HomeMy WebLinkAbout20514-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22428
Date JUNE 30~ 1993
THIS CERTIFIES that the building
Location of Property 3175 STARS ROAD
House No.
County Tax Map No. 1000 Section 22
Subdivision
ADDITION
EAST MARION~ N.Y.
Street Hamlet
Block 2
Filed Map No.
Lot 21
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 25r 1992 pursuant to which
Building Permit No. 20514-Z dated MARCH 31~ 1992
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 ATTACHED GARAGE & OPEN BREEZEWAY ADDITION TO EXISTING ONE
FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to
of the aforesaid building.
JOHN P. SGOUROS
(owner)
SUFFOLK COUNTY DEPARTMENT OF HEAL~ APPROYAL N/A
UNDERWRITERS CERTIFICATE NO. N-280052 - JUNE 16~ 1993
PLUMBERS CERTIFICATION DATED N/A
~Buildin~ nspec
Rev. 1/81
FOB, B~ NO. !
TOWN OF SOUTNOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N- N? 20 l Z
County Tax Map No. 1000 Section .... ...~...~ ....... Block .............. ~...... Lot No....~ ............
pursuant to application dated ........ ~ ~~ ......................... ,
Building Inspector.
19..~.~d approved by the
Re~ 6/30/80
Form No. 6
TOWN OF SOUTIIOLD
BUILDING DEPARTMENT
TOWN ~ALL
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. Coramercial 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 Certifidate 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 - $i00.00
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-existin~qg Buildin~ ...............
Location of Property...~ZZ~... ..........
House No. Street Hamlet
Onwer or Owners of Property.. . .....................
County Tax Map No 1000, Section...~....'f.....Block ................ ~ Lot...~.J ....
Subdivision ................................... · Filed Map .......... .. Lot ......................
Permit No.. .. ..Date Of Permit ....... Applicant ~ ..~ ......
Health. Dept. Approva~ ............ .............. Underwriters Approval .........................
Planning Board Approval .................... .. ..
Request for: Temporary Certificate ...... Final~Certicate.
Fee Submi:ted: $ .... .~.. .................
.............
THE NEW YORK BOARD OF FIRE UNDERWRITERS
[~'/~ SUREAU OF ELECTRICITY
[~ BS JOHN STREET, NEW YORK, NEW YORK 10038
Date
THIS CERTIFIES THAT
in the following f.cation; [] Basement [] I st FI.
t~sexamlnedon ,'~[~[~ 1{~ ~ I993
[] 2nd FI. ~)~/O[}~J~ Section Block Lot
and found to be in compliance u'ith the req.lrements Qf this Board
RANGES , OVENS EXHAUST FANS
OTHER
TIldE CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS
SYSTEMS
HO. OF FEET
SERVICE DISCONNECT
OTHER APPARATUS:
S E
NO Oi~ERCC~COND
AWG,
OF CC, COND
~ c E
NO OF HI-LE~ A W O, NO OF NEUTRALS
OF H~-t EG
OF NEU'[RAL
P.O. gO~ 1268
GENERAL MANAGER
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
INSPECTORS
Victor Lessard
Principa! Building Inspector
Curtis Horton
Senior Building Inspector
Thomas Fisher
Building Inspector
Gary Fish
Building Inspector
Vincent R. Wieczorek
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector
Telephone (516) 765-1802
OFFICE OF BUILDING INSPECTOR
TOVv'N OF SOUTHOLD
SCO'IT L. HARRIS, Supervisor'
Southold Town Hall
P.O. Box 1179, 53095 Main Road
Southold, New York 11971
Fax (516) 765-1823
Telephone (516) 765-1800
19, 1992
WILLIAM T. CONWAY
P. O. BOX 1902
SOUTHOLD, NY 11971
RE: JOHN P. SGOUROS
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
xxx An application for Certificate of Occupancy is
not on file. {Enclosed)
xxx No Underwriters Certificate on file.
The check is fd~not on file.)$25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT 9. 20514-Z
Please contact our office on this matter.
cooperation.
Thank you for
SOUTHOLD TOWN BUILDING DEPT.
lID,:,? ~ il :Ju;'ff¢,i£,vT£
FOUNDATION (1st)
?OUNDATION
2.
(2nd)
ROUGH FRAME &
.PLUMBING
INSULATION PER N.
STATE ENERGY
CODE
ADDITIONAL COMME~ITS:
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING
[ ] FINAL
DATE
765-1802
BUILDING DEPT.
INSPECTION
[~/~OUNDATION 1ST [ ]' ROUGH PLBG.
[/FOUNDATION ZND [ ] INSULATION
DATE
INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] F~DATION 2ND [ ] INSULATION
[//]' FRAMING [ ] FINAL
· /
REMARKS. ~
MAR 2 ? Igg2
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING OEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.; 765-1802
Examined ..... 19 .~..~T.
......
Disapproved a/c .....................................
(B~ding In~/c4tor)
APPLICATION FOR BUILDING PERMIT
BOARD OF IIEALTll .........
3 SETS OF ?LA:tS ..........
SURVEY ...................
CllECK
HAIL TO:
Date ................ , 19
~ INSTRUCTIONS
a. Tiffs application must be completely filled in by typewriter erin ink and submitted to the Building Inspector, with 3
:ts 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
r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
:tion.
c. The work covered by this application may not be Cbmmenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit
'.a/l 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
all 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
filding Zone Ordinance of the Town of Southoid, Suffolk County, New York, and other applicable Laws, Ordinances or
-'gulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
~e applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
mit authorized inspectors on premises and in building fo~ necessary inspections.
