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HomeMy WebLinkAbout20165-z ~ FORM NO. 4 TOWN OF BOUTHOLD AUILDING DEPARTMENT Office of the Building Inspector Town Ha11 Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22652 Date OCTOBER 8, 1993 THIS CERTIFIES that the building NEW DWELLING Location of Property 590 PRNATE RD. #18 ORIENT NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 14 Block 2 Lot 30.5 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 17, 1991 pursuant to which Building Permit No. 20165-Z dated SEPTEMBER 25, 1991 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 ONE FAMILY BWELLING WITH ATTACHED DECK, BALCONY & GARAGE _ IN CELLAR AS APPLIEp FOR. The certificate is issued to PETROS KOUGENTAKIS (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 91-SO-49 - SEPT. 17, 1993 UNDERWRITERS CERTIFICATE NO. N-260708 - DEC. 21, 1992 PLUMBERS CERTIFICATION DATER OCT. 4, 1993 - EAST END PLUMB & HEATING Bui ding Inspector Rev. 1/81 r ' F08ffi NO. ~ TOWN OF SOUTHOLO 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 o 2 01 6 5 Z Date ~ 19 I Permission isjh~evre~br~y gmn/te~d~/ , P~-~j~~'~~~/~f{/~/ff ..~na::... ~ /5~~.......f..~. p t ..:~~r.... ~.t~11~...G~ .~A....~y.f:~~..... f!y? ~ of premises located o~i..1..1~...~.....~..~1~.... y~....11J ............................................(v./......... County Tox Map No. 1000 Section Block z:......... /Lot No...c~r.~.~~...•....J.t..' pursuant to application doted .....~1.~ 19~,/..., and approved by the Building Inspector. 6~ Fee 3..~F~:~r.e.~ .1 ..s:~... '.mss..... wilding for cN.% Rev. 6/30/80 rowN bF souruoLb ~~,rG~ r~~6~ $UILbiNO b>;pAltfiNeNr TOWN HALL ~65~1$02 APPLICATION FOR CERTIFICATG OT' OCCUPANCY G~ this application must be filled in by typewriter OP. ink attd submitted to the building inspector with the following: for new building br hew use: 1. Final survey of,propetty 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 farm). 3. Apptoval of electrical installation from troard of t'ire Underwriters. 4. worn statement from plumber certifying that the solder used in system contains less than 2/10 of 1R lead. . 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate bf Coda Compliance from architect or engineer responsible for the buildings 6. Submit Planning Boatd Approval of Completed sits: plan requirements, E1. For existing buildings (prior to April 9i ,1957) non-confotming uses, or buildings and "prc-existing" lahd uses: 1. ,lc curate 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. Certificnte of Occupancy - New dwelling $25.00; Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25,00, Accessory building $25x00f Additions to accessory building $25x00, $usittesses $50x00, 2. Certificate of Occupancy on Pre-existing Euilding ~ $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 ~ kesidential $15,00, Commercial $15:00 Data s.,~?$~~P4bsoi~'s~~o.,~s~~'?s,...,sss....xs,s, ::ew Cunstruction.,..,$..,,, 01d Or Pre-existing Buildingsxa,,.,..,,s,,, „ Location of Property.... ~a9~.,,,...s..{.,s,. ~cz'ivate{Roads#18 sx,.s.,s,:,Orient {.,,,.,,s{{ House No. Street Hamlet unwer or owners of Petrol Kou~entakis - PrapeYty,,,.,,.a, {saro t,,,s „ {,asx,,,,,,a,,,ia,,,;,,,,,,,,,,{,,,,{x,sx „ Cuunty Tax Map No 1000, Section.a,...1,4,,,s{{aBlock,.,,,a?c..{a, „ „ Lot,s,~~ t5s.,,,,,s,.,{s, subdivision ...................s,,......a.,,,,.;Fi1ed Maps,..as,s,xsal,ot..t,,..,:a,{,,,,.,ax,{ Pcrmlt \o..,2Q965.