HomeMy WebLinkAbout18023-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 219782 Date MARCH 11, 1991
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property PVT. RD. OFF EAST END RD. FISHERS ISLAND
House No. Street Hamlet
County Tax Map No. 1000 Section 004 Block O5 Lot 10
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 4, 1989 pursuant to which
Building Permit No. I8023Z dated MARCH 10, 1989
was issued, and conforms to all 4f the requirements of the applicable
provisions of the law. The occupancy for which this certificate is
issued is ONE FAMILY DWELLING WITH ATTACHED SCREENED PORCH AND DECK.
The certificate is issued to BASIL HAKKI
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 89-SO-43 NOV. 7, 1990
UNDERWRITERS CERTIFICATE NO. N174664 FEB. 15, 1991
PLUMBERS CERTIFICATION DATEB MARIO ZANGHETTI SEPT. 14, 1990
Building~I Spector
Rev. 1/81
sosx 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)
N 18 0 2 3 Z Date ...~,~.~P 19.x'9.
Permission is hereby granted t9:
ct premises located at ...T.,tir'.:v,M~..~,~~+.e~~~
.
County Tax Map No 1000 Section Block ..,.l...y.. Lot No. 1 a.
pursuant to application doted 19r~~„ and approved by the
Bui ldi ng~ /Inspector~,~~
Fee 5..?..Q.r~ Jc
Lis j~m>' ...s~
B ding Inspector
Rev. 6/30/80
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Fox.M xo. a P t j~ a
TOWN OF SOUTHOLD ~ OCr 2 6
,Building Department {
Town Clerks Office , ,
Southold, N. Y. 11971 70W~~""~,
.
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE 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
unusual natural or topographic features
2. Final approval of Health Dept, of water supply and sewerage disposal-(S-9 form or equaq.
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and
installations, a certificate of Code compliance from the Architect or Engineer responsible for
the building.
5. Submit Planning Board approval of catnpleted site plan requirements where applicable
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses
1. Accurate survey of property showing all property lutes, streets, buildings and unusual natural
or topographic features.
2. Swam statement of owner or previous owner as to use, occupancy and condition of buildings
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in-
formation required to prepare a certificate.
C. Fees:
1. Certificate of occupancy $5 00
2. Certificate of occupancy on pre-existing dwelling or land use $5.00
3. Copy of certificate of occupancy $1.00
/ Date yyl.l~.'.~
New Building .....Y........ A~dditi/on Old or Pre-existing Building Vacant Lannd
Location Of Property ...f.C.!.~?1:~.....~~..../.~/. '.~~......~k°C~...~s~..'~k~....N.~.....
Owner Or Owners Of Property .....k~~:a:~.l....l.$~,F~
Subdivision .................................................../.............Lot No............. Block No............. House No............
Permit No. ~~QQ? 3..... Date of Permit ..Y,lfU,.lfl..,( .Applicant
Health Dept. Approval ............................................Labor Dept. Approval
Y
Underwriters Approval ..............................................Planning Board Approval
Request For Temporary Certificate Final Certificate
Fee Submitted $
Construction on above described building and permit meets all applicable codes and regulations.
Applicant ~
Sworn to•before me this ~ <
day of k~....... ~ ° (stomp or seal)(J~ G
Notary Public c~'~~~''~`. County 3a 1
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QueL(ied ,n z 9509185
Fa r Sulfdk County
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' TEL. 765-1802
Oc,~ffOlk~O~ TOWN OF 80UTHOLD '
OFFICE OF BUILDING INSPEC,fOR f~ R RR
P.O. BOX 728 ~ l'D ~ Q ~ t5
0~~, S01JTFIOLD NAY 1 1971 ~
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C E R T I F I C A T I O N
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Bu113inq~Permit No.
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~ ~ pease pr nt).
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Plum}:~~r /!/divp ~GK4/,~/i~j`
' (please~,pr )
' T. certify that the solder used in,,the water supply system '
I conttins less than 2/10 of 1~ lead.
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Sworn ~o before me this
/ day of .S ~
f / ~
~ ~ 19~j'D_, Notary Public
Not.x.y Public, ~oc.(~' County
TNgMkS i~DbMERrt Jx
Naury Tublic Statr of Nsw xu~.
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I2ISULATIOPI PER N. Y.
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Memorandum from .
BUILDING INSPECTORS OFFICE
TOWN OF sOUTHOLD
TowN HALL, SovrxotD, N Y 11971
765-1802
Js
April 12, 1989
Dear Mr. HakkL,
Enclosed Ls your Building Permit.
Please send us ] copy of the Board
of Health Survey stamped by them with
their approval (red stamp).
Thank you.
~y G~~
_
P. k:. Hat fa
14'.?1 N. 4i:th 5t.
