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HomeMy WebLinkAbout20881-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22298 Date MAY 3~ 1993 THIS CERTIFIES that the building. INGROUND POOL WITH FENCE Location of Property WINTHROP ROAD~ FISHERS ISLAND~ NY House No. Street Hamlet County Tax Map No. 1000 Section 9 Block 10 Lot 4 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated O-JLY 9, I992 pursuant to which Building Permit No. 2088t-Z dated AUGUST 10r 1992 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 AS APPLIED FOR. The certificate is issued to DAVID S. KETNER & WF (owners) of the aforesaid building. SUFFOLK COUNTY DEPANTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. N 251871 PLUMBERS CERTIFICATION DATED N/A SEPTEMBER 28r 1992 Building Inspector~ Rev. 1/81 FO~M NO. ~ T(YWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, H. Y. BUILDING PERMIT ('FHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No-N°, 20881Z Dot, ....~ ......... /....~. ........... , ~..~..,Y-.,~ Permission is hereby granted to: r~ , ..... ~~...../.~4.~.~. ' ..... ~4...~~ ....... ~. ........... ================================================================ County Tox Map No. 1000 Section ....... :..~.. ........... Block .... L~.- .......... Lot No ....... ...~.. ............ pu~uon, ,o op~',co,io, do,~ ........... ....~. ........ ~...7--.... ''..~o,d o~rov~ b, ~e Building Inspector. Building Inspector R~¥. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 B~PLICATION 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 qpre-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 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 $15.00 · .. Old Or Pre-existingD~g~ New Construction ........ 1 Locati~n of Property .......................... ~/.~. ~?/.~..~..~.. ~ ...... House No. Street Hamlet o~= o= o~=$ of ~o~ ..... ~.~....'.... ............................... . .. .. ... . . ... ... ... · Subdivision Filed Map Lot .. . Permit No.~.~ll.Date Of Permit.~.f~.XpplicanJ~.-~i Health Dept. Approval ..... ~ .................... Underwriters ApprovalS.! Planning Board Approval ...................... .. Request for: Temporary Certificate ........... Final Certicate.~... ............ ................... ?OU~DA~ION (1at) ?OU?~DATIO:; . (.2 n__d ) _~. IOUGH FRAME & -PLUMBING [~;SULATIO~ PER N. STATE E~ERGY CODE FI;;AL RDDITIO~;A'L COMME~;TS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ................ , 19... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF REALT~{ ........ 3 SETS OF PL.,NS SURVEY CllECK ................... SEPTIC FORH CALL HAIL TO: Date .... 7~/q !9¢~. a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with ~ 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 street, or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli cation. ¢. 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 permi~ 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 pursuarlt to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances m 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 i.n~pection~. / ,5 _ ' ,/7 ~ _ --' (Signa~re of ~pplicant, or name, if a corporation) (Mailing address of apl~cant) ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... : .'.'~f.~...~.77....~....'~..4 ./.Z:'..~.~..~7..T.~... i~'~"~./.'"~..t~'..~ .................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ......... ......... ...... e and title O~'corporate o me~) Plumber's License No ......................... Electrisian's License No ....................... Other Trade's License No ...................... Location of !and on which proposed work wm':" be done .................................... .... ...... .... lIouse Number Street I-lamle t Cotmty Tax Map No. 1000 Section ....... ~. .......... Block..././-~. ........... Lot... ~ ............. 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 ............................................... .T/,ec., d/.Off. . . :'......'. b. Intended use and occupancy .......................................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ......... Repair .............. Removal .............. Demolition .............. Other Work.. ~ ......... ....... (to be paid on filing this apthication) 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 nature and extent of each type of use -- 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth .............. Height ............... Number of Stories ....................................................... Diraensions of same structure with alterations or additions: Front ................. Rear ................. Depth Height Number of Stories 8. Dimensions of entire new construction: Front ............ ~Rear .............. D pth ............. Height ............... Number of Stories ........... ~.~2C. ~.& :...~.')j~?~2/f/ef~. f..~. '..~. ........ 9. Size of lot: Front .,,.,...,~,,..:..,...... R ...................... Depth ..................... 10. Date of Pnrchase ""'zr~.e":"".".-ear ..... Name of Former Owner ...,~.~/.'~. tOf..~/~..-iq, ....... 1 I. Zone or use district in which premises are situated ..... .,~..&-'.,-5'/~..~/,:J~. Z, .............................. 12, Does proposed construction violate ~ny zoning law, ordinance or regulation: ... ,8/t:~ ........................ 13. W~.II lot be regraded ............................ Will exce~s Ifil be removea from premises: Yea Nc i4. Name of Owner of premises . .,~.~..-ff-/~/~./it ....... Address ~O~..t~.~.P...80..~.15t~.R..,.5. Phone No. ~., Name of Architect ........................... Address ............. ff.../~¢P, hone No. , Name of Contractor .~../4N.,gi//~.~/~0~.~/.N.6... , Address ,470~..'~'Y:~ d~' .. Phon.eI)lo.,,~..~g: .0.7'~1,. 15. Is this property within 300 feet of 'a 't'i'd'~i wetland?' ''*~'e's.'.'..'.'.'.. ~o...~. .... *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing 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 coruer lot. STATE OF NEVi YO RK,---~ county or..~.. ~, s.s .......... ,... ~P~A:9~'/ ./-r(4ZS.M~r'/~. ........... being duly sworn, deposes and says that he is the applicant (Name of i~dividual sigrtlng contract) ~bove named. Ie i, the ................ ';tl '> ............................ ~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 york will be performed in the manner set forth in the application filed therewith.