HomeMy WebLinkAbout16686-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 building .... .A.B.O.V..E.. p~O.U..~p. Y. 99.L ........................
Location of Property ....4.5.5...8~.m.m..e.r..~a..n.e ......... S. 9.u.t.h. 9.1.d.,' .~.e.w, .Y. 9.rk
House No. Street ........
County Tax Map No. 1000 Section 078 . .Block 09 .Lot 13
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
· .D.e.c.e..m.b.e.r...1.7.,.. ! .9.8.7 pursuant to which Building Permit No. 16686 z
dated .... December........ .... 18,........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 .........
ABOVE GROUND 'SWIMMING POOL AS APPLIED FOR
The certificate is issued to C11ARLOTTE GADOMSKI
..................... ~d~;;/~,~ex~¥ ~x~;~ x x .......... ' .........
of the aforesaid building.
Suffolk County Department of Health Approval Iq/A
UNDERWRITERS CERTIFICATE NO. 11002271 - },lay 3, 1988
N/A
PLUMBERS CERTIFICATION DATED:
.........
B qj/'ding Inspector
Rev. 1/81
1~~wt ~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 THE WORK AUTHORIZED)
Permission is hereby granted to.:. _
...~..~,..~:.'t,.....~.~..'u ............
~ .............................. ?, ........................................... ~ .....................................................................
ot premises located at .**~.....:**~***....~....l~***~,....~.~~ .......................
County Tax Map No. 1000 Section ..... ..(~...?..,~, ........ Block ...... ..~..~. ........ Lot No....)...~ .............
pursuant to opplicotio, dated ~.~...,.~.~. .............. , 19.~-.7., and approved by the
Building Inspector.
Fee $. }..~.-. t....../..,,.. ·
Building Inspector
Rev, 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
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 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.
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 featu res.
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.
C. Fees: Additions $25.00 POOLS $25.00 ALTERATION $25.00
1.Cert[f[cateofoecupanc¥ New Dwelling~$25.(10, Accessory's. S10.00 Business $50.00
2. Certificate of occupancy on pre-existing dwelling $ 5 0.0 0
3. Copy of certificate of occupancy $ 5.00, over 5 years $]0.00
4.Vacant Land C.O. $ 20.00
5.updated C.O, $ 50.00 Date M.ay 1.3,. i,98.8 ....
NewCons truction ...... Old or Pre-existing Building ............ Vacant Land .......
Location of Property 455 Summer Lane Southold, N.Y.
House No. Street Ham/et
CHARLOTTE GADOMSKI
Owner or Owners of Property ............................................................
tyT 1000S ti 78 Bi 9 13
Coun ax Map No. ec on ............... ock ............... Lot ................
Subdivision ................................. Filed Map No ........... Lot No ..............
!6.5.86.Z . i2/18/87 A .. Charlotte Gadomski
Permit No ...... Date of Permit .......... /~pp,cant ....
Health Dept. Approval ........................ Labor Dept. Approval. ..................... ..
?.0,022,7. l .............. Planning Board Approval .....................
Underwriters Approval .....
Request for Temporary Cer~:ificate ..................... Final Certificate ...................... .
Fee Submitted $ 25.00
Construction on above described building and permit meets all applicable codes and regulations.
Charlotte Gadomski
Applicant .................................................
Rev. 10-10-78
OUNDATION (1st)
OUNDATION ( 2nd )
OUGH FRAME &
PLUMBING
iNSULATION PER N.
STATE ENERGY
CODE
FI~;AL
· ADDITIONA'L COMMENTS
VICTOR LESSARD
EXECUTIVE ADMINISTRATOR
(516) 765-1802
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
OFFICE OF BUILDING INSPECTOR
TOWN OF SOUTHOLD
Ma=ch 4, 1988
Ms. Charlotte Gadomski
455 Summer Lane
Southold, New York 11971
Re: Building Permit #10921 Z
#16686 Z
Dear Ms. Gadomski:
We are unable to complete your Certificate of Occupancy
because you have not supplied us with an Underwriters Certificate
for the above ground swimming pool and the enclosure of your
existing porch.
In order to complete these files it is necessary that a
Certificate of Occupancy be issued. Please fill out the enclosed
applications and return to this office. Your check in the amount
of $200.00 #498 dated December 17, I987 is on file with this office.
This covers the fees for Building Permit 16686Z - Above ground
swimming pool $150.00 - CO $25.00 - CO for porch enclosure $25.00.
Occupancy or use is unlawful without a Certificate of
Occupancy. Please help us to clear up this matter so that
action does not have to be taken.
legal
Thank you for your prompt attention.
Very truly'yonrs,
SOUTHOLD TOW BUILDING DEPT.
Victor Lessard,
Executive Administrat:or
VL:gar
encts.
