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HomeMy WebLinkAbout5700-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Oi(ice Southold, N. Y. Cerfi[icate O[ Occupancy THIS CERTIFIES that the building located at .~.r.e..e.n. ~..1.~. ~a~.~ .......... Street Map No]~.s.~;el~ .81~Q~[~ck No...T ....... Lot No...l?+~...~..~. e~o..l-.t.t' .N. ,¥.. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ~a.II...20 .... , 197'~... pursuant to which Building Permit No..~.~... dated ........ ~&n...2~ ...... , 19.72, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . P~iva.te. o~e..fa~Xly, dw. ei Iing ....................................... The certificate is issued to .. 0.e.e.r.g.~..&..F.,.a.~..p0~l~.a. kl.Z .......0w_~e.~'.~ .............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .!~..ay...~. 7...1.~.7.2...blt. R.*..v. ~!.~.a .... UNDERWRITERS CERTIFICATE No .... ~..?-. ?.."~..'~. Y ........................ ' ......... [lOUSE NUMBER~[.~0 ........ Street ......G~'eenh~.l.2.. I,~u® ........................... Building Inspector ' ~ FO]B~ NO. 2 TOWN OF SOUTHOLD i BUILDING DEPARTMEH~ TOWN CLERK'S OFFICE' SOUTHOLD, N. Y. ~ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5700 Z Permission is hereby g¢<3nted to: pursuar~t to application dated ........................ ,,~,.~'.~., ......... ,~,,,~. .............. , 19,..2~, and approved by the Building Inspector, ....... l.~....,.,, .............. ., ..................... :~. ............. Building Inspector / FOBM NO. 6 TOWN OF $OUTHOLD i Building Department Town Clerks Office $outhold, N. ¥. 11971 ~ APPLICATION FOR CERTIFICATE OF~OCCUPANCY Instructions A, This opplicatian must be filled in typewriter OR ink, end sClbmitted in triplicate to the Building Inspector with the fallowing; for new buildings or new u~e: 1. Final survey of property with accurate location of all ~uildings, 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 FireUd~derwriters. 4. Commercial buildings, Industrial buildings, Multiple Rbsidences 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 completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming ~ses, or buildings and "pre-existing" land uses: ]. Accurate survey of property showing all property lines, Streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, qccupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent formation, required to prepare a certificate. New Building ..... .~ ....... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property , Gl~eenhill Lane~ O~eenp..o.~ti. NY ..... Owner Or Owners Of Property ~L~. & t~s. George ~ouz'akis Subdivision ........ ~.~..l:,..e.~...~.b..o.,.z,,,.e..~ ...................... Lot No..~.0,.i,. Block No, ..8...e.,a,..~. House No....1...]:.3.,0.. Permit No. ~.'..~..0..0.~ ....... Date Of Permit ....1./..2.~./..?..2.Applicant T~la.n.d Homes, Inca . Health Dept. Approval 3~.~.9./.T.~...~..-.~.Q~,~. ....... Labor Deptl ~Pprova ................................................ Underwriters Approval .............. .T. ............................ P g Board Approval ........................................ Request For Temporory Certificate ........................................ Finol }Certificate ........ X ............................... Fee Submitted $ .................................... Construction on above described building and permit meets all, Applicant ...... .Z..~..~...~..~...D.....~..0. ~..S.,....~..! Sworn to before me this ................ day of ............................................ Notary Public .................................... County )licable codes and regulations. (stamp or seal) P'OR C~RT~:~CA?~ OF OCCgPANCY A. This app icot on must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector with the following; for new buildings or new use: ~. 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 equet). 