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Home My WebLink About27027-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27554 Date: 02/12/01 T~IS CERTIFIES that the building ACCESSORY Location of Property: 275 JERNICK LA SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 70 Block 3 Lot 7 Subdivision FiledMap No. __ Lot No. -- conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 31, 1995 pursu~mt to which Building Permit No. 23132-Z dated NOVEMBER 27, 1995 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 IN REQUIRED REAR YARD AS APPLIED FOR. The certificate is issued to ROBERT & PATRICIA VANBOURGONDIEN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTI~ENT OF I~F~ALT~ APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 H-067878 05/09/00 N/A Au~horlze~Slgnature FORM NO. 3 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) PERMIT NO. 27027 Z Date JANUARY 19, 2001 Permission is hereby granted to: ROBERT & PATRICIA VA_NBOURGONDI~ 580 GRIGONIS PATH SOUTHOLD,NY 11971 for : INSTALL INGROUND SWIMMING POOL IN REQUIRED REAR YARD AS APPLIED FOR. (REPLACES BP ~23132Z) at premises located at 275 County Tax Map No. 473889 Section 070 pursuant to application dated OCTOBER Building Inspector. JERNICK LA SOUTHOLD Block 0003 Lot No. 007 31, 1995 and approved by the Fee $ 150.00 Authoriz~ignature ORIGINAL Rev. 2/19/98 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 oh 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. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and Ppre-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. Fees i. 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 Buildin~ - $100.00 3. Copy of Certificate of Occupancy - , .~5~ 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Construction ........... Old Or Pre-existing Building ................. Location of Property ......................................................................... House No. Street Hamlet Onwer or Owners of p y ~ . ~ .~ ............... ._........... County Tax Map No 1000, Section.../...~. ...... Biock ..... .~...~.'''...Lot ..... ~.[~.''.'''''.'''' Subdivision ................ Filed Map ............ Lot .................... Permit No.~.~. ...... '7...Applicant~.~ ~'".~. ~. ....... .~...f~ OC ~ ~ ~ Health Dept. Approval .......................... Underwriters Approval ..................... .... Planning Board Approval ........................ / Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: Go.z.. 590 1t) THE NEW YORK BOARD OF FIRE' UNDERWRITERS PAGE 40 F~TON STREET, NEW YO~K~ NY IQO~e ~ ~ THIS ~ERTIFIES THAT ~ ' ' only t~e ~lec~cal e~uipm~nt as d~cHbed below and Mtroduc~d b~ the appt~a.t n~med on' t~e~ove appHcado, number Ir In t~e p~m~e~ ROBERT VAN BOURGONDIEN, 580 t. t~e/oUowl. S Io~u#o.; [] wot examMed o.MAY O1,2000 GRIGONIS PA~R*{, '$OUrfHOLD, NY ' : [] 1st FI. [] 2nd FI. OUT : ' ~eC~O. BlOC~r and ~ound to be ~n compl~nce ~#h the National Eleetrlcal Code. FIX~RE RECE~AC~ ~WITCHES FIXTURE~ COOKIN~ DECKS EXHAUST FANS OUTLE~ FLUORESCENT OTHER Lot DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT.TfME CLOCKS UN]T HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R V · , I ' ~C E OTHER APPARATUS: OF NEUTRAL - 580 GRIGONIS PATH SOUTHOLD, NY, 11971 GENERA~L,UANA/GE~/~ This oe,iflGate must not be altered In any manner; return to the ~flGe of the Board If Inoorre~t, I~lpeOtors may be Identified by their Credentials, COPY FOR BUILDING DEPARTMENT· THIS COPY OF CERTIFICATE MUST , ALTERED IN ANY MANNER. . THE NEW YORK BOARD OF FI E uNDERWRITERS BUREAU OF ELECTRIG'ITY "; ~' ' ~ 40 FULTON STREET, NEW YOR~', ~Y 10038 ~HIS CERTIFIES THAT , only the ~lec~al equipment as desc~bed be~w and inWoduced b~ the appl~ant named on th~bve apPl~a~n number is in the prem~es of tn the fol~wtng locmaon; ~ B~ment ~ 1st FI. ~ 2~ Fl. 0~ / See~n B~ck ~t w~ examined on ~ ~ SYSTEMS AMT. ~,W. OIL H.P, aaa H.P. FUTURE APPLIANGE FEEOER8 SPECIAL ~E¢'P[ A~T, ] AMES. TRANS, NO. OF FEET DRYERS I FURNACE MOTORS TIME CLOCKS B~LL UNIT HEATERS MULTI-OUTLET SERVICE DISCONNECT ~o. OF S OTHER APPARATUS: POOL- ~ G.F.C. I:'"l *(SWIMMING POOL) This certificate covers compliance at the date of inspection only. Because of unusual environments it is advisable to c F.XHAUST FANS AMT. H.P. DIMMERS F. ~ave frequent test/and or repairs made by a gualified person. <<< Continued on Page 2 Per GENERAL~ ~AGER Thll cerllfloafe must not be altered In any manner; return to the office of the Board If Incoriect. I~$pectots may be Identified by their credentials. · COPY FOR BUILDtNG -DEPARTMENT.' THIS COPY 'OF-CERTIFICATE MUS/~ NO;~'~BE A4TERED IN ANY MANNER. '' 'OHNI)AT IOH ( t,~'l') 'OUHD~'FIOH (2II1)) ~OIIGII FRAHF. & PI,HHB I ~(~ iqSIII.A'FIO['I PER N. ¥, STATE EtIERG¥ COI)E I)ATE GOHHE?I ES FINAl, 765-1802 BUILDING DEPT. INSPECTION [ ] FRAMING ...~,~]~=INAL [ ] FIREPLACE &,CHIMNEY ~DATE~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:3 Approved ~/'/'~} 7' - it No ..... i} i/q r6i" Disapproved a/c APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH .......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... SEFTIC FORH .............. HAIL TO: a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ;e~ts 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 ~r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ation. 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 ;hall be'kept on the premises available for inspection throughout the w6rk. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy ;hall 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 3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable, Laws, Ordinances or legulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. Fhe applicant agrees to comply with all applicable !a~s, ordinances, building code, housing code, .and/egulations, and to ~dmit authorized inspectors on premises and' in building t~O~"necessary ins=p~tions. ~ !, : ~: ,~: : ~,( i~rnature 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 prem~4.r?(~/:<%.,. ~...~.~ .... ~/~zQ.....~..<'&'~ .~O..C?..~. ~ ............ (as on the tax roll or latest deed) [f applicant is a corporation, signature of duly auth~orized officer. (Name and title of corporate officer) Budder s L,canse No./~.../~..~..~. ~.~.. ......... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY', Location of lan,d on which proposed work will be' done .................................................. ........... ............ .... ......... .................. House Number b~reet Hamlet County Tax Map No. 1000 Section ...d~..~. (--) ......... Block ..... 3 .......... Lot.. Z ............. "o.~..~+.~ d..~4. ~.~ Subd~vis~ '.~..~-. . 00 d 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 ............ ~ .......... ,r2.~ .... . .~. ,,: ,,, . ...... %.. 3. Nature of work (check which applicable): New Building · · Addition ~eration Repair ............ Removal .............. Demolition ...... 4. Estimated Cost - ' ............ Fee . .' ....... I (to be paid on filing this application) 5. If dweliing, number of dwellinglunits .............. Number of dweliing units on each floor ................ I ' f garage number of cars 6. u Ouslness, commercial or mixed occupancy, specify nature and extent of each type of use . . 