(Signature of applicant, or nam~Ji~ ~ 'c~-t;t;ia~'o'n') ....
(Mailing address of applicant)
ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builderJ
.........
' ..................................................
(as on tlie tay roll or latest deed)
~pplicant is a corporation, signature of duly authorized officer.
amc nd title of corporate officer)
~Ider's Lice.se ~o ..... !35.~.~ .... .~. t ......
Plumber's License No .........................
Electricia,n,',s License No.
Other Trade's License No ......................
Location of land on which proposed work will be d~'~'e
5/7 ~ ~1~ '~ ~ ~ ' ,
..................... ~ &~s~ ~..
~ouse Number Street Hamlet "
2oonl7 Tax Map No, I000 Section ..... ~¢ ......... Block .... .~ .... Lot ~ (
;ubdivision Filed Map No.
(Name) ........... Lot ...............
;tatc ex/sting use and occupancy of premises and in tended use and occupancy of proposed constrnction:
· ~xJsling USC a~d occupancy
Intended use and occupancy .. ~..~ .
· ' · Addition
3. Nature of work (check which applicable): New Building ......
Repa/r .............. Rcsl val .............. Demolition' . .......... \Iteration
~ ............. Other Work ..... . ...........
l¢. '
4. Estimated Cost ..... ,z .. esc t~on)
· I (tol,epaid',;,;~ii;;.'t;][' '5''7 .......
5. If dwelling, number of dwellin- ~nlt~ x apphcatmn)
If garage number of car~ I 4 ~ ...... unlbcr of xvt ling till tS on each floor
..... 4- q-~ .'C. .........
6. If business, commercml or mixed occnpancy, specify nature and exit' ' , '
7. Dimensions ot'exis*: ....... ~ .~ ,.,, . n of each ty~e of nsc ..
.... ~, ~,-s~tmt:mrcs uany Frol t .':-t.~. .... lb. ,r ~4'q ' ' , ..... :. ....
ne ~t .~.o. ...... . . ' '''
g ........ Nu ~ber ot'Sf,~ries ~_9 ................. Depth...~] ....
Dimens'ons of same sim,- .... '- . '7 ' "~ .................... ' ' '
n~,,,~, o. / t ..... wt!n a~terattons or additions: Front /., -7 ' ' '.~ .....?' ~; > ...........
· -,~v,,, .....~.,. He' * 0,~., · . · ~..'. · · · ~qear ~a .r. .
· . ..... . ~t.t ........ .r...} ........ Nt~lberofStor/es. ~ ....
iii. ,D,n~,enstons of?n~_tjre new constnictton: Front ...~. ~.. -, - , '.,. ........
,, ~e~oltt ..... lP... · .Nun~6erofStories /.' .... l<ca: .... .~._.% ....... Depth .~./.'.. .
:, =ize oflor Front J &-o ............ .. ' .......
I0. Date of Purchase . · ....... Rear ...... /.&.p ..... Dest /.&~.,~* '
11. Zone or use distric[ i~ ~l;i~',-'~-'--''~'j- .... L''' '.' .... .Na,2_n[e o[ Fo~n. er. Owner ... :... [iii. i [ii ......
,~,, v,~,,z~ are mtuatea .... Y. CO.l~.e.~. t. 15[ ..... .
12. Does proposed Construct on viol itc any zoning law ordinance or re~,, [ .... t3 .........
13. Will lot be regraded ..... oDi ' . ~-,a:ion: ..?. ............ ilJ '''
14. Name of Owner of premises E2-O~'-' ' k'l' ":Y: ...... Will excess fill be removed from prem scs: Yes'
' ,"~ ' '~'~O~v' .~. ....Address ................... Phone No .............
Name of Architect .. ,' ..... ] .. .
Name of Contractor . ..04 O.~,,~,a'i'~ ~~, ....... ^d&ess ................... ?hone No ............
Is thi~i~roperty wi'thi~' '3~b f~e't'%¥ ~ ..... Address .~.o./.h~a' .I.q.o.~fi..,~?. !e~one No..?.~*'--~7,,X), '~
yes, Southold Tqwn Trustees tidal wetland? ',,:es ........ No..~. ..... ' ...........
Permit may be req, tired.
· "'.' i PLOT DIAGRA/vI I
Losat.e. clea~y and distinctly all buildings, whether ~xisting or propos Id, and. indicate all set-back dknensions from
oroperw lines. Ciive street and block m tuber or description accordin,, to de
.ntenor or comer lot. o e~, and show street names and red,cate whether
'ATE OF NEW YORK,
~UNTY OF.. i ........... S.S , .
(Name of individual s ~(~)flg cb~ tract) .... being duly swo~ a, deposes ahd says that he is the applicant
,renamed. .. i '
is the '
corporate · ·
:aid owner or owners, anti s dul out'lot z '
Itcation. tba' '," .......... ~ , ~d to perform or have perfom~e{[ the said work t * ......
a id ,u make a~o file this
. , -,, ~-,c,-ents toni.undo ~m tins application are true to the bes: of bis knowledge and belief; and that the
k will be perfo~ed in the manner set (orth iu the application filed therewith
,m to before me this
............. ~ ..... day of...~. 1o ~
.. , "' .......