-.2.{...Date Of Permit..xRl25J~1.,..,Applicants?'etrossKou~entakisos,,,ss :lcalth Dept. Approval.~t'.1.7~~'..~~1T~~:,4,~~..,xUnderwriters Approval.l~l~.1a~-f4.i~HKQtY$i,a,a: .'l:uming Eoard Approval..... NIA +.s.....a.,.ci{ .:!equest for: Temporary Certificates.:.....,.. Final Ccrti , {CY ,,,.s .'cc Submitted! $.2~,QQ,,,,,,,,{.,.,,,,,.,x{. JamasE.Fitzgemld,Jr. i, i ~.s, .a_y sia,,,,aa..,{i.a Q,~JC.+~(t4q aA P.O. Box 617, Cukhegue, NY 11435 A~ ICANT ~.0 ~ ~r ~5 ^ Phone: (S16) 73MS600 1NSPECTORS ~7 ~~51;FF~3l,„'{~,'~, dG - f~~^~ SCOTT L. I-IARRLS, Supervisor ~ ~ b 4 C°' = Southold Town Hall Thomas Fisher ` ~ r'r P.O. Box 1179, 53095 Main Road Buildinglrupector ~,'.{~i??a~.T ~ Gar Fish ,;J~ Southold, New York 11971 y =-'z Fax (516) 765-1823 Building Inspector Telephone (516) 765-1800 Robert Fisher Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR Telephone (516) 765-1802 TOWN OF SOUTHOLD C E R T I F I C A T I O N HATE: October 4, 1993 Building Permit No. _ 7~1hS-7. owner: Petros Kougentakis j (please print) Plumber: East End Plumbing & Beating . (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1~ lead. ~J~~~~J y . ~/7 (Plumbers Signature Sw'o`r'n to before me this `~'~l day of yl~b~R.A 19 C! ~ . Notary Public, ~~-x~-~t~ County Notary Public ROSEANN GRIFFITH Notary Public, State of New York i111 ~ No. 4814667 Qualified in Suffolk County Commission Expires Ar'~ ~ 1/Jl - , ae.. - 9~5 Z THE NEW YORK BOARD OF FIRE UNDERWRITERS r~<=c. 1. ~ 10b~7.079. BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date DFICFt9A~t{ 2'L,1492 APPlirationNo.anfile 19~4bU91141 ii ~E41'7~£3 ~ THIS CERTIFIES THAT only the electrical equipment as described 6ebw and introduced 6y the applicant Homed on the above application number in the premises of aer.~L7s xouGf;~rrx~zs, son~awl:>"w~%>ti~~~xvl~~~-~, o~tlctar, in [hefo(louing lncatian; LJ Basement L'J 1st Fl. L'J Pnd F'l. {~A1t/f)9YT .Sertfon Bfock Lot was examined on pF; l".f F%F1 NJR 14r14`7~ and found to 6e in comp(ianre with the requirements o/this Board. iIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS INCANDESCENT RUORESCENT OTHER AMT. K W. AMT. K.W AMT KW pgqMT K.W. AMT. N, P. DRYERS FURNACE MOTORS FUTURE APPl1ANCE FEEDERS SPECIAL REC•PT TIME CLOCKS FELL UNIT HEATERS MULTI.OUTLET DIMMERS AMT. K. W. Oll H. P GAS H P. AMT NO. A W. G AML AMP PMi gMPS TRANS. PMT N P, SYSTEMS AMT WATTS NO. OF FEET 9 ~ 9. 2U 9. 5 G~iG SERVICE DISCONNECT NO.OF S E R V 1 C E AMT. AMP, TYPE METER I NO.OF CC. COND A. W. G. A W G. A. W G EQUIP. ~TW 193W T,6'~W 3Ar 4W PER .P Of CC.COND NO. OF HbLEG OF HELEG NO. OF NEVTRAlS /OF NEUTRAL 1. 7~f1 Lli 9 f 4 ~ / f~ OTHER APPARATUS: M.U7'UR511-1.0 A, p. ,1 3.(~ Ii.P.,i 'i.N %%.~',F1 N if. PAk1EL13UARD~ e1_atl U.1:R. 10(d 3HUKG IYE9'EC1'URs°.I. - L~?~~ ~ G~~~ G & u CONTRA.CTOlt GIC,$57E1-•~ C/~~'" ;1U7C 21 AOlltHOGlt, NY, 9,1471 GENERAL~I~NAGER 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. ' INSPECTORS „w~~z Principal Building Inspector ~ ~~~~~U~~Dj~ G Curtis Horton ~ ' !:a SCOTT L. HARRIS, Supervisar Senior Building Inspector ~ Thomas Fisher ~ f ~ _ ~ Southold Town Hall ~ 'j P.O. Box 1179, 53095 Main Road Building Inspector ~ ' ~ ~ ^v~ Southold, New York 11971 Gary Fish -.,;d _ ~ Fax (516) 765-1823 Building Inspector ~ Telephone (516) 765-1800 VincenCR.Wieczorek Jr Ordinance Inspector Robert Fisher Assistant Fire Inspector OFFICE OF BUYLDING INSPECTOR Telephone (516) 765-1802 TOWN OF SOUTHOLD JUNE 14, 1993 JAMES FITZGERALD, JR. P. 0. BO% 617 CUTCHOGUE, NY 11935 RE: PETROS %OUGENTARIS To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: %IC% An application for Certificatg of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. The check is ( not on file. )$25.,~0,,J0 Rl~ No Health Department Approval on file. ° n. