HomeMy WebLinkAbout18297-z FORM NO. 4
TOWN OF SOUTHOLA
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 218572 Date NOVEMBER 17, 1989-
THIS CERTIFIES that the building INGROUND POOL
Location of Property 210 5TH ST. LAUREL
House No. Street Hamlet
County Tax Map No. 1000 Section 126 Block 07 Lot 04
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 7, 1989 pursuant to which
Building Permit No. 182972 dated JULY 12 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--AMENDED TO INCLUDE DECK.
The certificate is issued to GEORGE THOMAS & RUTHANNE WOODHULL
(owner, xxxxxxxxxxxxxxxx)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N089099 AUGUST 29, 1989
PLUMBERS CERTIFICATION DATED N/A
t ~ VI t~.d. ~ Q"'L
Building Inspector
Rev. 1/81
goaas xa 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° x.829'7 Z Date 15YJ.~l.
Permission is he~ granted to• ~f _ /
~ ~ 9~c~~zzd Y.stG . ,(cifG
.
ct premises located at .....~o.Z....1./~.......-~..~~~.qa.C~
................................................l~.Genfl~:(...........................................................................................
County Tax Map No. 1000 Section ......~cz~~..... Block Lot No..........T.........
pursuant to application dated .........,.././...,7 14.~.~, and approved by the
Building Inspector, ~
ga
Fee 51.? v
~~e d'i~ ~ B din I for
Rev. 6/30/80
TOWN OP SOUTIIOLD
IlUILDING DEPART:SENT
TOWN IIALL
SOUTIIOLD, NEW XORK 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY pp
DATE... ~~,C./?!. a.(...
NEW CONSTRUCTION ....,OLD OR PRE-EBISTING HUILDING_.....VACANT LAND....._..
1~
Location of Propcrty..a~0,,,,,5• _ .__-.___4.c~~atl..-•_-
UOUSE NO.
• .STREET UAMLET
Ovner or Ovners of Property_.~??Q~E ~0'1~'1A3.~~u~N4a/~UE' -•~vpIJHUL~.~
County Taz Map No. 1000 Section .~.aZ.lo. Block Lo C' O ~
Subdivision..4~~.~^..7U,TN/I/-.-„- Filed Map ......_.Lot._.._..._.
Jl qq
PermiC No. ~8a,~~.~,Date of Permit .?[~~J,$J,,.ApplicanC lA'.~!E11I41{'_~C~U,~„)NC,
IIealth De C. A royal f V q
P PP Undcrvritcrs Approval. Q.qj ~ 9,~-
PLannioE Board Approval ~
Request for Tempora^^~ry Certificate Final Certificate
Pce Submitted: $_Y:s~~,•Q~._,,,,,,,,„
APPLICANT:yB~' , _7"'r, ~'~p'~
3~~as
'~5~~
l0/14/8a
FORM NO. 6
TOWN OF SOUTIIOLD
BUILDING DEPARTMENT
TOWN HALL
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS
A. This application must be ,filed in typewriter OR ink and submitted to the Building
Inspector with the following; for new buildings or new use:
1. Pinal 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).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Swora statement from plumber certifying that solder used in system contains less'
than 2/10 of IZ lead.,.
5. Commercial buildings, industrial buildings, multiple residences and similar, '
- buildings and installations, a certificate of code compliance from the Architect
- or Engineer responsible for the bull"ding.
6. Submit Planning Board'Approval of completed site plan requirements.
B. For existing buildings (Prior to April 9, 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. A properly completed application, a consent to inspect signed by the applicant
and a certified abstract of title issued by a title company which shall
show single and separate ownership of the entire lot prior Co April 9, 1957,
If a Certificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
3. Date of any housing code or safety inspection of buildings or premises, or other
pertinent information required to prepare a certificate.
C. For Vacant Land Certificate of Occupancy:
1. An application for vacant land Certificate of Occupancy shall be submitted,
and a certified abstract of title issued by a title company showing single and
separate ownership of the entire lot prior to April 9, 1957 shall also accompany
the application. If a Certificate of Occupancy is denied, the Building Inspector
shall state the reasons therefor in writing to the applicant.
D. FEES:
1. CERTIFICATE OF OCCUPANCY - New Dwelling $25.00, Additions to Dwelling $25.00,
Alteration to Dwelling $25.00, Swiouaing Pool, $25.00. Accessory building $25.00
Addition to Accessory buildings, $25.00 - Businesses $50.00.
2. Certificate of Occupancy on pre-existing dwelling - $100.00.
3. Copy of Certificate of Occupancy - $5.00 - over S years - $10.00
4. Vacant Land Certificate of Occupancy $20.00 '
5. IIpdated Certificate of Occupancy - $50.00
6. Temporary Certificate of Occupancy - $25.00 Residential
$50.0(1 Commercial
ev. 10/14/S8
~ ~
I
THE NEW YORK BOARD OF FIRE UNDERWRITERS '
7>J111.f$,1 BUREAU OF ELECTRICITY ii
88 JOHN STREET, NEW YORK, NEW YORK 10036
RLJ£rSISTl,~,l~!'-09 t~`3$1~If$~1$9 Pd Z)u4f)~J9
Date Application No. on file
- THIS CERTIFIES THAT
only the electrical equipment as described 6e/ow and introduced 6y the applicant named on the above application number in the premises of
t#~r9. 'P. WCJ4Y~HI71+l:, aTH S`l.'i~~1~S~;T, 3'(DL~G+$b7, IeA1;f~h~~T.L, )~T.Y.
