HomeMy WebLinkAbout20007-zFORM NO. 4'
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20167
Date AUGUST 26~ i991
THIS CERTIFIES that the building
Location of Property 1620 GRAND AVENUE
House No.
County Tax Map No. 1000 Section 107
Subdivision
ACCESSORY
MATTITUCK, N.Y.
Street Hamlet
Block 3 Lot 9.2
Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 7, 1991 pursuant to which
Building Permit No. 20007-Z dated JULY 9, 1991..
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 INGROUND SWIMMING POOL & FENCE 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
Rev. 1/81
GEORGE & ADRIANA ROHRBACH
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)
N-o 20007 z
Permission is hereby granted to: ,.__, /'~
..~.~..~.~....-' o, ~ .................................. ~ ............
............ ..................
at premises I~at~ at ..~ .................. ~~....~ .......... ~.l.d.~~ .................
Cou.ty Tox Mop No. 7000 Section .... I...0..~. ........ e o~k ..~ .~ ..... Lot No .Cl...:.~...: ....
//
Building Inspector.
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN I~LL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
1. 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:
i. Final survey of prqperty 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 archiuect or engineer
responsible for the buf. lding.
6. Submi~ 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.
'. 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 Build,n§ - $100.00
Copy of ~ertificate of Occupancy - $5.00 over 5 years - $[0.00
4.Updated Certificate of Occupancy - $50.00
5.Temporary Certificate of Occupancy - ~esidential $~5.00, Commercial $15.00
ew ~onstruction ......... Old Or Pre-existin~g B~ilding .........
House No. Street Hamlet ' '
'~wer or Owners of Property.. ..
~unty Tax Map No 1000, Section..~..~. .... Dlock ..... ~. .......... Lot....~..~.~/ ..............
~bdivtsion ................................. Filed Map ..................................
· ' ' Lot
............. Date Of Permit ...... ~.Applicant
alth Dept Approval
· ' ........................ Underwriters Approval ........................
anning Board Approval ........................
'quest for: Temporary Certificate ........... Final Cnrticate ...... ·
~O~Of~7 APPLICANT
I
THE NEW YORK BOARD OF FIRE 'UNDERWRITERS i
I O01 '~f¢ 1
BUREAU OF ELECTRICITY~
JOHN ~TREET, NEW YORK, N~W YORK 10038
Date Applleatlon No. on file
THI~ CERTIFIES THAT
only the electrical equipment ~ ~scribed be~w a~ int~duced by the applicant ~med on the a~e application number in the premises of
[] Ist FI. [] 2nd FI. ' .... Section Block Lot
and fou, d to be in co, pi ante with the requirements of this Board.
FIXTURE FIXTURES RANGES .'OOKING DECKS EXHAUST FANS
OUTLETS SWITCHES FLUORESCENT OTHER
DRYERS
SYSTEMS
E R V I
NO 05 CC. COND
PER ~
OF CC, COND,
C
AWG,
OF HI-LEG
NO OF NEUTRALS
AWG.
OF NEUTRAL
OTHER APPARATUS:
eove~ comp]iai)ce at. the date
GENERAL MANAGER
Per~ :t ~-q
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspecfors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFIC, A~E MUST NOT ~E A~TERED IN ANY MANNER.
IIDATE
FOUNDATION -- ( ~ s_t)
COMM£NTg
FOUNDATION ( 2nd )
2.
ROUGH FRAME &
-PLUMBING
INSULATION PER N.
STATE ENERGY
CODE
FINAL
ADDITIONA'L coMMENTS:
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION ZND [ ] INSULATION
FRAMING [,~FINAL
REMARKS:
DATE
INSPECTOR
# = MONUMENT
.,' YOUNG & YOUNG
, 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK
SURVEY FOR: N[W ~
GEORGE ROHRBACH
at MATTITUCK
'row. o,. souTH. O/D
1 SUFFOI.K CO., N, Y,
BOARD OF HEALTH ......
