HomeMy WebLinkAbout14128-zFORM NO. 4
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Z-16370 Date November 5, 1987
THIS CERTIFIES that the building ABOVE GROUND POOL WITH DECK & FENCE
805 Donna Drive Mattituck, New York
Location of Property ~s~ ~oi .............. Street HamNt
County Tax Map No. 1000 Section ! 15 . .Block 16 .Lot 7
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
July 8, 1985 pursuant to which Building Permit No. 14128 Z
dated............................July I0, 1985 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 POOL WITH DECK & FENCE
The certificate is issued to HERBERT & LINDA GUNTHER
(owner, i~r~}J
of the aforesaid building.
Suffolk County Department of Health Approval .. N /A
UNDERWRITERS CERTIFICATE NO. N835999
PLUMBERS CERTIFICATION DATED:
N/A
Building Inspector
Rev. 1/81
FORM NO. 0
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PRENUSES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N~ 14128 Z
Permission is hereby granted to:
..'2..?..~.~.~.~.~ ..............
.~.~..~.:~.,...u.~.~.~ .......
~-~.~: ...... ~ ............... ...~~~ ................................... . ..................... ;. .................................
ot premlsesLated at .....4~..°...~.....~~...~...~-~-.......~~~... ...................
County Tax Mop No. 1000 Section ........ [/...~..". ...... Block ........ l...~. ........ Lot No .......~. ................
Building Inspector.
Building Insl~ctor
Rev. 6/30/80
FOP,~ NO. 1~
~ TOWN OF $OU'~HoLD ¥
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 1;1183 Z
Permissior is hereby granted to:
.................. ~..q.~ ........ b~.~..~:~....:...~.:t~..
....................................... .~...4.~..(.~u.._cu¥.
................ i.]::..¢...~.~ .................... , .................................................. : ....... ~ ........................................
at .......... ~ ~0~'~ ~ -~ .
at premise~ located ............................................... ~ ..........................................................
................ i ........................................... : .......... ~.~...~.L...?..~c:.!..~...: ...............................................
.... · ~.:i ......................................... :~ .......... ~ ...... ~.... ...... ,~:....:....,z ............................................
~o.,~ ~& ~., ,o. ,ooo.~.~,,o....Z.L.~ ......... ,,o~ ..... ,L..~ ........ ~o,,o ....... Z ............
pursuant iO applicofion dated 0'~ ~9.~ ond opprov~ by the
Building li~spector.
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
~Oouthold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instruotlons
in duplvicate~o
A. This application must be filled in typewriter OR ink, and submitted ~: the Building Inspec-
tor with the following; for new buildings or new use:
1. Final survey of property with accurate location of all budd'ngs, propertv tines, 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~
lions, a cart f cate of Code compliance from the Architect or Engineer respon.s!bl.e for the budding.
5.Submit Planning Board approval of completed site plan requ rements where appl~cao~e.
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 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 preoare a certificate,
Fees:
1, Certificate of occupancy $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
$15.00
Dete, .~ ~./.J./~. ........
............ Vacant Land .............
· .zT.e ........... . .~, ~...~/f..~ .2~.~.~....
Street Hamlet
New Building ............. Old or Pre-existing Building
Location of Property .. ~..d;~. ............... House No,
Owner or Owners of Property .....................
Coun~ Tax Map No. ~000 Section /L.~. .......... B,oc~ ...~:.~ ......... Lot...?, ...........
Subdivision ................................. Filed Map No ........... Lot No ..............,
Permit No. ~rZrJ~. ·. Date
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporarv Certificate ..................... Final Certificate ...... '../-/'~. · · · · · · · · ......
Fee Submitted $...~ .' ,.d~.. ...................
Construction on above described building and permit/meets all applicable cod~ and regula,tions.
Applicant .... ,v~~'// .~ .~f~_~...x'~. ............
