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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-24139 Date JANUARY 24, 1996
THIS CERTIFIES that the building ADDITION
Location of Property 405 LAKE DRIVE SOUTHOLD NY
House No. Street Hamlet
County Tax Map No. 1000 Section 80 Block 3 Lot 16
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated OCTOBER 25, 1993 pursuant to which
Building Permit No. 21766-Z dated NOVEMBER 8, 1993
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 A DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to ISMAIL FMK & NILUFER NOBER
(owner's)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
i - Z4~
B lding 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)
N Date ....r~~ 19.~~3..
21766 Z
Permisslo Is hereby granted t ;
. 1(1/
7 7 .
to ,4:,........
.........................v
at premises located at.... Z~~
GG•••
EE County Tax Map No. 1000 Section .........4..U........ Block Lot No. .
f pursuant to application dated 19..' and approved by the
E
4 Building Inspector.
f ~
f Fee ZJt
i
d~?..li
/Building Inspector
Rev. 6/30/80
~ JI
o~OS~FFDi/r 0
o~ Gyp
rn x
Town Hall, 53095 Main Road p • Fax (516) 765-1823
P. 0. Box 91971 y~lpl ~.a0~ Telephone (516) 765-1802
SoutholdNewYork 11971
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
January 19, 1996
Mr. Emek Ismail
22 Elizabeth Drive
Laurel Hollow, N.Y. 11791
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 # 21766-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPAP.TMENT
TOWN FALL
765-1302
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 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.
B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
"pre-existing" land uses:
1. Accurate survey of property snowing 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 525.00, Additions to dwelling 525.00,
Alterations to dwelling 525.00, Swimming pool 525.00, Accessory building 525.00,
Additions to accessory building $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existin-c Buildine - $100.00
3. Copy of Certificate of Occupancy - $20.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date ..........fA
New Construction......... Old Or Pre-existing Building
L y cc
Location of Property 40~ Gu~~../~ff U"(7i......... eAl• p,~ t!~t71^P`?....... . . . . . . . . . . . . .
House No. Street Hamlet
Dower or Owners of Property....
County Tax Map No 1000, Section Block 3....... Lot.... `
Subdivision -......./.....Filed
permit No...~.1.7.~ 7.~'.Date Of Permit. .~1h1f)....... Applicant...... P'• -
Health Dept. Approval ..........................Underriters Approval........................
?'-anning Board Approval
3eauest for: Temporary Certificate........... Final Certiczte.....j~
Pee Submitted: S..- I.......
p~o7 ~N
APPLICANT
o~~gOFfO(,~co
Gyp
Fax (516) 765-1823
Town Hall, 53095 Main Road W -
P. 0. Box 91971 Telephone (516) 765-1802
Southold, NewYork 11971
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
January 5, 1996
Mr. Emek Ismail
22 Elizabeth Drive
Laurel Hollow, NY 11791
Re: Building Permit #21766-Z
Premises: 405 Lake Drive, Southold
Suff. Co. Tax map #1000-80-3-16
During a review of our files it was noted that the above
building permit has expired, and a Certificate of Occupancy has
never been issued.
According to the Code of the Town of Southold, Article
XXVIII 100-284, it is unlawful to occupy or use a structure
until a Certificate of Occupancy has been issued.
Please contact this office as soon as possible so that we
may clear up this matter.
Thank you for your cooperation in this matter.
Very truly yours,
SOUTHOLD TOWN BUILDING DEPT.
o~~gOFFOJ.t
Gym
I Z
Town Hall, 53095 Main Road W-
40 Fax (516) 765-1823
P. 0. Box 91971 Telephone (516) 765-1802
Southold, New York 1
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
January 19, 1996
Mr. Emek Ismail
22 Elizabeth Drive
Laurel Hollow, N.Y. 11791
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. $25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 21766-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
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acc®zdan a wi d;~ the coy er.t Tidal Wetlands Land 1766
rh~rrn. aye, Sal a.- r~ ai ed under the Tidal
y' 66mj no pezx4 ~y ~g VIC anst^1CCian,
=.a>a" ns ( NY m? be advised, hoc~~avs lace seaward of
We ' yands Ord P ga ' nd oay ~e p
dis turbo ~c of any eau nda. as indicated above,
Bac:.iaen~a or ivsi.cidca o..a tc ensure tha-
: or
thQ ti :sl wetland9 ras enlhi~!.ty
xt is yQ+a p any s edisenntatioa
c;itk:C" a lparmiw. °aaSan t C ;r `1Fsfle 1 a
nec~ssa Y precautions ara a -d r taco c vegetativ
other alteration or diem art as~ca to trio a.w ok may reSult tram yo"
is~ticticn a3ee;aata work
:rith:ra Tidal wetla,.ds in hide ma.int-°ix:inq Your
pro ; e". Such pr6cal4tiOns may or arec ia
area bet=ween the tidal w land j tst - Mi C~jcn bo+axtdaxy an Yo Y
prajsc= (i.a. a 15, to 2~' or wise haY bale be,n. area,
temporary taAcm, bx fir, you of hat this 1 +er dies noC'reoreap rovals
please bs furtre~ advised GTI ny necessary p6t'u s p
the responsibility of obta=-n jn5 any
f.oaII ether agencies.
