HomeMy WebLinkAbout13568-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No.Z13246 Date March 6 985.
THIS CERTIFIES that the building ADDITION
Location of Property .... 1. .27Q Greenh£11 Lane Greenport -'
Mouse ~vo. Street Hamlet
County Tax Map No. lO00 Section . .0.3. 3. ....... Block 3 .Lot 5
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore fded in this office dated
· .. ~.qv.,..q .3. ......... , 19 .8.4. pursuant to which Building Permit No.q 3. 5. .6.8.Z. ...............
dated .... N.<~w,. 2.1 ................ 19 .8.4., 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 .........
Addition to existing q.n.e f.a..m.il.y, dwelling.
The certificate is issued to GEORGE LEVINDIS
(owner, lex~e~ ~:~JX X
of the aforesaid building.
Suffolk County Department of Health Approval ............... I~ ?'.~ ........................
UNDERWRITERS CERTIFICATE NO ....................... ~/.A ........................
Rev. 1/81
Building Inspector
Fow~r NO. ~
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, ti. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
NE 13568 Z
Permission is hereby granted ~
.,.~...~ ............. g..~~;..~ ............... ~ ....................... ~ .........
at premises located at J...~.~a~ ....... ..~*~ ......... ~......~'~,,P.J~x~,~ ...........
County Tax Map No. 1000 Section ...... .(~..~.~.. Block ........~ .......... Lot No ...... ..~'
pursuant to application dated ...fl.~~.....~/...~, ......... , 19.~..~.., and approved by the
Building Inspector.
Fee $ ~...~/.~..~...
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
,~outhold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
Bo
This application must be filled in typewriter OR ink, and submitte~p!!cctc 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--iS-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.
Fees:
1. Certificate of occupancy $5.00 !
2. Certificate of occupancy on pre-existing dwelling/ land
3. Copy of certificate of occupancy $1.00
use--Pre-Existing C.O. $15.00
Vacant land C,O. $ 5.00
Date ....~' FT ./~ · ¥ .............
New Building ....~.. ....... Old or Pre-existing Building .... ~ .... Vacant Land .............
Location of Property .. ~ .~..~. ....... C~,,.~'. ~'.k/. ~/.~.~,....~ .f~..~. ~. ..... O..~ .~..~..~.O. ~. (.
House No. Street Ham/et
Owner or Owners of Property .....................................
County Tax Map No. 1000 Section ...O...~,?~ ...... Block ............... Lot ...............
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No..~.?.~.. ,~ ,~. ?'Date of Permit .I,/7~.)? pplicant .... (?~.'.~./;~./?, .~..~../~. ..............
Health Dept. Approval ....................... abor Dept. royal ........................
' -- Planning Board Approval
Underwriters Approval ......... . .....................................
/
Request for Temporary Certificate ..................... Final Certificate ..... .~.. ...............
Fee Submitted $ ..... ~ ...............
Construction on above described building and permit meets al~p~plicable codes and regulations.
~ ~)'"'~'"~qfl Applicant .... ~vg.-~.v-~,...Y..~.-.~. ........................
Rev, 10-10-7a
FIELD JfNSFECTION
FOUNDATION (1st)
FOUNDATION (2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N. Y0
STATE ENERGY
qODE
FINAL
COM,4EN Fo
ADDITIONAL COMMENTS:
TEL,: 765-1802
'FO.M "O. '
TOWN OF SOUTHOLD
BUILDING DEPARTMENTI[J \~l
TOWN HALL '
8OUTHOLD, N.Y. 11971
sapproved a/c .................. : ..................
Received ........... ,19...
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. This application must be co~npletely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
s of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing locgtion of lot and of buildings on premises, relationship to adjoining premises or public streets
areas, and giving a detailed description of layout of proPerty must be drawn on the diagram which is part of fifis appli-
ion.
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 issued a Building Permit to the applicant. Such permit
11 be kept on the premises ~ivailable for inspection throughout the work..
e. No building shall be occupied or used in whole or in part for any purpose whdtever until a Certificate of Occupancy
1l have been granted by the Building Inspectgr.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to tlie
~lding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
;ulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
~ applicant agrees to comply with all applicable laws, ordinances, building code, housing code, an0 regulations, and.'t6
alt authorized inspectom on premises and in building for necessary inspections.
