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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-32698
Date: 10/26/07
THIS CERTIFIES that the building ADDITION
Location of Property: 1600 SOUND
(HOUSE NO.)
County Tax Map No. 473889 Section 33
DR
(STREET)
Block 4
GREENPORT
(HAMLET)
Lot 81
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
OCTOBER 2, 2007 pursuant to which
Bui1ding Permit No. 33472-Z
dated
OCTOBER 12, 2007
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 "AS BUILT" DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED
FOR.
The certificate is issued to EILEEN FORGIONE & LAWRENCE JONES
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPAR'l'MENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
N/A
PLUMBERS CERTIFICATION DATED
N/A
/~~
Authorized Signature
Rev. 1/81
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
.rnr
\
L-
-1jill
T"
i,c?T.
. cr" 'THOLD
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or il]k and submitted to the Building Depalimenl with the following:
A. For new building or new use:
I, 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 fonn) ,
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 2/1 0 of I % 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-exisling" land uses:
I, Accurate survey of property showing all property lines, streets, building and unusual natural or topographic
features,
2, A properly completed application and 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
I, 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 - $,25
4, Updated Cetiificate of Occupancy - $50,00
5, Temporary Celiificate of Occupancy - Residential $15,00, Conunercial $15,00
Date,
o c:-r"Z- ? cd?
,
New Construction: ._._ Old or Pre-existing Building:
Location of Property: sea $"'" '"' .. & IL-.u___,^-
1T~~1f No; b (7 cJ So ~ ~eeY2-(T ,-.A
Owner or Owners of Property: ~ v-~~ p. JVl'VtLJ
x
( check one)
c;:.\r e- ~ (J CJ ...- r-
Hamlet
-f--
t:;.'~ F~J'I'v~
8 1
Lot
Suffolk County Tax Map No 1000, Section
033
Block
y
Subdivision
__ Filed Map, _m____ . Lot:
:3 '2>'1 J~__ Date ofl'ermil_J () - (J '0, Applicant:_______
Pennit No
Health Dep!. Approval: ________
Planning Board Approval:
Underwriters Approval'
.----==-_---.-- C-Iv~ 3)~q~
_FinalCertificate:__~__ (check one) f2ec.-133/1,
Request for
Temporary Celiificate
Fee Submitted $ _ I (}cJ .--
t)W~n\ /b (.,1 fuve I1iU< ~ S MELANIE DDRDSKI
1) 1Ic1 J (\~t :?I^^ .Ll.n .. ., .,^...., NOTARY PUBLIC, State of New 't\I11l
,,- --10 LNl V vy I <.VU I No.01004634B70
\1 ~. .\",L ~ aualiliedinSUffolkCoun~~J\'L>
\\llv~ UV\)...~I CommlssionEllpiresSeptemb81 O~
~tSi2refb--
FORM NO. 3
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)
PERMIT NO.
33472 Z
Date OCTOBER
12, 2007
permission is hereby granted to:
EILEEN M FORGIONE
58 SOUND ROAD
GREENPORT,NY 11944
for
"AS BUILT" DECK ADDITION TO AN EXISTING SINGLE FAMILY DWELLING
AS APPLIED FOR
at premises located at
1600 SOUND DR
GREENPORT
County Tax Map No. 473889 Section 033
Block 0004
Lot No. 081
pursuant to application dated OCTOBER
2, 2007 and approved by the
Building Inspector to expire on APRIL
12, 2009.
Fee $
400.00
~~
t Authorized Signature
ORIGINAL
Rev. 5/8/02
3 3t.f 7 d- ~
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING I STRAPPING ~ FINAL
[ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
REMARKS: );~ ~~~-~
c: nk"
\.A--v' ( '--, .~
DATE
/()~;J.} - tJ 7
INSPECTOR /~. ~r---
.~
PERMIT NO.
"',;,,1 p- c..
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
BoanI ofHeallh
4 sets of Building PIanll
Planning Board approval
Smvoy
Check
Septic Fonn
NY.S.D.E.C.
