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Home My WebLink About18598-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Towri Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23602 Date APRIL 20, 1995 THIS CERTIFIES that the building ADDITION Location of Property 395 DOGWOOD LANE SOUTHOLD NY House No. Street Hamlet County Tax Map No. 1000 Section 54 Block 5 Lot 28.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 20, 1989 pursuant to which Building Permit No. 18598-Z dated OCTOBER 25, 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 ie A FIREPLACE AND CHIMNEY ADDITION TO E%ISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to JAMES & ELAINE RELEMBELIDIS (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Bu lding Inspector Rev. 1/81 absas xo. a 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) .....ln a::~ ............................19.~,r.. N o 8 9 8 Z Date ~f Permission is hereby nted to: / ,~XGClA"~O to ....~~z~.~: , of Premises located at .ly.~C..~....,............................................ County Tox Map No. 1000 Section Block Llot No..........~.Glc.~. pursuant to application dated .........ll~~~•••••••.•..••••••••••••••••, 19.f~J.., and approved by the Building Inspector. Fee $...4.~ ~J. ...~.t~................. B Idin nspector Rev. 6/30/80 ~ O~ Porm No. 6 • TOWN OP SOUTIIOLD L / BUILDING llEPARThIENT ~~~//~J~ TOWN EIALL 1~ 765-1802 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 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 - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, gCommercial $15.00 Date .....~f 5 _ New Construction........ Old Or Pre-existing Build' g............ Location of Property.... ~ ....~d~, ,(~l,/t?; ;c~ • _ • House No. Street Haml t Onwer or Owners of Property.. ~~~j~~ County Tax Map No 1000, Section.. ~~,,,,,.Block,. ~ ......~5......LOt...... Subdivision .Filed M:~p...... o ~y /r'7 t Permit No...~~V,/,~_,Date Of Permit.~U.L!1~/(~p• ,p .Applicant~~4~!.Y.~!~~4f![:.f /S health Dept. Approval.......... ••••••••••••••..Underwriters Approval Planning Board Approval Request for: Temporary Certificate........... Final Cer[icate........... Fee Submitted: $„•,,,q~~ ~e~ k 934 3 ~%~~4-~~ . . ~a3~~~ ........APPLTCANT _ Y ~1 h'1 =0U17DATI0`1 ~ ( 1st ) ~ - "3+^' ~ ?OU)JDATIO;J (pnd) ti. ~ _a - - - ~ , • o` C,y~ 30UGH FRAtfE & .PLUMBING y 3 , a m ItJSULATIOAJ PER N. Y. I c7 H STATE EPIERGY I ` CODE H m~ FZiJAL i ~ • • I o ' ADDITIOtIAL COMMEt7TS: • m ' x ^o\ H H O m - / m~ H TORN OP SOUTIIOLD BUILDING DEPART:IEi7T TORN IIALL ' SOUTIIOLD, NE47 YORK 11971 ' 765 - 1802 i% APPLICATION FOR CERTIFICATE OF OCCIIPANCY DATE.. /~~J~.... NEH CONSTRUCTION ._....,OLD OR PRE-EBISTIi7G BUILDING.=•.--pACANT LAND.... Location of Property....~1.~.~.,,:,•._•.•..,(~(~~~~,___,~.Q(~,.... DOUSE NO. ST •ET °rt- UAMLET Ovner or Ovncrs of Pro crt ~j~~~?E ' County Taz Map No. 1000 Sectiao, IIlock .`S • Lot' Subdivision.. Filed Map ........Lot_. Permit No. ,pate of Permit ~~j~••.~.•f~PPlicant /6'.v=`~='q.~!~y~ IIealth Dept. Approval Undcrvritcrs Approval......,_•,••_ Planning Board Approval Request for Temporary Certificate . Final Certificate Pee Submitted: P /~//,J, ///~I I\\ APPLICANT`:'::-;: ~~;'~7.Zr'2_t~'L~0^~-~N••.•••.•••. ~~~'~S rey• 10/14/88 ~r~ ' _ ~ 4 FORM N0. 6 TOWN OF SOUTNOLD BIIILDING DEPARTMENT T, 765 - IBO APPLICATION FORCERTIPICATE OF OCCUPANCY INSTRUCTIONS A, This application must lte filed in typewriter OR ink and submitted to the Building Inspector with the following; for new buildings or new use: 1. Final survey of prolerty with accurate location of all buildings, property lines, streets, and unusua} natural or topographic features. ' 2. Final approval of Deal[h DepC. 