HomeMy WebLinkAbout10311-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 ba~ ................................................
Location of Property . .~75..14.99.d.o. rtd.. ~/.a.y.,..S.o.q .b..h.o.l.d. ~. ~I.Y. ..........................
House No. Street Hamle~
County Tax Map No. 1000 S~ction .7.q ......... Biock . ~.[ ........... Lot..[.8. .............
Subdivision...~.o..u.~.h.o.~..d ................... Fi]ed Map [No..2.~.~ .~...Lot No.. ~.~ ..........
conforms substantially to the Application for Building Permit heretofore f'fled in this office dated
·..J.u.]..y...]..3 ........... , 19 ?.9. pursuant to which Building Permit No..~. Q~.]..Z.Z. .............
dat~O 1.y.. ~.3 ....................... 19 79., 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 .........
~.n. ~r.qu.n. ¢..s?.t..m.m.~.n.~. p.o.q~..a.n.c!, t.e.n, qe. ..........................................
The certificate is issued to . .J.a,¢ 9.b..P.~UJ-..~. 8ia.v.~.~yta..~91~.~.~,r~0le .......................
of the aforesaid building. /
Suffolk County Department of Health Approval .... R Z I~ ...................................
UNDERWRITERS CERTIFICATE NO .... Hq/t ~ b.6. Q .....................................
1/81
Building lmpector
------.,TnWI~O~-~THOLD' '~' ' :' '
BUILDING ;DEPARTMENT
SOUTHOLD, N. Y.
BUILDING pERMIT:
(THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N.° 103~1 Z
Permission is hereby granted to:
..~2£(?../.~..... ~..~/~.....,~¢.~.!..~./..~L./;-..'L.~ .........
~', ~,~. ,~ ~.:.u.5. ......... ~.~!.~..;.!.Y.! .~.LC-......~J!?..L..~ ...........
to ........... ~J,J.l,.~ ........ .~.. ...................... l.....~. ............. ~. ........................................................
c-~ ~,I '~ ?.u.'T H b~ool~ C/..~..~...b. .b..J~,~..~,... ,~,,L.~./ /.. ......................
pursuant to application dated ~J L/L '(' ~ ~ 1~..~.. and approved by the
Building Inspector.
Fee $....../..~. ..............
REGRADING LOT
DRIVEWAY CONSTRuCTIoN
CESSPOOL CONSTRUCTION'
CELLAR CONSTRUCTION
OTHER
Building Inspector
PERMIT INCLUDES ApPrOVAL
TO REMOVE EXCESS FILL
FROM ABOVE PREmiSES By
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 in duplicate 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 ResideOces 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 peoperty showing ail property lines, streets, buildings and unusual natural or
topographic featu res.
2. Sworn statement oi~ 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 ............ Vacant Land .............
Location of Property ~-/~.~: ..............................................................
House No, Street Ham/et
. , .....
Owner or Owners of Property ?..~..~:: .Z-~. '.~.~..~./.2~.. Z~...~.~.~. ,/~ .~'~..U... ~,
.. c: .... //
CountyTax Map No. 1000Section . ..~.~ ......... Block ........... Lot ...............
Subdivision..~:~.,!,.-:~.-.~.'~-?.,./:.d:~. ............. Filed Map No. :~. ?..Y.~...Lot No .... J~ .....
Permit No..~.d~. :~..///., Date of Permit .... .~....Applicant..~..'~./)~¥..~.'...~.'./~?.
Health Dept. Approval ........................ Labor Dept. Approval ., ......................
Underwriters Approval..~,/../~/. ~/. ':-~ ~ (~7 .Planning Board Approval
Request for Temporary Certificate ..................... Final Certificate
Fee Submitted $ ~' ~I-~
Construction on above described building and permit m,~ all/~p~cab~e codes and regulations,
Apphca . . .~ ..............
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
TOWN HALL
SOUTHOLD, N. Y. 11971
October 2, 1979
Mr. J. P. Scheiner
R. Ro#1 Box 596D
Southold, New York 11971
Re:
B.P. #10511Z, Inground Swimming
Pool
Dear Mr. Scheiner:
In reply to your letter dated September 24, 1979, the above
permit is for the pool and fence enclosure, too°
Your permit will expire January 13, 1981. The fence you described
in your letter would be acceptable for a total height of 8'0"~
You will, however, be required to keep your fence set back a min-
imum of 5'0" from the property line due to the 8'0" height. I
have checked the fence you now have for a temporary enclosure. It
meets code requirements until such time you can construct the en-
closure you have mentioned.
When you have completed your permanent enclosure, notify us so that
we may make a final inspection. At that time, you may apply for
a Certificate of Occupancy.
Yours truly,
EDWARD F. HINDERMANN
Building & Housing Inspector
EHF/mw
z,z- x>>-'/×£~/
Memorandum from.,..
