HomeMy WebLinkAbout19800-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20449 Date JANUARY 6, 1992
THIS CERTIFIES that the building POOL FENCE, DECK
Location of Property 400 GREENHILL LANE GREENPORT NY
House No. Street Hamlet
County Tax Map No. 1000 Section 33 Block 3 Lot 11
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 19, 1991 pursuant to which
Building Permit No. 19800-Z dated APRIL 23 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 i5 INGROUND POOL SPA, FENCING AND DECK AS APPLIED FOR.
The certificate is issued to PAUL DALECKI & ANOTHER
owners
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N 189910 JUNE 5, 1991
PLUMBERS CERTIFICATION DATED N/A
v~
uilding Inspector
Rev. 1/81
roast xo. s
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°- 19 8 0 0 Z Date ~~1.......~ 19.91..
Permission is hereby gmnted to:
S a~-aQ~-....~1...~s....~.~....~.:.........
.....~.4.~....~.~.~
to .CA`^'F.l~.~'...-`'..s:~...41m...9:?:1~1k?~~:~::~t!...1.'.~;...~.(~.::~...?.'.:~!-.~!:."^R.~:.1.-.~....s-~~'
~ 1
n ~ p ~
at premises located ot .......4..~........~t.~F.,?z::1..C.~rs.N..t..... e.:Y4~C.........~?1.~.:4~::5~.~?
,oo.
. `~f ....:'.........i~.Q~:
County Tax Map No. 1000 Section ...~..°d....'~. Block Lot No....~.t
pu?suant to application doted 19.~./..., and approved by the
Building Inspector. u
' Fee 5.~..rS~.~~..
....................................g. n.............................
' Buildin I for
Rev. 6/30/80
INSPECTORS
w
Victor Lessard ~
~ ~l)(y~~~
Principal Building Inspector ~L ~ -Q
Curtis Horton Yom' ~`~-x SCOTT L. HARRIS, Supervisor
Senior Buildin Ins ectar ca
g p ( c', ` Southold Town Hall
Thomas Fisher u~- ~ ) ,kS,v ~~n p,0. Box 1179, 53095 Main Road
Building Inspectrn ~ ~
~j, Southold, New Yotk 11971
Gar Fish ':~Ar
Building Inspector " Y Fax (516) 765-1823
Telephone (516) 765-1800
Vincent R. Wieczorek
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING YNSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
NOVEMBER 13, 1991
SOUTHOLD POOLS,.iNC.
BO% 539
SOUTHOLD, 1!IY J J9 71
RE: Paul Dalecki
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
g~_ An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
The check is ( 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 # 19800-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
CC: PAUL DALECRI
i
THE NEW YORK BOARD OF FIRE UNDERWRITERS ,~'~t~"~
1J131"f ~ l BUREAU OF ELECTRICITY
EIS JOHN STREET. NEW YORK. NEW YORK 10036
.rCr~rt:, t9~i,'l9!1'I "7~'A17d(b1_J!~2 R 'E89~'i0
Date Application No. on file
THIS CERTIF{ES THAT
only the electrical equipment as described below and introduced 6y the applicant named on the above application number in the premises of
to n>a~~,r,~r, rt~t: ;,~z~;~rl~r.~r,xtT 1.~.~zrr a, (,~1~~~~~~~~s,. 1S.Y,.
nE~ c{a2
in the following loco t ~ f , t i Bp~ement ? /at FY. ? 2nd Fl. .Section B/oek Lot
was exarnined url and found W be in cunRplianre with the requirenreats of this Flaard.
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS ECEPTAClES SWITCHES INCANDESCENT fIUORESCENi OTHER AML K W AMi K. W AMi. K W. qMi K W. AMC H P
2 1. 9
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECtAI REC'PT TIME ClOCK3 EEtI UNIT HEATERS MUtll-OUTLET pIMMERS
AMi K W. Oll H. P GAS H P AMi. NO A. W G AMT. AMP, AMi AMPS. TRANS. AMi H. P. SYSTEMS AMi. WAIIS
NO.OF FEET
SERVICE DISCONNECT NO.OF S E R V I C E
METER NO, OF CC. COND A W G. A W G A. W G
AMi. AMP. LYPE EQUIP t,6' Yw 1 ,9 ~W 3.e' TW 3 jr 4W pEA ,a OF CC. COND NO. Of HblfG OF HbLEG NO.OF NEURRALS Of NEUTRAL
OTHER APPARATUS:
~ Ssl3.M79IRtG pn(7I1°'1
sglsr:rnzl r<.~c~;i''7~nrl,r;^, :l-2C)F~~P((:,~t~~url- 1-x
*(5671.NIM.tNG PC1(Jlr} 'I'1Ti.~ c~~rra.fiir~i:~;
r^nvc3.c~ <~u*Rp7iatir.+.:' ra'L 717e dat.L +`a
i~
y r.nspu,~ E all c:n]y. BL~£;UL7Et. 04 ulaTl,ncaf,
e,n*r~GrogxilerlLr; it :is iyr9r~%:~ab1;7 to
have f:r~~tlus~;r,+,; hest, axed/al° t°~sh;t~rs
IR~de lag ~ duG.~iP:i~r1 ne.r.soEt, -E'~
't Y
42 a ~i0N:5:i<;l,l, i,7lYv'fS GENERAL MANAGER
E a" .i r ~ r
Perl ~
I 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.