,46rJ truly yours,
Q~$~a ~dmir.iatrator
Print Key Output Page 1
5738SS1 V2R2M0 920925 SOUTHOLD 10/25/93 11:30:44
Display Device . . . . . . WY
User . . . . . . . . . . . GEORGIAR
PLO10-23 WY TOWN OF SOUTHOLD 10/25/93
*UPDATE* PARCEL MASTER FILE MAINTENANCE 11.30.18
Address: 405 LAKE AVE
APN: 1000 80 3 16
SEL TYPE EFF DATE EXP DATE EXCPT DESCRIPTION TEXT?
1. PMT 6/18/93 12/18/94 BP #21488-Z ALT - CO Z-22556 Y
2. PMT 1/05/89 BP #17738-Z ALT/REPAIR COZ-18264 Y
3. TRA 12/07/88 TRANSFER OWNERSHIP PROPERTY Y
4. TRA 0/00/60 TRANSFER OWNERSHIP PROPERTY Y
Selection: H=History, T=Text: H
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'?YEN -'•.'^3~,°rNlf av
BOARD OF HEALTH
FORM NO.1 3 SETS g,P'PLANS
TOWN OF SOUTHOLD SURVEY
BUILDING DEPARTMENT CHECI .)Q
' 251993
TOWN HALL SEPTIC FORA
SOUTHOLD, N.Y. 11971
TEL.: 765-1802 t: 0'c i FY
CALL
Examined • • , , 19 p ! NAIL TO:
/(o 7PS-;217
Approved 19V. Permit No. .
ro pox ~y~
Disapproved a/c j ffe;
u' g Inspector)
APPLICATION FOR BUILDING PERMIT
Date 195
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 ar%as, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
catiegi.
c. The work covered by this application may not be commenced before issuance of Building Permit.
& 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 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.
..........Y~nC1'~./...lL 1/ttiG~Gr
Name of owner of premises
(as on the tax roll or latest deed)
If aappplicant is a corporation, signature of duly authorized officer. OK
(Name and title of co ate officer)
Builder's License No. ...n~C) g/v /f•2
Plumber's License No .
Electrician's License No .
Other Trade's License No .
1. Location of land on which proposed work wi 1 be d ne. , , , , , , , , , , .
, • , • •
.
House Number Street Hamlet
County Tax Map N9 10000 Section Block Lot...................
Subdivision • 40 '1 Filed Map No. Lot
(Name)
1 State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy • .k!Sf'?.
b. Intended use and occupancy • , S~r~~C' ~
.
yam. 4'>taLh 1. ?ui~i.S Yks-f'~j}r!SJ e.,y -r i -n - -c n
•3. Nature of work (check which 'applicable). New Building ' ' ' ' ' ' Addition Alteration _
Demolition . Other Work . _
4. Estimated Cost 6OU II'' (Description)
Fee...........
5. If dwelling, of dwelling (to be paid on filing this application)
If garage, number of cars Iunits . Number of dwelling units on each floor .
, , ,
6. If business, commercial or mired occ , upancy, specify nature and extent ofeach type of use
g structu
Dimensions of existing Number of Stories
Height N`rres, if any: Front Rear Depth , . , . .
Dimensions of same structure with alterations or additions: Front . • • . • . . . . ' ' ' ' ' • ' ' '
Depth.... Rear.....
Height . Number of Stories .
8. Dimensions of entire new construction: Front . Rear . . . . . . . . ' ' '
Depth
Height of Stories . .
9. Size of lot: Front . Rear .......................Depth...........:...........
10. Date of Purchase , . Name of Former owner . . . .
11. Zone or use district in which premises are situated . . . . . . . . ' • • ' ' ' ' ' . •
12. Does proposed construction violate any zoning law, ordinance or regulation: (J. . . . . . . . . . . .
13. Will lot be regraded . , Will excess fill be removed from premises: Yes No
14. Name of Owner of premises . , , Address . O1' p' ~lzY
Name of Architect • • • , Phone No..7..
••••••••••......Address . . .PhoneNo..
Name of Contractor ! . . Address . . Phone No.
15. Is this property within 300 feet of a tidal 'wetland? *yes.
*If yes, Southold Town Trustees Permit may be required. No
PLOT DIAGRAM
Locate clearly and distinctly alll 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.
l
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ALL
C.CJrf; r¢tR~ ti4'?f',Si••7• ET' .
3E dBC~kh1l9lk: f! NY OF l't9w N. L:
aY6~TE a OkU f&;tbfT3`ia~~4 81 ENERGY
fs",4kvk a°a, l€~T R3r.''q`P'ftftlSl0l.E FOR
~t, k.cat+~ rr~a~~~'t nl ERRORs
I
STATE OF NEW ~~RVl.
CO 5
Y O~ I I
. Z being duly sworn, deposes and says that he is the applicant
(Name of of individual signing!, contract)
above named.
le is the
(Contractor, agent, corporate officer, etc.)
,f said owner or owners, and is duly authorized 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
cork will be performed in the rganner set forth in the application filed therewith.
worn to before me this
....25:.. :.day ~TOll ~ 1
9-11
'otary Public, . County
ktUiieii(1.'
State of N.Y. " " " "
NOTARY
No. 47250 , Suffolk Coin (Si ppialilf-e applicant)
Term Expires May 31,19