HomeMy WebLinkAbout9691-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Sou~hold, N. Y.
Certificnte Of Occupnncy
No...Z.9.! .8.6 ..... Date ...A.u. gt~.s..t .... .2.~ ............. , 19...7.8
THIS CERTIFIES that the building located at .. 200 .Greenht.l.1 .Lane .... Street
Map No.../40.24 ..... Block No ........... Lot No ......... .1/~7 .....................
conforms substantially to the Application for Building Permit heretofore filed in this office
dated .' 'Apz':[l'' 48 ........ , 19'78. pursuant to which Building Permit No....969.1Z
dated '"April" '2/4 ......... , 19.78., 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 .......... Private. One .Fam.i. ty .Dwet.ting ..............................
The certificate is issued to ...Pantelis..Psa.l,bak~.i.s ..............................
(owner~
of the aforesaid building.
Suffolk County Department of Health Approval ........ 8~.~0.-.~8. ....................
UNDERWRITERS CERTIFICATE No ........... .P.e.n.d~..rig. /'J ~ ~ ?~5 ~
HOUSE NUMBER .. '200 ........ Street ..... Green .I~it~ .Lane ..................
........................................... ~reenper.~,..Ne~..Yerk. .............
Building Inspector
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTH'OLD, N. Y.
BUILDING PER, MIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Ne 9691 Z
Permission is hereby granted to:
.... ~z ..................... ~; .......... ~ ........................... ~ ..... k~ I ~
pursuant to application dated ..................................... ~.~}.~L....f.?-19~., and approved by tho
Building Inspector.
Fee .......................
Building Inspector
FOI~( ~qO, 6
TOWN OF SOUTHOLD
Building DelMItment
Town Clerb Office
$outhold, N. Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted in triplicate 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,
§. Submit Planning Board approval of completed site plan requirements where applicable.
B. For existing buildings (prior to April 19§7), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of property showing all property lines, streets, buildings and unusual natural
or topographic features.
2. Sworn statement of owner or previous owner os 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:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use'
3. Copy of certificate of occupancy $1.00
$5.00
Date .....A. ~t. cJ ~t..s.:.~...~.3.. ~.....Z. 2.',7..8. ........
New Building ..... ~ .......... Old or Pre-existing Building ............................ Vacant Land ............................
Location Of Property Green Hill Lane~ Greenpor~:=
Owner Or Owners Of Property Fan,elis Psal~caksis
.........................................................
Subdivision ................................................................ Lot No..~,,~,.,7,,,,o Block No, 200
............ House No .............
Permit No. ,.,~.6,.~..Z. ..... Date Of Permit .,,4,',/,,~,,,~,/,,7.,8,.Applicant ,.,,I,~,~...~,D,,d,..~,o,.~...e,~.~...,~,,t2,,.g,,. .....................
8/22/78 ~ 8-SO-38,, N/r
Health Dept. Approval ............................................ LODOr Dept. Approval ................................................
Underwriters Approval .............................................. Planning Board Approval ..... .y..e..s. ............................
Request For Temporary Certificate ...... .~..o.. ............................. Final Certificate yes
Fee Submitted $ ...5...,..0..0. .........................
Construction on above described building,~mcLl~ermit meets q~applicable codes and regulations.
Applicant 1~ '~'~ '~';'"~'~ r'"'~i~ '~t."vd~i~§';"*'~i~'; ...................
Sworn to before me this
......... day of ..............................
Notary Public ..... ~.g.~ ~.o. ~ ~. .............. County
(stamp or seal)
THE NEW YORK BOARD OF FIRE UNDERWRITERS
~r~ BUREAU OF ELECTRICITY
~-- 85 JOHN STREET, NEW YORK, NEW YORK 10038
THIS CE~IFIE5 THAT
Pentells Psaltekls~ ~rden Hlll Lane~ off Moorss Lane,Homesteed-lnlet
Pond R~ ~reenp~r~ L.~.
in t~ f~lowlng ~at~n; ~e~nt ~xJst FI. ~ 2nd Fl. O U ~ S ~ de ~t~n B~ ~t .,
~exami~on Seo?ember ~ [qT~ andfoundto~incomplia~ewiththerequirementsofth~.
RXTURE LEPTA I WIT I RXTURES
OUTLETS ? OESS C~S ,~C~DeSC~NTiF,U(~ESCENTi ~
DRYERS I FURNACE MOTORS FUTURE AI,~IANCE FEEDERS
· .'~T. K* W* ~r~, H*F' P' G^S H.P. MT* NO. r~ W* O*
SERVICE DISCONNECT I~.o~ I S
I I00 CB x
OTHER APPARATUS:
I-G, ;,C. I
l-Smoke ~)e'l'e cto r`
RANGES
R
EXHAUST FANS
DIMMERS
I 4 I 4
Richard Relyee ~~"~
Delmar` Pr. MNI~ M~N~Ma
t Laurel, L.t. 11048 Lic.2148
~This ce~fi~te mud ~t ~ el~r~ in e~ menner~ r~urn te the e~ice of
I~___~ ........ ~ ..................
