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Home My WebLink About10814-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT' Town Clerk's Office Southold, N.Y. Certificate Of Occupancy Z10263 November 20 80 Date ................................ , 19 ... THIS CERTIFIES that the building ................................................ 865 Stars Road, East Marion, N.Y. Location of Property ~DtJs'e 'N'o: .................... 'S't6~i .............. ~ ..... /~$r~iei County Tax Map No. 1000 Section ............ Block ............... Lot ................. Stars Manor 5 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Bmldtng Permit heretofore filed in this office dated July 29 80 ..................... , 19... pursuant to which Building Permit No. 10814 Z dated August 7 1980 was issued, and conforms to all of the reqmrements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Private One-Family Dwelling Vasilios and Ourania Theoharakis The certificate is issued to ..................... [o~n'o'r,~ ...................... of the aforesaid building. Suffolk County Department of Health Approval 10-80-5~ - 11/19/80 -Robert A. Villa UNDERWRITERS CERTIFICATE NO, ?./4.977.6.? ........................................ 'Building Inspector Rev 4/79 * High Nitrates - Water not to~e used for ~reparation of baby formula or consupmtion by infants under 6 mos. of age. ,N°. 10814 BUILDINIG~ PEI~Ii~ (THIS PERMIT MUST BE KEPT ON THE Pt~E~J-. COMPLETION OF THE WORK AUTHORIZED) Date. ~S UNTIL ~ULL Permission is hereby granted to:. , ...... '.,72/¢.... '~'"'~i ..... ": ............ / ~'? ,~V,~,~: ~f,~/~ ,~z~.,....... · .......... ~ ...................... ~t ......... ..~~~....,,~.., /.., ........ ~o ...~.t~.~~....~....~rz~..,~ ..... ~z/~.~ .~-. -. ~z~z ~~ ~. ..~ ~ /~ ....................... ...l. ..... ~ ................................ ~ ........................................................ ,... ................ .;..~... ................................ ........................................... .......... ................... c~,,w T,x M~p No. ];~00 S,,,o. ~Z ....... ~:~.. B~,~¢ ~.......-~, ~o...~.~ ...... pU~uant to application~ dated ...,,.~.~.....;;.... ...... , 19~;~, and approved by the Building Inspector. Rev. 6/30/80 COUNTY OF SUFFOLK DEPARTMENT OF HEAl. TH SERVICES The attached approval was issued subject to the nob~tion contained below our approval st~. ~buld ym~ please type the following condit"L~ of approval on the final C of 0 as tlLis will ensure that any future owner will be made, aws~'e o£ the nitr~te problem. '~rivate well with ;' ~t] gh nitrates - see weolth Department note on final sur~-ey. Thank y~t~ Robert Ao Villa, P, E. FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY 'instructions Ao 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" ~and 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 $5.00 3. Copy of certificate of occupancy $1.00 Date ..... /.~2..-~.. I. f..':-..~. .... New Building ~,~ Old or Pre existing Bull 'n ............ Vacant Land . , .... .... - Location of Property/~o'u'~ ~k/o/S''' ~ ~'~ ...... ~).t.~ ........ . ./~.~.!J~. ... Street Hamlet Owner or Owners of Property . County Tax Map No. 1000 Section . .~, .~.[ ......... Block . .'~ ............ Lot ................ Subdivision..~...~J~.~....~ ~.. ~-. ............. Filed Map No ........... Lot No...~.. ......... Permit No. 1O~.J.~'. .... Date of Permit .~.-?, ."..~..Applicant Health Dept. Approval ...... [.0..~.O, ,~.'~5 ........ Labor Dept. Approval ........................ Underwriters Approval..~. ............. Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ~' 00 Construction on above described building and permit mgets all applicable codes and regulations. Applicant ._.~J."~.'.. ~/~4,, .~ ............................... THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the electrical equipment as described below and introd~u~ed ~¥ the apl~licant named on the above application number in the premises of in the follo~ng Io~ atiot? [] Basement was e~amlned on Ou~ober 20, t9~0 [] 1st FI, [] 2nd FI. Section Block Lot and.found to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES OVENS DISH DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS EXHAUST FANS TIME CLOCKS UNIT HEATER~ MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT S E R I NO OF CC COND A W G NO OF HI-LEG PER ~' OF CC COND 1 2/0 OTHER APPARATUS. ~]~c. room t~at~rc~; 1--2.3kw, 1~2,0kw, 3~1, 5k~, 2-1.0k'w, 4-. 75kw MoLors; 1--F 1 ~aot~e Detec~r 1-~4.5kw C E AWG OF Hi-LEG NOn, NEUTRALS A W O OF NEUTRAL 2/O FIELD. INSF. ECTION COMMENTS FOUNDATION FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY CODE FINAL ADDITIONAL C_0_I~4ENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 Approved '7 ....... , Date ........... 