HomeMy WebLinkAbout12246-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. ,..Z.1.3.6..3.7 ........ Date ,.. July 16 19 .8.5.
THIS CERTIFIES that the building .... .S.w.i..r~..i.n.q..Pp.ql...(..&..F..e.n.c.e.. ) ..............
. Donna Drive Mattituck
Location of PropertyHouse' .1.3.6.5.tvo. ....................... 'S't/e~ ....................... /'l~r~/e~
County Tax Map No. 1000 Section .... 1.1..5 ..... Block . ...1.6. ......... Lot ... 9.1.3. ..........
Subdivision..D.e.el2...Hg.l.e...C.r.e.e.k...E.s.t.: ...... Filed Map No.. 4256..Lot No. 61
conforms substantially to the Application for Building Permit heretofore filed in this office dated
March 24 19 .8 .3 pursuant to which Building Permit No. 12246 Z
dated ...... ............ 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 .........
........ swimming Pool & Fence .......
The certificate is issued to SACKS, GREGORY
(owner, ~e~e~u~-
of the aforesaid building.
Suffolk County Department of Health Approval N/A
UNDERWRITERS CERTIFICATE NO. N 605137
Building Inspector
Rev. 1/81
BUILDING DEP.~RTMENt~
ToWN H~LL ::
SOUTHOLD,'N. Y.~ ,-
BUILDING pERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISE
COMPLETION OF THE WORK AUTHORIZED)
22t6 Z
UNTIL ~ULL
Permission is hereby granted to: ~ '
to
~un~ Tax Map No. 1000 Secton B~k ~ . ..... ..... ~'~t No ......................... -
put,ant ~o apphcation dat~ ........ , ..................... ~. ,.~., 19,. and app,~ by the
Bull~lng I~pector.
DRIVEWAY cC'N:~TRUCTION
CESSPOOL iCONS1-RUCTION
CELLAR CQNSTR~CTION
OTHER
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted m ~ to the Building Inspec-
tor with the following; for new buildings or new use:
1. Final survey of propertv with accurate location of all buildings, property lines, streets, and unusual
natural or topographic features.
2. Final approval of Health Dept. of water supplv 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.
For existing buildings (prior to April 1957), No.n-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.
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
$15.00
Date . .~-[...~.cv'..~'~.. J.~ 19 ? ......
New Building .~..~¢~2f,~. .... Old or Pre-existing Building ............ Vacant Land .............
Location of Property ./~....~... ,1~..~; .... ~TTITCCC¢.. .............................
House No. Street Ham/et
Owner or Owners of Property . .~¢~..~-.'¢'.....~..-..c-~ .......................................
County Tax Map No. 1000 Section ..... ,/,/~."~. ..... Block .... ~(-¢, ........ Lot... { ~.. ..........
Subdivision'[~J)~z.~.,¢,'~O,~.~...~¢¢¢.~. ~.~¢r~-r~$ .... Filed Map No..z¢-.¢,..~.(¢,..Lot No....~. ~,,' .......
Permit No. /.~,~, .4~,~. , . Date of Permit ,~../J,~.]~.~..Applicant. ,~ .1~..G(2.~,'-C..~. ,o.¢¢5 ..............
Health Dept. Approval ..... ,N]~, ................ Labor Dept. Approval .... t,J,l,~ .................
Underwriters Approval . . . ~J ~Q,~..~.~;~. ......... Planning Board Approval . . [4,1 .~ .................
Request for Temporary Certificate ..................... Final Certificate ...... ~ .............
Fee Submitted $ . ./'~..~, .(~.47 ....................
Construction on above described building and p~t., ?eets all a~licable codes and regulations.O~b-~-~ ~ ~o ~ -._'5 ~ //
Applicant .~.._/. ,-~4J~,_.,~,~- ............................
Rev. 10-10-78
10O07T1 THE NEW YORK BOARD OF FI'RE UNDERWRITERS
BUREAU OF ELECTRIC;ITY ~
n~ 8~5 JOHN STREET, NEW YORK, NEW YORK 100:38
Gregory Sacks, F,/S Do~ula Dr. 200' N/O Theresa Dr., Mattttuck, N.Y.
thefoltowing location; [] Basement [~ 1st FL ~ 2,d FI. (k~tlsid~. , Sectlo,~ Block
ex..."od o, 3uae 2, 1983 and found £o be in compliance witk the r+quiremenZs of this Board.
FIXTURE FIXTURES RANGES OVENS DISH WASHERS i EXHAUST FANS
OUTLETS SWITCHES FLUORESCENT
2 2
DRYERS
SYSTEMS
NO. OF FEET
E
E R V I C
NO OF CC, COND~
PER ~'
AWG.