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 completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), No -conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual noturhl or topographic features. 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 in- formation required to prepare a certificate. Date ...... ........................... New Building ...,~. ......... Old or Pre-existing Building ............. ............... Vacant Land ............................ Location Of Property ,.~.~e~.~,~,~.~...i~.>~...(.~ee~y~t,.~....~;~ ........................................................ Owner Or Owners Of P'roperty , 4 ~* '~'...~ ~.... ~ ' · . ~ ,¢ ,~P,~ t~.~,~}~t~ ~ ~lY@,~.~ ............. ~ .................................... Subdivision .......9~m.~e~!~...!-bt>~*~,.m ........................ Lot No.~ ...... Block No;.~a...~'~.. House Permit No.!;r/G{~:z~ ......... Date Of Permit .1.~..~,;./.~..Applicant ~r~[~¢~.. ~i4~ .Z~:~(:~ ................... Health Dept. Approval ]..~/~,.~?~;F.Z?..~.tt~,~}G}~ ......... Labor Dept. Approval ................................................ Underwriters Approval ..../f]~+/.f'.~...fL.~l~,,,~,~, ......... Plann ng B~ard 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 ma this ................ day of ............................................ (stamp or seal) Notary Public .................................... County S-9 SCHD SUFFOLK COUNTY DEPARTMEI~T OF HBALTIt ~:~v ~ 7 I~-72 Date ~'~ ~ Bldg. Permit No. ~y~U/~ TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give ~'ed locatton~/ -/ have been inspected by this department and found to be satisfactory. ~hief of ~en~ral ~ngin~ring Servio~ EASTERN DISTRICT ~ RIVER~AD, N. Y. A_PPLICATION FOR APPRO%~AL TO CONSTRUCT PRIVATE ~EWAGE DISPOSAL SYSTE,MS e~ Approval to construct said systems i's' 're'q~ested~pertineht 'data ~e~ewith: Dat Address _~,.~,~.~ ~ ~, , j .7-Section ~. 2.Betaile~rty 10c~tion~/~ ~~4d ~,~¢~.~ 8-~t No. / V~ .... Hamlet ~ ~.a~,-.~,~,~'~~ ]" ~ ,, ~o~"~~ ~9~P~ivate well? , 3-~blic~ter s~ppl~ name ~j~[~?~ ~, DiStance to nearest ~in_ , 4-Lot Size: Width ;~ ft. Le~gth~ft. (also enter on center plot plan belowS) ~-me~i~: sin~% Fa~i~ ~ Two Family? ~Ce~!a~? ~ /~ab? ~Cr~w~ S~ce ~ ~ lO-Prooosed sMstem: Septic ~nk ~yPrecast~Cess~ools / /Shallow pools ~ /Other ~ ll-Se ~ic ta~ inside dimensions: V~l~e Gals.Length ft. Width ft. Liquid depth~ _ft. i2-Precast sectmons: ~ ~Number~Square Ft. Cesspools: Block szzeL~ zncs.D ~,ins. H ~ Ans. Total blocks below inlet: ~1~ $~ ~" "2~3 , h PLOT PLAN ~ Ca.city Gals. Street Indi ~ate No ~th Dat, a ,.ICe,t o 2 8 lo 12 18 and amendments thereto, covering Private Sewage Disposa: Owuer Or FOR HEALTH DEPARTMENT USE ON~, Ba'sed on the informati~ The Undersigned QERTIFIES: "Constructionof authorized installations will be in accordance with the Suffolk County Health Departments* ~rrent S~andards, Bulletins, S~tems'~ · ~pinion of the Health Department, that an adequate and can be installed on this Plot. Date (m/65 Revis.') S-15 Builder n presen6ed herewith, it is the atisfactorySewage Disposal System q FOB~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT .,., SOUTHOLD, N. Y. Examined .... ,:~..~...~. .............. , 19~...¥. ,, ~.../...o....o.....~.. ......... Approved ........................................ , 19 ........ Pemit No. .... i ............ ................................................... ............... -,__ ..................... ....................... APPLICATION FOR BUILDING PERMIT ~,1 o. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the BuildinG Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is par~ of this application. 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 permit shall be kept on the premises available for inspection throughout the progress of 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 hove 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 cede, housing ced~ and regulations. (Signature of applicant, or name, if a corporation) (Address o~applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner .