HomeMy WebLinkAbout22189-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCuumANCY
No Z-23248
Date SEPTEMBER 28, 1994
THIS CERTIFIES that the buildin~
Location of Property 1435 SMITH ROAD
House No.
County Tax Map No. 1000 Section 98
Subdivision
SWI~IMG POOL
PKCONIC, N.Y.
Street
Elock 4
Filed Map No.
Hamlet
Lot 16.1
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 15, 1994 pursuant to which
Building Permit No. 22189-Z dated 4uh~ 15, 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 ABOVE GROUND SWIPING POOL WITH FENCE ENCLOSURE & ATTACHED
DECK AS APPLIED FOR.
The certificate is issued to
MICHAEL & HARRIET GRMENBERG
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
N-326788 - SEPT. 13, 1994
N/A
Rev. 1/81
FORM NO.3
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOU';~O~.D, N.Y.
N_O
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
22189 Z Date ......... ~D~... ..................................... 19..?..~...~
Counfl/ Tax Map No. 1000 Section ....... ~..O~'. ........ : Biock ........ ~ ...........LotNo .......... ..,~....,~..r/
pursuant to application dated..~ ...................................... 192~..., and approved by the
Building Inspector.
Rev. 6/30/80
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 of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of i% 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
Vpre-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 Buildin¢ - $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 ...... , ...............................
New Construction ........... Old Or Pre-existing Building
Location of Property ............................................
House No. Street Hamlet
Onwer or Owners of Property... ~/~.~.X (~l~'~.~ ,,~,.. . ....... ~d~ ~C¢- .... ~ ..........................
000. ....... ........ .............
Subdivision .................................... Filed Map ............ Lot .................. .. ..
Permit No..,.~..].~.~ ..... Date Of Permit.. ?.~..~...~. ............................ Applicant .....
Health Dept. Approval .......................... Underwriters Approval ....................
Planning Board Approval ........................
Request for: Temporary Certificate .....
Fee Submitted: $. ~--
Final Certicate '
APPLICANT
THE NEW YORK BOARD OF FIRE UNDERWRITERS a
1~,8~077 BUREAU OF E-ECTRI¢ITY
~- *'~' 85 JOHN STREET, NEW YORK, NEW YORK 10038
THIS CE~IFIES THAT
~IET G~EN B~RG, 1435 SMI~ DRIP, PECONIC, N.Y.
~. ~h. yo".wi.~ t..c. tio.; ~ S.,e,~nt ~ ;st FL ~ ~ ~L O~/SHBD .%~aon ~ Lot
~ examlned on SEPT~ER 07,1994 and found to be in compl~nce wlth the NaMo~l Electdcal Code.
FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS
OUTLETS SW~TCHES FLUORESCENT OTHER
DRYERS
SYSTEMS
NO. OF FEET
OTHER APPARATUS:
E R V C
NO. OFECCCONDpR,e' A w. O,
OF CC. COND,
OF HI,LEG
NO. OF NEUTRALS
OF NEUTRAL
ROSLAK ELECTRIC
P.O.BOX 164
CUTCHOGUE, NY, 11935
LIC. #3677-E
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 TH S COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
THE NEW YORK BOARD OF FIRE UNDERWRITERS pa E
1185077
/,..-.~ ~ ~ BUREAU OF ELECTRICITY
~- ~ 85 JOHN STREET, NEW YORK, NEW ~ORK 10038
Dete S~ 13 ~ 1994 ~pplication Ne. on file e639e994/94 N 326788
THIS CERTIFIES THAT
~RIE~ GREEN BERG, 1435 SMI~ DRIP, PECONIC, N.Y.
in the followlng location; ~ B~ement ~ Ist Fl. ~ 2~ FL O~/S~D ,Section Bilk Lot
~s examined on ~T~ 07 ~ [ 99~ and found W be in compl~nce with the NaEon~ Electdcal Code.
SERVICE DISCONNECT NO. OF [ S
~T. AMP. TYP~ ~U~. i,~2W 1,ff3w 3~'3W 3,ff4w NO
SWIMMING POOL- 1
G.F.C.I.-1
*(SWIMMING POOL) This certificate
covers compliance at the date of
inspection only. Because o~ unusual
environments it is advisable to
have frequent test/and or repairs
made by a qualified person.
<<< Continued on Page 2 >>>
RANGES
PECtAL REC'PT.
E R
OF CC. COND.
PER ,ff
TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET
SYSTEMS
AMT. AMPS. TRANS. NO, OF FEET
V' I C
A*W.G t40. OF HI-LEG
OF CC. COND.
OF HI-LEG
EXHAUST FANS
AMT. H* P
DIMMERS
oENr~AL 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. TH~S coPY, OF CERTIFICATE Mi)ST NOT BE ALTERED IN ANY MANNER. ~,/~ ~'
Town Hall, 53095 Main Road
P. O. Box 1179
Southold, NewYork 11971
Fax (516) 765-1823
Telephone (516) 765-1802
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
September 23, 1994
A. Reilly & Sons
P.O. Box 98
Mattituck, NY 11952
Re: Michael & Harriet Greenberg
Premises: 1435 Smith Road, Peconic
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
An application for Certificate of Occupancy is
not on file. (Enclosed)
xx No Underwriters Certificate on file.
The check is (outdated/not on file.)$25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 22189-Z
Please contact our office on this matter.
cooperation.
Thank you for
SOUTHOLD TOWN BUILDING DEPT.
FOUNDATION (1st)
FOUNDATION
2.
{2nd)
ROUGH FRAME &
.PLUMBING
INSULATION PER N.