PA~E I
THE NEW YORK BOARD OF FIRE UNDERWRITERS
8003~)54
BUREAU OF ELECTRICITY
[ .AY 03,1988 85 JOHN ST"EET. NEW YORK. N~t41~0]~I~/~'~ZJ'------------------ "00227~
~t~ Appl~ati~ No. ~ fll~
~{~ CE~IFIES ~T
~ exami~ on and found to ~ in ~m~ian~ with the ~ui~nts of th~ ~.
nxTu~l RXTUI~ ~ OWN~
sle~FIC]~ S~SC. ONNIBCT S ! R V I
VISUAL DEFECTS: "An electrical
survey has been made of the exposed
electrical equipment in the
premises indicated." "Mo obvious
.nsat/sfactory condition was found.
C. GODOWSK!
445 SUI~ER LRNE
SOUTHOLD, NY, 11971
This certificate must not be aB&ed in any manner; return to the office of the Board if incorrect.
COPY FOR BUILDING DEPARTMB~. 'figS
'FORM NO. 1
TOWN OF SQ~UTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N.Y. 11971
TEL.: 765-1802
Approved~..¢37~. ~...}~.., 19~..'). Permit No. ] .~0.~. .~..~..
BOARD OF HEALTH ......
3 SETS OF PLANS .......
SURVEY ..........
CHECK ..........
SEPTIC FORM ............. :
NOTIFY
CALL ................
MAlL TO:
Disapproved a/c .....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted 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 public streets
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 permit
shah 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 taws, ordinances, building code, hopsb3g code, and regulations, and to
admit authorized inspectors on premises and in building for nece~a~y/inspectio,~..s.
(Signature of applic?mt, or name, if a corporation)
~" .'q'7.r,:.:~.:.; (Mailing address, of applicant)
State whether applicant is ow/~iy-; lessee~',~ge~f~.~chitect, engineer, general contractor, electrician, plumber or builder.
r,
Name of owner of premises ...'-~._?..t.~.....t ?. .... .-- ................. x t, .-~.-~ ...........................
(as on the tax roll or latest deed)
If appli6ant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer) .
ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED
Builder's License No ..........................
Plumber's ~icense No ........ .~/' · .........
Electrician s,License No ..... ~X,~jk~ ~ ...........
Other Trade s License No ..... XT..[ .............
1. Location of land on which proposed work will be done~ . ,,. ............................ , ..................
...........
House Number Street Hamlet
County Tax Map No. 1000 Section ...Z/~. .......... Block .... .~. ............ Lot ..... ...........
Subdivision..~....~...7. '..~......~.r.~....~... ~...C.~,~,_Filed Map No...~.OJ~..Z~/. ..... Lot.. ~. ~ ........
2. State existing use andfoccupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .... ~,.-. .....~ ....... 0 ...... i '(~ ................. " .............
b. Intended use and occupancy ..................... (). .............
3. Nature of work (check which applicable): New Building .......... Addition ......... Alteratior/ .......... /3
Repair .............. Removal. ............. Demolition .......... !... Other Work · .~..~...~..O...~.
. Ach&, .~:~.cn)~D,escri i
4. Estimated Cost ...................................... Fee ......... , ............................
' (to be )aid 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 Wipe of use .....................
7. Dimensions of existing structures, if any: Front ............... Rear ...... i ....... Depth ...............
Height ............... Number of Stories ........................... I ............................
Dimensions'of same structure with alterations or additions: Front ........... [ ..... Rear ..................
Depth ...................... Height ...................... Number of Stories ......................
'--$. Dimensions of entire new construction: Front ............... Rear ....... i ....... Depth ...............
Height .. Number of Stohes ...............
9. Size of lot: Front ...................... Rear ...................... i Depth ......................
10. Date of Purchase ............................. Name of Former Owner I ............................
1 1. Zone or use district in which premises are situated.
12. Does proposed construction violate any zoning law, ordinance or regulation: ...~ ..... .c~.O .... , ..............
13. Will lot be regraded ............................ Will excess fitl be removed from pr~nises: Yes No
14. Name of Owner of premises Address ' . Phone No.
Nmue of Architect ........................... Address .............. i .... Phone No ................
Name of Contractor .......................... Address .... : .......... ! .... Phone No ................
15. Is this property located within 300 feet of a tidal wetland? Y~s ..... No .....
· If yes, Southold Town Trustees Permit maybe required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, .w, hether existing or propose~~aANCt~a0~inensions from
property lines. Give street and block number or description according to deed, ~ttJ,~[10%s~ee~ ~rt~s ilr[d, ill~c¥~e whether
interior or corner lot. U~L] 15 UNLAWFUL
,,,iMMEDIATELY" '
ENCLOSE pooLTO cODE
WITHOUT CERTIFICATE
OF CCCUPANCY
STATE OF NEW YORK, S.S
COUNTT~ OF .................
.... Q.!. cc ....
(Name of individual signing contract)
above named.
being duly sworn, depo.ses and says that he is the applicant
(Cbntractor, agent, corporate officer, etc.)i
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 hisI 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
Notary Public, . ~'ff. ..................... Count
~. 4707878, S~folk Ceunty~' . . (Signature of applicant)