~Jf)~ .Ser[ion Block Lot
in the following location] ggas e t ? Ist Fl. ? 2nd Fl.
RiP~il f. l0 0 ~~t~"~
was examined on and found to 6e in conLpliatrre with the requirements o(this Doard•
FLXTURE FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS ECEPTACLES SWITCHES INCANDESCENT FLUORESCENT OTHER AMi K W nMi K W. PMi K.W AMi R W AMC H P
1 3.
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPEGAI REC'PT TIME CLOCKS ggtl UNIT HEATERS MSYSTEMStET DIMMERS
AMi. K. W. Oll H P GAS H. P. AMT NO A. W. G, AMi AMP AMT. AMPS TRANS. AMT. H. P NO. OF FEET AMT. WARS
1 ?tl 1
SERVICE DISCONNECT NO.OF S E R V I C E
AMT AMP TYPE METER L ]W 1 A 3W S A 3W S,B' AW NO OF CC COND A. W G NO. OF HbLEG A. W. G NO OF NEUTRALS A W. G,
EQUIP. PER A OF CG COND OF HI-LEG OF NEUTRAL
OTHER APPARATUS:
fs.f1 ~..",l-
*(.S`§fIlN7~.CDiG' ~"OC71r3 't"h.iv <rert~l~ic~r~
c~v€act~ nom~s:tiaDC~ at t;t.1e <9Gat~ of
ita~i~~c?~ic>xI ui1~,~*, f}rnr~ih@E T)y ttsatlsls&~
~r~vi.t-r~Itls~nnCa 'CC ~1.d ~~.vis~~b~Le CtR
h;~v~ fr~yLi~Dt t;eae iindf%~e xe~aai~~
Ixad~z ~iY a c~ttal,~faet~ prar.~;orz.. p
E}f3C1'1 k~(1~377ti,t1 1.,~c".~2~t1a-F
YAT I,ATaE
FfAT'S'l"PfICT<; hIY, ~ 14r+i GENERAL MANAGER
I.~
Per
This certificate must not be altered+n any manner; return to the office of the Board if incorrect. Inspectors may be identified by their crodentials.
COPY FmR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
lELD I;:S:c...IiJ:i ~Ivni~ j (1 ~JMMLNTS 't
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'OUtiDATION._.. (1st)
'OUNDATION (2nd) _ _ ~
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;OUGft FRAME &
PLUMBING c~
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C1ISULATIOPI PER N. Y. • • 'j
STATE ENERGY ~
COpE
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FIiJAL
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BOARD OF HEALTH
3 SETS OF PLe1NS
FORM N0.1 SURVEY
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC r•OR*i
TOWN HALL
SOUTHOLD, N.Y. 11971 NOTIFY ~C/~'" $ (U-6
TEL.:765~1802 CnLL
Examined /z........., 19lf9 MnIL T0:
G/' ~y D
\pproved (9(1./,PermitNo.~r~a~./.
Disapproved a/c ~ !
BLDG. DEPT.
TOWN OF SOUTHOLO
ddino Inspector)
~'IMMEDIATELY'~ App///LICATION FOR BUILDING PERMIT
ENCLOSE P004T0 CODE q
UPON COMP4E110N Date ~ ? . _ 15 P.
BEFORE "WATER'
• INSTRUCTIONS
a. Tltis 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 York, 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, housin; code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections.
'~IMMEDtATELY (S~gnaturg oL>applicarlk ~o'~ nar~t•e; if a corpoinnon)
ENC40SE POp4T0 CODE y7 ~ c/
UPON COMPLETION . 1~ ~3iN7~~°=~°~ ~'(,;;'/~;SC/C:.'~(..'... - .
BEFORE 'WATER" d.~C; (~yjl1}g Rdrilr~s~°ditappli'caitf}"'
State whether applicant is owner, lessee, agent, architect, engineer, general,~c~q~t~gypt'lerelectrician, pluin`ber or builder.
~w:~ •„3;,i,.,
Name of owner of premises ...lrJ/`r:~?~C:~.... ~'??f9',5~...+F....x..;•.;2~ZN~~/~~
, ..,•l.lLtD~FFI([-c-.
(as on the tax roll or latest deed)
e. ,
If app ' a t 's a corporation, signa ure my authorized officer. st.a i..
0 ,~ACY OR
Name and title of corporate fi )
qq ~ UNL4FUL
Builder's License No. G~ Z . • • • • • IT®UT CERT~F~CATE
Plumber's License No . • • F CCU9 A C
Electrician's License No. ....4,';"'~Z?Z!t:.. ~eT'?2tC
Other Trade's License No . .
