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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-18331 Date AUGUST 30, 1989
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property 625 HENRY'S LANE PECONIC, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 74 Block O1 Lot 17
Subdivision PECONIC HOMES Filed Map No. 4181 Lot No. 6
conforms substantially to the Application for Building Fermat heretofore
filed in this office dated MARCH 15, 1989 pursuant to which
Building Permit No. 17928-Z dated MARCH 17, 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 ONE FAMILY DWELLING WITH ATTACHED GARAGE AS APPLIED FOR
The certificate is issued to PETER & BARBARA TENIDIOS
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 88-50-138- 7/21/1989
UNDERWRITERS CERTIFICATE NO. PENDING - AUGUST 15, 1989
PLUMBERS CERTIFICATION DATED 5/17/1989-GALE KASRE PLUMBING & HEATING
N
Building Inspector
Rev. 1/81
rosa~ 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)
017928 Z Date .......~..,..~..7 19.~•t
Permission is hereby gron to: II
~,s
r~-~y4~~ n ~C~[.t .
to ...4,..cv.~^..'Y}(.
.}.'u....~.... 0..:...A~:4R,Y ' ...~,1~.{,~?.`4.P.G~!:!:t~ef.,..~<,•....`~I
.
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ct premises located at ...~~~......1~.'.~. .:Q:4~-~..~r
V~
.......:~7~.~:.....J
a-~-~..-~
Caunty Tox Map No 1000 Section O7'~. Block ......~.1......... Lot No .
pursuant to applicotion doted .....~,(1~!4-.l'.Y1 19G.~.., and approved by the
Budding Inspector.
Fee 3...0~~„~~,.:St7....
rt f--L
Bullding Inspector
Rev 6/30/80
. 1 ~ _
~ FOflM NO. 6 ~ IP
~ TOWN OF SOUTHOLD '~'f
Building Department I II I R g
~ Town Hall G141
Southold, N.Y. 11971 -
` 7b5 - 1802 G.DEPI:
APPLICATION FOR CERTIFICATE OF OCCUPANCY TOW FSO_UfNbl-D
i Instructions j
A. This application must be filled in typewriter OR ink, and submitted ~f~~ to the Building Inspec-
tarwith 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 equal).
3. Approval of electrical 'installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa-
tions, a ceriif~cate of Code compliance from the Architect or Engineer responsibie for ~he building.
5. Submit Planning Board approval of completed site plan requirements where applicable.
• t
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and ~'~re-existing"
land uses-
1. Accurate survey of pBUperty showing all property lines, streets, buildings and unusual natural or
topographic features. I ( F
2. Sworn 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 informa-
tion required to prepare a certificate.
C. Fees: Additions $25.00
1. Certificate of occupancy New Dwelling, $25.00, Accessory~;$10.00 Business $50.00
2. Certificate of occupancy on pre-existing dwelling $ 50.00
3. Copy of certificate of occupancy $ 5 .0 0 , over 5 years $ 10 .00
4.Vacant Land C.O. $ 20.00
S.Updated C.O. ~ $ 50.00 Date ,Aup~izst 9t 1 9 .
NewConstruction,~„Old or Pre-existing Building Vacant Land
Location of Property . ~i25. Het1x~.'s..~~rie,, .~BC.R1~7-A.,. N. Y . .
House No. Street [ ~ Hamlet
Owner or Owners of Property ..~6tEX:.$~. ~~1?~F.~ .Tenedios... , . , • , _ iE , .
County Tax Map No. 1000 Section ...7.4.......... Block ~1.......... Lot.l? ~
Map o£ Peconi~ Homes
Subdivision ............................Filed Map No. .47-$a,.....Lot No. .
` .
Permit No. i7.cj~g.... Date of Permit 3~~-.7?.$9..Applicant .IN~D HOMES, 11VC.
Health Dept. Approval .'~,(2~,/.89 ...............Labor Dept. Approval
Underwriters Approval ........................Planning Board Approval
Request for Temporary Certificate .....................Final Certificate g... .
Fee Submitted $ . 2J`.,QQ
Construction on above described budding d permit me is all4a licable c d nd regulations
~ -
Applicant . :
Robert •E.~ Hiltz, ~7Vr;9Stl5~ P~`i~~
par 10-10 78
Q.ee.3~13d ' i ,
ed?Ig33(
TEL. 765-1802
~
SuFFOL,~CO~ TOWN OF SOUTHOLD
~c OFFICE OF BUILDING dNSPECTOR
P.O BOX 728
~ TOWN HALL
''O~y~o~ ~ SOUTHOLD, N.Y 11971
'~l C E R T I F I C A T I O N
Date~~ ~ `~-r
Building Permit No. 179282
Owner Peter Tenedios
(please print)
Plumber Gale Fiaske Plumbing APating
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1~ lead.
