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HomeMy WebLinkAbout13113-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate O[ Occupancy 'rlnground Swimming Fool THIS CERTIFIES that tile building ' Location of Property 1 7.5 p.~p.q.~ .L,a. i3. e . .Cu.~c..hp.gq?~ .N.:~: ..... I~ouse No. Street Hamlet County Tax Map No. 1000 Section .. 102 .Block .~. .Lot 25 .. · ' ' Filed Map No Lot No Sub&vJslon ...................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated H..a..y q 0 ,. , 19 .8.4. pursuant to which Building Permit No. ! 3.~. ! .3,Z ~t[d 1.0.: ......................... 19..~.~, 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 ......... Zng. ro.u.nd. Swimm~.ng ?.ool ... David H. Albrecht& Amy Albrecht The certificate is issued to ........................................................... Iowner, lem~x :~e~nt, Ix x of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO ................ .~.6fi.$. ! ?.0 .......................... Rev. 1/81 ]gOR,M NO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THF. WORK AUTHORIZED) N? 13113 Z Permission is hereby gra~ , ~ ~.....~ .... ~.~ ................................. -~ !.~....~.~~.....~. ................. ,o ,..~~...~.~.~...~L.~..~,.......~ ................... .~~....~..,..~j,.~.~ ...... ._~....~ ................ ~'~i"'~ ........................... mt premises located at ...l ....... ~. ....... .).~ ,~,......~',~ ......... ~.~.~ .......... .... ~'".~i~i'~'i ......... i'i~i'~ ...................... iiii"i'"i ...... iiiii'iii'iii"i ........ i'i'i'"ii'i ............ County Tax Map No. 1000 Section ..... /....o.....~.. ....... Block ....... ,~'~.. ........ Lot No. ~'~"%~ pursuant to application dated .............. ....~.~..~...C~ ............., 192..~.., and approved by the Building Inspector. Building Inspector 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 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 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 sifnilar buildings and installa- dons, 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 property 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 occupancv $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 $15.00 Date .......................... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property..%~ .......... .~..~.F~. lC-..././f~../~..E~.' ............ .~..M' .~.' .¢¢ .~..¢~. ..... House No. Owner or Owners of Property /~ " F~-/~/-~ County Tax Map No. 1000 Section ............... Block ................ Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. PermitNo..]~.'.~.~. Date of Permit .~//?/~.¢/Applicant. f~0~.,.¢...~..~../I../¢._ ............... Health Dept· Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... FeeRequest Subm for ttedTemp°rary$ ........................... .~.~o~3Certifi'ca'te J";~ % J*'T/~ ..................... Final Certificate ....................... P/ Construction on above described building and permit meets all applicable codes and regulations. ~¢'AppHcant .................................................... Rev. 10-10-78 · R~_. ~oo7~' c~ I~1~ THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ 85 JOHN STREET, NEW YORK, NEW ~ORK 1003~ THIS ~ERTIFIES THAT only th~ elec tdcal equipment as described below and int~duced by the applicant named on the able application number in the premises of in thefollowlng Iocarion; ~ Basemet~t ~ l~t FI. ~ ~,~d Ft. ~t~ide Section Block Lot wasexamlnedon ~ ~ 1~ andfoundtobelncompllancewiththerequlrementsofthisBoard. i ,,l FIXTURES RANGES OVENS NCANDESCENT FLUORESCENT 1 DRYERS FEEDERS DISH WASHERS EXHAUST FANS SYSTEMS NO. OF FEET E E R V I C NO, OF CC COND. A. W, G. NO. OF Hi-LEG A. W, G NO OF NEUTRALS OTHER APPARATUS: (g~,~ ~P99_~.)_ This certi£ic~te ~)vers (x~plianc~ a~ the d~te of i~ctlon only. ~6ause ~T ~1 env~or~nts it is ~vi~e ~o ~ve f~nt te~ ~or repair~ Llc. 2300 COPY F ! MANNER. F 1~ E L]3 T;iS?ECTION (,Od,'i L N 1'~ ................. :~t FOUTIDA'F 70N ( t S t, ) t-'OUND~IT [Otl (2nd) 2. ROUGtl FRAME & PLUMBING ItISUL~TION PER N. STATE ENERGY C.ODE 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS: [~]~NAL DATE 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL DATE ~ INSPECTOR / 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 pproved ..... ' Oisapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT INSTRUCTiONs Received ........... ,19... a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ets 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 )r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- 'ation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the J~uilding Inspector will issued a Building Permit to the applicant. Such permit hall be kept on the premises available for igspection 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 hall bare been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the luilding Zone Ordinance of the Town of Southold Suffolk County, New York, and other applicable Laws~ Ordinances or {egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. 