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FORM N0.4
TOWN OFSOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. ~ 8533... , Date . , ,November . 2 ,..1989. , . , ,
THIS CERTIFIES that the buildin ALTERATION
g
Location of Property , , , ~ 3 i 75 MAIN ROAD GREENPORT, N . Y .
House No. Street Hamlet
County Tax Map No. 1000 Section 4 5 ........Block 3..........Lot ~ .
Subdivision . ....................Filed Map No. ........Lot No. .
conforms substantially to the Application for Building Permit heretofore filed in this office dated
AUGUST 4, 1989 18399-Z
pursuant to which Building Permit No. .
dated AUGUST 18 , 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 KITCHEN & BATHROOM OF E%ISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to ANTONIOS 6 TNEODORA PSAROUDIS
(owner, /~Zcg}~x~x '
of the aforesaid building.
Suffolk County Department of Health Approval N/A
UNDERWRITERS CERTIFICATE NO PEND?NG (BATHROOM/KITCHEN) Nov. 2, 1989
PLUMBERS CERTIFICATION DATED: OCT. 30, 1930 ANTONIOS PSAROUDIS
wilding Inspector
Rov. t/81
IPOB11![ NO.
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)
Date ,
N°- ~ 83~~3 Z ~ 19
Permission is hereby nted to:
Via.- ~,=~..~.:3~..~.... ~J,~~
...~?~~c:ar..,..~...........:f11....~J...~........
ct premises located at ..~~.1.7+.~••.......ii.......,~~~
.............................................~.~~...-i~
js~.-.~.....~..................................................................................
County Tax Map No. 1000 SectionC.......~,yi'~./`~.~........ Block Lot Na...~
pursuant to application dated ......0~.`~ 19. y~.., and approved by the
Building Inspector.
v/a
Fee $..`.~.ar~
1..G...~....................
uilding I for
Rev, 6/30/80
` TOWN OP SOUTHOLD
BUILDING DEPART2IENT
TOWN HALL
SOUTIIOLD, NEW YORK 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCIIPANCY
DATE _ _ .~~1„
NEW CONSTRUCTION .......OLD OR PRE-E%ISTING BUILDING.,~'...VACANT LAND._...__.
zz
Location of Property.. .J ~ ; _ (ti;.~.(_,~ _ _
HOUSE NOYY.\\~~ STREET HAMLET 1
Ovaer or Owners of Property..S~S,~.~°°=~\~,~, pp~~~\~i~~t;~1"~~Z~~_.{~'C~~~~`~~~j~5
County Taa Map No. 1000 Section BlockL:~o1L~~. LoC~..~~.~~~Lv
Subdivision Filed Map ........Lot........_.
r
Permit No. ~t~ ~,~~,.Date of Permit ~o;,""' e, S\ _.C~~~C~~`r1~~S
PPlicant ~:~.,'~~.a~::..
Health DepC. Approval Underwriters~Approval..._......_
Planning Board Approval
Request for Temporary Certificate Final Certificate
2s'
Fee Submitted:
APPLICAN
c ~n '
rev• 10/14/88
('~.vc. 383
~ o ~ i gs33 j
_ _
C
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGr: 1
8015581. BUREAU OF ELECTRICfTY
8S JOHN STREET. NEW YORK, NEW YORK T0036
pea DSCISMBSR 06,1989 gpplicetionNo.onJtle 661036$9/89 A 01309Q
THIS CEiI!TIFfE6 THAT
only the eleetrbd equipment at eLtcrlhed bsloto attd ineteduced by the opp/icent nomad on the oboes opplicetion ntam6)r in thepremisu of
AHTOMIDS PSAROIJDI3, 73175 NAIH ROAD, GR6BNFORT, N.Y.
in tke fdbtcinq bcatian; ? Basement ® /At Fl. ? Ynd Fl. OVT Section Bloelt3 Lot 1
teat examined on ~YE~DISR 07,1989 endfound to be in compliance friththe
reyuirementt of this Board.