(Signature of applicant, or name, if a corporation)
..............
(Maitin, address of appdcanD
,re whether applicant is owner, lessee, agent, architect, engineer, general contractor, electricia3~, phimber or builder.
. · -," .........: ............................................
,ne of owner of premisqs...~ .~
(as on the tax roll or latest deed)' ~ ' '
.~pplicant is a corporation, signature of duly authorized officer.
(Na~ne and title of corporate officer)
Builder's License No .... ~/~-~,~.~ ....... i ....
Plumber's License No ............ ~.r~..,--- ........ ,...'..
Electrician's License N~..~..~..
Other Trade's License No ................ : .....
Location of land on'which proposed work will be done. ~ .:I~M~....~. ~..'~..~'~ ................................
House Number Street Hamlet
County Tax Map No. 1000 Section .... (~..i~. ..~. .......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 aml occupancy'.....~.~[1~. ?.~45..~...\Cc. |..'~ ....
use ana occupancy ..................... ~~ ........
3. l'*?.'ure vfwork [check wi!ich applicable): New B:~ilding ..... ' .....Addition . ......... Alteration ........
'" e~k ..... . F.~mova! Demolition Other Work
4 Estimated Cost ' Fee
'x (to b~ paid rip filirlg this application)
5. Ir dwelling, number of dwelling units ...... ~. ....... Number of dwelling u~its on each floor ..............
If garage, r. mnber qf cars ......... .................................. ~ ......· .....................
6. If busines% commercial or mixed occupancy, specify nature and extent of each t~pe of use ....... ~'(~'r~ ....
7. Dimensicns of existing structures, if any: Front... ~ 6! ~, ...... Rear ...... i'. .... i.. Depth ...........
Height .... ~ ........... Number of Stories ........ [ ................. ~ ........ ~ ..................
Dimensions of same structure with alterations or additions: Front ...,~t°O~ .~x. j ...... Rear .gS:..~..~. .......
Depth: ...................... Height ............ , ......... Number df Stories ....................
8 D'mm;slons of entire new construction: Front ~ .~'Aiu'~q~- Rear .' Depth '
I~t. eigllt .............. Number of Stories ............... '
Of 1 ' ~ t ...................... ~ ' pth ~.',~.'i~.~i ........
S~ze et: Front /¢.o ............... Rear ~.1 ~. IC.~? .: De ....
Date of Purchase . r°Oo.~ .~qC/.9.~ ~ ............ '. Name of Former Owner I ...........................
Zmie or use district in which premises are situated .... t'~¢.~,~.~.~.,4*72 r4~.....i ...........................
Does proposed construction v~mate any zoning law, ordinance or regulation: ...~../~..C2. ..................
Will lot be.regraded ....... ~,~L9 .... r ...... :,. ~... Will excess fill be reinqx/eql ,Ir.om premises: Yes (~/'
Name of Owner of premises .t~Orz~.~ ?-..~.~( .~.o-r.ca.. Address .~. ?.t~qf ~. ~.?.//.~t~Phone No. '~.7.'~',.-.
Name of Architect ......................... Address ............. ; ..... Phone No ...... , .......
Name of~Contrac.tor . .~t~ c~.~.. :,qt~..~. ~/.~ .~.r?... Addiessc.O~.s }Ogq,x~,.4. ~. Phone No. ¥.~fo.*i.-~ .c¢. ~5/. ~'.
PLOT DIAG~
Locate clearly and distinctly all buildings, whether existing or proposed, and, ihdicate all set-back dimensions fro
property lines. Give street and block number or description according to deed, and show street names and indicate whetb
,interior or corner lot.
10.
11.
12.
13.
14.
/
STATE OF'NEXV~OIj~Ig t~' S.S"
COUISrI'Y'OF .,..r:??:(.'l .~. ]~-'~-. . .
.~ ~ ~v~ .................
being duly sworn, deploses and says that he is the applican
(Name of individual signing contract)
above named.
(Contractor agent corporate officer,
of said owner or owners, m~d is duly authorized to:perform or have perfomed the }aid work and to m~e ~d file thi
application; that all statements contained in this application are true to the best of his'knowledge and belief; and that
work will be perfo~ed i~ the mmmer set forth in tl~e application filed therewith.
Sworn to before n e flus. :
........ .....
I')EsIGN bP. UCC-ION E~fZ09.S.