HomeMy WebLinkAbout23368-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z--24718
Date OCTOBER 29, 1996
THIS CERTIFIES that the buildin~
Location of Property 965 GREENWAY WEST
House No.
County Tax Map No. 1000 Section 15
Subdivision
ACCESSORY
Street
Block 1
Filed Map No.
ORIENT, N.Y.
Hamlet
Lot 27
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 8, 1996 ~ursuant to which
Building Permit No. 23368-Z dated APRIL 12, 1996
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 SWIF~ING POOL WITH FENCE TO CODE AS
APPLIED FOR.
The certificate is issued to
NICHOLAS & GENEVIEVE BOLLETIHO
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
Rev. 1/81
N-390035 - JUNE 28~ 1996
N/A
ildin~ Insp~or -
FOBM NO.3
TOWN OF SOU'[HOLD
BUILDING DEPARTMENT
TOWN HAIL
SOUTHOLD, N.Y.
BUILDING PERMIT
[THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
23368 Z Date ............ ~..../..~ ...........
hereby granted to:
........ ~Z~ .~....,~.~..... ,/.~...~
Countv Tax Map No, '~000 Section .......... ,~',_.~,,,,,,, Block .......... Z ............ LotNo. ~.,..~-... ................
1
and
approved
bythe
Building Inspecto~p
Fee ~.Z~.~..,,~..
Rev. 6/30/80
Form No. 6
TOW 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-disposaI(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.
For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
"pre-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
tensors therefor in writing to the applicant.
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 Buildin~ - $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 $15.00
Date .........................................
New Construction ........... Old Or Pre-existing Building ..................
Location of Property... ..... . ............................
House No. Street Hamlet
Onwer or Owners of Property..b.~/~/-'~.../~4/~..~-~r.~'~..~.~../.~..~/~.... ~.~..~..~..~.q~..ff. ............
County Tax Map No 1000, Section.../..~. ........ Block ..... / .......... Lot .... ~'7 ..............
Subdivision .................................... Filed Map ............ Lot ......................
Health Dept. Approval .......................... Underwriters Approval
Planning Board Approval
Request for: Temporary Certificate ........... Final Certicate ...........
Fee Submitted: $ ............................
...................
THE NEW YORK BOARD OF FIRE UNDERWRITERS 1
11850'77 BUREAU OF ELECTRICITY
~-- 85 ,JOHN STREET, NEW YORK, NY 10038
Date JUN~ 28,1996 Application No. on file 11951596/96 N 390035
THIS CERTIFIES THAT
o~y t~ el~tric~ ~utpment ~ ~scri~ be~w e~ tntr~uc~ by t~ applicant ~med on the a~ve application number in the p~m~es of
NICK BOLLETINO, 965 GREEN~/AY ROAD, ORIENT, N.Y.
in the following loc.~io.; [] Basement [] Ist Ft. [] 2nd FI. OU~ Section Block
~s examined on ,~U,.~ 20~ 1996 and found to be in ¢ompliance with the National Elect~cal Code.
Lot
FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS
SWITCHSS
1
PLUO4~ESCENT
OTHER
SYSTEMS
NO. OF FEET
E R V I C
NO. OF CC. COND.
PER ~
OF CC, COND.
NO OF HhLEG
AWG.
OF HI-LEG
OTHER APPARATUS:
SWIMMING POOL-1
TIM~CLOCKS-AMP.40~I
G.F.C.I-1
G,F,C.I:-I
*(SWIPING POOL) This certificate
covers compliance at the date of
~nspec%ion only. Because of unusual
environments it is advis~le to
have frequent test/and or repairs
<<< Continued on Page 2 >>>
GENERAL MANAGER
]his certificate must not be altered in any manner; retur, to the office of the Board if incorrect, Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
THE NEW YORK BOARD OF FIRE UNDERWRITERS ~A~E ~
llS~e'~7 SU.=AU OF E'£CTFUC,TV
-- 85 JOHN STREET, NEW YORK, NY 10038
Oat~ ~ 28 ~ 1996 Jppfication No. onftl, ~195~596/96 N 39~35
THIS CE~IFIES THAT
o~y the e~ctric~ ~uipment ~ ~scri~ be~w a~ int~uc~ by t~ appl~ant ~med on the a~e appl~ation number in the prem~es of
NICK BOLLETINO, 965 GREENWAY ROAD, ORIENT, N. ¥.
u~s examined on ~ 20,1996 and found to be in compl~nce with the NaHon~ Elect~c~ Code.
Lot
FIXTUR$
OUTLETS
FURNACE MOTORS FUTURE APFLIANCE FEEDERS SPECIALREC'PT TIMECLOCKS BELL IUNITHRATERS
DRYERS
OTHER A~ARATUS:
MULTI-OUTLET
SYSTEMS
NO. OF FEET
EXHAUST FANS
DIMMERS
made by a qualified person.
ROSLAK ELECTRIC
PoO.BOX 166
CUTCHOGUE, NY, 11935
LIC.
GENERAL MANAGER
!his certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPy OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
fll!;tlI.A'l'l()ll I'1~11 If. ¥,
Sl'Arl~ I~lll~ttfiY
1: I I1~ I,
Alii) I T I I)IIAI, I;I.Illlll~.lt I',~i:
TOTAL P.Oi
76S-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST
[ ] FOUNDATION 2ND
[ ] FRAMING
[ ] ROUGH PLBG.
