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HomeMy WebLinkAbout16756-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z-I6669 Date February 25, 1988 THIS CERTIFIES that the building INGROUND POOL; HOT TUB; & FENCING Location of Pro err 1800 Country Club Dr. Cutchogue, New York House No. Street Hamlet County Tax Map No. 1000 Section ... ! 0..9 ...... Block 03 ..... Lot 2. 18 S ..... M/o Country Club Ests. 17 uoalvlslon ............................... Filed Map No..6.7.3.6 .... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... · J.a.n.u..a.r.Y. · .6:.. 1. 9..88 pursuant to which Building Permit No. 16756 Z dated .... .F.e.b.r uar y.............25, 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 ......... ..... ~?.q~.p.u...p..s~!..~..~...q' ~..o.o.~. ~..~.o.~. ~..u.~. ;.. ~...~.~.~.c.[.~.~.. ~..s..~.~.~.77.~.~.. ?.o.~. ....... ROBERT & NANCY BERTORELLO The certificate is issued to ..................... [o~,'o;,T/~b'~$rT-.t~ ..................... of the aforesaid building. Suffolk County Department of Health Approval ..... N / A UNDERWRITERS CERTIFICATE ~t~ N 848730 N/A PLUMBERS CERTIFICATION DATED: Building Inspector Rev. 1/81 ~vOEM NO. ~ 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) No- 16756 z County Tax Map No. 1000 Section ....... I...O...,~l. ....... Block ....... ..~....~. ..... Lot No......~...:.1..~ ....... pursuant to application dated .....~.~...b ..................... 19..~..~..., and approved by the Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 BLDG. DEPT. TOWN OF SOUTHOLD APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted m~ to the Building Inspec- tor with the following; for new buildings or new use: I. 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 equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect 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 p~operty 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 condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate, C. Fees: Additions $25.00 POOLS $25.00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling $25.00, Accessory,$10.OO Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date ~' ~-,1'~,~ NewC°nstpucti°n ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property L?,°.°...~,.,.~u.q~.. ...........'~'4.~ ~L'L~JD '~'': ..... ~O'cf'L~',?"]~:'/'I~3s ...... House No. Street ~J Hamlet Owner or Owners of Property .~.~.~'%. ~..~...O~,q. ~, .~..~,o~..~..~..~. J.O. .................... County Tax Map No. 1000 Section .... I. ©.~. ....... Block ...~ .......... Lot...~..'. I ~ Subdivision ~:o...u~..~.:,~.~.LL~.~. ..... .~.~.'.~.~..7?.%. ...... Filed Map No. ~7.~ L~ .... Lot No... !?/ ........ Permit No ........... Date of Permit .......... Applicant .¥.q~. O~ . .~;~..~.~..~e~L ~ ~. ......... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes and regulations. Rev. 10-10-78 P .3qo53 . FOUNDATION FOUNDATION (1st) ROUGH FRAME & -PLUMBING (2nd) INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONA'L COMMENTS: 330.00' $' 4°13 '50 III ~' 259.83' ~,v m~TNI7 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the electrical equipment ~ ~scrlbed below and introduced by the applicant ~ed on the a~ve application number in the prances of Bob & Nancy Burtorello~ W/$ 1800 Country Glub D~lve, ~orem in the followlng location; ~ Basement ~ Ist Fl. ~ 2nd FL O~t ~d~ Section Block Lot wasexatn~nedott Dec~ber ]0~ ~ and found to be in compllance u'ith the requirements of this Board. I 1 1 MULTI-OUTLET SYSTEMS NO. OF FEET E R V I C ~Wv~_M~N~G..f.~0~)j This certificate covers co~liance at ~he date of inspection only~ Because of ~usual environ~n~s it is advisable to have frequent te~t end/or repairs ~mde by a qualified Celi Electrical Lighting Inc. 211 Riverhead Road Westhamp~o~% Beach ~ N,Y. 11978 Lie. 1022E MANAGER This cerfificdte 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 BOARD OF HEALTH ...... 3 SETS OF PLANS ....... [:OHM NO. 1 SURVEY . . TOWN OF SOOTHOLO C~ECK . ~' BUILDING DEPARTMENT SEPTIC FORM ............. : TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 TEL.: 765-1802 CALL ................ MAIL TO: Approved .,~ .~, ."q4 ..~...a.'(., 19~. .~. Permit No. [ .lq .