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FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-18487 Date OCTOBER 20, 1989
THIS CERTIFIES that the building ADDITION
Location of Property 750 GRETON COURT MAT'fITUCK N.Y. _
House No. Street Hamlet
County Tax Map No. 1000 Section 107 Block 02 Lot 3.4
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated OCTOBER 13, 1989 pursuant to which
Building Permit No. 18582-Z dated OCTOBER 20, 1989
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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to ARVO & RUTH KANERVA
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N A
~W.,
Building Inspector
Rev. 1/81
rosai xo. s
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)
~.8:~8~ ~y-~ q
N ~ Z Date ..Q.S:I!.. ~ 19 $..1.
Permission is hereby granted to:
. ~ C~~ ~ .
o ).y.Arh.1~.V.~:1.R?1......5~,-...~4.~.Y4.....S~4.E~:k2~:t.~(<f~ta.~e......~!.:1...~L~
of premises located at .................~§.!:.~:1......4!J..:...................t~~................................
.l.,Sr.... ~.A.t!r1l.l~A~~':. ~~1Y~....11. ~'.1.'!~'i1:4:Q^
County Tox Map No. 1000 Section Block ....Q fir.......... Lot No.......~~i.:.~.........
pursuant to application doted .....0..1:.11.SF.... 19~i~.., and approved by the
Building Inspector.
Fee
a:
Building Inspector
Rev. 6/30/80
_ TOWN OF SOUTIIOLD ~ ~ n ~ ~
BUILDING DEPART2IENT (4j U D
f ~ TOWN HALL OC.I- +
SOUTDOLD, NEW YORK 11971 7
765 - 1802 ~NLD~.60Up7. LD
APPLICATION FOR CERTIFICATE OF OCCIIPANCY
DATE.. /G..~~. U /
NEW CONSTRUCTION .......OLD OR PRE-E%ISTING BUILDING......VACANT LAND....._..
Location of Property.. ,~j.7~. , _ _C~ ~/>l,(~7%T,,fC~ _
HOUSE NO. STREET t
HAMLET
//,Q
Owner or Owners of Property.,/,Y!l~!,~__`~_.~~~~_/~il/~,~~/,y~.•--.-•.•.
~ r
County Taz Map No. 1000 Section . _/~~Block
. Lot...
Subdivision......,! ~7_ Filed Map Lot.
tt
Permit No. ate of PermiC
D
..........Applicant
Health DepC. Approval Underwriters Approval..........__..
Planning Board Approval
Request for Temporary Certificate
Final Certificate
Fee Submitted: ~ ~ w..._...._
APPLICANT. ,i~ Lit-s'~
reV• 10/14/88
6Z.ec. 3 S y ~ a,
Co ~ I $Y8`7
~ .
FORM N0. 6
1' i TOWN OF SOUTHOID
~ BUILDING DEPARTMENT
~ ~ ~ I TOWN HALT.
765 - 1802
APPLICATION FOR'CERTIFICATE OF OCCUPANCY INSTRUCTIONS
A. 'This application must be filed in typewriter OR ink and submitted to the Building
Inspector with the following; for new buildings or new use:
1. Final survey of property with accurate location of all buildings, property lines,
streets, and unusuall,natural or topographic features.
2. Final approval of 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 solder used in system contains less
than 2/10 of IZ leadt
S. Commercial buildings; industrial buildings, multiple residences and similar
buildings and instal)rations, a certificate of code compliance from the 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'iuses:
1. Accurate survey of prioperty showing all property lines, streets, buildings and
unusual natural or topographic features.
2. A properly completed`~pplication, a consent to inspect signed by the applicant
and a certified abstract of title issued by a title company which shall
show single and separate ownership of the entire lot prior to April 9, 1957.
IF a Certificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
3. Date of any housing c¢de or saFety inspection of buildings or premises, or other
pertinent informationirequired to prepare a certificate.
C. For Vacant Land Certificate of Occupancy:
i. An application for vaunt land Certificate of Occupancy shall be submitted,
and a certified abstract of title issued by a title company showing single and
separate ownership of'the entire lot prior to April 9, 1957 shall also accompany
the application. If a Certificate of Occupancy is denied, the Building Inspector
shall state the reasons therefor in writing to the applicant.
D. FEES:
1. CERTIFICATE OF OCCUPANCY - New Dwelling $25.00, Additions to Dwelling $25.00,
Alteration to Dwellling $25.00, Swimming Pool, $25.00. Accessory building $10.00
Addition to Accessory buildings, $10.00. -'Businesses $50.00.
2. Certificate of Occupancy on pre-existing dwelling - $100.00.
3. Copy of Certificat'ie of Occupancy - $5.00 - over 5 years - $10.00
4. Vacant Land Certificate of Occupancy - $20.00
5. Updated Certificate of Occupancy - $50.00
6. Temporary CertiFicate of Occupancy - $15.00
I
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reo. 10/14/38
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IIdSULATIOt! PER N. Y. y
STATE EP7ERGY
CODE
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1 SLOG. DEPT.
TOWN F SDUTHDLD
BOARD OF HEALTH
3 SETS OF PLANS
FORM NO. 1 SURVEY
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC FORM
' TOWN HALL
°,OUTHOLD, N.Y. 11971 NOTIFY .
