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HomeMy WebLinkAbout21378-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22377 Date JUNE 7, 1993 THIS CERTIFIES that the buildinq Location of Property 2095 RUTH ROAD House No. County Tax Map No. 1000 Section 106 Subdivision ACCESSORY MATTITUCK, N.Y. Street Hamlet Block 7 Lot 6 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 28~ 1993 pursuant to which Building Permit No. 21378-Z dated APRIL 29, 1993 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 ACCESSORY STORAGE BUILDING "AS BUILT" The certificate is issued to KONSTANTINOS & MARIA DIAKOYASILIS (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A ' Buildin~ I-ns~ector - Rev. 1/81 I"O~~M' ~0. I TOWN OF SOU]HOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT Cr'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~N'.° 2]378 Z _ . ~ /-- ,~ ~ / ~Y , P / ,/.,.,...,'"' · .~..~...~....~....~....././....~ '~., . .......... ........ ................................... .................................................. m..~f...~.....~., ...... /..z..~..~.....~_ Coun,¥ To,, ~op No. ~000 S.c,,o,~ ..... ./....~.~ ...... B,~,~ .......~... .......... Lot No....d.. ............... ,,ur,uon, ,o opp,,c°,,on do,~ .~ ........... .,.¢...~ ........ , ,,.~ ,,,d opp,-o,,e~ b,, ,",e Building Inspector. Building Inspector Rev. 6130/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR 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: 1. 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. 4. 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 responsible 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: 1. 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 - New dwelling $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-existing Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ~. '~...~..~....~ New Construction....~..... Old Or Pre-existing BuilJg...~...-- ................. i House No. Street Hamlet Onwer or Owners of Property. . ~. .4 .... County Tax Map No 1000, Section.o~. ...... Block ..... ~ ........ Lot .... ~ ................ Subdivision .................................. .. Filed ~ ~a, ........... . Lot ...................... Permit No.~...~..~...Date Of Permit.~ ~.~.~ ~pplicant .......... Health Dept. Approval.... .... ... ,..............Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $.~..~Y..~.~..... APPLICAIqT UNDATIO:! ¢2nd) BOUGH FRAME & ·PLUMBING ~SULATION PER N. STATE ENERGY CODE FI;;AL ADD/TIO~A'L COMMENTS: ,occup~ Us[' ls u~ WITHOUT OF OCCU~ Nature of work,(cfieck which applicable): New Building . ~..%~.' .... Addition ......... Alteration .... ; ..... Repair .............. Removal .............. Demolition ..... : ......... Other Work ........... .a' D.Q . ..., (Description) 4. EstimafedCost ....... /./.CP. 9. m ................. Fee .. ~.~....~. ................... f dwelling, number of dwelling units (to be paid on filing this application) 5. I ..... ,'~.x'F-J ..... Numberofdwelhng umts on each floor ...... · Ifgarage, numberofcars ....... .?I//.~. .......... .' ' . . ..,~.-.-.-.-.-.-.q~..z(.~... 6. If business, commercial or mixed occupancy, specify nature and extent of.each type of use ' ' ' ' ' lmenslons ol existing structures, , ..... if any: Front ............... Rear .............. Depth. Height ............... Num her o f Stories .............. Dimensions of shine structure with alterations or additions: Front ...Z ~..~c..~. ...... Rear .... Depth .... ; .... /. $. ~: .~. .......Height ..... /O1 ~.Z? ..5~..~ ....... ....... ;.. Number of Stories ....,.~. .... '. 2..~ ...... 8. Dimensions of entire new construction: Front .... / 57..r?(~-~... ~ Rea ..... /..Y..,~. ~. Depth '--' ' ' Height . .. ~../.0.~. ' .,~... Number of Stories ........ .~..~ . ~ ...... /"~'~ ....... 9. Size of lot: Fro'hr Rear ............... ...................... Depth ...................... 10. Date of Purchase ......... 11. Zone or use district in which premises are situated ................................ · .......... ' ......... Name of Former Owner ............................ 12. Does proposed construction violate, any zoning law, ordinance or regulation .... ) ' ............... 13. Will 16t be reeraded . t//,. : .................... .......... t~' ~" ................ WHI excess fill be removed from premises:/F/t~ Yes ..... 14. No NNameo[?w.n.e~rofprem~es fYJt~.~../~.~?o~;n.~adress ~.~..~"2.~q~/n ./.*:4 Ph~,,~M,, Name of Contractor (~ O~'r.~5 ............... ¢~,ress ................... Phone No ......... . · v.._ .................... ~aa . '': .... 15.' . . · ress ................... I.s thxs property w~th~n 300 feet of a tidal wetland? ,v^ ~.Phone,No ................ · . *If yes, Southold Town Trustees Permit ma" ~ ' ~?s.; ...... no..t~f. .... ' y ue requ~rea. ' .... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. G' we street and block number or description according to deed, and show street names and indicate whether interior or corner lot. 3rATE OF NE,W~O~ 1// _ _ ' ' ' :oum;¥,or .... . ..... ....... '.. ........ being d'ly sworn, deposes and says that he i; ,he applican, (Name of individual signing contract) .bove named. leis the....... ................ 0(~ (C or, a ffi ) .............. ontract gent, corporate o cer, etc. f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this >plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the · ork will be performed in the manner set forth in the application filed therewith. worn to before me thi_so a ~ __ , ...... Notary Publlo. State of New Yo~k . No. 487950~5 ' ' · - · .. Qualified in Suffolk County Commission Expires December 8, 19~,~. (Signature of applicant) Examined ............... ,1r. Approved . . , 191 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ~. Pc)mit No. ,Disappr?ed. a/c BbARD ~ 0~'~ HEALTH 3 SETS OF PLA?~S SURVEY CHECK .._._ .... ~ ......... SEPTIC FORH NOTIFY | CALL FLAIL TO: (Building Inspector) APPLICATION FOR BUILDING'PERMIT Date. gt~At'./..2,..~. ..... , 19 INSTRUCTIONS a. Tkis 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 0f lot and of buildings on premises, relationship to adjoining premises or public sfi'eets or areas, and giving a detailed desciiption of layout of property mu~t be drawn on the diagram which is part of this appLi- cation. ' o. ' The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this applidation, 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 occupi{d or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Build!ng Inspector. A PLICAfiON IS HEREBY M{LDE 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 housin code and reoulafions and a ' . · ~ .... g , = , to dmrt authomzed inspectors on premises and m budding _ for necess//,cinspectiona~ . ... (Signature of applicant, or name, if a corporation) (Mailing address of applicant) / State whether applicant is owner, !essee, 'agent, architect, engineer, generai contractor, electrician, plumber or builder· Name of owner of premises ... &,./~O/~'. 5.7'-,~./.~. yT]. rl/O ...C i (as on'the tax roll or latest deed) If applicant ' . . is a corporatmn, mgnature of duly authorized officer.' ; (Name and title of corporate officer) B llder s License No ..... (~..0(/./(.~.t~. ' Plumber's License'No. .~./:a~..~.C' .~ ......... Electrician's License No. . ./~2/atE..4~.~.~. .......... Other Trade's License No..../19.L~./~..~'.~. .......... Location, of land on which proposed work will ~e 'done .... ,9.. ~ fff~....~O:.,~... ..' ./f"~. · ... .. .~f~'/..~ .2Z/~..'.. .,~.;...... ltouse Number Street Hamlet Cou'nty Tax Map No. 1'000 SectioH ............. Block .......... ' Lot ..... ~ Subdivision i . ........ . ......... ~ .................... Filed Map No ............... Lot ............... (Nmne) State existing use and occupancy f premises and intended u~ and occup, ancy of proposecL onstruction! a. Exlstmg use and occupancy ..i.'...'.6;'f~...~ ~ .in eauseanaoccupancy .~...D./7..(,c..O. ...... ....~/.~ ~...~..... '