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Home My WebLink About12417-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13119 Date Jan. 9 198..5. THIS CERTIFIES that the building Pool Location of Property 1980 He .nry' s Lane Peconic House No. Street Hamlet County Tax Map No. 1000 Section ....0 7.4 ...... Block ... 0..2 .......... Lot ....09.2 ........... Subdivision ...... × .Filed Map No. . .Lot No. conforms substantially to the Application for Building Permit heretofore fled in this office dated June 1 19 83 pursuant to which Building Permit No.. 1241.7Z dated .............. J..u.ly..........12 19 . .8.3, 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 ......... Inqround Swimminq Pool ............. The certificate is issued to DOUGLAS ELMIGER ..................... ?d~n'o'r,'fdr.&~;.~i~'il ................... of the aforesaid building. Suffolk County Department of Health Approval .......... ['J../.A ............................. UNDERWRITERS CERTIFICATE NO N610869 ............... Building Inspector Rev. 1/81 IFORlt~ NO. I~ 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? 12417 Z Permission is hereby granted to: ............. ~..~..,.~.~....~,~...&~.....~c.~ ....... ~ ....... ~.~......~.~.~ .................. ........ Z~.~~...~..~....~..:.F.....r./..?~. '2- ~o ....~~:....z~:~a~ ~.~....~~'.~....~.~..: ....... ............... ~.~_. ....... ~.~.~....¢...~~.~....~.~...~~ ~, prem,~s I~ated at ..... .~.~.~ ....... ~~.~-...~..~ ............................ ...~ ............................................................................ ~ ............................... ~.~~.c~..~..& ~~e..~~ .............. ~<~._.~.~ .................. ~z:~..~z ................. .~ co..~ ,~ ~o~ ~o. ~o0o s.~,o. ..... O.ZM .... ~,~k ..~.~. ........ ~o~ ~o..~.~ ...... Building Inspector, Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall ~ ~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A. This application must be filled in typewriter OR ink, and submitted ±n dup£tothe Building Inspec- tor with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. F~es: 1. CertWicate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $I.00 4.Vacant Land C.O. $5.00 New Building . ?.~. ......... Old or Pre-existing Building ............ Vacant Land ............. Location of Property \ ~'~ " House No. Street Ham/et Owner or Owners of Property ......... ~ .......... ! ....... ~. ' ........................... County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision .......................... ...... Filed Map No ......... ,.Lot No .............. Permit No ~ ~'"~ 1 ~} ~, Date of Permit ~ ' / ~'~ App cant ' ..... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval .~..~.\ .~..~ .~. · .~ ....... Planning Board Approval ...................... Request for Temporary Certificate ................... Final Certificate ~ . Fee Submitted $ .~ ....................... Construction on above described building and permit meetA all,applicable codes and regulations. ~' ~' ~ APPlican~~~~h' :' ~'~ ~ ........... FIELD ~i~SPECTION FOUNDATION (1st) FOUNDATION {2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE o FINAL COMMENTS ADDITIONAL COMMENTS: L I:IN[ - 100.0 THE NEW YORK BOARD OF FIRE UNDERWRITERS l~J~ BUREAU OF ELECTRICITY ~ Jt~y 26, 1983 es JOHN STREET, NEW YORK, NEW YORK 10038 .a,e ~.~,~i~,io.~Vo, o,.f~e 224758-83 N 610889 THiS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application nu tuber in the premises of Lk)ug].as ~lakinger, Hen~'s La. E/S, Peconic, N.Y. in thefollowing location; [] Basement [] Ist Fl. [] 2,d ri. Outside / Sectlo~ B~c~ ro~ was examined on ~U3.y ~1 198~ and found to be in compliance with the r~, quirements of this Board. DRYERS i FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS INCANDESCENT FLUORESCENT SYSTEMS OTHER APPARATUS= S E R V I : C A W ~ NO OF HI-LEG OF CC COND, NO O~EECC~.COND NO. OF NEUTRALS 1-G.F.C.I. (Swimaing Pool) This certificate covers compliance at the date Of inspection only. Because of unusual environme.nts it is ad~fisable to have frequent ~est and/or repairs' made by a qualified person. AWG OF N~UTRAL Glenn R. Bradley Horton Ave. pla~t±tuck, N.Y., 11952 LIC. #1227 GENERAL MA~,~ER This certificate must not be altered ~n any manner; return to the office of the Board if ~nc~rrect, Inspectors may be lldentified by their credentials. COPY FOR ~BU ILDING DEPARTMENT. THIS COPY OF CERTIFICATE MOST~ N~T BE ALTERED IN ANY MANNER, ~ FORM NO, TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 7654803 ..?? Disapproved a/c ......................... ff../. ....... (Building Inspector) APPLICATIOrq FOB BUILDING PERMIT Application No.../.