HomeMy WebLinkAbout16189-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z17154
Date
AUGUST 3, 1988
THIS CERTIFIES that the building
Location of Property 115
House No.
County Tax Map No. 1000 Section 107
Subdivision
INGROUND POOL
GRAND AVENUE
Street
Block 8
Filed Map No.
MATTITUCK
Hamlet
Lot 41
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 29, 1987 pursuant to which
Building Permit No. 16189Z dated JULY 8, 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.
The certificate is issued to
RUSSELL & CAROLEWELLS
(owner,
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N830812
PLUMBERS CERTIFICATION DATED N/A
~'~ B~ui~g Inspector
Rev. 1/81
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)
N9 J6189 Z
Permission is hereby granted to:
,o
at premises located at ..J.(....~.........~.~A......~.:.....~.~ ...........................
County Tax Map No. 1000 Section .... J...~....~. ......... Block ....... ..~..~... ....... Lot No......~..~ ..............
pursuant to application dated ....... ....~..~.....~.?J ................. , 19.~.~.., and approved by the
Building Inspector.
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 ~ Imlllllam 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 featu res.
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 p~operty showing all property lines, streets, buildings and unusual natural or
topographic featu ms.
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 occupancy New Dwelling.$25.Q0, Accessory iS10.00 Business $50.00
2. Certificate of occupancy on pre-existing dwelling $ 50.0 0
3. Copy of certificate of occupancy $ 5.00, over 5 years $]0.0/0 /
4.Vacant Land C.O. $ 20.00
5.Updated C.O. $ 50.00 Date .... .[,,!?'.~.~.~. .........
New Cons truc t ion ...... Old or Pre-existing Building ............ Vacant Land .............
LocationofProperty .,~/,.~..~...~,~.~.~..0(...~.I~[¢ .~.~.~..(,..?.~.e.[.Cj ~,,..Xi~..
House No. Street Ham/et
Owner or Owners of Property .~.%~.5'~ Il ~ ~.~/I~{F~
County Tax Map No. 1000 Section .............. Block ............. Lot. ~. .............
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No ...... Applicant
Health Dept. Approval ........................ Labor Dept. Approval ..................... ~..
Underwriters Approval ..................... Planning Board Approval
Request for Temporary Certificate ...................... Final Certificate .......................
Fee Submitted $ ....... ~.J.~. ...........
Constru. ction on above described building and per~it meets all applicabl~ codes and regulations.
App:ca., . .....
Rev. 10-10-78
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
~- ~fJ BS ,JOHN STREET, NEW YORK. NEW YORK 10038
DateSepteatbcr ~ 19~7 500665/$7
THIS CERTIFIES THAT
only the electrical ~ulpment ~ ~scrlbed be~ and introduced by t~ applicant ~med on the a~ve application nu tuber in the premises of
~le]le.West South 115B Grand Avenue,~ou~h of Wes~view Drive 2nd on lef~,~a~tituck
in thefollowlnglocation; ~ Basement ~ Ist Ft. ~ ~nd FI. ~stde Section Bilk Lot
u~s examlned on ~ ~ 7 1~ ~ and found to be in compllance with the req.iren~ent s o/ this Board.
FIXTURE SWITCHES FIXTURES RANGES OVENS DISH WASHERS EXHAUST FAN
OUTLETS
DRYERS
FLUORESCENT
] 2
FURNACE MOTORS FUTURE APPLIANCE FEEDERS
TIME CLOCKS MULThOUTLET DIMMERS
SYSTEMS
NO. OF~ FEET
SERVICE DISCONNECT
OTHER APPARATUS:
GFC I -- 1
S E R V I C
NO, OF NEUTRALS
OF NEUTRAL
(Swimmtn~ pool)This certificate cavern compliance at the date of inspectiom only
Because of tmu~ual environments,it i~ advisable to have frequent test/and or repair~
made by a qllslffied person,
Men~7 Bohn
~21 Sheep Pasture Road
East Setauket,New York 11733
This certificate must not be aJtered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentla[s.
COPY FOR ~HIS COPY OF Cl Y MANNER.
UNDATION (1st)
UNDATION (2nd)
UGH FRAME &
FLUMBING
SULATION PER N. Y.
STATE ENERGY
CODE
FI;~AL
. ADDITIONAL COMMENTS:
INSPECTION
FOUNDATION SST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] iNSULATION
FRAMING r~/]~l NAL
D INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
FRAMING D~ FINAL
REMARKS:
DATE ~/z [/~'~ INSPECTOR
FORM NO. 1
I~ TOWN OF SOUTHOLD
~ll I~"~'~'='~'z-~u.-~ll I IUILDING DEPARTMENT
1! ,~"r/I . _. ~, Ill I TOWN HALL
~IM~ J[IN~'~'IOI~' ,qll SOUTHOLD, N.Y. 11971
Approved ...~.~.. ~.., 19~.lPemitNo..~ ~t~...
