HomeMy WebLinkAbout21416-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22369 Date JUNE 2~ 1993
THIS CERTIFIES that the building ACCESSORY
Location of Property 155 WOODCLIFF DRIVE
House No. Street
County Tax Map No. 1000 Section 107 Block 7
Subdivision Filed Map No.
MATTITUCKr N.Y.
Hamlet
Lot 27
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 12, 1993 pursuant to which
Building Permit No. 21416-Z dated MAY 19~ 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 ABOVE GROUND SWIFR4ING POOL 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
MICHAEL T. & LINDA J. BURKE
PENDING - JUNE id 1993
Rev. 1/81
/~ildi~g Inspector
FOR,H NO. ,s
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N?.N? 21415Z
Date ~"'-'-/
Permission is hereby granted to:
............................................ ~ .......... ~....: ...........
....... z~.,~,~ ...... ~..../.l~.:...~..
/. . ./..~. ~ ........ ~. ./... ........ ~ ~ . ... .:~.:... :: :'./.~: ~ ...... .~ ....... ~<./.. .~,. . '.-..~ .......
........ ~.. .......... d: ............................................. ~ ...........................................................................
e remfses locate at .~...~.....~.......~..~..,~ .~.~!/~' ~. ~' . ...
tp ' d ................................ .q. ~ ..........................................................................
..................................... ..~.../~....~.. c_/~_ . ......~..:./_...~.
............................................................ ~.~.~:~..) ........................................................................
/
County Tox Mop No. 1000 Section ..... /,~..Z .......Block ......... ~ ....... Lot No ........~..,Z. .......
pursuant to application dated ............................................ ..,~../../.~-... , 19..~..-'~...., and approved by the
Build~ng Inspector.
Rev. 6/30/80
Form No. 6
TOWN OF SOU~HOLD
BUILDING DEPARTMENT
TOWN ~L4LL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY .
This application must be fi&led 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 ali buildings, property lines,'
'streets, and unusual natural or topographic features.
2. ~ Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 f~rm).
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-~onforming uses, or buildings and
'-'pre-existing" land uses:
i. 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 t9 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 - $i0.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date ....~...~..~.../. ~.../f ~ .~. .................
New Construction ........... Old Or Pre-existing Building .......
Location of Property ..... . .. ....
House No. ~ Street Hamlet
.. .
Onwer or Owners of Property /.,'. ............... ~.:.. ./~.f .....
0 ............. 9..Q ............
County Tax Map No 1000, Section../....~. ...... Block.. ~?'
Subdivision .................................... Filed Map ............ Lot ......................
Permit No ................ Date Of Perait ................ Applicant ......... ;. .
Health Dept. Approval .......................... Underwriters Approval .........................
Planning Board Approval. ......
lequest for: Temporary Certificate ........... Final Certicate..../.. .....
' ...............
THE NEW YORK BOARD OF FIRE UNDERWRITERS
[00 ~, ,3 ~ ! BUREAU OF ELECTRICITY
~- 85 JOHN STREET. NEW YORK. NEW YORK 10038
Date
THIS CERTIFIES THAT
o~y the elec trical ~ulpmen~ ~ ~scrlb~ be~w a~ intr~uced by t~ applicant ~med on ~he a~e application ~umber ~n the prem~es of
in the~otlow~n~ lacation; ~ aasement ~ Ist FI. ~ 2nd ~7. O[l~ Section Bilk Lot
~s examined on ~ II ~1 ~ ~ 1. ~ ]~ 9 9 ~ and found to be in compliance with the Na~onal Elect~cal Code.
SERVICE DISCONNECT [ NO. OF I S E
. . METER, NO. ~ . ,
RANGES
SPECIAL KEC'PT
R
COOKING DECKS OVENS DISH WASHERS
TIME CLOCKS B~LL UNIT HEATERS MULTI-OUTLET
mT. AMPS TRANS.~ NSo.YSoTFEMFE~,
V I C
EXHAUST FANS
DIMMERS
A.W G
OF NEUTRAL
GENERAL MANAGER
This certificate must not be altered in any manner; return to the office of the Board if incorrect, inspectors may be identifiec~ by their credentials.
COPY F~OR BUILDING DEPARTMENT THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
THE NEW YORK BOARD OF FIRE UNDERWRITERS
[ ~ 0 '1 3 t5 !~ BUREAU OF ELECTRICITY
-- 85 JOHN STREET, NEW YORK. NEW YORK 10038
THIS CE~IFIES THAT
in the followin~ location~ ~ U~s~n*
~s examined on '~ [~ ~ k~ (~[t~99~ and found to be in compliance with the Na~onal Elect~c~ Code.