-./.S."~...q:,.. Disapproved a/c ..................................... ................................... : ....... (Building Inspector) · APPLICATION FOR BUILDING PERMIT 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 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. . .~...~.c~.~.ff......~4.'. :~.r.-:,e., .~,/:O. ............... (Signattffe of applicant, or name, if a corporation) (Mailin~, add~gs of applicant) //~-:?.5 State whether applicant i.,os~essee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................................................................... ~.~o~,:~~. .~;~ ~97!~ ..... Nameofownerofpremises ~'c~.~-.~- ' ,c/.~.&'r~., ..~.~4.~ q~ on the tax roll or latest deed)~ ,~..~. ~ ,~, ~]. I~ ./~ If applicant is a corporation, signature of duly authorized officer. ~'~©T~F¥ ~tk.O~NG FOCi O'~'~ f'i[~ (Name and title of corporate officer) ~OtJ~DATIO~;~ ALL CONTRACTOR*S MUST BE SUFFOLK COUNTY LICENSED ~ff Builder's License No .......................... ~G~ Plumber's License No. / ~& ~.~ .............. 4, ~,~AL Electrician's License No ........................ ~ 'aec' ;~¢,. r. lq Other Trade's License No. C ¢ff?~ ~nl 1. Location o¢land on which proposed work will be done .................................................. House Number Street Hamlet Co,nty *~x m, ~o. ~000 S~¢tio, . ./~7.0.0 ......... mo~ ~ .9.~ .......... rot .0.¢2:~(. ....... Su~ai~i~io, .~X~.~. ~¢:~ ........ ~il,d U~ ~o. ~'.7¢.¢ ........ ~ot../.7 .......... ¢ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................................... b. Intended use and occupancy ~O./~... {d ¢2~.. ' ....... 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Descriplion) 4. Estimated Cost d//O~ ooo. oo ' (to be!paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling unRs on each floor ................ If garage, number of cars ............................................ , ............................ 6. If business, commercial or mixed occupancy, specify nature and extent of each tyke of use~ . .................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Nmnber of Stor/es ............................ ............................ Dim i f with It ti dditi F ' R ens OhS o same structure a era ons Or a ons: ront ........... , ..... ear .................. Depth ...................... Height ....... ............... Number of Stories ...................... ' 8. Dimensions of entire new construction: Front .......... ..... Rear. ...... ;.....' .. Depth ............... Height 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: ...2 ............................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises Z.'9.~.&~.-ff. ?.2/d~..q.r~..d['J~'f',~ffdress/.~.o9.('p.~.4 .t,y~..¢&~4 Phone No 73~'-.~776 0 Name of Architect ........................... Address . .27... ~.z..~gL/z~. ~ ~..~.... Phone No ................ Nan~e of Contractor Address ' Phone No I5. Is this property located w±thin 300 feet of a t±dal wetland? ~Y~s ..... No ..... *If yes, Southold Town Trustees Permit may_ be required. ~ PLOT DIAGRAM ~ Locate clearly and distinctly all buildings, whether existing or proposed, and, ifidicate all set-back dimensions from property t/nes. Give street and block number or description according to deed, and shoVe street names and indicate Whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ................. ....~..~/,c~/."}C~..../~...~../.O..~..~../.{'O. ................ being duly sworn, depOses and says that he is the applicant (Na~e of individual signing contract) above named. He is the..~ ................................................................... (Contractor, agent, corporate officer, etc.} of said owner or owners, and is duly authorized to perform or have performed the ~aid work and to make and file this application; that all statements contained in this application am true to the best of hi~ 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 ............. e .... ., ..... day of ...... ~ .......... 19..~. Notary Public, ....... ~ .... County HEt.£~* I{. I~l~ ~E ' ' ' ................ NOTARY POfll. l~. State af N~w York (Signature of applicant) rio. 4707878 Suffolk Countyc:,~