~..~../.Z ...... Date ...3.Ll0e...l,.. ~3J..., 19... INSTRUCTIONS a. This application must be completely filled in by Wpewriter 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 appli- cation. 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 issued 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 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, arid other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or den)~,ition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housingffode, and regulations, and to admit authorized inspectors on premises and in building for necessary inspectiongt. (Signature of .ap_~Uc~n~ og~e, if a corporati6n) - . ....... ¢..a.o..a ............. (Mailing address of applicant) State whether applicant is owner, lessee, agent architect, engineer, general contractor, electrician, plumber or builder. -AGENT Name of owner of premises ....... D. 9 .u.g. 1. a..s..a.n.d.. 9.1.o.r..~.a..E. 1..m.~.g.e.r. .................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corp.~ac~ officer) Builder's License No .......................... Plumber's LicenseNo ......................... Electrtc]ans License No. 12.9../.. (3;r.~ O .1 y .... Other Trade's License No ...... 5.8 .............. 1. Location of land on which proposed work will be done... Henry ' s Lane Peconic House Number Street Hamlet County Tax Map No. I000 Section ....O..?..~. ........ Block ....... ~..~c,~ ....... Lot...'~.~).~... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... .R.e.s. J:..d.e.n.c.e. ................................................ b. Intended use and occupancy .... SM;[KHIblO..P. 00L..gSD. Y.E~OE ..................................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... : POOL t~ND FENCE (Description) 4 Estimated Cost . g3-]-]. , (~ .(.) ¢:)~) .. Fee 15. ................... (to be paid on filing this application) 5. If dwelling, number of dwellinglunits ....... ], ....... 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. ag ........... Rear A.0 ........... Depth 25 ............. Iteight .... : .......... Number of Stories ........................................................ Dimensions of same structure With alterations or additions: Front ................. Rear .................. Depth ................... i · · Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... I?ight ............. Number of Stories Si~oflot: Front ...1.1.0. ............... Rear.. ,[9.0. ................ Depth .2.1.? .................. Date of Purchase ............................. Name of Former Owner .... .F.r.a.n..k. jq.q. ¢ .~.a.q c. y [ .G.L.Q Zone or use district in which pr~mises are situated ...r e s Does proposed construction vio!ate any zoning law, ordinance or regulation: ...... .n 9 ........................ Will lot be regraded ....r) 9 ....................... Will excess fill be removed from premises: Yes > > )No Name of Owner of premises . .0ou~..E ~[nj..ger .... Address U.e.q~y ! .s..L..a.n.e ..... Phone No. 7..6~5.-.~0¢~ ...... Name of Architect ......... ~ ................. Address ................... Phone No ................ Name of Contractor .... .S.K.I.N, .Ny..D.I..P..P.0. O..L.K.b.g.~td~ssg .S ..................Phone No. ~ [ .2.~.8.-5.0.1.q... 10. 11. 12. 13. 14. PLOT DIAGRAM Locate clearly and distinctly al! 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. STATE OF NEW YORK, COUNTY ~9.1~ .......... S.S (Name of individual signing contract)~ above named. ..... being duly sworn, deposes and says that he is the applicant He is the..g.g.e.n.t; .............. . ................................................................... (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 contgined in this application are true to the best of his knowledge and belief; and that the work will be performed in the manne;r set forth in the application filed therewith. Sworn to before me this ...... '... ~~':i .day of; ........ Notar~ Publ. ic, . ..... ,,~-h...-.,-~ ...... ~ County COUnt'~ ........ ~?,~o~ c~o~un..~..0~.' , / · ~ ~ (Signature of appljtcant)