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 20165-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD,TOWN BUILDING DEPT. BUILDING DEPT. INSPECTION [ ]FOUNDATION iST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ FINAL REMARKS: DATE ~ INSPECTOR Proper-T Permit Services POST OFFICE BOX 617, CUTCHOGUE, NEW YORK 11935 (516) 734 - 5800 D JUN 2 81,9 Town ~u-'., June 23, 1993 Senior Suil.ding Inspector Town of Southold P. O. Box 1179, 53095 Main Road Re: Petros Kougentakis Southold, New York 11971 Building Permit #y20165-Z Dear Sir: This is to inform you that we are acting on NIr. Kougentakis' behalf. we are in the process of obtaining the papers that are neces- sary to apply for a Certificate, of Occupancy. The application will be submitted shortly. Yours truly, ti Dorothy F' geral a subsidiary of THE PECONIC EASTERN CORPORATION EAST END PLUMBING & HEATING Post Office Box 1052 1030 Osborne Avenue Riverhead, New York 11901 51b - 369-4074 LEONARD T. REMP$ INC. March 19, 1993 Town of Southold Main Road Southold, NY 11971 To whom it may concern: This is to certify that all solder used on the plumbing at the residence of Peter Kougentakis, Route 25, Orieht New York is lead free. Leonard T. Rempe President . r License # 117-P ~ f%IL ~ ~ G~~~~~~ a 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ( ]ROUGH PLBG. [ J FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: ~~P~ ..G.,/,~,(~ - w 1 l.~y ~ G~~2%!~G~11~. Bd~''~ //~1 F DATE INSPECTOR s 1c:LD i;:.`:C~ J:i ~IJn:,, j ~i;?4i'16NT.^. H 'OUIJDATION (1st) 'OUNDATIOJJ (2nd) _ _ N o C, ;OUCH FRAidE & dam' O PLUMBING J, r ~ r~ m = ra :IJSULATIOf! PER N, Y. I STATE EfJERCY CODE ~ FI;lAL s ADDITIOfIAL COMMEPJTS: x~ ~ 9 ~ X \ ~3 3 N H O ~ ; ~ x - m i. _ r x 1 . v, J~ • a t\J' ~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ( ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ l FRAMING [ FINAL REMARKS: ~ - _ , _ n 3 ~ . DATE INSPECTOR ~o/~ ~ ~s5-iso2 BUILDING DEPT. INSPECTION [ ]FOUNDATION 15T [ )ROUGH PLBG. [ ]FOUNDATION 2ND [INSULATION [ ]FRAMING [ ]FINAL REMARKS: ~G'~~ i~ ~ y- ~'~`1 DATE ~ v INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 15T [ ] ROUGH PLBG, [ ]FOUNDATION 2ND [ ]INSULATION [ FRAMING [ ]FINAL REMARKS: DATE ~ ~ ~ INSPECTOR ~''~'"J T65-1802 BUILDING DEPT. INSPECTION [)FOUNDATION 1ST [ ]ROUGH PLBG. [FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL I REMARKS: i DATE ~ l INSPECTOR P~3 ` lU 765-1802 DUILDING DEPT. 1 NSPECTION [ FOUNDATION 1ST [ ) ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: ~ - ~l ~ ~ f g f :f 'f ~ a L DATE ~Q l ~ INSPECTOR ~t I ~ { ~ i Y i:, Y3"'=` DE " APR 12 4~~63 ~i t~~'9 ~ BUILDING CO., INC. P.O. BOX Ir16A, SOUTHOLU, NEW YORK 11971 * 1516) 734-7898 c~~H, ~'e~-,~~T ~ I6S" t Neva York State Department of Environmental Conservation _ Building 40-SONY, Stony Brook, New York 11790-2356 (516)• 751-1389 August ]2, 1991 Thomas C. Jorling Commissioner Pettus Kougentakis 1700 East 55th