FIXTURE FIXTURES RANGES C~KINGDECKS OVENS DISH WASHERS EXHAUST
~'I~flH(; POOl, ~,I
covel:~ cot~pl, iauee at the da:,a
have [:t'equent t.e~lL/imd ot
COPY FOR BUILDING DEPARTMENT THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER,
7G5-~,802
BUILDING DEPT.
INSPECTION
FOUNDATION IST [ ] ROUGH PLBG.
FOUNDATION ZND [ ] I/I~ULATION
FRAMING [/] FINAL
DATE
INSPECTOR
'OUNDATIO|I (2nd)
~UGH FRAME &
-PLUMBING
.~SULATIO:! PER N.
.STATE E};ERGY
CODE
FI~;AL
ADDITIONA~L COMME~TS:
IO0,O
' MAY12 1993
Exam,ned...Y/../.7. ...... ,1,
Approved . . .O-~¢~. ...... , 19~
Disapproved a/c ..............
FORM NO. 1
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
·
Pc;mit
B~ARD OF HEALTH
3 SETS OF PLANS
$IJgv£Y
CIIECK .......
CALl. .. '. ·;..
HAIL TO:
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
'~ a. This apt~lication 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 olf lot and of buildings on premises, relationship to adjoining premises or public st?eets
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. _T. he work covered by this application may nt~t 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 y the Bufldzpg 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, ordinance, s,---building code, housing cod.~a and regulations, and to
admit authorized inspectors on premises and in building for neq~S'~ry'il~tigrm.
' -- ' ' - (Signature of applicant, or name, if a corporation) ' '
State whether applicant is owner, l~ssee, 'agent, architect, engineer, generai contractor, electrician, plumber or builder.
No'ne of owner of premises . . . .~ ............. ~ ....................
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
; (Name and title of corporate officer)
Builder's License No ..... , .
Plumber s L cense No ........ : .................
Electrician's License No '
Other Trade's License No ..... . ................
1 bocati?n of land on which proposed work win be done.. , .................. /~.'/.
House Number , Street Hamlet
Subdivision ........ , ......... : ................... '. Filed Map No ............... Lot ...............
(Name)
Stat~ existing use and occupancy o£ premises and intended use and occupancy of proposed constructioni
a. Existing use and occupancy .. i: "' ' '/j-
b. Intended use and occupancy . ~ .........
· 3. Nature of work (check which apPlicable): New Building .......... Addition .......... Alteration .... ; ....
Repair .............. Removal .............. Demolition .... : ......... Other Work ...............
4. Estimated Cost ........ Fee .....
(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 .................... ' ................
Ifb ...............................................
6. usiness, commercial or mixed occupancy, specify nature and extent of.each type of use ............
7 mens OhS of existing structures, any: Front ............... Rear .............. De .
ight N b fSt ' . pth . ..
He ............... um er o ories ......... ' .........
Di h ith ti ...................................
mensions of s me structure w altera ons or additions: Front
Depth ..' ......... Hight .................. Rear .....
8 Di f ' '
............ e ............... ,.. Number of Stories ............. . ........
· H mensions o entire new construction: Front ............... Rear ........... De
eight ............... Number of Stories ............. · ·.. pth ..... ...........
9 Si ~ ............................................
· ze of lot: Fro ~t ......... , ........ ' ·. Rear .................. De .....
D of P .... pth
I 0 ate urchase ........................ Name of Former Owner .....................
1 Z di hi h p .....
I one or use strict in w c remises are situated ...................................
12. Does proposed construction violate any zoning law, or nance or regulation: ............
Will 16t b ...................
I~' N f ;regraded ..; ...... ; .................... Will excess fill be removed from premises: Yes Nd.
· Name of Awner of premises .................... Address ................... Phone No ............ :.. !4'
Name o rchit¢ct ........................... Address ................... Phone No .............
amc of Contractor .................... Add . .. ' '' .
.. ...... ress ................ Phone No.. .
15 Is this proper within 300 feet of a tidal wetland? *Yes ........ No..
·If yes, Southold Town Trustees Permit may be required.
... PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether ex}sting or proposed, and. indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot. ~'~/,~-~,d) ~TE,',g/d ~.fl
STATE OF NEW YORIC~
zOUNTY OF... .....
..... ~(..~7 ..~, ~.....~-.../.~..~ .~_.. .... being duly sworn, deposes and says that he i~ the applicant
(Name of individual signing contract)
~bove named.
(Contractor agent corporate officer etc) ' '
f said owner or owners, and is duly authorized 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
,ork will be performed in the manner set forth in the application filed therewith.
worn to before me this
~OTAR¥ PUBIJg, State of I~.Y. , ' ' (Signature of applicant)
IVO. 4725089/_~uffo~k Cou~f, ' , .
. Term Exl~r~alr $1,19.~ ....