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Home My WebLink About15788-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22490 Date AUGUST 2r 1993 THIS CERTIFIES that the buildin~ Location of Property RESERVOIR ROAD House No. County Tax Map No. 1000 Section 09 Subdivision ACCESSORY FISHERS ISLAND¢ N.Y. Street Hamlet Block 09 Lot 05 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 18~ 1987 pursuant to which Building Permit No. 15788-Z dated MARCH 21r 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 INGROUND SWIMMING POOL & FENCE AS APPLIED FOR The certificate is issued to CHRISTINA RHODES (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A N-064948 - APRIL 5~ 1989 N/A / ~lding I~spector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y, BUILDING PERMIT (I'HIS PEP,~iT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPL~ION OF THE WORK ^UTHORIZED) N~ 15788 Z County Tox Mop No. 1000 Section ....... .~.~ ......... Block ..... ..C~..~ ........ Lot No ....... .~..~.'~. ........ pu~uon, ,o o~,,~,~ ~o,~ .... ...~.~.....L~ ................ , ,,~..~, o~ o~ov~ ~ ,~, Building Inspector. Fee $.~.~..:..~......~ ...... Building I~or 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 "pre-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 $25.00, 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 $15.00, Commercial $15.00 Date . .--~J ~ ..~.~ ~ ~..~.. N~w C6L~maction ........... Old or rS~-exis~iL~ ~ou~e ~o. Street ~a~et On.et ot O~ne~s o{ ~ope~t7 .................................. ,o 000. ....... ....... .............. Subdivision .................................... Filed blap ............ Lot Permit No ~--~ .~ .~..~. .Date Of Permit~..~.~. ~7 Applicant .~.O.~ Health Dept. Approval.~[~. ~ ........ Underwriters Approval. Planning Board Approval. N~...~.~ ........ Request for: Temporary Certificate ........... Final Certicate .......... Fee Submitted: APPLICAN~ - OU~DATIO.U (1st) OUNDATIO~U I 2nd ) Ye OUGH FRAME & ?LUMBI:JG i:~SULATION FER N. STATE ENERGY CODE FI:IAL · ADDITIOI;AL COMME~JTS: · - · FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined..x/T~...~J.., 19 ~.? ~.~.~n~_ ~ /rt,~.~ Approved . .~...O~..c~... ~7! .., 19~.7. Permit No../.~..7..~.~...~ Disapproved a/c ..................................... ..... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... Date...3..~/..~. ......... 19 .~. ? 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 properW must be drawn on the diagram which is part of this appli- cation. ¢. 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 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 laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. ~ , ~ .... ?...=_., ....... (Signature of applicant, or name, if a corporation) .....~.'.~.. 5~ ~g¢.~..t3.~.c.~.. ~.o .......... .... (mailing address of applicant) State wheti~er applicant is owner, lessee, agent, architect, engineer, general contractor~ electrician, plumber or builder. .F_~ ~ we-~c rue_ .......................... :, ....... : ..... : .... i.. v ............. Name of owner of premises ...... .~..~.....~'.~.'~.....~..~.0~ .~ ..... L..~...3 ............. (as on tl~e tax roll or latest deed) If applicant is a corpora,,~ion, si;?nat)lre of duly authorized officer. r{Name and title of corporate officer) Builder's License No... ].~..j.~...c/.[__ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done. '4-- ~ ~ ~.:~. ltouse 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 ¢[33~-~ ~'310q ,.t~ b. lntendeduseandoccupancy ]~,)~ld.~ fK~'~"lP-'O0~O0 ?0~3{_~ ]..~. ~....~... ~.tg~.. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair . .. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost ..... :~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, 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 ........................................................ D~nensions of same structure xvith alterations or additions: Front ................. Rear .................. Depth ............... HeiSt ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front .... q..5/. ~ ..... Rear .... q'.~ ( ...... Depth .. ~ ~ f ...... Height ............. Number of Stories ........................................................ 9. Size of lot: Front ................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Foyer Owner ............................. 1 1. Zone or use district in which premises are situated ..................................................... 1 2. Does proposed construction violate any zoning law. ordinance or regulation: ...... ~.~ ...................... 13. Will lot be regraded .... ~.~.. ~ .................. Will excess fill b~remoyed~, from premises: Yes. ~ ~o Phone Name of Architect ......................... Address ................... -- Phone No ........ ]5. ~s th~s propev~v Locdted wiChin~.00 ~eet of a t~da~ web,and2 ~ ~es ........ * ~ yes, Souchold To~m Trustees Pem~t may be required. PLffT DIAG~ ' Locate clearly and distinctly ~I bulldogs, whether existing or proposed, ~d. indicate ~1 set-back d~ensJons from prope~y ~nes. Give street and block number or description accord~g to deed, ~d show street n~es and ~dicate whether STATE S.S COUNT~ OF...?.,...~-. ......... · . ~-! .,'. '~,(i :45: .4?. .... 4 ......~.~. q/5~ ..... being duly sworn, deposes ~d says that he is the applicant t Name of individual signing contraffO above named. He is the ..... :'~. T.~.' ~:~:~ ......................................... (Contractor. agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perfo~ or have perfo~ed the said work ~d to m~e ~d file this application: lhat all statements contained in this application are true to the best of his knowledge and belief; ~d that the work will be perfo~ned Jn the m~ner set forth ~ the application flied therewith. Sworn to before me this ........... (.. 7~./~ . .day of.. ~Z,:,'~ : ''~/ 19 ~.~ Nota~ Public, ' ~' " " '~~ ........................ :~..::..... County / ~~~,.. · ~ j,~ ~ · -0 '(Si~ature of applicant)