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Home My WebLink About15106-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z1566I Date April 21, 1987 THIS CERTIFIES that the building P o o 1 Location of Property ...3. 5. .5. ~.q ? .d .c.1. J:. f..f. ,D.r. ~ ¥ .e .......... .M.a.t.t. ~..t .u.c.k. ................. House No. Street Harnler County Tax Map No. 1000 Section . . .1. QT. ...... Block .... 0.7. ......... Lot 25 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... J.u 1, ¥.. 1.4.,..1.9.86.. pursuant to which Building Permit No.. ! 5. .1.0.6. Z. ............. dated.. J..u.l.y.. ! .9.,.. 1. 9..8,6 ............ 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 ......... ..... z,n g r.o.un, d. p. qQ .1..a. ad...f.e.n.e..e.. ............................................... The certificate is issued to MICHAEL T. DICKSON & CATHERINE L. DICKSON (owner, I'ds~e~ ~tT~Ta}~ X X of the aforesaid building. Suffolk County Department of Health Approval ..... N./A ................................. UNDERWRITERS CERTIFICATE NO .... N 802356 PLUMBERS CERTIFICATION DATED: N/A Building 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) 15106 Z Permission is hereby granted_~to: . ~ ~oV~ ~-a~ ............. ~..~....~.:~.:...:.:..~;~..~ ........ ~, ~ ,o .~~....~...~~..L.~..~..~.~.....~...~......~ at premises located at ...s~ .......... : ................... County Tax Map No. 1000 Section ..... I..?...~. .......... Block ...... 0,.,?, ........ Lot No, pursuant to application dated ........ ~..t...~ ....................... , 19..~...~..,, ond 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 m ~ to the Building Inspec- tor with the following; for new buildings or new use: I. 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 p~operty showing all property lines, streets, buildings and unusual natural or topographic features· 2. Sworn statement of ownor 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: I. Certificate of oc_cupancy $5.00 2. Certificate of occupancy on pre.existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 $15.00 Date .......................... NewC°nstructi°n ...... Old or Pre-existirm Buildina ............. Vacant Land ........... Location of Prooertv /~ ~J.~,~ (/~j .~2 Owner or Owners of Property ~*~ I , ~J ~ rWz:'/ /- ~,3 ~ ~ . - 7 .o. 2 County Tax Map No. 1000 Section . / .............. Block ........... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. · · ,Appli .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Foe ~ubmitted $.. -~(r0 .................... .~. Construction on above described building and p~rj:~tff,,~'~ll ~ codes and regulations. Rev. 10-10-78 z / THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY N 802356 THIS ~ERTIFIES THAT onl~ the electrical equipmen~ ~ ~scrlb~d ~elow a~d introduce~, by t~ applicant ~med on the above application nu tuber in the prem~es of ~side in the followlng location; ~ ~asen~at ~ Ist Ft. ~ 2~d ~T. SectJon Bilk Lot u~sexaminedon ~ ~ ~ andfoundtobelncompliancewlththereqtire.~ents~f~hlsBoard. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES INCANDESCENT FLUQI~E$CENT 1 t 1 DRYBRS SYSTEMS 1 S E R NO, OF CC COND,/A, W G PER ~' ~CC COND*-. C NO. OF HI-LEG NO, OF NEUTRALS1 (~_~I__N_G_~POOL~)~ This certificate covers ~omplience at the d~e of lns~tion only ~se of '~ on~r~nts it ~ ~vis~le ~o ha~ ~nt t~t ~d/or repots ~e ~ a qaalifi~ ~r~n. AWG, OF NEUTRAL Boul R. Burns 275 Town tlarbor Lsne Southo~d, N.Y. 11971 Li6. Per This certificate must not be altered in any manner; return to the office of the Board if incor[ect, inspectors may be identified by their credentials. FIELD I~S[~ECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & ?LUMBING INSULATION PER N. STATE ENERGY CODE IIDATE !t ADDITIONAL COMMENTS: FINAL 7GS-18~2 BUILDING DEFT, INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ]/i=INAL REMARKS: ~ 765-1802 BUILDING DEPT, INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL.BG. [ ] FOUNDATION ZND [ ] INSULATION [ ] FRAMING REMARKS: FINAL DATE INSPECTOR i SOUTHOLD POOLS INC.' P.O. BOX 539 ,$OUTHOLD, NY 