HomeMy WebLinkAbout22461-z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-24018 Date NOVEMBER 6, 1995
THIS CERTIFIES that the building ACCESSORY
Location of Property 27754 MAIN ROAD/ROUTE 25 ORIENT NY
House No. Street Hamlet
County Tax Map No. 1000 Section 18 Block 6 Lot 21.9
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVEMBER 1, 1994 pursuant to which
Building Permit No. Z-22461 dated NOVEMBER 10, 1994
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 AN ACCESSORY INGROUND SWIMMING POOL WITH ON GRADE PATIO AND
FENCE TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to CAROL LEE TAYLOR
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N350397 MAY 2, 1995
PLUMBERS CERTIFICATION DATED N/A
la'-~ z4w
ild ng Inspector
Rev. 1/81
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)
Date t....~...................... 19. .
N® 22461 Z
Permission Is hereby granted to;
..,......,......r..c.~~
to......
K.~ Pa... ........fir..
.....,rr~?.......cP~~sfii.....'~.1..%k j
, ~r. C'.......
QQ
at premises aced at..........p~.../....1... 7.........
b..r p/..f~....relv..f..................................................
County Tax Map No. 1000 Section /...P..... Block ...........6........... Lot No...epf f..5...........
pursuant to application dated 72 19........ 7...Kand approved by the
Building Inspector.
Fee $...~41
i
7
.
Building Inspector
Rev. 6/30/60
k
Farm No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. 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 of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of 17 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:
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.
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 - $20.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date ....!J~ l99J
New Construction...... Old Or Pre-existing Building
Location of Property....
House No. Street Hamlet
Onwer or Owners of Property....G: • • • T• • "G"""""""
"
County Tax Map No 1000, Section... . l Block . . . Lot .
Subdivision ..F/iled Map............ Lot..........~.......C(.~...
...Applicant ~ /7 7
Permit No. Date of Permit..
Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate...........
Fee Submitted:
I/$.~~ S
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M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSU ION
[ ] FRAMING [ INAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE 49 ~1 i INSPECTOR
, / / *
C3, /3 7]
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG-
[ ] FOUNDATION 2ND [ ] i LATION
[ ] FRAMING j ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE INSPECTO
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INS TION
[ ] FRAMING [ INAL
[ ] FIREPLACE & CHIMNEY
REMARKS: _ L~ J`,Psu~C A7~
DATE f~ INSPECTO
70.1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] IN LATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY REMARKS: ~"061e-2z G
DATE INSPECT
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- a 2- 4 Lo 1
PAGE 1
THE NEW YORK BOARD OF FIRE UNDERWRITERS
].195095 BUREAU OF ELECTRICITY
I 85 JOHN STREET, NEW YORK, NEW YORK 10038
Date MAY 02 ,1995 Application No. on file 87613695/95 N 350391
_ THIS CERTIFIES THAT
1 only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
TCAROL TAYLOR, ROBIN ROAD, ORIENT, N.Y.
in the following location. s nt 11 Ist Fl. El 2nd Fl. GAR/OUT Section Block Lot
I0 w,9
was examined on er and./ound to be in compliance with the National Electrical Code. MAY FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS ECEPTACIE$ SWITCHES INCANDESCENT FLUORESCENT OTHER MIT K W. AMT K.W. AMT. K.W. AMT. K.W AMT. H. P.
5 1 5
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS 'RILL UNIT HEATERS MULTI-OUTLET DIMMERS
AMT. K. W. Olt H. P. GAS H. P AMT. NO A. W. G. AMT. AMP AMT. AMPS. TRANS. AMT. H. P. SYSTEMS pMT WATTS
NO.OF FEET
1 20 1 - 40
SERVICE DISCONNECT NO. OF S E R 'v I .C E _
METER NO. OF CC COND. A. W. G. A. W G. A. W. G.
AMT, AMP. TYPE EQUIP. 1 q 1W t,e' 3W I30 3W 3$ 4W PER m OF CC COND NO. OF HI-lEG OF HFIEG NO. OF NEUTRAIR OF NEUTRAL
OTHER APPARATUS-.
-
SWTMHING POOL-1.
*(SWIH14ING 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
I made by a qualified person.
Continued on Pace 2
GENERAL MANAGER
` Per.
This 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 COPYOF CERTIFICATE MUStNOT BE ALTERED INANY MANNER.
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BOARD OF HEALTH
FORM NO. 1 3 SETS OF PL,\NS
TOWN OFSOUTHOLD SURVEY
BUILDING DEPARTMENT CHECK _ .
