HomeMy WebLinkAbout12485-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
THIS CERTIFIES that the building Inground Poe]. w±th Dock
Location of Property . .17.0.0. ................... .O?.e..5..u.~.e...h.a.n.o. ........ ~.a.~.~..i.t.u.c.k....
House No. Street Hamlet
County Tax Map No. 1000 Section 122 .Block 04 . .Lot 004
Subdivision .......... .X .................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
·..~.u.g .u.a.L.....5 ........ 19 .8.3. pursuant to which Building Permit No. 12 4 8 5 g
dated ..... ~.u. $.u.s.t...~.1 ............. 19..., was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for whiclx this certificate is issued is .........
...... Construct In,round Swimming Pool & Deck ......
The certificate is issued to DAVIS, CLAUDE E. , JR.
(owner,:~ff~.~:~r~)
of the aforesaid building.
Suffolk County Department of Health Approval tq/A
UNDERWRITERS CERTIFICATE NO .... N 7 4 412 9
Building Inspector
Rev. 1/81
l~'OB~ NO. ~
TO~VN 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)
12485 Z
Permission is hereby granted to:
.......... C'~.~.~...~..~...~c.~...
........ ~..~.~?..~.~/~..x...~/,: ...... : ........ x.~..?~
. ,/.....~....~.~.~e....~-~Z..,..,.~.~ ................................................... ....../... ........................
at premises located at .../....~...(~....~.. ............... ./.~...~.~.. ...... · .,~.../.~-....d .~../~'~,~ ..............................
............................................................................................................... ~/~.,e. ..~.zTo.~..::~..~.Y
Coun~ Tox Map No. 1000 Section ..... /.z~.~. ....... Block ..... ~....~... ...... Lot No...~....~...,,~... .......
pursuant ,o application dated ..,.././.~'~...~..~........~.... ............ , 19 .~.~., and approved by the
Building Inspector.
/~.
Fee $.; ............... : ......
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
This application must be filled in typewriter OR ink, and submitted ia~ 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 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.
For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of p:Coperty showing all property lines, streets, buildings and unusual natural or
topographic featu res.
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 $15.0 0
3. Copy of certificate of occupancy $1.00 / /
4.Vacant Land C.O. $5.00 -
New Building ,,; .......... Old or Pre-existing Building ............ Vacant Land .............
Location of Property ":..?.:'J o-. '
House No. t Street ~ Ham/et
Owner or Owners of Prope .. ............ .......
County Tax Map No. 1000 Section ,.../, .~ ........ Block ...... ,~. ....... Lot ........
Subdivision ......................... .t .,, .... Filed Map No .... ....... Lot No ...............
Permit No/~,.~/.~. ,~. ,~, Date of Permit .~1/,//. ?.-?.Applicantj / .,~,~'.~.',~...~, 1'¢~.~-.~, l;~~ ......
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate Final Certificate
Fee Submitted $ .... ~., 8, ¢ .... ., ,~,..4~, 1 .......
Construction on above described building and perm[t meets ~Fa~-~-[cable codes and regulations.
cc~C~_.~ ,-~%,~%~--tq '~(e~ ' Applica ~. .................
Rev. 10-10-78
PERMIT NO.
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAl- CONSERVATION '10--83--O923
PERMIT
UNDER THE ENVIRONMENTAL CONSERVATION LAW
E ARTICLE 15, (Protection of Water) [] ARTICLE 25, (Tidal Wetlands)
ARTICLE 24, (Freshwater Wetlands) ~L~I ARTICLE 36t (Construction in Flood Hazard Areas)
PERMIT ISSUED TO
Claude E. Davis, Jr.
ADDRESS OF PERMITTEE
Box 17, Ole Jule Lane, Mattituck, NY 11952
LOCATION OF PROJECT (Sechon of stream, tidal wetland, dam, braiding)
James Creek, west side of Ole Jule Lane, south of lands now or formerly Cabave'
DESCRIPTIONOFPROJECT~nd north oF~land~ now or Tormerly Siemerling
Construct 16'x32' swimming pool with long side 5' from back of house~ and 3'
-wid~g~pool~
COMMUNITY NAME (C~ty, Town, Vdlage) TOWN
Mattituck Southold
COUNTY F~ COMMUNITY NO. DAM NO.
Suffolk
GENERAL CONDITIONS
1, The permittee shall Die In tile office of the appropriate Regional
Permit Administrator, a notice of intention to commence work at feast 48
hours in advance of the time of commencement and shall also notify him
promptly in writing of the completio*r of the work.
