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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 -~.