HomeMy WebLinkAbout19299-z Y~
F FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20507 Date SANUARY 29, 1992
THIS CERTIFIES that the building INGROUND SWIMMING POOL
Location of Property EAST END ROAD FISHERS ISLAND N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 5 Block Z Lot 7.9
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 27, 1990 pursuant to which
Building Permit No. 19299-Z dated AUGUST 6, I990
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 & DECK AROUND POOL.
The certificate is issued to DRUSCILLA VAN HENGEL
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-200552 - AUGUST 16 1991
PT,UMBERS CERTIFICATION DATED N/A
Building Inspector
Rev. 1/81
TOBM N0.
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) tl .
~ qq
N° s ~ ~ ~ s' Z Date .....a.:" 14..F...~
Permission is hereby granted to: ~ ~ ~a~-~~'
' ...r-~C Y°'~'.
o ..1~.~...o.~L...~J..%~.~...
. .
' ~ ~ UG3 ~o
,~~~!~r~
,~2_ //a
of Premises located of .....~~......~Q!~~
.~........Sr...:~?!~.~..........~ ...h:itlrs~(.F:YL........r~Za~~.'.~`.T.. ~
.......................................!.1..1 /G...........~!.:............................................
vv// ~~yy
County Tax Map No. 1000 Section Block ......s~J.......... Lot No.......l,.r.....~
c
pursuant to application dated .......G ` ............I.~'~....,~........, 19...f...~and approved by the
' Bullding/y In~/spector.
~ Fee S.+of.:..l.•01..0.~
k
` Building Inspector ~ J~
Rev. 6/30/80
1
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FORM NO. 6.', ~ ~ ~
TQwN of souTHOLU ~ ~ ° J~~! 2 '
Building Department ~ '
•~a.
Town Hall ~
r 4..
,Southold, l~.Y, 11971 i
.765 - 1802' ~ 5.. - -f.°., .
APPLICATION FOR CERTIFICATE OF~OCCUPANCY
Instructions
A.' This application must be filled in typewriter, OR ink, and submitted ~ e~...~ to the Building Inspec-.
for with the following; for new buildings or new use: ~i
. 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual
natural or topographic features.
' 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equall.
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa-
tions, acertificate of Code compliance from the Arohitect or Engineer responsible for the building.
5. Submit Planning Board approval of completed site'plan requirements where applicable.
B. for existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of property showing all property lines, streets; buildings and unusual natural or '
topographic features.
2. Sworn statement of owner or previous owner as to use, occupancy and conditioh of buildings.
" 3. Date of any housing code or safety inspection of buildings or premises, or'otherpertinentinforma-
tion required to prepare a certificate, '
C, Fees: Additions $25.00 POOLS $'25~LTERATION $25.00
1. Certificate of occupancy New Dwelling $25.00, Accessory 10.00 Business $50.00
2. Certificate of occupancy on pre-existing dwelling 50:0.0 '
3. Copy of certificate of occupancy $ 5 .00 , over , 5 years $ 10 .00
4. Vacant Land C.O. $ 20.00
' S.Undated C.O. $ 50.00 Date /~1,~ ./rod........
c~--~._ C
NewConstruction~0 ~ ~pc/Ohtl,~o~r'Pre-exi~sti~ng Building , , Vac~aJnt Lann~d '
Location of Property • • .4'e:~~. ,°•'zi, .~Ae!s, , ,~~ti;~' ' , , , . , .
House No. ~ , ~ ~ /Street J ~ ~ ~ Hamlet
Owner or Owners of Property ~~/-f~~':~i~~ 1~i,9~ ( . .
County Tax Map No. 1000 Section . , Block ~ , Lot ~ .
Subdivision ..:.Filed Map No. ~.~./.Lo'tj No.
Permit No. / Date of Permit ~~.~~:..Applicant . ,•Z~:
S, .!~/,~`?^,'~I:k~: : . .
,Health Dept. Approval . .Labor Dept, Approval .
