HomeMy WebLinkAbout27925-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-28148 Date: 01/07/02
THIS CERTIFIES that the building ADDITION
Location of Property: 2360 MARLENE LA LAUREL
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 144 Block 2 Lot 28
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVEMBER 19, 2001 pursuant to which
Building Permit No. 27925-Z dated NOVEMBER 20, 2001
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 DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to PANAGIOTIS KANARAS
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
""-4/ /-'Z�
ro ed Si nature
Rev. 1/81
FORM NO. 3
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)
PERMIT NO. 27925 Z Date NOVEMBER 20, 2001
Permission is hereby granted to:
PANAGIOTIS KANARAS
DIX HILLS,NY 11746
for
CONSTRUCTION OF A DECK ADDITION TO AN EXISTING SINGLE FAMILY
DWELLING AS APPLIED FOR
at premises located at 2360 MARLENE LA LAUREL
County Tax Map No. 473889 Section 144 Block 0002 Lot No. 028
pursuant to application dated NOVEMBER 19, 2001 and approved by the
Building Inspector.
Fee $ 150 . 00
Authorized Signature
ORIGINAL
Rev. 2/19/98
Form No.6
;-�
E` n�
TOWN OF SOUTHOLD
BUILDING DEPARTMENT i� "# �
TOWN HALL L
765-1802 BLDG.
T01r�N Q.F` LD
APPLICATION
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
A. 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%0 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 Building- $100.00
3. Photocopy of Certificate of Occupancy-$0.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy- Residential$15.00, Commercial$15.00
Date. 0 2
New Construction: '� t Old or Pre-existing Building: (check one)
Location of Property: _Z 3 b 0 r I gA La h e IM.h't rt 1 TV C�
House No. Street Hamlet
PAOwner or Owners of Property: jj a 0- -1 S KC( ✓1 a VA 's
Suffolk County Tax Map No 1000, Section 473 Block d 00 Z Lot 0 2
Subdivision Filed Map. Lot:
Permit No. Z -7 2 S Date of Permit. i 2 0 - O Applicant:
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $ -Z S' yU
(\JJ
Applicant
pp Signature
WT
Applicant/ / Date
Owners Name: tuna ;o ti s Reviewed: 60 p
Architect/ / Date
Engineer: Lo-ci S Sa�Foti-e, Submitted:
SCTM :
District: 1.000 Section: fJ/y Block: Lot:�$
Project —_ Subdivision
Location: a3( d � _ Name:
Sin&le& separate Required >�
certification: (Yes/No)
`/
Req. oc 0 Its _
Zoning District: Td (IAl S12c: (1�}� AduaC 7r�� 1 (Lot covera6 Prolxised i_ l
Req. Req- Req. I
(front Yard 7-- Proposed:yy. I (Side Yard !- _ Proposed (Rear Yard
Sa I ropose�_
Project Description: d"
N N ERM TM Permit .
REQUIRED FOR REVIEW N.A. NO YES ber
Suffolk County Health Dept.
New York State D. E. C.
Town Trustees
Town Zoning Board approval:
Town Planning Board approval:
Flood Plane Elevation???
Flood Zone:
Notes:
STATE OF NEW YORK )
) ss:
COUNTY OF SUFFOLK )
&ACQbelng duly sworn deposes and says:
That deponent i over the age of 18 years and resides at
That on the day of , 2001 deponent architect/engineer,
licensed by the State of New York, hereby states that s/he accepts full
responsibility for the accompanying plans compliance with the New York State
Fire.Prevention and Building Code (9 NYCRR); said plans pertain to property
located at S CTM# 1000- 1/4 4 o Z" 2?5 ,
street address 2360.
6
4.,�j M
Architect/En i eer
w
Sv
vornto-beforern this ARS+
day of IXV , 2001.