~Y ~ ~I~INe ~MINT. 1HIS COPY OF CIRTI~Ti
TOWN OF SOUTHOLD
I-IFFIOE OF BUILDING INE~PEOTOR
TOWN I~.LI='RK'~ OFFICE
S[:]MTHOLD, N. Y. 11cJ'71
TEL. '765-366G
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEI~AI~TMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
......
{guildin~ Inspector)
Application No ..... ..~....~...~/ ............
APPLICATION FOR BUILDING PERMIT
April 18 78
Date ................................................ , 19 ............
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted in tripJlcate 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 giving a detailed description of layout ofproperty must be drawn on the diagram which is part 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 Pen'nit to the applicant. Such 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 whatever until a Certificate of Occupancy
shall have 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 code, housing code, and regulations, and to
admit authorized inspectors on premises and in buildings for necessary inspections.
(Signature of applicant, or name, if o corporation)
Box 117, Mattituck, New York 11952
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
General Contractor
Name of owner of premises ...... ?.?....q~.?..J:.%..s....?.~..a:~.~.~.i..s. ...................................................................................................
If appli~~uthorized officer.
.........
Builder's License No .....................................................
517-P
P~umber's License No .................................................
Electrician's License N°. 2"1'~"8':~ ............................... /~'~/~1 -~m.~- --~- '-~
Other Zrade's License No ............................................... ?.~..~.. ~ .~.
Location of land on which proposed work will be done. Mop No.: ........................... Lot No. 147
L:- /V /-/ , L ..................
Street and Number ....................... Municipality
State existing use and occupancy of premises and in~.ended use and occupancy of proposed construction:
Vacent
a. Exisiting use and occupancy ................................................................................................................................
1 - Family
b. Intended use and o¢cuponcy ................................................................................................................................
3. Nature of work (check which applicable): New Building' .....~..~...,.. Addition .................. Alteration .................
Repair .................. Removal .................. Demolition .................... Other Work ................................................ ~...
(Description)
4. Estimated Cost ~.?..0..~.0...0..0..?.?.0. .................................... 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 cars .............................................................................................................................................
6, JF business, commercial or mixed occupancy, specify nature and extent of each type of use ............................
7. Dimensions of existing structures, if any: Front ........ .5..8. ................ Rear ....... ,,5.8. .................... Depth 2,8
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 ................... , ................ Rear ............................ Depth ........................
Ideight .................... Number of Stories .....................................................................................................................
9. Size of lot: Front ..... ~,g.Q ............................................ Rear ........ ,!.0.O. .......................... Depth .~...~.?,. ........................
10. Dote of Purchase ........................................................Name of Former Owner ........................................................
11. Zone or use district in which premises are situated .....................................................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: .... .~..0.. ...............................................
i3. Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ( ) No
14. Name of Owner of premises~....a..~......t..e..~..s....?..s.~.?:..t.,.~..~.....J:,s. .......... Address ................................Phone No .......................
Name of Architect .............................................................. Address ................................Phone No .......................
Name of Contractor ~...~.......~....(~..~.,....~..~.C..~. ................. Address ,~_o..~....~..1.~.t...?l...~.~.!;..i'~i~t~r~'-l¢~ No.~..9...8..-...9.?.,.9.0. ....
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ail set-back dimensions from
properly lines. Give street and block number or description according to deed, and show street names and indicate
whether interior or corner lot.
0,,1' ID' E
Lo
'7
STAffEOF NEW OR , ~SS
..... // .
............................ .,I.....i....~~...~ ........ being dul~tworn, deposes and says that he is the applicam
(NameJof ~n~i~ing contract) ~
abow~ named./ / /1
[ J Contractor / I
H~ L~ the ........... .F....L ..................................................................... ~..$ ..................................................................................
J ~ (Contractor, agent, como/ti officer, etc.)
of said owner or ~wn~rs, and is duly authorized to perform or~hl~ performed the said work and to make and file
this application; ~atJall statements contained in this applic~ are true to the best of his knowledge and belief; and
that t~e work wiJJJbe.(erformed in the manner set forth in the'~iication filed therewith.
Swo? to b~fore m~ this ~ ~ ~, i ~
..................... v ...... ..................... , ....... /
Notary Public~ .................................................... Coun~ ............... ~~ ............................
, ~/~ , ~ ~ (Signatur~f ap~
~ OWNiI~IR; '* ~' · ; ~ VAI. I,t~ ~. . ,,, ! ,
' '//1 / tO THis SURV~ ~ OLAT ON OF
~P O~ LOT ~I4_ : ':'* ' :~ "s'
~- , ~ . ,, ,_ , ,
' ' ' -~ ' T :, '
' ,/ ~ ~ 315 West ' '
.. j "' . .,, ..'"-:'- :-..
. ,,, ., ~ = :: ~W2~Z:~, .... ~
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ge_ ~
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