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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 9-20885 Date JULY 23, 1992
THIS CERTIFIES that the building ADDITION
Location of Property 800 HARBOR LIGHTS DRIVE SOUTHOLD N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 71 Block 2 Lot 15
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 2, 1992 pursuant to which
Building Permit No. 20687-Z dated JUNE 4, 1992
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 UNHEATED ADDITION ON AN EXISTING DECK AS APPLIED FOR.
The certificate is issued to ANTHONY & JEANETTE PRINCIPE
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
S
B ld ng I Spector
Rev. 1/81
poaai xo. a
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. T.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
/rr``f............................, 19.E
NN? 20667Z Date
Permission is hereby granted to:
"f.'t171
to 1~ r r?+n ~ .....CpY(....~e^^-
at premises located/at A..7/.......... .r.............................
P..:..
County Tax Map No. 1000 Sectio .........~1........... Block (2) Lot No....~ti.............
pursuant to application dated 19..2 and approved by the
Building Inspector.
Fee 3....0
rfO~!1
ui(ding Inspector
Rev. 6/30/80
Form No. 6 ~
TOWN OF SOUTHOLD W~/
BUILDING DEPARTMENT
JUL J 5199?_
TOWN HALL
765-1802
~i-.,.,_w ~ ~~~k~ bi .ail?•~FV~)i 6.'i..,..,, ,u
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 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.
:S.• 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 $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 .
:;ew Construction... Old Or Pre-existing Buillding..................
Location of Property ..........................[4..~IIPI....... t.ihd?/7
House No. Street Hamlet
)nwer or owners of Property..
.fezj
',ounty Tax Map No 1000, Section.... ? .......Block..... Lot..... r
subdivision ....................................Filed Map............ Lot......................
'ermit No.,Q064.72,,Date Of Permit ................Applicant.. ~n ~(Cpp J
iealth Dept. Approval ..........................Underwriters Approval.........................
'l;nning Board Approval
equest for: Temporary Certificate........... Final Certicate....
r~..
ee Submitted: $.....v~.o.C9c.
64c., yyyl 7
00-`2- 0 0 p 9's + APPLICANT
I
INSPECTORS
Victor Lessard
Principal Building Inspector
Curtis Horton SCOTT L. HARRIS, Supervisor
Senior Building Inspector a
va Southold Town Hall
Thomas Fisher P.O. Box 1179, 53095 Main Road
Building Inspector f c~! Southold, New York 11971
Gary Fish Building Inspector Fax (516) 765-1823
Telephone (516) 765-1800
Vincent R. Wieezorek
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
JULY 20, 1992
BOB GRIGONIS
BUILDING CONTRACTOR
P. O. BOX 1611
SOUTHOLD, NY 11971
RE: ANTHONY 6 JEANETTE PRINCIPE
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 (outdated/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 # 20687-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
CC: ANTHONY 6 JEANETTE PRICIPE
H
FOUNDATION (1st)
FOUNDATION
(2nd) i7
2.
o
ROUGH FRAME &
PLUMBING
Cb
cn
3. 3
n H
INSULATION PER N. Y. y
STATE ENERGY I d
CODE
4.
~ +A H
Aoaozde~ "Alf
FINAL f Q s
t~
ADDITIONAL COMMENTS: x
a
H
O
x
' r
• x
- v i
M
_ -b
H
BOARD OF HEALTH.
q~~~ FORM NO.1 3 SETS O~PLAYS
TOWN OF SOUTHOLD SURVEY . . .
J M
i { + 21992
BUILDING DEPARTMENT CHECK
L(L(e x_ _ - - - - TOWN HALL SEPTIC FORM
K o~
SOUTHOLD, N.Y. 11971 ..765'_5070
TEL.: 765-1802 NOTIFY
CALL
Examined • , , 199A_ p MAIL TO:
Approved 197k Permit No V. . .
- .
Disapproved a/c . .
. w
(Buildi g nspector)
APPLICATION FOR BUILDING PERMIT
Date ......Y!... 19.
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 hitve 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 inspectio, nsn
(Signature of applicant, o ame, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
..................`Gct 014?'Z
Name of owner of remises
(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. .r. . to 3.:' . .
s
Plumber's License No .
a:
Electrician's License No .
Other Trade's License No .
1. Location of land on which proposed work will be done. .GT./?s rl T t , , , D , • • Ia N 1 t~ rJ
Q .Q.>.......... SS~..~.~ r1,d,_4J.............
House Number Street Hamlet
County Tax Map No. 1000 Section Block , , Lot ....17-,P-.f
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 ~R 1E. l P b .a %,k.y
b. Intended use and occupancy .......f-.C ? ~~.,N (N.: n , , - ,
3. Nature of work check which ap licable): New Building Addition Alteration
Repair 'val Demolition Other Work
Description)
4. Estimated Cost , ..A$. 3.!, i'iao, ° . . . Fee (Descri .
(to be paid on filing this application)
5. If dwelling, number of dwelling units k , , , 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. Dimensions of existing structures ) , if any: Front (o , , , , • , , Rear I.fA...... Depth 1 c.;e , , .
Height , Number of Stories ,
Dimensions
.iensions , of f same
,.me , , , structure whh alterations or additions: F . ront t< , . Rear 1
Dront ~.1. 4...... , Rear Number lf Stories
Dimensions o entire new construction: . .
Depth .../.d.
Height tr3-......... Number of Stones 1 . , , . .
soo i
9. Size of lot: Front ,1..°(? Rear .....k.r?R,............ Depth
P.•
10. Date of Purchase , Name of Former Owner
11. Zone or use
12. Does proposed district in thou vole ises are situated ........F t'S 4'P.OWTTY, prL .
to any zoning law, ordinance or regulation: N?R . . . . . . . . . . . . .
1
14. Name of 3. Will lot be regraded ......1 .y Will excess fill be removed from premises: Yes AP
Name of Architect • •~~NC'n ~"5' ' • • Address k hR~¢. ~1 o,n i.5. ,P,v,-..Phone No
` ................Address...................Phone No................
1?remises I N , Address Re? vy~wi o}o, Noccry Pn, Phone No..
Name of Contractor RI
15. Is this property within 300 feet of a tidal wetland? *yesNo, .P'••
*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.
S L ~ F~ TS Ft~ r1 ~o I 5 M cr-isc~
I
STATE OF NEW YORK, S S
COUNTY OF .
'•••••••••'••••••••••••••••••••••i••••••••••.••.... being duly sworn, deposes and says that lie is the applicant
(Name of individual signing contract)
tbove 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
vork will be performed in the manner set forth in the application filed therewith.
;wom to before me this
4Z l?u............day of.. I! .........,19.gJ.
Ntary Public, .....Q County
UNDDAA J. C
DOPER
Notary Public„ Stale of New York (Signature of applicant)
No. 4822663, Sgffolk Count*~
Term Expires December 31, 18
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APPROVED AS NOTED
OCCUPANCY OR FEEf~-ML'o BY' -h'7,414
BUILD 9 9 A AMG DEPART ENT AT M TO 4 PM FOR THE
USE IS UNLAWFUL 765-7NOTIFY802 2 FOLLOWING INSPECTIONS:
WITHOUT CERTIFICATE 1 FOR POURIED CONCRETE REQUIRED
1
OF OCCUPANCY 2. ROUGH • FRAMING & PLUMBING OCCUPANCY 3. INSULATION P 4. FINAL - CONSTRUCTION MUST
_ BE COMPLETE FDA C.O.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y.
r e' UNDERNRDERSCEIMICATE STATE CONSTRUCTION & ENERGY
REQUIRED CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS
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