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Home My WebLink About21537-zFORM NO. 4 TOWN OF SOUTHOI/D BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22636 Date OCTOBER ir 1993 THIS CERTIFIES that the building. Location of Property 360 LESLIE ROAD House No. County Tax Map No. 1000 Section 97 Subdivision ACCESSORY CUTCHOGUE f N. Y. Street Hamlet Block 9 Lot 7 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 28, 1993 pursuant to which Building Permit No. 21537-Z dated JULY 15t 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 & FENCE AS APPLIED FOR The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 WIESLAW & ANNE LASOTA N-284659 - JULY 30~ 1993 N/A Jud/innspector FORM NO.$ 'tOWN OF SOU'[HOLD BUILDING DEPARTMENT ToWN HALL SOUTHOLD, N.Y. NO_ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ,...~.~,,/..~,. .............................................. 19.~...~.... 21537 Z Permission is hereby granted 1o: Counfl/Tax Mop No. 1000 Section ......... ~...~.. ....... Block ........ ~ .............. Lot No ......... ~ ............... pursuant to application dated~,~..~./.~.. ~.. ....................................... 19..,,~.... ...... Building Inspector. Fee $../.,,~~ and approved by the / ~_,~uJldlng inspee or Rev. 6/30/80 Form No. 6 T6~ OF' SOUSItOLI5 TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY be filled in by t~pewriter 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, ~roperty 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. 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 Inspec£or sfiall state the reasons therefor in writing to the applicant. Fees i. 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 Date · New Construction. ~... Old Or Pre-existing Building ................. Location of Property. ~.~.O /~.g.S~/_/' .......... House No. Street Hamlet Oewer or Owners of County Tax Map No i000, Section .............. Block .............. Lot ................... bP. Subdiv sion. I. ~ ............... Filed Map ..... Lot .................... Permit No.2]~.?....~...Date Of Permit .... Health Dept Approval Underwriters Approval ' Planning ~oard Approval ........................ Request for: Temporary Certificate .......... Final Certicate...~. ...... ~'x-A~ · cl {~ ~' ~'~ APPLICANT' ~OU~DAT~O:! (2nd ~ ~OUGH FRAI.IE & .PLUMBING ~SULATIO:I PER N. Y. STATE ENERGY CODE Fi~!AL ADDITIONA'L COMMENTS: BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION REMARKS~ DA'~ INSPECTOR THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ :~ 1185~77 BUREAU OF ELECTRICITY [~ 85 JOHN STREET, NEW YORK, NEW YORK 1003~1 Date J~]~' ~J, 993 Application No, onfHe ~4803393/9~ ~ 28(~6~9 THIS CE~IFIES THAT only the el~trlcal ~uipment ~ ~scrib~ be~w a~ intr~uced by t~ applicant ~ on the a~e application ~umber in the prem~es of in thefolio~,Jng location; ~ Basement ~ ]st Fl, ~ 2nd ~], 0[~? Section Bilk ~t ~s examined on J~ 27~1993 and found to be in compliance ~vith thv Na~onal Elect~cal Code. ~,~[~LEcE'TACLESI SW TCH,S I,NCA~0ESCE~, ,FrIo~EU~EENS, OTHER ~ANG~. 'Ic~'NG~KS~ ~VE~. IOl~? WASK.~E. RS I E~AUST HF.~NS $$EVl~ DI~ONNECT ~F S S ' R 'V ' I ' C E o 'N~UrR~r OTHER AP~RAYUS: covers compliance at ~he da~e of i-t~pecgion only, Becaase of unusual environments it is advisable to have freqae~ test/and or repairs <<< Continued oil Page 2 >>> GENERAL MANAGER This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by t~r credentials. COPY FOR BUILDING DEPARTMENT THIS COPY OF CERTIFICATE MUSTNOT BE ALTERED N ANY MANNER. ? I FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:3 Examined .~-/~. ......... , 19 .~. BOARD OF HEALTH ..-~..... SURV£Y ....... SEPTIC F 0 R,~I .............. C^LL . :575¢. ........ HAIL TO: a. Tiffs application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to scliedule. 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 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. - ,..,/ / -- (Si,,nature of applicant, or name, if a corporation) .' (Mailing address of applicant) State whether applicant is o~vner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . ~.a.~..~...~....,.~./.,'d. '....~/,,~,.~O .~.q- .......................................... (as on the tax roll or latest deed) If applicant is a ~orporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No.../.a~.:/.