HomeMy WebLinkAbout31176-Z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-31SS0 Date: 05/02/06
THIS CERTIFIES that the building INGROUND SWIMMING POOL
Location of Property: 1150 OLD
(HOUSE NO.)
County Tax Map No. 473889 Section 122
MAIN RD
(STREET)
Block 7
LAUREL
(HAMLET)
Lot 8.6
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
MAY 25, 2005 pursuant to which
Building Permit No. 31176-Z
dated
JUNE 1, 2005
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 SUSAN LOMANGINO
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
100s83C
07/18/05
PLUMBERS CERTIFICATION DATED
N/A
~'~.g~ature
Rev. 1/81
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY'! 2 I 0" I
llis application must be filled in by typewliter or ink and submitted to the Building Department with the followiIQ;:___.J
{pI .-/'Jg YD 52-
?
A. For new building 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 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 2/1 0 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.
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
I. 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 - $]00.00
3. Copy of Certificate of Occupancy - $.25
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
New Construction:
t/
//517
House No.
Date.
~./~b
/ /
Old or Pre-existing Building:
0/,0 /11,4/~ /6
Street
~SA.v b7?:>.A$/7 / NO
Suffolk County Tax Map No 1000, Section I a..':). Block
(check one)
?7/A7/l7tfC/(' ffi/ //152--
Hamlet
Location of Property:
Owner or Owners of Property:
Subdivision
Pennit No. 3 I , , l,
'7
Lot
'iU..
Date of Pennie
Filed Map.
Applicant:
Lot:
Health Dept. Approval:
Planning Board Approval:
Underwriters Approval:
Request for:
Temporary Certificate.
Final Certificate:
-----?check one)
~~<~~
Applicant Signature
Fee Submitted: $
~. 7~(S'D5
CO -2:31550
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.
31176 Z
Date JUNE
1, 2005
permission is hereby granted to:
SUSAN LOMANGINO
327 GREENLAWN ROAD
GREENLAWN,NY 11740
for :
CONSTRUCTION OF AN INGROUND SWIMMING POOL IN THE REQUIRED REAR
YARD FENCED TO CODE
at premises located at
1150 OLD MAIN RD
LAUREL
County Tax Map No. 473889 Section 122
Block 0007
Lot No. 008.006
pursuant to application dated MAY 25, 2005 and approved by the
Building Inspector to expire on DECEMBER 1, 2006.
Fee $
150.00
. :L.~.- L!J d ~
( Authorized Signature
ORIGINAL
Rev. 5(8/02
. -~>. -,_.---
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TOWN OF SOUTHOlD BUilDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [] ROUGH PlBG.
[ ] FOUNDATION 2ND [] l~lATION
[ ] FRAMING I STRAPPING [4INAl
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS:
eo
DATE
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\
INSPECTOR
--------"-.---::----.--- -
?1(7~-C
TOWN OF SOUTHOLD ILDING DEPT.
765.1802
[ ] FOUNDATION 1 ST [
[ ] FOUNDATION 2ND [
[ ] FRAMING I STRAPPING [
[ ] FIREPLACE & CHIMNEY [
CTION
] ROUGH LBG.
] IN ATION
FINAL
] FIRE SAFETY INSPECTION
DATE L{. [J..O l ()~
INSPECTOR
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TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [] ROUGH PLBG.
[ ] FOUNDATION 2ND [] INSULATION
[ ] FRAMING I STRAPPING 0{ FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS: ~
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DATE r-J-o - 05' INSPECTOR ~ ~
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FIELD INSPECTION REPORT DATE
COMMENTS
FOUNDATION (1ST)
FOUNDATION (2ND)
ROUGH FRAMING &
PLUMBING
INSULATION PER N. Y.
STATE ENERGY CODE
FINAL
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PROP. CLASS
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TOTAL
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FRONTAGE ON WATER
FRONTAGE ON ROAD
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Breezeway Rooms 1st Floor
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LAND IMP.
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TYPE OF BUILDING
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Roof Type
Parch
Rooms 1 st Floor
Rooms 2nd Floor
way
Dormer
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TOWN OF SOUTHOLD PROPERTY RECORD CARD
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OWNER .' STREET VILLAGE DIST. SUB LOT
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ACR. REMARKS
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TYPE OF BLD.
PROP. CLASS
LAND IMP. TOTAL DATE
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TOWN JTHOLD
BUlLDIJi.; 'PARTMENT
TOWN IfALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www.northfork.netlSouthold/
PERMIT NO.
"3J1 76 .'{;
'r
BUILDING PERMIT APPLICA nON CHECKLIST
Do you have or need the following, before applying?
