HomeMy WebLinkAbout20939-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUP~J~CY
No Z-22665
Date OCTOBER 20~ 1993
THIS CERTIFIES that the buildin~
Location of Property 20075 ~IN ROAD
House No.
County Tax Map No. 1000 Section 17
Subdivision
ACCESSORY
Street
Block 3
Filed Map No.
ORIENT~ N.Y.
Hamlet
Lot 6.1
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 3, 1992 pursuant to which
Building Permit No. 20939-Z dated SEPTEMBER 3, 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 & FENCE AS APPLIED FOR.
The certificate is issued to
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HF~kLTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
THOMAS & URSULA MURRAY
N-291219 - OCTOBER ir 1993
Rev. 1/81
~o~,~ NO. ~
TO~N O~ $OUT~OLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
CrHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N~To. 20935Z
Permission is hereby granted to:
,o. ....o~. .. ~ .o~..~ ~. .......
at premises located at ...~..~:~...~....~.~...~.: ........ .~..~....,......~...'.~.: ...............................
Cou.w Tax Mop No. ~ooo Sectio. ...... .C>.1.~ ....... mock ....... ~.~ ...... Lot No....Le.:...~. ............
pursuant to application dat~ .... ~..~....~-- .......... , 19.~.~ and approv~ by the
Building Inspector.
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter OR ink and submitted to the buflding
inspector with the following: for new building or new use:
i. Final survey of ~roperty 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 ~sed 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.
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, Coramercial $15.00
Date .........................................
New Construction...........~ Old Or Pre-existing Building ............ .. ...
Location of Property ................................ . ·
House No. Street Hamlet
0nwer or Owners of Property ..... (~-~.~.~...~ ~ ~ ~A~ zTf~ ~
County Tax Map No 1000 Section ~] Block ~. TO~ ~o /
Subdivision ~ · Filed Map Lot
Permit No....~.?.~..~?..~....Date Of Permit .... ~./.~. /~ .Applicant.
Health Dept. Approval ...................... .... Underwriters Approval .........................
Planning Board Approval
Request for: Temporary Certificate ........... Final Certicate .... ..~.....
Fee Submitted: $ ~...~.. '
THE NEW YORK BOARD OF FIRE UNDERWRITERS
[~0129~ BUREAU OF ELECTRICITY
~'- 85 JOHN STREET, NEW YORK, NEW YORK 10038
Date OC~J~O~R (;) [ ~ ].993 Application No. onfile ~4 ~0B8~9 ~ / 9 ~t
THIS CERTIFIES THAT
only the electrical equipment as d~scrlbed below and introduced by the applicant named on the above application number in the premises of
in the following b,cation; [] Basement [] Ist Fi. [] 2nd ~7. Ot]T Section Block Lot
~s examined on ~ ~] I~ ~{~ ~R 16~I99~ and found to be in compliance with the National Electrlcal Code.
FIXTURE FIXTURES RANGES COOKINGDECK~ OVENS ~)ISH WASHERS EXHAUST FANS
SERVIC~ OISCONNECT NO. OF S E R V I C E
covers co~upliauce at the date of
iflSpection oily Because of u;lusua]
e~vlroumeuts it is advisable to
made t)~ a qualified
<<< Co~t, lnu.d on Page 2
GENEIIAL I~tNASER
Per
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY.FOR BUILDING DEPARTMENT THIS COPY OF CERTIFICATE MUST~OT~ ~E .... ALTERED~ IN ANY MANNER
THE NEW YORK BOARD OF FIRE UNDERWRITERS
[~)C,',)[ 290 BUREAU OF ELECTRICITY
~'- 85 JOHN STREET. NEW YORK, NEW YORK 10038
Date Of'dJ~()~[/ ~l~ [9~3 Application No. onfile ~8~e93/~3 ~ ~9:[?~9
THIS CERTIFIES THAT
o~y the e~ thee] equipment ~ ~scri~ below and int~uced by t~ applicant ~med on the a~e application number ~n the premiss of
Lot
FIXTURE
OUTLETS
IECEPTACLES
SWITCHES
FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS
DRYERS
SYSTEMS
NO. OF FEET
OTHER APPARATUS:
S R V I C
NO, OF CC. COND,
PER ~'
AWG
OF CC. COND
NO. O,; HI-tEG
OF HI-LEG
NO. OF NEUYRAI.$
A, WG
OF NEUTRAL
GENERAL MANAGER
Per
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
INSPECTORS
Victor Lessard
Principal Building Inspector
Curtis Horton
Senior Building I~pector
Thomas Fisher
Building Inspector
Gary Fish
Building Inspector
Vincent R. Wieczorek
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector
Telephone (516) 765-1802
OFFICE OF BUILDING INSPECTOR
TOWN OF SOUTHOLD
Sept. 9, 1993
SCOTT L. HARRIS, Super~iso~
Southold Town Hall
P.O. Box 1179, 53095 Main Road
Southold, New York 11971
Fax (516) 765-1823
Telephone (516) 765-1800
Mr. Thomas Murray
20075 Main Road
Box 2032
Orient, N.Y. 11957
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
An application for Certificate of Occupancy is
not on file. (Enclosed)
XX No Underwriters Certificate on file.