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 lead. 5. Commercial buildings, industrial buildings, multiple residences and similar, buildings and installations, a certificate of code compliance from the Architect or Engineer respons}ble for the building. 6. Submit Planning Board Approval of completed site plan requirements. S. For existing buildingsl(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, buildings and _ unusual natural or Xopographic features. 2. A properly completed application, 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~iivriting to the applicant. 3. Date of any housinglcode or safety inspection of buildings or premises, or other pertinent informatipn required to prepare a certificate. C. For Vacant Land Certificate of Occupancy: 1. An application for bacant 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. I~f 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 Duelling $25.00, Additions to Dwelling $25.00, Alteration to Dwelling $25.00, Swimming Pool, $25.00. Accessory building $25.00 Addition to Accessory buildings, $25.00 -'Businesses $50.00. 2. Certificate of~',Occupancy on pre-existing dwelling - $100.00. 3. Copy of Certificate of Occupancy - $5.00 - over 5 years - $10.00 4. Vacant Land Certificate of Occupancy - $20.00 5. IIpdated Certificate of Occupancy - $50.00 6. Temporary Certificate of Occupancy - $15.0,0 Residential Commercial p? I " co. 10/14/S8 - - --------1- - DATE: ~~~~~sR39~ ~ ~ ~ - ~ ~ r N0TIF4~ UIhDIN6-9 'f - - - 765-1802 8 AM TO 4 PM THE __--FOLI01L1[ING INSP-EC'TIONS~--- - 7. FOUNDATION ' - TWO REQUIRED . . FOR-~UR~CONCRETE-._-- 2. RQUGH -FRAMING & PLUMBING _ 3. 1NSUl.ATION 4. FINAL - CONSTRUCTION MUST - -v-~-T-- 8E COMPLETE FOR C.O. ti.-CC-CDlUSTRUG N-SFf~ll MEN--- TNE REQUIREMENTS OF THE N,Y. .-CONSTRUCTION--& -ENERGY---- .....,F.S NOT li',~t f4R C-0NSTRUC ION ERR0R3~- - ~ - _ - G// - - - G~12_I~ ~ - ~ -r-- 1 ~ ~ L/ rss-1802 BUILDING DEPT. INSPECTION [)FOUNDATION 1ST ( ) ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ )FINAL REMARKS: ~ G H DATE [J INSPECTOR u~~ 765-1802 BUILDING DEPT. 1 NSPECTION [ )FOUNDATION iST ( ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [)FRAMING ( FINAL REMARKS: DATE ~ INSPECTOR N~V BOARD OF HEALTH O ' 3 SETS OF PLANS FORMN0.1 SURVEY TOWVOFSOUTHOLD CHECK BUIL"O,INGDEPARTMENT SEPTIC FORCt TOWN HALL T WN4FSOU HOLD ~OUTHOLD, N.Y. 11971 NOCALL TEL.:7G5~18 MAIL T0: i Examined ./.~a..;~;?......., 19~ ~ ~ ~y Approved .~~~t6, , , , , . , , „ 19~.~. Permit No. ~ ~ 7"~~Qy~ a' Disapproved a/c ~ ~ (Bu' t o Inspector) APPLICATION FOR BUILDING PERMIT Date 14:. l- 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"1'3EREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone. QrdiraHae of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Re=tilations, for the construction of buildings, additions or alterations, or for removal: or demolition, as herein described. The applicy~,Y;a¢raes,to~cornply,with all applicable laws, ordinances, building code, housing code, and regulations, and to admit aufrorjzed in~paptors,on prerises and in building for necessary inspections. is ~ _ .l. .~.x xl{, 7~'~ In : ,tpi1 1'~"'s, ' ~ (S lgnalLlre Of apphcaRt, Or Home, if a COi OrattOn ilu?![5'-,'r~4~.'~.9'~? st cJSn.a,f+i~, • b.. ~V~'~'~'~~C~U~~ ~r~°. ~.~a.~ t.. 'ra.p~m ~i'trl:,t.'a..,„;r.., (hfailing address of applicant) State whether ap t~~+ 3~'{~ ~t~ ~1v,# „L,f ii2 d4i~1"9~+'~?~~tr~ee,,agent, architect, engineer, general contractor, electrician, plumber or builder. y u~y~yy j~,~'~y(yT)11llyp Ji',~3t~i`,i~'l;~ 'ir'~^ • , TRM:R~F,1 AI ~~IP\~!Jl^4-~.~i\.~.