Street Brooklyn, N.Y. 11234 RE: UPA ~F1-4738-00347/00001-0, Owner - Pettus Kougentakis Dear Mr. Kougentakis: A review has been made of your proposal to construct a single family dwelling and associated structures at property in Orient, BCTM 11000-14-2-30.5 as per the survey by Roderick VanTuyl dated 6/]4/9] and last revised on 7/3/91. Based on the information you have submitted, the New York State Department of Environmental Conservation has determined that the project is landward of the topographic crest of a bluff, cliff or dune which is greater than 10' in elevation above mean sea level. Therefore, no permit is required under the Tidal Wetlands Act (Article 25 of the Environmental Conservation Law). Please be advised, however, that no construction, sedimentation or disturbance of any kind may Cake place seaward of the ]0' contour or topographic crest without a permiC. St is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation in this area as a result of your project. Such precautions may include providing adequate work area between the 10' contour or topographic crest and the proms ect_(i,e._a ]_5_'_.to__20'_ wide construction area)__._ or erection of a temporary fence, barrier, or hay bale berm. The Department has also determined thaC no permit is required under the Coastal Erosion Management Regulations (Article 34 of the Environmental Conservation Law) because the project is more than 25' landward of Che cresC of the bluff. Please note that any additional work, or modification to the project as described, may require authorization by this Department. Please contacC this office if such are contemplated. Please be further advised that this leCter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies. Very truly yours, ~~YUV-~nci David DeRidder Deputy Regional Permit Adminsitrator LJS/DDR/rw cc: Proper-T Permit Svcs. file 1700 E. 55th Street Brooklyn, New York 11234 July 26, 1991 Senior Building Inspector Building Department Town of Southold Town Hall, 53095 Main Road Southold, New York 11971 Dear Sir: Please be advised that I hereby designate and authorize James E. Fitzgerald, Jr. of Proper-T Services to act in my behalf as my agent in the submission and processing of permit applica- tions which may be necessary for Y.he construction of a residence on my property located in Orient and designated by Suffolk County Tax Map No. 1000-14-2-30.5, and to furnish, upon request, supplemental information in support of the application. P~ truly, °z.o~ rj~. ~°--a~ Petros Kouaentakis Be s ;Speteially (',onftructt3n~;, Inc. lf"1~CG°3 `lf G°~ °QI~~~N~' y ;?520 Coney Island Avenue Ilnx)Icl1'nuulVcw l'orlcuu 11223 eAT ~ JOB NO ~71('~ ()Z7-7700 ATTENTI J RE ~ - - TO ~ l WE ARE SENDING YOU ? Attached ? Under separate cover via the following items: ? Shop drawings ? Prints ? Plans ? Samples ? Specifications ? Copy of letter ? Change order ? COPIES DATC NO DESCRIPTION P U 2 • D®~ a THESE ARE TRANSMITTED as checked below: ? For approval ? Approved as submitted ? Resubmit ~ copies for approval ? For your use ? Approved as noted ? Submit _ copies for distribution ? As requested ? Returned for corrections ? Return ^ corrected prints ? For review and comment ? ? FOR BIDS DUE 19..-? PRINTS RETURNED AFTER LOAN TO US REMARKS - _ 'teaI ` ~S~ TDWftr nG. p . e.~'.~J - -~,.,„,~~..