HomeMy WebLinkAbout16598-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z18654
Date DEC. 19, 1989
THIS CERTIFIES that the building.
Location of Propert~ 670 SEAWOOD DRIVE
House No.
County Tax Map No. 1000 Section 79
INGROUND POOL
Street
Block
SOUTHOLD
Hamlet
08 Lot 11
SECTION ONE
subdivision SEAWOOD ACRES Filed Map No. Lot No. 10
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOV. 2, 1987 pursuant to which
Building Permit No. 16598Z dated NOV. 5, 1987
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 INGROUND POOL AND FENCE.
The certificate is issued to ROBERT E. BOERGESSON
(owner,
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N849451 JAN. 11~ 1988
PLUMBERS CERTIFICATION DATED
Building Ins~ctor
Rev. 1/81
TOWN OF $OUTHOLD
BUiLDiNG DJ:PARTMI:NT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N~1659~ z
Permission is hereby granted to: ~ ~) ~
.................................................
·
County Tax Map No. 1000 Section ...... ..~...')....~ ........ Block ....... ..~....~ ........ Lot No..../.I. ..................
pursuant to applicofion dated ..... .~L~.~...,...~m,, .............. , 19.~..'~.., ond approved by the
Building Inspector,
Fee $..~/...~....:. ~
Building Inspector
Rev. 6/30/80
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING
REMARKS: ~
,r ¢,}*'*FI NAL
DATE
INSPECTOR
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
85 JOHN STREET. NEW YORK. NEW YORK 10038
o.t..~,~n,~ ,.:~. ~.986 ~pp,,c.,,o. No..,,;,,e s~s,~/~,N 849451
THIS CERTIFIES THAT
ordy the electrieal equipment a* described below and introduced by the applicant named on the above application number in the premises of
Robert Boergesson~ Seawood Drive, North Bay View &
in the following location; [] Basement [] ;st Fl. [] 2nd FL Out:side Section Block Lot
was exatnined on December 2~, 19~ and found to be in con~pllance teith the requiretnents of this Board.
OUTLETSFIXTURE SWITCHES FIXTURES RANGES OVENS DISH WASHERS FANS
] 1 2 i
DRYERS
TIME CLOCKS UNIT HEATERS MULThOUTLET DIMMERS
SYSTEMS
rio. OF FEET
SERVICE DISCONNECT S E R
OTHER APPARATUS:
OF CC COND
I C E
NO OF HI-LEG
A W, G NO OF NEU?RA[$
OF HI-LEG
iS~I~ING 1~3OI,~. This certificate covers compliance at the date of inspection only.
Because of ~usual e~Lvironmen~s it is advisable to have f~eq~ent test and/or repairs
nmde by a qua].lfied ~rson,
OF NEUTRAL
Sage & Lademann Inc
P,O. Box 1768
Southold, N.Y. 11971
]
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified
COPY FOR~BUILDING DEPARTMENT.
GENERAL MANAGER
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NEW YORK
765 - 1802
11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
NEW CONSTRUCTION ....... OLD OR PRE-EXISTING BUILDING ...... VACANT LAND ........
Location of Property.~-~%c~.-~.~%~. ~/~o~,..~ ./tg<.,~ //~7/
HOUSE NO. STREET HAMLET
,Owner or Owners of Property.. '.. .,. .
county ~a~ ~p No. ~O00 Section .~... ~loek .qF.... Lot .~ ......
............ ed Nap ........ Lot
~ea[th ~ept. Approval .................. ~nderwrlters Approval..~'. ......
Planning Board Approval ..~
Request for Temporary Certificate .......
Fee Submitted: $ ..... .,~./ ............
Final Certificate
APPLICANT..
q///
rev. I0/14/88
FOP. M NO. ~
TONN OF SOUTHOLD
i BUILDING DEPAR'I?.iENT
I TOWN HALL
APPLICATION FOR C~RTIFICATE OF OCCUPANCY INSTRUCTIONS
'~is application must be i filed in typewriter OR ink and submitted to the Building
Inspector with the following; for new buildings or new use:
J. Final survey of property with accurate location of all buildings, property lines,
streets, and unusual fiatural or topographic features.
2. Final approval' of Health Dept. of water supply and sewerage-dlsposal(S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from ~lumber certifying that solder used in system contains less
than 2/10 of IZ lead. i
5. Comercial buildings, iindustrial buildings, multiple residences and similar
buildings and installations, a certificate of code compliance from the Architect
or Engineer responsibIe for the building. '
6. Submit Planning Board iApproval of completed site plan requirements.
For existing buildings (Prior to April 9, 1957) non-conforming uses, or buildings
and "pre-existing" land dses:
]- AcCurate survey of prqperty showing all property lines, streets, buildings and
unusual natural or topographic features.
2. A properly completed ~pplication, a consent to inspect signed by the applicant
and a certified abstract of title issued by a title company which shall
$how single and separ~'te ownership of the entire lot prior to April 9, [~5~.
· If a Certificate of Oclcupancy is denied, the Building Inspector shall state the
reasons therefor in wrliting to the applicant.
3. Date of any housing colde or safety inspection of buildings or premises, or other
pertinent information required to prepare a certificate.
For Vacant Land Certificate of Occupancy:
1. An application for vaemnt land Certificate of Occupancy shall be submitted,
and a certified abstract of title issued by a title company showing single and
separate ownership of .the entire 10t prior to April 9, 1957 shall also accompany
the application. If al Certificate of Occupancy is denied, the Building Inspector
shall state the reasons therefor in writing to the applicant.
