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Home My WebLink About29112-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29224 Date: 01/28/03 · ~IIS CERTIFIES that the building ACCESSORY Location of Property: 175 CLEARVIEW AVE SOUTHOLD (HOUSE NO.) (STREET) (PIAMLET) County Tax Map No. 473889 Section 70 Block 8 Lot 40 Subdivision Filed Map No. __ Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 16, 2003 pursuant to which Building Permit No. 29112-Z dated JANUARY 16, 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 A~OVE GROLrND SWIMMING POOL WITH DECK AND FENCE TO CODE AS APPLIED FOR. The certificate is issued to GERARD & JEAN WORYSZ (OWNER) of the aforesaid building. SUFFOLK COUIF~Y DEPi~RT~4ENT OF HEALI~{ APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DA'f~23 Rev. 1/81 N/A 487941 05/07/99 N/A Au'th;rized Sig~ure~ FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUIT~ING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 29112 Z Date JAiqUARY 16, 2003 Permission is hereby granted to: GERARD & JEA/q WORYSZ SOUTHOLD,NY 11971 for : CONSTRUCTION OF ABOVE GROUND POOL & DECK IN REAR YARD AS APPLIED FOR. at premises located at County Tax Map No. 473889 Section 070 pursuant to application dated JANUARY Building Inspector to expire on JULY 175 CLEARVIEW AVE SOUTHOLD Block 0008 Lot No. 040 16, 2003 and approved by the 16, 2004. Fee $ 225.00 Authorized Signature Rev. 5/8/02 ORIGINAL 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. 25822 Z Date JUNE 23, 1999 Permission is hereby granted to: GERARD & JEAN WORYSZ 175 CLEARVIEW AVE SOUTHOLD~NY 11971 for : CONSTRUCTION OF ABOVE GROUND POOL & DECK IN REAR YARD AS APPLIED FOR. at premises located at 175 County Tax Map No. 473889 Section 070 pursuant to application dated MAY Building Inspector. CLEARVIEW AVE SOUTHOLD Block 0008 Lot No. 040 28 1999 and approved by the Fee $ 85.00 Authoriz~ Signature ORIGINAL Rev. 2/19/98 mo Be TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF occUPANcY This application must be filled in by typewriter OR ink and submitted to the buildi~ 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 1% lead. 5. Commercial building, industrial building, multiple residences and similar build~ 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 a '!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 applican 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 Buildin~ - $100.00 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 Date ................................... New Construction ........... Old Or Pre-existing Building ............ Location of Property ..... ( ............................................................... House No. Street Hamlet Onwer or Owners of Property ........................................ County Tex Map No 1000, Section..(~). '70,00 O~'~, O0 Lot' 0 ............ Block .................................. SubdivSsiom F/~/~/~c) ~//~K Filed Map ~ ~ Lot'-'L.~. uu, ' .... q'l ......................................... Permi~t No.~. ' .~.~ ~ .... Date Of Permit.. ~.~..~/ff .... Applicant...~. ~ .~i~:'.~. ............ Planning Board Approval ........................ ~/ Request for: Temporary Certificate ........... Final Certlcate ........... ....... ......... 765-1~02 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INS/UJ,ATION [ ] FRAMING [/-~ FINAL [ ] FIREPLACE & CHIMNEY DATE NSPE ~IDAT ION (IST) ~ ~ATION ( 2ND ) ~UGH FRAME & PLUMBING iNSULATION PER N. Y. ~fATE ENERGY CODE # BI~G. DEPT. TOWN OF $OUTI~,OLD FORH NO. I TO~] OF SOUTHOLD BUILDING DEPARTHENT TOWN HALL SOUTHOLD, N.Y. 1197 I TEL: 765-1802 Disappw~ed a/c .................................. ........ APPLICATION FOR BUILDING PE1LHIT INSTRUCTIONS BOARD OF RgALTH ............... 3 SETS OF PLANS ............... SURVEY ........................ CBECK ......................... SEPTIC FORI/ ................... a. This applicatio~ -,--t be o~letely filled in ~ ~iter or iu il ~ ~itt~ to 3 ~ts of pl~, ~ate plot pl~ m ~le. F~ ~i~ to ~le. b. Plot pla ~ l=tim of lot ~ of ~il~ m ~i~s, mlati~ip m Mjoini~ p~s or ~lic struts or ~e~, ~ gi~ a ~il~ ~pci~ of l~t of pio~ ~t ~ ~ ~ ~ di~ ~i~ is ~n of ais ~liatim. c. ~ w~ ~ ~ ~is a~li~tim ~ ~t ~ m~ ~fo~ i~ of ~ildi~ ~t. d. ~ ~ of ~is ~li~tim, ~ ~ildi~ l~ctor ~11 i~ a hildi~ ~t to e. ~ ~ildi~ ~1 ~ ~i~ or ~ in ~le or in ~ ~r ~ ~ ~t~r ~til a ~ifi~e of ~ ~1 ~ ~ ~ ~ ~ ~ldi~ ~mr. ~~ IS ~ ~ m ~ ~ildi~ ~,,~t for ~ is~ of a ~ildi~ ~ldi~ ~ ~,..of ~ T~ of ~ld, ~folk ~, ~ Yo~, ~ o~r ~li~hle ~s, ~i~s or ~a~i~, ~r ~ ~ti~ of ~ld~, ~ici~ or al~era~i~, or for ~ or ~li~i~, ~ ~in ~ri~. ~ ~lie~_~s ~.?!