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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-22637 Date OCTOBER 1, 1993
THIS CERTIFIES that the building ALTERATION
Location of Property 1555 BAYVIEW AVENUE GREENPORT N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 52 Biock 5 Lot 11.1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 23, 1989 pursuant to which
Building Permit No. 18175-Z dated JUNE 6, 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 ALTERATIONS TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to ALLAN GOODMAN
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N/A
PLUMBERS CERTIFICATION DATED N/A
1..-' _
B lding Inspector
Rev. 1/81
roaae< xa 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)
N°- 817 5 Z Date 19
Permission i her by granted to:
ro.~ny~Z'!.'i~'J ~ ~xi ~C
of premises located of .....~.~~.r.
s:~.....~..~.l/......r
..................................................~i7z~LT//~j.4~7T...~..........................................................................
............................................................~r
County Tox Map No. 1000 Section ....:~y........ Blnck Lot No .....Q..d~
pursuant to application dated 19..'~.~r, and approved by the
Building Inspector.
Fee
...5-~~ .C~' .:~ti:--
ilding for
Rev. 6/30/80
1~onn No. 6
~ TOWN OF SOUTHOLD y k j ~~s f
BUILDING DEPARTMENT !
TOWN HALL
765-1802 " C'~`(~4 ~ ~
APPLICATION POR CERTIFICATI: OF OCCPAN~CY~
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A This application must be filled in-by'typewrite' OR ink;-and submitted to. the building
inspector with the"following: for'new building or new use r ~ ~
1. Final survey of property with accurate Io'cation 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.
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 Euilding - $100.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
4., Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential ~$~~1/5.00, Commercial $15.00
Date ....~C:Y
New Construction........... Old Or Pre-existing Building,.' y.
Location of Property.. ~~;p~;,,,~„},-,,,,,,,,,,~?,h~eZd~,'~. i
House ((``N~,o.QQ II ,~jStr/feet Hamlet
Onwer or Owners of Property.~j1~J?:Y, ~
County Tax Map No 1000, Section..~,/J~,~~-,-;,,,,,Block....~........Lot.....~.1;,~,,,,,,,,,,,,
Subdivision Piled Ma „
/ /p~Q p. .Lot .
Permit No.,~,~ ` „w,,,,,,,Date Of Permit.~,l~ !.p /,,,,,,Applicant
Health Dept. Approval...:~`~
::.................Underwriters Approval.~.~.~:":.
Planning Board Approval...~~
Request for: Temporary Certificate........... Final Certicate...~...
Fee Submitted:
p r- A APPLICANT
~o~~G3~J
0~0 £ O~y TORN OI' SOUTIIO~,D
"a~ ,..'~~.,,~c OPP[CE OP BU[LD(NG INSPECTOR
o .~«j
+j~"nq' ,z P.O. BOX 728
.~i~ ~ 'I'01VN f(ALL ' '
°yol ~a~~ SOUTiiOLp, N.Y. 11971
7~a Q~~/
To Whom This May Concern,
We are unable to complete your Certificate
of- Occupancy because of the following reasons.
hn application foyr Certificate of Occupancy
is not on Li le. ~KC-C:e*~~.
/ / No Underwriters Certificate on file.
Tftc check is{~/not on file. } ~~i3J~
No EIca1L-h Dept. l:pproval on file.
No final inspection has been made.
Please contact our office on this matter.
Thank. you for your cooperation.
Building Permit li ~ ~ ~ ~ s 2 Q~~~~L~.,,~
Buildinc[ Dept.
No Plumber So].cler Certificate on file. ~ ,
( all permits involving plumbing being
i:sucd after ~1pri1 1,1984 )
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OUGH FRAME &
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I7SULATION PER N. Y. y
STATE ENERGY
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FINAL _
ADDITIOPIAL COMMEPITS: ~
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765-1802
BUILDING DEPT.
1 NSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUN TION 2ND ~ INSULATION
[ FRAMING (L] FINAL
REMARKS: 4 7 ~
0
DATE U INSPECTOR i
765.1802
BUILDING DEPT.
INSPECTI®N
[ ]FOUNDATION 1ST [ ] RROUGH PLBG.
FOUNDATION 2ND INSULATION
[~RAMING [ ]FINAL
REMARKS: ~~.~f d'~-
DATE ~ ~ INSPECTOR ~"""v
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BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST ( ] ROUGH PLBG.
[ ) FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [~INAL
REMARKS:
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P~YJ ~ BOARD OF HE.ILTH
fl`~ 3 SETS OF PL.1N5 . -
ip ~A~ ~ ~ FORM NO. 1 SURVEY
f M TOWN OFSOUTHOLD CHECK
.H..m_....~~__,..a~.,.,,,a'-..t BUILDING DEPARTMENT SEPTIC r•oart
01-(tG. DEPI. ~ TOWN HALL ~ ,
TOWrVOFSOU"iNgLtl ~ SOUTHOLD,N.Y.11971 NOTIFY
..,~..,m...w.,,..a,..,.... ..1 TEL.: 7651802 ~,7~~
,O ~ CALL
C-xantined.(p/(;a........,19 / MAIL T0:
\pproved ...t~........, 19~~Pcrmit No. ~L~~.?~
Disapproved a/c
1~.~...... .7~ MAY 3 0193
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BLDG, oE~w..~ .
o n ) TOWN OF SOUTNOLD
uild' ~ Ins ector
APPLICATION FOR BUILDING PERMIT
Date .~A.T `Z.`'S„ _ „ 158.Q~
INSTRUCTIONS
a. Tltis 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 [his 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
Rc;ulations, 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.
