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Home My WebLink About22833-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23845 Date SEPTEMBER 1, 1995 THIS CERTIFIES that the buildin~ ADDITION Location of Property 2125 KENNY'S ROAD SOD~HOLD NY House NO. Street Hamlet County Tax Map No.,1000 Section 59 Block 7 Lot 9 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 2, 1995 pursuant to which Building Permit No. 22833-Z dated JUNE 2, 1995 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 A DH~K ADDITION ON THE REAR OF A SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to GEORGE & DIONYSIA GEORGILAKIS of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 N/A N/A N/A Buil'd~ FORM NO.$ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNtiL FULL COMPLEtiON OF THE WORK AUTHORIZED) ~o,~ ........... ~~.,':,.~. .................... ~..'" 22833 Z CounlyTaxMap No, 1000 Section ......... . ..~......~'.,... Block ........... ~ ......... 'iot No......~.,. ................... Building Inspecto.9~ Fee $,,Z,~,,. ............. Rev. 6/30/80 Building Inspecf~f Form ~o. 6 TOWN OF SOUTUOLD BUILDING DEP ARTHENT TOWM HALL 765-[802 APPLICATION POR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building or new use: l. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate.of Code Compliance from architect or engineer. rssponsibla for the building. 6. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: [. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C, Fees ' 1. Certificate of Occupancy - Ne~ d~elling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00. Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-exist[hZ Buildin~ - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00-, Commercial $15.00 Date ..................... New Construction....~. ...... ilM~jOld~Or Pre-existing Building ........... , ..... ~ocatio,~o~Proper~y .... a~:~.~...~.~.~.~'~..~.' ..... o.o.m~.~,..~:r,_ _ ................. House No, ' Street Hamlet o~ Pro,erty.-~¢~q.~.~ .... :.~7~,.~..6:C.0.~.~.~.~.~ .............. ~ubdivisio. .................................... Fi lcd iqup ............ Lot ...................... ~,er,.it ,o.a~.a?3. Z...,ate O~ Permit ........ .~.)~/~.r ..^mi~::,,t..&~.°.~.F. 0~0: ~ ~W.~-~''" .... ilenJ, th Dept. Approval .......................... U.derwriters Approvul ......................... 'isnning Board Approvoi ........................ 2equest for: Temporary Certificate ........... Fiu;tl Certicate...~/.~-.- ...... Tee Submitted: FInD INSPECTION REPORT , DATE CO~ENTS II INS~.~TIO~ PER ~. STATE ENERGY ]] . . -II · ADDITIONAL CO~4ENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] RO~PLBG. [ ] FOUNDATION 2ND [, ]/~SULATION [ ] FRAMING [ z/] FINAL [ ] FIREPLA/~& CHIMNEY REMARKS: ~.~_..*~/_~ ~ _~ DATE INSPE Approved l)isapprove¢. PORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL, SOUTIIOLD, N.Y. 11971 TEL.: 765-1803 ] SETS O-F PLAHS S U R V E'Y" '~ ................ CIIECK ......... : .......... SEPTIC FORtl tlOTl py } CALL H^IL +0; ' '' JUN - 5 199'5 ' INSTRUCTIONS a. This application must'be completely filled in by typewriter or in ink and submitted to the Building Inspector, with sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing lpcation of lot and of guildings on premises, relaHonship to adjoining premises or public st}eets or areas, and giving a detailed description of layout of property mn~t be drawn on the diagram which is part of this appli- catiou. c. Thc work covered by this application may not be commenced before issuance of Building Permit. d. Opou approval of this application, the Building Inspector will i~sued a Building Pe~it to tbe 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 sball have been granted py the Building Inspector. APPLICATION IS HEREBY MADE to thc Bnilding Department for the issuauce of a Bnilding Permit pursuant to tbe Buikling Zone Ordinance of the Town of Soutlmld, Suffolk County, New York, and otker applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or a terations or for removal ~[ demolition, as herein described. The ap ~lica ~t agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectdrs on premises and in building for necessa~ insgections. rporation) ' ' ' (Mailing address of applfcant} State wbetber applicant i~6ssee, ·agent, architect, engineer, general contractor, electrician, plumber ( ~tbe tax roll or latest deed) .................. If applicant is a corporatioq, signature of duly authorized officer. (Name and title of corporate officer) Bnilder's License No... '/' ~/'?