The check is on file. $25.00
No Health Department Approval on file.
No final inspection has been made.
No Pl~unber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT ~ 20939 Z (POOL & FENCE)
Please contact our office on this matter.
cooperation.
Thank you for
SOUTHOLD TOWN BUILDING DEPT.
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INS~.ATION
FRAMING [l/]' FINAL
DATE
INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
] FOUNDATION 2ND [ ]INSULATION
]FRAMING ~"AL
REMARKS:
/ ///'
INSPECTOR~..~
OUNDATION (1st)
OUNDATION (~nd)
!.
:OUGH FRAME &
-PLUMBING
iNSULATION PER N.
STATE ENERGY
CODE
Fi:;AL
Ye
ADDITIONA'L COMME~;TS:
, : FORM NO, 1
' i':: S.Ft0 -- 3 '"'>~ TOWN OF SOUTHOLD
~. ,,,, BUILDING DEPARTMENT
~ TOWN HALL
~ " SOUTHOLD, N.Y, 11971
)isapproved a/c .... . .............................. ./~ .
-- .. (Building Inspector)
APPLIC,&TION FOP, BUILDING PERMIT
gOARO OF HEALTIt .........
3 SETS OF PLA;{S ..........
SURVEY ...................
ClIECK ..........
HAIL TO:
Date ' 19
INSTRUCTIONS
a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
ts 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
' areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
tion.
c. The work covered by this application may no~ 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
all be'kept on the premises available for inspection throughout the w6rk.
e. No building shall be occupied or. used in whole or in part for any purpose whatever until a Certificate of Occupancy
all 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
dlding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
:gulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
~e applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
mit authorized inspectors on premises and in building for necessa.po inspections. /4, ,~
(Signature of at~pLicafit, or name, if a corporation)
(Mailing address of applicant) .
ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
~me of owner o f premises ....T~..g,g3.~...~C..X~ ,~. .... ~..~..~~..~.C4, ..........................
(as on the tax roil[Dr latest deed)
applicant is a cbrporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No ....
Plumber's License No .........................
Electrician's License Nb .......................
Other Trade's License No ......................
Location of land oh which proposed work will be'done, e,~ O ~) ~ !
................ ': .................
·
.................. ··
llouse Nmuber Street' l~i ...........
Co,,nty Tax Map No. ,000 Section ........ /.7.. Block3 Lot ./. ....
Subdivision
Filed Map No Lot '
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
'. Existing use and occupancy ...... .O.%-~t~.....~. 'At" .%~k. Vy., .~'-~....t~... ~
'. Intended use and occupancy ~..M~.\ .X'j%....'3'XA.\~.Q:.' .~..~. ~...
3. Nature orwork (check which a~plieable): New Building .......... Addition Alterati~'n ....
Repair ..... ~ ...... Removal .............. Demolition .... i' ~ih'e} Work ,' .....
$. If ' . ' i (to be paid on filing this application)
dwelling, number of dwelling! units
If garage, number of cars .... ~ ............... Number of dw lling unit,s on each floor.... .............
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ......
