HomeMy WebLinkAbout12213-zFORM HQ. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Z]2261 Date FEBRUARY ~ ~ r~ ............. 1984
THIS CERTIFIES that the building ..................................... NEW D.~.EL.LI.NG ........
Lo cation o f Property . ~. ~. 99....G .~.L.L.E..~ ?.E.. ~..~ .~.~. E. ........... E. g. ~. ?. g bt. ~ .~ .O.~ ...............
House No. Street Ham/et
County Tax Map No. I000 Section ....0.3.8. ..... Block .... .0,3 .........Lot .... .2.2 ...........
Subdivision .... .H ~.~.~.O..~..M.~.~ .0 .~ ............. Filed Map No. 2. 0. 3, .8 .... Lot No .... ~..5 ........
conforms substantially to the Application for Building Permit heretofore filed in this office dated
~ g. ~.C.~...7 .............. 19~.~. . pursuant to which Building Permit No. 1 2 2 1 3 Z
.dated ... ~.~.~. C..Ii...2.8. .............. 19 .~.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 .........
FOR g NEW ONE FAMILY DWELLING
Tlze certificate is issued to ANDREW & KATY PAFITIS ............ ~ ......
(owner, lessee or tenant]
of the aforesaid building.
Suffolk County Department of Health Approval 1 3 - s o- 3 ~
Building Inspector
Rev, 1/81
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
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 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 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 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 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.
Co
Fees:
1, Certificate of occupancy $5.00 /
2. Certificate of occupancy on pre-existing dwelling ~r
3. Copy of certificate of occupancy $1.00
/
land use $ Is-/$5.00
Date
.~ebruary 8, %984
New Building XX Old or Pre-existing Building(X) -~/Vacant Land
Location of Property 18.OO~,Gillette Dr.i.ve., East Marion, N. Y.;
House No. Street Ham/et
Owner or Owners of Property . ,~qd.r..e.w..Pa£:i.1%.i.~: A-.J4a~ ry..P.-%f;~.t~,~ ........................
County Tax Map No. 1000 Section 0.38 Block 03 . Lot. 022
Subdivision ................................. Filed Map No ..... 2..0.3.8..Lot No....4.5.
· 12213Z ~./.2..8./.8.3. Inla.na Homes, Inc.
Permit No ........... Date of Permit . ,Applicant ,, ................................
Health Dept. Approval 11/1/83
........................ Labor Dept. Approval ......................
N622291 i Planning'Board Approval
Underwriters Approval .........................................
Request for Temporary Certificate Final Certificate ...-...
Fee Submitted $ 5. O0
Robert E. Hii~z, ~ND HOMES, INC.
Rev. 10-10-78
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
.- SOUTHOLD, N.Y.
NOTICE OF DISAPPROVAL
File No...~,.i .......... ;: ......... - .......
....,¢~.x<.. z~:7. ..................... ~'
.... ~.~. ~. ~..~ ......
House No. Street Hamlet
County Tax Map No. 1000 Section .... ~.~... Block ...~.~ ...... ~t ...~ .....
s~a~v~o~e<~e.~ F~d ~p No ..... ~4~ .... ~ot ~o .... ~. ........
is returned herewith and disapproved on the following grounds ~. (~.~.d ~.
~,.~,~~... ~.~...~.~.~.. ~.~~~...
