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HomeMy WebLinkAbout21574-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. ~RTIFICATE OF OCCUPANCY No Z-23169 Date AUGUST 17~ 1994 THIS CERTIFIES that the buildin~ Location of Property 210 GLENWOOD ROAD House NO. County Tax Map No. 1000 Section 110 Subdivision ACCESSORY cuTCHOGUE ~ NY Street Hamlet Block 6 Filed Map No. Lot 4 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JOLy 26~ 1993 pursuant to which Building Permit No. 21574-Z dated AUGUST 4, 1993 was issued, and conforms to &ll of the requirement~ of the applicable provisions of the law. The occupancy for which this certificate is issued is AN ABO~E GROUND POOL WITH FENCE ENCLOSURE AS APPLIED FOR. The certificate is issued to of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. N280542 PLUMBERS CERTIFICATION DATED Rev. 1/81 JON LAKE (owner) N/A JDNE 22r 1993 N/A ilding fnspect/ FORM NO.$ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HAU. SOUTHOLD, N.Y. No BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date, ~. ,//~., ................................................. 21574 Z --/~ CounlyTax Map No. 1000 Section ..../.',~....~. ............ Block .......... .~'. .......... Lot No ..........~ ............ pursuant to application dated .......................................................... 19 ................ and approved by the Building Inspector, Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOI~N tb%LL 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: 1o 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. 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 res:dences 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 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. 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-existinR 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 Buildiog ...... Location of Pr°petty' '~' '/' '~'House .... No.~' ' '/'~'~' ' ' '~'~'~' ' ' '~'Street ................ ~" ~]~" '~'~'~' ~'-- 0nwer or Owners of Property....~--.~.....~.~-~...... .......................... ...... . · . County Tax Map No 1000, Section.../../..~. ..... Block ....... ~. ...... Lot ....... .~. ............ Subdivision ................... .. .. .. . .......... Filed Map..~.~. ~...Lot.. ..[[[~ . .. . ermit Of .............. ~lealth Dept. Approval........ ......... .. . ... ... Undor~riters ^pproval ................. ~lanning Board Approval ........................ {equest for: Te~rary Certificate. . . Final Certicate ........ ?ee Submitted: ...................... · · - THE NEW YORK BOARD OF FIRE UNDERWRITERS '[1~00~J43 BUREAU OF ELECTRICFTY ~'- 85 JOHN STREET. NEW 'YORK. NEW YORK 10038 ~ JUS~ 22,~993 ~pplicarlonNo. onfile 0~6~e193/93 ~ 28e542 THIS CE~IFIES THAT w examin~ on ~ UN~ [ 7 ~ ~ ~ ~ ~ and found to be in compllan~ wlth the ~qulre:t~ents of this floard. THE NEW YORK BOARD OF FIRE UNDERWRITERS [OOO3d~3 BUREAU OF ELECTRICITY ~'~ 85 JOHN STREET. NEW YORK. NEW YORK 10038 D=t,~ 3UN~ 22,1993 ~pplicution~o. on/ile ~463~193/93 N 28~547 THIS CE~IFIES THAT ~ t~ e~t~ ~u~meAt ~ ~ ~Mw a~ i~fM~M b~ fb ~t ;0S ~AKB~ 2ND H0~S; 0g RZG~ GGBg~OOD R0., CUTC;0GUE, int~/ol~ifl~l~a~ion; ~ ~nt ~ I.tFI. ~ ~ ~. OUT .~ftion ~examln~on ~U~g t7,~993 andfoundtobedncompl4aneewi~hthe~qud~me~t~ofthdsB~rd. RXTUI~ L..,,EpT I T I FIXTURES I RANGES O~lSTS ACtlS SWI Ct,lES i~NCAHD~SCENT FLUQIESCENT OTHER A~T. lC. ~. COOKINGDlCKS OVENS DISHWASHERS EXHAUST FANS~I-~) A/,4T. ,.w. I A~,. ,c.w. AMT. I K.W. I A~*. ,,--'~ ,,,,.,~K,J .,. ~,,,~,,~,,,,} ,),,,,,,,ss ~ A~T. A/~S. TRANS. N~T~ FI~T .*. { WA,TS ~ V I C E SilVlCl DISCONNICT NO. Of ,I SWIMMING POOL-1 G.F.C,I-1 '(IWI#MI}G POOL) ?his certificate covets compliance at the date of inspection only. ~ecnuse of unusual ~vitonlents it is advisable to have frequent test/and o~ repairs made by a qualified ((( Continued on Page i certificme must not be altered in any manner; return to the office of the Board if incorrect, inspectors may be identified by their credentials. -This · ER. ~,'J. ELD -' """ .... ' FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & .FLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] ~=OUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [/~NAL DAT~: BUILDING DEPT. INSPECTION FOUNDATION &~T [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSU~N FRAIIMIIIG [~L BUILDING DEPT. INSPECTION []FOUNDATION ~ST [ ] ROUGH PLBG. [.! FOUNDATION ZND [ []~ ~]'~FINAL ~.