Allentown, F'a. 181:"~4
.''.15 ~9~ 577i tF-I)
~1°, .91 455 tP7
March 4, 1989
Mr. Curt Norton
Liuxldzng Inspectrar
Town of Southalci Esuzldang Department
Town 1ia11
Southold RI. Y'. 11971
Dear Mr. Horton:
As per our telephone conversatzan on Frzday,
march 1989, I am farwardzrag in you the documents needed
i:a obl:azrr a permit to buzld a przvate home on Fxsl-ters
Island. `four Land offer l-a e;:pedate the Lioard of Health
procedure xs accepted with yr-atxtude, and I am enclosing
four copzes of the pert test far that purpose.
Tra cover the fees, I am enc_losxng two signed
blanE C11eCl'S: 6ne for the Ernard of Health Suffnlt County,
and annthtar for the E<ir~ ldang Dr~partmPnt 5uffol4• Cn::nty. My
estimate of each fee tames to ~i77.8 kiased on iii5 sq. f{:
of lxvanq space an the first floor and S~? sq. ft on the
sernnd float. I am sure that you will checF these numbers
accardang to yo:.tr normal methods.
Finally, my cantrartar Tom Shilla hap<s to
breaF ground as soon the weather permits. Ther-afarE,, we
Nape to get e.:pedztxous action on the permit and your
effort in than regard would he greatly appreciated.
Szncerely,
$as,"~ Clr1 ~ ~
Esasz 1 W. ffad { x
....r~__
i
/vi/- J~d~7~/i'1
I'~ ! Y~ / ~ 1(n < <~/o c~+ ~r., Tom'
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THE NEW YORK BOAcRD OF FIRE UNDERWRITERS PAGE t
1.000656 BUREAU OF ELECTRICfTY
83 JOHN STREET. NEW YORK. NEW YORK 10038
pot, FEBRUARY 15,1991. Application No. onple 72191191/91 N .1")4664
THIS CERTIFIES THAT
only tM electrled equipment v deeeriked heknD orsd introduced hY the oppUcont notned on the a6~e
applieot[on nam6er in the promitsx q/
B.N. BAKRT, PRIY.SECTION MEND ISLAND, FT.SBER ISLAND, N.Y.
in thefoUominR kteatlon; ®Basement ®/xt Fl. ®Ynd Fl. per" 4ection Block Lot
aoee examined un FEBRUARY 12 , 1991. and found to 6e in compliance with the rpuirementR of thu Board.
1nflYtl RXTURlf RA tDORINa fMCRS. OVBK CISN WASIINf E%NAUST FANf
OURETZ ACYf fWIrQMf NCAl10tSClNT RIID!!btlM OTHER NAT. K. W. AMT. N. W. AMT. K.W. AMT. R. W. AMT. M, t.
40 33 41 35 2 1 12.7 1 1.?. 3 £
6RYRRS RIRNACE MOTORS IUTINR AN41Attq RtlM6 lNOAttlCK rsltt CLOCKS RNl INMTNUnRS nlutn.ouruT OtlAMNRS
AMT. K. W, pl K t. OAf M. r. AMT. NO. A. W.O. AMT. AW. AMT. AMTS. TRANS. AMT. N. t. ~
«
~T AMT. wATTB
3 F 1 30
RRRMOY DISOOtINRCT NO. W S ¦ R V I C E
AMT. AMI. TYN 11 TM t / TV ] / TV ] /!W NO.Oi CC. CDND. A. W. ND. OF HFIEG A' W' G' NO.Ot NlUTRAlS A. W. G.
ROOM. N! 1 CC. C D. of IIFIECi G NlUTKAI
1 aoo c8 1 x 1 a/o 1 2~n
o»wR At?iturus:
G.F.C.I:-3
dd(
Z & S CONTRS, T.NC. LIC.~424-E
P.O. BOx 20a
FISHERS ISLAND, NY, 06390 dMRK MANAON
11 v 4/
Pss '
Thi; mrtficoN must not be alNrad in any manner; return to tM offiu of the Boord if incorreel. In]pMors may be ideMifisd by their credeMialt.
COPY FOR ~IILDING DEPARTMiNT. THIS COPY OF CERTIfiCAT! ANJST !!WT !E A~"{~ragY R1A~X hNW1ER
- y BOAKD OF HEALTH
\
3 SETS OF PLANS
FORM NO 1 SURVEY .
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC FORM
I TOWN HALL
I SOUTHOLD, N Y. 11971 NOTIFY
TEL:765.1802 CALL
t~ MAIL T0:
Examined •~D 19~!
Approved 19 Permit No/ y,3.
Disapproved a/c .