19 INSTRUCTIONS 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 issu~ 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.,q,r demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, hc/us~ng code, and regulations, and to admit authorized inspectors on premises and m buildings for necessary intp~c~ . . I.o].?. . . . hr ,. . . . . ress of applicant) State whether applicant is owner, lessee, agent, architect, enginee[~contractor,'j~lectrician, plumber or builder. . t.~.~ ~~ ~.~./L,.~ ..~.z~ (as on the tax roll or latest deed) Ifapplica t's po ion, ' nature of duly uthori d officer. (Name and title of corporate office~/ Builder's License No .......................... Plumber's L~cense mo.~.-..~.~.'~. I ~1~.~.. Electrician's License No. ~, .0.~..~..~..~...T'.~..t ~.:.. Other Trade's L~cense No ..................... / 1. Locationoflandonwhichproposedworkwillbedone....~./.~.J.I~.....~.~.~.'...(X:'.).~.: ....... . . . . ........... . , ............. House Number Street Hamlet County Tax Map No. 1000 Section ... ~'~ ~ ......... Block . ~. .............. Lot Subd,vision..~ ~S ~.~.0 ~ ............... Filed Map No ............... Lot.~ ........... (Name) 2. State existing use and occupancy of premises and intended use and occOpancy of proposed construction: a. Existing use and occupancy ......... V~. ~ ............................... j ........ b. Intended use and occupancy ...... I'" ~ ~' ~ ~-'-.. ~. ~ ~. ~- .~ L~ ......... Depth ...................... 8. Dimensions of~entire new constn Height .. [~1, ......... 9, Size of lot: Front., . J~L~....', 10. Date of Purchase ........... 11. Zone or us~ district in which pr~ 12. Does proposed construction vio.11 13. Will lot be regraded ....... .~,, 14. Name of Owner of premises Name of Architect .......... Name of Contractor Locate clearly and distinctly alll property lines. Give street and block interior or corner lot. Nature of work (check which applicable): New Building ...'~.i .... Addition .......... Alteration .......... Repair .............. RemOval .............. Demolition .............. Other Work ............... Estimated Cost .~.~.0 0..O~...: Fee t~.~//( ~. (Descript. i~n) (to be paid on filing this application) If dwelling, number of dwelling ~ [nits ............... Number of dwelling units on each floor ................ If garage, number of cars .... .~ ~-. .............................................................. If business commercial or mixe~ occupancy, specify nature and extent of each type of use ..................... DimenSions of existing structureis, if any: Front ............... Rear .............. Depth ............... Height ............... Numl .er of Stories ........................................................ Dimensions of same structure wil h alterations or additions: Front ................. Rear .................. · Height ..... ~-, ............... Number of Stories ......... , ............. ction: Front. ,~(o .......... Rear...~ ......... Depth . .~ .~ ......... er of Stories ...... tPl,~.. '...~ ........................ , ................ .......... Rear ..... /. ~.llk ............. Depth .l~O. ................. ................. Name qf Former Owner ............................. discs are situated .......... ~ '.'. ...................................... !e any zoning law, ordinance or regulation: .... /~0~. ...................... ~ .... ~. ........... Will excess fill be removed from premises: Yes ~) ~-., .~!J~¥'.~..~: Address ................... Phone No ............. ~ ......... Address ................... Phone No. ~O. '.R~i .~.~,0~ddress IV~.~..~.iO~..t:..~ .~F~,e Phone No..~..~Y.'~'~i./.~'. i i i PLOT DIAGRAM >uildings, whether existing or proposed, and, indicate all set-back dimensions from amber or description according to deed, and show street names and indicate whether STATE OF NEW Y~hRK~ _.,, i ~' ~ COUNTY OF i .I,~,~.""~..~.~.o.~.../,~./, ........... . (Name of individual sigr above named. He is the ..................... of said owner or owners, and is du application; that all statements cont work will be performed in the manne~ before me this ...... .~..~t~q.. .............. being duly sworn, deposes and says that he is the applica: ~g contract) ~~gent, 'corporate officer, etc.) ' !ho-'F~,d lo ~rform or have perfomed the said work and to m~e and file t2 is ned ~ this application are true to the'best of his knowledge and belief; and that t .e set for~ ~ the application filed therewith· NOTARYPUBLIO, Stat~of N~Yo~ I ~ ~ J~ 0 a /~ _~ , Qualified in Suffolk ~o~.~' ' ~ ' ~ ........ ~: ~ ~ ~ ~ } · . · ~ .... Commlssian Expires March 30, 1~ (Si~ature of applicant)