~xAJ ,ODD COPY TO - SIGNED: _ 1(anclosures are not es noted, kindly noli! sal once. I3eys specialty Contrueiing, Ilse. f~G~~l"U CG°3 OG~ `U G°3Q[`~S~[M/l~~'~1' ° L 252(1 (~)ncy Island Avet)u)te] III'ol)~C~)'n, NeIV ~rt)t~'C I lZZf3 DATE JODNO q ^~u ~I ~ ~ 9 (7I ~ f)21 -710 ATTENT O aE TO _ 9 97/ WE ARE SENDING YOU ? Attached ? Under separate cover via o owing items: ? Shop drawings ? Prints ? Plans ? Samples ? Specifications ? Copy of letter ? Change order COPIES DATE NO ^/DESCNIPTION 0. THESE ARE TRANSMITTED as checked below: ? For approval ? Approved as submitted ? Resubmit copies for approval ? For your use ? Approved as noted ? Submit ,copies for distribution ? As requested ? Returned for corrections ? Return ~ corrected prints ? For review and comment ? ? FOR BIDS DUE - 19 ~ ? PRINTS RETURNED AFTEfl LOAN 70 US REMARKS J ~ q x l iii .x y/ I ....+xe+......~...A.~. a(,i.j l; COPY TO _ ' SIGNED: _ ll onclosures are nol es noted, kindl Lily us al once. _ I ~ ff h~l, ~ -rl ~r~ b Z i~ r~i rri ~ '4 f~ C C ~ •1 b C i K ~ _ i~ ~ ~ N to ~1 , ~ ~ v 2 r, 1" I it ~ _ ro e M n ~ o I ~'Vlyn~~ ~ f ~ ' ~n' .t ~ el o ~ b fil ~ n ~ ~ N `J :`a Zl I ~ I i pP~Y ~ n TI n~ I f3, „ In ~ h ~ 1' -V I ~ c`~ I , 9v~~ GN I ~ ~ ~ r'I t ~ ~ v. { j ~ T v . ~ U ~ G n r~ i w y ~ rl . . ~ a ~ - _ - - - - - - ~ ~ , d r- N ?1) ~ N I f tl PV ,t d I b ~o ~ ~7 ~ 'I -C 1 •I I I~ N a. ~ i ~ x* ~ ~ I ~ d -U i to m II r I ~ $ ~ ~ _i ( 6th T I ' ~ ~ ~ ~ r ~ ~ v ~ p ~ I ' C V c j7 't1 =r I n• ~ 1 p~ ~ ~ c i .1' a~ to c0 'I r 11 ~ ~ ~ I v i i i Q i t ~ I it T~ In , BOARD OF HEALTH ..v"........ ~°'~-=~","°~~°t: - ~ 3 SETS 0 F PLANS f' . ' FORM N0. 1 SURVEY . TOWN OF SOUTHOLD CHECK . ~6~~ 1 71991 BUILDING DEPARTMENT SEPTIC FORM • ~ TOWN HALL ~'I`-'` SOUTHOLD, N.Y. 11971 NOTIFY &SLD~. CYF~i'''f. TEL.: 765.1802 CALL . ROW Os~ S/OllTl-~flt~1•o,.. MAIL T0: Examined • ice/ • Approved . • • • • • 1~~ Permit No.~.~.'~~~~~ Disa rove ad' /c PP (B~mg Ins ctor) APPLICATION FOR BUILDING PERMIT Sept 17, 1991 ly,._ Date 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 a plicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations r or moval e i o , as herein described. The applicant agrees to comply with all applicable laws, ordinances, uilding c de, h si segula ~ nd to admit authorized inspectors on premises and in building for necessary i ec ' (Sig t re of applican , e, if corpo arson) PROPERrT BEYtVICEB James E. Fifag®rald, Jr . ...........D . P.O. Box 617, Cutahogue, NY 11435 (Mailing address of applicant) Phone: (516) 7345800 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Applicant is the agent of the owner......••...,,•,,,•,,,,,...,••.• Name of owner of premises ...Petrol Kougentaki8 , , • , , , , , • . . (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 . . Plumber's License No . . Electrician's License No . . Other Trade's License No . 1. Location of land on which proposed work will be done. 4? 9a... ~ :4' . r~ • • • • . .................................................Q2~.-•••6••....... • • ~ ~ ~ ~ • ~ ~ • • Street Hamlet House Number 2 30.5 County Tax Map No. 1000 Section ...,•1.4••,,,••,••, Block Lot................... Subdivision Filed Map No. Lot . (Name) 2. State existing use and occupancy oC premises and intended use and occupancy of proposed construction: Undeveloped a. Existing use and occupancy b. Intended use and occupancy PriVa.te• T2SideriCe .'r'.'