HomeMy WebLinkAbout12436-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. zi5247 Date February 4, {987 ,
THIS CERTIFIES that the building ... I. n. ~ 5.o.u..n .d..p.o. 9.1 ..............................
Location of Property ....6.3.0...Y.e.n.n.e..c.o.t. ~...D.r.~v..e ............?.off. ~..h .o.l.d. ...............
House No. Street Hamlet
County Tax Map No. 1000 Section 055 .Block 06 .... Lot 005
.............................. Filed Map No. 5 187 .Lot No. 50
Subdivision Yennecott Park .....................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
J u n e I 6, I 983 , pursuant to which Building Permit No. I 2436 Z
dated ...J.u.l.¥..2.0.,...I .9.8.3. ............ , 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 .........
Inground pool and fence.
The certificate is issued to ........ ?.A.U.L...r....A.~ .I3..A.~.~.E..D. :..K.R.A.E. ~ .L.I.~ C. ................
(owner,~b~¢~
of the aforesaid building.
Suffolk County Department of Health Approval N /A
UNDERWRITERS CERTIFICATE NO. N 6 1 0 8 7 2
PLUMBERS CERTIFICATION DATED:
N/A
Rev. 1/81
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? 12436 Z
Permission'
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......... .~..,~. .......... ~z.v..~c.~...?7...i...,Dzc ·
.......... . .,~....~z=../.,~:,a~./....~= .Z..: ..........
~o ............. ~. ....... ~....z'.~z.¢~.. ...... ~......z.,,~..c~..~./.~.~......~..~..~,r~.~://¢.~
....... .~,.... ....... ~?...-.. ......... i~,_ ...... ~.r~..,.:.~c~.~..~..c~, ............. ../..
~tpre~,,e,'o~ate~ ~t ...... dd.~ .......... ..~.~...~,~..ZZ..../--~ .................. '. ....................
................................................................................................................. ~..~.~..~.~,.~.~,.. ~..,..%
..... ...'~,~.zz:......~.~ .......... ~/.,a-..r.~7 .................. Z.~:..~.....,,~..~.
County Tax Map No. 1000 Section ...~..~...~... ...... Block ....~.~ ........ Lot No...~.C~.,~.... .....
pursuant to application dated ....... . .~..~.~.~:~. ....... ./...~. ............... , 19.d~....,.~.,., and approved by the
Building Inspector.
Fee $.../..'..~ ........... : ....
Rev. 6/30/80
FORM NO. 6
TOWN OF $OUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
765- 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
~nstructions
A. This application must be filled in typewriter OR ink, and submitted mm to the 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 featu res.
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. Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling
3. Copy of certificate of occupancy $1.00
4.Vacant Land C.O. $5.00
5 .Updated C.O. $15.00
$15.00
Date ....................
New C on s t z~uc t i on ...... Old or Pre-existing Building ............ Vacant Land .............
Location of Property . ~' 3~ .~.~.,~¢_,c~.'~..'~.
House No. Street Hamlet
Owner or Owne'rs of Property
County Tax Map No. 1000 Section ..... ~...~ ..... Block ............... Lot ................
Subdivision ................................. Filed Map No ........... Lot No ..... ~ ......
Permit No '1 ~ ~3 ~'~ Date of Permit Applicant
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ..... . ..Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .... y~
Fee Submitted $ .... ~'....¢~. ....................
Construction on above described building and permit meets all applicable codes and regulations.
Rev. 10-10~78
Applicant
looo663 THE NEW YORK BOARD OF FiRE UNDERWRITERS
BUREAU OF ELECTRICITY ~ ~
~- IlS 85 JOHN STREET, NEW YORK, NEW YORK 10038 ~ t ~ ~ ~ ~
~-~ .m~y ~, ~8~ ~,~-,,~-~.~,,~,~ ~247~7-83 N 610872
THIS CE~IFIES THAT
o~ly the e[ectr~oi e~uipment ~ d~erlbed below and introduc~ by the applicant named on the able application number in the prendses of
~, & ~s. l~hli~, Y~ott Dr. S/$ of St., ~old~ N.Y.
in the following location; ~ ~....,.,~t ~ ~t F~. ~ ~.d Ft. ~tside s.~tio, mo~ Lo,
wasexao~inedon g~y 21 , 1983 amd found to be in compliance with the requlrememts of thls Board.
FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS
1 1 1 1
DRYERS MOTORS FU'IURE APPLIANCE FEEDERS TIME CLOCKS
MULTI-OUTLET DIMMERS
SYSTEMS
NO. OF FEET
SERVICE DISCONNECT
OTHER APPARATUS:
S E R I C
A WG. NO. OF HI-LE~ A. WG A, W.G.
OF CC, COND OF HI-LEG OF NEUTRAL
NO OF NEUTRALS
1-G.F.Io
(Swimming P~)I) This cergificate covers conplim~ce at the date Qf inspection only.
Because o£ %~sual e~viror~ents iE is a~hrisable to have frequent test and/or repairs
~de by a qL~lified person.
Gler~ R. Bradley
}k~ton Ave. RFO 169
·Mat. titu~k, N,Y., 1].952
LIC ~ #1~27
This certificate must not be altered i. any manner; return to the office of the Board
CO,P? FOR BUILDING DEPARTMENT. THIS COPy OF CERTIF
Per /
may be. identified
their credentials.
MANNER.
YIEL~ INSPECTION COMMENTS
FOUNDATION (1st)
FOUNDATION (2nd)
2.
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
q?DE
FINAL
ADDITIONAL COMMENTS:
X
0
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
This is co advise you that the job under buildlng
permit no.l~436Z _ issued to Paul KE.~ehlin~
on ~.1~2Jl/_~3____ for Accessor~ is completed and
a final inspection has ( X ) has not ( ) been done.