T",,_
Contact:
Mailto' ~'- vt: ""C.e J""'''S
.n:J So ~..J R.o. ~~ R -p'^'7; IV 'f
Phooe, &'31 -'-(77 - f3 '17:1-
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 7~-1802
FAX: (631) 7~-9502
www.northrork.netlSoutholdl
Examined~,20.22
Approved~J22
Disapproved ale
f Lv-, 20...1'/
I
(UA
Building Inspector
Expiration
APPLICATION FOR BUILDING PERMIT
Date
)-pp r- ,2007
.
INSTRUCTIONS
8. 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 waterways.
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 issue a Building Pennit to the applicant. Such a 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 what so ever until the Building Inspector
issues a Certificate of Occupancy.
f. Every building pennit shall expire if the work authorized has not commenced within 12 months after the date of
issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the
property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an
addition six months. Thereafter, a new permit shall be required.
APPUCA TION IS HEREBY MADE to the Building Department for the issuance of a Building Pennit pursuant to the
Building Zone Ordinance of the Town of South old, 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.
1-----..--'
,
(Signature of applicant or
,\f{ SOL.-p f<.-~ &-r<.e'ft2#.,~
. . H, a-.' .' (Mailmg ad . a of applicant) ,
State whether applicant IS owner, lessee, agent, architect, engIneer, general contractor, electncl8n, plumber or builder
1'/'1
Ot.-v,"" II"'
Name of owner of premises F(}.r5''u~ ,f3:f<<.",r"-l"'" 0""".r~ LA..,.....""'<< F.
, (As on the tax roll or latest deed) )
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
I. L,~n of land o~hieh proposed wor~lI be done:
Ot.-.N [) fl..
( House NUfD\,!er Street )
\fiKA /600 >(/'-'-;V~ pi'll vt
County Tax Map No. 1000 Section 03 ']
Subdivision
Cv~e"", ,o(;l....-r-
Hamlet I
Lot
Lot
9/
Block '1
Filed Map No.
(Name)
.
2. State existing use and occupancy of pre;mises and intended use and occupanc)1of proposej;l construction:
a. Existing use and occupancy )'. ....7 I", ~,/7 (~>.' tR eo-. c-lI.-.
b.Intendeduseandoccupancy <;:"'y4.. Fc-.-"/7 A.~: d~~
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
4. Estimated Cost # YaI -
Addition
Other Work
r-
Alteration
(Description)
Fee
5. If dwelling, number of dwelling units
If garage, number of cars
(To be paid on filing this application)
Number of dwelling units on each floor
6. If business, commercial or mixed occupancy, specify nature and extent of each type cfuse.
Rear 37 '
I
7. DimenSIOns ofexistin~ structures, lfany Front 37
Height ?-. \ Number of Stories -:L
Depth
?-6
I
Dimensions of sam} structure with alterations or apditions: Front ? 7
Depth :s I? Height '2.. " Number of Stories
Rear ~ 7
?-
I
8. Dimensions of entire new construction: Front
Height Number of Stories
Rear
Depth
'"
10. Date of Purchase
/7 ')1
/qqy
Rear
/
/7 ~
Name of Former Owner
Depth / Y 1
S Tv-A t.-tS.r f1 ev-
9. Size ofIot: Front
11. Zone or use district in which premises are situated
R-l.Jo
12. Does proposed construction violate any zoning law, ordinance or regulation? YES ~ NO ~
13. Will lot be re-graded? YES_NO $Will excess fill be removed from premises? YES_NO_
14. NamesofOwnerofpremis~~~ 'JU~Addres,rgt;;;'~~:;:-!.,t-!r Phone No. 6J I , '?77-Ef't7'L
Name of Architect Address Phone No
Name of Contractor Address Phone No.
15 a. Is this property within 100 feetofa tidal wetland or a freshwater wetland? *YES_NO ~
* IF YES, SOUTHOLD TOWN TRUSTEES & DEC. PERMITS MAYBE REQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES_NO-A
* IF YES, DEe. PERMITS MAYBE REQillRED.