- FORM NO. 1 TOWN OF SOUTHOLD ~,~r= ~-- r~.: .' ~ ...... !BUILDING DEPARTMENT LJ~ SOUTHOLD, N.Y. 11971 fi I JUL 2 6 1993 TEL.: 765-1S03 DL~a v · ppro eda/c ..................................... . (Buildja~ Inspg~tor) APPLICATION FOR BUILDING PERMIT ROARD OF' HEALTB ......... ' CIIECK .................... SEPTIC FOR,ti .............. 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- t 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, edditiox~s or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing cod~e~ and~t~gulations, and to admit authorized inspectors on premises and.in b~ilding for necessary i~ ~ -- - .(~[gdature of applicant, or name, if a corporation) · . ' (Mailing address of applican~l~//~7.fff-~ State whether applicant is-o~er, lessee, 'agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .................................................... (as on the tax roll or latest d If applicant is a corporation, signature of duly 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... .................... I. Location of land on w~hic]}.jproposed work ~ be 'do:~l~ ................ ~ ....... : ................ ..... .... ............. . House Number . . Street . · Ha~tet 'County Tax Map No. I'000 Section ....*. ~. '~..~. ....... Block ' .. ~. ..... ' Lot.. '..~. ............ Subdivision ......... ........................ ' Filed Map NO ..... ~..'-ff. ~... Lot .... ,-ff....: ..... (Name) 2: State existing use and oceupanc¥ of premises and intended use and oCCUpancy of proposed constmction~ a' ~nXi~2~;uSe and °cc~anc~ .... ' ..~ .....~..,~' ~ , -3. Nature of work (ch~ck which applicable): New Building ' · ..... Addition .......... Alteratio~ ...~... ~.. Repair Removal Demolition . Other Work · /..~.'.' ..... ~ f (Description) 4. Estimated Cost ~,~.O.~D C~'. Fee , .. ......... (to be paid on f'dinl~}bis application) ~ $. If dwelling, number of dwelling units ., .. Number Of dwelling units on each fl,9~?e-,.~..-..... · .. If garage, nh'tuber of cars ....... , ' ' · 6. If business, commercial or m~xed O~upancy, specify nature and extent of each type of use ..... ; ............... 7. Dim~nsionsofexistingstructures, ifany: Front...' ........ · ... Rear .,..,......... Dept~-. ...... Height Number of Stories ' Dimensions of shine structure with alterations or additions: Front Rear .......... Depth ' Height Number of Stories 8. Dimensions of entire new construction: Front ......... .... · ; Rear ............... Depth ........... . .. .Height ............... Number of Stories ......................... . ....... , .......... ~;'. ....... 9 Si of lot: Front ' Rear :'. Depth ' 10. Date of Purchase .................... · ........ .. Name of Former Owner ............................ 11 Zone or use district in which premises are situated ' 12. Ooe~ pt~lsosed construction violate any zoning law, ordinance or regulation: .............................. '13. Will lot be regraded ..... ,~. 47_. .............. ~',, Will exco~,t'lll be removmi f!;~premises: ~Ye,' ~o 14. Name 0f Owner of premises . .~ ~.~./...... ~,~.,.~./,.~. Ada~ ff/~,~'.. ~t./'.,¢~,~.., ,~/P~one No,~'. ~.. L,4'~. :~'..~.· Name of Architect ' Address Phone No Name of Contractor Address Phone No ' 1~.' IS this property ~ithin 300 feet of a tidal '~etland? *Yes ........ No ......... · 1£ yes,' Southold To~ Trustees Pet'~l.t may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, Whether existing or proposed, and, indicate all set4~ack dimensionS from~ property lines. Giv~ street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ]. 7~;,'180~ 9, AM TO 4 PM FOR THE . / -- i~OR POURED CONCRETE /~2. ROUGH , FRAMING & PLUMBING · /'"/~ ~-~ ~,.~ [3. INSULATION ' · ~ 4. FINAL . CONSTRUCTION MUST' ~ FiE COMPLETE FOR ;' ~ ALL CONSTRUCTION SHALL MEET ~ THE REQUIREMEN"rs OF THE N.'~ . I STATE CONSTRUCTION & ENERGY STATE OF' NE'~ ¥O~E, COUNTY OF' .,~,~.g.~crp./~.:. .'S.S CODES, NOT RESPONSIBLF. ~;OR ' ...... DE,~ OR CONSTRUCTION Et~ROR$ ........................................ - ......... b~ing ituly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. 'L. a 9.a. " He is the -,-~.0 ~ . (Coniractor, agent, corporate, officer, etc.) of said owner or owners, and is, dul~.~uthorized to perform or have performed the said work and to make and file this application; that all statements cont, aincd ~n this application are true tO Ilxe best of his knowledge and belief; and that the work will be perf~aed in the manner set forth in the application filed th~lewith. Sworn to before me this ..... ! ..... - .da, o,....-J.. N....' '.. ~0~lic, stal, of N., ~o~ ' .. . .......... ~:...