Rev. 10.10-78
~o ~ 1~370
THE NEW YORK BOARD OF FIRE UNDERWRITERS
100077 3 BUREAU OF ELECTRICITY
THIS CERTIFIES THAT
only the electrical equipment ~ ~serlbed be~ ~ ~ntrod~ced by t~ applicant ~ned on ~he o~ve application number in t~ premises of
Herb~r~ Gu~er, 805 ~a D=ive, ~a~ituck, ~
in the following tocatlo,: ~ B~ement ~ Ist Ft. ~ 2,d FL ~i~ Sectio, Bilk Lot
~s examined on ~ ~ "~ t ~9~ 7 and found to be in co, pliat ce u'ith the requirements ~( tt is Board.
FIXTURE FIXTURES RANGES :OOKINGDECKS OVENS DISH WASHERS EXHAUST FANS
SYSTEMS
NO. OF FEET
E R V I C
OTHER APPARATUS:
Orient, ~Y 11957 L~2334 S / ~EN~/~ANAGEE
must not,be altered in any man.er; return to the off~~y th(~edenfi~s.
TOWN OF SOUTIIOLD
OFFICE OF BUILDING INSPECTOR
1'.O. BOX 728
TOWN HALL
SOUTIIOLD, N.Y. 11971
tol le7
TEL. 765-1802
To Whom This May Concern,
We are unable to complete your Certificate
of Occupancy because .of the following reasons.
/~/ An application for Certificate of Occupancy
is not on fil~.
/'~/ No Underwriters Certificate on fileo
~_-/ The check is(outdated/no~ ol._~] filel)
/~/ No Health Dept. Approval on file.
/~/ No final inspection has been made.
Please contact our office on this matter.
Thank you for your cooperation.
Building Permit tt _~ .~ _L ~ I Z
Building Dept.
***/~/ No Plumber Solder Certi'ficate on file.
( all permits involving plumbing being
issued after April 1,1984 )
TOWN OF $OUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
TO Whom This May Concern,
We are unable to complete your Certificate
of Occupancy because .of the following reasons.
/5/ An application for Certificate of Occupancy
_//~s not on ~ile.
/_~/hB~Underwrlters Certificate on file.
~/~ The check is (outdated/not on file.) ~D-7O~
/5/ No Health Dept. Approval on file.
/5/ No final inspection has been made.
Please contact our office on this matter.
Thank you for your coo'peration.
.-Building Permit # _~/ ..Z~L C~ ~ Z
Building Dept.
***/5/ No Plumber Solder Certificate on file.
( all permits involving plumbing being
issued after April 1,1984 )
APPLICANT:
TOWN OF SOUTItOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
DATE: July 15, 1986
Dear:
Whil'e rev~ew__ing our files I find that your expired
'--~-~ ~'h?s never been finalized. Kindly return
the encl~o_sed app-Ticatlon with a check for $5.00. Also, please
~/~/~/~ call and arrange for a final inspection so that we may issue
a Certificate of Occupancy on the above pool and complete
this outstanding file.
Yours Truly,
Victor Lessard
Executive Adminstrator
OCCUPANCY OR
USE IS UNLAWFUL
WITHOUT CERTIFICATE
OF OCCUPANCY
"IMMEDIATELY"
ENCLOSE POOLTO CODE
UPON COMPLETION
BEFORE "WATER" '
COMMENTS
FIELD .N ~ll~ECTION
1.
FOUNDATION (1st)
FOUNDATION (2nd)
2.
RONGH FRAME &
PLUMBING
INSULATION PER N. Y.
STATE ENERGY
C,ODE
FINAL
o~. ~ c.o
ADDITIONAL COMMENTS:
'"-t:JSE IS UNI.AWFUL
WITHOUT CERTIRCATE
OF OCCUPANCY
STATE COf¢~;TR~
D~S~(E;N OR
; EPARTf~ Ei",lT Al'
4 ~'h%~ FOR THF
'tONS:
OF THE N.Y
{S{BLE FOR
L~CTION
'FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
8OUTHOLD, N.Y. 11971
TEL.: 765-1803
., 19~ .~. Permit No.]. ..........
