HomeMy WebLinkAbout29101-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-29935
Date: 12/30/03
THIS CERTIFIES that the building ACCESSORY
Location of Property: 1540 JACKSON ST NEW SUFFOLK
(HOUSE NO.) (STREET) (HAMLET)
Cothnty T~ Map NO. 473889 Section 117 Block 10 Lot 12,4
subdivision Filed Map No. __ Lot No, --
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JANUARY 9, 2003 pursuant to which
Building Permit No. 29101-Z dated JANUARY 14~ 2003
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 SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR.
The certificate is issued to CLAIRE & ALLYSON MANNING
(OWNER)
of the aforesaid building.
SIIFI~LK CO~ DBPART~I~T OF t{F~%LTH APPROVAL N/A
EI~EC~ICAL CERTIFIC-~q~ NO. 1156387 08/07/03
pLI3MBERS CERTIFICATION D/¥~d3 N/A
nature
Rev. 1/81
FORM NO. 3
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)
PERMIT NO. 29101 Z Date J~kNUARY 14, 2003
Permission is hereby granted to:
ALLISON MANNING
1540 JACKSON ST
NEW SUFFOLK, NY
for :
CONSTRUCTION OF ~N ACCESSORY INGROUND SWIMMING POOL IN THE
REQUIRED REAR YARD AS APPLIED FOR
at premises located at
County Tax Map No. 473889 Section 117
pursuant to application dated JANUARY
Building Inspector to expire on JULY
1540 JACKSON ST NEW SUFFOLK
Block 0010 Lot No. 012.004
9, 2003 and approved by the
14, 2004.
Fee $ 150.00
Authorized Signature
ORIGINAL
Rev. 5/8/02
Form No. 6
~owNDESOI/IHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to thc Building Department 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 1% lead.
5. 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.
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, building and unusual natural or topographic
features.
2. A properly completed application and 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.
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25. J~0, Alterations to dwelling $25.00,
Swinuning 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 - $.25 /
4. Updated Certificate of Occupancy- $50.00 ~
5. Temporary Certificate of Occupancy - Residential $15.00, Commcmial $15.00
Date. December 30, 2003
New Construction: xx Old or Pre-existing Building: (check one)
Location of Property:
1540 Jackson St
Suffolk
House No.
Owner or Owners of Property: l~nning
Suffolk County Tax Map No 1000, Section
Subdivision
Permit No. 29101
Health Dept. Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $ 2~ .00
Date of Permit.
Street Hamlet
! 17 Block 10 Lot 12.4
Filed Map. Lot:
I / 14/03 Applicant:
Underwriters Approval:
Final Certificate: x (check one)
Applicant Signature
BY THIS CERTIFICATE OF COMPLIANCE THE
NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
STREET ~ NEW YORK, NY 10038
40
FULTON
CERTIFIES THAT
Upon the application of upon premises owned by
DOROSKI ELEC. INC ALLISON MANNING
P.O. BOX 781 1540 JACKSON STREET
CUTCHOGUE, N.Y. 11935, NEW SUFFOLK, NY 11956
Located at 1540 JACKSON STREET NEW SUFFOLK, NY 11956
Application Number: 1156387 Certificate Number: 1156387
Section: Block: Lot: Building Permit: BDC: NS11
Described as a Residentia! occupancy, wherein the premises electrical system consisting
electrical devices and wiring, described below, located in/on the premises at:
Outside, Pool/Spa,
was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below, was
found to be in compliance therewith on the 7th Day of August, 2003.
Name QTY Rate Rating Circuit Type
Appliances and Accessories
Pool/Spa Bonding 1 0
Time Clock/Switch 2 0
Furnace 1 0 Gas
Panels
1 50 3
Wiring and Devices
Receptacle 2 0 20 amp Pool/Spa
Switch 2 0 General Purpose
Receptacle 1 0 GFCI
Fixture 1 0 Pool/Spa
(Swimming Pool): This certificate covers compliance at the date of inspection only. Because of unusual environments it is advisable to have
frequent test and/or repairs made by a qualified person.
seal
1 of 1
This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated.
BUt-LD} NG-t -a¢t GI- EC -
Applicant/
Owners Name:
Architect/
Engineer:
SCTM #:
District: L_00~0 Section
·
Date
Submilted
Io ,.o~
I.ocanon: /3 ~L~ ~, -- Name
Single & separate Reqmred iff A
cemfication ~es / N~3 ~/ ~
Req Req
[JVronl Yaa-d prorJoscd: __] [Side Yard ~t~_ /ltoposed
~] [Rear Yard _
Project Description: / 3 C~
AGENC~x~:I?ERMIT$
REQUIRED FOR REVIEW
N.A. NO YES
P..ermit
Number
Suffolk County Health Dept.
New York State D, E. C.
Town Trustees ,/
Town Zoning Board approval:
Town Planning Board approval:
Flood Plane Elevation ???
Flood Zone:
Notek:
765-1802
BUILDING DEPT.
INSPECTION
] FOUNDATION 1ST
] FOUNDATION 2ND
] FRAMING
[ ] ROUGH PLBG.