. : . • , , , , , , • „s ~ < < r~ ~ _ 3. Nature of work check which a ~ ~ ( ~plicable): New Building X Addition Alteration . Repair . Removal Demolition , Other 1Vork . (Description) 4. Estimated Cost 1'!14?'?..l'eh~n..~20, 000............ Fee . (to be paid on filing this application) ~ . 5. If dwelling, number of dwelling',units , , ,One , Number of dwelling units on each floor . , , N A If garage, number of cars ~ . N/.A t . . 6. If business, commercial or mixed occupancy, specify`naturc and extent of each type of use .....~/#i . 7. Dimensions of existing structures, if any: Front . , , , , ,Rear Depth . Height ..............:NumberofStories...............................,......,.. Dimensions of same structure with alterations or additions: Front Rear . Depth ~ ..Height . , Number of Stories . ' 8. Dimensions of entire newconstiuction: Front ....7.5l-9!'..... Rear ...7.5'.-9!'...... Depth .5a!-7P!'...... Height . 3.3 ! -9 Number of Stories ,2 . , , , , , , , , , , , , , , 9. Size of lot: Front ....125..9~l... , , , , , , , Rear .....1:1.8,49.'.......... Depth ..4.1,3.,43.' .v~1:'. , 10. Date of Purchase , .7/.x/.91 Name of Former Owner . , Benngtt Bxplcaw 11. Zone or use district in which premises are situated R-80 • . ~ • ' • ' • • I2. Does proposed construction vio4ate any zoning law, ordinance or regulation: No. ~ ~ ~ ~ ~ ~ ~ • ~ ~ ~ ~ • 14. Namlot be regraded Y?~... , ..Will excess fill be removed from premises: Yes X No e of Owner of premises .SEe lie~ow , , , , ,Address . . . . .............Phone No..... . . Name of Architect . ................Address , .........Phone No. . Name of Contractor . . . . .Address . , , . .Phone No... IS.Is this property located within 100 feet of a tidal wetland? *YES..X.NO..... *If yes, Southold Towri Trustees Permit may be required. 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. Owner; Petrol Kougentakis Contractor: Pride Building Co., Inc. 1700 E. 55th Street Phone 734-7898 Brooklyn, ~ 11234 Phone 718-6,27-7780 Attached: Three sets of stamped & signed plans Two copies of survey approved by SCDHS 7/24/91 Letteriof non-jurisdiction from NYSDEC dated 8/12/91 Letter of authorization Energy code calculations COUNTYF NEWSu~~oKlkyS.S OF James E. Fitz e (Name of indivfdual s~ni~ald, Jr. being duly sworn, deposes and says that he is the applicant g 'ng contract) above named. I He is the . agent .............1...................................... (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 contajned in this application ace true to the best of his knowledge and belief; and that the work will be performed in the manner~set forth in the application 131ed therewith. Sworn to before me this ~ 7th ...........day of i, ...$Eptember.... m, 199 Notary Public, .?~~2~~~~ f'_ `~uYhJ z-,~ c--__.~~,~.c. .County JANET R NOrARY PUBLIC, Sg' eEwNRw York • No 62 ~;s3eas (Signatur f applicant) Ouillfied in Suf olk County Commla,Ion Expiro, N,ov; 30,°19~a n - a p - 8 ~ m~ ~ m ~ _a o ~~~~a , ~ ~ " ~ q V K fD -2~ ~1 ry i O _ L m <n '-n ~ , - ~ ~ \}l))o ~ s'`~~~1 t`°. ~ ~ ~ i J ~ ` 1. ~ - ,zt~ ~ I, , k~m „3 l> \V ~1eu1Rp ~ j -o ~ ~ ' ~ Im~,3j~ ; , A ~ i r~tir~ I ' 4i~ ~ c ~ ~ ' ~ o < i i' ~ m zz ~ ~ ~l a ~ ~ ;~j ~ ~ i~ 3,~7 a o ~ p~~~s ~ ~ ~ ~~4~ , F ~ ~ I\ ~ ~ ~ ~t,` ~ ~ A ~ ri 1,.