OF CC, COHD
NO' OF Hi-LEG
A. WG
OF HI-lEG
NO OF NEUTRALS
OF NEUTRAL
OTHER APPARATUS:
1-G.F.C.i.
(Swim~h~. Pool) Tv. is cert'~icate covers m~l~e at t~ ~ of ~t~n only.
~e of ~ ~,r~ts it is ad~le to ~ ~t test ~d/or rei~rs
~ by a q~lifi~ per~.
LIC. #242
Rulamd Elect. Co.
P. O, ~ox 143
~ttituck, N.Y., ].1952
, GENERAL MANAGER
This certificate must notbe qJtered in any manner; return to the office of the Board if incorrect, be, idehtifled by their credentials.
COPY FOR E~U[LDI~G DEPARTMENT, THIS COPY OF CE~RTIFIC/~TE MU~T~ BE ALTERED N AN~f MANNER
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
Disapproved a/c ............. ~ ...................
...... . .~T..~<< .?./'../.~.
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Application No ..................
Date... ~].Z..~/ .......... 19~.
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 dia~am 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 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 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, ?~l~in.g c,~e, housing code, and regulations, and to
admit authorized inspectors on premises and in buildings for necessa~pCot~on~ -r.
(Signature of applicant, or name, if a corporation)
.0.~. ~..¢. ,,.%..x..~..~..o..~..v~...~...~y.. !!~. ~ .....
(Mailing address of applicant)
State whether applicant is owner, lessee, ~architect, engineer, general contractor,
electrician,
plumber
or
builder.
Name of owner of premises .~..~..~... >..~. · .~&.' .~q. ........................................................
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No ...... .~..%1..~. ..............
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
l. Location of i nd on which propo d wor will
· .~ ~.~..~'....E~..~.~..~.."P.~.......I:M,..~:~. m~,.~..~. ..................................................
House Number Street Hamlet
County Tax Map No. 1000Section .: .... [.(.~ ....... Block ..... [~ .......... Lot ..... (~.. ............
Subdivision..~¢~...~. '..~..x~ .~,%,~...4~.~.~.,. ,~.. Filed Map No....~; .*.~.(,O... Lot.. (~ .I ..........
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .......................................................................
b. Intended use and occupancy .................................................................
3. Nature of work (check which applicable): New Building . . '~'O" .O..l~.. Addition .......... Alteration
Repair . ............. Removal .............. ., Demolition ',,, ,...../,d. .... Other Work .......... .~, . . .
' ~ ' ' (O - (Description)
4. Estimated Cost. !! .)O. 9.O. .... i ................... ' ...... Fei... ;\/. ...............................
: (to be paid on filing this application)
5. If dwelling, number of dwelling ~nits ............... Number of dwelling units on each floor ................
If garage number of cars
6. If business, commercial or mixed occupancy, specify r~ature and extent of each type of use ...........
7. Dimensions of existing structures, if any: Front...
Height: ............... 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 ..... ?.O ....... Rear .... ~I, ¢~. .......Depth .¥.O ...........
Height ............... Number of Stories ..................... ~);~il~''' i i~~ ~.~ ..............
Name of Former Owner
10. Date of Purchase ........... : ...............................................
11; Zone or use d~stnetc~n whmh pr~m~ses are s~tuated .....................................................
1'2~,Does propose~t 'c0~s~ruction violate any zoning law, ordinance or regulation: .... t.~..O. ........................
13. Will lot be re~raded ...... ' ........... : ...... Will excess fill be removed from premises: Yes No
14. Name of Owner of prem~ses(,¢;~ r .(.%. ~.<. r. ::,~ ..... Address ~,;~¢~.. ~-, ,,a)~,, ~., .~*Phone No ......... ,a ......
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.
STATE OF NEW.YORK,. _~" S"
COUNTY
OF..
........... .............. .~~..~ ~ ~eing duly sworn, ~eposes and says that he is the applicant
~(Name of individual sigt~ing contract)
He ~s the ..................... ' ........................ ~ .:~ ............................. (Contractor, agant f~porate
of said owner or owners, ~d is d~ly antho~zed to perform or have perfo~ed the said work and to m~e and file this
application; that all statements con(aincd ~ this application are true to the best of his knowledge and belief; and that the
work will be perfo~ed in the m~er set forth in the application filed ~erewith.
Sworn to before me this
.............. ~ ....... ~ ~ .......... ~ .......... , ~..
--
Gnllgl~d In Suffolk Count~ -- '- ' , -
:. ,~, ~2.~a~ ' tSignature o~ applic~t)