HomeMy WebLinkAbout17403-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-19688 Date JANUARY 29, 1991
THIS CERTIFIES that the building ACCESSORY
Location of Property 3300 REEVE RD. MATTITUCK, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 100 Block 1 Lot 3
Subdivision Filed Map No. Lot No._
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 26, 1988 pursuant to which
Building Permit No. 17403-Z dated SEPTEMBER 8, 1988
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 ACCESSORY INGROUND POOL WITN DECK & FENCE ENCLOSURE.
The certificate is issued to BRIAN E. & DIANNE F. KELLER
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
CERTIFICATE NO. N-122217 - APRIL 4, 1990
PLUMBERS CERTIFICATION DATED
o'L _
Bu' ding Ins ector
Rev. 1/81
roans 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)
Ns 01740s Z Date ......1'1..-..~ ...................................... 1
Permissi2on`is he by g nt~to„
~~3~`~,~
~~~
to .L^aQa`"y` ......Qr....
at premises located at ..~..'3.S
..... `....c...........~..~r.....~~.~
...
......
r... .....................::..:..:..
~,....C1,T1. r'~........~1~~s~ ~~~~c-
........................................................................................
Caunty Tax Map No. 1000 Section ....,,~Q.d........ Block ...........~....... Lot No .............`~~...........
pursuant to application dated .........,~~..~~...:6 ............................... 19 and approved by the
Building Inspector.
O~
Fee $./...
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A.
This a'~~-l~cation must be filled in by typewriter OR 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 Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of 19 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.
B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings anc
"pre-existing" land uses:
1. Accurate 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.
If 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,
Alteraeions to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00,
Additions to 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 $15.00
Date ......~:'2d'-.9~ .........................
New Construction....: ... Old Or Pre-existing,~Byu~ilding .................
Location of Property...,r~.r?.4P..~~:~~.~_ill.l.'4.~:!NC!c......!1/'•.(!J .. ................
House No. Street Hamlet
Onwer or Owners of Property...lJJ~l~Ari!.~ .~ . ~/f :/•%E .~.. ti~~4~:~ .................. .
County Tax Map No 1000, Section...,l.O ~.~......B1ock...~............Lot......~ .............
Subdivision ....................................Filed Map............Lot......................
Permit No.~~~p~......Date O/f Permit...l.:d.:~~....Applicant....C7:..ifGGl.G~ll-c.1L.S!Q:k!,~;
Health Dept. Approval...... N/~• ..............Underwriters Approval....~.~. 2 Z:~ / 7........
Planning Board Approval.... ~~~ .............
Request for: Temporary Certificate........... Final Certicate....~..
Fee Submitted: ~~
~O ~ t~(p~$~ APPLICANT .
THE NEW YORK BOARD OF FIRE UNDERWRITERS t•A(,1 =
_
~ 111) 7, ~"~(~ BUREAU OF ELECTRICITY _
8S JOHN STREET. NEW YORK, NEW YORK 10038
paw Ai"kii Uh,14411 ApplicsttonNo.onJile 6h4.6;M16ty(FS9 M ]22211 ~i
THIS CERTIFIES THAT
owty the alecAted puipment a dsscri6ed 6e/oto and introdrtced 6y the sppNcent rtamsd on the ebooe eppBcation numtiv in lhs premises of -
fl
iiit(AN Xf.tLEN, RP.r.yrss AW'.., i1A1"f(_flY.::K, H.Y.
in thsfdlouinq lorntion; ^ Barement ^ let Fl. ^ Ynd Fl. 0111 .Section Block Lot
toss examined on MANCM D7;, 1,44Y) ondJound to 6e in rnmplisnce frith the reyuiremenu of thu Board.
pX7URE RXTURlS RANGES COOKING DRCltS OVENS Dell WAfINRS FDBIAUST ANS
OUTIMS ACIES SYpTCMK INGNpESCEM ~ FlUOREECEM OTNEfl NAT. K. W. AM7. K. W. AMT. R.W. AMT. K. W. AMf. N. r.
