HomeMy WebLinkAbout18166-z FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 218350 Date SEPT. 12, 1989
THIS CERTIFIES that the building ACCESSORY
Location of Property 295 RHODA RD. & 1875 CAPT. KIDD DR. MATTITUCK
House No. Street Hamlet
County Tax Map No. 1000 Section 106 Block O1 Lot 11
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 22, 1989 pursuant to which
Building Permit No. 181662 dated JUNE 2, 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 is ACCESSORY GAZEBO.
The certificate is issued to MARY & NICK KAVOURIAS
(owner, XXXX}OOOIXXXXX}OCX)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
l ~ill.6 V~ , ~ L.2~a,rt_.
Building Ins ctor
Rev. 1/81
xosas xa s
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)
N ~ ~ $ ~ ~ Z Date 19..
Permission is hereby gra ed to: ,
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to .G~~rG~CZ'~~...~~Z~..~.~
.~....•..~.....ur~'.?'r.~~l.~r.. i.......t..... ~ 5~.. r..l~.
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4%~~ ......................~..j.,......................................................................
of premises located at .....a`.1..~~~..n.~..t.[?.1,
County Tox Map No. 1000 Section .....,l~.s'P........ Block 1......... Lot No.....~~...
pursuant to application doted ......`:S~.~" 19.81., and approved by the
Building Inspector.
Fee
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Rev. 6/30/80
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;l~Ili~`,'1~..~-~(~~~~` `~'~~.,.~~',~~~I~ ~if TOWN OF SOUTIIOLD ~,,~~Q
~e!' St~~ _5 ~98g BUILDING DEPART2IENT p~
8....n.,_.z,..r....r,_..,_.<.... ~ ti TOWN HALL ~ 5~- 7 ~ (0~ ~Q,.
Iil.l1G.!3}:Ea'T. ~ ~ SOUTIIOLD, NEW YORK 1 197 1 j/ ~F- „
TODU!\ {~,7= S~Ji1"TI4iJ1, Y.~.,. ww,vWtk6Gtl ~ /V
~ 765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY 113
DATE.. cJ~
NEW CONSTRUCTION ~OL~ OR PRE-E%ISTING BUILDING......VACANT LAND.....__
r~ ~J//
Location of Property..... _ _ _ _
e
HOUSE NO. 4 STREET UAMLET ~
Owner or Owners of Property, . ~~T~~-y_ C-^_ ~i . ~~j~~-~,-F[~~~.~
County Taa Map No, 1000 Section ..I}!~.U/Jglock LoC
i1....
Subdivision Filed Map ........Lot.2.........
Permit No./~/~k~.„Date of Permit ~~~,.Applicant'<y.~~y~~?~
Health DepC. Approval Underwriters ApprovlalY............._ ~I
Planning Board Approval
Request for Temporary Certificate
-7 Final Certificate
Fee Submitted: ,V~~
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APPLICANT..,~~~~ G~G~~-c.`~--,=~I~/
I~-~-C/
9/~a~~9
Ca zi~3~a
rev. 10/14/88
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FORM NO. 6
' TOWN OF SOUTEIOLD
BIIILDING DEPARTMENT
TOWN HALT.
~ 765 - 1802
~ APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS
A. 'This application must be filed in typewriter OR ink and submitted to the Building
Inspector with the foll'wing; for new buildings or new use:
1. Final survey of property with accurate location of all buildings, property lines,
street
s, and unusual~,natural or topographic features.
2. Final approval of Health Dept. of water supply and sewerage-disposal~5-9 form).
3_ Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from'~Iplumber certifying that solder used in system contains less
than 2/10 of IZ lead,
~ 5. Commercial buildings, industrial buildings, multiple residences and similar,
buildings and installations, a certificate of code compliance from the Architect
or Engineer responsit~le 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" landl,uses:
' 1. Accurate survey of property showing all property lines, streets, buildings and
j unusual natural or topographic features.