STATE ENERGY
CODE
FINAL
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSU/LATION
[ ] FRAMING ., [~ FINAL
REMARKS: ~
~,, ~ ~ ~/~"t.~..~-~, TOWN OF SOUTHOLD
/~Fv"/) .~,/~- ,.~'/'~'" "BUILDING DEPARTMENT
" ¢'.~1 "'1 ,"~'~~ow~ ,A,L
SOUTHOLD. N.Y. 11971
/ TEL.: 765-1802
DisapprovedI a/c ............... ' ................. : ....
......
· ( B~SU'I din ~,q's p e c t o r )
APPLICATION FOR BUILDING PERM IT
B6,~o OF ~at.r~ .........
~ S~TS Or Pt.~S .........
SURVEY ..................
ClIECK ........ ~ .........
SEPTIC ;ORH
NO?IPY ~
CALL
HAlL TO:
Date .... 2/~.~- ........ 19 ?.~.
INSTRUCTIONS
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 premises, relationship to adjoining premises or public st?eets
or areas, and giving a detailed description of layout of property muir 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, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections. .
-- (Signature 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.
~.~..~...'....~..~ .,~..,,c~r~z.' ........
' ~ i.c.~.,~.~.. ~'~z'~,/.~..~ -
Name of owner of premises ...........................................
(as on the tax roll or latest deed)
If app at duly authorized officer.
"v '~77;'~;;~~ ___ ;~;r') .........
Builder's License No ..... '~' (l' '~'g~.. '//'~- · ....
Plumber s Lmense No ....... . ..................
Electrician's License No .... ~..3-¢-:~..C.....L?..~tC
Other Trade's License No ......................
I. Location of land on which proposed work will be done...S./~..q/.?.....~. )J~...~....~..~2'~.. ?/./.C..~.~..01~..j'.7/~...~) ..........
. . /.q ~.< .... .y'~. ,. ~ .... . .r¢. .~. . · .,.Y .~. ¢'x./~. . ~. .... A/!. ~ .... / O. ~. x ......
Itouse Number Street Hamlet
County Tax Map No. lOOOSection ...:...'~.~.....:. Block ' .O.t~. ' Lot .... /~' /
Subdivision ........ . ............................. Filed Map No ............... Lot ...............
(Name) ·
State existiug use and occupancy of premises and intended use and occupancy of proposed construction:
Existing use and occupancy ' f..~/./~..~.~
b. Intended rise and occupancy ........
'' '~'y;:''u%; , · ','~ ' ~' ....................
., .
'3. Nature of work (check which!applicable): New Building . ~ ........ Addition . .' ........ Alteration . '
Repair .............. Re[novel .... ........... Demolition ..... : ......... Other ~ork .... ~ . . .
(to be paid on filing this application)
5 If dwelling number of dwelling units Number of dwelling units on each
· If garage ' ' .............. floor ................
number of cars '
6 If business commercial or mi~ed ................................................
· , . occupancy, specify nature and extent of.each type of use
7 Dimensions of existing structu' if Front .....................
· :res, any: .......... Rear Depth
Height N tuber of Stories ..... '
Dimensions of shme structure ~v ........................................................
ith alterations or additions: Front ' Rear
Depth ' ' Height ...........................
~ Number of Stories ' '
8 Dimensions of entire new construction: Front ...........
' Rear Depth
Height Number of Stories ............................................
Size of lot: Front i . r,.__ · .........
~ °o~rru~;Cn.ase. ': .... · .... i .......... ' ......... Name of Former Owner .........................
e d~stnct in whmh premises are situated .......... ' . ... .......... . . ..
Does proposed construction violate any zoning law, ordinance or regulation: ..... ". .......................
,W, fil lot ?..regrade~d .... ...."i' ';~x ' · · :: · · .,; ..... Will exce~s fill be remqved from premises: Yes No
Name of Architect ... ~. ~ .................. Address ................... Phone No ....
15.' I.s t:hJ.s properl:y wit:h±n !300 feet: of a t:±dal we,:lanai? ~Yes ........ No ....
~If yes, Soul:hold iTown Trust:ecs ?erra±t may be requ±red. ' ....
' ' PLOT DIAGRAM
Locate clearly and distinctly all buildings, Whether existing or Proposed, and. indicate ail set-back dimensions from
property lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF NEW YOR-K ..... o ~
COUN~Y~gF ..... ~. ~ .t'-.'4·~..~.~.. °?
...... h.
(Name of individual signing contract)
above named, i
DATE: ~ B.R ~ ~
F~E: d ..... BY: .
7~5-1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1: FOUNDATION ' ~0 REQUIRED
FOR POURED CONCR~E .
Z ROUGH, ,FRAMING & PLUMBING
3. iNSU~TION
4, FIHAL ,. CONSTRUCTION MUST
BE COMPLETE FOR C,O.
ALL CONSTRUCTION 8HALL ME~
THE REQUIREMENTS OF THE N.~
STATE CONSTRUe/ON & ENERGY
CODES. N~ RESPONSIBLE FOR
DES~G~ 0.
. R CONSTRUCTION ERRORS
· ' .....being duly sworn, depose~ and says that he is the applicant
Heisthe . :~ ............ i .~_~.~
i age 'p ffi ) .....
ontractor, nt, cur orate o cer, etc.
>f said owner or owners, and is duly ' ' .
~authonzed to perform or have performed the sa~d work and toimake and file this
~pplication; that all statements contai~ed in this application are true to the best of his knowledge and ibelief; and that the
~/ork will be performed in the manner ~et forth in the application filed tllerewith.
Sworn to before me~ this ~ ' i
............ .... /.//& or i . .z. ..... . ..... , l
// · .... :'7 ....
· ~' NOTAR¥~'UiffJE?Sfai'g~'Jt~v '
Term F.J~ .r~Malt IU, lb-~ .