HomeMy WebLinkAbout28810-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-29570
Date: 07/10/03
· ~{IS CERTIFIES that the building ACCESSORY
Location of Property: 2270 HIGHLAND RD CUTCHOGUE
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map NO. 473889 Section ~02 Block 8 Lot 27
subdivision Filed Map No. __ Lot No. --
conforms substantially to the Application for Building Permit heretofore
filed in this office dated OCTOBER 7, 2002 pursuant to which
Building Pe~rait No. 28810-Z dated OCTOBER 8, 2002
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 ACCESSORY INGROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR.
· ~ne certificate is issued to ALDO BARSALI TRUST
( OWNER )
of the aforesaid building.
SUFFOLK COUNTY DEPARTT~NT OF H]~LTH APPROVAL
ELECTRICJ%L CERTIFICATE NO.
PLUMBERS CERTIFICATION DAT~
Rev. 1/81
N/A
1138403 06/02/03
Aut hori~z ed Signature
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
(THIS
BUILDING PERMIT
PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 28810 Z
Date OCTOBER 8, 2002
Permission is hereby granted to:
ISLANDIA POOL FOR BARSALI
PO BOX 130
CUTCHOGUE,NY 11935
for :
CONSTRUCTION OF AN INGROUND SWIMMING POOL IN THE REQUIRED REAR
YARD AS APPLIED FOR
at premises located at 2270
County Tax Map No. 473889 Section 102
pursuant to application dated OCTOBER
Building Inspector to expire on APRIL
HIGHLAND RD
CUTCHOGUE
Block 0008 Lot No. 027
7, 2002 and approved by the
8, 2004.
Fee $ 150.00
Authorized Signature
COPY
Rev. 5/8/02
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 Departmenk~w~th-143~_fotlowing:
A. 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.
B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses:
l. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic
features.
2. A properly completed application and 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 - $.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy- Residential $15.00, Commercial $I5.00
Date.
New Construction: Old or Pre-existing Building:
LocationofProperty: .2270 /-//G ,'q c/o w_o ~ 0.
(check one)
~ ur~oao~
House No.
Owner or Owners of Property: ,~ ~- DO
Suffolk County Tax Map No 1000, Section
Subdivision
Penuit No.
Street Hamlet
Block ~> Lot ~ 7
Filed Map. Lot:
Date ofPermit.~/'~2 2~ Applicant:
Health Dept. Approval:
Plamfing Board Approval:
Request tbr: Temporary Certificate
Fee Submitted: $
Underwriters Approval:
Final Certificate: /
(check one)
/ A'~'pli~t Signatur~e
BY THIS CERTIFICATE OF COMPLIANCE THE
NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
40 FULTON STREET - NEW YORK, NY 10038
Upon the application of
CERTIFIES THAT
C-CAT CO.
9280 SOUND AVE.
MATTITUCK, NY 11952,
upon premises owned by
Located at
Application Number: 1138403
Section: Block:
Described as a RcsJdcutia]
CINDY LAKE
2270 HIGH LAND RD.
CUTCHOQUE, NY 11935
2270 HIGH LAND RD. CUTCHOQUE, NY 11935
Certificate Number:
Lot:
1138403
Building Permit: BDC: NS11
occupancy, wherein the premises electrical system consisting of
electrical devices and wiring, described below, located in/on the premises at:
Outside, Pool/Spa,
was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below, was
found to be in compliance therewith on the 2nd Day of June, 2003.
Name QTY Rate R~ting Circuit Type
Appliances and Accessories
Furnace 1 0 Gas
PooVSpa Bonding 1 0
Wiring and Devices
Fixture 2 0 Pool/Spa
Receptacle 2 0 20 amp Pool/Spa
GFCI Circuit Breaker 2 0 20 amp Pool/Spa
Switch 3 0 General Purpose
Receptacle 1 0 General Purpose
(Swimming Pool): This certificate covers compliance at the date of inspection only. Because of unusual environments it is advisable to have
frequent test and/or repairs made by a qualified person.
seal
I of 1
This certificate may not be altered in any way and is validated only by the presence or a raised seal at the location indicated,
BUILDtNG PF_5_I~M-IT ~I¢,J3Vt-E~-WC-H~K LtST~
Applicant/
OwnersNmne: ~,o ,~t~:
Architect/
Engineer:
SCTM #:
District: 1,000 Seclion: t/O~.~ Block c~~ Lol: ~ ~
Date
Reviewed:
Date
Submilted:
Single & separate Required
ceruficalion: ~/No) ~
tl:ronlY~d ~_~d:~_ I [SidcYard /~/ Propos~ ~0 } [R~rYard /O* Prol~sed [
Project Description:
.~RE. QUIRED FOR REVIEW
Permit
N.A. NO YES Number
Suffolk County Health Dept.
New York State D.E.C.
Town Trustees
Town Zoning Board approval:
Town Planning Board approval:
Flood Plane Elevation
Flood Zone:
Notes:
BUILDING DEPT.
FOUNDATION I ST [ ] ROUGHPLBG.
FOUNDATION 2ND [ ] INSULATION
FRAMING
FIREPLACE & CHIMNEY ,~
FIELD INSPECTION REPORT DATE~[ COMMENTS.