3 SETS OF PLANS ..... ..
FORM NO. 1 SURVEY ..........
TOW~ OF SOUTHOLD CHECK ..........
BUIL'D, ING DEPARTMENT SEPTIC FORM .............
TOWN HALL
SOUTHOLD, N.Y. 11971
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
NOTIFY
CALL ................
MAlL TO:
a. Tiffs application must be completely filled in by typewriter orin ink and submitted to the Building h~'spect~r, 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-
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 Buildi'ng 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
Regdlations, 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 insj~ections.
..... 14.:._g.t-:7. c..c: t....?-k .~.~. Y~.....-~...q: ........
(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.
Name of owner of premises ...... ~:f--0 ~1~ ~-.~ ..... .~...~..~.~./-~.~ ......................................
(as on the tax roll or latest deed)
.... >" ' ~;e' ~ '~iJ/~ ..............
(* e and title of corpora(t/eVol'ficer) .
ALL CONTRACTOR'S MUS'~B,,E SU,F. FO_.9~K COUNTY LICENSED
Builder's License No ..... ¢~./r,'7./;t',~ .........
Plumb-r's License No
Electrician's License No .......................
Other Tradc's License No
Location of land on which proposed work will be done~ ............ y ............ .o.~
/.( .o7..o c e . .' ............
..................... ~?.., .......... .~.Z-...~ ..... .- .....
House Number Street Hamlet ''
County Tax Map No. 1000 Section ...... /.?.7. .... ................ Block . 3... 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 ~ g.g.~/.~..ff~. ~. {..~. W~.~D .~3~f~l~d~~
occ.paney .................. ~.~x,l~,~..9. ~ ............
b. Intended use and occupancy ......... / / .
3. Nature of work (check which applicable): New Building ' Addition Alteration
Repair Removal .......... ' ......... ' .........
............ - ............. Demolition Other V, ork
4. Estimated Cost .......... 7..~,~.. ~r.~o (Descrip,tion)
i · (to be paid on filing this application)
S. If dwelling, number of dwe/ling ~nits ............... 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 structure~ if any: FrOnt ..................
Rear Depth
· Height Num '~er .......................... ~" .............
of Stories
Dimensions of same structure wiil~ alterations or additions: Front Rear
Depth ~ Height ...................................
8 ............................................ Number of Stories ......................
· Dimensions of e,ntire new constrUction: Front ' Rear
.............................. Depth ...............
0 Date of Purchase ' ' '
· . ............................ Name of Former Owner ...........................
I Zo or use district in hi hp rni re sit d
· ne w c re sesa uate ..., ....................................
. oe ropose construct,on vlo a e an on n aw, or lnance or regulation: .............
3 Will lot be regradcd ..............
4. Name of Owner of. pre i~s' -i ................. Will excess fill be removed from premises: (~ No
·, . t¢..~.q ..... Address ................... Phone No ................
Name of Architect ..... ~ ..... : ................ Address ................... Phone No.... .
5. p perry ±ocate~ ~zthxn 300 feet of a tidal wetland? *Yes ..... ~ .... .~
· If yes, Southold Town True!tees Permit raav be required. ..
." i PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from
roperty lines. Give street and block n~mber or description according to deed, and show street names and indicate whether
~terior or comer lot.
, ATE OF NE~:, ~R~,~ .... S.S
31/NTY OF.. o5 .eL ./.-~.L~...(...
... ............
(Name of indMdual signing contract)
: is the .......
: (Contractor, agent, corporate officer, etc.)
said owner or owners, and is duly ~uthorizcd to perform or have performed the said work and to make and file tkis
alication: that all statements contained in this application are true to the best of iris knowledge and belief; and that the
)rk will be performed in the manner sft forth in the application filed therewith.
.om to before me this
~l'~ i. SU"O#{ ~-.0~_ 2~''~ {'Si~n:l~rj~g £ ~pplican t)
being duly. sworn, deposes and says that he is the applicant .