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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-23240 Date SEPTEMBER 20, 1994
THIS CERTIFIES that the building ADDITION
Location of Property 210 BENNET ROAD EXT., GREENPORT, NEW YORK
House No. Street Hamlet
County Tax Map No. 1000 Section 40 Block 5 Lot 1.2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 19, 1994 pursuant to which
Building Permit No. 22239-Z dated AUGUST 8, 1994
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 PORCH ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to CHRIS & LORRAINE STAVROPOLIS
(owners) )
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-325383 - AUGUST 30, 1994
PLUMBERS CERTIFICATION DATED N/A
",-4 J, Xe~
Building Inspector
Rev. 1/81
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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 ......CJ.......
19..!..
N® 22239 Z
Permission Is hereby gr ed to: -7'2
/../,.~.Q/ ..............c...........~f...
.........0.. ~ fY.1.. •..~1..7: ..1~..e.....~d...l.°-'~./.!.... r
to Co. ..74~s..4 ~.G ..7,......~......~C~/2..~ ..,....T t.~4° /...T..(.~Q~.......
/..Gz......~~ ! ......70,WI.....
0.4 ........74fr......... a,•.
at premises located at.......... ~/o ./..~[..c..... /
, n
County Tax Map No. 1000 Section Block ....47 Y.......... Lot No,
l C'
pursuant to application dated / 19. and approved by the
Building Inspector.
as
Fee
Building Inspe..,.
[Rev. 6/30/80
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UNDATION (2nd)
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SULATION PER N. Y. II
STATE ENERGY
CODE I ?~1
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ac+aiC%:!,:~'.E"~r?G~~ -'y.-:.u.n. c~..•t a'G,tiYY,. %.ed , ~ ~ _ - _ _w
4~{~ (2 Ur p• 1. Form No. 6
15 lh U c~~/"
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
2 D 1994 TOWN HALL
! 1 765-1802
BLDG DEPT
TOWN OF SOUFHOLp
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.
5. Commercial building, industrial building, multiple residences ancf 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.
1• 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 $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 Building -'$100.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
4, Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date CJt 9.19C1V .
w Construction..;.,,,,,,, Old Or Pre-expiating Building ..v. Jj 1
cation of Property:......... 011CIS~EC
House No. x11 N~ ~1 o~y~
• Street • •FIamlet
acr or
Owners of Property. ..lY 1+01....
inty Tax Map No 1000, Section 4 o.....Block.... S ,,,,,,,,,Lot., L
division.........
.................:........Filed Map........
rc ....Lot.........
nit No. Date Of Permit. 4FI
1•Ei2VOS -~13UILj~Ek
~nin ddd .Applicant.~iN~AOIIS•• UILD
Ith Dept, Approval..... Underwriters Approval.
FV
g Board Approval........
lest for: Temporary Certificate......
Final Certicate...v......
Submitted:
1 ry
CO APPLICANT
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1.
1001071 BUREAU OF ELECTRICITY
F 88 JOHN STREET. NEW YORK. NEW YORK 10038
Date AUGUST 30,1994 Application No. on file 4)6332394194 N 325383
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
CHRT..S STAUROPOULOS, 210 BENNE`1'T ROAD, GREENPORT, N.Y,
in the following location; ? Basement ? Ist Ft. ? 2nd Fl. OUT Section Block Lot
was examined on AUGUST 22 , 1994 and found to be in compliance with the National Electrical Code.
FIXTURE III FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS ECEPTACLES SWITCHES INCANDESCENT FLUORESCENT OTHER AMT K W. AMT. K.W AMT KW. AMT. K.W. AMT. H P
2 1 1 2
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIALREC'PT TIME CLOCKS RELL UNIT HEATERS MULTI-OUTLET DIMMERS
AMT. K. W. OIL H. P. GAS H. P. AMT. NO. A. W G AMT. AMP. MIT. AMPS. TRANS. AMT. H P SYSTEMS "T WATTS
NO. OF FEET
SERVICE DISCONNECT NO. Of S E R V I C E
MAT. AMP METER
TYPE 10 YW 1 g 3W 30 3W 3 p AW NO. OF CG COND. A W G. NO. OF HIAEG A' w' G. NO Of NEUTRALS A. W G.