Approved .....~lJ
Disapproved a/c .....................................
..........................
(Building Inspector)
APPLICATION FOR BUiLDiNG
INSTRUCTIONS
Received ........... ,19...
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
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, housingj~ode, and regulations, and to
admit authorized inspectors on premises and in building for necessary~.
' ....
(Signature of applicant, or name, if a co p ' )
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
· ......................................................................................
Name of owner of premises //~ ./. ~..~.rT.././...~.:..ff... ~.. ,/~ ~. CC.. ~ .... .~.~ .~..'Q '.~..~..~../~. · · · ·
(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 License No ..........................
Plumber's License No .........................
Electncmn s L~cense o .......................
'Other Trade's License No ......................
1. Location of land on which proposed work will be done ..................................................
............ ~.. . (6'..~ ...............................
House Number Street Hamlet
County Tax Map No. 1000 Section ..//.'~..~ ......... Block.../~ ............ 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 an~l occupancy .... /../C]¢.~.. ). (.~... '.~. (AY ~,°/)/?~V' .~ ...................
b. lntended use and occupancy ... fi...i.~i~l~.f/.. '~.'.'~C2'(~'/~i)~'f~."~"./.~ ~ .~.~.~./ .........
'8.
Nature o f~,,~k (check which'~pplicable): New Building ..... ' .....'~ddition .......... Alteration,..j ,~_ __ ..........
Repair .~11~ '- I Removal . , Demolition . ..I .......... OtherWork/ff.~.q.[.~.l~.~.(-~..
................ Fee ?
Estimated Cost ............
5. If dwelling, number of dwellin~ units ............... Number of
If garage, number of cars .... i ...............................
6. If business, commercial or mixpd occupancy, specify nature and extent
7. ~Dimensions of existing structures, if any: Front ............... Rea
Height ............... Nu~nber of Stories ....................
Dimensions of same structure with alterations or additions: Front ....
Depth ................... i... Height ......................
Dimensions of entire new construction: Front ............... Rear
Height ............... Number of Stories
9. Size of lot: Front .......... i ............ Rear ...............
10. Date of Purchase .......... , ................... Name of Form~
11. Zone or use district in which pkemises are situated ................
12. Does :proposed construction viblate any zoning law, ordinance or regula
13. Will lot be regmded ........ i .................... Will excess fill
14. NameofOwnerofpremises ..i .................. Address .......
Name of Architect ......... .................. Address ......
Name of Contractor ........ ~ .................. Address ......
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or propo:
: number or description according to dee
S.S
..................... being duly s
ning contract)
property lines. Give street and bloc
interior or corner lot.
STATE OF NEW YORK,
COUNTY OF .................
(Name of individual si
above named.
(Description)
.........................
(to be paid on filing this application)
~elling units on each floor ................
~f each type of use .....................
.............. Depth ...............
............ Rear ..................
amber of Stories ......................
............... Depth ...............
: Owner .............................
ion: ................................
be removed from premises: Yes No
............ Phone No ................
............ Phone No ................
............ Phone No ................
~d, and. indicate ail set-back dimensions from
and show street names and indicate whether
torn, deposes and says that he is the applicant
He is the .........................................................................................
I · (Contractor, agent, corporate o ~ficer, etc.)
of said owner or owners, and is dQly authorized to perform or have perfo ~ned the said work and to make and file this
application;that all statements contained in this application are true to thq best of his knowledge and belief; and that the
work will Be performed in the man~er set forth in the application filed there~vith.
Sworn to before me this
, c HELEN K. D£ VOE ' i ....
NOIARY PUBLIC, 8tat~'o~ N~w ~rk
No. 4707878, Suffolk Co,My ..,
Term Expires Ma¥ch 30, mZ(7
(Signature of applicant)