HomeMy WebLinkAbout28066-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-28462
Date: 05/24/02
T}{IS u~RTIFIES that the building NEW DWELLING
Location of Property: 810 GREENFIELDS LA SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Ta_x Map No. 473889 Section 63 Block 5 Lot 22
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JANUARY 30, 2002 pursuant to which
Building Permit No. 28066-Z dated FEBRUARY 4, 2002
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 COVERED FRONT PORCH AND ATTACHED TWO CAR
GARAGE AS APPLIED FOR.
The certificate is issued to ZOUMAS CONTRACTING CORP
(OWNER)
of the aforesaid building.
SUFFOLK CO~ DEPARTMENT OF I{EALTI{ APPROV;%L R10-01-0228
ELECR~RICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DA'l'~a3
Rev. 1/81
05/07/02
05/06/02
1044733 05/06/02
HI-TECH PLUMBING
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. 28066 Z
Date FEBRUARY 4, 2002
Permission is hereby granted to:
ANTHONY & WF MEZZAPELLE
156 NORTH TITMUS DR
MASTIC,NY 11950
for :
CONSTRUCTION OF A SINGLE FAMILY DWELLING WITH ATTATCHED TWO CAR
GARAGE AS APPLIED FOR
at premises located at 810 GREENFIELDS LA SOUTHOLD
County Tax Map No. 473889 Section 063 Block 0005 Lot No. 022
pursuant to application dated JANUARY 30, 2002 and approved by the
Building Inspector.
Fee $ 1,045.20
COPY
Rev. 2/19/98
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765~1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to the Building Department with the follt :
A. For new building or new use:
1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual na
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%
5.
Commercial building, industrial building, multiple residences and similar buildings and installations,.. ~ :ficate
of Code Compliance from architect or engineer responsible for the building.
Submit Planning Board Approval of completed site plan requirements.
For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" ,:; i uses:
1. Accurate survey of property showing all property lines, streets, building and unusual natural or topogn~ i ! z
features.
2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate ofC~ z ?ancy
is denied, the Building Inspector shall state the reasons therefor in writing to the applicant.
Fees
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelli~ ~ $ i:-i.00,
Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Busines,,. :i 0.00.
2. Certificate of Occupancy on Pre-existing Building- $100.00
3. Photocopy of Certificate of Occupancy - $ 0.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Cormnercial $15.00
New Construction:
Location of Property:
t) or Pre-existing Building: . (check
Old
one)
House No. Street Hun
Owner or Owners of Property:
Suffolk County Tax Map No 1000, Section ~> ,~ Block
Subdivision m PrO OF ~O~lt6l~D~ ,~'-'qO~ct~ FiledMap.
Date °f Pennit.~O 7,--- Applicani:
Underwriters Appro.val:
Lot
Vermit No.
Health Dept. Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fe~ Submitted: $ '~. ~'-.00
Final Certificate:
(check one)
Town Hail, 53095 Main Road
P.O. Box 1179
Southold, New York 11971-0959
Fax (631) 5 ~823
Telephone (6. ~ ~5-1802
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATION
Date:
Building Permit No.
Owner: ~9~.~/~-~
(please print)
(please print)
Plumber:
I certify that the solder used in the water supply system contains less than 2/10 of 1%
lead.
Sworn to before me this
day of /t/,~¢)/
, 20o~,
Notary Public, ~tt F I~LI( County
" BUREAU OF ELECTRICITY '
4o FuL -o S-m -ET - NEW YORK, NY OO3S
CERTIFIES TItAT
Upon the application of
upon premises owned by
DOUBLE-POLE ELECTRIC
P.O. BOX 147
PATCHOGUE, NY 11772-0147,
Located at
Application Number: 1044733
Section: Block:
Described as a Residential
ZOUMAS HOMES
GREEFIELD LANE
SOUTHOLD, NY 11971
GREEFIELD LANE SOUTHOLD, NY 11971
Certificate Number: 1044733
Lot: Building Permit:28006 BDC: NS11
occupancy, wherein the premises electrical system consisting of
electrical devices and wiring, described below, located in/on the premises at:
Basement, First Floor, Attached Garage, Outside,
was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below, was
found to be in compliance therewith on the 6th Day of May, 2002.
Name QTY Rate Rating Circuit Type
Alarm and Emergency Equipment
Sensor 1 0 Carbon Monoxide
Sensor 5 0 Heat
Appliances and Accessories
Furnace 1 0 Oil
Range 1 0 40 Amps
Dish Washer 1 0 1.2 KW
Exhaust Fan 1 0 F.H.P.
