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Home My WebLink About10438-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Sou(hold, N.Y. Certificate Of Occupancy No. ........... Z12644 . ..... Date ........... G..u..1~..2.7 ............ ., 1984. THIS CERTIFIES that the budding One Family Dwelling Location of Property 6 5 0 Tasker Lane Grnpt. House No. Street Hamlet County Tax Map No. 1000 Section 033 .Block 04 .Lot 40 Subdivision X X X ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. .O.q~ ....4., 19.7. 9. pursuant to which Building Permit No. 1..0.4,3.8. Z. .............. dated ............ O..c~.... 1..1 ........ 19.7.9., 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 ......... Private 9ne Family Dwellin~ The certificate is issued to .... .pAp..?b~.,....A.N.~.QN. ~9.S.. a.. b.S.I.~...I.NA ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ... 9 r$,Qr 9 7 ............................... IkNDERWRITERS CERTIFICATE NO...4 7 3.4D,2 ........................................ Building Inspector Rev. 1/81 FOE~I NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 10438 Z Permission is hereby gronted to: ....... .~. . . .~. .~. . .= .~ ~.e. g; . . . . . (~ ~. s Z. . . . /. ~. .,,' c . ......... .db/~.~r.~.~.~.....~....~ ............ ~o ....... &o.~i~cx ....... ~....~,.~...~.~x.~ ........................... at premises located at ~.~...,..~~../~l~.7.--.-~~ff~.-~y,-- Buildin~ Inspector. Fee $ ................. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall $outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and subn~itted in duplicate to the Building Inspec- tor with the followlng; 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 supp)y and sewerage disposal--(S-9 form or equal). 3, Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple ResMences 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. B. 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. C. Fees: 1. Certificate of occupancy $5.00 2, Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date., ~- ~- New Building . ....~. ...... Old or Pre-existing Building(X)., ........= ZVacant Land Location of PropertyHouse' '~' '~'~-~lVo. ...... ~''Street"'''' , Owner or Ownors of Property ~tt.~4l~/o~ ¢ ~/~ ~ County Tax Msp No. ~O00Section '~]- 0¢-8~¢ B[ock ~ .., Lot.. Subdivision ................................. Filed Map No ........... Lot No Health Dept Approval ~'O- ) ~ .Labor Dept. royal Unde~riters Approval .... ~ .~ ~. ~.~.~ ....... Planning Board Approval .................. ~equest for Temporaw Certificate ..................... Fina~ Certificate .. Fee Submitted $ ....... ~. ~ ~ ............... Construction on above described building and permit~meets all app~cable~j;odes and regulations. ~¢ ¢~t, *~J'4¢'\x Applicant . . . .................... 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION REMARKS: DATE 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG, FOUNDATION 2ND [ ] INSULATION / FRAMING !~ FINAL /~///~' DATE .... INSPECTOR Al) DITIOI',d/~.L. THE April 2, NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTR!CITY~ 85 JOHN STREET, NEW YORK, NEW ~ORK 10038 only the elec trical equipmet~t ~s described below and introduced by the appllcant t~amed on the above application number in the premises of A~onios Pappas, e/s Tasker Lane, n/o S~tton Pl., 850', Greenpott, in the follmvi.g location; [] B.sen, ent ~l~t Fl. [] 2nd ~7, Section BIoel~ Lot was examined on ~ch ~. F ~980 and found to be in co.~pliance w~th the requirett~ents of this Board. FIXTURE OUTLETS 22 FIXTURES RANGES OVENS EXHAUST FANS RECEPTACLE.~ SWITCHES FURNACE MOTORS DRYERS FUTURE APPLIANCE FEEDERS TIME ~LOCKS UNIT HEATER~ MULTI-OUTLET DIMMERS SYSTEMS NO OF FEET SERVICE DISCONNECT OTHER APPARATUS: l~Smoke Degoc~or 1-G.F.Co£. S E R NO O~ECC. G, COND A W G. O5 CC COND i c E NO OF HI-LEG AWG OF HbLEG NO OFNEUTRALS A W G OF NEUTRAL Coram Elec. Box 242 Route 112 Coram, N.Y. 11727 Th,s certificate must not be altered in return to the office FOR BUILDING Lie. 733 E Inspector GENERAL MANAGER may be !denhfied by the,r credentials. IN ANY MANNER. 0.2,5 2.8:0 E. IC~,C'O ZAH~.A FOKM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ~'.'.~.~..~..~..../..../....., Approved ~....~./~T.~.~....../...z....., I9...7.....~ Permit No.....~'~.....~..'~>~....Z... ................... ...... Disapproved a/c .................................. ~ ................ : ........... :.; ~..;..,zx ...................... (tBuil~ng Inspector) Applicotion No..f~/,~.. ............ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter o¢ in ink and submitted in triplicate 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, relationsMp to adioming premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part af 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 Budding 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 port for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance'of a Bui'lding Permit pursuant to the Building Zone Ordinance of the Town of 5outhold, 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 apphcont 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) ....................... of .............................. