HomeMy WebLinkAbout16049-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z17578 Date DECEMBER 8, 1988
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Propert~ 310 THE STRAND EAST F~kRION
House No. Street Hamlet
County Tax Map No. 1000 Section 21 Block 05 Lot 05
Subdivision PEBBLE BEACH FARMSFiled Map No. 6266 Lot No. 135
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 18~ 1987 pursuant to which
Building Permit No. 16049Z dated JUNE l0t 19B7
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 ONE FAMILY DWELLING~ ATTACHED GARAGE AND 2ND STORY DECK.
The certificate is issued to NICK THEOPHILOS
(owner, ~)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 87-S0-97 AUG. 17t 1988
UNDERWRITERS CERTIFICATE NO. N047700 NOV. 29, 1988
PLUMBERS CERTIFICATION DATED CONSTANTINOS ZERVOS 12/1/88
Rev. 1/81
Building Inspector
~O]g~ NO. B
TOV/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)
16049 Z Date .~ .................... ,
Permission is hereby granted to:
,o ~..~~...:...~_..~.~....~~'~...~..~.~.
....~.......~......~...~~~.. ..................................................................
at premises ,oca# ted at ...... ..~..../.R~.. ......... . .~.~....,.~..../'~/;~.... .......................................................
............................. ~........~.~.,....~...~.~.....z ........................................................
County Tax Mop No. 10OO Section ........... .~..~.. ..... Block ....... ~ ........ Lot No ............ ~ ......
pursuant to application dated ............... ~...J...~. .................., 19...~..7., and approved by the
Building Inspector.
Fee $,.~...?. '.~./..~
/ Bul~JJ/ia Inspector
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
$outhold, N.Y. 11971
765 - 1802
BLDG. DEPT.
TOWN OF SOUTHOLD
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
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. 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:
1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or
topographic features.
t 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 occupancy 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. dat d c.c. o.oo Date..U :.'9. .........
!
NewCons%ruction . .~.... Old or Pre-existing Building ............ Vacant Land .............
Location of Property -
House No. Street Ham/et
Owner or Owners of Property ~ ~ ¼~,O ~l~ -~
County Tax Map No. 1000 Section .... .~.l. ........ Block ... ~. .......... Lot...~ ......... '..
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No. . ?[ ~- .Applicant ; .~-~.] .~.Y'.~.O.%
~u% 1'7j)~8~ 27- "?TEab pt Appr
Health Dept. Approval ,. . . -............~O or De . oval ...................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate ., .N~.. .................
5:oo
Fee Submitted $
Construction on above described building and permit meets all applicable codes and regulations.
Applicant ..................... ..... ...
Rev. 10-10-78
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
$OUTHOLD, N.Y. 11971
TEL. 765-1802
CERTIFICATION
Building Permit No. I~O~Q'~-
Owner h~C~ ' ~'l'e-.O[3~"l /O (please ~rint)
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
(plumber' s signature)
Sworn to before me this
19 ' ~-~c~, d Notary Public[
Notary Public, ~]~ County
EUzABETH ANN N.E..VtLL .E. _,.
Notaw Public, State ot New
No. 52.8125850, S~ffolk CoUp~
OUNDATIO:~ ( 1 s t)
OUNDATIO:;
OUGH FR AM R~'(
?LUMBi~//
i~;SULATION PER N.
STATE ENERGY
CODE
ADDITIONA'L COMMENTS:
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION ZND [ ] IN/~ULATION
/
[ ] FRAMING [//]/FINAL
REMARKS: ~
DATE / _. ,. INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
] FOUNDATION 1ST [ ] ROUGH PLBG.
] FOUNDATION 2ND [ ~NSULATION
] FRAMING [~ FINAL /~/o
INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND ~I~SULATION
FRAMING [ ] FINAL
DATE ~//~ ~'/~"* INSPECTORULh~ ~,
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST I-~ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
[ ~j~RAMI NG
[ ] FINAL
INSPECT~~__~
765-X802
BUILDING DEPT.
