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)