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HomeMy WebLinkAbout10226-zFORM~O. 4 TOWN OF S~F./THOU) BUILDING DEPARTMENT Office of ~he Buildtn~ Inq~'tm' Town Hall Southeld, N.Y. BUlf,.l~l~ PII~ (THIS PERMIT MUS~' BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF T~.~IE WORK AuTHoRIZED) N? 10~26 Z P~rmission is hereby granted to: ~ ~:~ ~...~....~. ........ .~...~.....~.~..~ ............ .~ ........ ~.......~ .......... ~.~. .................................................................. ~ ............. ~ .............. ~ Building Inscector FORM NO. 6 TOWN OF $OUTHOLD 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 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 or land use ~, Copy of certificate of occupancy $1.00 $5.00 Date . Fe.~r. uar.y..22,~..1.98.1 ..... New Building .... ~.' ....... Old or Pre-existing Building ............ Vacant Land ............. House No. Street Hamlet Owner or Owners of Property . ~. ~.~,O. f~ .1.~ .~, ~. ~. ~. ~2.~ ~.. ,~<~{~~ .... County Tax Map No. 1000 Section ....1.1.5 ........ Block ...t6 .......... Lot .... ~ ........... Subdivision ................................. Filed Map No ........... Lot No...'~ ...... Permit No, Z~.~ 2.~. Date of Permit Health Dept, Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .... ~: .................. Fee Submitted $ ..... 5 o D.0. ................... Construction on above described building and permit meets all applicable codes and regulations. Applicant. ~'~.~:..~ .......... Rev. 10-10-7a . TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, N. ¥. 11971 ? October 10, 1980 Antonios Savopoulos RR #1 Box 89G Mattituck, New York Dear Sir: This is to notify you that Building Permit No. issued.. . ~' 1 to same will expire on November 2~ 980 10226Z If more time is required to complete the job and obtain a Certificate of Occupancy, you may apply, ~y letter, for a six (6) month extension. If the work is not completed and the Certificate of Occupanby not issued after the six (6) month extension period, you are than required to apply for a new building permit. Very truly yours, ~ - H. FISHER///~- : or. muilding Inspector GHF/mw ~o! ?1 182. 00' Lo! 182. O0 ' NO T£: D = STAKE SUBDIVISION I~AP F/LEO IN THE OFFIC~ OF THE CLERK OF SUFFOLK COUNTY ON ' dAN. 28, 19G5 AS FILE NO. 42~G. NOV. ~1, 1975 MAY 12,1976 SEPT. IG,1976 THE ZOCATION OF W~,I'g8 KRD CESSPO0/,~ YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W, YOUNG HOWARD W, YOUNG SURVEY FOR: BEN MENDOZZA s, . "..' E '~'" ~~q'~""o'~' LOT 70 gEEP BQ~E" C REBK FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT~ TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 j,/ / ,,) Examined ................. , 19 . Disapproved a/c ............... } ...... i '.'- ..... ,' ........ (Building Inspector) APPLICATION FOB BUILDING PER,lIT INSTRUCTIONS Application No .................. ~ a. This application must be completely filled in by typewriter or 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, 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 issue 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 buildings 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. Name of of premises owner (as on the tax roll or latest deed) 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. 10Q0 Section ...... { ( ~"'~ Block [ 6 Lot ~>~ Subdivision..~...~..(~...~'.i Filed2;'~4~ '~.i~.i;ii.~.i... I~21 iiii~'~..16111111' 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: t a. Existing use and occupancy ..... /..~~...O~. ,. .... , ..................................... b. Intended use and occupancy ................. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cos ..................................... ff~fl Fee ...................................... f .~ (~t~, (to be paid on filing this application) 5. If dwelling, number of dwelling unit~L~ ~, ........... Number of dwelling units on each floor ................ If garage, number of cars ....... /,c.~. ~,~ ........................................................... 6. If business, commercial or mixed 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 construction: ~ ............... Rear ............... Depth Height ............... Number of Stories ........................................................ 9. Size of lot: Front .... 5,'d?'-7£ ........... Rear ...................... Depth ...................... 10. Date of Purchase .... ~.. t ./. ~, .................... Name of Former Owner ............................. 1 1. Zone or use district in which premises are situated...~. ................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................. 13. Will lot be regraded ...... ~o. ~q..~.-..~ ............ Will excess fill be removed from premises: Yes 14. Name of Owner of premisesf~/.q',~././~0~.~..~'~.. Address ................... Phone Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, an& indicate all 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. STATE OF NEW yQRK.. COUNTY OF..:-v. i...7~.~. ~< .4t. S.S ...... (~m~ o'f'i~'~ivi~t'~l'sii~i~ c'o~'~c'ti abow~ named. ·...~ ..... being duly sworn, deposes and says that he is the applicant 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 ..... 57.~. ('. ............. day of .... ./. Y[. ! f~,/ ........... 197./. Notary P. ublic, . ......... .>~), ........ ,, , ~' '~ .%,,..,:?./.~. Z{.'. County (_~? ..,' '7 /,..,; ~/ ELIZhBETH ANN N liLl~ ~0?ARY pUBLIC, State of New Yo~k (Signature of applicant) No. 52-8125850, Sufl01k l'arm Expires March 30.