[, ] I~~~TION
[ ~J FINAL
] FIREPLACE & CHIMNEY
REMARKS',~'~) ._ / /~
DATE /p/~.~,.~" ,NSPECT~
76S-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION2ND [ ]I~ULATION
[ ] FRAMING ~ FINAL
[ ] FIREP~ACE/E~ CHIMNEY .~~
REMARKS. ~~~/,~ ----
DATE ///~/~~//~ INSPECT~
Disapproved a/~ .....................................
// . (Building Inspector)~'
A,~P, LICATION FOR BUILDING PERMIT
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
INSTRUCTIONS
BOARD OF HEALTH
suav~Y v ........
C.EO: ~ ./dS..f(. ......
SEPTIC FORH ..............
CALL~ ~ ............
HAIL TO:
Date ..... ~./. '.~ .......... 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, accurafe 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 applfcation 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 ins,petters on premises and in building for necessary injpections.,.
:'"' '~ ~ ~"~ '~ ./ff. - /gL-/tt_ y<- ,.r~,,vr, ,.~.. c,
, :' ., . l~]'J;~' ~¢'°~vlailing address of applicant)
' ' ..... · ' i
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
........................... .... .c.v .......................................
Name of owner of premises .......... .~..I.CT/[.~..C'..lq:4 ..... /'~.0. 6..&..~.?j.4/.O. ................................
(as on the tax roll or latest deed)
If a~t isa corpo/~i~ sign~ure of duly auth~orized officer.
.. ........
' (Name and title offforporate officer)
Builder's License'No. ':., i~. ~.~. ~.~.~..: ./~..~.'~. ....
' Plumber's License No ........ ' .... .............
Electrician's License No...~..,~.b.~./.c....~..~..~...-~...tc~
Other Trade's License No ...................... . ' ,' '.
Location of land on which proposed work will be' done. ~)~'q/'~Y'vT'~ /l J- V '
.... ?(4 ................. .............. :..w7..-7. ..... ..................
}louse Number Street Hamlet
/ /
County Tax Map No. 1000 Section .................. Block .................. Lot ..................
Fil p N
Subdivision ..................................... ed Ma o ............... Lot ...............
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
E i ti d p y /~ 6'"~
a. x s nguse an occu abe ......... ,.. .........................................................
b. lntendeduseandoccupancy..... ................... . .. .. ..
3. Nature of work (check which aPPlicable): New Building .......... Addition .......... "/ '~
Repair .............. Removal .............. Demolition .............. Other Wg~r~t: ,... ~it~& .......
4. Estimated Cost t) OO. O r) Fee ............ ~~~,~,,.~..
(to be paid on
5. If dwelling, number of dwelling hnits ............... Number of dwelling units on each floor
If garage number of cars i ................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use
7 Dimensions of existing structure's if any: Front Rear
· , ' ............................. Depth ...............
Height Num!ber of Stories '
Dimensions of same structure wtth alterations or additions: Front Rear
Depth Height ' Number of Stories
8. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories
9 Size of lot: Front ' Rear
.......... ' Depth
10. Date of Purchase . - . ~,~
.................. ' ....... ,,amc ot~ggo~er ~wner .............................
11. Zone or use district in which premises are situated, t..':-.4 / ~'~ ~
12. ocs proposgd cons, tructmn v,zglate any zoning law, ordinance Or regulation: ......... ~.' .O1 ...................
13. Will lot be regraded ....... ,~..~-~ .................. Will excess fill be removed from premises: Yes
14. Name of Owner of premises ,, 4t~0,b,C.6r~Z../A,f~.. ...... Address .... 0~(O'Y:~.. ...... Phone No ................
Name of Architect ........ \ ' i ................ Address ................... Phone No ...... .~. ..~
Name of Contractor .,/~...[~&?.C,t..ct'. ~.j.q .~.J. ..... Address ...}f'~.~..~..Q/.(. Phone No.~ .~...,~..~'?../9'.
1.5. Is th±s property w±th±n 300 feet of a t±dal wetland? *Yes ........ No..~ ....
*If yes,,Sout:hold Tbwn Trustees Perm±t may be requ±red.
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 ' · '
number or description according to deed, and show street names and indicate whether
interior or corner lot.
'tO CODE
STATE OF NEW YQ.,RI~ ,, 2
COUnTy OF...
... .....
· .......... ,.
(Name of individual signing! contract)
there named. I
UN§ERWRITER$ CERTIFICATE
REQUIRED
APPROVED AS NOTED ~ .~
DARE: ~BP# ~
NOTIFY BUILDING DEPAR~i/t'EI~r~e~'
765.1802 9 AM TO 4 P~ FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION - ~0 REQUIRED
FOR ~URED CONCRETE
2. ROUGH - FRAMING & PLUMBING
~ FINAL - CONSTRUCTION MUST
~'" BE COMPL~ F~ C.O.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENT8 OF THE N.Y.
STATE CONSTRUCTION & ENERGY
COONS. NOT RESPONSIBLE FOR
DESIGN OR ~NSTRU~ION ERRORS
being duly sworn, deposes and says that he is the applicant
le is the ........................ i .............................................
i (Coniractor. agent, corporate offiqer, etc.)
)f said owner or owners, and is duly ahthorized to perform or have performed the said work 'and to make and file this
:pplication; that all statements containdd in this application are true to the best of his knowledge and belief; and that the
york will be performed in the manner se't forth in the application filed therewith.
;worn
to
before
me
this
CLmE L. GL. i '.
Commission Expires December 8, 19 -~.