~" ~' .Z-'Z./. ....... Phmlber s L'cense No. Electrician's License No ....................... ther lrade s License No.., .................... Date Location of land on which proposed work will be done ................................. i ................ . . .l z . . ...... llouse Number · ~"f" llamiet" ' ....... ,Con~lty Tax Map No. I'000 Section ...: ......... Block ...... '~. · '. ,. Lot .................. Subdivision ' ' Filed Map No ....... Lot (Name) Slate existing use sod occupancy of premises and intended nse and o~cupancy of proposed construction~ a. Existing nse and occupancy . ~]~¢~ .... ~,~ }~: t~.6~8.3]J~D:~.~R~TD~ .................... .. b. Intended use and occupancy Repair .............. ~emo al ............. . Demolition . .;...: ......... Other Work ........ ~ ...... ..... (Description) 4. Estt hated Cost ...~.~f. OOO ......................... Fee ...................................... (to be paid ou fi ing t lis application) 5. If dwelling, number of dwelling Units ... ~.~ ..... .~. Number 6f dwelling units on each floor ................ . If garage, nmnber of cars .................. , ................................................ . .... 6. If business, commerc;al or m~3ed~ occupancy, specify natnre and extent of.each type of t~se .................... 7. Dimensmns of existing stmcturea if a w' Fro It &~'~ .... Rear ~ l ~..~, ~_ / ' Height ............ un erofStones .............. : .................................. Dimeusions pf s~me st~ct~e w~h alterations or adb~tions: Front ... ~ ........... Rear ...~ .......... Depth ...~J ............. ~. tleigbt ...... [~t.. ........ :.; Nmnber of Stories .... ~.'.: ........ 8 Dimensions of entire new const~ction: Front ; Rear Depth .Height ... ~ ........... Number of Stories ............ f ............................... , .......... 11. Zone or use district in which pre~nises are s?ated..~3~.~ .... .. .................. ~ ...... 12. Does proposed construction violate auy zoning law, ordinance or regulation: . ~. '...' ....................... 13. Will lot be regraded .... ~O;. ~ ................... Will excess fill be rem0v~d~rom premises: Yes 14. Name o f Owner o f premis?~~~Address~~. ~.. Phone No.7~ ~' Name of Architect .... [PP.~.~ ........... .... Address ............ ~ ....... Phoue No ............ :. . . Nmne or Contractor .~.~]. [~.~./~a'. ..... Address~ ~b~,.~.. Phoue No~ ]~.' .... [5.' ~s chis proper~y w~thin 300 leer o~ a t~dal ~If yes, Soutbo~d 'I~own Trustees Perm,S;may be required. [ PLOT DIAG~ Locate clearly and distinctly ~1 ~buildh~s, whether existing or proposed, and, red,cate all set-back dimensious from property lines. Give street and block number or descrlptioh accord~g to deed, and sbow street names and indicate whether interior or cou~er lot. STATE O F NEW ,j~O 1~.-~ ~ k ,, COUN~I'Y OF ....:~.9~'~.'~-- ..... S.S ..... ............... .. (Name of individual sigr ing contract) above named. 5~:'lle is the , . ..... .... being duly swoin, depose9 mid says that he is the applicaut (Coutractor agent, cor'porate officer, etc.) of said owner or owners, and is dn!y anthorized to perform or have performed the said work and to make and file this application; that all statements contained iu this'application are true tO the best of his ~mwledge anti belief; and that the work w~l be performed in the maun6r set forth in the application filed therewith. Sworn to before me this ............ ~ ........ ~.~ .~ ................ 19... ' ~ ~~~p~J.~ , ' 'Z ........ ' ' (Signature of applicant)