~ ~ Gall 's signature)
Sworn to before me this
2~ day of ~ `1 /
19~L~' Notary Public /
Notary Public, ~ County ROSE H UONNELLY
Notary Public, State of New York
~ No 52 4624196~uffolk County
Term Expues 3 ~ /r//~d
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F OUtIDAT20*] ( t sad )
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FOU1dDATIO;J ( 2nd ) _ _ ~
2 . ^ ~ i -ceio
P,OUGH FRA;fE &
PLUMBING
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IIdSULATI0P1 PER N. Y.
STATE ENERGY
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765-1802
BUILDING DEPT.
INSPECTI®N
[ FOUNDATION iST [ ] ROUGH PLBG.
FOUNtfATiON 2ND iNSULATiON
[ ]FRAMING [ ]FINAL
REMARKS: i~
DATE INSPECTOR
_ `
765-1802
BUILDING DEPT.
fNSPECTf~N
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
(~~FOUNDATION 2ND ( ]INSULATION
[ ]FRAMING [ ]FINAL
REMARKS: _~~~3~ /~,fli
~ //TTT .
DATE U3 INSPECTOR
I 765-1802
BUILDING DEPT.
INSPECTION
[ )FOUNDATION 1ST ( ] ROUGH PLBG.
[ ] FOUNDATION 2ND ( )INSULATION
[ ]FRAMING [~INAL
REMARKS: -
DATE INSPECTOR
d 765-1802
BUILDING DEPT.
INSPECTION
[ )FOUNDATION i5T [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ] iN~ULATION
[ ]FRAMING [ vj
F/iNAL
REMARKS:
2
DATE ~ 3 p INSPECTOR
l ~9~~
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND ~SULATION
[ ]FRAMING /JJ [ ]FINAL
REMARKS: c_(/~y~,,~~,Oa.~~
C9~~s
DATE ~ INSPECTOR /G~
,..T_. _ ,--_-T-.~. o~--... s,
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1195112 - BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10088
oa. AUGUST 31,1989 gppltrotlonNo.onfile 62018089/89 N 089578
THIS CERTIFIES THAT
ott/y tka t>faettieal pnlpmsnt r drerikad 6alott and ineraduced 6y the sppNcant named on the ahote applirtton numher in the protnirt q/
PBTBR TENBDIOS, BBrNRYS LAMB, PBCONIC, N.Y.
in the foUacinR IocaNon L'J nt ~ I At Fl. ? Ynd Fl. GAR .Section Black 6et~
lest e:amtwed on AUG~13T 15,19 and found to 6e in compliance with the reyuirementA of thu Board.
R%~ AqK f1RITOHR TUREf RANOa COOICINO tNCRR OVENf DIfN W ANf
OUTYTf NCANettClNT FLUpFKClNT OTHER AMT. K. W. AMT. K, W. AMT. K.W. AMT, K. W. MAt. N. F.
30 0 28 30 1 F
DRYERS RIENACE MOTORS lUTUfl AMUANCE REDMf SMdAI RRC'?T 11AY C10CRR REl Itlgi IMATERR MUU4011TtRl DIARtAERf
AMT. K. W. ~ fMl ~ N. F. OAt N. r. AMT. NO. A. W. G. AMT. AMF. AMT. AMFt, TRANS. AMT. M. F. NO f
~T AMT. WAtTt
3 F 1 2 12 1 30 1
fERV1t,7 NO.Of S E R V 1 C E
AMr: AMr. trte p~j u, ~,e tw iw>w+ awtw awsw "o•o~
icoNO. a ccW.
c°o'r+o. No. or Ni.leu a~~~ No.a.surKAU a'~~l
1 150 CB 1 X 1 1 1 1
oTIwR At7WATUf~
G.F.C.I:-5
SNOKB DBTBCTOR:-1
Bo'~
SAGS & LADBNANN INC. LIC.~36358
P.O.BOR 1768
30UTBOLD, NY, 11971
11
Pn
This urtifitata tttsst tat b ukand in qtly mannary rNurn to 1M oHia of flr Eoard if intwrrtM, t -ma 6s ' sd tMir credsMibls.
LDING DE~'ARTMENT. THIS COr1f OF CERTIFN:ATE itBlST !E kLT IN ANY NMINE .
"~NFORbiATION FUR I3UILllI1VG UEPART111ENT ~
WE ARE IN THE PROCESS OF ISSUING A CERTIFICATE ~
OF COMPLIANCE FOR THE ELECTRICAL INSTALLATION
AS COVERED IN AN APPLICATION FILED WITH OUR
DISTRICT OFFICE
THE NEW XORK B,QO'A~RD OF FIRE UNDERWRITERS
APPLICATIO NO ~ ~ ~ / ~-7~
Y.~-dW
10~
DA E SPFCTOR
i
{DRM IBD ~ftF.\ Ileh)
r
BOARD OF HEALTH U'~"
~ 3 SETS OF PLANS • •
r ' FORM N0.1 SURVEY ....~•.I~~.