} ~ ) 1 i
DRYRRS IURNACE MOTORS IIJi1NE At7OAttt7 IRtRIMK SetOU IN'-T TKRE CI.OCIIS _ ~. 1NMi 11EA7NS DMAAIRRf i
AMT. K. W. 011 N. I. GA5 N. I. AMT. M). A. W. G. AMT. AMI. AMT, MVt.. TRANS. -AMT, K r. ~. ~ 1Yi AMT. WATfe -
S_
7 1(1 1 40
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7
SRRVK= gS COlBilCT NO.Oe S E R V 1 C E
AMT. AAV. Tm per. 1 ~ tw 1 e xw a.e xw x,e ew No. o~ ecouo. or cc c~i+o. No. a N1~tEC pA, w. No. a NEUru1t a 'NWeu~tN
O7NER AlMRATUS:
rggl rk 1:ev (rnl:ff r sru-1) Dell. Y )~ _
_
_
'(SMiCMMCNr; t'001_) Thlw ~:eriit'i~;al„ ^
rovers comp] i Nnce nt 1.11r date !rt
7..ISpOS='f.[411 Ollly. ISp,:.U,l$~) ~)P litllla,lal f!
PfiV'dPOll lK t?r1Y Fe a{'. 75 is (IV A'.:+ble Lb
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irtve fr~eaur.ni; 1;n~1L lndlor~ rep.lir,;
kndt~ by n uur711fied 1><,rvori.
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fP.l) CtNf'ililRl. JR. 1;[i. I R;,g45:5-t'
P. U. K U X '. `, h A ONlAI MAN ~
42RO rUUNIi AVE. f
MA1'I I Ill(,K, NY, i 1'1`., ~ Pte
This nrlificoM muff not be altered in any mannsrl return to the offin of the Board if incorrect. lnapacbrT igpy 4t,. id~ipd by their cradetKisit. t
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MBST NIIf K A4TERBD IN ANY M11!(6R. -
~. ~_ a _ .:.. ... ~_. ;; a
cIELD It;SPEC:iu;t ~ ~uaT:; ~ co~~rMrixrs ~
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FOUIJDATION (1st)
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FOUNDATIOtJ (2nd) f
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OUGH FRAME &
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.PLUMBING
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INSULATIOPI PER N. Y. ~ y
STATE ENERGY
CO
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ADDITIONAL COMMENTS: x
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765-1802
BUILDING DEPT.
1 NSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
DATE ~ ~~ INSPECTQ~/-~/ i~ /
[ ]FRAMING [~NAL
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LOT to
SUIIOLR lOUNIY J1E-ARIMFNT tli. NIAEIN SERYIi.EE
IOR M/ROVAI ~Oi IONSIRUEf10N ONLY` ~ ,
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uAfE~y,,,Hf,REi. NO,~,._,,,.•.;,y.-,_,,',
11~11~ 1 1•
~Ip/RDVID
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is I n/I A/1 E®IATELY"
~ + ENCLOSE POOL TO CODE
r UPON t;OMPLE7tON
• BEFORE "WATER"
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silE v9 ~E®iA
Gun. ws- _
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the weler fuPD~Y end seweq! dispofEi syitemt (or ` ~,;' '''
thu reiiderite I+ill lonlarm to tll ~
the SuHcl4 County Deperimcnt of HRill6~~-~~"'"'""""'-^•----
SUFF. GO. `f"!-~Yf MA.P CTS`T. IAG?C? I.+~G"E'. 1!}C~ , F31..d~ H. 1 ~ :l.:C'?"i' °S : .
G l.. E V /1'T 1 0 1•J Ia A tL ~'. 1 N /~.'~+S U M ~'. O ~ ~ f.7A."Y V M . •. ,:.~-., ^~~ ~,{. .~..
MAP NO. n-(.!~ ~~ pAT4i AI.R l4+ 3 ~ ~°~f•G,<4 '. ~ ~~y`1."iAE'Y O J~'•~
. .rr.nr,j ~i17 5 (!
