HomeMy WebLinkAbout18167-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 218807 Date FEBRUARY 16, 1990
THIS CERTIFIES that the building INGROUND POOL
Location of Property PRIVATE DRIVE OFF EAST END AVE. FISHERS ISLAND
House No. Street Hamlet
County Tax Map No. 1000 Section 005 Block 001 Lot 01.1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 24, 1989 pursuant to which
Building Permit No. 181672 dated JUNE 2, 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 INGROUND POOL WITH FENCE.
The certificate is issued to MARK ANDREWS
(owner )
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N090430 SEPT. 3, 1989
PLUMBERS CERTIFICATION DATED N/A
i ~
Build'in In
pect
Rev. 1/81
gosas 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 1816 7 Z DoteG%r.~....,.~...y/`.~ i 9..~.
Permission is hereby granted to: ~j~ i,,,
.
` d~....r~,..Q.~,
..y.. ` ` ........~,~..~i~...~~.~.^j~..........
to .......11~....... ......~~~r~.~N
of premises laoted/ot
County Tox Map No. 1000 Section Block,,(( Lot No....~........1.......
pursuant to applfcatlon doted .........~!1.7.•.....t7~:..~....., 19.~...~ond approved by the
Building Inspector.
Fee S•~...Tr...~i•~
/(n/
Building Inspector
Rev. 6/30/80
f
'rowN Dr• souTIloLD
BUII.OING DEPARTriENT
;t.
TOWN IIALL
SOUTIIOLD, NEW YORK i 197 t ~ ~.+1~`-~~~~~~~{~~ ~
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APPLICATION FOR CERTIFICATE Oi~ OCCUPA CY
~YOtNf~ C.7F;;fJU'CP~dLRLi7 d t
DATE :
~i ~113.~, .
NEW CONSTRUCTION ,.~~/J.OLD ORp~/PRE-R%'LSTI~N+G ~IIUyIT.DING.....~.,,aV`ACANT'~jLA,~N_ri..."~.... ,
LoeaCion of Propeerty.'/.~sYJ/~ef?~PJ~CGCdZ.~!YIGLQP~!' ~f/~U~Lz~..
llOUSE N0. y, STREE'E ` llAHLE'C.
Ovnr_r or Owners oF. Property,..~~'K~C:':^:!~...~.....~
County Tax Map No. 1000 Section P~~. Block .Q~~.. Lot
Subdivision Fil/ed Moa6p .Lot..,~~~~~~~~~~,...
Permit No. L~1.67.....llate o£ Permit .lP~~~~/..Applicant )E~~:4.~?t:R:!"~J..
Health Dept. Approval Undcrwritcrs Approval.,,,.,,,,,,,,,
Flaming hoard Approval
Request for Temporary Certificate Final Certificate
Fce Submitted: Sv~S,OD.........., ,
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ItJSULATIOPI PER N. Y.
' STATE ENERGY
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ADDITIOPJAL COMMENTS: ~
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THE NEW YORK BOARD OF FIRE UNDERWRITERS I'^`>~A 9. ~
9 ~`176~.T BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
Date 9lak"f'1iM9t'F;ft E7 1.9~~ Applicotian No. art file ~r a;P`7k15k49/S9 Pi Q~i7a1:3 i}
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced 6y the app(icont named on the above application number in the premises of
C<1nNR ARI~}`tk;WS, k'f:]:ViaTP7 7;R CT3~;, I'"~~iflhR .1.~>LY)PLr I~rY„
in the following Incotion> ? Basement ? l.at Fl. ? 2nd F-1. f~Ci`!,' .Sertion Bloek Lot
one examined on 1':C11ttJ1~4~ ~ 7 ` •t Ty$`: and found to be in coneplianre with the reyuirernea [s of this Doard.
