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Home My WebLink About7043-zFOKM NO. ~ TOWN OF SOUTHOLD BLTH.I~ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.~&39~ ...... THIS CERTIFIES that the building located at 8/8. ]lOl, tl~ .kl~a~ .((}1~7).. Street Map No... x~ ....... Block No... ~ ..... Lot No. ;~1;....~[r~e~po~'.~...$.,.~.~ ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... D®a .. 2[[.., 19.7~ pursuant to which Building Permit No..~.~. dated ........... D~¢..~1~ .... , 19. F-~, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. P~.vate. c~ .faintly. dwelltn~ .,~l~h .an. addl.~io~ ................. The certificate is issued to .. Ps.~er. g .~$L~.~I~.~c~ ..... ~4~r~ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .l~,R, .............................. UNDERWRITERS CERTIFICATE No.. ~.o~, ...................................... HOUSE NUMBER ..... ~"~?(~.. Street .. llerth .l~ad. ((~,-~7) ................... Ill)BM NO. ~ TOWN OF sOUrHOLD BUILDIN~ DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N,~ Y. IIUILDING I)~RMIT (THIS PERMIT MUST BE KEPT ON THE pREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 70~3 Z Permission is hereby granted to: ..~..~..~...e~.........~! restate, 3133 32 ~t t.I.C~t7 pursuant to application dated ........................................................ , 19... , and approved by the Building Inspector. FOlh~ NO. $ TOWN OF $OUTHOLD Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with 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 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 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. 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. C. Fees: I. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5·00 3. Copy of certificate of occupancy $1.00 Date 4/2/75 New Building ................ Addition ....~. ......... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...... ~,/.~...~.°.~...~..°.~.8;....(,C.,,~'L?.). ..................................................................................... Peter & Calliope Papantoniou Owner Or Owners Of Property ....................................................................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No ....... ~..,07.~..~.. Date Of Permit ....]~../.~/.~..Applicant ...~..e..~..e..~....~....q~.]:.~.J:.o.~..e.....~.~.~.~.o..~..J;.o..~. ........ Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ........... ~ ......................... · 5.oo Fee Subm,tted $ .................................... Construction on above described building an~, permit meets/alii applicable codes and regulations. ....................................... Sworn to before me this Notary Public .~..y~/~ County (stamp or seal) Di~p~ o/c .... ~ ................... ................................................ ::::::::::::::::::::::::::::::: ........................ INSTRUCTIONS a. This application must be completely filled in by typewriter o~, in ink and submitted in triplicate to the Buildin~ Inspector, with 3, ~t~ of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan'~ng location of lot and of buildings on premises, relationship to adjoining premises or public streets o~,~ arees, and givinga ~ description of layout ofproparty must be drawn on the diagram which is part of this applicotioe .--~. c. The'work ~cx~ve. rad bV this application may not be commenced before issuance of Building Permit. d. Upon a~ of this aPPlication, the Building Inspector will issue o Building Permit to the applicant. Such permit~) shall be kept o~ t~. premises available for inspection throughout the work. e. No building ~all be occupied or used in whole or Jn part for any purpose whatever until a Certificate of Occupancy,, shall have been gradted by the Building Inspector. ~. B ~PPLICATION JS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to ~ui dln~.' Zon? Ordinance of the Town.o.f. Southold, Suffolk County, New York, and other aPPlicable Laws, Ordinances or ~egu at,,.ons, tar the construction of buddmg~,~: additions qr alterations, orfor removal or demolition, os herein descr bed. rhe applicant agrees to comply with all apPhcuble laws, ordinanceS, building code, housing code~ and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ..................... , ................... __..... ..................... (Addl~ of op~icent) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 0 ofpremses ..~...~...~...~...~.. ~ ..C..~.j(I~.~.lY~.~.~ P~...~...?J. 1LO..'~.io..~... . Name of owner ..................... ~. ......................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... ..~..~...~.. 1. Location of land on whiCh Drol~sed work.will be done. ~AaD Ho.: ,.,~.. .~ ....... ~ Lot No .................. Street and ....... r'" ........................... t ........................................... T ................................................... Municipality 2. State existing use and occupancy of premL~es and intended use and occupancy of proposed construction: o. [xisiting use ond accupancy ................ 2 .................................................................... 'Natur'e of work (check which applicable): New Building .................. Addition .....~ ......... Alteration ........ ~.¢1~. Repair .................. Removal .................. Demolition .................... Other Work .................................................... ~o (Description) /C-'"- 4. Estimated Cast .................................................... Fee ,.......~ (to be paid on filing this application) '~ 5. If'dwelling, ndmber of dwelling units ....~ ........ Number of dwelling units on each floor ............................ . ff garage,;i~umber of cars ............................................................................................................................................ ~.~ 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 .................... Heigl~t ........................ 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 ............ ~..~ ............Rear .../....~ ............. Depth'~ ............... Height .................... Number of Stories .......... ~ .............................................................................. 9. Size of lot: Front ....... ~.....~....~.'~.. .................................. Rear ..... J~..~ ............ ....~pth.~.~..~. 10 Date of Purchase ..................................................... Name of Former Owner-F a~*~-"'..~. .............................. ~ iL1. Zone o~' u_~e district in _wh!ch pre~m~'L~l.~'e~si~ ..... ~....,:..~.,...~.~.........: ...... :...~., ...... ~:;...~ .......................... 12.' Does ~'-c~'~ed~construction ¥iolate any zoning'law, ordinance or regulation: ...... ..~.....?. ....................................... 13. Will lot be regraded ........~........~.. ........ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .................................................... Address ................................ Phone No ....................... Name of Architect ................ ~~ ~..~..~( .................................. Address ................................ ,~ ,~ zPh°ne No ....................... Name of Contractor .~~..(~. Address ..~.~one No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Gi~ street and block number or description according to deed, and show street names and indicate whether interior or corner Jet. STATE OF NEVV'tY5OR~# )'SS ........................... ~/~....~'. ............. ~, .: ................. , .......... ~ ....... ' g duly s~r~, d~es and soys t~t he is the opp[icont above name.: He is the ;.....~...' .................. ~.:.: .......................... ; ............................................................................................ (Contractor, agar, corporate officer, a~.) of said owner or'owners, and is duly authorized to perform or have perfo~d the said work and to ~ke and file this applicati~: that all stat~ehts ~ntain~ in thins apphcqtion are tree ~ the best of hm knowledge and belief; one .tha~ the ~rk will~ perform~ the ~anner ~t fo~h i~ the applicatiOn filed therewith. Swam to befom methis ~1 / ~ ~ __ ................ ........ ,......,,,.... . "atO~ PubliCationS-- '~~ .'5~.~.~~ .............. ~ -- (Si~ature of ~plicant) JUDITH T. BOKEN Public, State alc New York 5~-O344963 Suffolk Coun~ |? LO c,a, Ti (o t-I TOy