- IIKTiIp RXTURB ftAHOES COOKklO DICKS OVBVS DISMW fDIXAUST FANL
~f At:IK tICANEEtClM HUWEECENT OTXER AMT. K. W. AMT, K. W. AMT. K.W. AMT. K. W. AMT. M. P.
a 1 a
ollr66 RlftfiAd AaTOIa tiRUKE Atll1ANCJ K1BiNf aenu nrn TYAi ClOC1IS wu IANT 11S11TWf ttBtnouner oUtRtORs
AMT. K. W. pl X. t. nAt N. AMT. NO. A. W.O. AMT. AMI. AMT. AMPt. TKAtK, AMT. N. P. ~
p
~T AM7. WATn
1 50
' '.MSDOttlNCT NO.OF f E- R V 1 C E
A,M . ~AtV. TvtE p~ l w ru i w >•v s w rv t w rw w. o~
~cora. a cc
c°' no. oP n.uc of ~Wi~lcco ta. a nEUnA~s oiFUi;~KAl
CITIKiK ANAKATiISe
1(ITCHi3N HICTDISIOH ONLY-1 ~ C _ 2 ~ I
q~~
aC
All'POHIDS PSAROUDTS
30-d3 30TH STREET
ASTORIA, HY, 111.0'l oftlOAl AShNABM
11
Per
This eerNfieaN mlgt not ba alMrad in filly aw :tat to office of !M Board if ineorreet. Mspeetors. b. ideRtifiad fty ntiak.
ILDIIIG PA IF AUfT #L Nt -
-
. ~ -
I FORM NO. 6 `
i
TOWN OF SOUTHOLD ,
~ BDILDING DEPARTMENT
i TOWN HALL
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS
A. 'This application must be~'~ifiled in typewriter OR ink and submitted to the Building
Inspector with the following; for new buildings or new use:
1, Final survey of prope;ty 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).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from lumber certifging that solder used in system contains less
than 2/10 of IE lead.
5, Commercial buildings,industrial buildings, multiple residences and similar.
buildings and install~ti_ons, a certificate of code compliance from the Architect
or Engineer responsiblje 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:
I. Accurate survey of property showing all property lines, streets, buildings and
unusual natural or topographic features.
2. A properly completed application, a consent to inspect signed by the applicant
and a certified abstraict 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 code or safety inspection of buildings or premises, or other
pertinent information required to prepare a certificate.
C. For Vacant Land Certificate of Occupancy:
1_ M application for vaunt land Certificate of Occupancy shall be submitted,
and a certified abstraFt of title issued by a title company showing single and
separate ownership of khe 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 reason$ therefor in writing to the applicant.
D. FEES: I'I -
1. CERTIFICATE OF OCCUPANCY -New Dwelling $25.00, Additions to Dwelling $25.00,
Alteration to Dwel~ing $25.00, Swimming Pool, $25.00. Accessory building $25.00
Addition to Accessory buildings, $25.00 - Businesses $50.00.
2. Certificate of Occ~ipancy 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 - $25.00 Residential '
II $50.00 Commercial
I
I!
I
-ev, 10/14/88 ~ ~
~~`'~f.~, TEL.'GS-180'
TO~Y'P! OIL SOUTIZOLD
C.
~ r.' a.~~ ~
l~L,,,,,•y Y~~ Oi~f'iC1? OP TiU1LDINC INSPECTOR
cam.-, "b, 8~1; ~ I'.O. [SOX 1 17 9
m r•~ ~ TOWN IIALL
~,yyol ~1 ~~~t" SOIJ"I'ItOLD, N.Y. 11971
October 26, ]989
ANTONIOS & THEODORA PSAROUDIS
30-43 30th STREET
ASTORIA, N.Y. 11]02
To tdhom This, May Concern,
' 41e are unable to complete your Certificate
of Occupancy because of• the following reasons.
_ An application for Certificate of Occupancy
is not nn fi].c. (ENCLOSED)
No Undcr~orit-crs C~:rtificate on file.
/ 4~he chccF; .ic; (o~(K~7iLt~~9$not on file.) $25.00
1_/ No Uea1.L-h Dept. Approval on file.
