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HomeMy WebLinkAbout15786-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 INGROUND POOL & PENCE Location of Property .. 1.4. .9.0..W.a..t .e.r.v.i..e.w..D.r..iy.e ........ S..o .u.t.h.o. 1..d.,..N.: .Y.. .............. House No. Street Ham/et County Tax Map No. 1000 Section ...7.8. ....... Block ...7 ............ Lot ...5.4. ............ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated Mar ch I 7, 1 9 8 7 pursuant to which Building Permit No. 1 5 7 8 6 Z dated ....M.a.r.c.h...2 J.,.. ! .9.8.7 ......... was issued, and conforms to all of the requirements of tl~e applicable provisions of the law. The occupancy for which this certificate is issued is ......... INGI~OUND SWIMMING POOL & FENCE AS APPLIED FOR ROBERT & LAURIE STARON The certificate is issued to ..................... io~,,.e;,..,x~yg~fSf~rfx .................... of the aforesaid building. Suffolk County Department of Health Approval N /A UNDERWRITERS CERTIFICATE NO. N805759 - April 27, 1987 PLUMBERS CERTIFICATION DATED: N/A Building Inspector Rev. 1/81 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PER~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15786 Z Permission is hereby granted to: ...... ......................... I.~. O loc ~ ~ at premises located 0, ........ ~ .................... ~..~.~..t~, ....... ~......~, ....... County Tax Map No. 1000 Section ........................ Block ...................... Lot No ......................... ~u,uon, ,o o~,co,,on d~ed ..~..O~.....~....!..~. .............. , ~9~...'1., ond op,~v~ by t~, Building Insp~tor. Fee $ ........... : ............ Buildl~ I~tor Rev. 6/30/80 FORM NO. 6 ~1 ~t~ J ~' {rC~ [~ ~'~Z~-~l TOWN OF SOUTHOLD ~ UJ-~"''''''--lll !1 Building Depa, t,,~ent I1 [YI..... A ... Ill I! TownHall II1~1 mT *~ lull Southold, N.Y. 11971 II I~1' Ill Jl 765 - 1802 Iu ~;~ele-a~m~.Jl.~ APPLICATION FOR CERTIFICATE OF OCCUPA CY~..~...~____~[~ I Instructions A. This application must be filled in typewriter OR ink, and submitted m 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 feature~ 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. EL For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: t. Accurate survey of p~operty 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. C. Fees: Additions $25.00 POOLS $25.00 ALTERATION $25.00 1. Certificate of occupanc¥ New Dwelling.$25.ClO, Accessory ,$]O.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 c.o. 20.00 5.updat:ed C.O. $ 50.00 Date ......... NewConstruc~ion ...... Old or Pre-existing Building ............ Vacant Land ............. ,.ocat onof rope .... ........ ..... House No. /~ Street ~-~ Ham/et ..................... .... Owner or Owners of Property ...... .~...~.('~.. ~ ./~/'.~. ~'~ ~/~' ~'%~'~/~ ..... County Tax Map No. 1000 Section ............... Block ... ~)'7 Lot. Subdivision ......... ~/~. .................. Filed Map No ........... LotNo .............. lf~DateofPe m,t' ~/UJ~'~ . .~1~1..~1..~/~{.~..~ .~.~.~...~...'~ Permit No. .~. ....... r . ....... Applicant f~eSe~,-r ~r~ro~u. ' ...... Health Dept. Approval ................... Labor Dept. Approval ......... Underwriters Approval.. ~, ~ 0~ '].1~.~..~l~,~. / .~l~n ning Board Approval ..................... · Request for Temporary Certificate Final Certificate · · Fee Submitted $ ....... ~,J~.,.~..~. .............. Construction on above described building ~per~nit ~e~ets all al3Ptical~e codes and regulations. Applicant OUNDATION (lst) OUNDATIO:~ { 2nd ) OUGH FRAME & FLUMBING LUSULATION ?ER N. STATE ENERGY CODE ADDITIONAL COMMENTS: 15 fiXTURE · I I FIXTURES ] RANGES /COOKING DECKS I OVENS I DISH WASHERS I EXHAUST FANS" · I~ DRYERS I FURNACE MOTORS I FUTURE APPUANCE FEEDERS ISOCAL REC'PT~ TiME CL~KS ~ ~LL /UNIT HEATERS ~MU -OU ~ DIMMERS OTHER APPARATUS: ~ of ~1 ~~ it ~ ~v~le ~ ~ fret ~t ~/or ~t~et, N.Y. 11733 L~267~ COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. 765-1802 BUILDING DEPT. INSPECTION DATE 'FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined...~.aAx~ .~1.., Approved ....~..~, .~. [., 19~. .~. Permit No./. ~, .'~..~. ~.~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... 'OV~,N OF SOUYHOLD 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 i 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 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 iBuilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or 'Regulations, for the eonstraction 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 ~admit authorized inspectors on premises and in building for necessary inspections. (Mailing address of applicant) \ .State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................................................... ,.,. . ........ .......... ........... ..... · (as on the tax roll orYates~t deed) . \f ~. L If applicant is a corporation, signature of duly authorized officer, c.E~' ..£~.~: (Name and title of corporate officer) · Builder's License No. (~ .~..~.. ~J~.~. Plumber's License No .... .~'~..~J~. ............. Electrician's License No .....~...~.*'.~..'~.~. ......... Other Trade's License No ...................... Location of land on which proposed work will be done: . ./.. [ . ~M House Number Street Hamlet County Tax Map No. 1000 Section ............... Block ............. Lot ............... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 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 .Q~'. ~ ~ .*-~ .' .~. 3. Nature of work (check which applidable): New Building ..... ' ..... Addition ... ? ..... Alteration .......... Repair .............. Removal ..... , ........ Demolition .............. Other Work ............... 4 Estimated Cost ~..,~ (~©~ (Description) ......................... Fee ................................. " (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 ~aiterations or additions: Front ................. Rear ................ Depth... ...... I~.l. $ .J'~. · Height ...................... Number Of Stories ............ .,~ ........ 8. Dim .~ ' (::3 nslons of entire new construction: Front .......... . ..... Rear .... ~ ........ Depth- ~..c;~ Height ' Number of Stories ' 9 Size of lot: Front ~ Rear Depth 10. Date of Purchase ............................. Name of Former Owner ............................. 1 1 ....... !. ~.'~.../:. ,:~. · Zorn, or use al,strict m wh,¢h p. rem,$es are muated ................. ~ i ./~.' i ~ ................ 12 Does proposed construction v:olate:any zoning/aw ordinance or regulation: ~ 13, Will lot beregraded ...........,................' Will excess fill be removed from premises: Yes No 14, Name of Owner of premises '3.~,k?.~ .c.A-... f%~..E?.c?c.~. Address .~ .~.qP. ~,'~,~c..c,~ ~.~.-~9.~;~; Phone No, . .~. Name of Architect ............ ; .............. Address .......... ~?¥ ..... Phone No ................ Name of Contractor ....... ;...; .............. Address . .'(~'i ...... Phone No ............... 15. Is this property located within 300 feet of a tidal wetland? Yes ..... No .k~.. ' · If yes, Southold Town Trustees Permit may be rs~uired>/~ PLO~ DIAGRAM / Locate clearly and distinctly ail buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ;TATE OF NEW YO, RII, ., S.S ,OUNTY OF..,3~.~'©.\.~. ..... ..................... being duly sworn, deposes and says that he is the applicant (Name of individual signing: contract) bore named. te is the ............................................................................ (Contractor, agent, corporate officer, etc.) ~f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this ppi/cation; that all statements contained in this application are true to the best of his knowledge and belief; and that the ~ork will be performed in the manner set forth in the application filed therewith. worn to before me this ........... 1 ........... day of ......... , ~otary Public, ......... ~ ........... County NOREEN L. HAGER NotsW Public, State of New York .................. No, §2-4526433 ($i~ature of applicant) Qualified in Suffolk~Cpunty, Commiasion Exl~ires ~ I;" ~' ]