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HomeMy WebLinkAbout10775-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildin§ Inspector Town Hall $outhold, N.Y. Certificate Of Occupancy Z10372 igq! Date February © THIS CERTIFIES that the building ................................................ Location of Property 3735 K~enney's Road, Southold, N.Y. House No, Street Hamlet County Tax Map No. 1000 Section}5.9. .......... Block .... .1 .......... Lot...~.3...0.0. ? ....... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated July 11 19 ~.0. pursuant to which Building Permit No. 10'775 Z dated ...3.u. 3:..7..1.1 .................. 19 .'g.0., was issued, and conforms to all of the requirements of the applicable provisions of the law. Thc occupancy for which this certificate is issued is ......... Private One-Family Dwelling The certificate is issued to . John Kassimatis of the aforesaid building. 10-~0-~4 12/22/80 Robert A. Villa Suffolk County Department of ,Health Approval .......................................... UNDERWRITERS CERTIFICATE NO. Pending **Development Permit ~3F Building Inspector Rev. 1/81 FORM NO. 2 TOWIq OF SOUTIqOLD BUILDING DEPARTMENT TOWIq CLERK'S OFFICE SOUTHOLD, iq. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 1O775 Z Permission is hereby granted to: .... ~L..~/.V..~.....L!....~.~.~..~ ....... .,z:..~ .~. ......... ........ ~/~......?..!~.~.:. ........ .Z.....~'..~.Z.~ / ~'?.~.-,'., ................... ~j,.Q.~....L/,.Z...t....~..1.,~...~.j..j..-~U~..~' to ...... ~.U.,,~_:.) ....... .~......,O.A/l~,~.....£z.~./.:.~/.~..¥. ...... D. ~.~.. ~,~..~ ~./.~......z z¥...., z:q..~,.g..~. ............. at premises located at ........................................................................... ~.~.~..Z.6L(~.~,~ ....................................................... pursuant to application dated "JUL'/ ~.. .......................................... L ........... , 1 ~., ~nd approved by the Building Inspector. Fee $...~.~).~...~.. Building Inspector FORM NO. 6 TOWN OF SOUTHOLD 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 features. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of etectrmal 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 certihcate. Fees: 1. Certificate of occupancy $5.00 2. Cert~fmate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date December 29, 1980 New Building . XX ......... Old or Pre-existing Building ............ Vacant Land ............. Location of Property . .3.7.3.5.. ~e.O~y.'.s..Rgi~.c[,. Sp.u,l;bg,t.cl, ~. ~.,.Y. ........................... House No. Street Ham/et Owner or Owners of Property K. s,s, ~iae]~u.z;st. A~ze,. N ,¥,..;L0033. .... County Tax Map No. 1000 Section . . .0.5.9. ......... Block ..... .~ ......... Lot .P.c..~..~.3.. ........ Subdivision ............................. Filed Map No ........... Lot No .............. Permit No. 107.7,5 .Z.. Date of Permit 7../11/&0..Applicant .Inla~.d. H~aes ,..l,n¢ ............. Health Dept. Approval .1,2./.2..2~'.8.q. 7, .1.q :~q.O.-.~..Labor Dept. Approval .... t34(¢% ................ Underwriters Approval ........................ Planning Board Approval . .y.e.s ................. Request for Temporary Certificate... Ia.O. ............... Final Certificate ,..ye~ ................. Fee Submitted $ 5...00 ........................ Construction on above described building an~l~er~eets all applicable codes arC'~j~gu lations. ,~ ... /~ppl~cant ....... -~ ......... .'~-¢r-... ~¢,~'! ............ ~, .,~ .~ ~ ,~v.,o.,o-,8 Robeet ~. H~Itz - Ini~es,Inc. ~ Xh THE NEW YORK BOARD OF FIRE UNDERWRITERS J3D1 BUREAU OF ELECTR C TY~ ~ 85 JOHN STREET, NEW YORK, NEW Y~ORK 10038 O. te Feb~70~Sr 3, ]~l~ /lpplicati,,n No. on file THIS CERTIFIES THAT only the electrical equipment es described belo~v and introduced bY tke ~DDlic~Itt named o~ the above a~olicatio~t number in the ore ' Jom~V. Ka~inm~iz, 373,5 l~em~y'~ in the followlng location; [] Basement ~a~.,.,.