No final inspection has been made.
P]case contact: our office on this matter. -
Thank you for your cooperation.
l;u.il<7inq Permit: }t 1 8 3 9 9 Z
Duildinc DupL•.
tto Plumber ;;older Cert.ificatc on file.
( n7.1 pnrriil-s involving plumbing being
issucci after April 1,1984 )
S~FFOL,`' TEL. 7G5-1802
0~0.~~} COQ TOlY~N OF SOYJTIIOd.D
• l~~!Y;~! ~ OFFICE OF BUILDII~IG INSPECTOR
u°~ t~: P.O. BOX 728 ,
~ :~r ~ -e TOWN HALL
SOUTHULD, N.Y. 11971
C E I2 T I F I C A T I O N ,
Date -
Building Permit No.~
Owner~(V`T'~2(V/C1 S' F~,.$'/~(~ Q(/~I.S'
(please print)
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of to lead.
(plumber's signature)
Sworn to before me this
l7y day of OCR ,
19~. 51~ ~t, UI-e
Notary Public
notary Public, County
HELEN K DE YOE
NOTARY PUBLIC, State of New YorR
No. d7O7878, Suffetk County
7erro Expires Mareh 30,19_
I
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST f ] [LOUGH PLBG.
[ ] FOUNDATION 2ND [ ]INS CATION
FRAMING [ FINAL
REMARKS: ~U
q
DATE ~ / INSPECTOR °
` w` ~ 765-180
BUILDING DEPT.
INSI~ECTION
[ )FOUNDATION 1ST ~ ) ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ]FINAL
REMARKS: ~
DATE ~p INSPECTO ~
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING r~F`NAL
REMARKS: / ~ SS
DATE INSPECTOR
/ 765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION i5T ( ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ FINAL
REMARKS: pp~ vL-
r~ <
DATE ~ T INSPECTOR
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FOUIJDATION ( 1st ) ~1
- - a~
FOUNDATIOIJ (2nd) m
2 . 8 a, ~ -
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P,OUGH FRAME &
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PLUMBING
cn\?.
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IIJSULATIOAJ PER N. Y. y
STATE ENERGY
CODE
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4. y
FIiJAL
ADDITIOI)AL COMMENTS:
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~j BOAaD OF HE<1LTH
D ~ ~ ~ ~ ~ ~ Jf FORM N0. 1 3 SETS OF PLANS • • • • • • • • • • .
1~ SURVEY
AUG 4 ~ i TOWN OF SOUTHOLD GHEGK
` BUILDING DEPARTMENT SEPTIC POar1 .
TOWN HALL
BLDG.DEP'f. SOUTHOLD,N.Y.11D71 NOTIFY
TOWCN OF S~OiUTHOLD ,dry TEL.: 765 1802 L L I~.
E~amincd.O~~//.Q........`.,19':!. MAIL TO:,~~j`^~~1N\O$
Approved ~ 19~~.. Pcnnit No. l~•~~~~ ~ S V.~\ S
/ / 3~-y'~•- ~o S~
Disapproved a/c .
..l .p \~~~2
(B mg ns ~ r)
APPLICATI N FOR BUILDING PERMIT
Date . 15
INSTRUCTIONS
a. Tlus application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
4sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan strowing 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 threughout 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, housin; code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections.
(Signature of applicant, or n me, if a corporauon)
' ~ ~;~°y,y;-,;;x;~`".a ~ ~ _ =•:lt ~ (Mailing address of applicant) ~~~b~
gr4 : ; p,% ~ ~ ,
State whether applicant is owrier, lessee; agent, azcfiitect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ~~lv.~~~.~11~~~~5:.~~v~...~~~~:~~1•~~,••~,~~~,~u~\~
(as on the tax roll or latest deed)
If applicant is a corporation, signature off' duly authorized officer.
(Name and title of corp,oratg„bifficer)•,,, ,
Builder's Liccnsc No. .
Plurnbcr's Liccnsc No .
Electrician's License No . .
Other Trade's License No . .
