HomeMy WebLinkAbout21426-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22515 Date AUGUST 10¢ 1993
THIS CERTIFIES that the building. ACCESSORY
Location of Propert~ 590 ELIJAH'S LANE Mattituck
House No. Street Hamlet
County Tax Map No. 1000 Section 108 Block 3 Lot 5.8
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 17, 1993 pursuant to which
Building Permit No. 21426-Z dated MAY 20~ 1993
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 SWIMMING POOL WITH DECK AROUND & FENCE
The certificate is issued to T. MATTHEWS & WIFE
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
Rev. 1/81
N-281617 - JULY 1, 1993
N/A
ild~ng Inspector
TOWN OF $OUTHOI.'~
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
pursuant to application dated .......... ,,~..~ ........ I.,,Z.,... I9.,~,,~,. 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
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 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.
B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
'.'pre-existing" land uses:
61. Accurate survey of property showing all property lines, streets, building and
onusual 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 - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
O~-~ Date .................... . ....
New Construction ........ Old Or Pre-existing Building .................
House No. Street ~ ~Hamlet ....
County Tax Map No I000, Section ......... Block ................ Lot .....
Subdivision '
................................ Map ............ Lot ......................
· .. Filed
Health Dept. Approval ..................... Underwriters Approval .........................
Planni Board App al -- ' ng roy . ..... ·
Request for: Temporary Certificate ........... Final Certicate ..........
Fee Submitted: $ ...........................
APPLIC~T'
FOUNDATION (1st)
FOUNDATION
2.
(2nd)
ROUGH FRAME &
-PLUMBING
INSULATION PER No Y.
STATE ENERGY
CODE
FINAL
ADDITIO~L COMMENTS:
3
~o
THE NEW YORK BOARD OF FIRE UNDERWRITERS
[ [ ~ ~ 0 ? 7 BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK. NEW YORK 10038
Date
THIS CE~IFIES THAT
o~y the el~trical equipmen~ ~ ~scrib~ be~w and in~uced by t~ applicant ~med on the a~ve application number i. t~ p~m~es of
in the following lacatt~g ~s~ent ~ Ist FL ~ 2nd FL 0[1' &etlon Bilk Lot
~s examined on ~ and found to be in compl~ce with the N~Eonal Elect~cal Code.
RXTUKE FIXTURES RANGES OVENS EXHAUST FANS
OUTLETS SWITCHES FLUORESCENT OTHER
DRYERS FURNACE MOTORS FUTUKE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS
SYSTEMS
NO. OF FEET
SERVICE DISCONNECT $ E R V I C
OF CC, CONE).
OF HI-LEG
OF NEUTRAL
P.O,BOE 164
hlC',f3677~8
~NF. RAL MANAGER
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."iNO~BE AETERED N ANY MANNER
THE NEW YORK BOARD OF FIRE UNDERWRITERS
1185077
BUREAU OF ELECTRICITY
~-- 85 JOHN NEW NEW YORK 10038
STREET.
YORK,
Date ~pplicetion No.
THIS CERTIFIES THAT
o~y t~ el~trical ~ulpment
in ~he follo~ing location; ~ Basement ~ I,t F:~ ~ 2.d FL OU'f S~tlon Bilk Lot
u~s examined on ~ ~ ~ ~ ~ ~ ~ ]* 993 and found to be in compliance w~h the Na~on~ Elect~c~ Code.
FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS
OUTLETS EWITCHEE
NCANDE$CENT FLUORESCENT OTHER
1 1 i
DRYERS
SYSTEMS
NO. OF FEET
SERVICE DISCONNECT E R V C
A, W.G. NO, OF NEUTRALS A, W. G,
OF HI-t~G OF NEUTRAL
OTHER APPAR~US:
~IR~NG P005-.I
TINE
~(SW~N~[NG POOL) ~hts certificate
covers compliance
eRvirollmenhs it. is advisable LO
have frequen~ teat/and or repairs
<<< Continued on Page
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 credentiols.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUsT~NoT BE ALTERED I_N ANY MANNER.
FORM NO. 1
TOWN OF SOUTHOLD
'BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
Examined ................. 19 ...
Approved ,, Permit No, z_
Disapproved a/c .....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
BOARD OF HEALTH .........
3 SETS OF PLANS ..........
SURVEY ...................
CIIECK ....................
%
SEPTIC EORH ..............
