commission Exp1 es pece ber 8, 19
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PROPERTY OF:
STANLEY & JANICE FLISS JRa MAIN sr/iTE [GOAD
565 OLD MAIN RD.
MATTITUCK N.Y. 11952
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