HomeMy WebLinkAbout18377-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 218715 Date JAN. 12, 1990
THIS CERTIFIES that the building POOL HOUSE
Location of Property EAST END ROAD FISHERS ISLAND
House No. Street Hamlet
County Tax Map No. 1000 Section 004 Block 005 Lot 19.5
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUG. 9, 1989 pursuant to which
Building Permit No. 183772 dated AUG. 11, 1989
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 CONSTRUCT A POOL HOUSE.
The certificate is issued to MICHAEL ROTHFELD
(owner, J
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N085925 AUG. 9, 1989
PLUMBERS CERTIFICATION DATED N/A
/fi(/r
Building Inspector
Rev. 1/81
rows 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 1 8 3 7 7 Z Date ........,G..G~...........L.~ 19..1
Permission is hereby granted to:
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,~~,1~_ ~.,y
at premises located at .........~.~[~1....~t,'yL~...../..k..!/'~
...............................................~~........~I~
...~,..2~,..................
County Tox Map No. 1000 Section Block .......,~'.\....p~LyoJt No.....I.~....?~.°
pursuant to application doted ........~..I 19L7...-/, and approved by the
Building Inspector.
Fee $..~...l...~..l~.d
Building Inspector
Rev. 6/30/80
OZo~ ~L,61
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TOWN OF SOUTIIOLll
BUILDING DEPARTMENT -
TOWN HALL ~ ~ ~ ~ L, , I I I. ~ ~ ~ i
- ,
SOUTIIOLD, NEW YORK 11971 i'"
76s - lsoz sttt NOV - 31989 ~ ij
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APPLICATION FOR CERTIFICATE OF OCCIIPANC °~'R^M~~=ii^~rlsy ra1~S0tJYpjOL~7
DATE ,October ,25,..1.989
NEW CONSTRUCTION .X,,,,,OLD OR PRE-ERISTING BUILDING..,... VACANT LAND......,.
Location of Property ......................PCIYdt@.81:11!@....,Fi~YI2rS Island _
DOUSE NO. STREET IIAHLE'l .
Owner or Owners of Property.., M'iChael_ROthfeld__
County Tax Map No. 1000 Section .4,,,, Blor.k Lot .19:5....
Subdivision Filed Map ........Lot..........
Permit No. 183772 8-11-89 A. John Gada General Contracting, Inc.
...._...Date of Permit ..........APPlicant
Dealth Dept. Approval Underwriters Approva1,52Q1$48~~89 „
N 085925
Plannin8 Board Approval
Request for Temporary Certificate Final Certificate X
Fee Submitted: $.....25,:00,,,,,,,...
nPPLICnNT A._ John. Gada, General. Contracting,, Inc.
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rev. 10/14/88
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THE NEW YORK BOARD OF FIRE UNDERWRITERS ~'rdr~ ;E
6UREAU OF ELECTRICITY
85 JOHN STREET. NEW YORK, NEW YORK 70038
AC(f,Cl*;'i' tt~;, I9`;~ t %!()'C3!ii~7/f:9 1? Q~'.:?;:~~
Date Application No. on file
THIS CERTIFIES THAT
ppon//l''yyy yytAhye+(elect/rinca)l e*quitpment axydyexcyribed{6eloFyO~ and intiroy {dy~u{coed 6{y gth}{e~(a{pp/icantv~Omed on the above application number in the premises of ~
j'l.~l.ll/i F'!!) ~~i~,A li('l`.~I}I, ~~~1.I ~~dJ t~y~s JI~\. I.V I~/ ~'If)SI C~F4 iY 1~1.iS)AVI~!(it~rya VAa
itCf 4~
in the folioreing loca6jl~~/S~ 4 BK~P,r~ent ? )xt FL ? 2nd F'(. .Section Block Lot
axis examined on andfourzd to be in cuntpliance with the reyuireneents u(thix Doord.
iIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DI'iH WASHERS EXHAUST FANS
OUTLETS INCANDESCENT RVORESCENi OTHER AMi. K W. AMi K.W. AMi KW. AMi K W AMT. H P
l 1 ~
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
SYSTEMS e„+
AMi. K. W. Oll gH. P. GAS H P, MIT. NO A. W. G AMi qppM//P. ~3PMi. AMPS TRANS. AMT H P NO. OF FEET AMT WATLS S
t' a FH~ 1. ~EVt~
SERVICE DISCONNECT NO.Oi 5 E R V 1 C E ~
AMi. AMP TYPE METER L PW L ~ 3W ~ R 3W t ~ dW NO. OF CC. COND. A W G. NO OF HI-LEG A W C' NO. OF NEUTRALS A W G
EQUIP. PER% Of CC.COND OF MI-LEG OF NEUTRAL
l
OTHERgg ppAyyPPyyARyy~~A//TUSyy: yy 1
fL M`I ia,AIF`F~f~{iflnYn ~"J t~~&la 1{.~~
*trtrmr5lrl!> fr~ol~> 'rt~,~:. L.,.t.f~_~ftc~l~w
CC*ef L?X';i i760kg{.1281;C'.y <"t( t~l e• r~fTAY'.{'. !"i,(
Y.nsp~ei~~(x1 tr?Y7.Y. 14~3stu{~;;+ ~.t~ 11utt~t~~l7,
Alk'G'i PtYt111YEilE f: ~,^a li7 ~:i RtI x73. ~i$~{~. L.a i'. i3
h~ru~a ~r:~gaLtii~lr C~~;nT, alLdf~~r x~„~~ai;;
rR~lr3e by z irt,.:aa ~i i r<cR i,o->a•~<,n,
/!~~~~e~
r1aD~: Cr,(p3T€ti~C1`iY1H 6;C'f:.~~~3(w~; G
U,i{,yr{itF,ld - TS GENERAL h1AyAGER
F';i~ffh,R:> T:~I~ilTiv ~lY, 6G;9+i s
Per ? 1 4.._...-r'_'
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. PHIS COPY OF CERTIFICATE, MUST NOT BE ALTERED iN ANY MANNER.
:lELD II:S:'cC:iUN- ~Uni~ %OMMGNT°
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FOUIJDATION ~ (1st) ~ ~j
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FOUNDATIOid (2nd) _ - _
2 ,
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0
P,OUGH FRAME &
PLUMBING
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3. ~
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IIJSULATIOPI PER N. Y, • • Q
STATE ENERGY 1}X'
CODE
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FINAL
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ADDITIOIIAL COMMENTS: ~
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BOARD OF HEALTH
3 SETS OF PLANS
FORM NO. 1 SURVEY .
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC FORM
' TOWN HALL
SOUTHOLD, N.Y. 11971 NOTIFY
TEL.: 765-1802 CALL
MAIL T0:
Examined 19 .
Approved G.j...., 19~~Permit No. ~P.?..~~Z
Disapprove a/c
(Building Inspector)
APPLICATION FOR BUILDING PERMIT n
Date 19~~
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.
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 Petmit 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 Building 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
r .
Regulations, for the construction of buildings, additions or alterations, or for remova br~dem'~olitiioii, as'herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code;,housialg code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections.
Siggature or" applicant, or name, i~a.corporanon~
(Mailing a8dhessofrapplioan.#~s. ,
- t,~S°+.3e!s33°? , 54::3+~ ,-h
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician;iplumber.,or builder.
Name of owner of premises C -~~L4~.-~ 2G ~9 ~Fs _ .
(as on th tax roll oi"A~t~~i~d~d ~`'+r~`!$~ l`~ x+:11?
".~~;i~ ~.1a9t+rltt'`tr;.~~€ Yt;ZSds .sf`•,,r,', a
If applicant is a corporation, signature of duly authorized officer. ~ Fa~yl~ ;-3~t~.~iw~,rsq
, ,
Y ,
(N" ame and title of corporate officer)
Builder's License No......r~.~~-.~~.......... .
