HomeMy WebLinkAbout22010-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCUuwANCY
No Z-24469
Date JUNE 28, 1996
THIS CERTIFIES that the building.
Location of Property. 1775 GLENN RD.
House NO.
County Tax Map NO. 1000 Section 78
Subdivision
ACCESSORY
SOuT~OLD, N.Y.
Street Hamlet
Block 1 Lot 26
Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 6, 1994 pursuant to which
Building Permit No. 22010-Z dated APRIL 13, 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 INGROUND SWIPING POOL WITH DECK & FENCE ENCLOSURE AS
APPLIED FOR.
The certificate is issued to
EDWARD ROGOWSKY & PETER MCC~%RRY
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
N-313692 - MAY 12, 1994
Rev. 1/81
FORM NO.3
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y.
Permission Is hereby granted to:
.... ~.~. ...... ~.~.Z~.....~_..~, ..........
...~.iL/r;~ ....... £~.~...~...~.~..~.~ .......
to,...~<~.~.././,,.....~ ...... ~~. ........ ~~ ........ ~,~. ............
~ ...... ~..~ ................................................................................................................................
at premises Ivcakd J ............................................................................ : ..................................................
, , ~.~ ...........
CounIyTax Mop No. lO00 Sectlon.....~...?.. ............. Block ........ ~..~.. .......... LotNo ...... ..~...~. .............
pursuant to application dated ..................... ~.. ........................ 19...~....~......, and approved by the
Building Inspector.
Fee ~,,..~;~,,
Rev. 6/30/80
Fo~--~ No. 6
TOWN OF SOUTHOLD
BUILDING D EP ARTY--~NT
TO~ H-~. L L
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 su~'-vey of property with accurate location of al! buildings, proper~y lines,
streets, and unusual natural or topographic features.
2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form).
3. Aoorovai of electrical installation from Board of Fire Unde~---iters.
$~rn statememt from plumber certifying that ~he solder used in system con~ains
less than 2/10 of 1% !cad.
5. -Commercial building, indus~rlal building, mu!miple 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 ~ppliaation and a consent to inspect signed by the applicant.
If'a ~ertificate 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 S25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swimming pool $25.00~ Accessory building $25.00,
Additions to accessory building $25.O0. Businesses $50.00.
2. Certificate of Occupancy on Pre-e~:istin~ Buiidin_~ - $100.00
3. Copy of Certificate of Occupancy - $20.00
4. Uodated Certificate of Occupancy - ~50.00
5. T~mporary Certificate of Occupancy - Residential $15.00, Co~ercia! S!5.00
Date .~ ....................................
New Construction ........... Old 0r Pre-~isting Building. r ...............
~o~io~ o~ ~o~=y.../.~...~. ~.. ......... · .......................................
House No, S~ree~ Ra~e~
3nwer or O~ers of Proper~y...~*.~:K~.l/~'~~ .................... ' '
:o=n~7 ~ ~ ~o ~000, Se~:ion.. .......... ................
...................... : .... ........ ........ ................. ...........
~Sann~ng 3oard Approva~ ........................
~......
Recuesr ~or: ~emporar Cer~ificace ........ Final Cer~ica:e...
~ ~153 ...........................
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 SOUTHOI~¥ 29, 1996
Mr. Edward Rogowsky
113 sterling Place
Brooklyn, NY 11217
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)
No Underwriters Certificate on file.
The check is ~o% on file. $25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Bolder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT #~ 2_~010-Z~ ~ ~
please contact our office oh this matter.
cooperation.
Thank you for
souTHOLD TO~N BUILDING DEPT.
Town Hall, 53095 Main Road ~.~ ~' ~,,'.~ Fax (516) 765-1823
P, O. Box 1179 ~ ~ Telephone (516) 765-1802
Southold, New York 11971 ~)
Swim Tech Pool Services Inc.
467 Miller Place Road
Miller Place, NY 11764
Re:
Prem:
Edward Rogowski - SCTM#1000-78-1-26
1775 Glenn Road, Southold
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)
No Underwriters Certificate on file.
xx The check is not on file. $25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT #
22010-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
THE NEW YORK BOARD OF FIRE UNDERWRITERS
1145~59
/ BUREAU OF ELECTRICITY
J~ ~' 85 ,JOHN STREET, NEW YORK, NEW YORK 10038
THIS CERTIFIES THAT
ROGOWSKI, 1775 GLENN ROAD, SO3THOLD~
in the followlng location; [] Basement [] tst Ft. [] 2.d Ft. GE/OUT Section Block Lot
~s examined on ~¥ 09 t 199g and found to be in compliance with the National Elect~cal Code.
FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS
SYSTEMS
NO. OF FEET
E R V I C
NO, OF CC, COND. A W O NO OF HI-LEG A W O NO, OF NEU'/RA[$A. W G,
PER ~' OF CC, COND OF HI,LEG OF NEUTRAL
OTHER APPARATUS=
made by a qualift, ed reason.
NORTHEAST ~I[~]C, CONTR. INC,
3e3 J~JRICHO ~'PKE.sUITE 282
COMP[ACK, NY~ 11725
LTC,~381~E
GENEI~AL MANAGER
This certificote 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.
THE NEW YORK BOARD OF FIRE UNDERWRITERS 1
11~5~5~4 BUREAU OF ELECTRICITY
{~ ~ · 85 JOHN STREET, NEW YORK, NEW YORK 10038
~te ~tY 12 ~ 1994 Application No, on file 05868994/94 N 313692
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application nu tuber in the premises of
ROGOWSKI, 1775 GLENN ROAD, ~OUTHOLD; N.Y~
in the followlng location; [] Basement [] 1st FI. [] 2nd ~7. OaR/OUT Section Block Lot
tt~s examined on ]'{~¥ 09,1994 and found to be in compliance with the National Electrical Code.
FIXTURE FIXTURES RANGES OVENS I DISH WASHERS EXHAUST FANS
OUTLETS SWITCHES FtUOR~$CENi. OTHER
1 i
SYSTEMS
NO. OF FEET
OTHER APPARATUS:
SWI~{ING POOL-- 1
TIHE C~)CKS-AMP. 40-1
G.F.C,I-1
PANELBOARDS: 1-2 CIR, 1~
*(SWIMMING POOL) This certificate
covers compliance at the date of
inspection only. Because of unusual
environ~mnts it is advisable [o
have frequent test/and or repairs
<<< Continued on Pa~e 2
E R V I C E
NO. OF CC COND A, W.G. NO. O,: HI.lEG
A W G NO OF NEUTRA A W G
OF HI,LEG OF NEUTRAL
GENEI~AL MANAGER
PdF
This certificate must not be altered in any manner; return to the office of, the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT, THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
~.~o~ oC
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST
[ ] FOUNDATION 2ND
[ ] FRAMING
ROUGH PLBG.
INfLaTION
FINAL
[ ] FIREPLACE & CHIMNEY
DATE
INSPECTOR
INSPECTION
[ ]FOUNDATION 1ST [ ]ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]IN/S~ATION
/
[ ]FRAMING [ ~]FINAL
[ ] FIREPLACE & CHIMNEY
INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION ZND, [ ]~/~ATION
[ ] FRAMING [//J FINAL
1.
FOUNDATION ( ls t)
FOUNDATION (2nd)
ROUGH FRAME &.
'¥LUMBING
3.
INSULATION FERN.
STATE ENERGY
CODE
CO~f~l£Nr2 ,
FINAL
ADDITIONAL
COZ~E~.;TS
TEL 51G-928-2694 p. ~
., .IMMI
": ~.PP;ROVE. DA$ NOT~I).
' -"," BUILDING OEPARTMENT' AT
., ,}.,,. 1802 9 AM TO 4 PM FOR THE
~; · INSPECT~IONS:
· '' ...... ~L~NDATION - TWO R'EQUI~'.ED
;' ?~' ';[;' ,'"' ' FOR POURED CONCRETE
f . ,, I:~U'GH - FRAMING & PLUMBING
~ISULATIO N' ,..
" ', :. ,.,. - · I~ : 'CONSTRUCTION MUST
ALL' SHALL MEET
, ' ...... ~" THE REQUIR,EMENTS OF THE N.Y...
~: , '"" ~ ..., ,. m' STATE CONSTRU(YrlON & ENERGY
~ ' CODES, 'NOT "RESPONSIBLE FOR
..... · . DESIGt~ OR 'CONSTqUCTION ERI;IO,R$
'"'"'""""",,_' ..,, - .V
· ~ ,,"..;I,~,~, ,' . .U'
[,, ;,'-:',+..,.';,.....:.
