HomeMy WebLinkAbout12723-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N,Y,
Certificate Of Occupancy
No. Z-15381 Date March 18, 1987
THIS CERTIFIES that the building ALTERATION & ADDITION TO EXISTING ONE
· '~ AS,Ii'L'?' b~7'f~ L i~'d ............................
Location of Property 12500 Main Road East Marion New York .
House No. Street Hamlet
County Tax Map No. 1000 Section 3 I . .Block ] 4 .Lot 7
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore fried in this office dated
November 2. 1983 12723 Z
April 4, 1984 ,. pursuant to which Building Permit No. 13062z
November 2, 1983
dated ...A.p.r.i..................1 26, 1984 ..... ..wasissued, and conforms to all of the requirements
of the applicable provisions of the law, The occupancy for which this certificate is issued is .........
ALTERATION & DORMER ADDITION TO EXISTING ONE FAMILY DWELLING
EMMANUEL XEFOS
The certificate is issued to ..................... io~n'ef','fdf¢~;~ .....................
of the aforesaid building.
N/A
Suffolk County Department of Health Approval ..........................................
N797155
UNDERWRITERS CERTIFICATE NO ..................................................
N/A
PLUMBERS CERTIFICATION DATED:
.... ~i~g Inspect;; .............
Rev, 1/81
~0~ 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)
N~ 12723 z
Permission is hereby granted tc~ ~
.... ........................
..... ~..~,~,....~,:. ...... ~ ................................
...... ~.~..~...~.~ ..........................
at premises located at ../..'.~...~..'~.. ......... .~.~......~.~ .......... ...~....~..~...?.....~.<.~.-~.~ .............
p~rs~ant ~o opp,=.o~ do~O ...... ~..~.(~ .................... ~ '~
19.....~., and approved by the
Building Inspector.
Building Inspector
Rev. 6/30/80
FORM NO. 6
TOWN OF $OUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
This application must be filled in typewriter OR ink, and submitted ~m~ 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 pX~operty 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 inform-a~
tion required to prepare a certificate.
Fees: ·
1.Certificateofoccupancy New Dwelling,$25.00, Accessory,,$tO.00 Business $50.00
2. Certificate of occupancy on pre-existing dwelling $ 50-. 00
3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00
4.Vacant Land C.O. $ 20.00
5.Updated C.O. $ 50.00 Date ..........................
New C on s t r uc t i on ...... Old or Pre-existing Building ............ Vacant Land .............
Location of Property . /"2'42''~ ")'1~.'--;- f~.~ .(~..~:.~-*'.~j ~..~.'. .~.~.
................................ ~'.'~. -:. .............
House No, Street Ham/et
Owner or Owners of Property . .~e-z'~¢~',~;-'~,~;.-2~-~..~.4-F~F~.~.'. .............................
3/ ./¢. 7.
County Tax Map No. 1000 Section .... ;-. ......... Block ............ Lot .............
Subdivision ................................. Filed Map No ........... Lot No ...... _ .......
Permit No./.J.4~ ~ ;z. ;~ Date of Permit .......... Applicant .... 7-~¢~.-.~,~..~¢;- ~ ..... .' .......
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $ .............................
Construction on above described building and permit meets all applicable codes and regulations.
Applicant..: ..... /~.-.M .... -,; 4f~ ..¢~.~..~ rv .--;-~;. ~;.-;-; -.'' ...........
Rev. 10-10-78
FIELD INSPECTION COMMENTS
FOUNDATION (1st)
FOUNDATION (2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
.- qODE
FINAL
ADDITIONAL COMMENTS:
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN ItALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
This is to advise you that the~job under building
permi~ no,12723z issued to E Xezos
on --~J-~3 ...... for Addition is completed and
a fi.r/al inspection has ( ) has not ( x ) been done.
An Underwriters Certificate is needed
rn order to complete this file, it is necessary that
~ Certificate of Occupancy be i~sued. Please fill out the
cnc}osed form, return same to the above office with a cheek
for $25.00 payable to the Towe of Southold. Please indicate
to Whom the Certificate of Occupancy is to be mailed, and
arrange with this office for an inspection date
Occupancy or u.qe is unlawful without a Certificate of
Occupancy. l'test~e help us to clear up thla~ mstter so that
legal action does not have to be taken.
Thank you for yo,r prompt attention.
Very truly ~y~,
Victor Lessard
Executive Administrator
VL:gar
encl .
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 7654802
Examined./0 ..~)4-?~....~...~--., 194~.~.
Approved. ~.. ~ ..~., 19'~3.. Pennit No.I..~.~. · · . · .'~. ·
Received .......... ,19...
Disapproved a/c .....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in inkand submitted to the Building Inspect°r, 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, Ordinm~ces 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 regu!atio__n~, and to
admit authorized inspectom on premises and in building for necessary inspe~ons. /// .-
(Sig' a~tu~re of applic/a'~i~ a corp°rati°n)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises .... ~:..~v~ ................
(as on the tax roll or latest d )
If applicant is a corporation, 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 proposed work will be done ..................................................
House Number Street Hamlet
County Tax Map No. 1000 Section ...... .'~.~ ........ Block ...... [..~. ........ Lot ...... .."~ ..........
Subdivision ............ -' Filed Map No, Lot
(i,/fifil)' ................................ ' ...........
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
· . ..... ............. .............................
b Intended use and occupancy~CC~c~ ~<~-' C~-3~6~
o
9.
10.
11.
12.
13.
14.
Nature bf work (check which applicable): New Building ..... Addition ..... Alteration
Repair .............. RemoVal ............ Demolition .............. Other Work ...............
, _~3 (Description)
Estimated Cost ' "° '
(to be paid on filing this application)
If dwelling, number of dwelling units .............. Number of dwelling units on each floor ................
If garage number of cars [ ~ : · · ·
If business, commercial or mixed occupancy, specify nature and extent of each type of use ...................
' ' Front Rear Depth
Dimensions of existing structureg, If any: ..........................................
Height ............... Number of Stories ......................................................
Dimensions of same structure wi~h alterations or additions: Front ................. R~'ar ................
Depth ..................... i' · Height ...................... Number of/~ries ....................
Dimensions of entire new constrUction: Front ......... , ..... Rear... ~ ....... Depth .............
Height ............... Number of Stories .................... .L~.~./o..~. .......... i'i ...........
Size of lot: Front ........... i ........... Rear .............. ; ....... Depth .......
Date of Purchase ........... i .................. Name of Former Owner ..........................
Zone or use district in which premises are situated ..................................................
Does proposed construction violate any zoning law ordinance or regulation: '
Will lot be regraded ......... ................... Will excess fill be removed from premises: Yes No
Name of Owner of premises ...i ...... : .......... Address ................... Phone No ................
Name of Architect .......... ........... Address ................... Phone No ................
Name of Contractor i Address Phone No
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 mmber or description according to deed, and show street names and indicate whether
interior or corner lot. ~/~d-t,:/ ~t/) · ~-~
.... i .~...~.. ! ................ ' g y worn, deposes and says that he is the applicant
" 7~'- (Nam ~d'~l's'i~ing contract)
above named.
He is the ........... ~ ...............................................................
' (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 that the'
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
NO3.~2/Publ.i,c ............... ,'f~~.. Count? ·
PU§LIO, Stye o1 t~eW/¥or~ '' . (Signature olapplicant)
No. 52-8125850, Suffolk
i ,, ' Term ~x~re$
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