RV 1/80
FIELD INSPECTION DATE COMMENTS
FOUNDATION ( 1 s t)
~' / 7
ROUGH FRAME &
PLUMBING
-
INSULATION PER N Y. / ~ ~
STATE ENERGY
~ODF
FINAL
ADDITIONAL COMMENTS:
1 he~'eby cert, ify t,lm& I haYe l)relmred ~he plm~a ~.nd r~paciftcnL~On~
~'or ~he abo'v'e r,~,('(>renccd pro,jec~ and~ &o~e~.hey '~rii,h 'Lhe fo].lowin~~.',nfornm~x''on~ ~
~Boy ~,r'e~ t,{* the })esi, of ~y knowledge and beli~l'~ in compliance ~'it,h l, he New ,
York ~fi*>./,e 'I,IN'EI~(Df CON~;1;R~'ATS~N {:O~(STI~JCTION CO1)E prln~nd Jamm, r'~ 1~ 1979 by' the'
,/,, I'A'I " '
_.';' .'/,:~/(' .,./,'. / :..z+':',. ,.. ..... .,-'":/. >
1)t ST}IIBUTI ON i If al,, ~-, ~i r Steam
t~ll~l Ilet~,'~.ing Only Cooling Only ........... .~ttg, & C !ln[,._~___Sy~!l
~t~e ¢ontrae'~o ~,
~meh ~ha't, the following 'U' ~luea are no~ o:xeeeded~
t% !?loop oiror Unhet~'~ed
O, Para. me,er Slab
lleai, in/~- Design INI)OOll Air Ten, peri,ute ~l~all be
tlen, J,in?;-- Doatlln OUTDOOR Air Te~perai,ure ahall be
Coolinf~-.. De,~cn OUTD00II Air Teh~perat, nre
Det,~l[n heat, Irma/him. t, gain through cinch ~xt, erior facade in
Co
Eo
Fo
l~rnlah and in~t,~ll consSm~ct,ion mal, erials
Values of Insulati,~E ~q~terials-As indicated on the Drn.x~.int~s.
inngall ,riCh nhu~ of~' m~4gch / , ',
}lle(:~.rical l:lch~ina and po~,~er desi[n data ~re in :~.ccordance ~i~h '
)
t~h('e~ No.
i0001?4 THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRIC T~
85 JOHN STREET, NEW YORK, NEVi/ ~ORK 0038
THIS CERTIFIES THAT :
O~[y t~e e[ectdcaJ equipment as described belo~ and i~trod~c~ by the applicant ~m~d on ~he abo~e application number in the premises of
, , ~r ~ &~ and found to be in corn~iaace with the r~qu re.teats of this Board.
DRYERS FURNACE MOTORS FUTURE APPL(ANCE FEEDERS SPECIALEEC'PT. TIME ~ocKs BELL UNIT HEATERS MULTI-OUTLET DIMMERS
3 ~ 1 3 8[ 1
SEEVlCE 01SCdNN~CX NO.OF I S ~ ~ ~ [~ t C
~: ~1~ ~. (~f ~ell)
Ibm ced~fi~c~e mus~ ~o* be chewed m c~ mc~me~ ~e~um ~o ~he office o~ ~h9 8oecd ~co~t ;nspec~o~ mom be ~de~hhed bM ~be~ c~ede.hc~.
DEPARTMEN~ ( MANNER,
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. This application must be completely filled in by typewriter or~ in ihk and submitted in triplicate to the Building
Inspector, with 3 sets of plans, accurate plot plan to scale. Fee a¢cordlng fo schedule.
b. Plat plan showingloc~ation of lot and of buildings on premises, relationship to adjoining premises or public streets az
areas, and giving a detailed description of layout ofproperty must be drawn on the dias[om which is part of this application.
c. The work covered by this application may not be commenced before: i~suance of Building Permit.
d. Upon approval of this~application, the Building Inspector will issue a Building Permit to the applicant. Such permit
shall be kept on the premises available for inspection throughout the Wor~.
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, bu!lding code, housing code, and regulations, and to
admit authorized inspectors or~ premises and in buildings for necessary inSpections.
INLAND HO~BS, INC.
(Signature of applicant, or nome, if a corporation)
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
General Contractor
Nome of owner of premises .A...~..c]..~..e..?....P...~.~..~.~.~.~...&.....K..~...t..y....?~..~..~..i..s. ..............................................................................
If applicant is a corporate, signature of duly authorized officer.
Robert ~. Hiltz, President.
..................... .........
[ -
Builder's License No .....................................................
Plumber's License No ....... .5...[...7..-...P. ..............................
Electrician's License No..,~2..8.,.]...~. ..............................
Other Trade's License No ...............................................
I. Location of land on which proposed work will be done. Map No.; ....~..O,~.8. ............................ Lot ~No ..... .O...2:.~. .............
Street and Number 1~00 Gillette Drives Bast Marions N. Y.