Q~fl~~ 3~~~'~~t~ G.trGNO~U~ D~U~-LF,~Mr„hlT; Cb2(~
(Signature of applicant, or name, if a corporation)
..~,..~.w.v..,
Tq~ ~~#'tl+AT4t~+i:;itR I!~tStl tltF~t ^t"€a~t~r~ (Mailing address of applicant)
State whether app~icant~,;I,~,.,gw~e,F„(es~ee,agent,: architect, engineer, general contractor lectrician, plumber or builder.
. ~ " r'~.'s~,y'v! 1!611
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Name of owner of premises f,'t*C~;?f: t`~~}.f~. ~ .
7?t#;ts tknt'r ;ie,+t. ~ ~ ' ~ ~ ~ (as on the tax roll or latest deed)
If ap !can is ~!ycor ora[ioris';gn~iul',e of~duly authorized officer.
~ z,~ r<<
(Named e o~ftco~)orat°e bfHcer) '
s'4t7~ 31Et'al~ ~ , re e ^
Builder's 2,i~e~~~I~lo~b~~:~s~a:~ k` ~T
Plumber's Liccnse No . .
Electrician's License No . . .
Otfter Trades License No . .
1, Location of land on which proposed work will be done. , B?~V`-
House Numbcr Street. Hamlet
County Tax htap No. 1000 $CCIIO? ®~.2-.Q.Q..... B14ck ..Q.y; ~ Q
Lot ®~Q~ .
Subdivision Filed tap No. Lot .
(N:unc)
State existing use and occupancy ofpppremises and intended use an~pd,~occ~~u,pp~ancy of proposed construction:
a. Existing use and occupancy ppp~n"""~...... .~IQG.W,t!;" . . . .
b. Intended use ,~I/.~~(. , `~'~r~N . - . • . • .
and occupancy q ~ :~~~`~~~L
3. Napure of work (check whiRhapplicable): New Uuilding Addition a..,,, tcration
Re air 'ptoval Demolition ~ri~tticr 1Vor ; .
(Description)
4. Estimated Cost ~ ~ .Q~ .I Fee .
5. If dwelling, number of dwelli (to be paid on filing this application)
rjg units ~ , , , , , , , , , Number of dwelling units on each floor .
If gara;e, number of cars ! .
6. If business, commercial or miffed occupancy, specify nature and extent of each type of use .
7. Dimensions of existing structu',res, if any: Front . , Rcar Depth .
Height Number of Stories . . , .
Dimensions of same structure 'with alterations or additions: Front • • • ~ ~ ' ~ ' ' ' ' ' ' '
Depth . Ileight . Rear .
' Dimensions of entire new cons~tnaction: Front , ' ' ' ' ' ' • • • • Number of Stories .
Height Rear............... Depth
. Number of Stories .
9. Size of lot: Front. Rear .......................Depth.......................
10. Date of Purchase . I . , ,Name of Former Owner • ~ • ~ ~ ' '
1 1. Zone or use district in which p,4'emises are situated •
oes proposed construction vtQlate any zoning law, ordinance or regulation: ...~nc~ .
13. Will lot be rem • • • .
oraded ,.ivl-O,, , , , , , , , , , , , , , , , , , , , ,Will excess fill be removed from premises: ,Yes No
14. Name of Owner of premises . .Address .
Name of Architect •••••••••••••••••.PhoneNo
Name of Contractor . • • . • • • ~ ~ • ~ ~ ~ ~ ' ' ' ' ' ' • • Address ...................Phony. No............... .
IS.Is this property locl•~~•~~~~~~""'•••Address ...................PhoneNo...... '
ated within X00 feet of a tidal wetland? *YES. • • N0.'
*If yes, Southold Town Trustees Permit may be required. •
. PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate ali set-back dimensions frGm
property lines. Give street and blocl4 number or description according to deed, and show street names and indicate whether
interior or corner lot. ~,~•2~
S'L~ I'i •FRTft~~~9 Q 1
AP D A= NAfED
'i DATE: ~ B.R N ~ ~ 7 S
Dd
OTIFY UI O~E~!!A E A
'786-1802 8 AM TO 1 PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION TWO RE~INRED
FOR POURED CONCRETE
2. ROUGH • FRAMING dt PLUMBING
INSULATION
4. FINAL CONSTRUCTION MUST
SE COMPLETE FOR C.O.
ALL CONSTRUCTION SMALL MEET
THE REOUIREMENTS OF THE N.Y.
i STATE CONSTRUCTION b ENERCiV
CODES. ,NOT RESPON$18LIE FOR
i, DESIGN f5R CONSTRUCTION ERRORS
STATE OF NE\V YORK,
COUNTY OF S.S
• • • • • ~•~US~~I-:~-..t'X`GL.lrr!1~,,,,, , , , , , , , , , , , , being duly sworn, deposes and says that he is the applicant
(Aamc of individual signijig contract)
above named.
!Ie is the . ,Cnc~(,~2..(~,,,, , . I , . • . '
(Contractor, agent, corporate officer, cte.) ~ • • ~ ~ ~ ~ ~ ~
of said otvner or owners, and is duly) authorized to perform or have performed the said work and to make and file this
application; that all statements contail~ted in this application arc true to the best ofltis knowledge and belief; and that the
work will be performed in the manner set fortis in the application (llcd therewith.
Sworn to before me this
3 v
..dayof.L.Th ,
rotary Public, T?:. R- Cou ty
NELENKDEVOEI •...•••..PP•••.
MNo~470
878 S~u9folk~~
f (Signature of a licant)
Term Expires March 30,19-~
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