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................... ................................................................................................................................................. · Name of owner of premises .... '.~..' .......................... y"3~m"m"~ ....................................................................................... If apphcan~ is a corporate, siDn~.~u~e of duly o~orized officer. (~e and title of corporate officer) Builder's License No ..... .~.~.~.<~......~ZZ. ................. Plumber's License No, ,.,:~ ...... ~ ....................... Electrician's License No...Z...~....~....,~F~. ........................ Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No,: .....~...<~.~.,~.. .................... Lot No, ~.~.?.. ............ Street and Number ...............:-~../~.s~.~.~.~ ....... ..~..~.: ........................................................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o Exisiting use and occupancy ........... .~..~......~....~.~.~.......~....,~...~../..~., ....................................................................... ; ..... b. Intended use and occupancy ........... ..~..~.....~........~..../~...~.......~./~..../~./~.~.~... .......................................... ] ...... 3. Nature of work (check which applicable). New Building ..... ~ ........Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................... 76- (Description) 4. Estimated Cost ..........,~..: ...... ~ .................................. Fee .~.,,...[.' ......... ~.. ............................................................... } , (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... ~ ................. Number of dwelling units on each floor ..... ,7.. .................. If garage, number of cars .............. ~,~.~ ,~,,,.(7,,~,.~ .................................................................................................. 6. if business, commercial or mixed occupancy, specify nature and exfent of each type of use ............................ 7 D mansions of ex~sting structures, if any: Front .................... Rear ................................ Depth .................... Height ........................ Number of Stones ................................................................................................................ Dimensions of same structure ,with alterations or additions: Front .................................... Rear .......................... Deptl~ ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ..... ~..~,~.~ ................. Rear ...~',~'.,.~ .......... Depth ..~.~, ............. Height .....z/~ ........Number of Stories ............. ,~.....~'~)~:; .......................................................................................... 9. S~ze of lot Front ........... .,~.;~¢~.~. ............................... Rear ........ ~f..~. ........................... Depth .....,~....~-~'...~. .............. 10. Date, of Purchase ........................................................ Nome of Former Owner ........................................................ 11. Zone' or use district in which premises are situated ................................................................................................... 12 Does proposed construction v~olate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded ..... y.~..,~ ............ Will excess fill be removed from premises: ( ) Yes (~ No ' ~ Phone No...~.,~..,(.~. 14. Name of Owner of premises .,~MJ.Z~.Z~S,..,..~...4..P..~ ....... Address ..,~I~.E~.~ ........ c~//-~ Nome of Architect ......................................................... Address ................................ Phon~ No ....................... Nome of Contractor ,~1~..~,.,/~....Z,~t.~...~..~..~'?l~.~....,/./M....~.,. Address ...,~,/~/,,J~../i~.~.~.,CM~t.... Phone No. PLOT DIAGRAM Locate clearly and distinctly oil buddings, whether existing or proposed, and indicate all set-back dimensions from property lioes. G~ve street and block number or description according to deed, and show street names and indicate whether interior or corner lot STATE QF NEW Y,~K~x ,, ~' ~SS COUNTY OF ~.,. ~' .............. i......~,,,~::~,m.~.....~, being duly sworn, deposes Ond says that he is the applicant (Name of incffvidual signing contracf) above named. He is the ....................... ~ .................................................................................................................. ~ , (Contractor, agent, corporate officer, etc.) 'of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and fife this application; that all statemehts contained in this application are true to the best of his knowledge and belief; and thor the work will be performed iq the manner set forth in the apphcation filed therewith. Sworn./...~...~.t° before me thiSof '~'~' ..... ...... ...... ...... , , ...... ........ ..,Coun ....... .............. : ........ : ...................................... /-~ ¥-~ · ~._.,~,,~, ~,~/~.~,~_-~r~-]~~. - /1 (Signature at appdcant) AB~H ANti NOTARY pUBLiC, State afl Hew No. 52.$1.25850, SuifotR Co~ Term Expires March 3Q, I.~J~ MAP rOF Pf~C~ER.. Y '8 0 ~ ,t 1 I ~m~ ~'l~'~.~-~ .... The sewago diaposal and ~-ater facllitlez for Lhi~ Icc~'t, ion Inspected by this depur~ment mud found ' , ~ ~,.,~,,. J~Y~ ~ ,k~