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HomeMy WebLinkAbout16206-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22655 Date OCTOBER 13~ 1993 THIS CERTIFIES that the buildin~ Location of Property 1980 BRIDGE LANE House No. County Tax Map No. 1000 Section 85 Subdivision ACCESSORY Street Block 2 Filed Map No. CUTCHOGUE~ N.Y. Hamlet Lot 27 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 2~ 1987 pursuant to which Buildinq Permit No. 16206-Z dated JULY 12, 1987 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 ACCESSORY INGROUND SWIMMING POOL & FENCE AS APPLIED FOR The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED THOMAS R. & WANDA S. SHEARIN H-037405 - OCTOBER 7~ 1993 Rev. 1/81 il~ing Inspector l~OB~ NO. B TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING ~EIU~JT CI'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6206 z Date Permission is hereby granted to: . · ....... ....~?..~.~.~..? ............................ .7...... ............. ........ ' ........................................................ .... ...~..~X~.~..~.~.... ....... ...... ro ~t premise~ located at .......... , ................................ County Tax Map No. 1000 Section ....... ¢~..~...~.. ..... Block ...... m,~t,,, ...... Lot No......'~...~. .............. purSuant Building Inspector. Fee $ ...................... Building Inspector Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and Vpre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C.' Fees 1. Certificate of Occupancy - New dwelling $Z5.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential/$15~O0, Commercial $15.00 Date ... ' ............................. New Construction ........... Old Or Pre-existing Building ................. Location of Property ............. - House No. Street Hamlet On.er or O~ners of ~roperty....,..,.~[Bi~.~> ........................... County Tax Map No 1000, Section ..... ~ ..... Block ............ Lot .................. .... Filed Map . . .Lot ..................... Subdivision .......................................... Permit No ................ Date Of Permit ................ Applicant ............... IIealth Dept. Approval .......................... Underwriters Approval ............... Planning Board Approval . Request for: Temporary Certificate ........... Final Certicate.....~..... Fee Submitted: $ ............................ i ,~,),~,'~,~,'~, ~ i~.~,).,x~,~.~3~ 55 - A LIC NT THE NEW YORK BOARD OF FIRE UNDERWRITERS p~{;r, ~ ~{'~)~t3~Jfi~ BUREAU OF ELECTRICITY ~- E5 JOHN STREET. NEW YORK, NEW YORK 10038 THIS CE~IFIES THAT o~y the electrical equipmen[ ~ ~scrib~ be~w a~ int~uced by t~ applicant ~med on the a~e application n. tuber in the prem~es of in the followlng location; ~ Basement ~ Ist ri. ~ 2nd FI. 0 ~ ~' Section Bilk Lot . 0 ~ ~ 0 [~ [~ R 0 4 ]~ ~ 9 :~ and found to be in compliance with the NaBonal Elect~c~ Code. FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES F!.UC~E$CEIqT OTHER 2 DRYERS SYSTEMS NO. OF FEET OTHER APPARATUS: * ( ~IMff[}IG POOh) c~vers ooraplianee at th~ date of in,peet]on <rely, Beoau~e of E R V I C NO O~,COND A W.O. NO. OF HI-LEG A W.G. NO. OF NEUTRALS A.W.G .,,A, COPY FOR BUILDING DEPARTMENT~ THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER THE NEW YORK BOARD OF FIRE UNDERWRITERS ~'~ ~ BUREAU OF ELECTRICITY ~ ~ 85 JOHN STREET, NEW YORK, NEW YORK ~0038 THIS CERTIFIES THAT o~y t~ electrical equipment ~ ~serlb~ be~w a~ intr~uc~ by t~ applicant ~med on the a~e application ~u tuber in the prem~es of in the following lacatlon; ~ B~sement ~, Ist FI. ~ 2nd FI. OtlaY S~tion Rl~k Lot u~sexamlnedon OC ~'0 ~] [{ ~(~ ~ ~993 and found to be in compliance with the Na~'onal Electdcal Code. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'f SERVICE DISCONNECT NO. OF S E OTHER APPARATUS: made by a qtlallfle~l }~t~lZ8Oll, COOKING DECKS OVENS DISH WASHERS TIMECLOCKS ! LIUNITHEATERSUNITHEATERS MULTI*OUTLET V I C i NO, OF HI-LEG oFA' HI-tEGW' G. NO OF NEUTRALS EXHAUST FANS DIMMERS OF NEUTRAL GENERAL MANAGER ...... ............ ........ COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. INSPECTORS Victor Lessard Prir~ipal Building Inspector Curtis Horton Senit~ Buikiing Inspector Thomas Fisher Building Inspector Gary Fish Building Inspector Vincent R. Wieezorek Ordinance Inspector Robert Fisher Assistant Fire Inspector Telephone (516) 765-1802 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD September 21, 1993 SCOTT L. FIARRIS, Supervisor Southold Town Hall P.O. Box 1179, 53095 Main Road Southold, New York 1197l Fax (516) 765-1823 Telephone (516) 765-1800 7 Hr. & Mrs. Thomas Shearin 1980 Bridge Lane Cutchogue, N.Y. 11935 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. (Enclosed) No Underwriters Certificate on file. The check is (~/not on file.)