HomeMy WebLinkAbout19964-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20262 Date OCTOBER 3~ 1991
THIS CERTIFIES that the building. ADDITION
Location of Property 250 PARADISE POINT ROAD
House No. Street
County Tax Map No. 1000 Section 93 Block 1
Subdivision Filed Map No.
SOUTHOLD, N.Y.
Hamlet
Lot 5.2
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 17r 1991 pursuant to which
Building Permit No. 19964-Z dated JUNE 20, 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 DECK ADDITION AROUND INGROUND SWIMMING 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
Rev. 1/81
J. DOUGLAS & BUSAN BLI%E]N
I~-~ NO. ~
TOWN OF SOUTHOLD
BUILDING DE~ARTJ~ENT
TOWN HALl.
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED,)
N° 19964 Z
Permission is hereby granted to:
..~..~/~~. ........ ~_..~.~..~~
~z~.~...~~~~~ .......
,o .~~~..~?_~~ ....... ~~..~ .....
..~ ........ ~~..._~...~ ....................... ~ ...................................................................
at promises I~at~ at ....~.~~~ ........ ~~..~.~ ............
.............................................. .......................................................
c~ ,~ ~ ~o. ~ooo ~,o~ ......... ~ ..... ~ ...... Z ........... [o~ ~o ........ ~.g. .....
Building Insp~tor.
Rev. 6/30/80
Form No. 6
9 I
TOWN OF SOUTIIOLD
BUILDINC DEPARTNENT
TOWN ILALL
765-1802
?PLICATION FOR CERTIFICATE F OCCUPANCY
O~ r
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 instal, lation 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 C,~pliance from archiuect or engineer
responsible for the bui%ding.
6. Submi~ Planning Board Approval of COmpleted site plan requirements.
;. For existing buildings (prior to April 9 1957) nOn-conformzng uses, or buildings and
~ pre-exzstzng 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
1. Certificate of Occupancy - New dwelling $25.00:2Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swimming pool ~ 5.00, Accessory building $25.00,
Additions to accessory building $25.00. Businesses $50.00.
2.Certificate of Occupancy on Pre-existing Buildlng _ $100.0fl
3. Copy of Certificate of Occupancy - $5.00 OVer 5 years - $10.00
Updated Certificate of Occupancy _ $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date ~ ~
~ ur ~re-existzng Building. . . .
Ha mi e t
1wet or Owners of y.. .% ..
''' ' ..................... Filed Nnp ............ Loc ............
rmit No · ate Of Perml. t.. -.Applicant.~.
alth Dept Approval
' ' ........... Underwriters
...... ~ ...... Approval
Inning Board Approval ...... ..,.~
lues: for: Temporary Certificate ...........
~ Final Corticace ........
CO '~ ~OD~a APPLICANT -
FOUNDATION
(lst)
FOUNDATION (2nd)
ROUGH FRAME &
.PLUMBING
INSULATION PER N.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
't
m
(D
<
Fq
NOTIFY '~UILDING OEPARTMENT AT
7(~5~t~02 9 AM TO 4 PM FOR THE
FO LL{')"b,/JN G INSP,ECT~ONS;
1. FOUNDATION ~ TWO REOUIRED
FOP, POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3. INSULATION
A, FINAL CONSTRUCTION MUST
BE COMPLETE FOR C,O.
ALL CONSTRUCTION SHALL MEET
THF. REQUIREMENTS OF THE N.Y.
STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
DND~{ITERS CER~'IFI~I~£
.REQUIRED
FORM NO. 1
TOWN OF SOUTHOLD
BUILDINQ DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
~sapproved a/c .....................................
(l;LCCdiag I s~'ctor) ' ' '
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS "'
a. This application must be completely filled in by typewriter or in iak and submitted to tlie Building Inspector, with 3
s r~f 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
are~es, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appll-
¢. The work covered by this appllcation may not be cbmmenced before issuance of Building Permit.
d. Upon approval of this application, the Bt~ilding Inspector will issued a Building Permit to the applicant. Such permit
!l be kept on the premises available for inspection throughout the work.
e. No building sliall be occupied or used in ~vhole or in part for any purpose ~vhatever until a Certificate of Occupancy
11 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
lding Zone Ordinance of the Town of Southold, Suf£oU- County, New York, and other applicable Laws, Ordhaances or
:ulations, for the construction of bu;idings, additions or alterations, or for removal or demodtion, as herein described.
applicant agree~, to comply ~vith all applicable laws, ordinances, building code, housing code, and regtfiations, and to
'at authorized inspectors on premises and ha building for necessary inspections.
(Signature of applicaut,'or name, if a corporation)
· · , Z.7525~ CPUrt~y.~oS~.~.~8~ Cutcho~ue, NY 11935
(Mailing address of applicant)
:~ whether applicant is owner, lessee, agent, architect, engineer, general contractor, electric/au, plumber or builder.
.Agent
leofownerofpremises .R,.Dougl~.~¥~B and Susan L, Bliven
(as on the t~.t roll or latest deed)
· hcant Is a corporat on, s~gnature of duly authorized officer.
(N d titl f .... i .........
amc an e o corporate officer
· Builder's License No ...
Plumber's License No ........... : .............
Electrician's License No.
