HomeMy WebLinkAbout12954-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-17461
Date OCTOBER 26, 1988
THIB CERTIFIES that the buildin~ ALTERATION
Location of Property 6305 COUNTY RD. #48 & 35 CONKLIN RD. MATTITUCK~N.Y
House No. Street Hamlet
County Tax Map No. 10Q0 Section 139 Block 03 Lot 50
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 18~ 1984 pursuant to which
Building Permit No. 12954-Z dated MARCH 29~ 1984
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 ALTERATION ONE FAMILY DWELLING DOORS TO PATIO & FENCE
The certificate is issued to
ANDREA GOURLIDES
(owner,
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Building Inspector
Rev. 1/81
FORM NO. 111
TOW'N OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
12954 Z
Permission is hereby grante f--~ ON ~' L I 'D ~ ~
~-~ u~~ .....
.........
,o ..~.....~.:.~.....~.~;t.:.~...~......~.....~
..............................................
... ...... ~ I~t~a ~t ....... ffJ~....~ ................. ~ .......................................................
County Tox Mop No. ,000 Section, ....J....c~..C~. ....... Block ....... ..(~.....~.. ...... Lot No ..... .~.~.~ ...........
pursuant ,o application dated ...... .m.~....J....~.. ................... , 19..~..~., and approved by the
Building Inspector.
Fee $..;.J, ..................
Building Inspector
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y, 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
.... o spurn, OEO ~
A, This application must be filled in typewriter OR ink, and submitted m ~ 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.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
I. Accurate survey of p~operty 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: Additions $25.00
1. Certificate of o¢¢upancy New Dwelling $25.00, Accessory ,.$~0.00 Business $50.00
2. Certificate of occupancy on pre-existing dwelling $ 50.00
3, Copy of certificate of occupancy $ 5.00, over 5 years $]0.00
4.Vacant Land C.Oo $ 20.00
5.Updated C.O. $'50.00 Date ..........................
Newconstruction ...... Old or Pre-existing Building ............ Vacant Land .............
Location of Property .... ~ ~. .... ~¢_p.q~ ~. ~ ./.~ ..... .~. ~. .12 ........ /.~c.~./. ~7.~ ¢/~ ........
House No, Street Ham/et
Owner or Owners of Property .../~.3./,~,C~/%...Z'~Y~,~¢.~,~"/ ....... ~, ,/~ ~L-./.'./P. 4~ .~' ........
County Tax Map No. 1000 Section .... ~ ./~ .~ ...... Block ..... Z:~. ~, ..... Lot....~. ~? .........
Subdivision.. ~../~r./~. p~.., ~??./..~.J.~-7.£..Filed Map No. ~...~, .~....Lot No... ~.4 .~..~..~./.P~¢-
Permit No./.~-.~ ~.LJ,~_ Date of Permit ~') .~/~q .J~o...Applicant ..... ~/V./~7~'~ .....
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate ...... ~ ...............
Fee Submitted $.,/. ~.: .O.q ...................
Construction on above described building and permit meets all applicab~ codes and regulations.
Applicant ...................
Rev. 10-10-78
F~I EL'D~ INS F ECTION COMMENTS
FOUNDATION (1st)
FOUNDATION
2.
(2nd)
ROUGH FRAME &
FLUMBING
INSULATION FERN.
STATE ENERGY
C,ODE
FINAL
ADDITIONAL COMMENTS:
LOT.S ' HOLE
/z
SURVEYED FOP, , /
C 0 l',J S'i"~ R UCTION
.NOTES.
ELEVATIONS '5NOWN JklZE EELAI'IVE
TO ASSUMED ELEV. 1{5.O AT
COIZN EIZ. OF
LOT NUMBERS SNO\Vl4 ~EFIER TO
'~MAp OF C~ARDEN ~{I~IGI4TS," FILED
It,{ ]'{.IE SYFFOLK COUNTY CLERK'S
OFFICE AS MAP N? 5'/7"
SITUATE AT
M ATT ITU CK
TO\VN OF SOLITI-.IOLD. kl.Y.
CORP.
