HomeMy WebLinkAbout25765-Z FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT I�/J
Town Hall
Southold, N.Y. NSL
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 25765 Z Date JUNE 1, 1999
Permission is hereby granted to:
CHRIS MITROFANIS
178-10 80TH DR
JAMAICA ESTATES,NY 11432
for
DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING & INGROUND
SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR.
at premises located at 1225 LEETON DR SOUTHOLD
County Tax Map No. 473889 Section 059 Block 0001 Lot No. 014
pursuant to application dated APRIL 13 99 and approved by the
Building Inspector.
Fee $ 228.60
Authorized Si nat re
COPY
Rev. 2/19/98
V�
:LD INSPECTION REPORT DATE CO�II�NTS
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Town Hall,53095 Main Road Fax(631)765-9502
P.O.Box 1179 G Q Telephone(631)765-1802
Southold,New York 11971-0959
COU
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
July 5th, 2006
Chris Mitrofanis
178-10 80th Drive
Jamaica Estates,N.Y. 11432
RE: 1225 Leeton Dr.
SCTM# 059 0001 014
Dear Mr. Mitrofanis,
Please be advised that your Building Permit#25765 issued June 1 st, 1999 has expired.
According to the Code of the Town of Southold, a Certificate of Occupancy must be
issued prior to use of the structure.
To renew your Building Permit, please submit a fee of$228.60 at that time we can
schedule an inspection by one of our Building Inspector's.
If you have any questions, please call us at 631-765-1802.
Respectfully,
SOUTHOLD TOWN BUILDING DEPT.
BOARD OF HEALTH . .. . . . . . . . . . . . .
FORM NO. 1 3 SETS OF PLANS
TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . .. . . . . . . . . . .
BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . . . . . . .
TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . . . . . .
SOUTHOLD, N.Y. 11971
TEL: 765-1802 NOTIFY:
CALL 7�;. ..lSL. . . . .
ii,,
Examined.....�.l......... 19 .'7- MAIL TO: . . . . . . . . . . . . . .. . . . . .
(P.11........ 19.0 Permit No. .a5.....
Disapproveda/c .................................. ....................................
........................................ .............
(Building Inspec )
APPLICATION FOR BUILDING PERMIT
Date. . .'�. . . . . . . . , 19%ppqq
.
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector wit
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 mist be drawn on the diagram which is part of
this application.
c. The work covered by this application may not be co mienced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issue 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 Certificate of
Occupancy shall have been granted by the Building Inspector.
APPLICATION IS HKMW MATE 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 an premises and in building for necessary inspections.
-RD,t7f*t�;T, ��2t,-
. . . .(Signature of or-name, if a corporaattion)
orf........ ...
(Marling address of applicant)
State whether applicant is owner, lessee, agent, chitec engineer, general contractor, electrician, plumber or builder
........................................................................................................................
cR s �c Y...ln i r ois....
Name of owner of premises .......................... ................................
(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. Iocation of land on which proposed work will be done..............................................................
/ A-' �� TD P1 Dfes'/V'C OUr,'10,GD
................................. ........................................... ......................................
House Number StreetHamlet
County Thx Map No. 1000 Section .... ....... Block ......1.//........ Lot ..r ..........
Subdivision ...................................... Filed Map No. ............... Lot ...............
(Name)
2. State existing use and occupancy of premises and i tended use and of proposed construction:
a. Existing use and occupancy .....\d kQ ....................
/2.. � Cc�, le ...........................
......
b. Intended use and occupancy ..... �n. l ... :l'.�...:f: l e..............................
J. Mature of work lctwck 4nch applicable): New Building .......... Addition .......... Alter tion
Repair ............ Removal ............. Demolition ............ Other Work 947
( scription)
4. Estimated Cost
.. ...... fee ...............................................
(to be paid on filing this application)
5. If dwelling, nuiher of dwelling units ............ umber of dwelling units on each floor ................
Ifgarage, 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....to 3 ........ Rear ...�i:3........ Depth .yS............
Height .......... ..
g.............. Number of Stories ....�..............
Dimensions of same structure with alterations or additions: Front .D. ..... Rear ...............
Depth ................... Height .................... Number of Stories ...............
8. Dimensions of�jentire/new construction: Front ...t ......... Rear .?. .. Depth :5.4........
.J.. ,q.
Height .... ................ Number of Stories .� ..............
9. Size of lot: Front ...f®0............ Rear ......../00 ....... Depth ...0700 ...........
10. Date of Purchase ..................... Name of Dormer Owner ........................................
11. Zone or use district in which premises are situated ..Ae-.J!/?.elCl fl d ........................................
12. Does proposed construction violate any zoning law, ordinance or regulation: .. o..................
13. Will lot be regraded ............. Will excess fill be removed from premises: YES
14. Names of Owner of premises lP/X...zo.imm'�V1,5.... Address ..,�[ ,5..;1�. �:�/. .A.':..... Phone No. .............
Name of Ardhitect Ph f/3�'.�u!n.................. Address .7:/ ., is .Sf /: 1�°?��Phone No.
Name of Contractor ................................... Address ...............................Phone No. .............
15. Is this property within 300 feet of a tidal wetland? * YES .......... ND ..........
*IF YES, SOITI M MM TRDSHE.S PM-ffT MAY HE RF gMM.
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.
SrNIT Or. NU YU ,
SS
OUMIT OI . �.. ........j�..f
---............. ..--1..................being duly sworn, deposes and says that be is the applicant
(Nam of individual signing contract)
above named, �(
11eis the ........ ... .1.........................................................................
(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 to before me this P Q
....�.3.......day .... .... 19..`.. -
r
Notary Public ......... ... .. ... ..
.. ... .............................
(S of Applicant)
JOYCE M.WILKINS
Notary Public,State of New York
No.4952246,Suffolk Coin/
Term Expires June 12,1 S l