Disapproved a/c .....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Received ........... ~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
of 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
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.
~...~.~m~...~,~..%..'~:~..~. ...............
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant) \
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises . .~.~..~.~-~\.~. ....... ~,~.~.~&2\5.'~ ...........................................
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
.....
(Name and title of corporate officer) .
Builder's Ucense No...G ~.q. :..X..4.~ .........
Plumber's License No .........................
Electrician's License No ..... c.~..,~.. ,..-, .........
Other Trade's License No ......................
1. Location of land on which proposed work wilt be done; L~- · .-. ~.~. · · .~.~ .x~ .~,~ ........... ~.¢~- · .~.: ........
..............~..~o. ~ 5~ ~;~.~..~. ...... ~ ~.~. 2' :~.~:~..~?: ....... I./D...(~..~.~.c~5... ~.~ .. 5...~(..~.~.c~
House Number Street Hamlet
County Tax Map No. 1000 Section ...~ ~..~ .......... Block ....... ~.~ .......... Lot ....... Z~. ! ..........
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 . .{ .~..'~ .~- ~ ~ ...
/ c_o¥-e. --'
3 N of k (ch ck which appl'~able): New Building ' Addition ~"
. attire war e ] ............ Alteration
Repair .......... Remova! ............. Demolition ...... ~ ...... :~O}her'Worl~
· ~ ~ \lI ~ .r, :, ~ ~:
': ~ t~ '~ (Descnpt~on)
' '' '1) .;: *
4 E tiuatedCo ~,~90~ F
. S I S~ ....... , ,*.,,: ............... e~ ..... (~O~be~'t'; ....... p--''~"' ~ i~~' ................ Sapplicatio~) ....
5. If dwelling, number of dwelling units ............ Number of dwelling units on each floor ..........
If garage, number of ~ars ..; .... ............................... .......................... . .......
6.If business, commercial or mtxed o~cupancy, spec~y nature and ex,eat of each type of use .....................
7. Dimensions of existing structures ff any: Front ............... Rear .............. Depth ..............
Height Numbe~ of Stories
D~ensions of same ' ' ' or additions: Front Rear
' structure w~th ]a]teratmns
Depth ...................... .Height ...................... Number 'of Sto~es ....................
8. Dimensions of entire new construction: Front ...... [ ~.Z~ Rear ............... Depth . . ~ .......
Height ............... Numbe~ of Stories ......................................................
9. Size of lot: Front ..... 'D. ~ :.~'.~ ...... Rear ....... [~ .......... Depth .... ~.~ ...........
10. Date of Purchase ............................. Name of Fomer Owner ...........................
11. Zone o'r use district in which premises ar* situated ........................ , ...........................
12. Does proposed construction vi~ate~ any zomng law, ordinance or regulation: ...........................
13. Will lot be regraded ...~. 'CC ' ~ ........ Will excess fi12~7~ ,om premises:_
14. Nme of Owner of premises .. ~. .... ]~ .Address t.ff ¢~ ....... Ph~neN~
, , '" ' ' ' ~d~?~c~ .........................
Nmo of Architect .~ ......................... Address ................... Phone No ................
Nme of Contractor~xm. %x~k. ~go3~ ..... Address 6)!..~,g¢50 ~.. Phone No..¢ h6a gAOo...
15, Is this property located within 300 feet of a tidal weti~¢~[~'.?3 No .....
· If yes, Southold To~ Trustees Permit maybe required.
; PLO~ DIAG~M
Locate clearly and distinctly ~l b~fld~gs, whether existing or proposed, and. indicate ~l set-back d~ensions from
prope~y ~nes. Give street ~d block nm nber or descflption accord~g to deed, ~d show street names and indicate whether
interior or corner lot.
;TATE OF NEW YOALK, ' ~ S S
:ou rr¥ OF .... '
.............................. . .................. being duly sworn, deposes and says that he is the applicant
(Name of individual signing?ontract)
bore named.
is the ............ ~ ................................................................
(Contractor, agent, corporate officer, etc.)
said owner or owners, ~d is duly authorized to perform or have perfomed the said work and to m~e ~d file this
ppllcation; that all statements contained ~ this application are true to the best of his ~owledge and belief; and that the
/ark will be perfo~ed in the m~ner s~t forth in the application filed there~th.
worn to before me this
............... ~, ~,~5, .day of .~0~ ............ , 19 ~ q
.... ' ....... co. y
Notary Publlo,$tdt;O~Vo~ ~' -~-~ ~ ~~. · · ~.~~.
No. 524626433
Qualified in Suffolk County
Comml~ion Expires &/{~L~f
(Signature of applicant)