11971 \^IDOL) CL.I f:~' IS ' MMEDIATELY'; pool WAll .9o' To Cr'33 poJ.. ~ I~' .SURVEY FOR t?OB£RT HII TZ AT MATTITUCI( TOWN OF $OUTHOL. D SUFFOLK COUNTY, NEW YORK ffuNAuTHoRIZED ALTERATION OR ADDITION TO 11118 dULY 30, 1982 F£8. ~, 1~82 /" : $0' 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ..................................... (Building Inspector) APPLtCATION FOR BUiLDiNG PERMIT BLDG. DEFr, - TOWN OF SOUTHOLD 3elve ...... ~ .... ~ ,,, Date .................. , 19... INSTRUCTIONS a. This application must be completely filled in by typewr(ter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedble. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premise~ 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 p~ermit 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 Southotd, 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 ~ iSDUIHOLDPOOLS INC. (Signature of applicant, of name, if a corporation) ' P.o. BOX 539 OUTHOLD, NY 11971 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . ~r.~.~l(.J~ .... b.l~.v~ .O..~. ................................................ (as on the tax roll or latest deed) If a~a c~~thorized officer. (Name and title of corp~, ~officer) Builder's License No ...... ~.'~'l.~. ............. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done...,~.~..~..... ~..~..C.J~; ~.~...~..(~.. ......... - ,,/ ....................... ...... I.v).~.l J. [.. ~.cA ..................................... House Number S/treet Hamlet County 'Fax Map No. 1000 Section ..... J.(~ ~ ....... Block .... I~..'? ......... Lot....~. ........... Subdivision ..................................... 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 ...(~. ~.~-... ~t~. {,.~./,, .... .~¢4. ~.1 J .[.&)...~. ............................ b. Intended use and occupancy .... 1.~:?..~.~..t~.... ] .A~..~3..~..0:-4...~.. ~...~..P?..lyf. ? .~ .~.q~.. ~..~ ........ 3. Nature of work (check which applicable): New Building ..... ' ..... Addition.. ~ ....... Alteration ,. ......... (Description) 4 Estimated Cost ~ (to be Paid on filing this application) 5. If dwelling, number of dweiling units ...(~.~.-'x. ...... Number of dwelling unit~ on each floor ................ If garage, number of cars .... ~2.,~F-,- ................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each typ~ of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ......................... ~... ~ ........................... Dimensions of same structure with alterations or additior}s: Front .... (_~q~, .... ~ .... Rear . .~ ............ Depth .... ~. (c~.' ............ Height ..... [ ~. . . Number of Stories.. ~>/~. I.~ ........... 8. Dimensions of entire new construction: Front ............... Rear ; Depth ............... Height Number of Stories 9. Size of lot: Front ...... ~/O.W~. ~ Rear ...~.CTlm ~ Depth 11. Zone or use district in which premises are situated...j~.q,, ................. ........................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... /~ O ............... .~ ........ 13. Will lot be regraded .../~...O ......... · ............ Will excess fill be removed' from premises: ~es~ No Name of Architect ........................... Address ' . Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, ind:icate all set-back dimensions from property lines. Give street and block number or description according to deed, and sho'~ street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ................. ...~.~ ($.T.O .~.~.~...&. .... ,,.~C~.&~.~"~..~. c_. .......... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) ~ above named. : He is the .' .......................................... ~ ........................... (Contractor, agent, corporate officer, etc.) 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 his 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 ............. · ' '~.'.~' '~..k~/ra~.:: ;'~ ,~· ............ 19.~.~. Notary Public, .)(de~4~.. ~. ~ .......... County Notary Public, State of New York No. 4674306, Suffolk County Commission Expires, July 31.1 (Si~',lture of ~pplicant)