Underwriters Approval . N~.Q~.~t7, .v~, , . ,planning Board Approval '...1./....~............ '
Request for Temporary Certificate .Final Certificate ...,~F
Fee Submitted$...as!U~ ,
la
all appli~ca~li codes and regulations.
Construction on above described building and
p~t meets -~I? .
Applicant ' .
Rev. 10.10J8 1, uIl/
Q,~,e., Y3a 6
~
s 7
~ . ~ THE NEW YORK BOARD bF FIRE UNDEI~RITERS ~
1444esr> euREwu of ELEGTRIOITY l,`
66 JOHN STREET. NEW YORK. NEW YORK /0090; -
Mte AUGUST 16,199] Application No. onjile 6R700190J90 N 2.04552
THIS CERTIFIES THAT
only the decttkol equipmswe v dacriked fts/ote awd Jwtrodwced 6Y Ua oyllerrwt Mtnod ow tM o6ooa eprBwtfaF rutm6ee iw the promisnq/ -
FIAARTEN VAN HENGRI„ EAST F.N4-PRIVATFs SFCTI4N, F'ISHEttS 7'3T,AN4, N.Y.
oUT rtL
iw thejo/law•inR location; ? Basement ? /xt Fl. ? Ynd fl. Rertiwt Block Lot
max ezemined an JULY 25 , 1.991 and found to 6e in compliance with eke royuiromentx of thL Buord.
c~
's fRITIIA _ 7C.-_ _ RRCRf BISN WASINRS EIfXAUST VA/K
gltttRTf M~ fMTCI~ INCANpESCFNT nWktttENT OTHER AMT. K. W. AMT. K. W. ANT. -k.W. AMT. R. W NAT. n. F.
0lYNS R!lIACR MOTORS IUi1MR AtfW111CR IRipf fMgAI SRC'?T TIAM CIOCKf SNL (ItNT 1lAiMf. MIIITFOYTIRT ORAIAlRS
AMT. R. W. pl M. F. OAS R. F. AMT. NO. A. W.O. NAT. AIM. AMT. AMR. TRANf. AMT. N. I. ~ ~T AMT. WAITS
SRRVIOT DIf00t111RCT MO.OF S R R V I C i o`.
AMT. AAV. TrIF ~ I 1 tw I J tw ] ~ tw )JAW NO.OF~fCOND. Or A. w. NCI. a. w-lt0 01 N'' ND. a NEUTRALS a ~Nwt111GxAl -
-sF=
i
s OTtIM A1MRIgUf:
Rlade by R Qualified pwreon.
-
Z & S CONTRS. INC. f,iC.#92415
y~
P.O. BOA 24?
FISHERS ISGANA, NY, 05394 OMAI MANAOEi
11
Per ~ ~ -
Thit artifxoN mwt not ba olhred in any monner; rNurn b 11» elfin of eM fburd if ineorrM. IntpeetoR 6 thu'i endeMiult. -
~Or1f FOR 6lIIL,DINC DEPARTMlNT. 'DES COPY OF` GERTi1!!16?~ ANISTNOT BE A4T~P UI A~„Y.Y~NIER. tl~,
_ _
` THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGP ]
1000656 •UREAU OF ELECT/MGITY u J 1 j.
83. JOHN STREET. NEW YORK. NEW YORK 10038_
Date AUGUST lb,l991 .IpplicotionNe.unJ7k bB1003$O/90 N 200557.
TNIS CERTIFIES THAT
ortly the eleetrted equipntant es dexrihsd heloro and Introduced 6y the appliawt ranted on tlurahow ~pp8ootfat number in the promises of "
lc
~ M7IARTRN YAN NRNGRI„ FAST F.NO-PRT.'VATIS SkCTION, FTSBRRS 7Si,ANO, N.Y.
in Ike dlowin /acet7onl n e~mant
j B JULY 53,x991 ~ Ist Fl. ? Ynd Fl. t7UT Section 81ock Lot
was examined en endfound to he in compliance with the requiromenM of thu &wrd.
