HomeMy WebLinkAbout18195-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-18102 Date JUNE 9, 1989
THIS CERTIFIES that the building ADDITION
Location of Property 250 RAMBLER RD. SOUTHOLD N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 088 Block 05 Lot 25
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 8, 1989 pursuant to which
Building Permit No. 18195-Z dated JUNE 9, 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 EXISTING DECK ADDITION TO EXISTING ONE FAMILY DWELLING
The certificate is issued to CHARLES N. & BLANCHE COROVESSIS
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N/A
PLUMBERS CERTIFICATION DATED N/A
~O.t.. CLL
Building Inspector
Rev. 1/81
voaas xo. 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 1 ~ 19 5 Z Date ............~..u~::....q 19..A 9
Permission is hereby granted to:
a :~:I~:'
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1. A........
at premises located at ..a~..l~....~Y'~!^.~:1:4....~1.......~ti`~-!-:~,~L.~1~4~~
County Tax Map No. 1000 Section ,.....Q.g.g....... Block ......A.>~........ Lot No...3J...
p' p
pursuant to appiicotlon doted .......~...1.!~!ti3..,..A 19.~...{„ and approved by the
Building Inspector,
Fee S...w`~~.:.:.:~.....
. 9.....
Buildin Inspector
Rev. 6/30/80
,
' .i a 1~"
TOWN OF SOUTIIOLD
BUILDING DEPARTi1ENT
TOWN HALL
• SOUTHOLD, NEW YORK 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCIIPANCY
/ DATE..Jggg _6 ,1989 .
NEW CONSTRUCTION .('~./...OLD OR PRE-E%ISTING BUILDING._(_/./VACANT LAND........
Loca~°ion og property,...,..,Rambler.Road_ Southold
HOUSE NO. .STREET HAMLET
Owner or Owners of Property...S~:}P~~~,Coroyessis and Charles Corovessis
County Taa Map No. 1000 Section Q~~... B1ock05:00.._ Lot-025.000
Subdivision Filed Map ........Lot..........
Permit No. ..........Date of Permit ..........A 1' Marie Ongioni, Esq.
PP scant
as Attorney
Health DepC. Approval Underwriters Approval..............
Planning Board Approval -
Request for Temporary Certificate
Final Certificate
Fee Submitted: $
APPLICA}`YT..
MARIE~ONGIONI, ~as ~ttorney
37 H 6 0
Co IS 16,2
reV• 10/14/88
Li•
~ FORM N0. 6
~'~I TOWN OF SOUTEIOLD
BIIILDING DEPARTMENT
TOWN HAL
.
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS
A. 'This application must ble filed in typewriter OR ink and submitted to the Building
Inspector with the follgwing; for new buildings or new use:
1. Final survey of property with accurate location of all buildings, property lines,
streets, and unusualnatural or topographic features.
2. Final approval of He~lth Dept. of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement fromi,plumber certifying that solder used in system contains less
- than 2/10 of IZ leach
5. Commercial buildings; industrial buildings, multiple residences and similar.
buildings and installations, a certificate of code compliance from the Architect'
- or Engineer responsilile 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, buildings and
unusual natural or topographic features.
2. A properly completedilapplication, a consent to inspect signed by the applicant
and a certified abstract of title issued by a title company which shall
show single and sepaz~Ia[e ownership of the entire lot prior to April 9, 1957.
If a Certificate of Olccupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
3. Date of any housing code or safety inspection of. buildings or premises, or other
pertinent information' required to prepare a certificate.
C. For Vacant Land Certificate of Occupancy:
1. 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. Ifa Certificate of Occupancy is denied, the Building Inspector
shall state the reasons therefor in writing to the applicant.
D. FEES: ~
1. CERTIFICATE OF OCCUPANCY - New Dwelling $25.00, Additions to Dwelling $25.00,
Alteration to Dwelling $25.00, Swimming Pool, $25.00. Accessory building $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 Certificate of Occupancy - $20.00
5. IIpdated Certificate of Occupancy - $50.00
6. Temporary Certificate of Occupancy - $25.00 Residential
$50.00 Commercial
~I
APPLICATION ON BACK
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IIJSULATIOP7 PER N. Y.
STATE ENERGY
CODE
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BO.~RD OF HE,ILTH
FORh1 NO. 1 3 SETS OF PL.\NS , ,
SURVEY
TOWN OFSOUTHOLD CHECK _
, BUILDING DEPARTMENT SEPTIC r•oarl
T04VNHALL
• SOUTHOLD, N.Y. 11J71 NOTIFY ~7
TEL,: 765.1602 CALL .~?l.l~~y~
Examined.. „W.~.~....,19L"1 MAIL(~TO:
\pproved 19 ~9. Permit No. ~.8~ 9.~..2"~, r L~ ~ a
Disapproved a/c ~ r
~I,~~
eLDG. DEPT.
