HomeMy WebLinkAbout12678-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No..~..1¢.5.1.7. ......... Date.· June 7
............................... 1984
THIS CERTIFIES that the building .-:-:r~e.w..clweJ,%i~f ...............................
Location of Property 2155 Greenway East Orient
County Tax Map No. 1000 Section ...0.1.5. ...... Block ....0.1. ......... Lot .... 008
Subdivision... Gr.eert. kcres..e,~. 9r.~,e¢l~.. ·Filed Map No...3.5.4.Q..Lot No...4.2. .........
conforms substantially to the Application for Building Permit heretofore filed in this office dated
.... Qcg.o.b.e~7..7 ....... , 19..8.3pursuant to which Building Permit No .... 1.2. 6. .7.8..~. ..........
dated .... Qc..~9.b.e.r...1.0 ............. 19.8..3, 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 .........
~ p~.~¥~te ~Be-famil~ dwelling.
The certificate is issued to ....... V.~$.]~!9.S..T. $.I.S.I.N..O.S..a...~.NAS.? .~.S.I.~., .T.S.I.S./..N.O.S. ......
(owner,
of the aforesaid building·
Suffolk County Department of Health Approval . .].$r~.q': .1.3~,,.. 5,[3,1,/..8~,~..R.o,b,.~....~:..V..J:.l. 1..a,
UNDERWRITERS CERTIFICATE NO .......... ~. 6.4.5. 7. O ~- ...............................
Rev. 1/81
F~I~ NO. ~
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)
12678 Z
Permission is hereby granted to:
.... ~~..~....~; ...............
......'7~.~.~...U...q. ................................................
......~..~~....~...%....J..L~.~....~ ....
at premises located at .m~....'~..~......~-.~e~d~.~...- .~.-.~....J.........~.~ ...................
..... ~ ...... ~i.~...~....~~..~.~..~~~ ...............................
County Tax Map No. 1000 Section ...... J~.~..~'. ....... Block ....... ~ ......... Lot No ........ .~ .............
pursuant ,o application doted ...~..~.....~. ....................... , 19.~J.~1~., and approved by the
Building Inspector.
Building Inspector
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec-
tor 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 featu res.
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 installa-
tions, 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.
For existing buildings (prior to April 1957}, Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or
topographic features.
2. Sworn statement of owner o? 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 nforma-
tion required to prepare a certificate.
C. Fees:
1. Certificate of occupancy $5.00 / /
2. Certificate of occupancy on pre-existing dwelling ~r land use $/5'/ $5.00
3. Copy of certificate of occupancy $1.00
Date ..June_~, 1984 ..
New Building X.X. Old or Pre-existing Building(Z) ......... ~/Vacant Land -'
Location of Property .... 2~];,5,5 Greenway ~:ast, O~c±ent,..N.ew ¥or.~.11.957
House No, Street Hem/et
Owner or Owners of Property V&s±lio$ T$i$ino~ &Ana. stas±a Ts~sinos
County Tax Map No. 1000 Section ...0.1~5. ......... Block .... .0~ ......... Lot ..... ',8. .........
Subdivision ................................. Filed Map No. 3540 .Lot No. 42
Permit No .......... Date of Permit .3;0../'.~.0./.8..3Applicant . Inland Homes,. Inc.
Nl.2678Z .................................
~/31/84 App
Health Dept. Approva ........................ Labor Dept. royal ...................... ,..
Underwriters Approval . .N. 6.?. .5 .7 .0. ~. .............. Planning Board Approval ..................
Request for Temporary Certificate ..................... Final Certificate .... ¥.e.s._. ........
' ' . 5.OO
Fee Submitted $ .............................
Construction on above described building and pern3~e~l~ all app~cable_.codes j~,,d regulations.
Applicant .; ...... ;" 'NC; ......
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 100S8
THIS CERTIFIES THAT
only the electrical equipment as described bel~ and introduced by t~ applicant ~d on the above application nu tuber in the prem~es of
in thefollowinglocation; ~ Basement ~ 1st FI. ~ 2nd Fl. ~d. ~1. Section Block Lot
was exa~nined on ~ ~ ~ ~ and found to be i~ compliance witk the requirements of tbis Board,
FIXTURE FIXTURES RANGES OVENS EXHAUST FANS
OUTLETS
DRYERS FURNACE MOTORS
FUTURE APPLIANCE FEEDERS
TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS
SYSTEMS
NO. OF FEET
SERVICE DISCONNECT
I~G .F.C. I.
