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Home My WebLink About13420-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13371 Date April 18 ,19 85 THIS CERTIFIES that the building ...... A..d,cl.J:,~ '.zg.n. ................................ Location of Property . .5. 0...O.l.d...C.o.v.e...R.d..,. &. . .3.1. 0. . 9.a.r. ql...R.d... ........ Southold House No. Street Hamlet County Tax Map No. 1000 Section . .0.5.2. ....... Block . . .0.2. .......... Lot . .0.98. ............ Subdivision ........ .X. ..................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .S.e.R.t' .....6. ....... , 19 .8.4. pursuant to which Building Permit No. 13 4 2 0 Z dated ...... .S.e.p .t:...6. ............ 19..8.4, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... .... .~$,~..~.~.o.~., ,?..~,~..~?,t.~..~5..~.?..s.~.o..~.z. ?.. ?.~.e..~. ?.~.~.Z.¥. ¢~.Z..Z.~.: ............ The certificate is issued to ...... ACHILLES STACHITARIS (owner, z~=m~ of the aforesaid building. Suffolk County Department of Health Approval ... N/A UNDERWRITERS CERTIFICATE NO. . N / A Building Inspector Rev. 1/81 FO]R~d[ NO. 0 TO~N OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13~20 Z Date ...........r.....~ ........................ , Permission is hereby gronted to: ...... County Tax Map No. 1000 Section ...... ..0.....~'....~.. ..... Block ..... ..~.~ ....... Lot No ...... ..~ ............... ~u~uon. to op.,,cot,on dot~ ..... ~~...~ ............. , ,,..t~.., o~ o~p.ov~ b. the Building Inspector. Building Insl~ctor Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD , Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector 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 installations, 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 property 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 in- formation 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 ~!6oL ?5 ~ Date ..................... ' ............ New B~ilding ................ Addition ...... ~./.... Old or Pre-existing Building ................ Vacant Land .............. -ocat,o, OfProperty fL.4'., . . Owner Or Owners Of Property ~d~-~,lt'~-X 'ST~.~~,C~.~%Y '. . Subd v s on ~ ~' ' ' ' · ............................................................... Lot No ........ ~.. Block No ......~.. House No . Permit No. L.~.~..~ate Of Permit ..~~..~?:~..~ Health Dept. Approval ............................................ ~bor ~pt. Approval ................................................ Unde~riters Approval .............................................. Planning B~rd Approval ........................................ Request For Tempora~ Ce~ificate ........................................ Fin~ Ce~ificate ..~ ................................. F~ Submitted $ ~. ........................... Construction on above described building and permit meets all applicable~ codes and regulations. (-~ .~. 12~.~,..~ ,~ Apphcant .,. :,'.~, ..... ~......,~.. S,w,~in 'o be'o~me this , .............. ~e'y o~ ............................................ (stamp or seal) Notary ~?'ublic ~\~ ...... ~ ............................. County FIELD INSFECTION COMMENTS FOUNDATION ( 1 st) FOUNDATION (2nd) ROUGH FRAME & FLUMBING INSULATION ?ER N. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.; 765-1802~ Examined... . 19 Approved...~. ~....~.. 5.., 19~fl.. Permit No..1..~fl. 5.0.% Disapproved a/c ..................................... Received ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................. , 19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted 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 issued 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 building for necessary i[Lspections. ~ ~ (SignaturgJof applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is ~wner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............. Name of owner of premises ..... ................ °~/,1 t ~ Lo_ $ ,.~....~. q. tx~. ,'T.c~. id. / 5 ................................ (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 Lidense No. ~ ~ Plumber's License No ......................... Electrician s License No ....................... Other Trade's License No ...................... '2~10 1. Location of land on which proposed work will be done..?.0... 9.~?.... ~. ~.~...~.~. ~ .... .~.,c~..'(~..~...~.o.~t..6(.' ..... House Number Street Hamlet County Tax Map No. 1000 Section (~ ,5 ~ Block t~ ~x Lot t50 ~. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ~..~. ~..~...~.h."(~..~....]q.o..m..~. .................................... b. lntendeduseandoccupancy ....[?. ~..,...,~,,.¢ . .... ,' "' "''~ 3. Nature of work (check which a~plicable): New Building .......... Addition ...~. ..... Alteration ......... Repair .............. Remloval .............. Demolition .............. Other Work .~. ~. ~ .eOk -- (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 ................ If garage number of cars [ / 6. If business, commercial or mixed occupancy, specify nat~r~-~nd extent of each~tEl/e of use .................. 7. Dimensions of e~,xis, ting/structurbs, if any: Front ..... ~. ~ ..... Rear.. ~ ~ ....... Depth...~--. Height ..... ~.&...~ ~ ....Number of Stories ..... ~, .............................................. --- Dimensions of same structure with alterations or additions: Front ..... ~.~. ........ Rear . .d'/~ ............. Depth ......... .~7~.~. Height · · · ¢. 3. ~ ........... Number of Stories ....... · · r ~' ......... ~' ..... 8. Dimensions of entire, new constrUction Front .~.' Rear . ~. . Depth .~.. . · 0~ , ~ ............... ~ ................... Height ....... ]. ....... Number of Stories... ~ ................................................... 9. Size of lot: Front .... ~/'~4 '6' 'mx ........... Rear ...................... Depth ...................... 10. Date of Purchase .... l Y... 2~ .................. ,NAme of F~ormer Owner ~e4,~¢,~. · ~.a~./.~. ;~- .... 11. Zone or use district in which premises are situated .... ~/'~'~/, .~.%~'~oc.}. -. .................... 12. Does proposed construction violate any zonin~ law, ordina' nee or regulat' inn:'-[. ......... 13. W/II lot be regraded ... ~..~. ............ ,~,, ......Will excess fill be removed from premises:t_ Yes 14. Name of Owner of premises /~ [~&~ ~,.L/.-o,-.5 ~./~.~gki~0aC~s Tk.W- ....... Phone No.'2¢.57-. Name'of Architect ........ , ........... ~ ....Address ................... Phone No ................ Name of Contractor...-~.' ] .~?..~ .~.., · .~.o.' B.~)~. ·Address .... .............. . Phone No. ¢~.. ~,..~-/. ~ .~. PLOT DIAGRAM Locate clearly and distinctly o11 bu/ldings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blockl number interior or corner lot. or description according to deed, and show street names and indicate whether STATE OF · ..... · .. . ............ bein tpplicant of ]ndiv~ual~ign!ng contract) ' above named. '~. He is the ................... !..~ . ~. ............... ............... '...5 ....... ~ntractor, ag~, corpol~ate omc;r, etc.)' "' of said owner or owners, and is duly anthor~ed to perle'tm or have peffo~ed the said work and to m~e ~d file this application; that all statements contfiined ~ this application are true to the best of his ~owledge and belief; and that the work will be perfomed in the m~ne~ set forth in the application filed therewith. Sworn to before me this ............. -~ ...... ;': .day o~.~ ~ ........ 19~ No ' ( ~ taw Public, . ............. ~. ~ ~ County .... ~ ~,l~,~2t~ '~ ~ "~ (Signature ofapphcant)