~ +r ~ H~ A~~A rpm ~ yW' ~ ~ ~I' O' i / ~ t% ' ~ 2r ~ .3~~ ~ ~ y~ f ~~.a r,, n ~ ' I i ~ d ~ C} I I'"~ ~ n ~~~ffi 140 ~ x ~ O ~ O r ti ~ ( ~ , , ~ o I~p 3 ~{r~ rn ~ C7 ~ ~ f!1 m !i'~ ~ ill r~ 'T'- r wl +71!x°3 ..q f °`7 F= Im fit; /n4kA ~ R t -d ) V J r ,r ,~,,r,7 ;~~T` ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Gl ~ ~ m ~ ~ 7b ~ tt ~ n ~ ~ 1 ~r in ~ C"s tb ftl t~ O 3 ~ q ~ ' O ~ ~ b !a ~ t ~ ~ ~ ~ Y~ ~ 0 ^~1 2 ~ ~ ~ 3 x T ro ! x r~< ~mi<Z ~ g ~ a~ rn~ „~.~\'1 S'I' A 6 ~ ra s o i <S ~ u~, o~ 7 n a yy ~ Q ~j Q p ova .-p „ R,9 O ~ J , ° u ~ n m ~ iP. c V z In i~'c A sZ ~ueS'~ ~o ~+~@. 4_`<r ~ '~i ~ ~ Z m ~ a 0 , (;:0 2 CT r ro n 2' 3 is < .'w it ~ ~ h Q ~ b tf' ~ ' e:"'.-'~ Y M ~ . rv c 'T itl ~....e~ `t' ° +r m O m n 71 Ciiti G 9 hP Ub a o c, ~ o ~ m ~ n n o xtl l,l~ ~ ~ , yon ~ , : a ~ ~ C? ~ z rA° n 1 ~ A~ n~ ~2 mrra- SUFFOLK CO. HEALTH pE~. AfTROVAL S":~'v~'~~ _F 2 t r-..~ i ' A'~ _ ~ ~ ~c _ ~ rr~~ ~"t ~ j ~ \Pa ~ S y Z~ fTATEhItFJt1' OF iNTfi-#!T bh/ ~ ~ ~ THE MtATER SUP?lY ANO>E1EA6E tDtif*Ef~AL . \ry, ~ < sYSTEtrs FOR Tats. k ~cn ~p Z oDwF~ To THe ss,worr,;~ oY Tfll~ , \ ' s ~ O fUFFpLK f0. DEPT. Of HEALTH fLRiliC@f. \ ci ~ t, Is? ~x \ ~ ~ `~C~ AI'f'LICANT \ \ ~ GOUMTY Dt?T. Oi SCPILE_{?Q,1,~ ~ ~ ~ \ ~p 3 ~ tiERVICEf - trQR ~'ROVAi hCfR . • ptPE ~ ~ ~ ~ ` ~ ~P C01ATRlJETK?MOMt„Y t ~~-c\~ 3 sL pu?TE: AC2~4',4E,5C~93>~, ~°t~ ..\f` t N. s.REf.ND.: ~ , ray ,g,L AlrROYEO: "'~{ONI.iMENT ;`~/iicAtv'r) ~t' ` t N o `x . ~L ~rfp~ CO. TA?C Mli#~ ,1 , A"ii~l ^ t9Ml7. fECT. tl.©CJt 1 ~ ~l ~ \ tQ~J 1~ 'L ~ ,S a~ ~ , ~ ~ % o r t ! `jam / \ ~ ~ ' ~ .S' ~ ~ . i ~ -7~e ~l pis' t ~Y ~ / ' 1 ~ ~ N ~/^t~~ y. Wn 7L.._ _ ° ~ - O Y dacatwri taw. ' ~ Q rwt aaanrtt 7fl s • ~ ~ ~ - ~ f .k L ~lian~ his ~ srv~Y ma" . a; 0 .rveYar ~ x s' sn'ISrad _ ' PL 59ai arias nom: t'R Cnr1 ` \ ~i' i 7"0 ~ - a ~ a ~afitl truo ccaY i ~ ~ \ ~ ~ J Guarantees end°'ataa haeeon s oar~ml41 { .t j, ~ r ~ f V LL I h~yr ~V ~ Of11Y i6 fnR :tt:[San (af Y~?~ajn 1{ 2a ~ , 1` I- ! :1V1~y y s Vlr Is Or ~ar3d antl an nt~nen '1 ay „nd ~ ~ ttFCen env 9m'nr n aff. 7 C n itUtN ra h h V1 ^+..-.+'.aa s ,razes of s ~ur.C n~ S "1 O ~ ~ ' ~~~7'~ t ~ ~ 'R`~~x`ar " tv ~~-rar t9as are ptrt5u4~gaYBK p _ to scC!:ianal inaritutiMS - owner. :~A!vP,Ayr j MAP AM~KjpE„r,~-,}vN,2t ! l;.tuLV 3, ~99i 5j1'~D . w _ . QGT 101t~l. ~`a ~ V Y ~r - '~'•-'-~^^F ~ ~ f~.A~fi ~o Alf ~ < s 7~ R ¢ `A Q YA7q~„ ~ ^ 2 ` 4~~ ye bv.~ ~ CS 256ry~'~v I LICft}1~,~? LAMD - ~ AFC c,{~16 taela. tT WEMf Yp~1( I+ - SUFFOLK CO. HEALTH DEPT, APTROVAL ',~F ~'R~~'Er~-T-~~ H S. N0.9~'Sa-d9 'i'G ~L~. '.J ~G 1 - ~ 1 \ v , _ ~ ~ ~ A, - ~ t ~ y I i STATEMENT OF INTENT " ~ ~ ry. ~ ~ ~''y I THE WATER SUPPLY AND SEWAGE DISPOSAL 1'JW~ Q~ •~~',,,'"r ' ' " `v-' ~ ~ y 4 S ~ SYSTEMS FOR THIS RESIDENCE WILL ^ - `yam---~ \p;~ ~ ~ ~ 7~ v' I ~ CONFORM TO THE STANDARDS OF b ~ y P SUFFOLK CO. DEPT. OF HEALTH SERV/CES, - ~ ~C ~ ffl :ii - - / S ?1~ APPLICANT ~ 1 dl~S C'_~j ~ ~4 ~ m - - a.,~ ~ ~ ~ 7~ ^r r, SUFFOLK COUNTY DEPT. OF HEALTH j_~ ~ y ~ ~ SERVICES -FOR APPROVAL POR f .ALE -C,p = t v .x' • _o r r t o~ CONSTRUCTK)NONLV - ~Q ~iPE ' , DATE: ' ' ~ : ____.~hr2£"A' r~(c 'x.78 S F ~ ,'t, r c r~%' 4~m., H. S. REF. NO.: gl- SO -.4g d _ APPROVED: n rr [7_M1"rJ~t~k IMEPJT JACA ~ ~x i'/ ~ { 3 ~ SUFFOLK CO. TAX MAP DE516NATION: p _..6 , / G ~ r~~~/ ° DIET. SECT. BLOCK PCL. ~ OWNERS ADDRESS: p r~, 9; 1; it'. 