~-~ ~1 ~lic~le 1~, o~i~s, ~ildi~ ~lat~, ~ ~o ~t ~r~ ~ors ~ ~i~ ~ in ~ildi~ for ~s~ (l~r~ and title of corporate officer) Builders License No ......... ~../~.. .......... Pl,~hers Licorice No .......... .~. l..~.. ......... , ...... ....... I. ~tim of 1~ m ~i~ ~ ~11 ~ ~ .............................................................. ~ ~r St~t ~let (~) ~,~'TA~ A ~SU~ ~Yw~M *n ~ *~ .~[ ?,~:L?~ , Y> ~T~H 2. S~e ~st~ L~ ~ ~ of ~ ~ ~t~ ~ ~ ~~ ,~'~ti~: .... T o. ............ ~ir ............ ~,.~l-. ............ ~lltlm ............ O~r ~ ...~[.,~.~ .......... / ~ripti~) ~tilm,~ ~st ,.~...~ ............ f~ .............................................. (to ~ ~id ~ fili~ this a~>li~ti~) (.~,-. t~ ......................... ~ ~ ~ ~1~ .................... ~ ..................... ~ ..... ............... .............. ~ ......................... ~ ~ ~ ~ ~ ~ ~ ..... /.~ ........ ~ ..... ~.~.~ ........ ~, .... ~ ........ 3. ~te of ~m~ ..................... ~ of Fomr ~r ........................................ I. ~ or ~ district in ~{~ p~,,i~s a~ s~t~ .............................................................. 2. ~s ~ mt~tim violate ~ ~l~ 1~, ~i~ or ~lsgim: ...~. ................ 3. ~ill lot ~ ~ .................... Will ~ss fill ~ ,. ~ o~ ~ o~ ~,~,~ ~.;.;~....=.~:. ~ .-.....;~/.=..,,~.=. ~ ~ ............... ~ of ~it~t .................................... ~ss .............................. ~ ~ ............... ~ of ~r~tor ................................... ~ress ............................... ~ ~ ............... PLOT DIAGRAH locate clearly and distinctly all buildings, ~dmLher existing or proposed, and indicate al! set-back dimensions property lines. Give street and block m~ber or description according to ~d, and sho~ street nmos and indicate hether interior or corner lot. 'IMMEDIATELY" J~PPI~OyED AS NOTED D^m ~ B.P. ~ 3-/~ ~ FEE: ~('~ ,~.~- ~'~ "~1~ .UI~ING ~A~MENT AT FOXING INS~ONS: 1 FOUNDA~ON - ~O REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. F~NAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS s~rn, deposes and says that he is tl~ applicant le is the ~-J~ ~ (Contractor, agent, eor~rate officer, etc.) said ~r or ~rs, ~ is ~ly ~t~ri~ to ~r[om or h~ ~rfo~ tim ~id w& ~ to ~ a file this ~lieatia~; ~at all stat~ts ~tai~ in ~is a~licati~ a~ t~ to ~ ~st of his ~1~ ~ ~lief~ ~ lint ~ ~& viii ~ ~rfo~ in ttm ~r ~t forth in ~ a~li~ti~ fil~ ~- .......................... ~T~Y PUBLIC, ~~ (S]~ of A~h~t)~-~ ~.01ST~173. ~ ~ T~ ~ June 8, ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS 1195099 BUREAU OF ELECTRICITY [-- 40 FULTON STREET, NEW YORK, NY 10038 Date MAY 07,1999 Al, plicu,o, No. onfile 18155399/99 N 487941 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premt~es of FIR. WORYSZ, 175 CLg/~VXgW AV~., SOU~ OLD, ~ in the following location; [] Basement [] 1st Fi. [] 2nd FL OUT Section Block was examined on MAY 03,1999 and found to be in compliance with the National Electrical Code. Lot FIXIU[~ OUTLETS DRYERS FIXTURES RANGES FLUOR~ECENT OTHER I I FURNACE MOTORS FUTURE APPLIANCE FEEDERS TiME CLOCKS UNtT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R PER ~ V I C E NO. OF HI-LEG OF Hi-LEG OT~R APPARATUS: $~IMMI~G POOh-1 GFCI-1 *(SWiq~4ING POOL) This certificate covers compliance at the date of inspection only. Because of unusual environments it is advisable to rave frequent test/and or repairs made by a qualified person. <<< Continued on Page 2 >>> GENERAL MANAGER .Per This certificate must not be altered In any manner; return to the office of the Board If InCorrect. Inspector~ may be Identified Dy their creden/Icds. THE NEW YORK BOARD OF FIRE UNDERWRITERS PA E 2 1195099 BUREAU OF ELECTRICITY ~- 40 FULTON STREET, NEW YORK, NY 10038 Date MAY 07,1999 Application No. onfile 18155399/99 N 487941 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of MR. WORYSZ, 175 CLEARVIEW AVE., in the following location; [] Basement [] was examined on MAY 03,1999 SOUTH OLD, NY 1st FL [] 2nd Fl. OUT Section Bloclc and found to be in compliance with the National Electrical Code. Lot FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS FLUORESCENT OTHER DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT, TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R C OTHER APPARATUS: NO. OF CC COND. PER ffi V I OF CC. COND, NO. OF HI-LEG OF HI-LEG JIM SAGE ELEC. INC. PO BOX 38 GREENPORT, NY, 11944-0038 This certificate must not be altered In any manner; return to the office of the Board If Inen.,~,'-~ i,,,,~,,~,~,~ ...... ~--- ,- ............. T ,,ISlOI~elBUES,,