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Exisiting use and occupancy ........................................................ : .......................................................................
b. Intended use and occupancy ................... .];....~..~..]:..~.....d...w..?..1.~.~.~.g. ......................................................................
3. Nature of work (check whicF applicable): New Building, .......X...X. ....... Addition .................. Alteration ................
Repair .................. Removal J, .................. Demolition .................... Other Work ' '~' ' '~~';il~'~ i~'f~-[De .............
: j (to be paid on filing this application)
5., If d'welling, number of dwelling units ............................ Number of dwelling units on each floor ............................
If garage, number of cars ' 2
6. If business, commercial or Imixed occupancy, specify nature and extent of each type of use ............................
7. Dimensions of existing structures, if any: Front ............................ Rear ................................Depth ...... : .............
Height ........................ Number of Stories .................................................................................................................
Dimensions of same structure with alterations or additions: Front .................................... Rear ............................
Depth ................................Height ............................ Number of Stories ................................
8. Dimensions of entire new cehstructian: Front ........... .~7. .................... Rear ..... .~.7. .................. Depth .....37, ...............
Height .................... Numbe:r of Stories ......................................................................................................................
9. Size of lot: Front . Z.3. O . . Rear .................. .3:...3..O. ................. Depth 87
10; Date of Purchase ...... i ....................................... Name of Former Owner ........................................................
11. Zone or use district in whicl~[ premises are situated .....................................................................................................
12, Does proposed construction qiolote any zoning law, ordinance or regulation: ........................................................
13. Will' lot be regraded . ............ , ............... Will excers fill be removed fr~4o..r~j'~iS~Jch )&Yve~nue (211,~1o
14. Name of Owner of premises ..~ ~drew Pa:~iti~ Address .ltl. a~itag.~...N.,.¥ .Phone No. 88~-317~
Name of Architect .............................................................. Address ................................ Phone No .......................
Name of Contractor[..N.~?...~..~.~..~......Z..N.C...' ................... A,~4re~Box
"" ..................
PLOT DIAGRAM
Locate clearly and distinctly dll buildings, whether existing or proposed, and indicate all set-back dimensions from
property lines. Give street ~na hi,fi ....... ~ .... -~ .... =-,~ ........ ~,, ~,~ 4~.~c~v,.street names and indicate
whether interior or c
,.,¢.25~35'30"~.
STATE
COUNT~
......... .i~.O..~..ff~'.~....~..~....H..3..'.~.t~.~. ......... J ......................................... being duly sworn, deposes and says that he is the applicam
(Name of individual ~i~nihg contracf)
above named. ~ I
ContzactOz
He is the ...................................... k ..........................................................................................................................................
I (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 fife
this application; that ali statements contained in this application are true to the'best of his knowledge~and belief; and
that the Work will be performed injthe manner set fo~h in the applicatiq~ filed therewith. ~/
: 5 ILIZA~TH ANN N~[~L~
~ ' ~OT~RY PUBLIC, State of New Yale
No, 52-B~2~850, Suffolk Oeu~/
, Te,m E~ires March 30, 19~
~=~00
su~: F~
soFr~ :OU~,'rY ~A~r~ O~ ~:~Lm s~v~c~s ANDREW PAFITIa A KATY PAFITIS
LOT ~., "NAP 0F MARION MANOR"
r~ i,,PF~,,'~V¥. O~ CONSTRUCTION ONLY AT EAS~ MARION
N NEAREST W~ IAIN--MI, ~ N SOURCE ~ ~TERt ~I~TE P~IC MENTAL~ A~NCY AND bENDiNG IHST ITU TI ON LiSAD '
M ~F CO. T~ MAP ~ITIO00 IECTION 038 UCK ~ L0~22 -- H~E~g,AN~ TO ~E AISI~N~ OF THE LENDIN8
t~ll Al ~ ~ELLIII WITHIN lOG FEET OF TH S PROPERTY ~NSTITU~I~, GUARANTEES:ARE ~T T~SFERAB~E
OTHER THAN THOSE ~HOWN HEREON. TO A~ITI~ INSTITUTES OR BUB~QUEHT
PURPOS~ A~D ARE NOT TO BE USEO TO ESTABLISH ~~'~~
S UBDIVISJON MAP FJLEO IN THE OFFICE OF THE OLERK OF SUFFOLK COUNTY
ON MAR. 18. m~a A~ FILE NO.~OaO ~ AND ~D SURVEYOR N,Y.S. UCENSE NO.
