HomeMy WebLinkAbout10164-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No..Z.1.5593 Date April 6, 19.87
Pool
THIS CERTIFIES that the bufld~g ...................................
LocationofProperty ..9.0.0..P.v.t:..Rd, #2 Birds .E.y.e. Ro.a.d Orient .
House No. Street Hamlet
Cotmty Tax Map No. !000 Section 17 ~Block 2 ..... Lot .I. 00 ! ....
SubcUvlaion .............................. Filed Map Ho ......... Lot No ......
conforms substanttauy to thc Apphcation for BtdlcU~g Permit heretofore f'ded ~ this office dated
·: .~p.:.~.t. %. )777 ....... ' ,,. pursuant to which BuilcUag Permit No..!.0.!.~.*.~ ...............
dated . .Ap.=.i.1..1.2~..I .9.77 ................ was issued, and conforms to aU of the requirements
of the apphcable provisions of the law. The occupancy tot which this certificate is L~sued is .........
Swiming poo! and fence.
T~e certificate is issued to JONATIL~,N O. STRR_,q
(own~',~
Of the aforesaid buUcltng.
N/A
Suffolk County Department of Hca~th Approval ..........................................
N432225
UNDERWR!TERS CERT!FICATE NO ................................................. .
N/A
PLUHBgRS CBRTTFTCATTOI~
Rw. 1/81
FOR~ NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN GLERK'S OFFICE
SOUTHOLD, N!. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 10164 Z
Permission is hereby granted to:
~o ..i~.~....L.t). ...... ~ ............ .~S~..t.!.L.L~'..t.M.~ ....... i~...q..o..~ ........ .~.....~.~.!.V...~- .~-T. ..........
ot p~emlses Iocoted ot .............................................. ~ .................. ~.~
................................................. ~..~./..~:~.Z ..............................
pursuont to application dated /qT~ c~' 19Z.~.. and approved by the
Building Inspector,
Fee $ ...... /....~.. ...........
Building Inspector
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 in duplicate to the Building Inspec-
tor with the following; for new buildings or new use:
I. F~nal 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 peopertv showing ali property lines, streets, buildings and unusua~ 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 or land use
3. Copy of certificate of occupancy $1.00
$5.00
Date ......
New Building ~,~, .~..' ..... Old or Pre-existing Building(Z). ~ -- ~/Vacant Land - . .~ .....
'
Location of Property . .~?.,<?~. ~'~,~-(~L~.~_'-~--- ~ /f
House No. ' ........... '! 'S't-r'eet ....... I~;~e't
Owner or Owners of Property . ,-~ .,~ .' ...........................................
County Tax Map No. 1000 Section .............. Block ............... Lot ................
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No ........... Date of Permit .......... Applicant ..... , .............................
Health Dept. Approval ........................ Labor Dept. Approval ...................... ,,.
Underwriters Approval ........................ Planning Board Approval .................. ~, ..
Request for Temporary Certificate ..................... Final Certificate .................
Fee Submitted $ .............................
Construction on above described building ar~ permit~ mee~s all a ~p~~ r_egu lations._
Applicant, .~.~,,,,..'~ .,.,, ._....~..~. ,: ....... r
Rev 10,10-78 ~ ~
I ~, THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
85 JOHN BTREET, NEW YORK, NEW YORK 10038
';r. J. Ste~n, Blrdseye Rd., 900~ ~o Main Rd., Orient, H.Y. .,,
RANGES
J
TITANS ..... SYSIEMS
I C E
Fool) This ce~$1ficate covers compliance at the date oB
,etlon only. ~eeause o£ unusual environments it i6 advisable
C~eq~nt Ces$ ~nd/orrep~lr$ m~de ~y a qualified pc~on,
PoPt 'JeFferson Sta,, N.Y. 11776 LIo.1101E GENEI~MAN,d~R
must not be ~ltered. in any man~r;_~rn to t~ ~f~ of ~ ~rd'if ~orr~t, Inspectors ~y ~h~ by t~ ~edenti~/
TOWN OF SOUTI~OLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
$OUTHOLD, N.Y. 11971
TEL. 765-1802
Applzcant
This is to advise you that the job under Building
Permit No. ~Oi~q issued to~.~ ~
on ~/t~J7~ for ~~ ~ ~ ~s completed and
a flhal inspectio~ has/--7 h~s no6~ been done.
In order to complete this file, it is necessary that
a Certificate of Occupancy be issued. Please fzll out the
enclosed form(s), return same to the above offzce,w~ ~
eq=r~k~'e~-~-$'-5-.~-t~-6aw~!--~---t-o ~h~-Tcwn~e~--.~ou~ho~Ld. Please
indicate to whom the Certificate of Occupancy is to be
and arrange with this off~ce for an inspection date.
Thank you for your prompt attention.
Very truly yours,
Victor Lessard
Administrator
VL:ec
Enclosures
mailed,
FO~M NO.~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
$OUTHOLD, N. Y.
