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Home My WebLink About30113-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z 30521 Date: 10/26/04 THIS CERTIFIES that the building ACCESSORY Location of Property: 80 JERNICK LA (HOUSE NO.) (STREET) ColLnty Ta~ Map No. 473889 Section 70 Block 3 Subdivision Filed Map No. Lot No. -- SOUTHOLD Lot 16 ( HAMLET ) conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 23, 2004 pursuaknt to which Building Permit No. 30113-Z dated FEBRUARY 25, 2004 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 INGROIIND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR. The certificate is issued to JOSEPH L & LYNNE CARDACI (OWNER) of the aforesaid building. SO-FFOLK COUN~I~f DEPART~TT OF ~%/{ i~-PPROVAL N/A ELECTRICAL CERTIFICATE NO. 1206876 04/29/04 PLIIMBERS CERTIFICATION D~£~U3 N/A 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. 30113 Z Date FEBRUARY 25, 2004 Permission is hereby granted to: FOREIGN MISSION CATHOLIC PO BOX 306 MARYKNOLL,NY 10545 for : CONSTRUCTION OF AN ACCESSORY IN-GROUND SWIMMING POOL IN THE REQUIRED REAR YARD AS APPLIED FOR at premises located at 80 JERNICK LA County Tax Map No. 473889 Section 070 pursuant to application dated FEBRUARY Building Inspector to expire on AUGUST SOUTHOLD Fee $ 150.00 Block 0003 Lot No. 016 23, 2004 and approved by the 25, 2005. ORIGINAL Rev. 5/8/02 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 ,q APPLICATION FOR CERTIFICATE OF OCCUPANCY ,~[D 2 ~ 20~ This application must be filled in by typewriter or ink and submitted to the Building Depart nt v~ith'the following: A. 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. 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. 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, 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. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations 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 - $.25 4. Updated Certificate of Occupancy- $50.00 - $15.00, / 5. Temporary Certificate of Occupancy Residential $15.00, Commercial Date. ¢~/~ ~/q/ New Construction: Location of Property: Owner or Owners of Property: ~-~-~ ~/:/5/ Suffolk County Tax Map No 1000, Section Subdivision Permit No. ~-~'t~ .// :~ Health Dept. Approval: Old or Pre-existing Building: House No. Street (check one) Hamlet (_.~37d P Block (~ 0 o.~ Lot Filed Map. Lot: Date of Permit., ~.~5//~G~ Applicant: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate. Fee Submitted: $ ~ ~- ~- Final Certificate: (checkone) A~pl~cant Signature BY THIS CERTIFICATE OF COMPLIANCE THE ' ' ~ ~' NEW YORK BOARD Of FIRE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON STREET ~ NEW YORK, NY 10038 CERTIFIES THAT Upon the application of upon premises owned by PLATNUM EAST ELECTRIC, INC. 145 MILLCREEK DR SOUTHOLD, NY 11971 JOSEPH CARDACl 80 JERNICK LANE SOUTHOLD, NY 11971 Located at 80 JERNICK LANE SOUTHOLD, NY 11971 Application Number: 1206876 Certificate Number: 1206876 Section: Block: Lot: Building Permit: BDC: ns11 Described as a Residential occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: Outside, Pool/Spa, A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed herein, was conducted in accordance with the requirements of the applicable code and/or standard promulgated by the State of New York, Department of State Code Enforcement and Administration, or other authority having jurisdiction, and found to be in compliance therewith on the 29th Day of April, 2004. QTY Rate Rating Circuit Type Name Appliances and Accessories Time Clock/Switch Pool/Spa Bonding Wiring and Devices Fixture Receptacle Receptacle Switch I 0 I 0 1 0 Pool/Spa I 0 20 amp Pool/Spa 1 0 GFCI 1 0 General Purpose (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. 0 Z 0 L~ LIJ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING REMARKS: [ ] ROUGH PLBG. [ ] INS..~LATION ~-'~INAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION DATE FIELD ENSPECTION REPORT [ DATE COMMENTS FOUNDATION (1ST) FOUNDATION (2ND) ROUGH FRANIING & PLUNrBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www. northfork.net/Southold/ PERMIT NO. Expiration Examined '~1 "L< __ 20__ Approved .~\'}-~<~ ,20~ Mail to: Disapproved aye ~[~~. Phone: BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? ~ Board of Health 3 sets of Building Plans Planning Board approval Survey Check Septic Form N.Y.S.D.E.C. Trustees Contact: Building Inspector APPLICATION FOR BUILDING PERMIT ; i INSTRUCTIONS a. This application MUST be completely filled in by tyi: ewriter or in ink and suhirfitted 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 until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not conm~enced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an addition six months. Thereafter, a new permit shall be required. 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. // (Sigrra'~ture °f applicant °r name7 if a c°rpqrati°n) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name ofownerofpremises "~oS~//7/~. ~,;/,Z'Z:)~i Z~-~/,~- (As on the tax roll or ~test deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. '~/?/O Other Trade's License No. l. Locati_pn of land.~.d.d on which proposed ~ork will be d_one: House Number Street Hamlet County Tax Map No. 1000 Section 0'70~0¢ Subdivision_//4,d~5 7'./r~'~ ~-x?,~-s (Name) Block 2. State existing use and occupancy of premises and intended use and occupancy"¢~ .proposed construction: a. Existing use and occupancy b. Intended use and occupancy 3. Nature of work (check which applicable): New Building Repair Removal Demolition 4. Estimated Cost 5. If dwelling, number of dwelling units If garage, number of cars Addition Alteration Other Work Fee (Description) (To be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Height. Number of Stories Rear Depth Dimensions of same structure with alterations or additions: Front Depth_ Height Number of Stories Rear 8. Dimensions of entire new construction: Front Height Number of Stories Rear Depth 9. Size of lot: Front Rear 10. Date of Purchase Name of Former Owner .Depth 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES __ NO__ 13. 14. Will lot be re-graded? YES __ NO__ Will excess fill be removed from premises? YES NO Names of Owner of premises Name of Architect Name of Contractor Address Address Address _Phone _NI}. Phone IgZ/ 5 7- 0//7 Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet cfa tidal wetland? * YES NO * IF YES, D.E.C. PERMITS MAY BE REQUIRED. NO 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. STATE OF NEW YORK) SS: COUNTY OF ) -~_~c ?/~ (_ /%¢~/~/'('_-~ being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the O LC//L-'/~ (/~ (Contractor, Agent, Corporate Officer, etc.) of said o~vner or owners, and is duly authorized to perform or have perforated 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. S~of~to before me th~ ~ ~, ~-~- day o~f Not~./~ Public BONNIE I. N~a~ Public, S~ Ot N~ffi Term ~pims Ju~ /? ~ggi'~anature of Applicant