NOTA PUBLIC SS e�New York
No.01.CR5027WS
Quelifled In Suffolk Cour�y
Otary Public- Commission Expires May 23,
qrF
OF N��
cc: Applicant �►9nI1g� �
r
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ;71NAL
SU ONFRAMING [
[ ] FIREPLACE & CHIMNEY �
REMARKS: II
Q
II
DATE INSPECTO ^"'/�
�IBLD INSPECTION-RRPORT - DATE GOMMSNTS
h ATION 1ST).
!�' iNDQ,TION _ (21TD) ul
--
ROUGH FRAHE O
t�I
PLUMBING '
' S
tl-snLMON PER N. T. ^
STATE ENERGY
r
CODE
ADDITIONAL C MMENTS
S
o
TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUIL,DING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD,NY 11971 3 sets of Building Plans
TEL: 765-1802Survey
PERMIT NO. 7 q(;L Check
Septic Form
N.Y.S.D.E.C.
Trustees
Examined ,20 01 Contact:
Approved1 200) Mail to:
Disapproved a/c
Phone:
Building 4ft9peetm
PPLICATION FOR BUILDING PERMIT
o , 20
�� av`Ho � 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 waterways.
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 issue a Building Permit to the applicant. Such a 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 what-so-ever until a Certificate of Occupancy
is issued 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,ordinances,building code,housing code, and regulations, and to admit
authorized inspectors on premises and in building for necessary inspection
�J fct,4_ CA-4�
(Signature of applicant or name,if a corporation)
�2 riae PL-
(Mailing address of applicant)
115 N`f- 1 1 -71 6
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
()w" er
Name of owner of premises ?GLAa y '0+-( &` LCL Via Y,Cc
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be done:
236a vhatr(Qvt'e LCtK2 ✓KAT 7 i rt, ��
House Number Street Hamlet
County Tax Map No. 1000 Section Block 0 2 Lot 2
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 1 Fg V+i1 v f r}� S ,
b. Intended use and occupancy 1 Fa-u l y a;A� S-�-
3. Nature of work(check which applicable): New Building Addition ✓ Alteration
Repair Removal Demolition Other Work
(Description)
4. Estimated Cost S 00-V Fee
(to be paid on filing this application)
5. If dwelling,number of dwelling units Number of dwelling units on each floor
If garage, number of cars
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front 1 0 Rear Depth S
Height Number of Stories -
Dimensions of same structure with alterations or additions: Front L(c) Rear
Depth i I Height Number�bf Storms
8. Dimensions of entire new construction: Front Y c� Rear Depth r^4-
Height Number of Stories
9. Size of lot: Front ° `' Rear ( Y (- Depth
10. Date of Purchase q 4 Name of Former Owner Cvv S �-
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation: /V U
13. Will lot be re-graded /lTU Will excess fill be removed from premises: YES NO
oS 17- P( Ke Fci�ePL-
14. Names of Owner of premises A Ka 04 is kct N Q Address 0 t f 14(1 f f S /V`( Phone No. 2 V2 - ( o k r
Name of Architect Address Phone No
Name of Contractor Address Phone No.
15. Is this property within 100 feet of a tidal wetland? *YES NO %,,-
0
• IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQUIRED
16. Provide survey, to scale,with accurate foundation plan and distances to property lines.
17. If elevation at any point on property is at 10 feet or below,must provide topographical data on survey.
STATE OF NEW YORK)
S:
CO Y OF fc
Vk 0, ,S Zk A &Y c&- S being duly sworn, deposes and says that(s)he is the applicant
Name of i dividual signing contract) above named,
(S)He is the
(Contractor, Agent, Corporate Officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application;
that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be
performed in the manner set forth in the application filed therewith.
Sworn!tob ore me this
of / 2001
Notary Public Signature 6f Applicant
JANICE CRESCIULLO
NOTARY PUBLIC State of New York
NO. ICR5027908
Oualif tlin Suffolk Cour�ty
Commission Expires May 23,1002
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