7. Dimensions of existing structures if any. Front -¢'&:. v 5g~/ ",~ ..... -~'~, ~' ......... ne~gnr ,~"O ........... Nun~ber of Stories ../.d~? ...................................... Dimensions of same structure with alterations or additions: Front ............... 'Rear" 'i i ...... Depth I Height Number of Stories 8. Dimensions of entire new construction: Front Rear ~ .............................. Depth .............. Height ............... Ngntber of Stories 9. Size of lot: Front .. '~ ......... Rear.. e .......... Depth .. I0. Date of Purchase ........... ........... l .... : ....' ....... Name of Former. Owner ............ II. Zone or use district in which prdmises are situated~,~5,r, la~,,,~ /,~ { ................. 1 2. Does proposed construction violhte iny zonin~ law ordinance or re-u~*~'--' ~/5 ........... 13. Wdl lot be regraded . .,..~.-e,-5.. 'i' · '. ................ Will excess fill be removed frompremises: ~ No Name of Architect ~r ..... Name of Contractor ~ ~.4~..~.-.~..~ ..... . ....Address .'727.~..<~'.qx../.*. ~%v~. Phone No. 15. Is this property within 300 feet of a tidal wetland? *Yes ....... " \~ '' · If yes, Southold ~own Trustees Permit may be required. ' no..~ ...... [ PLOT DIAGRAM Locate clearly and distinctly all [buildings, whether existing or proposed, and~ indicate all set-back dimensions from property lines. Give street and block ~umber or description according to deed, and show street names and indicate whether interior or corner lot STATE OF NE~"YORI~ ......... (Name of individual signir contract) above named. "*DAm NOTIFY BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1, FOUNDATION . TWO REOUIRED FOR POURED CONCRETE 2, ROUGH - FRAMING & PLUMEING 3. INSULATION 4. FINAL ~ CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REOUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS being duly sworn, deposes and says that he is the applicant is the ........................ I...,~..';....~'~x.~'"x ............................................ I ((Con~ract~agent, corporate officer, etc,) ' ' '. said owner or owners, and is duly ~uthor-Tlzed-tO~erform or have performed the said work hnd to make and file this Ipplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the .york will be performed in the manner s~t forth in the application filed therewith. ¢worn to before me this o7 ......... ,197..[ %tary Public'~~;^~' '~' '~~'3 'C°unty ~/~_.. No. 4879505 ~ ... ~ ~... Qualified in Suffolk Coun¢ ~ / =remission Expires December ~, 19-~ I (Signature of applicant) FORM NO.3 TOWN OF $OUTHOID BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. N°_ 23132 Z BUILDING PERMIT [THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED] Permission Is hereby granted to: .~.~.~.~ ......... ,~....~...~. ....... ..//..~ ........ to..~.,.~/./. ........ ~ ....... ~~....._~.~/.....z~ ...... ~.~.....~ .... ...... ~ .......... ~ .......... ~~. ......... ~.~.. ......................................... Rev. 6/30/80 J~Z. NICK MAP ~ P~8~F~LrF'Y %t- ~ae£1tties for tnspectea ~ to be and water SuDDI~- location have beem and found ef of General ~gi~eri~ RODERICK VA~Y-E P.C. ' GREEN~RT NEW YORK H.S. NO. ~ATEMENT ~ INTEN~ THE WATER SU~LY AND SEWAGE 5Y~EM5 FOE THIS RESIDENCE ~ILL CONFORM TO THE ~ANDA~DS O~ T~ SUFFOLK CO. DEPT. :OF HEALTH ~RV~S, A~LICANT SUFFOLK COUNTY DEPT~ OF HEALT~ SERVICES -- FOR APPROVAL OF cONSTRUCTION ONLY DATE: ,' , ', H. S. REF. NO.: ,. . , , ~PROVED ~ - SUFFOLK CO. TAX MAP DESIGNATION: DI~. SE~. :' SLiK : ~L. OWNERS ADDRESS: . ~ ~. ~ ~~~ . :. C~~,~.~ lt~. L/~/~ ~ ~. ' "" .,-' DEED: HOLE ,- ~MP , 'SEAL: :.. :-':'~':