~,~,,u Jar~og~y 29, 1981 [] 1st FI, [~ 2nd FI, Section Block aud found to be in compliauce w~th the requtrements of this Board. Lot FIXTURE FIXTURES RANGES OVENS DISH WASHER EXHAUST FAN OUTLETS SWITCHES ~CANDESCENT FLUORESCENT FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIALRSC'PT TIMECLOCKS 14 34 DRYERS UNIT HEATERS MULTI-OUTLET SYSTEMS NO OF FEET DIMMERS SERVICE DISCONNECT S E R NO Oi~ERCC~COND OF A W g CC COND 4/O OTHER APPARATUS 1~4.5i~ ~t Wat~~ }~ter V I C I NO OF HI LEG ~ A W G OF HI LEO F 1 AWG NO O NEUTRALS OF NEUTRAL Jo?a~ V. Ifa~sJ~natis 116 P~rst Ave~ bt~y York, N.Y, 10033 be altered ~n any BUILDING return to the off,ce of the Board if THIS COPY OF Jnspecto GENEI~AL MANAGER 11 may be identified by their credent IN ANY MANNER. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 f,~ f t .~:~1 Examined . Approved ./.. ': ........ ,,,~1.9... Permit No ............ Disapproved · ............................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Application t~o.: ................ Date ................. , 19... INSTRUCTIONS a. This application must be c~ompletely 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 Buil&ng 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 owner of premises .......... ................................................................ (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 LicenseNo ......................... Electrician's License No ................... Other Trade's License No ...................... 1. Location of lgnd on which proposed work will be done ............ : ....................... :.: ............ House Number Street Hamlet County Tax Map No. 1000 Section .................. Block .................. Lot ................... Subdivision ................................... Filed Map No ............... Lot ............... (Name) 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 (check which applicable): New Building s~ Addition Alteration Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost ¢.~O~OO0.O0 Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units . ~ ·...- .......... 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 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: Front . .'~..C~. ........ Rear .. ~ .g;b ........ Depth .-~} .{~l ......... Height . .~a~.~. .... ,'o'4 · Number of Stories ..................................................... .,~. 9. Size of lot: Front ...................... Rear ..... J-~ .............. Depth ...331 ................ 10. Date of Purchase ............................. Name of Former Owner ............................. 11. 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 ..... Y.~.~ .................... Will excess fill be removed from premises: Yes .,.. NO 14. Name of Owner of premises ~ P.":~3. Ko..~.~,x.s.-,A~.~¢~.J~xldress ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor I.J~,~,D ..ON~.,, !NC. ~" ~' +- ............... , ........... Address .~9-'.c..1.4 ~.. ,.~;o... Phone No. 2.fia.96.9.6 ..... 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 number or description according to deed, and show street names and indicate whether interior or corner lot. Y STATE OF NEW YORK, ~ ~ ~ ~ COUNTY OF...Z~u..~.2.q~l.~ ...... o.o ~_~ ....... :: .-:....I~.: .~.z .................... ~ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) / ' above named. Col?Jr ~c ~ 02: 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 f'fle 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 .... ~,~ .... 19S~. ........................ day of ..... '" ' ~ . ...... , Notary Public, ...o.~..~p:~:~. ...................... Co ~,obe~c Z. I15..~ tz _J~ll~ of applicant) D .SUFFOLK CO. HEALTH DEPT. APPROVAL STA~'EMENT OF INTENT THE WAT£1~ ~UPPLY AND S~WAGE DISPOSAL SYSTEMS FOE THIS RESIDENCE WILL CONFORM. TO ,THE STANDARDS OF, SUFFOLK CO. ~.P/T=.¢~' ~VICES, SUFFOLK COUNTY DEPq~. OF hEAL SERVICES -- 'FOR APPROVAL 'OF' DATE: H. S. REF. APPROVED' ,,DIST.,:." ' STATEMENT OF INTENT SYSTEMS FOR THIS R~IDENCE ~[L CONFORMrt~TO THE STAND~DS OF'T~ ~FFOLK CO. D~. 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