HomeMy WebLinkAbout9285-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20629
Date APRIL 7~ 1992
THIS CERTIFIES that the building
Location of Property 35870 MAIN ROAD
House No.
County Tax Map No. t000 Section 20
Subdivision
ACCESSORY
Street
Block 3
Filed Map No.
ORIENT~ N.Y.
Hamlet
Lot 13
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 6~ 1977 pursuant to which
Building Permit No. 9285-Z dated JUNE 6¢ 1977
was ~ssued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is
issued is ACCESSORY INGROUND SW/MM~NG POOL & FENCE
The certificate is issued to
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
FREDERICK LLOYD TERRY
H-027855 - MARCH BOg 1992
N/A
Inspector
Rev. 1/81
~ TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
N°.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COJ~PLETION OF THE WORK AUTHORIZED)
9285 Z Date ...................... ~, ...... ~'.lJl~l~..... ~. .......... , 19..~.~..
P~e~mission is I~ereby grdnted to:
............... O~t~..~ ........ : .........................................
to ~J~3`~n~.~.~t~~~..~..~.~.e.~..~..e.~.~.~...~.~.". ..... .~.i ............
................ ~;~ ....... :.;.,;.~ ........ ~....,..~; .~.L.~.....i.~i~.l~ .....................................................................................
dated ................ ' , ........ ~,~ ................ , 19..~,.., and ~ppmv~ by tile
Building inspector
Form No. 6
TOWN OF SOUTtlOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
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 Compllanca from architect or engineer
responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
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
i. Certificate of Occupancy - New dwelling $25.00, Addztions 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. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.O0
Date.. ~/.~yf~. ..............................
Location of Property.. ~.~.~ ............... ~.;.~..B.%~.~ .............. ~.~j.~.n¥.? .........
House No. Street Hamlet
Onwer or Owners of Property ...... ~.~.~.~i~A .... ~7P~..,..-~..~.~% .......................
County Tax Map No 1000, Section .... ~.~. '. .... Block ..... ~ ......... Lot /~
Subdivision .................................... Filed Map ............ Lot ......................
Permit No...~~............Date Of Permi .
Health Dept. Approval .......................... Underwriters Approval .........................
Planning Board Approval ........................
Request for: Temporary Certificate ........... Final Certicate ...........
Fee Submitted: $ .... ~ .~.,..O.~. .................
-- ...........
co
THE NEW YORK BOARD OF FIRE UNDERWRITERS
-~,{ ). 5 7 ~' BUREAU OF ELECTRICITY
8S JOHN STREET, NEW YORK, NEW YORK 10038
THIS CERTIFIES THAT
o~y t~ e[eetric~ ~uipment ~ ~scribed below and intr~uced by t~ appl~ant ~ on the a~e appficat[on number in the premises of
m thefollou, tng location, ~ Basement ~ Ist FI. ~ 2nd FI. I~ ~ / (}0~ ~t,,n Bilk Lot
~sexamtnedon ~PC~[ ?~,~992 andfoundtobelnco"tpllon~ewtththere~t"trementsoftbtsBoard
FIXTURE EPT H ~ RXTURES j RANGES ~C~KING DECKS ~ OVENS ~ DISH WASHERS, EXHAUST FANS
[ J - I
SERVI~ DI~ONNECT [ NO, OF [ S E R V I C E
OTHER APPARATUS
GENE~.AL MANAGER
Per_ .~
Th*s cerhf~cate must not be altered ,n any manner, return to the office of the Board ~f ~ncorrect Inspectors may be ,denhfmd by thmr credenhal
= COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY t4AHHER.
INSPECTORS
(516) 765-1802
VICTOR LESSARD, Principal
CURTIS HORTON, Semor
VINCENT R. V~/IEGZOREK, Ordtnance
ROBERT FISHER, Assistant Fire
Braiding Inspectors
THOMAS FISHER
GARY FISH
OFFICE OF BUILDING INSPECTOR
TOWN OF SOUTHOLD
March 31, 1992
SCOTT L. HARRIS, Supervisor
Southold Town Hall
P.O. Box 1179, 53095 Main Road
Southold, New York 11971
Fax (516) 765-1823
Telephone (516) 765-1800
Mr. Frederick Terry
35870 Main Road
Orient, New York 11957
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
The check is (outdated/not on file.)$25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT ~ 9285-Z (POOL)
Please contact our office on this matter.
cooperation.