P. 3
Town Hall, 53095 Main Road
P. O. Box 1179
Southald, New York 11971
Fax (516) 765-1823
Telephone (516) 765-1802
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
May 29, 1996
Mr. Edward Rogowsky
113 Sterling Place
Brooklyn, NY 11217
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.
.
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(Ail permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT ~ 22010-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUT~OLD TOWN BUILDING DEPT.
TEL 51~-928-2694
Disapproved a/c .....................................
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-180~
· (B~ding~nspector)
APPLICATION FOR BUILDING PERMIT
/3 SITS OF FL~S .[ .
/SURVSY ..........
/C~l~cn ........... .
/SEPTIC FORH ......
N~TIPY:
CALL ...................
~AIL TO;
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 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 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
Regplations, 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
admi.t authorized inspectors on premises and in build, lng for necessa~ect~ff~
ooL Smo .... ,. ...........
-- (Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is 9wner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder.
~me o~ owner of premises . .~.~..~.~..~..~. ......... ~..~.0 ........................
i (as on the ta× roil or latest deed)
If applicant is a corporation, signature of du)y authorized officer.
(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 ofland on wh~,~op~, work will be donec ' .... [.~.7.~.. ..... .~..[~MA2............... .&~ .............
House Number Street Hamlet
County Tax Map No. 1000 Section .............. Block ................. Lot ..............
Subdivision..~. 5.~.....~...e.~..~--....~. S..~. r~.¢.. 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 ...1.(0~. .......... .~ ........ ~. ...... ,:...:,~
3. Nature of work (check which applicable): New Building .......... Addition ......... .!';~~~d[era[mn .~...'" t...
........ Ot
RepEr ............ Removal ............ Demolition '' :~ :0 ~ ~ ~ · ..........
-. ~ .... ~ ~,- n~escfiption)
4. Estimated Cost I / 00~'
· · '~ ........... Fee ~ ..
(to be paid on ...... ication)
5. Ig dwelling, number of dweiling units ............... Number of dwelling units on each floor ................
If garage number of c~s
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .....................
7. Dimensions of existing stmcture~, if any: Front ............... Rear .............. Depth.. ~qT. ff q.~
Height ............... Number of Stories ........................................................
Dimensions of same structure wi~h, alterations or additions: Front ................. Rear ..................
Depth HeiSt Num her of Sto~es
8. Dimensions of entire new const~ction: Front ............... Rear ................ Depth ..............
Height Number of Stohes
9 Size of lot: Front , Rear
· .................................
10 Date of Purchase ~3. Name of Fomer Owner ' ' ....................
11. Zone or use district in which premises are situated ....................................................
12. Does proposed construction violhte any zoning law, ordinance or regulation: ......................... '.. ....
13. Wnl lot be regraded .~{5..B~ ............. , ....Will excess fill be removed from premises: ~ No
14. Nme of Owner of premises .~9~ .~.0~9~( Address ... ...... PhoneNo ................
Nme of Architect .......... ~ ........... , ..... Address ................
~m~,o~ Contractor .~. '~[~t¢~ ~ECAddress .~67.~4;~r.~1 .g0... ' Phone N~ ................
. Phone No.
15. xs cn~s property ~thSn 3;00 feet of a
~If yes, Southold Tiown Trustees Permit may be required.
P~T DIAG~
Locate clearly and distinctly ~1 ibuild~gs, whi~er exist~g or proposed, ~d. indicate ~1 set-back d~ensions from
property fines. Give street ~d block ~ umber or desc~ption accord~g to deed, and show street nines and ~dicate whether
inte~or or comer lot.
STATE OF NEW YORK,
COUNTY OF .... -~/,~...x. · ~'~
~..~¢~e\ ' ~-r~ ~ ~. ......
.............. ~'~...~:~. · · ~ ........... being duly sworn, deposes ~d says.that he is the applicant
(Name of individual signing contract)
above named.
He is the
.......................,
(Contractor, agent, corporate officer, etc.)
of said owner or owners, ~d is dulylauthofized to perform or have Perfomed the said work and to m~e and file this
application; that all statements contaihed ~ this application are true to the best of his knowledge and belief; and that the
work will be perfomed in tho m~ner ~et forth in the application filed therewith.
Sworn to before me this ~'~
. ...........