2. The permitted work shall be subject to inspection by an authorized
representative of tile Department of EnvironmentaJ Conservation who may
order the work suspended if the public interest so requires.
3. AS a condition of the ~ssuance of this permit, the applicant has ac-
cepted expressly, by the execution of the application, the full legal respon-
sibility for all damages, d~rect or indirect, of whatever nature, and by whom-
ever suffered, arising out of the project described herein and has agreed to
shall be removed evenly, without leaving large refuse piles, ridges across the
bed of the waterway or flood plato or deep holes that may have a tendency to
S. Any material to be deposited or dumped under th~s permit, either in
at the locality shown on the drawing hereto attached, and, if so prescribed
thereon, within or behind a good and substantial bulkhead or bulkheads, such
6. There shall be no unreasonable interference with navigahon by the
work herein authorized.
Jn the posit~on of the structure or work herein authorized, or if, in the opinion
of the Department of Environmenlal Conservation it shall cause unreasonaNe
condihon the navigable and flood capacity of the watercourse. No claim shall
PERMIT EXPIRATION DATE
Sept. 30, 3-983
8. That the State of New York shall in no case be liable for any damage
or injury to the structure or work herein authorized which may be caused by or
result from future operations undertaken by the State for the conservation or
improvement of navigation, or for other purposes, and no claim or right to
compensation shall accrue from any such damage.
9. That if the display of lights and signals on any work hereby authorized
is not otherwise provided for by Jaw, such lights and signals as may be pre°
scribed by the Umted States Coast Guard shall be mstalled and maintained
by and at the expense of the owner.
10. All work camed out under this permit shall be performed in accor-
dance with established en§meenng practice and m a workmanlike manner.
il. If granted under Articles 24 or 25, the Department reserves the right
to reconsider this approval at any time and after due notice and hearing to
continue, rescind or modify this permit in such a manner as may be found to
be just and equitable, if upon the expiration or revocation of th~s permit, the
modification of the wetland hereby authorized has not been completed, the
applicant shall, without expense to the State, and to such extent and m such
time and manner as the Department of Environmental Conservation may require,
remove all or any pomon of the uncompleted structure or DII and restore the
s~te to its former conditron. No claim shall be made against the State of New
York on account of any such removal or alteration.
12. This permit shall not be construed as conveying to the apphcant any
nglrt to trespass upon the lands or interfere with the riparian rights of others
to perform the permitted work or as authorizing the ~mpairment of any rights,
title or interest in real or personal property held or vested in a person not a
party to the permit.
13. The permittee is responsible for obtaining any other permits, ap-
provals, lands, easements and rights-of-way which may be required for this
pro)ecl~.
14. If granted under Article 36, this permit is granted solely on the basis
of the requirements of Article 36 of the Environmental Conservation Law and
Part 500 of 6 NYCRR (Construction m Flood Plain Areas having Special Flood
Hazards - Building Permits) and in no way signifies that the project will be
free from flooding.
15. By acceptance of th~s permit the permittee agrees that the permit
is contingent upon strict compliance with the special conditions on the
reverse s~de.
95-20~4 (9/75)
SPECIAL CONDITIONS
1. There is to be no disturbance to vegetation or topography within 50'
of mean high water by ~onstruction, excavation, filling, grading, clearcuttin
temporary or pennanentlplacement of construction materials or debris.
See additional conditions A-J
PERMIT ISSUE DATE
July 29, 1983
cc: U~ACE
'/~) "~ ~ ~ %~ '~'~ ADDRESS
J PERM T ADMINISTRATOR ,/ ~ ~/ ~/~ ~ t
Danie!' J. Lark%~J~%%~/~'~"'~J~SDEC Bldg ~0 SU~ Stony Brook
TOWN OF $OUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
5OUTHOLD, N.Y. 11971
TEL. 765-1802
October 22,1985
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.
/~ ~The check i~--ouLd~ted.
/~ No final inspection has been made.
Please contact our office on this matter.
Thank you for your cooperation.
Building Permit #
Expiration Date ~~
Building Dept.
Sincerely your~s,
Dorothy~.~Mi_dgley(~
Bldg. De~t.' Sec.
FIELD ~NS?~TION COMMENTS
FOUNDATION (1st)
FOUNDATION 2nd)
2.
ROUGH FRAME &
PLUMBING
INSULATION PER N. Y.
STATE ENERGY
C~gDE
FINAL
ADDITIONAL COMMENTS:
.ooo a THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY ~ .
~ ,,*~'~g ~5 JOHN STREET, NEW YORK, NEW YORK 10038
ivas examined on ~ ~ ~ ~ &~k~5 and found to be in compliance with the requirements of this Board.
FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST
OUTLETS SWITCHES FLUORESCENT
J ~
DRYERS
SYSTEMS
NO. OF FEET
E R V I C
NO, OF CC COND.
PER ~'
AWG.
OF CC, COND.
NO. OF Hi-LEG
AW, G
OF HI LEG
NO OF NEUTRALS
AWG.
OF NEUTRAL
OTHER APPARATUS:
t-G, 1,'o
~ t~;f ~ envlro~nt;~ il; ~.; [~vl~bte to ~ve fr~en~ test ~/or repai~.'~
Glenn R. Br. wtley
Horton Ave. RFD
Nattituck, N.Y.
Lic. 1327
Per
This certificate must not,be altered in any manner return to the office of the Board if incdrrect, Inspect s m~y. be ident f ed by the r credent
COPY FOR ~U LD[NG DEPARTMENT TH S COPY OF CERT FICATE ~'US~ N~T BE ALTE~E~ N ANY MANNER
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
^pp oved ..... ,l ..4ee itNo.
Application No,../.~...~..~.~: ......
Disapproved a/c ........ i ...........................
APPL,CAT,ON FOR BU,'D,N PERM,TDate ...... SJ
INSTRUCTIONS
a. This application must be completely filled in by typewriter 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, 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 building for necessary inspections.
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant i~lessee, agent, architect, engineer, genera contractor, electrician, plumber or builder.
....................... i '.O:/.d.O. '.P. ..... F .... '0. i ....... i ............................
Name of owner of premises . .X:~ 4, ......................... ~lv~- .............................
(as on the tax roll or Pfitest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No ..... ~ ./. .............
Plumber's License No .........................
Electrician s License No .......................
House Number Street Hamlet
County Tax Map No. 1000 Section .... .]?..~ ......... Block...Z~. .............. Lot ...................
Subdivision ................ ('~a'n~) ................ Filed Map No...~.. Lot i.~.. .~.
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ...... ~.4 ..........................................
b. Intended use and occupancy .... f...t?~.../. ..... ~.. ~.. ~..~...~...-~. .................
9.
13.
14.
Nature of work (check which applicable): New Building .......... Addition ......... Alteration ..........
Repair .............. Removal .............. Demolition .............. Other Work ...............
F fimated Cost F
; (to be paid on filing this application)
If dwelling, number of dwellingiunits ..... / ......... Number of dwelling units on each floor.....~. ..........
If garage, number of cars .... i ..... { .................................................. - ............
If business, commercial or mixe'd occupancy, specify nature and extent of each type of use . .-7. ..................
Dimensions of existing structures, if any: Front... ~..'.'~...: . . . Rear ...~7-..-~. ...... Depth ~..7.. ........
Height ..... ~ ....... Number of Stories ..................................................... g i
Dimensions of same structure with alterations or additions: Front ' -- Rear "--"--
Depth ................... i · ' Height ...................... Number of Stories ......................
Dimensions of entire new construction: Front ,. ~ ...... Rear ~ Depth
Height ......... .c'7'...~ Nmmber of Stories .... . .-.':-~-7..-. ...............................................
o,ze of lot. rent . .... ~'C~., ........... Rear ~ ~ De~th .~f.~.'. ...........
Zone or use district in which premises are situated.. ~,~ .~..~..'T-. ................................ .'Tr. .......
Does proposed construction viohte any zoning law, ordinance or regulation: . .~...iQ. ....................
Will lot be regraded ....... ._~ .,.~. ...... ~ .~ .... ... Will excess fill be removed from premises: _ Yes
Name of Owner of premises . ~[..~.0.~t~...]?tr~et.~. Address 0]~'.. ~.a].~;. ~1~..~.~.. Phone No..~..cji.. 7.
Name of Architect ..... i~i~12 1 ~. i ~.' i i i i i i i i i Address ................... Phone No ................
Name of Contractor .... Address ................. Phone No ..............
PLOT DIAGRAM
Locate clearly and distinctly al! buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF NEW~OR~:$_ I 7/
COUNTY OF...O'?..~...c~ ....
t'
.......... ,j.,. '. ....... being d ly sworn, deposes and says that he is the applicant
(Name of individual signing contracll/
above named.
He is the ......................
(Contractor, orpora .)
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 contained in, t,his application are true to the best of his knowledge and belief; and that the
work will be performed in the manner set fj~ffth~in the application filed therewith.
Sworn to before meAh_is [ /
........... · .~..'. <Y~. ...... day off. ~. ~, 19 .~.O~'''