EQUIP. PER 9 OF CC. COND. OF HI LEG OF NEUTRAL
OTHER APPARATUS:
PORCH-1
G & .5 CONTRACTOR F.,TC.#578
SOX 215
SOUTHOLD, NY, 11971 GENERAL MANAGER
11
Per
Ais 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.
MIDDLE ROAD (C• R. 48) NORTH OR MAIN ROAD
75.04'
FNO 1242.89' N 71 ° 28' 20" E
MON
fi 1225.14
0
v
m
ro
N
W
Z _ f o
h
Q SCENIC
J °
0
o S°
o BUFFER
Q LOT
LOTO LOT
'12 sq. ft.
TAVROPOLIS
70POLIS
TITLE INSURANCE COMPANY
INC.
STEPS
ice with the minimum 35.3'
vet's as established
roved and adop ted 2 STORY
P.w York State LNd Y FRAME
3 _ 25.0' ROUSE a
20.0' ? 15.4' S O_
~ ~TEP
2
h b nos. ~
w
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p a9 ' ~
tG ~ I 7
a N
2 > LL 3\ v
N
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75.00'1 S 75 ° 31' 23" W
PUBLIC WATER'- MAIN
SURVEY OF QE rl/1v,` TT ROAD
LOT 2
ISION OF CEDARFIELDS H. S. REF. NO. 90 - SO - 51
JUNE 27, 1990 FILE NO. 8966
T GREENPOR T
lVN OF SOUTHOLD ~o ° tI,
"OLK. COUNTY, N. Y.
- 40'- 05 - P/O 01
Scale 1" = 30'
JU/y 11, 1g90 `s~q 0.408~B yoQ
D Ur'6 U V BOARD OF HEALTH
(p FORM NO.1 3 SETS OF PLANS
Il,fl ~g( TOWN OFSOUTHOLD SURVEY
t. BUILDING DEPARTMENT CHECK TOWN HALL SEPTIC FORM
BLDG. DEK 41, SOUTHOLD, N.Y. 11971
TOWN F LO
TEL.: 765-1802 t:oTIFY:~~!!yy ryry
• 0.. CALL M7c2S?5
Examined y/y 4a. 1, . . . . 19W , MAIL TO:
Approved ..t/0• , 19~~Permit No.......
_ .
Disapproved a/c .
(Building Inspector)
LICATION FOR BUILDING PERMIT
Date ..U L l 19 1~
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 necessai e t1•~ns.?
CoNS7.
G'b ITJ~I ®~VBS -7tLeND03
(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.
gEN&RA-L...C..Qt0'T.KAs:-ro.W
Name of owner of premises E• • , • STA-V Rd F?O L? S
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and -title.
itle of corporate officer)
Builder's License No......... 1f:9 :F~6 ¢}T. .
Plumber's License No .
Electrician's License No .
Other Trade's License No .
1. Location of land on which proposed work will be done. NCT O/}~ - CEAIzF IlDS
•L~ 1 ,Etg).N . C .T.....................a ~EE1.t4'oR~
House Number Street Hamlet
County Tax Map No. 1000 Section '.fQ Block ! Lot . Q.l i.ci... .
Subdivision . c1 1 ALP S, , • , • , • , , , • , , , , , , . Filed Ma No. Lot .
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ?~M,L°( , , • • , p bJ• I_L l N ~'j wI,TK SCRE~^1b-7J I N
b. Intended use and occupancy , ~/f Di 1 L N W. 1J, S& [z6N t=(), , IN
0.4J~11 L .
3. Nature of work (check which applicable): New Building Addition . Alteration
Repair Removal , Demolition Other Work,.............. .
17 (Descr iption)
4. Estimated Cost . ill 19?in n D Fee .75...............`
?
(to be paid on.filinglthisapplication)
5. If dwelling, number of dwelling units ......I. , TAN t Ly Number of dwelling units on each floor
If garage, number of cars . .
6. If business, commercial or mixed', occupancy, specify nature and extent of each type of use .
7 Height off ixisting structures', if any: Front . ~ 5e. 3 Rear ...3A,.3 Depth =1:4.0!... . , .
er of Stories X .
Dimensions ions of fs same same s , , , , ,tructure with efternOem or additions: Front . 3 S. 3.......... Rear A,5,,. i4lo
Depth , Height .....W. f Number of Stories . R y, , , • , , , , , ,
~
9. Dimensions
Height ,.Numbction: Front . Rear Depth
ize of lot: F on t entire 5 um new construction:
g . . ler of Stories . i'......... .