2-Sm(A~ ~etectors
S E
R V I C E
OF CC, COND.
NO. OF HI-LEG A W.G. NO OF NEU A W G,
OF HI-LEG TRALS OF NEUTRAL
.
~co ~l~t.Co.-Cli~ Cornell
3~ %'~lllow Pt. i~t.
GENERAl. MANAGER,
Per ll/.
This certificate must not be aJtered in any manner; return to the office of the Board if ipcolTect. Inspectors may be identified by their cred~n~iaJs.
COPY FOR ~IT. THIS COPY ' BE ALTER
765-1802
BUILDING DEPT.,
INSPECTION
FOUNDATION ~,ST [ ] ROUGH ,pLBG.
FOUNDATION 2ND [] INSULATION
DATE 'INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST .~[/~ ROUGH PLBG.
FOUNDATION 2ND [ ]~INSULATION
FRAMING
REMARKS:
FINAL
FIEL~ INSPECTION
FOUNDATION
(1st)
COMMENTS
FOUNDATION
2.
ROUGH FRAME &
?LUMBING
(2nd)
INSULATION PER N.
STATE ENERGY
qODE
Ye
FINAL
FORM NO, 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL,: 765-1802
Examined. ~'.~..I. 9.., 19~.
Approved . ~ . .~...a~..../. I.., 19~.*. Permit No.. ] ,:~.~.") .~'~--
Application No ..................
Disapproved a/c .....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date October 7 198..3.
INSTRUCTIONS
a. This application must be completely filled in by typewriter or }n 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 giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
cation.
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 issued a Building Permit 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 building for necessary inspections.
........ .................
(Signature of applicant, or name, if a corporation)
(Mailing 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 Vasilios & Anastasia Tsisinos
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
Robert E. Hiltz, President (Name and title of corporate officer)
Builder's License No ...........................
Plumber's License No. 517-P
Electrician's License No. 2816
Other Trade's License No ......................
1. Location of land on which proposed work will be done..L.o.t....~.4.2. ~.. [.M.a.p.. 9.f, .G.r..e.e.n..A..c.r.e.s...a.t..O.r..i.e.n.t.'~:.
...... ..............C3 ..................
......... Street Hamlet
House Number
County Tax Map No. 1000 Section 015 Block O1 Lot. 8
Subdivision ..................................... Filed Map No. ...3.5.4.Q ....... Lot ...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a: Existing use and occupancy ...... .V..~..~./~..~..i. ....................................................
b. Intended use and occupancy 1 family dwellin9 ..
3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ..........
Repair .............. Remoyal ........... Demolition .............. Other Work ...............
i (Description)
4 Estimated Cost L} O / o ~ .Q Fee
~ (to be paid on filing this application)
5. If dwelling, number of dwelling dnits... 1 ........... Number of dwelling units on each floor ................
If garage number of cars ~
6. If business, commercial or mixed" occupancy, specify nature and extent of each type of use .....................
7 .... ~ if any: Front Rear Depth
· Dwaensmns of ex~shng structure~ .............................................
Height Number of Stories
iih '
Dimensions of same structure w alterations or additions: Front ................. Rear ..................
Depth .................... :.. Height ..... ~161 .... iiii ...... Number of Stories ........ ga ............
8. Dimensions of entire new construction: Front ......... Rear ...5.6. .......... Depth ...............
Height ............... Number of Stories ..... 2 .......................
' ' ' )"~2;~?i ..... pth .15.7.: ............
9. Size of lot: Front ......... 1,3..27 ......... Rear .................... De .......
10 Date of Purchase ' Name of Former Owner
1 1. Zone or use d~stnct m which premises are situated .....................................................
1 2. Does proposed construction violate 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 oremisesAnastasia .Tssi~°SAdrlr~ 2g,12.~8t[% ~'c. phnn~Mn212-9g2 2582
- '' '. ...................... l~l~ol~o-'ai 'm','r ~ ...........................
Name of Architect .......... i ......... ilq~'. ....Address ................... Phone No ................
Name of Contractor . .Ily...L~...D.i.H..O1~..~.~., .......... AddressB.o.x...1.1Z,.M..a.t.t.!t..u.e?ehone No..2 0. .6 .0.6. .....
