The URL can be used to link to this page

Home My WebLink About15379-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..~14~.8.8 ......... Date... October 14 198..6 Additip, n. THIS CERTIFIES that the building ............................................... .... %9.7.5 .D.c..ep.h.o.1. ,e .D.~,i..v.e Mattituck Location of Property House No. Street Hamlet County Tax Map No. 1000 Section l l 5 .Block 16 ..... Lot 22 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated Au!Just 12 19 .8.6pursuant to which Building Permit No. 15379Z datedO.c.t, ql~¢.r..8. .................. 19...8,6was 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;l~:¥.u.c.~..¢U.t.e.¥.ig.r. stairs and entrance to basement. The certificate is issued to JOHN VLASTARAS ..................... ...................... of the aforesaid building. Suffolk County Department of Health Approval ....... .N/.A. ............................... UNDERWRITERS CERTIFICATE NO ........................................... Rev. 1/81 Building Inspector FON, M NO. S TOWN OF SOUTHOLD I~UILDING DEPARTMENT TOWN HALL SOUTHOLD, N. BUILDiHG PER. MIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 i5379 Z County Tax Map No. 1000 Section ..... I.!..~..~. ........... Block ....... I...~.. ........ Lot No.....'~......'~i'.. ........... pursuant to application dated ...~.~.~..~.. ....... .[...'~... ............. , 19..~.~e, and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FIELD I~SFECTiON FOUNDATION FOUNDATION ( 2nd ) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL !IDATE iI ADDITIONAL COMMENTS: FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Instructions A. This application must be filled in typewriter OR ink, and submitted I ~ to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of properW 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~'t)perty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previDus owner as to use, occ,~pancy 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 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 $15.00 New C on s t r u c t i o n ...... Old or Pre-existing Building ............ Vacant Land ............. · ocat,on of Property.. :3.¢..7 ....... House No. Street Hamlet ¢ Owner or Ownersof Property ...~./?.~ .V.I~/.-~..~..~.~.~ ............................... County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ....... ...... . .................... Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .................... Construction on above described building and peymit y~eets all ap,olicable codes and regulations. Rev. 10-10-78 76S-Z802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS: FINAL r DATE INSPECTOR FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved 12>.~.tl~..~..., 19<~¢. Permit No. AU[; I 2 1986 [ TOWN OF '~oUTHOLD ReCeived , 1 9 Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tins 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 in~ ~r~~ (Si~gfiaturet6f applicant, or name, i~ a corporation) (mailing address or-- oli'capp icah~)) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises...~.~]/.9... ~./~S./~..~..~.~. ............................................. (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 ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ............. ~ .................................... .................. D r ...... ........... House Number Hamlet County Tax Map No. 1000 Section ...... / [~.C ....... 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 and occupancy .]~.).~.tX~../~)~>.t?..):(...~..~.~'~q.~4]~. ~P2. Tt~.~ ~p~ ....................... b. Intended use and occupancy ....~'.~F//. ~2/'7 .-~.~.. ~).6~.S .~./.~ .~7~ .............................. 3. Nature of work (check which Repair .............. Rer 4. Estimated Cost ....... .o.o.o. 5. ~ If dwelling, number of dwellin ~plicable): New Building .......... h. ddition .......... Alteration .......... ~oval .............. Demolition .............. Other Work...C~/.~....~... (Description) (to be paid on filing this application) units ............... Number of dwelling units on each floor ................ If garage number of cars 6 If business commercial or mix'ed occupancy specify nature and extent of each type'~f 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 .................. i · · · Height ...................... Number of Stories ...................... 8 Dimensions of entire 'truction: Front Rear Depth · new con~ ............................................. Height ............... Nulmber of Stories ......................................................... 9 Size of lot: Front ' Rear Depth 10 Date of Purchase ~ Name of Former Owner 11. Zone or use district in which premmes are situated ..................................................... 12. Does proposed construction viplate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ....... i ........... Will excess fill be removed from premises: Yes NO 14. Name of Owner of premises . i .................. Address ................... Phone No ................ Name of Architect ........ i .................. Address ................... Phone No ................. Name of Contractor : Address Phone No 15. Is this property located within 1.00 feet of a tidal wetland? * Yes ..... No ..... · If yes, Southold Town T~ustees Permit may be required. 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 number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S ........ /('b~a'~~h~'c'o~l;a'cli .......... being duly sworn, deposes and says that he is the applicant above named. He is the (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 application; that all statements coqtained 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 NOTARY rUBUC, S~te ot ~ yedL ................ N0. 4707878, Sufl01~ ,f~l~ ~O~2 (Signature of applicant) T~rm