In order to complete this file, it is necessary that
a Certificate of Occupancy be issued. Please fill out the
encl. osed form, return same to the above office with a check
for $10.00 payable to the Town of Southold. Please indicate
to Whom the Certificate of Occupancy is to be mailed, and
arrange with this office for an inspection date
Occupancy or use is unlawful without a Certificate of
Occupancy. Please help us to clear up this mmt'ter so that
legal action does not have to be taken.
Thank you for your prompt attention.
Very truly yo~,
Victor Lessard
Executive Administrator
VL:gar
encl.
Examined..
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-18011
*ppli~ation No./, .Z..q. ~.6. .......
APPLICATION FOR BUILDING PERMIT
Date
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 Pem~it.
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 1S 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 buildings for necessary inspections·
·. '/.~.< .Z~. Z'.....z¢/.4'.r: ./.- .... /.~'.'~..'../.,.'.:7.~. ~
(Mailing address of applicanO
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
................................... ~.~,9. 5. ~ ?lC ................................................
Name of owner of premises ....,/.~,.~ .~.c7. ..........................................................
(as on the tax roll or latest deed)
If appligant is a corporation, signature 0f-fl~O~Y authorized officer.
(Name and title of corporate ogficer)
Builder's License No .... ./.' .5 ...................
Plumber's License No .........................
Electrician's License No .......................
Other Trade s License No ......................
I. Location of land on which proposed work will be done..~5/~c...y.¢.' lO/..',d/.~.(iO...~./_~).~./. ~.~.~
................................................../ -- ..................
House Number Street Hamlet
ounty Map No. 1000 Section ......... Block ..0-¢.-
Subdivision--/~'/~/"/I/'C £1 9. Z-. - ,.(%a~n/~ .~. ~,~.. ........ Filed Map No...~f'./.g ~. ...... Lot....J..'70....--..~..'.
2. State existing use and occupancy of premises and intended use and occup~cy of proposed construction:
a. Existing use and occupancy..p..~, .e~. [}..{~..~. .... .~/w4,,.C~-.,.,, .~.~,. ........................
b. Intended use and occupancy/(./~ .................................. tL~.~...~....~ .....................
10.
11.
12.
13.
14.
Nature of work (check which applicable): New Building .......... Addition .......... Alteration ..........
Repair .............. Removal .! ............. Demolition .............. Other Work.~..¢.%¢~?.../~?.
.? (Description)
Estimated Cost ........... : ~ thee, ~ Fee
! (to be paid on filing this application)
If dwellingi number of dwelling unit~ ............... Number of dwelling units on each floor ................
If garage, number of cars ........ i ...............................................................
If business~ commercial or mixed occupancy, specify nature and extent of each type of use ....................
Dimensions of existing structures, if any: Front ............... Rear .............. Depth ..............
Height ............ ;.. Numberlof Stories .......................................................
Dimensions of same structure with 4Iterations or additions: Front ................. Rear .................
Depth ...................... Height ...................... Number of Stories ........... ' ..........
Dimensions of entire new construction: Front ............... Rear ............... Depth ...............
Height ............... Number, of Stories ........................................................
Size of lot: Front ............. i ........ Rear ...................... Depth ......................
Date of Purchase ............. ! ................ Name of Former Owner .............................
Zone or use district in which premises are situated .....................................................
Does proposed construction violate any zoning law, ordinance or regulation: ................................
Will lot be regraded ........... j ................. Will excess fill be removed from premises: Yes No
Name of Owner of premises .................... Address ................... Phone No ................
Name of Architect ............ i ............... Address ................... Phone No ................
Name of Contractor ........... [ ............... Address ................... Phone No ................
PLOT DIAGRAM
Locate clearly and distinctly all bluildi~lgs, whether existing or proposed, and, indicate all set*back dimensions from
property lines. Give street and block nfimber or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OFNEW~6~, , /.z .! o o
COU~.Y?.F~.~.. ?' ~,.~.¢ /~r_ ~1 .... being duly sworn, deposesand says that he is the applicant
' (Name of individual signing contract~
above named.
He is the .......... ~ ~¥5 ~f~ .................................................................
i (Contractor, agent, corporate officer, etc.)
of s~d owner or owners, md is duly author~ed to perfom or have perfo~ed the said work and to m~e ~d
application; that all statements contained ~ this application are true to the best of his ~owledge and belief; and that the
work will, be perfomed in the m~'ner set forth ~ the application ~ed therewith.
Sworn to before me this
.......... .......
Nota~P?~c, j~.~.. -~_~.. ~~. County
............................
, ~*, ,u8UC. S'¢~..I~r' ' (Signal' of aPPlie=t~
. 125850, S~yo~
765-18~2
BUILDING DEPT.
INSPECTION
FOUNDATION ZST [ ] ROUGH LpLBG.
[] FOUNDATION ZND [, ]/~LATION
[] FRAMING ~ FINAL
REMARKS:
APPLICANT:
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
DATE: July I~, 1986
Dear:
While reviewing our files I find that your expired
pool permit ~Lj~b~ has never been finalized. Kindly return
the enclosed application with a check for $~.00. Also, please
call and arrange for a final inspection so that we may issue
a Certificate of Occupancy on the above pool and complete
this outstanding file.
Yours Truly,
Victor Lessard
Executive Adminstrator
OOCUPANCY OR
USE IS UNLAWFUL
WITHOUT CERTIFICATE
OF OCCUPANCY
"IMMEDIATELY"
ENCLOSE POOL TO CODE
UPON COMPLETION
BEFORE "WATER"