/y
(B ldmg sector)
APPLICATION FOR BUILDING PERMIT n~
Date M c[,/.c ~l 19$:
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings on premises, relahonshtp to adjoining premises or public stre~
or areas, and giving a detailed description of layout of property must be drawn on the diagtam which is part of this app
cation.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this apphcatron, the Building Inspector will Issued a Building Permit to the applicant Such pern
shall be kept on the premtses available for inspection throughout the work.
e. No bulldmg shall be occupied or used to whole or in pazt for any purpose whatever until a Certificate of Occupan~
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the Issuance of a Bwlding Permtt pursuant to t;
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances
Regulations, for the construction of buildings, additions or alterations, or for removal or demolitron, as herein describe
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulatrons, and
admit authorized inspectors en premtses and in building for necessary inspe,/c~tions~ y ~ ~~f ` ~
(Signature of applicant, or name, If a corporatron)
/4,y/ A/. 4afh. SfrceYt
.,ALCen~o.wn. P.c>z...1.8toy.........
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buAde
okvn~r.
Name of owner of premises B0.~SiI VYr HCi' tE~~ .
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
ALL CONTRACTOR'S MUST BE SUFFOLR COUNTY LICENSED
Builder's License No l~,Z - 8 7. .
Plumber's License No •J
~ ~ . .
Electncinn's License No . g2.y .
Other Trade's License No. d'. .fZ . .
1. Location of land on which proposed work will be done. . f.l.S~'l.erg...,1.~44'vld . .
House Number / Street Hamlet
County Tax Map No 1000 Section OP.S~-:s-/P .Block . I.6.......... Lot . ~
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 1!f~:4R:/J ~ ..Lo.t..... .
b. Intended use and occupancy .iP./.S V.4?~~...~o/12e .
-
3. Nature of work (check which applicable). New Building Addition Alteration .
Repair Removal Demolition Other 1Vork .
(Descnption)
4. Estimated cost.Tu!o.~'I4+Y!dCs4~.~n~.St~t?s~?~tousan~ee..........
` (to be paid on filing this application)
S. If dwelling, number of dwelling units ....S ! Yt,~ ~.t... Number of dwelling units on each floor . .
If garage, number of cars /1/o.rl e .
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .?J ot. ~iRF(i t ct.ble . .
7. Dimensions of existing structures, if any Front Rear Depth .
Height Number of Stones
Dunensions of same structure with alterations or additions Front Rear .
Depth height . Number of Stones
8. Dimensions of entire new construction. Front ...3.~. ~ac Rear . .3A .~te.f Depth ..3,2..{ce .lt .
Height , ol.l..~C4:t:... Number of Stones ..T.4~(~.. ~7~N5 . ~JU-Str!'l.~.ti .
9. Size of Lot. Front ,~?60..-~ee Rear . 1.9.1.. fee 2~ Depth 2 SV..~FF.f .
10. Date of Purchase ~ttrlc. R.~ .../.Y8.4... ....Name of Former Owner Fixhcrt J.sPtna DeYe%~m. ~1>• ~'oiP~
1 I. Zone or use distract in which premises are situated ..~'~ts f. En oy... .
12. Does proposed construction violate any zoning law, ordinance or regulation. . R1/.a . .
13. Will lot be regraded !1(0.. Will excess fill be removed from premises. Yes ~Ic
14. Name of Owner of premises 8...4?, .f,~eF`et'.k i; , ..Address (SrR~. N Vnfh.Sf :...Phone No.R~.f 3.4,r:r??./.. .
Name of Architect (e1 t(. Ott r E.. ,k ~ ~ n,~ . , , , . ,Address 4i!h~ fshv.l! i . /°r!t•. ...Phone No z.<t" .Y3.~. ~'r~ J • .
Name ofContractor?b,$.C.4nl~rcgcf%H;~,.Itti.~...Address.Fishess.,('s/Snal~li?J~PhoneNoS~6 78d',?8,g';Q,.
15. Is this property located within 300 feet of a tidal wetland? *Yes No
*If yes, Southold Town Trustees Permit ma be required.
PLOYI' DIAGRAM
Locate cleazly and distrnctly all buildings, whether existing or proposed, and indicate all set-back dunensions from
property lines Give street and block number or descnption according to deed, and show street names and indicate whethe,
intenor or corner lot.
{Hnsy/ucwar'a
>TATE OF S.S
'OLNTY OF .
Qs~.'Si.~ w . s.~a.y~ IC t being duly sworn, deposes and says that lie is the applicant
(Name of mdmdual signing contract)
bove named
[e is the O W!? e1' .
(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
pork will be performed in the manner set forth in the application filed therewith.
wom to before me this ~ ~ q
.......-dya~y~ of ~~~-~i~s/~'
per' 19
totary Public, ~./.vl.~..i~x~~~~X~rT~... County
NOTARfAL SEAL ~.c,~~
DOREEN M MICHELETTi. Notary PubNc " " ' " " " " " " " " " " " " " " '
Allentown, Lehigh County (Signature of a licant)
My Commisfion Exoires Oct S7 7992
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