~ ~.i i~~C. iP. a . Name ofne ~s~~tV ~ ! \.~.4-.~ ~~~.J. . c.~lJ'° . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ...........r ~ (Name and title of corporate officer) ALL COttTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No . . Plumber's Liccnsc No. ~ . ~~f ~ Electrician's License No . . . . . ~ Otltcr Trade's License Ne . . I. Location o(land on which proposed work will be done. ~ . 3.~,5' .....................t~.~.~~~0.~..1,.I~N.a........5~~.; House `umber Street Hamlet 0./~.~..., County Tax M1tap No. 1000 Section Block Lot . .I. .~J Subdivision Filed A1ap No. Lot , ..iNamc) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Q . . . . . . . . . CC ~ b. Intended use and occupancy ..~J.psM.C.....C~Jt,) . ~-.~~~,-M:lnc;~?-~ 3. Nature of work (check which applicable): New Building • • • • Addition . t a ' Repair'r......... Removal . Demolition er orc..a.l: ~ G~~MN~~ .'t' FL.I~~ a ,r)i:~ionj.. . 4. stimated Cost . , 7 Fee .j...:..... 5. If dwellin number of dw~i~~ ~ ito be aid rrFi~irr~KhtS'°gq~S'1'ic6tiori) " ~ knits Number of dwelling unison ~a`c}i (loot ...1.....: • If garage, number of cars 6. IC business, commercial or mixed occupancy, specify nature and extent of each type of use . 7. Dimensions of extsting structttres~~ if any: Front . Rear Depth . Height . Number of Stories . ~ . Dintensio pf same str~ctur witkt alterations additions: Front ~ Rear , Depth ..~i! . ~`~k:k5t7~ Height Number of Stories 8. Dimensio s of entire new construction: Front Rear Depth Height Nuntlier of Stories 9. Size of lot: Front ' Rear ..................Depth . :.;Name of Former Owner : : : : : ' 1. Zorte or use district in which premises are situated . . ....f.. O, goes oro osed construcYon vtolal' , . • • • . P P b ~fl fe any zoning law, ordinance or regulation: ...M~,,, , , , , , , , , , , , , , , , , , , , , , , , 3. \Vill lot be re"raded ~ \Vill excess fill be removed from premises: Yes No A. Name of Owner of.premtses . , ................Address ...................Phone No. . Name of Architect ..............Address ...................Phone No.._. • • • . . Name of Contractor . .Address .......Phone No. . 5. Is this property located wa:thin 300 feet of a tidal wetland? *Yes No *If yes, Southold Town Trustees Permit may be re uared. PLOT DIAGIgAM Locate clearly and distinctly all 1>uildings, 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 aterior or comer lot. I ~ ~ APPROV D AS NOTED aArE: B.R # ~ NOTIFY UILD G DEPART TAT 785-7802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: i 7. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH -FRAMING dt PWMSING ! 3. INSULATION Q. FINAL - CON3TRUCTION MUST BE COMPLETE FOR C.iD. • I ALL CONSTRUCTION =HALL MEET THE REQtpREMENTB Of T}It N.Y. STATE CONSTRUCTION rA ~p(~V CODES. NOT RESPONSI~ FOq j DESIGN OR CONSTRUCTION ERRORS • • rATI: oh N>~«~ Yoar: II' - s. • • ........................e , , , , . , , , , , , , , , , , , being duty sworn, deposes and says that he is the applicant (\amc of individual si"nin 'contract) :ove named. :isthc (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly authorized to perform or have performed the said work and to make and fle this plicati~n; that all statements contained in this application are true to the best of }tis knowledge and belief; and that the irk will be performed in the manner sit forth in the application filed therewith. vom to before me this ~(!1 ....day of ~J. ~ 19 :tart' Public, ~',1c.! ,I~!.(cJ.2 . S!!`~.... County ~~~y,,~ HELEN K DE VOIi ~d.":' ~-.i. ; . ~.2~y? ;~v , . . NOTARY PUBLIC, Stall of NeN Yark (Signature o f applicant) No. 41078%8, Soffolk lbu ~ Term Expires March 30,19