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Home My WebLink About12149-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of OccUpancy THIS CERTIFIES that the building ... Qrz.e. ?. ~tra. i.Z.y, p.w.e.Z..1.~.n.q ...................... Location of Property . 22.fi 5 ........ ~.~;~1:~. .l~9g.d ................. .E.a.s.t. . .M.a.r. ~9.n ....... House No. Street Hamlet County Tax Map No. 1000 Section '. .... Clg~ ....Block ..... 0.4 ........ Lot ....0.0.6. .......... Subdivision .St;a.r.~ .~,IaJaQr ................. Filed Map No. $8.6.4....Lot No...1.6. ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated Feb 4 19 .8.3pursuant to which Building Permit No. 12149Z dated ..... .F.e~.. 1..0 ................ 19 . .8.3, was issued, and conforms to ail of the requirements of the applicable provisions of the law. The occupancy for whiclz this certificate is issued is ......... One Family Dwelling The certificate is issued to Politis, Mr&Mrs Antonios ..................... ¥&;dt;r 'rkMdt?- ..................... of the aforesaid building. Suffolk County Department of Health Approval ...1.3.-~S..O.-.1.9. i ............................. UNDERWRITERS CERTIFICATE NO .... N.6.1. ~ ~.6.8. ..................................... Rev. 1/81 Building inspector (THIS PEI~AIT MUST BE KEPT ON q~H~~ i~e~ission is hereby gronted to: . ~' · tO~.~ at p~emises located at · ~. :,~ ................... ~u~ T~X Map No. 1000 Sec}io~ ~ont ~o ~pplicotlon da~ ...................... .......~... B~t ~lng Ihspector. ' ' and approved by the FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall P~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions Bo This application must be filled in typewriter OR ink, and submitte~l[cctc 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 featu res. 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 informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling land use --?re-~×±s t±:~ C. 0. $15.00 3. Copy of certificate of occupancy $1.00 l~ca~t lanct C.O. $ 5.00 New Building ~'~ Old or Pre-existing Building Vacant Land Location of Property . . ."~.. ............................ ............... ~.. House No. Street .~.. ~. . ~e Hamlet Owner or Owners of Property ...~.~..'~.....~.. *.I~.'....]~... .................. County Tax Map No. 1000 Section ,., .(~)..2~. ~.; .... Block ...... .~..~. ..... Lot ..... .~. ......... Subdivision .... .~.~.., . .~¥~ ..... Filed Map'No..~...~..~.Lf..Lot No .... 1. ~ ....... Permit No.J..~'?.~..~/. .-~.. Date of Permit .~ .~..~..~...Applicant ..... ~...~..~ ...... Health Dept. Approval .... . .......... aborDept. 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. ~oo~o7~ THE NEW YORK BOARD OF UNDERWRITERS BUREAU OF ELECTRI( ~- 8S JOHN STREET, NEW ~..,,...o.~o.o.~,,~ ~o-83 N 612968 THIS CERTIFIES THAT : , only th~l~%trical equipment ~ described belo~ and intr~uced by the aonl~ant ~ed on the ahm~ nn.li~' mh ..... ~lzi.ope rolitis, St~s ~. 900' ~% Rt. 4H- West::Si~, ~ ~ion, N.Y. " E~XTURE ~ FIXTURES 21 ~ 31 Z~ Zi [] 2nd Fl. Section Block and found to be in com~>lia'~ce with the requirements of this Board. RANGES OVENS Lot EXHAUST FANS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT OTHER APPARATUS: !-G.F.C,I. 1-Smoke Detector~ S E ~ l!v [ c NO O COND. OF CC COND. NO. OF HI-LEG OF Hf-LEG NO, OF NEUTRALS AWG, OF NEUTRAL 1 G & $ P. O. ~)x 215 Sou:hold, N.Y., 11971 This certifi must not be return to the LiC. #578 ard may be,ident f ed credentials. iNT. i COPY OF ' MANNER. FIJ LD INS~)ECT~ON FOUNDATION (1st) COMMENTS FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C~DE FINAL ADDITIONAL COMMENTS': .-/ i ~,sten! I[or thi,~ r,~e~e will con. h~m~ to the ~tamlard of the 5uffo~ pool OF= P)~O,C~ =~'r~T'",F ~*vis~d Mort'. ~e, Tho sowa~ dispel a~d water 8Ul~pl~ ~a¢,i, liti~m for t.h~ lo~atiom ~ve b~eg ~ ~ ~ ~O~v~cje& 0~. 18, I~, FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in 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 adjo'ming premi~e~ 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 constraction of buildings, additions or alterations, or for removal or de~nolifion, 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) ........... ii'~ iii;ii o} ;i,l,i~;i) ..... '5,,'~5 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises...//~...~.'..~..../~...~...~:., d.'~...77.--../~../.~.?.....ff..'... ~.~i /. 77 . ./? .............. (as on the tax roll or latest deed) If ~pplicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .... 0 .~ ............ 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 '/fir- . Lot..~. ............... Subdivision....Q'.. ~.../'~..~.....~..~...~...(~.. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy 3. Nature of work (cheek which applicable): New Building .......... Addition .......... Alteration .......... Repair~ . ............. Remtval .............. Demolition .............. Other Work ............... .- : (Description) 4. Estimated Cost ......... ! ....~ ......................... Fee ........................... , / (to be paid on filing this application) 5. If dwelling, number of dwellin~ ~nits ............... 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. Dimensions of existing structur!s, if any: Front ............... Rear .............. Depth ............... Height .......... ..... Number of Stories ................................ ~ ....................... Dimensions of same structure wlth alterations or additions: Front ................. Rear .................. Depth .................... i' ' Height ....................... Number of,~qtories ........... /... 8. Dimensions of entire new constrUction Front .... ~ O' Rear ~ O Denth ~ ~.~ c~, , Height Nu,mber of Stories . [... ~. . ...... ff ./'r r,~ ~£D 9. Slzeoflot:Front ..... //.~.. i Rear . ./. /. .~.,. .~). ./ ............ Denth c~-,.[.7..7. 10. Date of Purchase /0.- o~ ~2- .NameofFormerOwner ./4*r?-od 1 1. Zone 6r use district in which prtmises are situated...~ ................................................ 1 2. Does proposed construction violate any zoning law, ordinance or regulation: .... ~ ?. ..................... ,~, 13. Will lot be regraded ......... .~ ....~ ............. Will excess fill b~ rem~vetl from premises: Yes [No) Name of Owner of premises ~./9. i:.°./?:.v.¢ i~....V.O?.r..3Address L~ Z7 3~' ,,4- ~5-rv~i~l~oneNo{Z/.z) Name of Architect . .p..~.~..A).)( .i.L~ ./f./~. ?..~.~ ....... Address ?~)~)' k~i '~xk'~2~/k~k¢Phone No--' '.~'~)~.'b~65 PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, and. indicate ail 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. ~ I STATE OF NEW YORK. "' ~".S COUNTY OF .~C..q.ff.......~.~..L.$7'.. :... q. (Namo o~ ~ndiv~duai signing oon~ra~O abow named. .... being duly sworn, deposes and says that he is the applicant ~Heisthe .....................~ .~..C ................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~ 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 ........................ day of[ ......... Notary Public ....... l¢ou~ (Signature of applicant)