FEES:
]. ~ CERTIFICATE OF OCC~ANCY - New ]~elling $25.00, Additions to Dwelling $25.00,
Alteration to Dwel~xng $25.00, Swiming Pool, $25.00. Accessory building $25.00
Addition to AccessOry buildings, $25.00 -Businesses $50.00.
2. Certificate of OccUpancy on pre-existing dwelling - $100.00.
3. Copy of Certificate of Occupancy - $5.00 - over 5 years - Si0.00
4. Vacant Land Certificate of Occupancy - $20.00
5. Updated Certificat~ of Occupancy - $50.00
~. Temporary Certlfic~te of Occupancy - $25.00 Residential
$50.00 Co~merelal
FOUNDATION
(1st)
FOUNDATION ( 2nd )
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
' SOUTHOLD, N.Y. 11971
TEL.: 765-1803
Examined .O.~[~--'E'. .b."'.., 19~.'J.
Approved ~.~..~.~.., 19~'~. Permit No..~.~.~..~..~..~.
.......................... ......
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
Received ........... ,19...
Date...(... 2 ~' 19 ~7
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 M~DE 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 ~yith ail applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections.
·..~;. ~.E../.~.z..~. ~. ~. ~ .s).....................~....c.,. ............
?, (Signature of applicant, or name, if a corporation)
(mailing address or app£lca~ltj
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
C~2~c .c. 9..~..V~..~..c.- .72-e...~ ............................................
Name of owner of premises ........ ~..~..~..~ .~..F... ~- .... '~- .O.]J. Z~..~..~. ...... ~.t~J:-'~/~ ~'.~. ?.~..C) ..~. .......... (as on the tax roll or latest deed)
If appl/vgnlt is a corporation, signa,toare of duly authorized officer.
..... .................
title 0f c~' ' '~te o'fficer)
Builder's License No ....... .~..?.~...~./.."ff .~.. · ....
Plumber's License No .........................
Electrician's License No..~..0.~.~...~/.....~.'-~.'~"~(~_
Other Trade's License No ......................
1. Location of land on which proposed work will be done ........... ~.'d..~..7-~..~..t.~. ..... ~ L: .................
House Number Street Hamlet
County Tax Map No. 1000 Section ...... 7ff. ........ Block ...... .(~.~. ........ Lot ..... .f( ............
Subdivision.. ~..~.~.~..09.~. ...... ~. ~.ff-~. · ......... Filed Map No ............... Lot .... /.~ ........
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .............. .~../-~.~../..~ .7../.~..~. ............. } ........................
b. Intended use and occupancy ....... .~..~.~./.~..Z~.. T-..i./f.&.....t4). f ~--.A/.., .~.~.0. ;~.~. ~.~.~.~.&.~5..~ ~)~.~. .....
3. Nature of work (check which applicable): New Building .......... Add/ti n .......... Alteration ......
Repair .......... Removal .............. Demolition ....._ o. ...... Oth~r Work ................
20 .{~/? ~ (Description)
4 Estimated C st ' Fee
(to be paid on filing this application)
5. If dwelling, number of dwellin~ units .............. Number of dwelling units on each floor ................
If garage, number of cars .... i .................................................... " ...............
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .....................
7 Dimensions of e~s~ting §tinctures if any; Front Rear - ' Depth
Height ¢; ~?.::., '> . · NumberOfrgtones ....................................................
Dunenmc ~me ;~ ~,'-~. ,~: .. :,:a: . ' ' Front Rear
'' ' st~tueture~W, ith ~t~atlons or additions:
Depth .................. ~--~/l~I~l~;ht ...................... Number of Stories ......................
8. Dimensic of entire n~v cc~Uc}~g~ Front ............... Rear ............... Depth ...............
Height ~. Num be~6~f Stories
9. Size oflc~t: ~~~;~.i.~ ..... ". ..... Rear ...................... Depth ......................
10. Date o f I~~[~:;~:,: ~(.~:~, ~ ·~' ............. Name of Form~ Ow/n~r .............................
11. Zone or use district in which premises are situated ............ ]~. (~. d: .:~.~/~-'~..~. .................
12. Does proposed construction violate any zoning law. ordinance or regulation: ..... ~.~ .......................
13. Will lot be regraded ........ !~ ~'-~,,,,. .......... . ....Will excess_fill be removed from premises: Yes
14. Name of Owner of premises . .,'~..O~ ~',,Cj'O, ,t~d,,, Address., ,d,~?-. 7'.~..t..D. .... Phone No. 2~: 2
Name of Architect ..... . .... ~ .~ ................. Address ................... Phone No.
Name of Contractor. ~].. t'~.~./.~.~..~.~...5' .0lq'..5' .... Address . J4~/(~. T./.],-'¢..O'.~.. Phone No.
15. Is this property located, withinl;00, feet of a tidal wetland? * Yes ..... No .....
· If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF NEW YORK, S.S
COUNTY OF ................. ,.
.... ~.6~ .~...~..~.~.. t4 ..... ~../.~[~.,,r,.. ~....~ .. ........... being duly sworn, deposes and says that he is the applicant
(Name of individual si ning contract)
above named.
He is the .................... ~ ...........................................................
(Contractor, agent, corporate officer,etc.)
said owner or owners, and is d~ly authorized to perform or have performed the said work and to make and file this
of
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 maniaer set forth in the application ill'ed therewith.
Sworn to before me this
.~. day ;f ~ . .0-~... 19 ?.~.
Notary Public, . ............ County
~ ~l. N I. I~ mt applicant,)
PUBtlC, State of f~ow Yo~
. N0._4707878~ Sdfork CouatyC~,~
lerrA ICxp~res March 30,
i'