INSPECTION
[ ]/~)UNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
FRAMING
FINAL
DATE /~/~/~/7 INSPECTOR _~ ~
765-1802
BUILDING DEPT.
INSPECTION
[~FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
'FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-180:3
Examined..~../~./.o ......... , 19~?
Approved..~./~.o. ......... 19 ~c. ~Permit No. /.~..~..~.~...~
Disapproved a/c .....................................
............................ ~:~ i ~.}I,dir i :i~' .......
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
Received ........... ~19...
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 applicaiion 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 shail 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 Bi~ilding 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 inspec[ions. 'l '
.~:.,d~..,~ .... c,.~.~./;:...~...~.)...
(Signature of applicant, or name, if a corporatioN)
B.~:.~.q~..¥9~5. 3. ~.~). ..~. t> .~. ,..Y.-..t.I.7.5~..
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.............. .C,..~.~ ~.R.A L..CChtx~l.~ ~C~71-Lb ~.~ ....................................................
Name of owner of premises ...~.l.C'..~.....~./.'~..~.Q?..}~J. ~..L.(~ .c~ ............................................
(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..J?.) .~..~.~..'.~. !q. :)~ .........
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
1. Location of land on which proposed work will be done .... .~. ~..~?..I..~....~..~.[~.C:~.~.-...~'.~..~.. ~..~ ..............
. .-~. 1.~. ........ W.u.:... ~-.r.. A~v .... '
......... ~' ~ . .-¢..a.%T...B.~..~.t.~. N.> ~.: ./.,:. !!~.~ ...........
House Number Street Hamlet
County Tax Map No. 1000 Section .... .~..~1 ..... Block .... ~...-~. ........ Lot.. ~ .~..5 ......
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 ......... Vo-c~T. LO .~.
........................ ~. :;;:~.' .......................
b. Intended use and occupancy ................................. ., ..,: ...................... '
3. 'Nature of work (check which applicable): New Building .. .' ..... Addition .......... Alteration ..........
Repair .............. Rem'ovai .............. Demolition .............. Other Work ...............
i ~._~ V~.b~ (Description)
4. Estimated Cost J'~ .~yCl ~v~.,. ~.O. Fee
'~ (to be paid on filing this application)
5. If dwelling, number of dwellin~ units.. . .a~) .... Number of dwelling units on each floor ................
If garage, number of cars .... i' .L Cow .............................................................
6. If business, commercial or mix{d 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 ...................... Numbet' of Stories .......................
8. Dimensions of entire new construction: Front ~ } ~ ..... Rear . ..,5.~.~. 9.0. ......Depth . .q ~[.~.
Height , .3.5. ?. ........ Number of Stones ........... ~-
10. Date of Purchase .......... ~ ................... Name of Former Owner .............................
11. Zone or use district in which ptemises are situated.. [~.I~.Ip.E..t~./4q¼ ......................................
12. Does proposed construction violate any zoning law, ordinance or regulation: . ~/D ...........................
13. Will lot be regraded .... ~'i .................... Will excess f~ll be removed from premises5. , Yes
14. Name of Owner of premises ~i~T. ~.~ .~..0.%. Address ~..fi'/g3...~.,q.o¥) .k4.¥,. .... Phone Nc~/.gJ. 7.t/.g.-.B.Y.~. .D...
Name of Architect ......... ' .................. Address ................... rhone No ................
Name of Contractor ~ .B.ff~. 7~.'q'~.~..0. 3 .......... Address ~.,.~,.6q~..::tD .z ........ rhone No. ~.:~B :~52L(~ .....
pLOT DIAGRAM
l,ocate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
LOT
¥
STATE OF NEW YORK,
COUNTY OF .................
............................ ' ......... : ........... being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the ..................... ....................................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is d~ly authorized to perform or have performed the said work and to make and file this
application; that all statements cofitalned in this application are true to the best of his knowledge and belief; and that the
work will be performed in the man,er set forth in the application filed therewith.
Sworn to before me this :
No. 4707878, ~U~bq (Signature of applicant)
Tern Ex~r~ March ~ xv,-,,~