16. Provide survey, to scale, with accurate foundation plan and distances to property lines.
17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey.
STATE OF NEW YORK)
SS:
COUNTY OF9.JId.Ji )
_Ln ooW'..... r t F Jor1tS being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the
(Contractor, Agent, Corporate Officer, etc.)
of said owner or owners, and is duly authorized to perfonn or have performed the said work and to make and file this application;
that all statements contained in this application are true to the best of his knowledge and belief, and that the work will be
perfonned in the manner set forth in the application filed therewith.
20 fL/.-
/~Me?:~
EM HEALY
Notary Public. State Of New York
No. 01 HE6059270
Qualified In Suffolk County Nil
Commission Expires July 23, 20>4 t
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MAP 0I="PROPER1Y
SUlNE'i'ED. FOR'
LAWI~ENtE JONES
ij
EILEEN FORG\OI'JE
NEAR
GREENpO\lT
TOWN QF SOUTHOLO , N~
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Q.MONUMENT
llTLE 1-<0, QH_94019'5
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GUARI'-NTEED TO COMMONWEALTH WJD TITLE INSUQA.NCe CD,;
NORTH FOR.\( e"'~".'.NO l,AW!1eI.JCE JONEs-tEILiiEN'F'OOGIONE
"'s 5\JllVEYED JUN.2B,1994
RODERICIl: VAN TUYL P.c.
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.LlC,lJio}ID SUIZVEYORS
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GRJ:EN,1'OR-T , lilY,
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CONSENT TO INSPECTION
~~ V' ert-. <-<' r: y,-vii:-(
Owner(s) Name(s)
, the Wldersigned, do(es) hereby state:
That the Wldersigned (is),(are) the owner(s) of the premises in the Town of
Southold, located at ~ ~ c;A.'\"';' fl.. C/. 6 V"JL~Q"'-~' ,v'f
which is shown and designated on the Suff~J,k COWlty Tax Map as District 1000,
Section 033 , Block Lj ,Lot ti / .
That the Wldersigned (has) (have) filed, or cause to be filed, an application in the
Southold Town Building Inspector's Office for the following: t/..
o ..... c..v v.:n- e' r-L.. .r
That the Wldersigned do(es) hereby give consent to the Building Inspectors of the
Town of Southold to enter upon the above described property, including any and all
buildings located thereon, to conduct such inspections as they may deem necessary with
respect to the aforesaid application, including inspections to determine that said premises
comply with all of the laws, ordinances, rules and regulations of the Town of South old.
The Wldersigned, in consenting to such inspections, do(es) so with the knowledge
and Wlderstanding that any information obtained in the conduct of such inspections may
be used in subsequent prosecutions for violations of the laws, ordinances, rules or
regulations of the Town of South old.
Dated ?A;/o '7
~?P
~V'~..R F :J?IVG-J
(print Name)
(Signature)
)llMtl h ~)t,pDVIL yWL
tkis 7..~ O~J.n~if, 1D07
~'tr~~
(Print Name)
MELANIE DOROSKI
NOTARY PUBLIC, Slale of New'lbrk
No. 01004634870
Qualified in Suffolk County ').1) I ()
Commission Elqlires Seplemb8130._
'~~ROVED AI NOTED I \
DATE: B.P, # 3:1 7 J- / '"
FEE: '" 'Iii Q~' fcJ,-; I
NOTIFY BUILDINS DEPARTMENT AT
765.18
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RI;QUIREME TS 0 THEC~S_OFNEWJ- US .,-~ I I I, II
vqRK S'fAT . Not RESpeNS\fl~'ElftlR' E IS UNLAW Ur-f. hee-4.((' I I '<::::: - 9 x"Sd (e """,,,,,,,'T
DiSIGN OR lCON~TRUCTIOU~~ WITH~Ut'CERTIFICAr IALLlcONSTicJC',,)~~, F",d-;""55" ('-t)
j (... _..! OF OCCUPANC Y 'MSiT U1E REQUIP\EME~TS OF THE
1 ," ," CODES OF NEW'voJiKSTATE,
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