CALL ........ ,~} ....
HAIL TO:
Date ....... .~.// ? ....... 19c~.
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 ~reas, 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, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary insf~ctions.
......../-/ :..f.2~Zc.~..'t .... ..-,~..o..x:.,~ ............
-- (Signature of applicant, or name, if a corporation)
.....
(Mailing address of applicant) / ( ?d
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
................................ ....................... ........
Name of owner of premises ............ J'~.~P~...~. ..... .~.~. 2.-~,?~.~r~7~/.-~...~-.....~..Z .~.~.'~.,-. ................
(as on the tax roll or latest deed)
If appl~~ authorized officer.
...... : (Name and title' of ~;rpor~e of~;;ri'" ......
Builder's License No....~..0. - {-Z'.f.. ..........
Plumber's License No .........................
Electriqian's License No ....
Other Trade's License No ......................
I. Location o f land on which proposed work w/Il be'done ..... /~.~../,~,, ,t~. ~..,,, ¢...Z,~..~./.. ,d,~,'/~'~, , , ,~,, ~
.... . .J27.o. ............ 4 .z- ?. ~. . /~ ~ ..... c n ~ c: ./ ..... m..~.zT.wz .77<~.~< .... Ar.: ..7. ............
}louse Number Street Hamlet
County Tax Map No. 1000 Section ..... /..0..~. ....... Block '~ Lot '4./~~. ~
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ' ~../..~..~../"--./..~.v .~.. ...................................
b. Intended use and occupancy .......... . ./~...C~.M..-~..{~...ff~..,'~...(vx..' . .Z~.. t...~. ..... .~..0~...c7/' ..............
3. Nature of work (check which a~plicable): New Building .......... Addition .......... Alteratfn~...~.( .c~. ....
Repair .............. Removall .............. , . Demolition .......... ;1~ Other W°r~8'~:~"-/,l~ {D'eSCri ....
4. Estimated Cost ........ fiFi 45-2)~ ..... .~./ ~...,~.~.tff.~.. '.'' ' '-
/' ~.~ ...... .'".v... Fee
~ (to be paid on filing this application)
5. If dwelling, number of dwelhng pints ............... 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 structure~ if any: Front ' Rear
· ' ................ ' Depth
Height ............... Numiber of Stories ........................................................
Dimensions of same structure wiih 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 DateofP rch ! N ofF rmerOw
· u ase ............................. amc o ncr ................
I 1. Zone or use district in which pre~nises are situated ........ ~..~j.~./P:t4. 7'-f~..,~7,_~ .........................
12. Does proposed construction vi.ol,~te any zoning law, ordinance or regulation: ...................... ,,-~.x,. ......
13. Will lot be regraded ...... ,/MO ................. Will excess 511 be removed from premises: ~t4e~ No
14. Name of Owner of premises ..~.'~.~.B.. i
· Address ....~'~... ~2-"~',7~z'..~. ~C~ Phone No ................
Name of Architect .. ~ ....... i ................ Address ........ . .......... Phone No...,,~.
N~am~o.f Contractor /~..:: ./~,~.~/?~ .~. ~..,.,.,.,.,.,.,.,.,.~.... Address..,/~.~/.~.CM. ct< Phone No...~..~.~:
15. ~s cnzs property wxtn~n 300 feet ota tidal wetland? *Yes ........ Wo -.- '
*If yes, Southold T¢wn Trustees Permit may be required. "'' W~'~'''
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 n'umber or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF NEW,XO!~,_
COUNTY OF..4.J4./.'77.?..~.. S.~
..... ~.~ ilL..P~ ~...~.?.C.6. ~ ..... ~..~... ....... being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
~bove named·
'~e is the ' '
~ (Contractor, agent, corporate officer, etc.)
)f said owner or owners, and is duly a~thorized to perform or have performed the said work and to make and file this
~pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the
~vork will be performed in the manner s~t forth in the application filed therewith.
;worn to before me this
............ ~.~....f:~...day oft..
JOYCEM. WILKIN$ -// /.~h_ ' ( ~ I//,O [?fl. // -
Notary Public, State of New York ...... //.../-/.U. _-_ . .~'~---~,~"---.~ ~ //
,o. su,o, ou%_ w' ............. / :.:r.. · .....
Term Exp es J 0 , _72; ~ · (~tgnature ~J a~lHicant)