. . ~. ~ .. , , ; ." r. ,',' ;1i'.!}.'.~'j~ :~,~N i ~.x. fJI:Q~ VEYORs
li~ 1':q'~ n ,.. '
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AuI• or 5/S.t....'T",d. (C~. ~.+ E:,.~`,1~ ~"t"' ' ~ ~,:~ :;J~t`. A r'~,,i ~. Y, • .
:. , r .., . ~ R 'lI ,P7~ IlGr tlA^ ~ ~ 0
LOCATtONr MA."f"a'~'(Tl..1C'.t~.. ~~'T'OWIJ ~~~~Ot?,'.~a01,t7M4. ~~, ~ ~ CI,Og7,4U ~lJ[~,_~
GoUN'rY c7 E' ~a1..Jt'f••C71..•K~ F+E+`(, 1i-.~. `.';41C,, hKrl?~ 16~475.03R9
SURVEY 6D: SEP"-', 27 + E J't"t' _
'GUARANTEED Tor ~-- ~, ~^ -ri1,,,F~, ~. c:-,. ,-T•~-
SCALE' ~ p.r i ~ E F:;-•r,
FO•..•IO aV /'.V-•. .• • • • ~u+~.. +w~. ..«r•'..n« r1r~r.. n..1.. ,...a.• ~~....au.•~
Y" x ~=----~ ~ "
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~. 2.14.r,~1/
FORM N0. 7
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
~...... ., 19~QU~(
~........., 19'!!! Permit No.I~~D`3 .~
Disapproved a/c .....................................
BOARD
3 SETS
SURVEY
CHECK
SEPTIC
NOTIFY
CALL
MAIL
..................................................
OCCUPANCY O ~~~~`~'
(Building spec or)
USE !S UNLAWFUL'QPPLICATION FOR BUILDING PERPAIT
~F HEALTH ....
OF Pi ANS ..
i
FORM .............:
................
T0:
~~°l~OUT CERTIf~C~~'E p Date .. ~1~G........., 195-? V
INSTRUCTIONS -aMpC~a.~'
a'~ hippli°caont~st~e completely filled in by typewriter or in ink and s~ 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, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections.
~~ ~~11i$~~r213
,,.,,,~...,,.~.,.,,.,,. * :4.A .,..„,_.._.,_.._. ~1 ~ k (Signa//tu``re of applicant, or name, if a corporation)
~~ ~ Al47t1 Ch. ~~l jpi i%'] 4. ,, 1^'.'.,V ~[/ /' "/•'•' •"•/•/• / •/~"• l.'/~C.... `
190 ~ Rita ~, ,,; (bailing address of applicant)
State wheta{is ow~q&,r~,r~@ssp~„~ agent, architect, engineer, general contractor, electrician, plumber or builder.
e~;:~,,., t,
Name of o'tcl4i~;tltofi~>~k"Ihhfi,<e~',~:.`_..... ~9~ f f~./.U ~~~ZL~~ ............... .
........................
C1.:3 t~+`~ t '-` g ~ ~ '~ (as on the tax roll or latest deed)
tuie of~dula authorized officer.
s
ALL CONTBACTbR'$ MUST BE SUFFOLK COUNTY LICENSED
Builder's License No......~q.`z.-.l:f.~........
Plumber's License No . ....................... .
Electrician's License No. ~d~~~~..~ZEz-~C
Other Trade's License No . .................... .
]. Location of land on which proposed work will be done. ...... !. "5'~"(.T./..~'ce~... !1~:.~ ............... .
House Number Street Hamlet
County Tax Map No. 1000 Section ....% ~~.......... Black ...... ~........... Lot .......~......... .
Subdivision ..................................... Filed Map No. .............. Lot .............. .
(Name)
2. State existing use and occupancy of premis~e/s and intended use and occupancy of proposed construction:
a. Existing use and occupancy ........ fLE3i,!~E!h1TIdlZ. , , . , , ... .