TEL.: 765-1802 CALL
~-p-~ ~n ~ MAIL T 0
Examined . (~'e~j~C(R.L. ,Z 19 b'q9
Approved ~i~:''Q~'t', , 19 ~ ! Perntit No.~ ~.,SB 22 ~9~? R
Disapproved a/c Q l5 ~ t'I LS p
• .........n ~ ~ ~ U
(Building Inspector) 8 .DE
F30
APPLICATION FOR BUILDING PERMIT
Date /G ~3 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 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 inspec~y~ns.~~
/
/p~ 'q (Signature of applica~nt,/`or name, if a corporation)
8'AiP teat R179W4j F°F+"a'~
Y ;•a.+t'. y.a,....:, ~,jb C~E'7l/,r/ ~1...~1~7.ril~C~('~!%t/.
!~@"t~"~p~'~"t'q~'~'~}~"~~~~'~~'~~1~ (Mailing address ofapplic~ri,t) //%S~
State whether applicant 1 ,went, architect, engineer, general contractor, electrician,,plumber or builder.
~.-f
J// ..~~j~... .~f,.~J. ,
Name of owner of premises ° U ~ ~;i, , , ~s!'+~~~~~ .
.
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
kGL ~ .
(Name and title of corporate officer) '
ALL CONTRACTOR'S MUST IIE SUrFOLK COUNTY LICENS`E'D "
Builder's License No . ,.,tr`:;': ~ ,
Plumber's License No . .
Electrician's License No . .
Othcr Trade's License No . 'i
1. Location of land on which proposed work will be done. , , - , , ,!;(,'p ~
7~'0 G~Ce,
~ti~ ..........:!~~2'.~1..~T~~~ . .
House Number / Street Hamlet
County Tax Map No. 1000 Section , , , , , , , , Block ~ Lot , ~ l '
Subdivision .G~,e7,lr~r/ ~;ST1~,l~„J', , , , , , , , , , , , , Filcd hlap No. Lot ,
(Name)
2. State existing use and occupancy ot-pr/emises and intendte/d use and occupancy.o/fproposed construction:
a. Existing use and occupancy ~.~~.~~1~,/. ~ ~
. ~yF{.. ...~Sp
• . '7~ ` yl`:~ ii'9 QS-iiiF ~1't'• W~tSi q-.• • .
b. Intended use and occupancy .~1; ; ;.rri t ~'~k~
3 Retu~ of work (check whiRem~plicable): New Building Addition . . Alteration ,
P pval Demolition Other 1Votk .
~ ~ (Description)
4. Estimated Cost......Y~.` Fee........................... ,
(to be paid on filing this application)
5. If dwelling, dumber of dwelling units . Number of dwelling units on each floor .
If garage, number of cars .
f1 occupancy, specify nature and extent of each type of use . . .
6. If business, commercial or mixe s, if any: Front Rear , Depth .
7. Dimensions of existin structure'
. Height Number of Stories .
Dirr~ens~e~of^same stry~tu~G,Ev{th alterations or additions: Front . Rear .
I7G ; Z . , . ~ ~;1~. ; ' . Hei t .
is Y;~..,...., ' g.~i .i.i. gh Number of Stories .
8. Da nsions of entire new ~~nn ruction: Front Rear Depth
t ~~pp.r.~*..~..#~I~~t~berofStories...........
9. loroht #`.~r Rear Depth .
10. Date ~hase~ ,y..W,~».i . ..................Name of Former Owner .
• p
1 1. Zone o ~ ° t`° ich emises are situated . . . .
radedp , , , • ate any zoning law, ordinance or regulation : . . . . . .
13. Will lot beore ) .
g9` Cbn r c io Gfol ~yill excess fill be removed from premises: Yes No
14. Name of Owner of, remises . ....Address ...................Phone No............... .
Name of Architect . • . , .Address ...................Phone No............... .
Name of Contractor . ...............Address .Phone No. .
15. Is this property located within 300 feet of a tidal wetland? *Yes No
*If yes, Southold Town Trustees Permit may be required. f
PLO"1' DIAG1tAM
Locate clearly and distinctly all bulldings, 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.
C ~
I~
APPROVEQ AS NOTED 1
PATE: ~O ~.c B.P',t~ ~ s s"B a OCCUPANCY OR
FEE: BY:I • G' . USE IS UNLAWFUL
NOTIFY BUILDING OE('ARTMENT A7
766•t802 g AM TO 4', PM FOR THE WITHOUT CERTIFICAT
FOLLOWING INSPECTI{SNS. Of OCCUPANCY
1. FOUNDATION - TWO REOUIREI) r,
FOR POURE!) CONCRETE
2. ROUGH • FRAMING~~ R PLUMBING
3. INSULATION
4, FINA4 - CONSTRUCTION MUST
BE COMPLETE FOR 1;,0.
ALL CONSTRUCTION ',SHALL MEET
THE REQUIREMENTS i,OF THE N.V.
STATE CONSTRUCTION , & ENERGY
CODES. NOT RESPI~NSIBLE FOR
DESIGN OR CONSTRUCt10N ERRORS
STATE OF KE~V Y~9RK, . S'S .
~Olii\*TY F...• .
• e • • • . • being duly sworn, deposes and says that }te is the applicant
(
`~n~e of indi ~d~l si ni~ ontract)
above named.
ieisthe ..(,1.w.~:~~.........................
(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 contairSed in this application are true to the best of his knowledge and belief; and that the
s~ork will be performed in the manner set forth in the application filed therewith.
worn to before me this
,.day o ~ 19CJ.1
;plat}' Public, County
CU41RE L. OLEW ..~CP.~i~G. 2
y~!~ . .
....Pp.....
NataryPublks,StMeofNewVork (Signatureofa licant)
QueliN
d
In
8u~f
folk pdurHy GI'h
Commisebn Expires DecemA~r 8,1