[ ] INSULATION
[ ~FINAL
] FIREPLACE & CHIMNEY
DATE
INSPECTOR
FOVN~A~ON Os~)
ROUGH FRAMING &
STA~ ~ CODE
TOWN OF SOUTHOLD
BUILDIN~ DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: 765-1802
Examined ~ /l'J ,20 0 ¥
Approved d/t{ ,200.~ _
Disapproved igc
PERMIT NO.
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying ?
Board of Health
3 sets of Building Plans
Survey.
Check
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
Mail to:
/ Building Inspector
APPLICATION FOR BUILDING PERMIT
Date
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 waterways.
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 issue a Building Permit to the applicant. Such a 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 what-so-ever tmtil a Certificate of Occupancy
is issued 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 Coanty, 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/c.~de, and regulations, and to admit
authorized inspectors on premises and in building for necessary inspections.
'q M M E D ~ATE LY" 8t0um (Si~e of a"'pblica~t-/)na~, ~-a corporation)
TO°ODE
UPON CO;'F'~LETION
B£FD,~E. "WATER" (Mailing address ofapplicanO
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
~q
Name of owner of premises ~]]kfOlq
(as on the tax roll or latelll~ed) 15-o. BY: Z ~
If applicant is a corporation, signature of duly authorized officer
OCC[IPANCY O~
USE !$ ~NLA~FUL
WITHOUT CERTIFICATE
OF OCCUPANCY
(Name and title of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No. 'q'~(a- k~ ]
NOTIFY BUILDING DEPARTMENT AT
765-180~ 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
2, ROUGH - FRAMING & PLUIvIBING
3. INSULATION
4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
THE REQUIP, EMENT$ OF THE N~Y.
STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERROR~
1. Location of land on which proposed work will be done:
I ¥ ~ 0.'Ta er_~ o t~ ,~'hee e r
House Number Street
County Tax Map No. 1000 Section
Subdivision
(Name)
113
Hamlet , :
Block J{~ ~. Lot 012, 4 ,
Filed Map No. Lot
State ~'istin~ use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy '----~ lfie~d.,
b. Intended use and occupancy ~ ~e~c~c ~'~0~M~,aJq /~2:.
Nature of work (check which applicable): New Building_
Repair Removal Demolition
Estimated Cost 1~ O'00 - Fee
If dwelling, number of dwelling units
If garage, number of cars ..----
Addition Alteration
Other Work~d~x0tvd .i~o L.
(Description)
(to be paid on filing this application)
Number of dwelling units on each floor ~
If business, commercial or mixed occupancy, specify nature and extent of each type of use.
Dimensions of existing structures, if any: Front Rear Depth ~ ~/2 --> ~
Height. Number of Stories
Dimensions of same structure with alterations or additions: Front
Rear
Depth Height.
Number of Stodes
Dimensions of entire new construction: Front
Height Number of Stories
Rear .Depth
Size of lot: Front ~ OO ' Rear 1(3t3' Depth c~D~O '
O. Date of Purchase
Name of Former Owner
1. Zone or use district in which premises are situated
2. Does proposed consti-uction violate any zoning law, ordinance or regulation: ~J O.
3. Will lot be re-graded ~0, ~ ~colWill excess fill be removed from premises: ~) NO
4. Names of Owner of premises ~li~gg ~t~l,,t~ Address L~to~J~t'.r,.51;)~ S-} Phone No.
Name of Architect'-DxO[t~s g '~e, illg Address:~l~Phone No
Name of Contractor ~ ~'omtos ~oo/s . Address .t~ ,~- ~ ~[d[~rPhone No.
?lac4
5. Is this prope~y within 100 feet of a tidal wetland? *YES NO
· IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQUIRED
4q6--
5. Provide survey, to scale, with accurate foundation plan and distances to property lines.
7. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey.
FATE OF NEW YORK)
SS: : '
OUNTY OF~.~rOLK )
~ '~}O~. ' ' being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above .gamed,
;)He is the
(Contractor, Agent, Corporate Officer, etc.)
said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application;
at all statements contained in this applicatioware true to the best of his knowledge and beliefi and that the work will be
~rformed in the manner set forth in the applicatipn filed therewith.
~om to before me this
~ day of
I- <J Notary Phblic
2003
MARGARET A. BANNWARTH
Notary Public, State of New York
No. 01BA6021t 11
Qualified in SuffoJk County
Commission Expires March 8, '~0~,
Signatu~ of Applicant
WOOD
FRAME
RESIDENCE
CHIMNEY
NOt I~VEFER,~X 10
¥ ~ v' /
/
N/F' GIRARDS
cy
SURVEYED: 25 SEPTEMBER 2002
SCALe 1 "=JO'
AREA = 20,343.54 S.F.
OR
0.467 ACRES
TM~ t 000-; ! 7 - 1 O- 012,4 SURVEY OF
DESCRIBED PROPERTY
SITUATE
NEW SUFFOLK, TOWN OF' SOUTHOLD
SUF'F'OLK COUNTY, N.Y,
SURVEYE*~ /:'OR: ALLISON MANNING
GgAf~NTEEO TO. ALLISON
STANLEY .J: ISAI<SEN, ,JR
P O 'BbX'294 ':
NEW_ ~UF'F:OLK. N:¥. ; 1956
631-73~-5835 ~..