2. A properly completed!iapplication, a consent to inspect signed by the applicant
and a certified abstract of title issued by a title company which shall
show single and separate ownership of the entire lot prior to April 9, 1957. •
. If a Certificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in vritin to the a licant.
g PP
3. Date of any housing code or safety inspection of. buildings or premises, or other
pertinent informatiod, required to prepare a certificate.
C_, For Vacant Land Certificiate of Occupancy:
I. An application for vacant land Certificate of Occupancy shall be submitted,
and a certified abstract of title issued by a title company showing single and
separate ownership ofithe entire lot prior to April 9, 1957 shall also accompany
the application. If is Certificate of Occupancy is denied, the Building Inspector
' shall state the reasons therefor in writing to the applicant.
D. 1:-
1. CERTIFICATE OF OCCCUPANCY - New Dwelling $25.00, Additions to Dwelling $25.00,_
Alteration to Dwe~ling $25.00, Swimming Pool, $25.00. ~ _ -
Addition to Accessory buildings, $25.00 - Businesses $50.00.
2. Certificate of Occupancy on pre-existing dwelling - $100.00.
3. Copy of Certificate of Occupancy - $5.00 - over 5 years - $10.00
4. Vacant Land Certi>icate of Occupancy - $20.00
5. IIpdated Certificate of Occupancy - $50.00
6. Temporary Certificate of Occupancy - $25.00 Residential
$50.00 Commercial
II
APPLICATION ON BACK
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rev. 10/14/S8
(.::LJ i;,S::. ._~;:i j~Dn'ir, ~ CvaKMENT°
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OUiJDATION (1st )
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OUNDATIOiJ (2nd) m
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OUGH FRAME & U ~1
PLUMBING
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IJSULATIOPI PER N. Y. y \ V`
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STATE ENERGY (\y
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U ~ t ~O ~ ~ 765-1802
BUILDING DEPT.
1 NSPECTION
[ ]FOUNDATION 1ST ( ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING ( FINAL
REMARKS:D
~~~~f `"L ~i CJ-~_ , ~
DATE ~ 2 `g' ~ INSPECTOR `
h BOARD OF HEALTH
Y D 3 SETS OF PLANS
FORM N0.1 SURVEY
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC rORM ..rc-°:_.,,,,,,,,
TOWN HALL
TOWNO SOU'fF10LD .riOUTHOLD, N. Y. 11971 NOTIFY
~ TEL.: 765.1802 CALL
Examined 19.0,7. MAIL TO : (SI - 7~ /kL4.~ , .
GG/ ~ h
Approved . G~Y 19~.~. Permit No..101. ~ (y
Disapproved a/c , //3f7
~ • !.~F2~. .
(B~ding In~tor)
APPLICATION FOR BUILDING PERMIT cy
Date 15 [
INSTRUCTIONS
a. Tltis 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 I
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, ordina,Aces, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary i ections, "
ignatur i applicant, or name, if a corporatton)
r
` (Mailing address of applicant)
State whether applicant is owner, lessee, agent, azchitect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises. v...2Z~:~~ ~~r4-2+;~ctr~.,e~ . . . . . . • , • - . -
(as on the tax roll or latest deed)
If applicant ist:'~f~po~a'fii`bn, signature of duly authorized officer.
~ ~ ~ , ~ , UACY
„„.,(Nam.e un~~itl~,,ofi Corporate officer)
~~4, f v. sr~~€ f;tr i : USE @ U LA FUL
B`&`i1`i3erts~ ~.~~'e~tse,ZVo~~'`~3j~/.Y~ ~ :./.'T. l........ .
Pltu'fri4>3~t~sl`)'~ceahs~Nq:,~..,/..~:z:~~:.::.: ! l' CE T~~C~`E
Eli~i;'t`r'Ici~3h's CYC`ense ~No: F C P C
Ot'}ier'`I`r~de's license No. .
1, LocaY~ n ~~'ita'i~~ oIj ~vhltic)t. p,roposLd"Work will be done. , ;
ei n9 ~~i4.h~ ,i
E(ou~~,~4((~~fll:+yY±t,ti.~ _ Street, Hamlet
/ r h
County Tax Map No. 1000 Section (d.S? Block , ~ , , , , , , , Lot l,~ , ,
Subdivision F.iled 1\fap No. Lot .
