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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 .............. " ............ .................