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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCDPANCY
No Z-22902 Date MARCH 14, 1994
THIS CERTIFIES that the building ACCESSORY
Location of Property 16855 MAIN ROAD BAST MARION, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 23 Block 1 Lot 14.7
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated OCTOBER 20, 1989 pursuant to which
Building Permit No. 18586-Z dated OCTOBER 20, 1989
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is
issued ie REPAIR EKISTING ACCESSORY BARN AS APPLIRD FOR
The certificate is issued to CONSTANTINS IOANNOII
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
L1 ~
Building Inspec r
Rev. 1/81
I
F08M NO. A
TOWN 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)
1586
Nfl Z Dare ..~.~it~.Y^c'1~4,..,5~'0 19~~
Permission is hereby grantend to:
.1...~:!:~.-.....-~...lt-wwn eau.
ct premises located at . ~0,8 S 5.....~cLw.....~ °~.a'.: ~ r.~1........,.........
County Tax Map No. 1000 Section .....f~...?,,.n~...... Block .....~..~.........QLot No....~.~1::1..........
pursuant to application doted ...~..G!.°.`~!`.:~-...~4 19...1., and approved by the
building Inspector.
Fee $..r~~
Building Inspector
Rev. b/30/80
~ i. Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. 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.
B. 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 Buildine - $100.00
3. Copy of Certificate of Occupancy - ,520.00
4, Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Cormm~ercial $15.00
Date .........:~/~~~y,T
New Construction........... Old Or Pre-existing Building..,,,,,,,,,,
Location of Property... 13:4.-S~ ~ST
/ ,~it~;t'/csa~
House No. Street Hamlet
Onwer or Owners of Property........~9'.dS7lJ,.?~1~/,~...:~d?9:~'~°~ . . . . . . . . . . . . .
County Tax Map No 1000, Section...~~`~.......B1ock....Q~ .........Lot.....« ~
Subdivision ....................................Filed Map............Lot......................
Permit No.. ~!S~.~P,~, , , , , ,Date Of Permit. QCT .~?/~!...Applicant ~,i9~,!'Sr7~t:?.T,?n/r,, , , ~d?1.~/.vc~[.t
Health Dept. Approval........ .............Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate....~ „
Fee Submitted:
CCU ~,o(~~~~V APPLICANT
:1~LDrIGS,~C::u;J ~~u„:E ;;o~KM~Nre
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_ H
OUNDATI0:1 (1st) ~ _ ~ aj
?OUNDATIO,d ~
(2nd) _ _ m
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2.
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?OUGH FRAME & ~
• U,
PLUMBING ~
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m
n
I17SULATIOf1 PER N. Y. y
STATE EPIERGY
CODE
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y
I
FI;IAL
• I o
ADDITIONAL COMMENTS: x
m
x
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F-1
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765-1802
BUILDING DEPT.
1 NSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[)FOUNDATION 2ND [ ] 1 ULATION
[ ]FRAMING )FINAL
REMARKS:
G~2!~ r ~
/ i
C 'C
DATE ~ ~ INSPECTOR
BOARD OF HEALTH
FORM No.1 3 SETS OF PLANS
SURVEY
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL
vOUTHDLD, N.Y. 11971 NOTIFY
TEL.: 765.1802 CALL
Examined . Q.. a'a., 199 MAIL T0:
Approved 19g~. Permit No. ~ .g.~~~ ~ •
Disapproved a/c
qqpp~~ ( ~
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
October 5, 1589 .
. Date
INSTRUCTIONS
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 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 Certjficate 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 of
Regulations, for the construction of buildings, additions or alterations, or for iemoval or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, bu' ding code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary ins a tick
(Signature . ap~iic,a~lt ur Hams, if a carpuranon)
16855 Main Road, East Marion, N.Y.
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractoF> electrician, plumber or builde{~.
,,,,,,,,,,,,OWNER(CONTRACTOR
Name of owner of premises , , CONSTANTINE IOANNOU
(as on the tax roll or latest deed)
If applicant is a corporation, signatux~ 4fr'duly authorized officer.
(Name and title of corpor~~`~~'~'~'.