Other Trade's License No. 15033ItI.-,.-,Suf. f. cd.k .Qo.u.n.ty Contractos
ocation of land on which proposed work will be done.. P.a. ra. cl.i. se Point Road, Southold,
.... 2~P. Paradise Point Road Southold, NY 11971
ous¢ Number Street .............. · .........
Hamlet
runty Tax Map No. 1000 Section ...... 93 .......... Block .I 52
bdivision ..................................... Filed Map No.
(Name) .............. Lot ...............
lie existing use and OCcupancy of premises and intended use and occupancy of proposed construction:
Existing Use and occupancy Residentia~
Intended use and occupancy .... l~q,s.%d.e,g.t.Lml ...............
]. Nature of work (check which aPPlicable): New Building
Repaff o .......... Addition . · .\ltcra/mn ...
.............. Rem val .............. Demolition .......
Other Work..Deck£n.g.
4. Estimated Cost .~.~.O~..a--O 073 ......
· ,. (Description)
ng tn (to be paid on filing this applicatmn)
5. If dwelling, number of d',velli q it ....... Number of dwelling units on c:lch fhmr ......
rfg s
· arage, number of cars ..... ! .......... , .........
6. If business, commercial or mixed occupancy, specify..ature and extent of each type of use ...... ...
7. Dunenstons et existing structuresL if any: Front .............. Rear ............
He ~ t . " b .............. Depth ...............
nnenmons ozSame structure, wit alterations or additions: Front .............. ear..
Depth ...................
................ Nnmber
8. Dimensionsofentiren w o Strut o t ....... : ...... P. ear .... ' ........
Height .... ~ ..........
........... Numb? of Stories ........... Depth ..............
9. Size o£1ot: Front ......... ~ ...... Rent ....................
0. DateofPurchase ''' ' .... ''' · ........ ' ...... Depth
of .[7or/ncr O,.vner ............................
I. Zone or use district in Which nremlises ..... i,-. ~ '~ .... Name ......................
Docs proposed Constructmn violate any zoning law, ' ......
3., Will lot be re-radea ' ordinance or regulation: ..... ,: .... ,;; ...........
....... l~ii~ .......... Will excess fill be removed from premisea:
4. NnmeofOwnerofpremises . , "J; .... J.J.Address ..,qctttt,ko3Z .... P oneNo Yes ,, No
Name of Architect .... · .i ........... Address ................... Phone No.. ' '
Name ofCbntractor . l(en. 14-~ ller ............
3. Is thi~. property within 30~' 'f~¥t' ~'¢ ....... Address Cutcho. g.ue., . '
· If yes, Southol4 To~n Trustee Permit may be requirgfi: ..... No.~o~ .....
... ! PLOT DIAGRAM
Locate clearly and distinctly all b~ildlngs, .whet.her e. mstmg or proposed, and, indicate all s"~ ~-~'. -' i '
:operty lines. Give street and block number or ' ,.,,-~,,~,m. utm
descnptmn according to deed ana ~t, ......... enmons from
tenor or comer lot. , ~, o,,,,,v a~ruet names and Intimate whether
APPROVED AS NOTED
DATE: .~__ B;R # ......
FEE: __ " BY:
NOTIFY BUILDING DEPARTME~ 'T AT
766-1802 9 AM TO 4 PM FO~ THE
-fOLLOWING INSPECTIONS: i
1. FOUNDATION 1we REGOIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3. INSULATION J
4. FINAL CONSTRUCTION MUST
BE COMPLETE FOR C.O. j
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF TNEi N.Y.
STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE iFOR
DESIGN OR CONSTRUCTION ERRORS
.TE OF NEW YORK, t
NTy OF...S.u.f.fp.l~ ..... S,S
I g d y Sworn, deposes and says that he is the applicant
(Name of individual signing cmltract)
~ named.
[(Contractor agel~t ............................................
, , corporate officer, etc.) ....
d OWner or OWners, and is duly auth6rized to perfoml or have perfomled tile saki work and to make and file this
at/on; that all statements contained in[ this application are true to the best ofhls knowledge and belief; and that the
will be perfo~ed in the manner set forth in the application filed therewith.
to before me this '
' ' · unty
API~ROV~ AS NOTED . ,,~
FEE: . '"g BY:
NOTIFY~ DEP~ '
765~1802 9AMTO4PM~FORTHE
FOL.LOWtN(~ ~NSP~CTIONS: , .
1, FOUNDATION TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3. ~NSULAT~ON
4. FINAL CONSTRL~CTION MUST
t~E COMPLETE FOR C.Oo
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y.
STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
OCCUPANCY OR
USE IS UNLAWFUL
WITHOUT CERT~FICATE
OF OCCUPANCY.
INSPECTORS
Victor Lessard
Principal Building Inspector
Curtis Horton
Senior Building Inspector
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
August 14, 1991
SCOTT L. HARRIS, Supervisor
Southold Town Hall
P.O. Box 1179, 53095 Main Road
Southold, New York 11971
Fax (516) 765-1823
Telephone (516) 765-1800
K & L Enterprises, Inc.
17525 County Road 947
Cutchogue, N.Y. 11935
RE: R. DOUGLAS BLIVEN & WF
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
XX An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
XX The check is (eut~ated/not on file.)$25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT 9 19964-Z (DECK)
Please contact our office on this matter.
cooperation.
Thank you for
SOUTHOLD TOWN BUILDING DEPT.