~..-v,~..-~... ........ Plumber's License No ......................... Electriffian's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be'done .................................................. .33..D. ......................... .............. .................. }louse Number Street Hamlet '~ County Tax Map No. 1000 Section . . .~.. ........... Block . . .~. ............. Lot.. ~.. ............... Subdivision/~.~]:o-/..d..,,~e-:o...,4/. ov,.~O!lv,, .......... Filed Map No.. ,6-i~.~ .~. ..... Lot ... ~. ......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~,,q.e~ . .,~.'-v-e':,.~'-I ~,.,'~,/./t[>/~.. ........ · .. .... . b. Intended use and occupancy . .O.,ff~......~.--.,qr~.,'.~...'~-e-vc//~_~...t-~,! .~q.~?,.~.'Og-tl:.r,~.. ,,~--~.,~/t. ........... 3. Nature of work (check which applicable): New Building ........... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition ..... '...; ..... Other Worlc~,oqa~,-a¢~.."~O/.. · ~.&. .... . ......'... ................ .~/. ~"~, (Description) 4. Estimated Cost .~.~O Fee .. fid). ............................ (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 n~tl~re and extent of each type of use ..................... 7. D]mensmns ut exmtmg structures, if any Front .... ?/ .......... Rear · · 2/4 .. . Depth . .~.]~.. . Height .. ~.t .......... Number of Stories ..../ .................................................... Dlmenslons ofsame.~t~:th alterations or additions: Front ..~. .............. Rear . ,T. ............... Depth.. ~6.'.... ~. !.'~O~.. Height ..... /..575. .............'.. Num bev of Stories./.'. ........ '...' ....... 8. Dimensions ofenti~~ction: Front ............... Rear ............... Depth ............... Hetoht ....... ...., ,,~._. Ni~tl~er of Stones ............... . ............... , ......... 9. Size of lot: Front .$.111[: .~1 ........ '.. Rear../21~.2£: ............Depth...~3. ................ I0. Date of Purchase ...~..7:;[$1k1{ ................. Name of Former Owner ~d~:.-r'A...~t~ ............... 1 I. Zone or use district in wl~p[.e~ises are situated ..................................................... 12. Does proposed construct~n vifilfi'te any zoning law, ordinance or regulation: ..~-4.4 ............................ 13. Will lot be regraded . ~.~ .... ' .................... Will excess fill be removed from premises: c_~. No . ·. Address 14. Name of Owner of premises ~.d~,..~4r~,.. L~.~. . ,Le,~/.,'.e..~4..fl. ck',b~',~¢3.. Phone No. ?~.q..~.r~,.~.q~'... Name of Architect ........... ,., ............... Address ................... Phone No ..... ;,.. ..... :.... Name of Contractor ~. d&lJJd~.. ~.c~t. ..~ae~.~$.. Address .'--.-.-.-.-.-.-.-.7~ ?,~A ~..ff~,k~.qfir3. PhongAqo. ~.~ .~./~,.,~ .... 15. ' I~ this property within 300 feet of a tidal wetZand? *Yes ...... ~. No..~. ...... · If yes, Suuthold Town Trustees Permit may be required. PLOT DIAG RAlM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicai!e all ~et-back dimensions from property hnes. Give street and block number or description according to deed, and show street names and indicate whether' interior or corner lot. API)RO~/ED AS NOTED aP. # -¢21 D~3'E 765.-t80~ 9 AM ~ 4 PM FOR'THE F~}L. LOWING iNSPECTIONS: 1. FOi ~NDATION ~O REQUIRED FOR POLJR6D CONCRETE 2. ROUGH - FRAMING ~ PLUMBING 3. iNSULATION 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL THE REQUIREMEN~ OF THE N.Y. STATE CONSTRU~ION & ENERGY cODES. N~ RESPONSIB~ FOR DESIGN OR CONSTRU~ION ERRORS 'OUNTY OF...,:~,~. 1../- ~,6~' r' l ...... -.--. .............. being duly sworn, deposes and says that he is the applicant (Na'/ne of individual signin,," ';"" ~contract) )Dye named. e is the .......................... i.. ~ ................................ ' .................. Contraeto , a)ent, coryra,e officer, etc. - said owner or owners, and is duly anthor]'Zed-"~lmfform or ha~e performed the said work and to make and file this ~plication; that all statements contained in tiffs application are true to thc best of his knowledge and belief; and that the ork will b~ 'performed in the manner set forth in the application filed therewith. )tary Publ'c.~ ~. . ..~.. ¢ ...... Co nty No. 4879605 ,- (Signature of applicant) Qtm#fl~d In Suffolk Countt