I. Location of land on which proposed work will be done. . , ~,',lN S~~ G~~~Z /y~ t:
House Iv'um ber Street. f ` ~ • • ~ • ~ ~ • " " " "
~ Hamlet
County Tax Map No. 1000 Section ~r~Sa BI'ock , , , . , , , , , , , Lot
Subdivision Filed Map No. Lot .
(Name)
State existing use and occupancy of premisesyand intended use and occupancy of proposed construction:
a. Existing use and occupancy /2,L~:1 UJ~;!~,ri ~ 4,
b. Intended use and occupancy /'~~~/•~r~!~?.~~.~.-, , , , , (.~`f na ~ L
i C
ature o work check which q
Re air • . • • • • • • R`mpplicable): New Building Addition Alteration
p oval " "
' • ' ' ' ' ( • • • • • • • • • Demolition Other SVork
4. Estimated Cost ~ (Description)
Fee.............
5. If dwelling, number of dwellin (to be paid on filing this application)
g units , , , , , , , , , , , Number of dwelling units on each floor , • .
If garage, num bcr of cars • • • • .
6. If business, commerci~libSjFnixed°ocep`p~.r~j~}i., specify natur and extent of each type of use . •
7. Dimensions of existing strt~ckuges, if any:lltront , Rear ~ ~ • ' ~ ' ' ' ' ' ' ' ' '
Height Number of Stories . . ' Depth .
Z ons or additions: Front ~ ' ' ' ' ' •
Rear
HLP,lnsrons of same st ~~rncl~tn: Ft { ~ ~ • ' • ' ' • • ' ' • • • • Number of Stories .
Nur... et
8. Dimensions of entire new cons nber of StQrics , , , , , , ' ' '
rotit . Rear , Depth .
9. Size of lot: Front Rear,
l0. Date of Purchase ~ Depth •
..Name of Former OwneY~ , $ £~'"3."t w; %i.; _ ~ • ~ ~ ~ "
41: Zone or use district in which premises are situated , , , , , , , ,~~i ~.?C9!•'~L6~ ~ 1 " .E f'i'ts' ' '
12. Does proposed construction violate any zoning law, ordinance or regulation: ~ ~5 i s': • ~ • ~ •
13. Hill lot be regraded , , , , • , , , , , • , , ,Will excess till be removed fronS piemisi•s:'' es NU
14: N.•rme of Owner of premises . , ~tj ~~+~-(r.1,4 • . • ,Address ,~~1;~7
f,TCe f'j~, Phone Na...' - $~iy
Name of Architect ,Address '
Name of Contractor , . G 1. ' ' ' ' ' • • • • • • • • • • Phone No. .
/'7` ~4 j. • • y. •~`.S~?a!~... Address q~ C
IS.Is this property located within 3100 feet ofd a•~~tland?n*YES~NO. •6~ ~ •
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly aI1' buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner~loet.~' I,
r,~---- r--..
PERMlT lR1d'L11~~~ ,~PPR0~I7T.
APP V A AS 1~07~E0g TC~ F3fmil~d~'E aN3~d:~ ~r9i.~.
DATE: 9.P. k,l.,(J ~ 97 '~FI~IIk';A(~`CSt+E PREM16.~fi FAY
F E: ~ @,y; - RECJRAENNt~L4YY' ~ `
. N~IFY BUI Ci tTEPA TAT 11tIIYAY CONSTRUCTION .••,,,~,,,,,o_„_„
766.1807 9 AM TO 4 PM! FOR THE t,'ES>IFOGiI CONSTRUCTION _,_,,,,,,.,.,t,,, -
FOLLOWING INSPECTIONS:'', L~,I,AR ~y TRUCTION
t. FOUNDATION - TWO REQUIRED
FOR POUREb CONCRETE ~TIIER ~./,,,3,,,,~,,,,,
2. ROUGH • FRAMING & PIUMSING
3. INSULATION ,
A. FINAL - CONSTRUCTION MUST
8E COMPLETE FOR C.O. '
ALL CONSTAUCTlOM SHAtI MEET
THE REgUIREMENT6 OF THE - NY.
STATE CON51'RUCTION ENERGY ~ r ~
CODES. NOT RE$RON, SI 1~ FOR
Of:SIGN OR CONSTRUCTION ERRORS . ° ` °
' ~ 0.1L;~9 ~~~~~'i i L.
STATE OF NE1V ORIi
COUNTY OF ..~~t-/.•:j`d C;(~ • - , S,~. ~ @,JC
~~a~ f ind~dua ~ nirl(L~ r • • ' ' ' ' ' • being duly sworn, deposes and says that he is the applicant
L g contract)
above named.
fie is the ...................~~~~CTOl~...... , .
(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 arc true to the best of his 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 I
.......................day of.;....
Notary Public, ,,,,,•,,,~..~•~4iUd-L
County
NELEN K. DE V6E
NOTARYPU8L16,Ste[eofNewYork a .re of applicant)
No. 4767878, Suffolk Ceue
Terra Expires Mxrch 30,1