Rear ...75ro..~ . Depth .
10. Date of Purchase 1l`( 1 Name of Former Owner
11. Zone or use district in hich premises are situated VFA1.1?:l! ATI.&( .
12. Does proposed construction violate any zoning law, ordinance or regulation: 4
13, Will lot be regraded NA Will excess fill be removed fro r s s: Yes ~o
14, Name of Owner of premisesO ?,1S. , `5..Tk:V,R.0,P0L1sAddress4tQ )3A?1N `i'Yionnee o. T71
Name of Architect Fa=NtS~ L M..... • , , , , Address QR N ?~T. , , P~ ne No. 4;111 :.0.~ PA , , •
Name of Contractor 'Dlia1(2S'Z 1QV051 Address 1':0, $oX, D3S OR1 I Bone No.
15. Is this property within 3(0 feet of a tidal wetland? *Yes........ No..
*If yes, 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. M 191 l-E RD. (Ceb2. fs)
%-C- N% G
BuFFat~ UTei2tOl2 L07-
1-0 T
L.OT 3 LOT 2 X16 a I
:.o
IT,
F~2eH /a o. ~
G~ J
-39.
M ~
15.0
N Gls^o>
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J~fftjNEFTT
STATE OF NEW YORK, SS
COUNTY OF
(Name femiv. idual
's ofC~ idual signing • . • • • . • • being duly sworn, deposes and says that he is the applicant
contract)
above named.
He is the......... Ar,.ENff ......ill
(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 sot forth in the application filed therewith.
Sworn to before me this
19
day of..l
NotaryPublic,:... ! ^ , , County
ILAAJ~
JOYCE M. WILKINS Z
Notary Pubilo, State of Now York (Signature of applicant)
No. 4952246, Suffolk Cou
Term Expires June 12, 192'5
f
MIDDLE ROAD (C• R. 48) NORTH OR MAIN ROAD
FM 1242.89' N 71- 28' 20 E 75.04'
P
1225.14'
A?0
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v
°
N -4--,I j ,T W
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Q SCENIC
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o BUFFER
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O LOT
LOT LOT
I
AREA = 21,112 sq. ft.
CER77FIED TO,
CHRIS JOSEPH STAVROPOLIS
LORRAINE STAVROPOLIS
FIRST AMERICAN TITLE INSURANCE COMPANY
OF NEW YORK
ARCS MORTGAGE, INC.
605-S9448 SrEPs
Proprad in aoeordama with the ar0170wm 35.3'
•tandrds for fide aarwys " aatabNahad
b the LLA.LS and *pprowd and adopted , 2 STORY
ryaua h y 11M /Nw York Stets Lrd Y FRAME
hMSE
t!O/1. a
3 _ 23.0' 20.0' s 13.9' _ O_
rER
h t
P
° I Q T ag~1 V 2 ~ pI N
I
75.00't 5 75' 31'23- W
PUBLIC wa TER _ MA/N- - - - - -
SURVEY OF BENNETT ROAD
LOT 2
SUBDIVISION OF CEDARFIELDS H. S. REF. NO. 90 - SO - 51
FILED JUNE 27, 1990 FILE NO. 8966
A T GREENPOR T
TOWN OF SOUTHOLD ~EZ,
SUFFOLK COUNTY, N. Y.~
1000 - 40 - 05 - P/O 01
Scale 1" = 30' r
July 11, 1990
N~
July 25, 1990(fou!7d. loc.) OF
Nov. 16, 1990(final)
Feb. 12, 1991(finof) _ n { N.Y.S. LIC. NO. 49618
NO V. 13,1991 (CERTIFIED) ECONIC SURVEYORS, P.C.
(516) 765 - 5020
P. O. BOX 909
MAIN ROAD
SOUTHOLD, N.Y 11971
sVA~I3Z FA CL vF F-YIgT r00 4AII
~IXZ, 4APPEL NOTED
N ~ -IK(c DATE; l B.P. # 2 3 u
I~G•rPIY V FEE:~ V. r~ ' p NOTIFY BUILDING DE OEPA AT '
3-1 AS4 765-1802 9 AM TO 4 P FOR THE
FOLLOWING INSPECTIONS: 1, FOUNDATIpr; - T\NO 9EOUIRED
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