I
E` COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NUT BE ALTERED IN ANY MANNER.
~/~C_cz~ ~v Phv~ t F~s42y .Dfic,Ee%r
Furm No. 6 la UQ~2(ti-f~~~ DI°.
ir' f .
~F hW{Sq YI ,
P;'°" ~ TOWN OP SOUTItOLD
~ ~ ~I~~~ ~ BUILDTOWND IALLTMCNT
'E ~ 765-1802
" ~ APPLICATION FOR CCRTIPICATL OP OCCUPANCY
This .application must be filled in by typewriter OP, 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 rite Underwriters.
4, Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of 17 lead.
S. 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.
:S. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
~~pre-existing" land uses:
1. .lc curate 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.
IE 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 Co 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
Date ..~2C.21iv;~,;..30.1 Ig.)~...
':ew Construction...... Old Or Pre-existing Building „
Location of Propcrty..:~t~v „C~2~E,-rJ ff i lL , L~tiE ~ ~ • (~2~~a~Pa2T. 1 . ~
Ilousc No. Street ~ ~
Hamlet
Onwer or Owners of Property........ `aQ..W.-2. '
':uunty Tax Map No 1000, Section., ~,~;~,,,,,Block....~,.j ,
.......Lot.....'
subdivision.. ,
.Filed Ti:tp............Lot....
'crmlt No.~~,~6,~,d;,z.,,,Date 0f Permit....."}~a-,3,Iq
..Applicant..
!ealth Dept. Approval ..........................Underwriters A ,.~./.~J.~1•~l~., 6..i~/~~
pproval „
'1:uuting Board Approval.,........
equest for: Temporary Certificate......,
Final Ccrticate...........
ce Submlitted: $02~:
~/~o~" FiPPLICANT
7 _ ro .
~IE~D I;:SPEC:iU17 ~~Un:E ~ i;OMMEN7.°.
'a
1 . _a 00
H C
_ _ y O
FOUtJDATION ( 1st )
i TI
tia
FOUNDATIOtJ ( 2nd ) _ _ ~~p
z
2 .
Z
P,OUGH FRAME & c,
.PLUMBING
C/~
H
3. ~ x
m
m
INSULATION PER N. Y.
STATE ENERGY
CODE (,'1
x ~J
4 . ~
FI7JAL C
z
ADDITIOt7AL COMMENTS: ~
x .
•
• ~
x
ro•~
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2
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tTJ
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t ~ /:i.Rx3bevN '<wm+.l,, ,,.au. v.'.Az .r,,s~+»wri;.e,:+ao_w.tS+:.'`YM ~9~+"am`~u'u4 ~ ~Y~sYal3~., t~~., v:~ ~
~.wr~~uca:.r s_., ...,v x. nit: aFe-~ wdn..a~..:
`
l
765-1802
f BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ FINAL
REMARKS:
- -
DATE d'r INSPECTOR
~It s4~~ ,I ~~a,4
r~ !F ~ B0,AFD OF HEALTF7
.nom,-r ` FORM NO. 1 J SETS OFy PL \:75 - • • • • .
~R ~ 9~ TOWN OF SOUTHOLD CIIECI:Y~?e~+3I~ . .
BUILDING DEPARTMENT
ESLOG.pEPT. TOWN HALL SEPTIC CORM
TO~JN OF SOlITHOLCI SOUTHOLD, N.Y. 11971
TEL.: 765-1802 t:aT I FY ; ,Q,a.dEjr1~
' CALL 71aS-.3 ~a Iv. .