(Name)
Stale existing use and occupancy of premises and intended use and\occupancy of proposed construction:
a. Existing use and occupancy D K ~~?~.t.tr. f~ C ~ i F-C~
b. Intended use and occupancy .....~:C-.~~: ~?.Sd.~~c .
~~f)
3. Nature of work (check which abplicable): New Iluilding • • • Addition ~AWltefp;iptl
Repair Removal Demolition ' ~tl~>~rk „~~U(~p, .
y (C~cscription)
4. Estimated Cost B'i, Fee '
h•.
l
~ (to bo paid'on' filing thfs application)
5. If da ellin~ number of dwellin 'units , , , , , , , , , , Number of dwelling units on each floor . , , , , , , , , , , , . •
If ~ rage, number of cars .
f business, commercial or mixe
n d occupancy, specify nature and extent of each type of use .
7; Dimensions of cxistin structur'
g Fs, if any: Front .Rcar p
it Dc th........
Height Nu~ber of Stories . , .
Dimensions of same structure with alterations or additions: Front Rcar . ~ • •
Depth IIeight . . Number of Stories .
8. Dimensions oC entire new construction: Front , . Rcar Depth ~ •
' Height ,,,,,,,,Nur~iberofStories..........
9. Size of lot: Front Rear. ......:.............Depth.......................
' 10. Date of Purchase . , , , , , , , , , ,Name of Former Owner • ~ •
j 11: Zone or use district in which premises are situated . , • ~ • ~ • • • • • • • ' '
12. Does proposed construction violate any zoning law, ordinance or regulation: .
13. Will lot be regraded , Nill excess 11 ye r~r~ oved from premises: Yes No
14. Name of Owner of premises y(~,{;,I~y •Y-M%ay,(~f}s Address~~,~Q4;d,(t~(,lF:~! Phone No.. o~9g'9rrS,
I Name of Architect ~~Q . Phono No. .
Name of Contractor ~1~,g6`."•rCT ~3,okNr ~:::.iCd~~s~ ~ • • e:tgaX phone No...~~P:s f~,
15.Is this property located with in 300 feet of a tidal wetland? *YCS.. .NO....
*If yes, Southold Towt} Trustees Permit may be required.
• 'i 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 comer lot.
T/-
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AP~~yVcED A~N07ED
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•~F~ 8 I - BY: x
-~~'~~m NOTI U LDINO 0~
r It~~~E;NT AT
766-7802 8 AM 7'0 q pM fOR THE
FOLLOWING IN$RECTIONS:
. ~k FOUNDA710N - TWO R$Q(gpEp
STATE OF \E1V YORI`, ~ ~ r / FOR POUREOCONtwflETE
COUNTY OF $'S 2. ROUGH .FRAMINGA~ PWMSING
3. INSULATION
• • • • . • • • • • • • being duly swom,4leflAbtG and sggicant
(A'ame of individual signi~ig contract) 8E COMPLETE FOR C.O,
above named. ALL CONSTRUCTION SHALL MEET•
• THE REQUIREMENTS Of THE N.Y.
f Ie is the . ~ „STATE. ,CONSTRUCTION ~y . .
(Contractor, agent, corporate officcr~p91~S. NOR RES~P~OMN~$IB KOR
of said owner or owners, and is duly authorized to pccform or have performed ~fi~I~MdR~c~tQ~t~ro-iri~eE~{Qti a this
1Pplication; that all statements contained in this application are true to the best of his knowledge`'and belief; and that the
'•vor}; will be performed in the manner set forth in the application filed therewith.
~wom to belorc me this
. ....P~ .'Z'... ..day of .I'..~.~/./. 19
rotary Public, t/i1`:L County
HELEN It DE VOE
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b701878; S~~Ik
CouMy~
7ermExpiresMereh80,19....rq/ (Si nature of applicant)
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