Wiring and Devices
Receptacle 39 0 General Purpose
Switch 29 0 General Purpose
Fixtm'e 36 0 Incandescent
Paddle Fan 4 0
Receptacle 6 0 GFCI
Receptacle 1 0 20 amp Laundry
Receptacle 1 0 30 amp Dryer
Service
1 Phase 3W
seal
Continued on Next Page 1 of 2
This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated.
BY THIS CERTIFICATE OF COMPLIANCE THE
. YORK BOARD OF FIRE UNDERWRITERS
;', BUREAU OF ELECTRICITY
40 FULTON STREET - NEW ¥ORI<, NY 10038
CERTIFIES THAT
Upon the application of
upon premises owned by
DOUBLE-POLE ELECTRIC
P.O. BOX 147
PATCHOGUE, NY 11772-0147,
Located at
Application Number: 1044733
Section: Block:
Described as a Residential
GREEFIELD LANE SOUTHOLD, NY 11971
Lot:
ZOUMAS HOMES
GREEFIELD LANE
SOUTHOLD, NY 11971
Certificate Number: 1044733
Building Permit:28006 BDC: NS11
occupancy, wherein the premises electrical system consisting of
electrical devices and wiring, described below, located in/on the premises at:
Basement, First Floor, Attached Garage, Outside,
was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below, was
found to be in compliance therewith on the 6th Day of May, 2002.
Name QTY Rate Rating Circuit Type
Service Disconnect: 1 200 cb
Meters: 1
seal
2 of 2
This certificate may not be altered in any way and is validated only by the presence of a raised sear at the location indicated.
STATE OF NEW YORK )
) SS:
COUNTY OF SUFFOLK )
c../VtcoS/A
, being duly sworn, deposes and says:
That deponent is over the age of 18 years and resides at
That on the ~--' day of ,)4~doA~.~'/Zoo,z.200g..deponent architec_.____~Vengineer,
licensed by the State of New York, hereby states that s/he accepts full
responsibility for the accompanying plans compliance with the New York. State
Fire Prevention and Building Code (9 NYCRR); said plans pedain to properly
located at SCTM#- 1OO0- ~,Z,- _q'- ~ Z..-
~~ Not~ ~b~, StYe of NewYo~ __~/e~n~eer
~~ Qualified In Suffolk County
~ Appointment Exp~ _~r~.0,.3J07/2,~0J
Sworn lo ~[oro mo this
cc: Applicant
BUILDING PERMIT EXAMINER CHECK LiST
SCTM# DISTRICT: 1,000 SECTION: ~ BLOCK:
DATE REVIEWED: t / $ t/02
DATE SUBMITTED: I //~o/02
LOT:
CITY:%owaxto c.~
DESCRIPTION:
APPROVALS REQUIRED
SUBD1V. NAME:
PROJECT DESCRIPTION: ~ki'-~00~d~
ESTIMATED PROJECT COST: $ 1~'o~ ,o o
ARCHITECT / ENGINEER: ~/~:~ $/~i~ FASTTRACK?
S~GLE & SEP~TE CERT~ICATION-~Q~D? ~o NOTES: /.~
~TS 40,000SF-100-24, ~t reco~ition.(C~ATED before June 30, 1983), ~DERS~ED ~ FROM J~.1997 ~0~5. Merger.(A nonc~o~ing at anytime afl~ 7/1/8
ZO~G DIST~CT:~ ~-~ COlOr'G?
~Q. LOT S~E: ~ o ~Z~
ACT. LOT S2E: .~Q. LOT COV.~-ff ACT. LOT COV.
~Q. FRONT _~ PROP- FRONT ~ ~Q S~E /~Z,~ ACT. SDE
~Q. ~ ~o PROP. ~ ~ /ff~-
ZOO: ff
/
SUFFOLK
COUNTY
DEPT(,.T..~r NO, (BED #):~__ DTE:
HEALTH
TOWN SEPTIC RECEIPT: Y or N
NEW YORK STATE DEC: ~'m~-DEC 9a/7~. YES o~
SOUTHOLD TOWN TRUSTEES: YES o
TOWN ZONING BOARD APPROVAL: YES ort
TOWN PLAN. BOARD APPROVAL: YES o~
TOWN HISTORICAL PRE (SPLIA): YES o~
NYS ENERGY: YES OR ~ ,.-- ~t~', ,,~
EGRESS (18 H min'? 4 sq t~-~al) ~~- k 4°/o) / J/~~~. x 8%)
BUILDING PERMITS OPEN/EXPIRED: gP' ' -Z/.12Z0 ~- N k, Q.__'/~
HAVE PRE CO'S: Y OR N BP
NOTES: -'
!
!