TOWN HALL SEPTIC FORK
SOUTHOLD, N.Y. 11971
TEL.: 765-1802 NDT I"FY ; ~1 5. 2 v
CALL ...1~.
Examined . 19..1. MAIL TO:
Approved .....~d...., 19Permit No... .
• • • .
Disapproved a/c
L B V L5 (Building Inspecto
)PLICATIONFORBUILDINGPERMIT
,
r.._FT. _ Date 19
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 planshowing 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, blfling code, housing code, and regulations, and to
admit authorized inspectors on premises and in lmijh} fpr tteC$s'sary, dn§ ections.
0iignature of applicant, or name, if a corporation)
(Mailing address of applicant)
i;z~cral contractor, electrician, plumber or builder.
State whether applicant is owner, lessee, agent, architect, en
tt~
..................AlUssA
~oh }1 ~1G¢ r
Name of owner of premises G pPQ , e?... ,Ta .f . .
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
~~*'d!~•.....~r'24 P{cs7tec n~....
(Name and title of corporate officer)
Builder's License No .
Plumber's License No.
Electrician's License No .
Other Trade's License No .
1. Location of land on which proposed work will be done .
..&qq,)
House Number ,f(alt Street /Ro6;n Rd. Hamlet 0iVCn-)
County Tax Map No. 1000 Section Qlg............ Block ...Q( Lot..P/0...?!
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 and occupancy .
b. Intended use and occupancy ~tS...~P.~ F.S .
i
3. Nature of work (check which a Ipplicable): New Building Addition Alteration
Repair Removal , Demolition Other Work .:F?oo). Ila1o
(Description)
4. Estimated Cost Fee
(to be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on each floor
If garage, number of cars . . -
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .
7. Dimensions of existing structures, if any: Front . . Rear Depth . , . , , .
Height ...............Nu berofStories........................................................
Dimensions of same structure with alterations or additions: Front . Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: Front Rear Depth
Height Number ofStories
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:
13. Will lot be regraded Y. K A Will excess fill be removed from premises: Yes
14. Name of Owner of Premises G• . ,1. L99..1.4y 14r.. Address Phone No.. A3'A." 7~.. .
Name of Architect . Address Phone No.. . .
Name of Contractor .~~ru«~ elf ~:r!n~s tP,S Address . Phone No..9 lvS. -/r?a 0, ,
15. Is this property within ~
* Y 00 feet of a tidal wetland? ~<Yes........ No.........
If es, Southold Town Trustees Permit may be required.
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.
Mgrs ~ ncloSe~
01
APPROVED 5 t'U' U
lMMEDIATELY'• DATE B.P. 2
ENCLOSE P
UPON FEE:
Wfo a -NOW NOTIFY BUILDING 0
- 755.1802 0 AM TO 4 FOR THE.
FOLLOWING INSPECTIONS:
I. FOUNDATION - TWO REQUIRED
rr)Fi P()U14',F. (7ONCPETE
UNUER{yRlTERgCER 2.-I;OUO~I - FRAMING la PLUMBING
TIFIQ 3, INSI.iI ATtON
QU/R~ 4. FINA1,, - CONSTRUCTION MUST
SE COMPLETE FOR C.O.
AU.I_ CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y.
STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
I
STATE OF NEW YqR S .S
COUNTY OF ~
j.{c kc, 0.0. , being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the......... C On +</eLCiL~j
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly1111 authorized to perform or have 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 knowledge and belief; and that the
work will be performed in the mann t forth in the application filed therewith.
Sworn to before me this
, ~C-.T...... f . I.. . A Xr44A -1r?(%.. f. 19 G
Notary Public, ountyY
ROBERT I:SCO J G(.`~:
N r472508~L0' iN.Y. nature of applicant)
TBrm Expires; May ,19(,
selCclosi+~
10
f
pry Wn~
For pc?I i
bwckwas~+
i
f r ~ P~ti
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Y ~ e I 1
1
Le c~7J.-=L
PATIO
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Gunn~4o Pooh
ELY" I
t
UNDERWRITERS CERTIFICATE \ y
REQUIRED W
44
_ EU
_ Salk C.losiny PS i YI ~ \
V) C3 a+e
V~r~l ~hA;~ LI>,k
Fence
Ift
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j
4
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JOB NgME .;~y~,~.
LOCATION mp n
SCALE ~j[H
DATE' ~v
10 I3 9I9y~
MOLLO COMPANY