Thank you for
SOUTHOLD TOWN BUILDING DEPT.
L. 7E~y
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
mO~N CLERK'S OFFICE
~_,~ ...... ~.....~ ..... ~z~. , ~~o~ ~o ...... Z~.~..~.~
' rav~ ...... ~ ....... ~.( ........ ,~ ......19...~. Permit No...~.~..~..~/7~
...... .....
· ....
~at~ .......... 5 ........... , ~.~.~..
a. This application must be completely filled in by typewriter or. in ink and submitted in triplicate to the Buildi,
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
areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this opplicotio
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 o Building Permit to the applicant. Such porn
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 Occupant
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 ti
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances,
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein describe.
The applicant agrees to comply w~th oil applicable lows, ordinances, building code, housing code, and regulations, and
admit authorized inspectors on premises and in buildings for necessary inspections.
.....
(Address of applicant)
If applicant is a corporate, signature of duly authorized officer. '~-~ - t ~
(Name and title of corporate officer)
Builder's License No. (~) 'T cc~ ~
Plumber's License No .................................................
Electrician's License No, ~.~ ..............
Other Trade's License No ............................................... ~ X
Street ond Number., ..~,n~ ...... ~ ............ :'"~'"~"~:'~:'~""~):::::::::~unicipolity
3. Nature of work (check which applicable) New Building ............ Addition .... ~,J~).,0 ~J' ,jr~~i~ ...... Alteration ...... ~.~,~..
Repa,r ................ Removal ............. Demol,t,or ............ Other Work ..~/T~;~,JZ...~.~.~--- ........
.~.Co'-~ Z JLa'--' ~ (D~scription)
4. Estimated Cost ............... ..-=..~ .................... Fee ......,.,~. .........................................................................
(to be pa~d on filing thru apphcahon)
5 If dwelling, number of dwelhng units ........ . ................. ~' .Number of dwelling umts on each floor .....................
If garage, number of cars ..............................
6 If bus~ness, commercial or m~xed occupancy, specify nature and extent of each type of use ...........................
7 D~mens~ons of exmtmg structures, if any' Front .......................... Rear ................................Depth ....................
Height ........................ Number of Star,es .....................................................................................................
D~mens~ons of same structure with alterations or addmons Front ................................... Rear ........
Depth ............................... Height ................... Number of Stories ..............................
8. D,mensJons of enbre new construct,on' Front. ..~.~ ............. Rear ...~'...~... ..............Depth ...~.....~.. .........
Height ................... Number of Stones ..............................................................................................
9. S~ze of lot' Front ................................................ Rear .......................................... Depth ..............................
10. Date of Purchase ..................................................... Name of Former Owner .......................................................
1 I. Zone or use distnct in which premises are situated ./'~- ........ ~ ...... /...: ...............................................................
12 Does proposed construchon violate any Tatung law, ordinance or regulation' . .............. ..¢~.......C~.. .........................
13 Will lot be regraded ..... ~ .......... WJJJ excess fill be removed from premises: (~'/'Yes ( ) No
14 F, ame of Owner of premises ..~ ................. . .~.... ........... Address ................................Phone No
Name of Architect ............. Address ................................Phone No ......................
Name of Contractor ....~., L.r....~..-._...~ ;¢, ' ~ .~"~'....'~-" ' ............Address .... "~ .......... Phone No ......................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether ex~st~ng or proposed, and md~cate all set-back dimensions fron
property hnes Gwe street and block number or descnphon according to deed, and show street names and ind~cat
whether interior or corner lot
STATE OF NEVV(~fORI¢,/~
COUNTY OF~
................................................. being duly sworn, deposes ond says that he ~s the apphcar
(Name of md~wdual si~'mng contract)
above named
He ,s the .................................. ~ ........................................................................................
(Contractor, agent, corporate officer, etc )
of said owner or owners, and ~s duly authorized to perform or have performed the said work and to ~ke and
this apphcat,on; that all statements contmned m thru apphcat,on are true to the best of his knowledge and behef; an
that the work will be performe~in the manner set fomh ,n the apphcahon filed therewith
Sworn to before me this
.............. " ............ .................