FOUNDATION OS'T)
FOUNDATION (2ND)
ROUGH FRAMING &
PLYING
STATE EN~GY CODE
~DmON~ CO~TS
T OVa?4 OF
BUILDING DEPARTMENT
SOUTHOLD, NY~ 119~!
TEL: (631) 765-1~02
FAX: (631) 765-9~
Exam/ned
Approved
Disapproved Wc
Expiration
~Bu~ilding Inspector
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the follow/ng, before applying?
Board of Hemlth
3 sets of Building Plans
Planning Board approval
Survey
Check
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
~,t~ane:_ 70-9.6~
APPLICATION FOR BUILDING PERMITDate ]/~ 1 ?~/
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 prem/ses, relationship to adjoining premises or public streets or
areas, and waterways.
c. The work covered by this application may not be commenced before issuance of Building Pemait.
d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such a 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 what so ever until the Building Inspector
issues a Certificate of Occupancy.
f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of
issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the
property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an
addition six months. Thereafter, a new permit shall be required.
APPLICATION IS HEREBY MADE to the Building Department for the issuance ora Building Pemfit 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 demohtion 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 inspe<aTGn~:~ /,
UNDERWRITERS CERTIFICATE
REQUIRED
"IMMEDIATELY"
ENCLOSE POOL TO CODE
UPON COMPLETION
BEFORE 'q, NATER"
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Nameofownerofpremises ~ LO 0 {~"~t:} ~g/'kL"-~ ,..k,~. 1~.
(As on the tax roll or lares[ o~l.~FY BUILDING D~P~RTMENT AT
If applicant is a corporation, signature of duly authorized officer 765-1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1, FOUNDATION - T~O.
(N~me and title of con?orate offioer) OCCUPANCY OR FOR POUREDCONC"~":
USE IS UNLAWFUL z ROUGH- FRAMING & PLU,~BmG
~uil&rs License No. ~'~ ~ d,¢/_/-/-~TIFICATEWIIHUUI[l'g ~. INSUI&TION
Plumbers License No. 4, FINAL - CONSTRUCTION MUST
[lectrioian~ ncense ~o. OF OCCUPANCY ~, COUP~rE FOR C.G.
Other Trade's License No. ALL CONSTRUCTIO~ gHALL MEET
THE REOUIREMENTS OF THE N.Y,
STATE CONSTRUCTION & IENERGY
1. Location of land on which proposed work will~d~m: .~ ~ ~ CODES. ~ RE$1~ONSIILE FOR
c,Q~.DO J'lLq~l-/- .~/"¥~,'~ ~ ~.~ C'O"ro ~ ORCORSTROCTi08 888Oi~
House Number Stree~ Hamldt
County Tax Map No. 1000 Section
Subdivision
(Ntane)
lock ¢ Lot 2
Filed Map No. Lot
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy -r
b. Intended use and occupancy ,~' c//,,j ¢ ~
3. Nature of work (check which applicable): New Building_
Repair Removal Demolition
4. Estimated Cost ~ ~ ~ Fee
5. If dwelling, number of dwelling units
if garage, number of cars
Addition
Other Work
Alteration
(Desc~pfion) -
(To be paid on filing this application)
Number of dwelling units on each floor
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front
Height Number of Stories
Rear
.Depth
Dimensions of same structure with alterations or additions: Front
Depth Height Number of Stories
Rear
8. Dimensions of entire new construction: Front
Height Number of Stories
Rear .Depth
9. Size of lot: Front Rear _Depth
10. Date of Purchase
Name of Former Owner
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO ~
13. Will lot be re-graded? YES )(~, NO Will excess fill be removed fi.om premises? YES ~)( NO__
14. Names of Owner of premises pt t-[3o Cp~$~l-t_~ Addresso2~l?O P/-q~ I/-Ct~a,~ ,~Phone No.
Name of Architect Address Phone No
NameofContractor,-Z-¢t-~w,ot~'~o~/,~ /_~,r9 Address /~r~'~F~PhoneNo.
15 a. Is this property within 100 feet of a tidal wetland or a fi.eshwater wetland? *YES NO/~
* IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES NO
* IF YES, D.E.C. PERMITS MAY BE REQUIRED.
16. Provide survey, to scale, with accurate foundation plan and distances to property lines.
17. If elevation at any point on property is at 10 feet or below, must provide topi)graphical dat~ on survey.
STATE OF NEW YORK)
SS:
COUNTY OF )
~ ~ A~ "~, ~gO~ZY~f ~ ~' being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing cgnt. raet) above named,
(S)He is the O ~ t'T_.
(ContraCtor Agent, Corporate Officer, etc.)
of said owner or owners, and is duly authorized to perform or haye 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 ~ow~edge and belief; and that the work will be
performed.in the manner set forth in thej~pplication filed therewith. .~. . ~
S~orn to before me this,,( ,~,4 ~ ,:~
,,~ ~ ,,~y of U'"--)" · ~ ;,' 20 0~...
' ~ '~W Public -
JOY~ M. ~INS
NO. 4952246, ~ ~u,,~;
Te~ ~ires June 1Z ~
- TITLE NO. 8108- 272780
AT CUTCHOGUE oJ~E: SEPT. 25, 1981