~UAR&NTEED TO THE ~ECIJ{ZITY
I'ITLE &NO GUAEiANTY C.,O, AND TO 'Th
F. IVEE~E,~D 5AVtMGG I~11~
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ J FOUNDATION 2ND
[ ] FRAMING
REMARKS:
INSULATION
DATE ,, ~/~" "~
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION ;ZND [ ] INSULATION
[]FRAMING [~FINAL
REMARKS: /~' , ~
TOWN OF $OUTIIOLD
OFFICE OF BUILDING INSPECTOR
1'.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-t802
This is to advlae you thaC the job under building
permit no. 12954Z issued to Andrea Gourlides
on _1129~[4. ._ for Alteration is completed
a final inspection [las ( ) has not ( x ) been done.
and
[n order to complete this file, it is necessary that
a Certificate of Occupancy be issued. Please fill out the
enclosed form, return same to the above office with a check
for $10.00 payable to tile Town of Southold. Please indicate
to Whom tile Certificate of Occupancy is to be mailed, and
arrange with tills office for an inspection (late
Occupancy or u:~e is unlawful without a Certificate of
Occupancy. Please }le]p us tO clear up thia matter so that
legal action does not have Co be taken. ,~
Thank you for yo.r prompt attention.
Very truly~,
Victor Lessard
Executive Administrator
VL:gar
eecl.
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
~TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
Examined...,~ ,a~.c~q .~..~[.., 19~fi..
Approved ... ~e~. qJ~..~. ~..., 19 ~. ~. Permit No../.~.~ .q..-~
Disapproved a/c .....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Application No ..................
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 ~ving a detailed description of layout of property must be drawn on the dia~am 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)
*o~'"~$'r'. v.,o~,~$~o~--,q ....
(Mailing address of applicant) I I "5 ~-.-
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises . .? .~'..~..~'., .~...~?..o..~..~..~.~.... ~7,~.~.o..~. ?. [ .I:? .~ $ ................................
(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 ............. .3/( .......
/
Electrician's License No ........ ~ ..........
Other Trade's License No .......................
!
1. Location ofland on which proposed work will be done. .~l..l~
............................. .............................
House Number/q.~. ~/, Street Hamlet
County T~x Map No. 1000 Section .... ......... Block .... ......... Lot .... ~..'W...h ........
Subdivision....~..~..{1(..O..g..~.... ~..~..~..¥)'~..~. ........ 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 ............. .~...~.~. } ?..~.~3. ! .~. ~...~ .$'.IPV..~..~.~....~...~..t~. I..~.~. ...........
b. Intended use and occupancy
3. Nature of work (check which applicable)' New Building Addition . Alteration . .
' ' (to be paid on filing this application)
5. If dwelling, number of dwelling ~nits..../~. : ...... Number of dwelling units on each floor ................
If garage number of cars
6. If.business, commercial or mixedioccupancy, specify nature and extent of each type of use ..... ~ i]: . ./~.~i .....
7. Dnnensions of existing structures, if any: Front .... .'t. ~ ....... Rear ....~ .~.-. ..... Depth ......
Height .............................................................
Dimensions of same structure wi~h alterations or additions: Front ................. Rear ..................
' St r/es
Depth .................... i. Height ...................... Number of o ......................
8. Dimensions of entire new construction: Front ...... ~ ..... Rear ..... .--=:m.. ....... Depth ..... -"w. .........
Height --' Number of Stories
Size of lot: Front ' Rear Depth
Date of Purchase ........... ~ ................. Name of Former Owner .............................
Zone or use district in which premises are situated ........
Does proposed construction violtite any zoning law, ordinance or regulation: .............................
Will lot be regraded ...... .t:ff..~. .................. Will excess fill be removed from premises: Yes
Name of Architect ........ .-r-. ............... Address ................... Phone No ................
Nam f C ~-' Ph N
e o ontractor .......................... Address ................... one o ................
10.
11.
12.
13.
14.
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 ~tumber or description according to deed, and show street names and indicate whether
interior or corner lot.
(Name of individual sig~ing contract)
above, named.
(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
appheat~on that all statements cont.amed m th~s apphcat~on 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.
Swam to before me this
Notary Pubhc,' County
'r ed In Queens County . ~q~t-O~;Ed~:~L. ................
Commlss,on EXpires March 30, I_gYFi~ (Signature of applicant)