Board of Health
4 sets of Building Plans
Planning Board approval
Survey
Check
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
Mail to:
'>/.31,200)
I -
hfl,20 Or
Examined
Approved
Disapproved alc
Phone:
Expiration
I :;.-// ,20~
f
JlcJL
<
Building Inspector
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APPLICATION FOR BUILDING PERMIT
Date
,20_
INSTRUCTIONS
a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location oflot 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 commenced 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 South old, 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.
_WI!.ITERS CERTIFICATt
REmo.
&J. CONSTRUCTION SHALL
M9rJ'BE R'FOUIREMENTS OF THE
CODES OF NEW YORK STATE,
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
"IMMEDIATELY"
ENCLOSE POOL TO CODE
UPON COMPLETION
BEFORE "WATER"
(Signature of applicant or name, if a corporation)
(Mailing address of applicant)
APPROVED.AS1IDIED
omM)t(tJO DATE: ~h,k B.P.' 31/7bl
(As on the tax roll or latdSi~~.-l) f,od) BY: <
If applicant is a corporation, signature of duly authorized officer NOTIFY BUILDING DEPARTMENT AT
765-1802 8 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REOUIRED
FOR POURED CONCRETE
2. ROUGH . FRAMING & PLUMBING
3. INSULATION
4. FINAl. CONSTRUCTION UUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET THE
REQUIREMENTS OF THE CODES OF NEW
YORK STATE. NOT RESPONSIBLE FOR
DESIGN OR CONs:rRUCllaN tRFlOA8.
Hamlet
Name of owner of premises
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
(Name and title of corporaG6tv6lP}iJ\JCY or
USE IS UNLAWFUL
~TE
OF OCCtwANCY
1. Location oflapli on which proposed work will be done:
'I 'fb 0 Id m cu. Y1 IUl - i\'\!J:'t'-tJ i'uUL-
House Number Street
County Tax Map No. 1000 Section 47 '3 'J~
:subdivision
I ~2 -l-'Il. IiJ
. Block
Filed Map No.
(Name)
...
"
-,
2. State existing use and occupancy of premises and intended use and occupancy of proposed construG-,n:
a. Existing use and occupancy
b. [ntendeduseandoccupancy~~ bu~\t-' \ (\. rool
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
Addition
Other Work
Alteration
. ,.
I
(Description)
4. Estimated Cost
Fee
5. If dwelling, number of dwelling units
If garage, number of cars
(To be paid on filing this application)
Number of dwelling units on each floor
6. Ifbusiness, 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
~ar:
1AH
8. Dimensions of entire new construction: Front
Height Number of Stories
Rear
Depth
9. Size oflol: Front
Rear
Depth
10. Date of Purchase
Name of Former Owner
II. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation? YES_NO_
13. Will lot be re-graded? YES NO Will excess fill be removed from premises? YES NO
- - --
m({.c^ lie Phone No(io~ J \2'1 ~-&o':>J-
Phone No
Phone No.
Address i (~o 0 Id
Address
Address
14. Names of Owner of premises 'V'''-^ LcmAjJl)I.0c
Name of Architect
Name of Contractor
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES _NO _
* IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES_NO_
* IF YES. D.E.C. PERMITS MAY BE REQUIRED. . ,.
Y , ' J '~",'f,1} I
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16. Provide survey, to scale, with accurate foundation plan and distances to property lill@l!).
r v,"'- ,>~~">~(i,:JA" i/'/," ;,:, .:'. ,'_ ~;.;~
17. If elevation at any point on property is at 10 feet Of bel{iW, fiiustptloviae1\0pographical d~ta ~~ s~ey~'
STATE OF NEW YORK)
;>S:
COUNTY OF~ ..
SV~ Y'\ \....0 'iY) C\. n ~''(\ 0 being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contra ) above named,
(S)He is the
~ey~
(Contractor, Agent, Corporate Officer, etc.)
of said owner or owners, and is duly auth" orized to perform or have perfoJ111edthl'~}1 work and to make and file this application;
that all statements contained in this applkation are true to the best ofiH~~~Mg'e'and belief; and that the work will be
performed in the manner set forth in the application filed t\u}{eJl~: ~l ~." "" l. i()~"
Sworn to before me this
_rl-S-tt:> dayof ~~ 20~
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400 Ostrander Avenue, Riverhead New York 11901 yha
N 631-727-2303
Howard N. Young, Land Surveyor bag
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Thomas C. be (pert, P'roast, Architect Engineer Sg
Robert C. Tast, Architect 936
Ronald E. Pfuhl, Landscape Architect g
LOCATION MAP W E Douglas E. Adams, Prafeanonal Engineer
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SURVEYOR'S CERTIFICATION
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MATTITUGK RIDING ARENA
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Suffolk County, New York
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