FEE STRUCTURE: FOUNDATION: I; .,~.~? SF
FIRST FLOOR :.~.,,_Z_i~ SF
SECOND FLR : SF
TOTAL: ~ _ ,~ .~ ~/ SF
FOT(~;~H SF)-( ~Y0 SF)=~/~/k SFX$
1NIT OTHER
FEE FEE
TOTAL
FEE
765-1802
BUILDING DEPT.
I oiPECTION
[ N l ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
DATE
//~~ ~NSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
~FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
765-1802
BUILDING DEPT.
INSPECTION
~~~UGH PLBG.
[ ] FOUN/~TIONIST
[ ] ~JJ~DATION 2ND [ ] INSULATION
~,,]'~ FRAMING [ ]FINAL
[ ] FIREPLACE & CHIMNEY
,,,A,.~s.- ~ a~~?~~~
DATE~_~,~,~INSPE~
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST
[ ] FOUNDATION 2ND
[ ] FRAMING
[ ] RO~LBG.
[ ~ INSULATION
[ ] FINAL
[
REMARKS:
] FIREPLACE & CHIMNEY
DATE
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [] ROUGH PLBG.
[ ]FOUNDATION 2ND [] IN~TION
[ ]FRAMING [/.~ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS, ~)~'
IFIELD INSPECTION REPORT I DATE I COMMENTS
...................................... o~ ~~C~~ ~~_~.
FO~DATION (2~) ~ g
ROUGH F~G &
PL~B~G
~S~ATION PER N. Y.
STATE ENERGY CODE
~D~ION~ CO~ENTS
/
TOWN HALL IL
~': BLDG. DEPT.
SOUTHOLD, NY 11+i' XOwN 9F SguTHOLD
TEL: 765-1802
Examined ¢ / ,20. '~'
Approved ~'/~/ ,20 ~"
Disapproved afc
BUILDING PERMIT APPLICA. TION..CHECKLIST
Do you have or need the following, before applying ?
Board of Health
3 sets of Building Plans
Survey
Check
Septic Form
N.Y.S.D.E.C.
~' ~d~{g Inspector
C°ntact:T~ cON/ ¢TINO COt .
M~ ~__ PO Box 361
"~ RJ~er, NY 11792
APPLICATION FOR BUILDING PERMIT
Date
INSTRUCTIONS
,20tO ca_
a. 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 Permit 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 a Certificate of Occupancy
is is!;aed 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, housing code, and regulations, and to admit
author/zed inspectors on premises and in building for necessary inspections.
(Signature of applicant or name, if a corporation)
r (Marling address of applicant) I ! 7~
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Nam ofown rofpr , s a4 o-z
(as on the tax rbll or latest deed)
If applicant is a corporatio~amre of dul.~ authorized officer
(Name and title of corporate officer)
Builders License No.
Plumbers License No.
Electhcians License No.
Other Trade's License No. '
1. Location of land on which proposed Work will be done:
House Number Sfi'eet
Hamlet
County Tax Map No. 1009 Section . $ ~-- Block ~'- Lot ~ ~
Subdivision fi'hlLla o /[ ~_ 00~t.~tt.-,-ag ~ Filed Map No. (_,,% I?; Lot et<)
_C0
State exis.qng use and occupancy of premises and intended use and occupancy7 of proposed c'onstmetion:
a. Existing use and occupancy
b. Intended use and occupancy
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
- t Cost ~' 29 007
4. Estima ed~ _ ..... ~,~io(~5.~'2 Fee
5. If dwelling,/ umberg q ng units
Addition Alteration
Other Work
(Description)
(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 of use.
7. Dimensions of existing structures, if any: Front Rear Depth
Height Number of Stories
Dimensions of same structure with alterations or additions: Front
Rear
10. Date of Purchase
Depth Height
Dimensions of entire new construction: Front ~ ~ .IZ// Rear
Height 0. O Number of Stories ~
Size of lot: Front /t--q"O Rear / Ctr~. ~o 7._- Depth
Number of Stories
/ //
Name of Former Owner
11. Zone or use district in which premises are situated
Depth
12. Does proposed construction violate any zoning law, ordinance or regulation: rr~ O ,
13. Will lot be re-graded , Will excess fill be rem?yed from premises: YES
'- o
14. Names of Owner of pren!ises ~v~0 ~,~ ,c. ~-~t44-- L~li[~
NameofArchitect ~-Z~tr AJtco~,~. . Address
Name of Contractor ~.O[J~h4e_ trft>tu~(aaoL_Address
r, qo. - ....