7. Dimensions et existing structur s, if any: F~-ont .............. '. Rear .............. Depth .............
Hight ~b fSt '
e ............... _.N?' u er o ones ...........
Di i f with dditi .............................................
mens oas o same structure alterations or a oas: Front
Depth 4 Height .......... ' .....
·· Rear ..................
8 .......................................... Number of Stories ...........
Dimensions of entire new const~ction': Front Rear
Height Nun~ber of Stories .............................. Depth ...............
Front ' '
9 Size orl;i: ............. ' .......................................................
10' Date of Purchase ........... i ........... Rear ...................... Depth ......................
· -, .... ' Name of Former Owner
I 1. Zone or use district in which pr~mises are situated ..........................
· Does proposed construction violate ~ ...........................
12 Will lot be regraded .... ' ..... ny zoning law, ordinance or regulation: ................ . ............
· ' i ............... Will excess fill be removed from prem scs ~ No
14. Name of Owner of premises ...~ .................. Address ................. Phone No .............
Name of Architect ....... i
15. Is this property x,,ithin ~00 feet of a tidal wetland.'? *Yes. '
Trustees Perrait may be required·
· 1'£ yes, Soul:hold ~own ....... No .........
PLOT DIAGRAM
Locate clearly and distinctly all [buildings, whether existing or proposed, and. indicate ail 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 comer lot.
STATE OF NEW YORK
COUNTY OF ' S.
.......... ' ....................................... being duly sworn, deposes and says that he is the a cant
(N ig t) ppli
amc of individuals nih contrac
:bore named·
{e is ihe ........................
' (Contractor agent corporate officer crc ) ...................
£ said owner or owners, and is duly a,uthonzed to perform or have performed thc said work had to make and file this
d in this application are trne to the best of his knowledge and belief; and that the
I Forth in the a, pplication filed therewith.
pplication; that all statements contain(
'ork will be performed Jn the mannersc
worn to before me this
~' r-q
50.9(
-- I_T-O.O
c) rm
> ~
THE NEW YORK BOARD OF FIRE UNDERWRITERS
[~0129~ BUREAU OF ELECTRICITY
~'- 85 JOHN STREET, NEW YORK, NEW YORK 10038
Date OC~J~O~R (;) [ ~ ].993 Application No. onfile ~4 ~0B8~9 ~ / 9 ~t
THIS CERTIFIES THAT
only the electrical equipment as d~scrlbed below and introduced by the applicant named on the above application number in the premises of
in the following b,cation; [] Basement [] Ist Fi. [] 2nd ~7. Ot]T Section Block Lot
~s examined on ~ ~] I~ ~{~ ~R 16~I99~ and found to be in compliance with the National Electrlcal Code.
FIXTURE FIXTURES RANGES COOKINGDECK~ OVENS ~)ISH WASHERS EXHAUST FANS
SERVIC~ OISCONNECT NO. OF S E R V I C E
covers co~upliauce at the date of
iflSpection oily Because of u;lusua]
e~vlroumeuts it is advisable to
made t)~ a qualified
<<< Co~t, lnu.d on Page 2
GENEIIAL I~tNASER
Per
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY.FOR BUILDING DEPARTMENT THIS COPY OF CERTIFICATE MUST~OT~ ~E .... ALTERED~ IN ANY MANNER
THE NEW YORK BOARD OF FIRE UNDERWRITERS
[~)C,',)[ 290 BUREAU OF ELECTRICITY
~'- 85 JOHN STREET. NEW YORK, NEW YORK 10038
Date Of'dJ~()~[/ ~l~ [9~3 Application No. onfile ~8~e93/~3 ~ ~9:[?~9
THIS CERTIFIES THAT
o~y the e~ thee] equipment ~ ~scri~ below and int~uced by t~ applicant ~med on the a~e application number ~n the premiss of
Lot
FIXTURE
OUTLETS
IECEPTACLES
SWITCHES
FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS
DRYERS
SYSTEMS
NO. OF FEET
OTHER APPARATUS:
S R V I C
NO, OF CC. COND,
PER ~'
AWG
OF CC. COND
NO. O,; HI-tEG
OF HI-LEG
NO. OF NEUYRAI.$
A, WG
OF NEUTRAL
GENERAL MANAGER
Per
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.