TOWNUFSOtfTHOLD
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
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 appB-
cation.
c. The work covered by this application may not be commenced before issuance of Bui]ding Permit.
d. ~Jpon approval of this application, the Bui]ding Inspector will issued a Building Permit to the applicant. Such permit
shall be kept on the premises available for inspection throughout the work.
t:. 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
3uilding 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.
Tite applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections.
. (Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
name of owner of premises . (~S , , M • ~ C h.2
.............~v.~/,,....
(as on the tax roll or latest deed)
f applicant is a corporation, signature of duly authorized officer. I~CC¢~,r~~
(Name and title of corporate officer)
Buildcr'sLicanscNo,
Plumber's License No . .
Electrician's License No . .
OtlterTradc's License No .
Location of land on which proposed work will be done. . , ~ ~ • • ~
f- ~
douse Nu e~ C ...~Q.~.. l~~GJ...,t~~f • . ~rfih.l~~,_. .
. ~ • ....Street.
Hamlet
County Tax Map No. 1000 Section , Block
Lot..........
Subdivision Filed l~fap No.
..(Nautcj' • Lot...............
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ...c~!ct: e.. • , .~C~<t-yXC!.c„
b. Intended use and occupancy ....s~.~.'"~..K':'~---•
3. A'ature of work (check which applicable): New Llu' ~ ~EG~
Repair thing Addition .1ltcration
Rc oval Demolition .
Othcrl5'ork..
4. Estimated Cost . ~~rr~~" (D::scription)
........~3.:'.
> Fee
5. If dwcllin^, nutnbcr of dwcllin (to be paid on filing this application)
• • • units . • • , NUmbl'r of dwelling units on each Moor , ,
If garage, number of cars
6, If business, commercial or mix~d occupancy, specify nature and extent of cacti type of use . ,,/.l~f.~- • • ~ ~ ~ ~ ~ ~ • .
7, Dimensions, of existing sttvctur'es, if any: Front .
Ncight . Nurjtber of Stories • • Rear Depth • . .
Dimensions of same structure with altcratio • • • • • • " •
Depth : , , I ns or additions: Front Rear . . • ~ ~ ~ ~ • • ' '
y ~•~~-r • • • . y Ilcight . . Number o(Storics .
' Dimensions o~ntuc new constYttction: Front , • • ~ • • ~ ~ • ' • ' • • • • •
Hcigltt . Nut»bcr of Stories • Rear Depth • • • . .
9. Sizcotlot: Front I
10. Date of Purchase ......1........... Rear Depth.......................
1 Zone or use district in which ri, • • ~ • • ~ ~ ' ' ' ' ' ' • • • .Name of Former Owner . .
p pmises are situated , , • • • • • • • • .
13, Does proposed construction vio~latc any zonin law, • • ~ ~ ~ • • • • • ' • ' '
13. Will lot be regraded S ordinance or regulation: . , , , , • , , • • ~ • • • • • ~ • • ' ' ' '
14. Name of Owner of premises , , , , , , • . • , • ' ' ' tiVtll excess till be removed from premises: Ycs No
Name of Architect • .Address ...................Phone No. .
Name of Contractor • ......Address ...................Phony. No.. • • • • • • • • • . • .
.Address . .Phone No..•.•~.••~•••
IS.Is this property local',ted within X00 feet of a tidal wetland? *ygS..~,NO,.
*If yes, Southold Town, TrusCees Permit may be required,
PLOT DIAGRAb1
Locate clearly and distinctly all ~~buildings, whether existing or proposed, and. indicate all setback 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. I
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T,1TE OF NEtV YORK, II
S.SI
OU\TY OF .
nG ~ ~
.../~J~t~e!.P.....C~.....~., .
h ' ' ' ' ' ' ' • • • • • • • • • • being duly sworn, deposes and says that ha is the a
(\amc of individual signing contract) pplicant
?ovc named.
is Ittc i
Said I~~ (Contractor, agent, corporate officer, ctc.)• ~ ~ ~ • • • ~ • ~ ~ ~ ~ • • •
owner or owners, and is duly at%tltorized to perform or have performed tltc said work and to make and file t11is
plication; that all statements contained in this application arc tiuc to the best of his knowledge and belief; and that the
;rk wdl be performed in the manner sctforth in the application Gled therewith.
orn to before me this
• ....................day of...f.................,19...
~ary Public,
County ~ `
/
~j'~ '/~°~_'^_~7-~ atnre of applicant)