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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22392 Date JUNE 15, 1993
THIS CERTIFIES that the building ACCESSORY
Location of Property 1325 PARKVIEW LANE ORIENT N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 15 Block 5 Lot 24.25
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated FEBRUARY 10, 1993 pursuant to which
Building Permit No. 21222-Z dated FEBRUARY 16, 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 INGROUND SWIMMING POOL WITH FENCE ENCLOSURE AS APPLIED FOR
The certificate is issued to DOUGLAS & JOAN BULLOCK
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL INSPECTION NO. 2528 DATED APRIL 19, 1993
PLUMBERS CERTIFICATION DATED N/A
B ilding Inspector
Rev. 1/81
FORK X0.9
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)
...°~~1..
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N °-N° 21222Z Dote 19.9
Permission is hereby granted to.
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...............................................:uOGf- 9............................................................................................
County Tax Map No. 1000 Section .........f Block Lot No......
pursuant to application dated 19.,sr., and approved by the
Building Inspector.
_ 421
Fee $••1~.0.
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r for
Rev. 6/30/80
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Form No. 6 7
t
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
MAY 2 5 (916 TOWN HALL
765-1802
_`'';;Cs:• 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:
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 - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date . ?
New Construction, Q491..... Old Or Pre-existing Building
Location of Property...('325..... Nr~ V.ew LC.e.~ ...........:.Q"_
House No. Street Hamlet
Onwer or Owners of Property....~~ ,s~Qa..~in~`Oc k
County Tax Map No 1000, Section...........Block..4 Lot.._L+."'Z
Subdivision .Filed Map............ Lot......................
Permit No. z22 Date Of Permit.16I93........ Applicant. Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate
Fee Submitted: LJ (DO
644rl(ba .
C 0 p~a~-2 q 2 APPLICANT
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST ( ) ROUGH PLBG.
[ J FOUNDATION 2ND [ I INSULATION
FRAMING [ FINAL
~ tJ
REMARKS:
-09
DATE INSPECTOR
~$~LD LLS. :1 ~IDn. I LNT~ N
FOUNDATION (1st)
1b
FOUNDATION (2nd)
r
2.
`o
DOUGH FRAME &
-PLUMBING
C/i
m
n
:NSULATION PER N. Y. j
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS: m
• x
a
a
O
m
• S
^o
H
765-1802
BUILDING DEPT.
r` NSPECTION
[ ] FOUNDATION 1ST [ ) ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ FINAL
R MARKS:
_czvr~-aa2te I
J4 4210~4
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DATE INSPECTOR
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BOARD' OF HEALTH ~1.. ,
FORMNO.1 3 SETS Of/PLANS
,r4 TOWN OFSOUTHOLD SURVEY
iPkin.t11 Q I a BUILDING DEPARTMENT C11ECK
I TOWN HALL SEPTIC FORM
1999 SOUTHOLD, N.Y. 11971
TEL.: 765.1802 1:OTIPYi
5 p~ 'CALL
Examined • 19(? MAIL TO: R
Ap}rroved 19 Permit No.ai1~P~ dl72
Disapproved a/c
( ild' nspector)
APPLICATION FOR BUILDING PERMIT
d , < <l sate . 19.-
740
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. + F'
b, ')C'lot'plan shoaling location of lot and of buildings on premises, relationship to adjoining
premises or public stieets
of ated8i and giving a detailed description of layout of property, must be drawn on the diagram which is part of this ?ppli•
>k YsI h I i U}(x 1 i,z~
t f!4"1& ~t8 wof covered by this application may not be commenced before issuance of Building Permit.
t, ti,I 1Jp$n 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 Certificatc.of Occupancy
shall have been granted by the Building Inspector.
r 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 Yorks and other applicable Laws, Ordinances or
Regulations, for the_coltstruction..,p - pildings, additions or alterations, or for removal or demolition, as herein described.
-The applicant agrees to comply'alitI`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.
I,~~ SC~'jvhv~i y~
1Vatneof owner of premises
C .
" (as on the tax roll or latest deed)
If, applicant ls's corporation, signature of duty authorized officer,
s:
(Name and title of corporate officer)
JJ-r
ai y a
.17-.4
Builder"s License No. . 1 '
Plumber's License No.