BUILDING iNSPECTOR'S OFFICE
TOWN OF $ODTHObD
Town H^L~, SOUT~OL~>, N. Y. 11971
765-1802
-C~Nr E ~'k;,~~,
THE NEW YORK BOARD OF FIRE UNDERWRITERS
~* BUREAU OF ELECTRICITY
~ 85 JOHN STREET, NEW YORK, NEW YORK 10038
..re July 30, 1979 A..,icatlo.~o.o.~le 031375 N
THIS CERTIFIES THAT
in the follo,~ing locat[on~ [] ~Base,nent [] l.t Fl. [] =nd Fl. Outside Sectlo. 1~.~ ~ot
tvas examined on July 25, 1979 and found to be in compllance ,~ith the requirements of this Board.
FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS
OUTLETS SWITCHES
DRYERS FURNACE MOTORS FUTURE APF%IANCE TIMECLOCKS MULTI. OUTLET DI~RS
SYSTEMS
SERVICE DISCONNECT S E
A. W.G. NO. OF Hi-LEG
OTH R PA TU -
C E
A. W.G. NO. OF NEUTRALS
OF HI-LEG
(Swinging Pool) This certificate covers compliance at the date of
inspection only. BeCause of unusual envlronment~ 1~ 1~ advisable
to have fPequent test and/o~ ~epalrs made by a qualified pe~son,
OF NEUTRAL
Phil Gordon
12 Dean St.
PoPt Jefferson Sra., N.Y.
11776 LIo.1101E
L
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified
credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED
Examined . . x. :, :.: .~ ........, 19...
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
Approved ~ ; ' { 3 19 ..Permit No.
Apphcat~on No. ,.:...).
Disapproved a/c .............. l .......................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
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, r
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining ..... premises or public st eets._,
or areas, and giving a detailed description of layout of property must be drawn on the d~agram which ss part of th~s apph-
cation.
not be com~nenced before issuance of Building Permit.
c. The work covered by this application may ·
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, building code, housing code, and regulations, and to
buildings for necessary inspections) /3 , /
admit authorized inspectors on premises and in ~ "~' '-~'/ ~C~'/.~.~...~ ~
(-/(Signature of applicant, or nmne, if a corporation)
.. ........
(Mailing address of applicarff)
State whether applicant i~/owne~Olessee, agent, architect, engineer, general contractor, eie'ctrician, pmmoer or builder.
Name of owner of premises .~ 0F-~O ~O..~.~. }...~°~5'tC-1 lq .q,4'T ..............................
(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 ....... .t?./.~. ...............
Plumber's License No ....... ff./.~ ...............
Electrician's License No ..... ~ //&.. .............
, I
Other Trade s License No ........ ~. ........... ./~
I. Location of land on which proposed work will be done ................................................. .~
..... x. ...................... lo.o.d.e d. . ............ ..................
House Number Street Hamlet
County Tax Map No. 1000 Section .......... 7..(~.... Block t~ Lot. (" ~
~~'f?.~.L. ............. Filed Map No. ~ [ 7/ .... Lot....~. ~ ........
Subdivision ...... (Name) .......
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy..~..tl . .~....~.. .....................................................
b. Intended use and occupancy . ] ....... ~. . .~d~0.~ ~..~..~ ..............................
3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ..., .......
R~,pair· .............. Removal .............. Demolition .............. Other Work ]~.~,o-~ .l/~/2t~J~
4. Estimated Cost..3../~..~.~.~. ,.ap. ........................ Fee..i..~.~'. ................................
(to be paid on filing this application)
5. If dwelling, number of dwelling 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 ............... Number of Stories ........................................................
Dimensions of same structure with alterations or additions: Front ................. Rear ..................
Depth ...................... Height ...................... Number of Stories ......................
8. Dimensions of entire new construction: Front ............... Rear ............... Depth ...............
Height ............... Number of Stories ........................................................
Size of lot: Front ...................... Rear ...................... Depth ......................
Date of Purchase ............................. Name of Former Owner .............................
Zone or use district in which premises are situated ........................................... j:. .....
Does proposed construction violate any zoning law, ordinance or regulation: ................... ,./,~ ..........
Will lot be regraded ...................... 0.. .....Will excess fill be removed from premises: ~, ~Y_es~ No,
Name of Owner of premises fi~¢t.c.~ .(J.".c~.4 .~tc.- .~. ~ ................... Phone No..?.~ ~ F...~.t./. ~
Name of Architect ....... ~. .................. Address ................... Phone No ................
Name of Contractor .......................... Address ................... Phone No ................
10.
11.
12.
13.
14.
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~
COUNTY S.S
.............. ~ ~.~....~.. ~.~'/....-~.0~.~/~.-~./.,'7.~. ~-being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the .......... ~7..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 contained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
/~2 da of ~2~/~ , 19 ~
Notary Public, ...~. ~z~J.. ~...~ ..... County /~) /~7h ~ ~
(Signature of applicant)
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