~~A
Builder's License No. not required
Plumber's License No. ,not required
Electrician's License No. not required
Other Trade's License No. none
I. Location of land on which proposed work will be dppe. ,see survey - Parn i
16855 Main Road East Marion, fJ.Y. "
House Number Sttegt . . . ....................1-larnlet ,
County Tax Map No. 1000 Section ..?3'1-14: 7...... , , , Block xx
Lot
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 BARN
b. Intended use and occupancy ,Same
3. Natpure of vXXk check whicRe anpplicable): New Building Addition Alteration .
(
' Re air xx , , , , oval . Demolition Other 1Vork ,
(Description)
4• Estimated Cost..~1,500 Fee
(to be paid on filing this application)
5. If dwelling, number of dwelling~units ,none. , , , , , , , , Number of dwelling units on each floor ,none
If garage, number of cars ....none
6, If business, commerctagl or mixed occupancy, specify nature and extent of each type of use none
7. Dimensions of existin structures, if any: Front ....5Q • Rear 50........... Depth , 30
Height ..12........... Number of Stories .Qllt
: .
Dimensions of same structure with alterations or additions: Front , samei , , , , , , , , , , , Rear ,same. ,
Depth, same ,,,,,,,,,,,,,,,,Height, same ,,,,,NumberofStories, one
8. Dimensions of entire new construction: Front ,same . , , , , gear , ,same , , , , ,Depth ,same : ; '
Height . same.......... Number of Stories .one .
9. Size of lot: Front .
10. Date of Purchase 12; 15. ,81, ~ ~ Rear • ; Name of Former Owner ~drl es .Rand . ~ . ~ " " " " " "
1 1. Zone or use district in which premises are situated ,R,-2, , , , , , . , • . .
12. Does proposed construction violate any zoning law, ordinance or regulation: @X'FSti ng •S ~Y'uGtiUre • • .
13. WiII lot be regraded . n9 : ...................Will excess fill be removed from premises: Yes No
14. Name of Owner of premises.G4pstdptine,IoannouAddress105.Beyerl,Y,Rd;DougphoneNo.718;545-3131
none
Name of Architect / ..:.....Address ...................Phone No............... ,
Noma of Contractor .Owner, contractor, ,Address same , , ,phone No. same
15.Ia this property located within 300 feet of a tidal wetland? *YBS....NO.XXX.
*If yes, Southold Town Trustees 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.
PROPOSED WORK TO REPAIR/REBUILD EXISTING SHED TO THE SAME DIMENSIONS
OF EXISTING. (SEE ATTACHED SURVEY DATED 11-29-82.
RPPROYED AS NOTED
DATE: ~ o ao a'9 B,P a 81~(0_~
NOTIFY BUILDING DEPARTMENT ~j
765-1802 9 AM TO ~S a~M FC~Fs , s-a E.
FOLLOWING INSF'Ef.T1C}:v,9
t. FOUNDATION 'fW0 REOlJJS3et)
FOR POURED CONCRETE ,
2. ROUGH • FRAMING Z9'~ PI_UM81NG
3. INSULATION
4. FINAL - CONSTRUGTIONtNt15T `:nF~;~~
BE COMPLETE FOR C.G~
ALL CONSTRUCTION SMALL MEET
THE REQUIREMENTS OF THE N.Y. OCCUPANCY OR
STATE CONSTRUCTION ENERGY USE IS UNLAWFUL
CODES. N(TI' RESPON~uIBLE FOR
DESIGN OR CONSTRUCTION ERRORS 1N~ O~ UOC~upTl TE
O IC~ ~
STATE OF NENew York $.S
:OUNTY OF .
CONSTANTINE IOANNOU
' ' ' ' ' ' ' • of i • i • ~ • • • • • • • • • being duly sworn. denases and saes that he is the applicant
N_me rdividua. si;niieg contract)
bove named.
fe is the ,CONTRACTOR
(Contr~etpr, agent, corporate officer, etc.)
F said owner or owners, and is duly, authorized to perfgrm qr have performed the said work and to make and file this
~plication; that all statements contained in this application ql'C true tq the best of ltis knowledge; and belief; and that the
ork wilt be performed in the manner'set forth in the application filed therewith.
vorn to before me this I
........6th... .day of .',,.October 19 89.
~
otary Public, , . , County Queens
t)IALECTE CQSTA
Notary Publio, State t?f New York
No. 41.4883589
~uallfi®d in 4ueona Count~( (Signature of a licant
Commieslan Expires 5?- 90 PP )
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