."e Y eta -:!Electrician's License No. .
,Othet Trade's License No.
Location of land on which proposed work will be done. • • . . .
r!en•....•..........•.•.'
' House, NumbetStreet Hamlet
~(otin j+ Tax Map No. 1000 Sectiop ~ J~• • , . Block Lot ....0.? .
Subdivision , , • • . Filed Map No. , Lot • .
f (Name) r
" 2, State existing use and occupancy of premises and intended use and ccupancy of proposed construction:
a,, Existing use and occupancy S ` S W P!. i n J1........ .
b.,lntetided use and occupancy 1~`~c• Cl°w v . 9?` x 3a Ln•~° L c1- • • •~cl'.
r Yf '
8.' Nature of work (check which applicable): New Building Addition . ~ • . Alteration .
Repair` Removal Demolition Ot er Work . .
U co a~C ` ~ ~t(Tescription)
"0 1
;Estimated Cost 1. q.~ Fee
(to be paid on filing this application)
w 5,' If dwelling, number of dwelling units . Number of dwelling units on each floor
?l`}4'" "s If garage' number of cars u 7 , t , .
If business, commercial or mixed occupancy, specify nature and extent of each type of use l.. /4
, , ^ ;Dimensions of existing structures, if any: Front Rear, Depth
y.Height . . . . Number of Stories ,
r;;,.Dimensions of Same structure with alterations or additions: Front . . Rear .
Depth'y s : . . .............Height Number of Stories .
s3sl'Dline, nsions of entire new construction: Front . Rear , Depth .
Number of Stories . .
4r<r;-Sloe of lot:
D i ront Rear De nth .
ate of PurchasC Name of Former Owner P f 1 .
t I; Zone or use district in which premises are situated . , , r . : .
Y t 2, ' Does proposed construction violate any zoning law, ordinance or regulation. = t , .
Iitt`tiyt be legraded , .Q Will excess tilt a emoved from premises:Yes~ No
14, z Name of Owner of premises. . Address ~3?S , ,7 li.` .Phone No...?
lr~
,M Name.of Atchitbet . ..'Address . . is , , . i = Phone No.. .y7
}~f ~r IVa1 Ke bC Grontractor 74".~jT, / ` .4h s < . Address/ 9)14T446°%(e_~' I li ri, i 3pt"opprty- t4i hin 300 feet of a tidal'taetland? Yea sa , I4o, . 11
,
elf yeas-Southold Town Trustees Permit may be requifed~,'~ `
t4crXlkNt ~iF'2, y, v,~,, PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions front
property lines. Give street and block number or description according to deed, and shoW street names and indicate whether
interior or,corner lot. "j
AWAS NOTED
2 a~
DATEBP. #
FEE: NOTI DEPART AT
765-1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRED
I FOR POURED CONCRETE
2. 9OUGH, FRAM114G;R PLUMBING
S.INSUL.ATION
51 r ,.iris.. r' t l i
4. FINAL - CONSTRUCTION MUST
SE COMPLETE FOR C:O•
• ALL "CONSTRUCTION SHALL MEET
' ara n",Rzt an ' 'ot THE REQUIREMENTS OF THE N.Y,
rSTArE CONSTRUCTION & ENERGY
COt)E$.I;fNOT(a, RE$PONSIBLE~_'.FOR,
DESIGN OR CONSTRUCTION ERRORS
=s ,
v, .
51A IEC3FNEyy!!Feofindividual YORK, S.S
~ UNTi'~ .S ......being duly sworn, deposes and says that he is the applicant
(Na signing contract)
above named.
He is the
v (Contractor, agent, corporate officer, etc.)
of shad owner of owners, and is duly 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 manner set forth in the application filed therewith.
" Sworn to before the this
...d .dayofZ41- 1
Notary Public, County
J08EP11 P. VACCARO .
NOTARY PUBLIC, State of New York (Signature of applicant)
No. 52..4606480, Suffolk County
Term Expires/V/t
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BE 'ms? Nowi`a SUFFOLK -COUNTY. DEPT, OF HEA' T i
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