TOWN OF SOUTHOLD CHECK
iCjC~1 i` BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL
r ,~v,.,,.~,„;1-i' °,OUTHOLD, N.Y. 11971 NOTIFY
rcr^ `~,~~~^,fD TEL.: 765-1802 MAIL T0:
Erauuned ~`t')w.~c~L~!.7 19~`~
Approved ...1:?' ~~-`:fit 199. Permit No~
Disapproved a/c .
.•71~~
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date March l~',,,,,,.,„198`
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, witi
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 stre
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this ap;
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 pen
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 Occupan
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Depaztment for the issuance of a Building Permit pursuant to
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 demolition, as herein descnb
Tlie applicant agrees to comply with all applicable laws, ordinances, budding code, housing code, and regulations, and
admit authorized inspectors on premises and m building for necessary inspections.
INLAND ,HOFIES, .INC... .
(Signature of applicant, or name, if a corporation)
Box 11'] ~ _ Mattituck,. N, , Y., ,1195? .
(Mailing address of applicant)
State whether applicant is_owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build
.General,Contractor,,,,.
Nance of owner of premises .Petsr . Tenedios
. .
(as on the tax roll or latest deed)
if applicant is a corporation, signature of duly authorized officer.
.Eobert. E.. Hil~z . .
(Name and title of corporate officer)
ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED
Builder's License No . .
Plumber's License No. ..24~1P .
Electrician's License No 36.35E
Other Trade's License No. .
GaS
1 Location of land on which proposed work will be done. . Hesii'~s..LAAe.,..PeGAS11C.,..N.. Y.« . .
liouse Number Street Hamlet
County Tax hiap No 1000 Section ...7.4........ Block ...Q~........ Lot ....7,7 .
Subdivision / . . Filed Map No. 4181......... Lot ..6.... , .
(Name)
? State existing use and occupancy of premises and intended use and occupancy of proposed construction
a Existing use and occupancy v~... .
b. Intended use and occupancy ].-Family. AFIellizlg . .
3 Nature of work (check which applicable) New Building ~ Addition Alteratron .
Repair .Removal Demolition Other LVork .
~ (Description)
.
4 Estimated Cost .~.b~ d.ad Fee '
(to be paid on filing this application)
S If dwelling, number of dwelling units . Number of dwelltng units on each floor .
If garage, number of cars y . .
6 If business, commercial or mixed occupancy, specify nature and extent of each type of use .
7 Dimensions of existing structures, if any. Front .Rear Depth
fieigltt Number of Stones .
Dimensions of same structure with alterations or additions. Front Rear .
Depot .............Height ..Number of Stones .
8 Dii»ensions of entire new construction Front Rear Depth .
height Number of Stones .
~ Size of lot Front Rear Depth
10 Date of Purchase .....................Name of Former Owner .
I l . Zone or use district in which premises are situated .
1 2 Does proposed construction violate any zoning law, ordinance or regulation .
13. Will lot be regraded .........................Will e~c~es~~j~j~ov~~~~},premises~18_8~~s 97Cri
14 Name of Owner of premises Fetar • Tenedioa Addres one No........... .
Name of Architect sBrooklyn; N•: 'Y: • • ' '
.........Address.. ...Phone No..............
Naive of Contractor INLAND. H.(1MES, .INC... AddressBo,X .17-;],Matti~~tckphone No29$-~~96... .
15. Is this property located within 300 feet of a tidal wetland? *Yes No
*If yes, Southold Town Trustees Permit ma be re uired.
PLO~I' DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimension fry
property fines Give street and block number or descnphon according to deed, and show street names and indicate w et;
mtenor or corner lot.
U
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19'~~ 3e'.i9r
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i io •o,•
SPATE OF NEW YORK, S S
i'OUNTY OF ,S17k'kY)T,1~... . .
.1i0bsrt Ilzltz being duly sworn, deposes and says that he is the apphc,
(Name of individual signing contract)
~bave Wanted
Ileist}te .....CoTltxaCtoT
(Contractor, agent, corporate officer, etc.)
~~f said owner or owners, and is duly authorized to perform or have performed ttte said work and to make and file t
application, that all statements contained m this application are true to the best of his knowledge and belief; and that
~,vork will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
1,~t}a......day of ...March 1989.
Notary Public, ...Suffolk Coun
NOTARYPUBUCStateotkewYak Robert E. Hiltz (Signat apphca
No 4707878,SuHolkCouirty
Term fxpues Msrch 30.19.-~
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