ORDER TO REMEDY VIOLATION
Dote
(owner or authorized agent of owner)
(address of owner or c~uthorized agent of owner)
PLEASE TAKE NOTICE there exists a violahon of:
Zoning Ordinance
Other Appbcab~e Lows, Ordinances'or Regulations ............................................
at premises hereinafter described in that rE k(C&: 40f?,'~ /kt~'~ ~ ~F~ 7'1- ~
(state character of wolation)
.........................................................................................................................................................
m violation of '
(State section or paragraph of applicable law, ordinance or regulation)
YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the law and to remedy the
conditions above mentioned forthwnh on or before the ......................................................................
day of ~i~f [' 19 ~
The premises to which this ORDER TO REMEDY VIOLATION refers are s~tuated at
~..,.,.~ ..... ~ ...................................................... , .. o ry of Suffolk, New York.
Failure to remedy the condihons aforesaid and to comply with the applicable provisions of law
may constitute an offense punishable by fine or imprisonment or bath.
Building Inspector
NO, I
TOWN OF SOUTHOI.~
BUILDING DEPARTMENT
TOWN CLERK'S OFFIC:E
SOUTHOLD, N. Y.
E×amined
~proved ................ 19.......~ Permit No .....................................
Disapproved e/c .............................................................
.......................... ........
...........................................................................
..............................
INSTRUCTIONS
a. Th~s application must be completely filled in by typewriter o¢ 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 oublic streets or ~
and giving a detailed description of layout ofproperty must be drawn on the diagram wl~ic'h is part of t'his application. ~')~
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 w~ll issue o 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 ax
shall hove been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances,g!
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe~ff
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and ir~ buildings for necessar~
inspections.
]re of-applicant, or name, if a corporation)
..........................
· (Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
......................................... u/ ,v ......
Name of owner of premises .~/~.../~..~'..h/..~.c.J......../~,......,~..7~.~-~.~.~/.. .............................................................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's ficense No ...............(~../. ................................
Plumber's License No ............ ..~.././...~.. ..........................
Electrician's License No ....... /./..~../..~'~ ......................
Other Trade's License No ...............................................
I. Location of land on which proposed work will be done. Map No.: ...................................... Lot No. ~
Street and Number ...... .Z~..x'z-)..~./..'-./.......~(..).¢~. ............................................................... .~,..~..../~/..,~ .......
~0 ~-:¢ .~d~ ~-- ~/~ E-z,'~m '~0~_~ Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a E×isiting use and occupancy ........ ./.......~...~?..~.~..~../..¢~.~......~./,~4~ .~l[~.~. .......................................................
b. Intended use and occupancy ..... .~.~.~'....~..~. ...... ./.~..~.~.~f?~'.,~'~t.....~.~'~,4~.~¢-~.~......~...~..~...~,- .....................
3. Nature of work (check whichjapplicable): New Building.. ................. Addition ......,~'. ....... Alteration ................
Repair .................. Removal ................... Demolition .................... Other Work ....................................................
(Description)
(to be paid on filing this application)
5. If dwelling, number of dwelli:ng units ............................ 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 ............................ Rear ................................ Depth ....................
Height ........................ NumlSer of Stories ........................................ ; ........................................................................
Dimensions of same structur~ with alterations or additions: Front ....................................Rear ............................
~ Depth ................................ Height ............................ Number of Stories ................................
B. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................
Height .................... Numbe~ of Stories .....................................................................................................................
9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................
................ ~ ....................................... Nome of Former Owner ........................................................
10. Date of Purchase
' which premises
11. Zone or use district in are situated .....................................................................................................
t2. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................
13. Will ,lot be regraded' .......~.~. ............. Will excess fill be removed from premises: (X) Yes ( ) No
14. Name of Owner of premises ....~ ............................................... Address ................................ Phone No .......................
Name of Arch tect .............................. Address ................................ .Phone No .......................
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,
COUNTYI OF ...................... ,.,
........ .~..~..~...,~....~,.,.~...~....'~..........~..'....~.~..~.. ............................. being duly sworn, deposes and says that he is the applicanl
(Name of individual si~ning contract)
above named. ,
He is the'. .................... ~ ......... ~...~..~./~....~.~,~ ...........................................................................................................................
(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 stotemedts contained in this application are true to the'best of his knowledge and belief; and
that' the work will be performed in jthe manner set forth in the application filed therewith.
Sw~,~,/fore me this
.,~.1¢ ............. day of/'~.4~f~'.~..~...,,~.:...., lcd....~...
....... . County ..........
Notary Public, . ~ (Signature at applicant)
Commllsl~n li~'es MIIr~h
PRE CAST
COPING
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SKIMMERS . RETURNS~ ~1
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sECTION ~__ FILTERondPUMP
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POURED CONCRETE
FOOTING
WALKS TO SE SMOOTH- NON SKID TYPE, SLOPED
AWAY FROM POOL
WATER DISPOSAL SHALL BE LIMITED TO OWNER'S
PRO._PE.R_T_~Y TO SUIT LOCAL REGULATIONS
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