FIXTURE ECEPTAClES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS INCANDESCENT FIUORESCENi OTHER prni K W AMi K.W AMT. KW. AML K.W AMi H P
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CIOCK$ EELI UNIT NEATER$ MULTI-OUTLET DIMMERS
AMi. K. W. OIL M. P. GAS N P AMi NO. A W. G. AMT. AMP. AMT. AMPS. TRANS. AMT. H. P. SYSTEMS AMi. WATiS
NO.OF FEET
2G tIET
SERVICE DISCONNECT NO.OF S E R V 1 C E
AMT. AMP, TYPE METER ~ ~ YW ~ ~ 3W R 3W 4W NO OF CC. COND A. W. G. NO OF HbLEG A W' G' NO OF NEUTRALS N' G'
EQUIP. PER OF CC COND OF HI-LEG OF NEUTRAL
OTHER APPARATUS:
~ts1l~t~f~~rra14 noo,a ~hkg t~~,rr,xr::i.r~~f~.e
cpucTx~& cem~,lia.xice afi 9:ta~ clahe e53
it~~pr:c4Ta.olt t7nly., Rs:T_a1~t>ta ~3 t4na1,=.>4~a7.
3nv'is'r~Xlmr:nTs it is a+~v'i.s~1~7.e t.o
hove EregnenC t+~st r~trd/rt rh~~i.r.s
1IYt1CIU ~ylr U f{11~7.1'L'1 t'i`I j?e T;a CSLI.
I=ATiA COPd"TRAC'lt7K t,.Gt;„295 C{
71RAb1FR B
F'~C Sl1Eli I~."r LAIV IdY,. (}Fi3q(1 GENERAL MANAGER
~..f, e
Per `t
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. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
shorelinepoolsinc. ~~4~~~ 4~Q~~~'°44Q~
288 VALLEY ROAD
COS C08, CONNECTICUT 06807 oaTE Q roe No
TELEPHONE 203/869.1203 ~ ~ CJ
ATTENTION
RE
~W ~ ~R~.t..`5°309'5 mAiaJ Rte. A~~r~~~s ~v
5o~r1~c5~o,~`~• \l`~~71
WE ARE SENDING YOU ip.t+ttached ? Under separate cover via the following items:
? Shop drawings Prints ~ Plans ? Samples ? Specifications
? Copy of letter ? Change order ?
COPIES DATE NO DESCRIPTION
3 ~ o -3 t • ~8 5v C1.~f E~ S~ W i f~ 1,0 1?o~J-1-T~o iJ
3 5.19~Sq 9-06'7 ~wir~+rtt~~ ~~ot„_°7~'rAEI_S
1 5'-2o-ff~ '3vlLfllrJ(o ~~~,n-~tr ~P~u~,~rtorJ
THESE ARE TRANSMITTED as checked below:
~~/For approval ? Approved as submitted ? Resubmit copies for approval
I q~For your use ? Approved as noted ? Submit copies for distribution
V?~As requested ? Returned for corrections ? Return corrected prints
For review and comment ?
? FOR BIDS DUE 19 ? PRINTS RETURNED AFTER LOAN TO US
REMARKS
1/ t
COPY TO SIGNED:'~\~
Ii enclosures are not as noretl, kindly not//y us of once.
BOARD OF HEt1LTH .
3 SETS OF PLr1N£.'-.. a........ .
FORMN0.1 SURVEY
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC FoRrt
' TOWN HALL
SOUTHOLD, N.Y. 11971 NOTIFY
TEL.:765.1802 CALL
MAIL T0:
Examined 19
Approve/~~tiYj;t,(.. 19~~Permit No. /
DisapprovedaJc
0
(Building Inspector) G,
APPLICATION FOR BUILDING HERMIT [OV1tN FSOIAHOLD
' . Date ~J.. 19~~
INSTRUCTIONS
a. Tlus 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 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 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 Yotk, and other applicable Laws, Ordinances or
Regulations, 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 inspections.
b.
(Signature of applicant, or name a corporarxon)
~
~7~Z7 ~C~.~.11~ . ~W.L.rJ..)11~G •..~.~'..~{~t:~.~~.~. G7~i 7
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
...~t~?':C...~!?-. M.
~~}it(G.t~'~A.n~~, ~~a~<~...~ ...Jnflti!4K., ..I.~rJ~v.V~ .