$25.00 No Health Department Approval on file'i No final inspection has been made. No Pluraber Solder Certificate on file. (All permits involving plumbing being issued after ADril 1, 1984). BUILDING PERMIT # 16206Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TO~qq BUILDING DEPT. UND~TIO~J ( ~st) UNDATION (2nd) UGH FRAME & PLUMBING SULATION PER N. Y. STATE ENERGY CODE FINAL 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ J FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS: [ ]~FINAL DATE ]'65-S802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ;ZND [ ] INSULATION INSPECTOR BOARD OF HEALTH ...... 3 SETS OF PLANS ....... FORM NO. I SURVEY .......... TOWN OF SOUTHOLD CHECK ~A~. ~.q BUILDING DEPARTMENT SEPTIC FORM ............. : TOWN HALL SOUTHOLD, N.Y. 11971 NOTIFY TEL.: 765-1802 CALL .............. MAIL TO: Examined .. ~..[.~., 19 ~.~ ~,~ Disapproved a/c .................................. ~. ,,(j (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date .................. ,19 a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 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 street.' 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 permii 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 Occupanc) shall have been granted by ~he 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 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 tc admit authorized inspectors on premises and in building for necessary inspections· ...zq. :. ~. k-/¢.~. L. :.~..,qT.~..w. F,..~ .......... (Signature of applicant, or name, if a corporation) · ~.,..x...qy..%... N~rT:./.'~/.<... ~.'.. 7... ...... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· .................... ~.4.~,..z.~..~..~ ..... . .co..~. r-~..~.c..~...,< ........................................ Name of owner of premises ... '].~. J~. 0..)~. 4q..J' ..../~. ....~.~.//~ .... ~4).~ ./4.~/:3...~.6.t-~7 ....,ff..//~..~7.7~. ~.Y..~. ..... (as on the tax roll or latest deed) If ap~tn~ is a corporation, signatgg~e of duly authorized officer. ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No ...... ~..~. '.~ .~...]'/:~.. .... Plumber's License No ........... .......... Electrician's License No.. Other Trade's License No ...................... 1. Location of land on which proposed work will be done~ .. ,~.~../..~.~ .~.-....~...~...~.-.:.. ?_....CC..~...~. ff..~. -~.. .... Itouse Number Street Hmnlet County Tax Map No. 1000 Section ..... ~).~-~. · ...... Block ........ ~:. ....... Lot .... ..~.2 .......... Subdivision ...... ~...~.~....~......~..~..~'Zt:5'~ ........ Filed Map No ............... Lot ............... (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 .~...Z~-ff..( 3. Nature of work (check which apphcabl ): New Building .......... Addition ..... Alteration .. Repair .............. Rem6val .............. Demolition .............. Other Work ~ (Descrip~tion) 4. Estimated Cost ....... . ...~.C.-.)...O~: .q,3~.,. . . .... ....... . . Fee . ................................ , ... . ! ~ (to be paid on filing this application) 5. If dwelling, number of dwelling:units ............... Number of dwelling units on each floor ........... If garage, num her 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 ...... ~ '~,, '~ · H:' · ! · ' Height ...................... Number of Stories ...................... 8 Dime ' s of~nti ' ~ st~uction' Front Rear Depth Height ............... Number of Stories ........................... ..... ...... . .. .. ............ . 9 Size of lot: Front i Rear Depth Date of Purchase .......... ~ .................. Name of Former Owner ............................. 1 1. Zone or use district in which pr~mises are situated ......... ~-Z.(.(~...~f'~...T-/.~'..~.)~ ...................... 12, Does proppsed construction vioiate any zoning law, ordinance or regulation: ...... t:.~. ...................... 13. Will lot be'regraded ....... ~J..~ ................. Will excess fill be removed from premises: Yes ~ 14. Name of Owner of premises .. j~,~..f'.zt&~..~..~..~. .... Address ................... Phone No ................ Name of Architect ......... ~ ................. Address ................... Phone No.. 15. Is this property locatediwithin 300 feet of a tidal wetland? *Yes ..... No ~... · If yes, Southold Town Trdstees Permit maybe required. ' PLOT DIAGRAM Locate clearly and distinctly all 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 YORK, COUNTY OF ................. S.S (Name of individual sigfling contract) above named. being duly sworn, deposes and says that he is the applicant He is the .................... . ~ .................................................................... ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d~ly authorized to perform or hav~ perfonued'tkle 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 mannyr set forth in the application filed therewith. Sworn to before me this ............... ..~, ...... day o!f...~x~'J. ............. ,19 .~.Z ...... ~ ~ (/.~..~'f.~...~.. CounW f~ - IN o'~ary VUOllC, ................ ,.. .............. ~~ ~,~ f~~:re of applicant)