HomeMy WebLinkAbout16677-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. ZI6762 Date April 1, 1988
THIS CERTIFIES that the building .C.h..i.m.n.e. y .......................................
Location of Property 2745 Peconic Lane Peconic
House No. Street Ham/et
County Tax Map No. ]000 Section . 9.7.4, ....... Block ...0.5 ........... Lot . .9.: .2 ............
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
..... D.e..e ....9. ,...I .9.8. 7.... pnrsuant to which Building Permit No.. ] .6 .6.7.7. ~ .............
dated D e c. 16, 1987 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 .........
Construct: a new chimney as applied for.
The certificate is issued to GItORGI~ KOKKII~IOS
(owner, Yo~ Y~Y~,~OX X
of the aforesaid building.
Suffolk County Department of Health Approval Iq/A
UNDERWRITERS CERTIFICATE NO. Iq/A
PLUMBERS CERTIFICATION DATED: N/A
Rev. 1/81
TO%VN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PEPJV~IT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N~_16077 Z
Permission is hereby granted to:
~....J...~~,......~.:~.,. ....... ~).~.~. .............
at premises located at .... ~',.. .~.. ~ .....................
County Tax Map No. 1000 Section ...... ..C},.,,~.,..~. ...... Block ..... ..~.....~.. ....... Lot No...?..~..~. ..........
pursuant to application dated ~.~....~. .............. , 19.~...~., and approved by the
Building Inspector.
Fee $..,'~....:.,'~.
Building Inspector
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Ha~l
Southold, NoY. 11971
765- 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted ... ~ 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.Approva~ 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:
1. Accurate survey of property showing ail 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.
C. Fees: Additions $25,00 POOLS $25.00
1. Certificate of occuDancy 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 $10.00
4.Vacant Land C.O. $ 20.00
5. Updated C.O. $ 50.00 Date.· .'~/.'~..~../ .g.~. ..........
New C on ,~ i; t~ u c t i o n ...... Old or Pre-ex isting Building ............ Vacant Land .............
ocat on of Property ....
Street Namlet
Owner or Owners of Property ...~..~.. J~,(¥"~' ........ ~-'~;~'~'~'fl''/~j'' 0..~ .............
County Tax Map No. 1000 Section 2.L¢:-~ Block ...~.'... ..... Lot. ?.~.
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No~'.. Dare of Permit ........
·
Health Dept. Approval ........................ abor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $ .............................
Construction on above described building and permit meets all applicable codes and regulations.
Applicant .... ~' ~.~',~-~. ,~ .~~. ........................
10-10-78
UNDATION ( 1 s t)
UNDATION (2nd)
UGH FRAME &
FLUMBING
SULATION PER N. Y.
STATE ENERGY
CODE
ADDITIONAL COMMENTS:
CERTI.FIED TO:
CO,'~MONWEAL. TH LAND TITLE
INSURANCE COMPANY
CEORGE KOKKIiVOS
SURVEY OF
PROPERTY
· AT P£CONIC
TOWN OF SOU THOL D
SUFFOLK COUN TY~ N.Y.
1000-- 74 -' 05 --9.2
.SCALE I''=
APR)L 24~ 1.9~7
3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ..........
Repair .............. Removal .............. Demolition .............. Other Work. /.'~.g rD. ~.~.~...
(Descripgion)
4. Estimated Cost ........ ~.~.%..T)~.. ..................... Fee ......................................
' (to be paid on filing this application)
5. If dwelling, number of dwelling uuits ............... 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 ............... Rear ............... Depth ...............
Height ............... Number of Stories ........................................................
9. Sizeoflot: Front ...................... Rear ...................... Depth ......................
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 ............ .~ .............. Will excess fill be removed from premises: Yes No
14. Name of Owner of premises ~0L~2. ~oiC. ~.t ~..r).~. Address . ~A~gvl.~ ¢. L~'~ .~.~.. Phone No...~. 6
Name of Architect ........................... Address ................... Phone No ................
Name of Contractor .......................... Address ' . Phone No ................
15. Is this property located within 300 feet of a tidal wetland? *Yes ..... No .....
*If yes, Southold Town Trustees Permit maybe required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back d/mensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF NEW YORK, S.S
COUNTY OF .................
..... G:~%'~./~......~. ~./?.(..~?.2 ................... being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract) ; ........................_ .._
· d"-/-- .....
He ~s the .... ~..~ .................................................... ..,. , ..............
(Contractor, agent, corporate officer, etc:).,
of said owner or owners, and is duly authorized to perform or have performed the sh~id work and to make ~ihle this
application; that all statements contained in this application are true to the best of hiJ lrmwledge anct'p~elief;.~ ~hat the
work w/ll be performed in the mm~ner set forth in the application filed therewith.
Sworn to before me this
........ .~..~. ............ day of. ~ ....... 19
UNDA J, COOPER / .......
Notan/Publlo, State of NOw Ym'k md./ (Signature of applicant)
No. 4822563, Suffolk County
Term Expires December al, 19
Examine..0%~....[Y~... }.~, 19 .~..'7
'FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N.Y. 11971
TEL.: 765-1803
BOARD OF HEALTH ......
3 SETSi OF PLANS .......
SURVEY! ..........
SEPTIC!FORM .............
NOTIFY!
CAL ! .....
MAILi TO:
I¢.7. 'e=it No. !7%
Disapproved a/c .....................................
'" . '
(Building inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
~Date ................... 19...
a. This application must be completely filled in by typewriter or in ink and subm!tted 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 th'adjoining premises or public streets
or areas,~ and giving a detailed description of layout of property must ke drawn on t~p diagram which is part of this appli-
catiom
c., The work covered by this application may not be commenced before ~ssuance of Buildmg Permit,
d. Upon approval of this application the Building Inspector wilt issued a ~uildingl~ei'mit_ . ,, , , 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 purpdse wh{teverruntil= a Certific'ate of Occnpancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuancei 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 premmes and m building for necessary inspections. :
(Signature of app!icant, or name, if a corporation)
(Mailinlg address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
(as on the tax roll or latestideed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of co~orate officer) ,
ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY
Builder's License No .... .57. ~ ................
LICENSED
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
1. Location of land on which proposed work will be done[ .................................................
House Number Street Hamlet
County Tax Map No. 1000 Section .'?.~.~ - O 5' ~2.- Block i Lot...
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.. ..... . .... · ......... ................. i' .............................