3 _ - - _ _ -
: IRITURI RX t:00111N0 ORCKf OY~1 WASIEkS !%MAUST FANS
t){rTiRTf ~6 ff/IT<7tff M nU0NfL1M OTXEn AMT. K. W. AMT. K. W. AMT. K.W. MAT. N W. AMT. M. r.
~ a 1 s 2
' orrRRS IWIfACR MOTORS tunRa nrtuilncR nfRRRf snctnitrrrr TtMlUOCIIS tRaTUlua~lf MpfT1.0YTtfT olffhtaRS
AMl. N. W. dl X. r. GAE K. r. AMT. n0. A. W.O. AMT. AMI. MAT. AMrE. - TUMf. AMT. - M r NOR W1~T AMT. WAITt
1 F 2 1.0 i 40
EiRVN3 pfCOfpIRC! NO.OF f R R V 1 t: ! _ _ A"
AMT. AAw. Tyre p~uM., i w tw , / ~w a e rw ew Aw uo. a ~ . coup. .w nod wucs a w. d NKUTIIAIt a 'r
einiM ar
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OTM~ AIPARh1Uf:
SHINNING POOL-1
MOTORS H.P.-1/G.F.C.I.-1-2
PANRi,BOARA3:1-5 CIR. lI,5 ~
G.F.C.I:-l
*(3AIKNING PAL) This t•.arri.ficate
covers coiapliance aC the date of
i-nepecr,ion only. Because of. unuaua7
environtnenCs it is advisable to -
: have tr.equent test and/or repairs ~A~
<<< Continued on Yage 2
Per 1 t t. t~ - ~V
Thh nrKfic9N map not ba altEnd in any morarerr retwn to the office d tha NMr credenhah
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i=..a 1::~: ..V:. iall'Jn:~ I~ ii:SMENT^, ~1 ~ `
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NSULATIOII P£R N. Y. ~ H
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7 SETS OI'~'PLAN~i
• ~FORM~NO. 1 SURVEY - ~
e
' TOWN OFSOUTHOLD .CHECK
BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL NOTIFY
SOUTHOLD, N. Y. 11977 CALL • • .
• TEL.: 765.1802 •
' MAIL T0:
Examined .................19...
Approved . 191~Petmit No..~. ~.~~..97 ~
1';lv ,
Disapproved
a~~~~~~ . ~ ~ ~ ~ ~t 'i'
APt; ~ 2 ~ ~ ~ .
V./y//~~ ~j/ - { ~ t
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(Building Inspector) ~ ~ s
APPLICATION FOR BUILDING PERMIT p
Date 7/.~y....:..:..> 19/.a
INSTRUCTIONS /
a. 'This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
sets of plans, accurate plot plan to scale. Fee according to schedule.
i b, Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public sheets
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appII-
cation.
c, ' The work covered by this application may not be commenced before issuance of Building Permit.
I 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 avaflable for inspection throughout the work:
e. No building shall be occupied or used in whole or in pazt for any purpose whatever until a Certificate of Occupaucy.
~ shall have been granted by the Building Inspector:
APPLICATION IS HEREBY MADE to the lluildirig 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
Regulations, for the construction of buildings, additipns or alterations, or fo'r removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code,/h'ous/ing ~c/ode, an-d~-regulations, and to
a mgt authorized ins ectors on remises anc( in bull ng'for neeessa ms ect~ons, dd~/~F"
' P P ~ di - - ..~FS Jpa.~esfa~GD7rlaV~'U`i~Fme~corporat.......
- - lonl'
. ~ ~ .:C~.?'.. ~?Da? ~ >i~r~.J'
(Mailing address of applicant)
State whether applicant is owner,/lessee, a/gent, architectl,/ engineer, general contractor, electrician, plumber or builder.
Name of owner of.premises ..!r1P.~frf. ~ (a..., ~~a / .
eo G/~r Gv, son the ta.e, r~ ~ . ; .
dll or latest deed)
If applica t is a earporation, signahve of duly authorized officer.