'he applicant agrees to comply with all @plicable laws, ordinances, building code, housing code, and regulations, and to dmit authorized inspectors on premises ~.a~B in building for nec~ary i~n~l~e~/flo,!~5.s~ //) ~ i i -~i~..~.¢¢~.~., t~¢~. ...................... }i (S},¢I~ ture of applicant, or.n-am'ch if a corporation) ~ t '' g PP 3tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plural;er or builder. /%_ ....k .'c>.~2 .w ¢~--~,..o.¢.<. ............................. : .............................. £5 .......... qume of owner of premise '~k]. [ ~). ~-~.~. J".~.&..~(~-~ (~ s{~n· t.t~e~a.x.~ia~}t~, c~'~dJ~.~ .C'.~.~. '.-~ j ............ ff applicant is a corporation, signature of duly~authonzed officer. (Name and title of corporate officer) Builder's License No., .q.~ !.O. :::~--'/.q¢. ~ ......... Plum ber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be:.done ........................... ~ ....................... ........... ............ ................. llouse Nuln her Street ' Hamlet County Tax Map No. 1000 Section .I.O...~ ............ Block..k~. ............. Lot .~T ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existinguse and occupancy,.9_f.!~remises and intended use and occupancy of proposed construction: a. Existing use~ and occupancy ,~...~..~.-. j~,~.,~..~x'~' ..-~.~¢.~ ......... / .................................. b. Intended use and occupancy .~.'.~..-:(~.~.(.~. -~....~. , .,-~..k.. ..... ?.~..~..~.t..r~...t+x,j.-,.t~.....~b...Q. ............. 3. Nature of work (check which apphcable): New Building .......... Add~tmn .......... Alteration ...... ?..¥ . Repair .............. Rem6val .............. Demolition ........ Other Work ,~dt dC s~t t ~'"~./c'~'),"i '" - (Description) 4. Fs'imate . . r o t .~. ~2,.-.'~< ........................... Fee ............................... : *" (to be paid on filing this application) 5. If dwelling, number of dwelling iunits ............... Number of dwelling units on each floor ................ If garage, number of cars .... 3 ................................................................... 6. If business, commercial or mixed occupancy, specify n~ttur~ iand extent of e~.ch ~yl~%of use 7. l)imensions of existing structur{s, if ally: Front..74¢. ~ ....... Rear . ~.. ¢ ....... tJeptn~ '. -oc~.~.'r I. i ..... 'q ...... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ................... i.. Height ...................... Number of Stories ...................... 8. Dimensions ofenfire new construction: Front ............... Rear ............... Depth ............... tleight ............... Number of Stories .~ ~ ....................... 9. S~zeoflot. Front .... :~.7] ........... Re~r../.'2-..~.., ............... Depth .[.~..,.?.~. ........... 10. Date of Purchase .... ;T:.. [.~ .l.. [ .~.' ."].? .... ~... Name of Former Owner ....... : .................... I 1. Zo ~e or use district in which pr~rhises are situated i. ~ ................................................ 12. ]Does proposed construction violate any zoning law, o}dinance or regulation: .b).C~ ................ .,-.:~ ...... ' 3. Will lot be regraded ..... .,~'m,'~,,'~' x.' .,.' ......... .i~., ~ill exc~s fill be removed from premises: (,Yes. fl No 4. Name of Owner of premises ~f?Y.~Y..~ t.x~-.~ t~!3~.l,{-~k~-tess . ~}~..O'~,..L:.j~. :~ ?hone I'4o . Name of Architect . Address ..... ?.l.'.t'~.~ .~...g~..... Phone No ................ Nmne of Contractor ......... ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all! buildh~gs, whether existing or proposed, anti. indicate all set-back dimensions from ,roperty lines. Give street and block humber or description according to deed, and show street names and indicate whether nter/or or corner lot. TATE OF NE~ YORK,j_ J~] $.S (Name of individual signi'ng contract) APPIIOYr:D AS NOTED FEE:/~"", -'"' BY: _ ~L). ~- 20 ,,, NOTIFY BLIILF)ING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR P©URFD CONCRETE, 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL- (~Ob?;TR!Jr'['ION MUST BE Cc~MPLr:T~: FOR C.O. ALL CON'STRUCF!C')N SHALL MEET THE REC)U[REMENTS OF THE N,Y. $1r^TE CON~ST~AIILJL'-"TI!,O~,II & ENERGY CODES. H'OT I~ES'P'ON'SI'I~/E FOR ~F~IIC~INI 0'I~ CONI.~:'IrI~uL"Tt!O~~ ERRORS. being duly sworn, deposes and says that he is the applicant eis the ...................... ~ ................ 1' .................................................. : : (Contractor~ a~ent corporate officer, etc.) f said owner or owners, and is duly authorized to perfo~ra or have performed the said work and to make and file this pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the 'ork will be performed in the manner set forth in the application filed therewith. worn to before me this NOT?,[iY PUBLIC, ! Qualified in SulJoik Coultty ~' (Signature of applicant) Co~tmission ~.<pirDs h4,uch 30, 198~2