1. Location of land on which proposed work will be done. '
house Number Street
y, Hamlet
County Tax i\1ap No. 1000 Suction • . • • • Block , , . , • • . • • . • • • • Lot
Subdivision Filed ~fap No. Lot .
(Name)
State existing use and occupancy of premi`s/es and intendud use and occupancy of proposed construction:
a. Existing use and occupancy O~}/C - • • L ~~C LL /11~G
b. Intended use and occupancy
2z
~ ` ~ ~I _
r (
3. nature of work check which 4Pplicable): New Building , , , , , Addition . , Alteration
Repair Ri.r~toval Demolition ~ • • • • ~ • •
OthcrtVQrk.
fi3• (Description)
4. Estimated Cost ~ DIO
.i . Fee........
S. If dwcllin~ number of dwcllin~ (to be paid on filing this application)
. • • S units . . . Number of dwelling units on each floor .
If garacc, number of cars
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ' ~ ~ ~ • • •
7, Dimensions of existing structures, if any: Front . ' ' ' ' ' ' ' '
Hci~lrt Number of Stories , Rear Depth .
Dimensions of same structure v{,ith alterations or additions: Front • ~ • • • ~ ° ' • ' '
Depth....... . Height. Rear........
Dimensions of entire new constnrction: Front , • ' ' ' ' ' ' • • • • Number of Stories .
Height Nurttber of Stories Rear ...............Depth .
9. Size of lot; Front. Rcar.••.~•~~~~•~••••••••~••••••'•°••' .
f0. Date of Purchase .........i............ Depth
~ p"•••••••••••••....NameofFonnerOwner
•.•••.•...emisesaresituated
1 Does ro osed construction vio
.oneP r Pse rstrict in which date any zoning law, ordinance or regulation: • ~ ~ ~ • ° • ' ' '
13. tVill lot be regraded
14. Name of Owner of premises ~ ~ ~ • ~ ~ • • ~ ~ • • ' ' ' Will excess fill be removed from premises: Yes Nc
Name of Architect • .............Address ...................Phone No.. .
Name of Contractor.~~~~~~ "•••••Address Phone No....•••~~~~•••~
15.Is this ro ert ••••••Address PhoneNo.. _
P P y looted with in~00 feet of a tidal wetland? *YES..,.NO....
*If yes, Southold Tow>i< Trustees Permit may be required. S
PLOT DIAGRAM
Locate clearly and distinctly alI buildings, whether existing or proposed, and•indicate all set-back dimensions from
property Gnes. Give street and block~!number or description according to deed, and show street names and indicate whether
interior or comer lot.
C/
P o as NanE~
. DATE• B,R N
i FEE: L BY:
NOTI UF'~~DEPART T
~ 785-f$02 8 AM TO 4 PM R THE
FOLLOWING INSPECTIONS:
1. FOUNDATION TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH -FRAMING & PLUMBING
3. INSFyLATfOIy
4. FINgL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SMALL MEET
THE REQUIREMENTS OF THE N.Y.
STATE CONSTRUCTION $ ENERGY
CODES. NOT RESPONSIBL$ FOR
DESIGN OR CONSTRUCTION ERRORS
STATE OF KEtV YORK, I
COUtiTY OF SiS
(Name of individual si nin' ' ' ' ' ' ' ' • • • being duly sworn, deposes and says that he is the applicant
above named. 6 contract)
fie is the
y (Contractor, agent, corporate officer, etc.) • ~ • • ' ' ' ' ' ' ' •
~f said owner or owners, and is dul ~mtltorizcd to perform or have performed the said work and to make and Gle this
~PPlication; that all statements contained in this application arc true to the best of his knowledge and belief; and that the
vork will be pcrtbrmcd in the manner sj;t forth in the application Glcd therewith.
'wom to bciore me t//his ~ ,
.............7.. ....dayof..' q
rotary Public, .....~`~"':..~1 r.. iN!R; County
!M'A~R't~~88
C&S~HoIMC~
TermFxpiresMerch30,1~ ~ (Signature of applicant)