°xamincd . ~ 19~/. CIA I L TO : • • • . -
approved . ..~~..a~.., 199 (.Permit No. ~.9 . ~ . .
Disapproved a/c _ _ .
.~C Y 0.L •
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date I.~ 19~
INSTRUCTIONS
a. This 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
r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
r2ion.
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
call 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
salt 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
wilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
egulations, for the construction of buildings, additions or ;alterations, or for removal or demolition, as herein described.
he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
unit authorized inspectors on premises and in building for necessary inspectio
(Signature of applica~ r name, if a corporation)
ra eox sse as
(Mailing address of applicant)
tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
"ame of owner of premises P~ ~ ~t; Y Ck- I
(as on the tarX roll or latest deed)
appli~ca~nt -is`a cor oration, signature of duly authorized officer.
(Name and title r/porate officer)
Builder's License No. r {O ^ ~ ,
Plumber's License No . . .
Electrician's License No . .
Other Trade's License No . .
Location of land on which proposed work will be done . .
..~j.~~.... GRi ~,v 1~'I L Nl'_
r.........` ~ ~r_i~ N pn,`
House Number ^~Street Hamlet
County Tax Map No. 1000 Section J~ Block Lot ~ ! .
Subdivision Filed Map No. Lot .
,~~~~~~~~(Name)
Slate existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ...C~:`~!=...r~+..`; ~ ~ "J
Sw; r~ ~J ~ ~.,L / - ~ c,:.. ~ :5~'~. 1. "r rk~1~%t ~ ~,l : x, i , ~ f, .
b. Intended use and occupancy t":. . (D.. ~ -
i
3, i\'ature of work (check which applicable): New Building Addition
Repair • • • Alteration .
Removal • Demolition Op~lVonk .
~ (Description)
4. Estimated Cost ....J~ dam„ , , , , . , , , , Fce .
J.....
(to be paid on filing this application)
5. If dwelling, number of dwelling Units ,T.. , , , , , , , 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 existin structure ' '
g if any: Front Rear ~ Depth L! S~ ~ .
Height 2 S. Num~ter of Stories " .
unensions of same structure wi h alterations or additions: wont , • , , , . Rear .
De th.........,.
g Num .Height Number of Stories .
8, Dimensions of entire new coast ction: Front , , , , , , , , , , , , , , , Rear .
Hei ht Depth
~ ljer of Stories . , , .
9. Size of lot: Front
Rear Depth ....Z~~!~..........
p p ' ' ' ' ' • • • • ' • • • • , .Name of Former Owner ! t"~... ~?ov,~,
12. Does ro osed construction vrol;mrses are situated ..RLs.
1 1. ZDone or use
distract m which rc to any zoning law, ordinance or regulation: t-:<? . .
..Will excess till be removed from remises: Yes No
v, ~ ~ 1~L6,CI~i , , ,Address 4JJ, ,~,:.eti4~~il I.b, Phone No. ~(.~~-•1.7.~`l... ,
^
14. Name of Owner of remisesu.na, Address ~i¢w;~ !'9?;
; , , , , , , phone No.
Name of Architect p P •
ame of Contractor ,~C_1~ ~1, V1,~ , , ,c,~. ~ , , ,Address -o ~ .K.5,1, , ; , hone No.
15. Is this 5 •7•!o.J`-:.~!~.(?.
property within 3Q0 feet of a tidal wetland? *yes......,
*If yes, Southold Tc}wn Trustees Permit may be required. ~ o•
PLOT DIAGRAM
Locate clearly and distinctly all 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 corner lot.
~I
!~I
i~'~i a # ~ .~+~iet~;
i~
~
TATE OF NEW YORK, S E3
'OUNTY OF .
' ' ' ' ' ' • • • • • • • • • • • • , • • • • • • • • • • • being duly sworn, deposes and says that he is the applicant
(Name of individual signing (',contract)
rove named.
eisthc
(Contractor, agent, corporate officer, etc.) ~ ~ ~ ~ ~ ~ • ' ~ • ' ' ' ' ' '
said owner or owners, and is duly a tltorized to perform or have perforated the said work and to make and file this
~plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the
irk will be performed in the manner seta forth in the application filed therewith.
vom to before me this
....day of 19 ~l
nary Public, , , , `
•<'ti : rrS~ •
•4~`-;`:-•~-_. County
No~rYi~ubCEM WItKINB' I~ .......~~,~,ti:^... .
No.4~62246~SuM
k~Co~u~ rgnature of applicant)
Term Explres.Nma q$18C~/
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