(Na a and title pf corporate officer)
ALL CONT ACTOR'S MUST BE SUFFOLK COUNTY LICENSED
Builder's License No. /,.x .~.~i.~c~.. 1~~=...'..... .
Plumber's License No.
Electrician's License No.....~~l:,.E. '
Other Trade''s License No. a:~~.`~~ .
P P ~ done.' ~ ~ ...~i?c-Y ~S~is ~S~~tc(i . ~ / '
1. Location of land on which ro osed work wilt be ..~5 . ~ .
,a /....,J.',
House Number Street Hamlet . '
I' County Tax,Map iv'o. 1000 Section .....'.y,(..., Block ~ ,Lot , / i.,.~.
.Subdivision . . . . . , ~ Filed ~b1ap No. Lot
(Name)
2.' State existing a^e and occupancy of premises and intended use and occupancy of progosed construction:
'a. Existing use and occupancy ,U. C~®~~~?~yn'Y'T/..... CI""~' .
` b. Intended use; and occupancy cJtrJir~Ii?~riu ia.L: ~.:4u.... , ~'d!~,rp`";?~'......'
.
M~,
ature ofworb (check which app'icable): New 13uildrng,' '~'ha,,t' Add~tron i...~?.:... Altera[ior~
depair Removal p~r~F~flUon ' Ot~ierl ork k1/~Nr"...~al..
Y' ~ription)
~D,Gvz~, ~ .
Estimated Cost , , , Fee . . .
` (to be paid on filing this application)
5. If dwellin , number of dwellin ~ units Number of dwelling units on each floor ,
g b
If garage, number of cars
6. If business, commercial or mixed gccupancy, specify nature and extent of each type of use , , , • . .
7, Dimensions of existing structures,',if any: Front Rear Depth , .
Height ...............NumberofStories.
Dimensions'of same structure with
De th alterations or ........:..s
p Herght , , additions: Front • :::Number of Storie Rear , .
8. Dimensions of entire new construatton: Front
' Rear..:..:......'... Depth ...,......r'....
Hetgltt Number of Stories . , .
9. Size of lot: Front ! Rear ' . r . Depth . .
10. Date of Purchase , ,Name off' Former Owner
l 1. Zone or use district in which premises are situated . .
.
12. Does proposed construction violatg any zoning law; ordinance or regulation : .
Will'lot be regraded , . , ....:Will excess fill be removed from remises. Y
P '
. • ,I • ...Phone No, es No
1Q, Name'of Owner of premises .............Address , .
' Name of Architect .Address , .Phone No
Name of Cp ntx~acto~ • • • ~ • ' ' ~ 300 f ee ~ ~ ~ Address , '..........Phone No..../.:.. .
~I 15. Is this ro ert located within, t'of a tidal ,Wetland? *Yes No
*If yea, Southold Town Truat~eea Permit ma be re wired.,
PLOxI''DIAGIgAM
,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, acid show street names and indicate whether
interior or.corner lof. ,
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STATE OF NEW Y~I:K, ~ ~ '
COliNTY OF S.S ~k
~ ~~~~5~ ~ ~ 'ontract) bein dul ~ sworn, de ores and sa S that he is the app
' (Name of individual lignin ~ ~ ~ ~ . ~ ~ g y p y licant
b,
~ above named.
L ~ ~e~~lC¢,,,. ~ ;
He is the' i..
(Contractor, agent, corporate officer, etc.)
' of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
application; that: all statements contained in this application are true to~the best of his knowledge and belief; and that the
work will be performed in the manner set~forth in the,appli,cation Gled tFiereWith.
Sworn to befc~te me this r
, ..:day of . ~ E'! 19 ~d
~ ~ ~I~otary Pu /L , ..~~County„ ~ {i
y~~; ~ "~','µ~~~bllasrnro~l•N¢w,Yark ~ ~ ~ ~ ~ (Signature ofappliaa~t)
i ~g ~ ~ ~ 1/° No,480655G, ~ ~ ~ ~ ~~;:~+r' i'~
R:~~'~~~ ~ O~iOHliata in &ullolk Cnuniy ~,,,~^*'~'y
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