N~L~T~W~L(W),~ICTANK(ITIBCE~OLS(~)~N~RE~ ~ ~ .:~) N.~S. LICENSE N0.4589~
~E ~ FIELD ~TI,ONS ~D OR DATA OBT~N~ FR~ OTHERS
~S _r~0V 1 19~5 H. D. RE~. ~ t~ ~/ ANDRI~W PAFITiS & KATY PAFITIS
~ - - ' - LO~,4~,"MAP~FMAEION MANOR" JULY8,,98~
tnspec'b=~: ~'~' ~-:- ': ........ ~,, ~a foun& SUFfOlK, , COUNTY, NEW YORK ao, 82-440
I~U~I TH~ I1ZED ALTERATION OR AOOITION ~ ~lS -~
~ NGUAI:AN' :ES INOI~TE[ HEREON ~ALL RUN~LY ~
HEALTH OEPARTM~NT-DATA FOR APPROVE TO C~STRUCT ' mEe ~e~ i ~e WHOM : 'HE SU~EY IS
~NEARE T ' a IN__MI. 3 ~SOURCE~'WATE~, ~I~TE PUBLIC__ HERE~,~ D TO'~E AS$1eNEES OF THE LENOINS ~ t i~.~J ~ ~. ~
~E~ AR~ ~ ~ELLI~S WITHIN IOO FEET OF THIS PROPERTY INSTIl ~Tll I, GUARANTEES ARE ~T T~SFERABLE
TO ADI;ITU ~AL INSTITUTI~S OR SUBSEOUENT
OTHER THAN THOSE *SHOWN HEREON. OW~E1 S [ ~
WILL C~O~ TO THE STAN~ROS OF THE SUFF~K COUNTY O~FART.ENT TO EX~ ~T,I ~0 STRUC~Rt$ ARE FOR A SPECIFIC
OF H~LTH I~ICES. PUR~C SE ~ND ARE NOT~TO BE USEO TO ESTABLISH
SUBDIVISION ~AP FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ;~ AN~ LANO SURVEYOR N.Y.S. UCENSE NO. 12845
~L~T~W~L(W),~ICTANK(ST)aCE~OLS(~}~NHERE~ ~ ~ ~ N.~.LICENSE N0.4589~
~E ~ FIELD OB~ATI~S ~O OR DATA OBTAINED FROM OTHER S ~ ,~ , .
OWNERSHIP OF DOCUMENTS
THESE DP. AWtNGS AHD SPECIFICATIONS ARE INSTRUMENTS
OF SERVICE FOR PROJECT NO. J~'AZ~ AND SHALL REMAIN
THE PROP~ T',' OF THE ARCHITECT WH~HER THE PROJ=CT
FOR WHIZH THEY ARE MADE 13 EXECUTED OR NOT. THEY
A~E NOT TO EE USED IN ANY OTHER PROJECT EXCEPT ~.Y
WRITTEN AUTHOgIZATION OF THE ARCHITECTi
DATE: ~B,P. I:~ ~
765-3802 g A~ TO 4 P~ FOE THE
FOLLOWING tNSPECTIONS:
], FOUNDATION - TWO REQUIRED
FOR POURED CONCEDE
2. ROUGH - F~MING & PLUMBING
3. INSULATION
4. FINAL - CONSTRUCTION MUST
BE COMPL~E FOR C. O.
ALL CON.RUCTION SHALL MEal
~E REQUIREME~S OF THE N, Y,
~A~ CON~U~ION & ENERGY
CODES. NOT R~NSIB~ [OR
D~IGN OR CON~U~ION ERRORS.
~J FA~4h--Y ~H
~X-CT H/-.,~.~ ,::>,:-4 N,,r.=W
~' ]
fl
I I
L.--i l
If coPPer tubing is used
for water distributing
-~,~ina shall be
of types~'~--K or L only
is used
for water distributing
system; piping shal[ be
of ~ypes: or [ onl?