Plumber's License No.
Electrician's License No. ~lO. : . • .
Other Trade's License No. ~
/ 7
1. Location of land on which proposed work will be done. G~'~~.~~-rte ~z~'l
House Number Street Hamlet l
County Tax Map No. 1000 Section Block Lot .
Subdivision Filed Map No. Lot
(Name) ~ ~ -
2. State existing use and occupancy of premises and intende/d use and occupancy of proposed construction:
a. Existing use and occupancy ..'.........~~..l7.lr../.....~ ~ .
b. Intended use and occupancy ~G.~• • 'a-t-~-~ • . .
3. Nature of work (check which applicable): New Building Y....... Addition Alteration .
Repair Remgval Demolition ..............Other Work...............
/ii ~r-- (Description)
4. Estimated Cost 3 daft
. Fee ~ t,71.~~. .
(to be paid on filing this application)
5. If dwelling, number of dwelling units 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 structures, if any: Front Rear Depth .
Height ...............NumberofStories........................................................
Dimensions of same structure with alterations or additions: Front Rear .
Depth ....................;..Height Number of Stories .
$ Hemhz~sions of entire new construction: Front .........9..... Rear q Depth 9 , , , , , ,
g Number of Stories .
9. Size of lot: Front Rear...................... Depth
10. Date of Purchase Name of Former Owner .
11. Zone or use district in which premises are situated . . .
12. Does proposed construction violate any zoning law, ordinance or regulation: ~ .
13. Will lot be regraded ..Will e~gess fill be removed from premises: Yes No
14. Name of Owner of premises „r~'-s:~ ~~~'-!:~~~Address ~K~d.~jtn-,r~,.. ~?d... Phone No '??vim: ?D~: ,Yao p
Name of Architect ...Address ...................Phone No............... .
Name of Contractor~~.l+~4.X~tC~~"~.~.Address~/~i~t~e~~~~', y/.zl/.. Phone No..~.~/v:7d~: ,7,oz3./, ,
15.Is this property located within 300 feet of a tidal wetland? *YES....NO....
*If yes, Southold Town! Trustees Permit may be required.
~ PLOT DIAGRAM
Locate cleazly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block umber or description according to deed, and show street names and indicate whether
interior or corner lot.
I
APP[R~OVf~E~D/AS NDTE~
DATE: ~~tL~~Y~~,.~~.'~' &P. k ..L~a~~~,L.~~'..'
FEE: ~.+,Lt~.-BY: -JC-~~.~T F r
NOTIFY BUILDING DEPARTMIEI A7 CCPACY OR
766-1802 8 AM TO d PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION - TWOR~Ol11RED - ' ®N®plg~~~
FOR POURED CONCRETE I MBINO U
ROUGH • FRAMING al PLU
3. INSULATION
a. FINAL - coNSTRUCTIQNMUST 9~TUT CET~F~CAT~
BE COMPLETE FOR C.O. I ~ CCU PANCY
ALL. CONSTRUCTION SHAIS. MEET
THE REQIMREMENTB OF THE N..Y. ,
STATE CONSTRUCTION al EROV
DESIGN OR CONRESTRUCTION ERROR$
I
. STATE OF NEW OR I$.S
COUNTY OF .
(Na e of individual signil ~ • ' ' ' ' ' ' ' • • being duly sworn, deposes and says that he is the applicant
ng contract)
above nathed. ~i
He is the 4~?:4~k-cr:C:~'.`~........................................
(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 ]tis knowledge and belief; and that the
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this l Q
~ ......day of . .~~I:,!,tce,'~n/'~ /~19~!~
Notary Public, .:!~~4,-.~1.....~?"'."-'.. JC/owuna oty-e.-e
EILEEN bl WALL Q,_ ,
NAVY Public, Slale of New Yodr ~../A'"'~"~°~
No. 529509185
Qualified in, SUfFolk Counfy d ~ (Signature of applicant)
C~ f%pire? ~ AYIE'6 30, 14_.r
~CJtf .