PLOT DIAGRAM
Locate clearly and distinctly all ibuildings, whether existing or proposed, and. indicate all set-back dimensions from
prope~y lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or comer lot.
STATE OF NEW YORK,
COUNTY OF..S..U.F.F.O.L..K .......
........... Roher t. Ii,. Hiltz ~ .................... being duly sworn, deposes and says that he is the a ?plicant
(Name .... "
of mdiv~dual s~gmng contract)
above named.
· ! C0ntrac. tot
Ho is 'the
of said owner or owners, and is duiy 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.
Sworu to before me this
......... ..... day o, ....., 19
No_t a~ Public ................ County
_ _ ' ................. '
~o1~¥ ~S~te.?!. ~w Y.~ Robert g. Hi(~}ttBa~re of applicant)
~I0. 52.8125850, Suffotk County,/
Lot
Lot 39
- Lol q ~8
Lot
[XCAVATIO! CTION REQUIRED
........ 5. __ - ...... ,
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
~0R APPROVAL OF CONSTRUCTION ONLY
,J
/ '
HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT
· **REss ..... -;;¥' x^}~ :T"/=~''''"'~'/' // ffi
Box 117 ~, Mo~tituck, N, Y. ~952 ~ ~- ~
NOTE: 0= PIPE
SUBDIWSION MAP FILED IN THE OFFICE OF THE CLERK
OF SUFFOLK COUNTY ON APB. I$, 195P AS FILE NO, 3540,
41
Lot 42
Aro°~ 19,961 s.f
Lof
4J
132.
SURVEY FOR
PAS/L/OS T/SS/NOS ~ ANASTASIA T/SS/NOS
LOT NO. 4P, *"MAP OF GREEN ACRES AT ORIENT"
AT OI~I£NT DATE:
TOWN OF SOU THOL D SCALE:
SUFFOLK COUNTY, NEW YORK NO.
N UNAUTHORIZED ALTERATION OR ADDITION TO THIS
SURVEY IS A VIOLATION O~ SECTION T209 OF THE
NEW YORK STATE EDUCATION LAW
OWNER~
WDISTANCES S~WN HEREON FROM PR~ERTY LINES
TO~XISTIN$ $TRUC~E$ ARE FOR A SPECIFIC
PURPOSE AMO ARE NOT TO BE USED TO gSTABClSH
I!
YOUNG 8 YOUNG
ALDEN W. YOUNG, PROFESSIONAL ENGINEER
AND LAND SURVEYOR N.Y.S. UCENSE NO. 12845
HOW~ARD W. YOUNG, LAND SURVEYOR
N.Y.S. LICENSE N0.45893
400 OSTRANDER AVENUE
RIVERHEAD, NEW YORK
Lot
4O
'-
,, Lot
Lot 42
e°= 19,961
0 ~ o~ (;eneval .
WILL C~FORM~ ~ THE STAN~ OF THE SU~K gOUTY DEPARTMENT
~ H~LTH I~ICEI.
NO?g: O¢ PIlE
SUBDIVISION MAp FlIED IN THE OIrFICE OF THE CLERK
O~ SUI~OLK GOUN ~Y ON APH 13 ~ 196~ AS PIL~ NO 3~40,
SURVEY FOR
VASI£/OS TS/S/NOS ~} ANASTASIA TS/S/NOS
/OT NO. 4~, "l~IAP OF Gt~E£1V 4CR£S 4T ORIENT"
AT ORIENT OAT[:
~WN ~ SOurHO:D SCA~E:
SUFFO~, , COUNTY,. NEW ~RK ~o.
MAY 25, 1984
0C7~ / O, 1985
$£P7: 29, 1983
I'-' 40'
83 ' 808
ff UNAOTH(~I~IZEO <ERA,TIDH DR ADDITION TO THIS
MENTAL'AG NeY AND LEN 'lNG INSTITUTION LISTED
ALDE~ W.~UNG~ PROF/~IONAL ENGINEER
A,o ~o SURVEYOR ~.Y.S. UCE,SE ,0.
HOwAko W. YOUaG. LA,O SURVEYOR
N.~ S,~LICENSE N0.4589~
400 OSTRANOER AVENUE
RIVERHEAD, NEW YORK