6~ - . - 'F' ~ - - ~ vJ r~:~, ~ `\-i ~>S, 1. (tiC g, ~IIC._~~ nt'I ,:~~y F ~ ~ _ ~ ~'I BRt~~' ~ti l IA. -f~t7'T78Q ~ ~ \y~ ~1' ,.1I r~`v ~c14 'O 'L ~T ~ DEED: L. P. ~ , jt ~ "'tom : ~ u ihorized altaratlon cr addltldl ~ ' t ~ , ~ '4• r - ~ n to ie survey is a violation of • Fi ~ 1 ~ T.)' r(` on 72..8 of the hex York SYN •aQ ~1- '~7.5 ~ ~ / rU '7 ibn to T' ~ / " t T rOPSUIi_ Wes ofD~s aeY map not i ~ ~ ! {S • lentl Sur ,o ; m!<ad Seel abI ~ 1 ~ .t~ ~ ~ 2e bcssed .Ral s I not be wneldasd - BQe~K pte,~`~ ea vaLd rue copX Z i C~ O j, J i n +-v~ G!`'I~/CE# G Y~th~esperso~lowhom he su ~ Is repared ' on his behalf to th 1 ~ V.• /~C ~ i_GT NCI~S 2~Fc~, T2~ AIgF•.r ;F A. Mt~~Oi~ _ 5 gmns ~ ~y.~~rr.heleonaen~d~ /~S t ~ v ,j~Ce ~1 ~ ~ Ci`i'A v l= F'~..AG Qi .~~_t a~r CBI~'iI~A_ t ~n Gu>rw ~ ~enotditransferobN t+ T ~,~~~~r, r'vF.C ~~a. - i'1~.t`. ._G~Y add~UOnal lr u:;.uu~u 0l 6ubeeQlMflt 1 ~ 3 % / ~ ~ `'-D '!A'~P~i' `:iii SEAL ~ ~b?~~~~ I5 bl Nti(' I~t ~ v;`~ v -T 0 ~ _:'Q nun ` } i F h!E •.4 f'f J~A{~~;~E~ G~~-.d lK T~ 1 TI TI..E :A~~. I h ~J~ Qr TG(~~ . >'tt~.! , 0~.}!4 pN-r~~'='J -P~ _!JRvE`/E~ ,,I.1h14.~ I * r ROOERICK VAN T YL. P.C. 'p - 1 e?. Yom..... ?'`~«,•,Q ~ o ~F em.tsax~o LICENSED LAND SURVEYORS r-r ~SFO IANO 5~~' ' GREENPORT NEW YORK attDrrt rox wrm ' Sl1FFOLK CO. HEALTH DEPT. APPROVAL ! ~ v' I~,,.' l I i ~ ! I pip ~ \o ~t~+~~'i'` p n~ ~ ~ STATEMEN70F INTENT ~ i THE WATER SUPPLY AND SEWAGE DISPOSAL i ( AWN ~.O~r~; a;.Y, a~i ' t ~ SYSTEMS FOR THIS RESIDENCE WILL i ' ~ 1 r~ T ~ CONFORM TO - / ~ '9 THE STANDARDS OF E~ ~l+ _ f% ~ \ y ~ SUFFOLK CO. DEPT- OF HEALTH SERVI~ , 4fr'L~K~~ h~Ti'trCir~i' iCl' _ JEr.~l,t.~ + II' ~ r~nr , k ~ v r,'~i , (rW (d`~ ~ ~ 7 l ~ ~''ti s \ ~ (SI APPLICANT ...h . ~ ~ ; \ 7~ ~ ~ Fr SUFFOLK COUNTY DEPT. OF HEALTH ~~4tE.~Q~_~u ~ \,;'~y~ ~ ~ *aa ~ ~ ~ SERVICES -FOR APPROVAL ROR f r " \ u?~C1 f~~,''~ ~ ' ~ ~ I Q' P(P~ ~ ~ t' ~ ' , ~ a CONSTRUCTK)N ONLY i _,~F.µ2irA~~6 $.F, ~ S DATE: I R y,r J ''r' _i ~ ~ _.-_...:.__-..~.a..' ~ ~ r~1 ~G~ H. S. REF. NO.: g~-Sd' 9 .r.__. `'j~~ ~ ~t ~ 'L APPROVED: ?'tE LENE) ~ I ~ ~ ~ a c i a ~ ? ' ~ SUFFOLK CO. TAX MAP DESIGNATION; !,1 asT. SECT. BLOCK PCL ' ~ li ~f(/'~ V~r~, , ~a bWNERS AODRESa: J ~ ~ ~b~~'l` ~ I S la ° ~ B~<Q?KLYN N.Y ~ i,~ ~ _ t J ' , v ~ ~rti, ~1i -r~~ ~ ~ , . ,c~ ~ , . -:~u ~ ~ , ~ ~ ~ ~ ~ ~ ~ ~ ~ ~4h DEED: L, P. r , i ~ / L ~ t;~ EST HOl STAM ~d, v } ~ P r ~ ' Q~ U authoriued alleriion or addltbn . *G' ~ t - c O' ~ p' to is survey is avioletion of 1 , 444 ~ V S 'on 72c~8 of the Kew York SWe I 'l~ % ~ , rGP 5tj ! pies of ,i v'Y map not bearlnp I i ~ig~ ~ - _ 4 land s~ . ; i^4ad seal or 4 's t ~ , - t ° -e bcssod e~+ t;;i not be wnsldered j to e a valid true copy. ~ ~ 1 l" l ~Q~ ' s4'~k o¢`~ ~ # G aranteestnalcatedhereonshallrun , f ~ s t~ ~ ; G,(?~E L o ly to :he person for whom the survey ~ _ t ry, ~ is repared a••d on his behag to the TTJJ i • _~T N(~~. ~ ~ _ - .;t comps ~ ~~;trr ent~ a;;ency end i t~~ 1 / f ~ rC ~ A 7'IA~' _ F P. M I P,ip(~ ding uuu ~ ,i ,i ec hereon and ,S ~ }~!4;V1?IQA,i; t~q,~~ !~rr E~E!J~i~'" ~ theassiy ~r e,erdinginstl• V t ' n Gus ~ ~ r; not transferable ~v ~ x ~ ~~'JPTK.iFwS ;~F/A,~; _E'~e, ! additwnal,r.~~,uuu~uorsubsequent (,~v'f~G IS I~ OZ ~~`u°,` _ ;y;~'•...,ti_Y __`~I ~D SEAL , ~~.r?. ~(~F , .i 31E~ -aCT, fQil~l~ i'tUG~2d~l.~ ~ ~,F NC ~`n. ~ a~ ~ ` ~ iv ,'v ~v/~fifu~i~~~,', •rr, ~~..V?K~ tTi~k.+: `^.f'~l:i T~io~ + r' ~ . 5 ~ :s!1 ,.°,~;~At~:' ; - ~'JR`JCYED ,;~.??,t,ll ~ ~ ~ II ~ I ~ * RODERICK VAN TUYL, P.C. ' r ~ ~'S Q ~F No. LS 25628 LICENSED LAND SURVEYORS t ; I roSFa LgND 5''P -ror - GREENPORT NEW YORK ' _ _ _ _ ' 1