~...~ 0..~ & ' ..~...~I U .~ A~'I.~. ~ · ' of premises .......... ~ ............................. ~.~...~*'.~S ...... · ~'~~'""~"'~'"lf applicant is a co~orat,, signature bf duly authorized .... officer. (Name and title of corporate officer) ,. ~,,o. o, ,~nd on w~ic~ ~ra~osed wor~ wi,, ~ ~one. ~ ~o.: .~..~..~ .................. ~o, ,o..l.~.~.......~ Street and Number ..... ~.~.....~.~.~ ...... ~&~l....~,~...~ ........................ Municipali~ 2. State existing use and occu~ncy of premises and intended use and ~cu~ncy of proposed construction: a. Exisiting use and occupancy ................................................................................................................................. Intended use and occupancy ..... 1....~...~1,. ~)~..I I~y....~ ~. ~..~1~ ~..~k~., ......... ~'"'"'t~ .......................... b. 3. Nature of work (check which applicable): New Building ..... ~ ...... Addition .................. Alteration ~ ................ Repa r Remova Demo t or .......... Other Work (Describe) ............. 4. Estimated Cost ...... ~m.~..~l~ ................................. Fee ~ ................................................................... -- (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ ~. ................. Number of dwelling units on each floor ............................ If garage, number of c~rs ............ e~ ............................................................................................................................... 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 ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ...~..~.t..~l~ ................ Rear .~...~.'..1~. .......... Depth ..~w~. ............... Height ..L~e. ..........Number of Stories ...... Z. ....... ::-"~1~ ................................ ~ .......................................................... 9. Size of lot: Front ...~.~....~...r.... Rear ..~..~..*..s~..~ ..............Depth ...~.~K~ ................ 10. Date of Purchase ....~f.l.~/..7..~m ............................ Ncc-ne of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ..J~..~.. .......................... ......... 13. Nome of Owner of prernises~J~..l~.~.l/.~...~.~......Address ~.~k..,..~a.¢ ...... Phone Name of Architect ...................................................... Address ........................................ Phone No ..................... Nome of ............. Phone PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. I1~ & I ~1~ ~,,~ ~r STATE OF NEW YORK COUNTY 'OF ..................... .......... ). S.S ..... ~l~l~e~~~..~.~ ................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ...................... ~M~J~.~..l~l~.~.r..~..~ .................................................................................. (Contractor, agent, corporate officer, etc.) 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. thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this /I .... day ot 0. . ' .............. , , Notary Public, ~~~~~[.County (Signature of applicant) Qi~alified in ~oik 0ounl~ FI ~ert. filed wi~!h N,Y. Co. Clks. & Re~. Oft, Term ;:~q~[res ,,larcll BUREAU OF ELECTRICITY 8.5 JOHN 'STREET, NEW YORK, NEW YORK 10038 22228 D,,te May 24, 1972 JpNicatlo,,,~o.o,,ylte 560748 N THIS CERTIFIE.5 THAT George Pourakis ll30 Oreenhill Lane Oreenport, L.I. inthefollowingtocation; ~ a~m~t ~ ~strt. ~ Zna rt. ouSside Section Bilk wasexaminedon ~y 22, 1972 andfoundtobeincompliancewiththerequirementsofthisBoard. --: 14 33 DRYERS FIXTURES 14 RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS ~.~: 1 I i00 OTHER APPARATUS: S E R V I C NO'O~pERCC' COND'~r OF A' W' G'CC. COND. NO-OF HI-LEG oFA' W' G'Hi. LEG NO. O~ NEUTRALS 1 2 1 ~ OF NEUTRAL *Furnaces: 1-1/8bp. , 1-1/12bp. , George Zimlinghaus 4 Park Place This certificate mu,t not be altered in any manner, return to the o"ice o'the Board i' incorrect. t o ~ rr 4~:4"