........................
b. Intended use and occupancy ...........~~~~~L:~!/!/.~Pt-....~.!~;J~,,,~~QL,,,,,,,,,,,,,,,,,,,
r~/I~JSkiOtlG /~ObG
i ~~
3. Nature of work check which a licable): New Building .......... Addition ......t.-, , . 'A,lt~'aiio ';:. t...... .
a +., v ... ~; ~.., it
Demolition therkWork . '
Repair .............. RemoYal ..... , :. .............. (~4 ~ s ion. '' .>
( Pp Ei t
4. Estimated Cost ........~,',
...................
Q .. •. °~ .Fee ............... °i. '~ .1'z~
s iY
5. If dwelling, number of dwelling u ~ (to be paid o `t`i)•t§HtY, ~
nits ............... Number of dwelling units one h ~
..............
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 ................. .
De th .....................
p .Height ...................... Number of Stories ..................... .
8. Dimensions of entire new construction: Front ............... Rear ...............Depth .............. .
Height ............... Numl?er of Stories ....................................................... .
9. ', Size of lot: Front .......... . .......... Rear ...................... Depth =...,'.................. .
10. Date of Purchase ....Name f Former Owner ' `
........... mises are situated ........~C~/{,~;J/T/o7Z, ;;.:..°. °.,.:..-: , `
1 1. Zone or use district in which pre
12. Does proposed construction viol t any zoning law, ordinance or regulation: . , ; . S , °.~~.' .. ...:.............
13. WIIl lot be regraded .........~~ ............... Will excess fill be removed ~,f,rpp-m-prernfses: - Yes o
1
Name of Architect p ;J<~?.~e~ • ' ' ' ' • • Address . !?1!~'77?~:~~; /~if~Pllone Not;CY2-,~'~ ^'.,,f'9~
......... ................Address................. ,. PhonegNo,.;..............~
Name of Contractor remises. • . • • . • ........ • ....Address ....:............. .. Phone No:, .'..............•
15. Is this property located w
*If yes, Southold Town Tru~ithin 300 feet of a tidal wetland? *Yes ..... 'No .....
tees Permit may be repga~ired, x
PLOT' DIAGxAM
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block riumber or description according to deed, and show street names and indicate whether
interior or corner lot.
it
S~Z= /~'T~ l~~ Sic ~U~~
AwA~w~~,. w A 0At
NM08&pDp~~pE~Y~~ DATE: /.R 11' ' S~O.~
8E OWE WArE~ON OE NOTIFY B l o ~
!, 796-1802 8 AM 1O 4 FOl1 TlIE
FOI.LOWINO INSPECTIONS:
1. FOUNDATION - TIMOIISQURNO
FOR POURED
•s ~~'~'~ $. "I~bUaH - FRAIMigN!
E'NCLOSEI LY 3, uuswu-rION
MIME®~~1T,F •• ~ A. FfNAI - CONSTRUCTION MuaT
UPON ~ ~P~FOOCOO 9E COMPLETE FOR C.O.
BEFORE "Wg7ER•N ~ ALl CONSTRUCTION SHALL MEET
THE REOUIREMENT8 THi N.Y.
STATE CON$TJl
CODES: NdT
DESIGN OR-CONSTRUCTION EMRONS
STATE OF NEW YORK, S.S
COliN,T~/Y OF ................ .
• • • • ,rYQ~~~• • • ~ •~• • 2~~G•~y• • • •~:....... , being duly-sworn, deposesand says that he is the applicant
(Name of individual signing contract)
above named.
He is the ................. ~ ~~~e~ ......................... .......................... .
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly~I 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 application filed therewith.
Sworn to before me this
............. GZ,I° .. ..... 19 /~~
~ 4u~u~wZ.....,
Notary Public, ......~•1xX.'~-.Y o7.G;-• . ~Jl:. , ~-:
... County
Term Ea iras Merch 30, ....... ............................. . ....... .
NEIENKOEVOE (S' a re of applicant)
NOTARY PUOI C; Slate ofNew Yatk
No. 4 p07S~e, ~SeHalk iou9 n~q