Name of owner of premises . t ! ! A:~l~..'.htN:?P:~~lta . .
(as on the tax roll or latest deed) -
If applica~is//a~orpo~r/atron, signature of duly authorized officer.
(Name and title o corporate officer)
/ ,
Builder's License No. ;5,~ F1.~~ . .
Plumber's License No . . . . .
Electrician's License No . .
Other Trade's License No . .
1. Location of land on which proposed work will be done. ..~[S~E1~5, , ~r?l~,rJ, , , , , , , , , , , , , , , , • ,
...................~/,':~:~!~:~....(/LAY.:!!.......................................
House Number Street Hamlet
County Tax Map No. 1000 Section ".......~-1....... , Block ...I Lot . I d.~, . ,
Subdivision Filed (\tap No. L'ot .
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed co_nstruction:_ -
a. Existing use and occupancy ...R~~\~~~ . 4.:......... .
b. Intended use and occu anc • . T,dc? L-
y' t .
3. Repair of w'ei-k check whi~h applicable): New Building , Addition Alteration .
Fmoval Demolition ............,.OtherNork..,.....,....
y~ (Description)
4. Estimated Cost~.J.~jt b~IG . . . Fee ~ .j~',V~b~ .
(to be paid on Cling this application)
5. If dwelling, number of dwelling units Number of dwelling units on each tloor , ,
If garage,numbcrofcars .
6. If business, commercial or mixed occupancy, specify natu~ a and extent of each t ape of use , . , 1, , , , , , ,
7. Dimensions of existing stn~cfures, if any: Front . Rear , j ~:~J", Depth . fir. ~ .
Height . Number of Stories . .
z s with alterations or additions: Front : Rear , , , , , , ,
t ~ . , IIeight f Number of Stories ° • . l• •U • ~ • •t• air'
8. [ nsions of entirc'ne stn:ction: Front , , , , . , Rear , . De th , 7?'.II~; ,
,1~I¢ ht ~ tuber of Stories . ~ •
9. . ' of~ront~ , , Rear ~.L~.~c% Depth .
10. ;Dat a~izii93; . Name of Former Owner .
11. Zone,gr~~ls, . a94~,[gt~hi remises are situated , , . , t~~,t,Q~N,T{ F};L,,, , , , , , , , , , , , , , , , , ,
12. Do'e's proposed construction violate any zoning law, ordinance or regulation: . .
l3. Will lot be regraded • . • , , , , , , , , , , , , ,Will excess fill be re~j;oved from premises: Ye N
14. Name of Owner of premises 1~Aw~.. Ar?Q~`.1', , ,Address .~~..~5 ..Phone No.SIf~-78~' .~2.'sl
Name of Architect ,'Address .Phone No. .
Name of Contractor~/6~Pf?~A~$.:~~?~,~?, S 1~1~; ,Address ~~S ~,r~,(lp ~~/,G~'hone No, 2~i~J.^$b.`l: ~
15.is this property located within 300 feet of a tidal wetland? *YLTS....NO....
*If yes, Southold Town Trustees Petmit may be required.
PLOT DIAGRAM
' Locate clearly and distinctly~11 buildings, whether existing or proposed, and, indicate all setback dimensions• fron
property lines. Give street and block number or description according to deed, and show street names and indicate whethe
interior or corner lot. ~y /
it
,
x„
n L
C~
STATE OF N S.S
COUNTY OF~~~;~~~~2,,, , . ,
(Name of individual sig ~ • ~ ~ ' ' ' ' ' ' ' • • • • being duty sworn, deposes and says that he is the applicant
vying contract)
above named. i
Eieisthe
(Contractor, agent, corporate officer, ate.) •
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and Gle this
application; that :dl statements coiu;lined in this application are true to the best of his knowledge and belief; and that the
work will be perl'onned in the mm[nek set forth in the application filed therewith.
Sworn to before mc. this
/ I
, l .~~.......da ofl~.. G~' 19 ~l'
Notary Public . County
Mrw?oh81,1l9 (Signature of applicant)
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