15. Is this property within 100 feet of a tidal wetland? *YES NO
· IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE RErQUIRED
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 OF )
_]~'- '-~,~ [-L~.J '~ u ~ ~ berg duly sworn, d~oses ~d says that (s)he is ~e applic~t
~me of indi~du~l'si~ing con,ct) above nmed,
(S)He is ~e ~ ~ ~ ~ ~ ~ A~ ~ 4~ ~
(Con~cior, Ag~t,~o~o~te office, e~c.) '
of said owner or owners, and is duly authorized to perform 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
performed in the manner set forth in the application filed therewith.
Sworn t~efore me this
~[t/ ' dayof 7~r/'
Notary Public
20mq
m~i~'. ~-.
N 71'11'QO'E' 150,OO'
7t t.47' 1 ¢4a.S)l
:FOLK COUI'~TY DEPAR';}'~E;~4T OF r~EALTH :~£R¥1CES
=ERMIT FOR APPROVAL OF C~N.C.,TRUCTIOt4 FOR A
)IRE.~ THRF. E YEARS FROM DATE OF' APPROVAL
S 70'31'20'"W
No. 01-51'9
~FOR
~ mlmllm mime-mm, mm m '~1 e ~qmll 1mi 'ami #
mqm m mm m m,-m{ -mm, mm 'nm ~m amman mm 'mLm -
CERllFIED ONLY TO:
J"--
HAROLO F, TRANCHON JR. latlet. U~.
HAROLD F. TRANCHON JR. P.C.
LAND SURVEYOR
1866 WADING RNER-IdANOR RD. WADING RIVER,
NEW YORK, 11792
631-929-4695
LOT NUId~E)~ lO
MAp OIr GREEI~ tis AT SOUTHOLO
SITUAtEU AT SOUTHOLD
~ OF SOUTHOLD - SUP'PuLK COUNTY N.Y.
SCALE 1' = 40' DATE 10--2,5-2001
F1LEO MAP Ne. 6313 OlATE 11--10--1975
TAX MaP Ne. (REF ONLY)1000-63--5-22 ~ 500
LOT AREA= 42,220 sq. ft.
GREENFIE S
~. ~ 7~'~ l'02"E ~50.~' ~0~.
Z ,
~ ~ ~ ~ ~ LONe IS~D ~L~ FOUND. LOCA~ON 2-15-2002
R~S~ D~ING 1-~1-2~2
~~A~~~~~ JOB No. 01-519 RLE No. GREENFIELDS AT ~U~OLD
~~m~~~ SU~ED FOR
u~~~m~A~~'~ LOT NUMBER 10
~ ~ ~ ~ ~ ~ ~ ~' M~ OF GREENRELDS AT SOU~OLD
~m~~ ~~~.~ SI~A~D AT ~U~O~
~ ~ ~,~ ~ ~T ~ m ~ ~ TOWN OF SOU~OLD - SU~OLK COUN~ N.Y.
~~~~'s~ S~E 1" = 40' ~ 10-25-2~1
~~~m~A~~. ~D M~ No. 6.315 DA~ 11-10-1975
CERTIFIED ONLY TO: T~ ~ No. (REF ~L~ 1000--63--5--22 DISK 5~
HAROLD F. TRANCHON JR. P.C.
~ND SU~EYOR
'" R~ER-~NOR RD. WADI~ RNER,
~/~ ~ , ~ ~66 WADING NEWYORK, 11792
N. . No. 048992 651--929--4695
~ROLD F. T~NCHON JR. PENN. LIC. No. 21~-E
LOT AREA= 42,220
LOT NUMBER 20
47'
Z
GREENFIEI.DS
N 71'1 l'02'E
19.3
DWrl L!N~
66.2
LANE
rD.
150.00' ~ON.
CERTIFIED ONLY TO:
EDWARD R. GILBERT & RICHARD C. SCHWARTZ
NORTH FORK BANK
SUNRISE ABS3RA~ CORP.
N.Y. LIC.'~. 048992
HAROLD F. TRANCHON JR. PENN. LIC. No. 2115-E
JOB No. 01-519 FILE No. GREENFIELDS AT
SURVEYED FOR EDWARD R. GILBERT & RICHARD C. SCHWA,~TZ
LOT NUMBER 10
MAP OF GREENFIELDS AT SOUTHOLD
SITUATED AT SOUTHOLD
TOWN OF SOUTHOLD - SUFFOLK COUNTY N.Y.
SCALE 1" = 40' DATE 10-25-2001
FILED MAP No. 6315 DATE 11-10-1975
TAX MAP No. (REF ONLY)1000--63--5--22 DISK 500
HAROLD F. TRANCHON JR. P.C.
LAND SURVEYOR
~66 WA~NGRNER-MANOR RD. WADING RNER,
NEW YORK, 1~92
651-929-4695
.9-,9E
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