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Home My WebLink About14454-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Occupnncy No. z- 16167 Date September 15, 1987 THIS CERTIFIES that the building BEDROOM ADDITION ofProperty/~/~Os3120 Korn Road Southold, New York Location hJol ........................................................ S~reet Hamlet County Tax Map No. 1000 Section 064 .... Block 02 .Lot 002 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated November 7, 1985 pursuant to which Building Permit No. 14454Z dated.....................December 6, 1985 ....... wasissued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy ~r which this certificate is issued is ......... BEDROOM 'ADDITION TO ONE FAMILY DWELLING The certificate is issued to KE ITH R. & TERRY A. JENSEN ..................... ?d~,,;e'r, )~f~Y,f ~,gC,~'f '2 ................... of the aforesaid building. Suffolk County Department of Health Approval .......... N../.A ............................. UNDERWRITERS CERTIFICATE NO P E N D I N c PLUMBERS CERTIFICATION DATED: N/A Rev. 1/81 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ ~4454 Z Permission is hereby granted to: ,~'-~ t .... ,1.2.0 ........ ~.~..~....~ ................... ....... . t to ............ ~.~.~2[~....c~. ~..........,,~...~.-~...~.0.~..~.......~..~. r~.~.~.~O..~..~......~ ..... ....~.~i~.c~.~.....~..~.~r...z.t~...q, .................................................................................... ... .... · ~t-c~ -~ ~... ot prem,ses located at ...J...Z..(~. ...... ~ ......................... .~..t:~n....~....t.........~.C~..~;~. ................. County Tox Mop No. 1000 Section ....~...~....~,~,. ...... Block .....~...~. ....... Lot No....~...~..~. .... pursuant ,o application dated ,,~L.~..f~..~...........~. .............................. , 19..~.....~, and approved by the Building Inspector. Fee Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted II to the Building Inspec- tor with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building, 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or topographic featu res. 2.Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: Add±tions $25.00 1. Certificate of occupancy New Dwelliao~,$25.0,0, Accessory ,~t0.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ ,50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $~0.00 4.Vacant Land C.O. $ 20.00 5. Updated C.O. $ 50.00 Date....'~,/~.~?~Q/. ............. NewConstruc ~;ion ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .., ~. ................. .~.~....J~P.,. ............ ~ ..... House No, Street Hamlet Owner or Owners of Property ..~/~ [~.~, El. "'~--~.t~--~. ~. ~...~.~1[, .~2~ ................... County Tax Map No. 1000 Section ..... .~.~ ...... Block ..... ~ ........ Lot .... .~. .......... Subdivision ................................. Filed Map No.. ~ ........ Lot No .............. Permit No. ~.~'.~ 7~,. Date of Permit %~..~.~.~. ...... ........ Applicant . [~kT~l..~-¢,...~....~J~ .... Health Dept. Approval ................... Labor Dept. Approval ..................... ".~ ~. dApp Underwriters Approval Planning Boar royal . . Request for Temporary Certificate ..................... Final Cer1~ificate ....................... Fee Submitted $ ............................. Construction on above described building and permit meets~ll applicable codes and regulations. Applicant ............. . ....................................... Rev. 10-10-78 TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 1 [971 TEL. 765-1802 CERTIFICATION , ate Building Permit No. iqq q 7_ Owner ~1~1 '[-I~ (please print) Plumber (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this /O~7L day of ~,' Notary Public,,~"~e.,[ /< .County Notary Public ~ollla 05~ 140TARY PUBLIC Stile of New N~. 47088~, S~lk FIELD INSPECTION ~ COMMEN'I'~ FOUNDATION (Jut), FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: ~--/I'OL'L-"OWI N~ INSPECTION LL FOUNDA"'rloN. TWO ~ FOR P~tJRcD CONCRE' 2, ROUGH- ~RAMINR & ~. INSULA'T~N 4, FINAL BE COMP/FTF ~OR C. ~LL CONSTRUCT~O~ SHA ~HE REQUIREMENTs ~TATE CONSTRUCTION &. CODES. NOT RESPONS D~IGN OR L TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 To Whom This May Concern, We are unable to complete your Certificate of Occupancy because .of the following reasons. ///_ An application for Certificate of Occupancy is not on file. /--~'-No Underwriters Certificate on file. /~/The_ check is(outdated/no~._ ....on file~)~.~ /Z/ No Health Dept. Approval on file. /Z/ No final inspection has been made. Please' contact our office on this matter. Thank you for your cooperatioq. Building Permit # ! ~/ ~ ..~.~ ,,~ Z Building Dept. ' ***/Z~/No Plumber Solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) Occupancy or use is unlawful without a of Occupancy. Clear up this ma~ter as soon so ~hat legal action does not have to be Thank you for your prompt attention. / Certificate as possible taken. FIELD INSPECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C~DE FINAL ADDITIONAL COMMENTS: '~,¥31 , '" :'", ,,"' ~ ,' ..... ,, , , ,~ ~ ' ~,~, ,- ~, ~,.~ ~',. , .,~.. , .,. ,.', .. . - . .... , ,~,;~ , ,~ X~,m~ ~, , ,.~' ~', .... , ,. , ,, ,, , . ~'~. ~,~ .,..~..~. :.. b.. ~ ,.. __. .- .. ~ ~ ~ ~. .~., ,..,~ .,' .,~..,'... . .: · ....... .,.,~ , . .... ,., .. ,,.~~~ ~'., ~ . , ' ,' . , ..,~,:~. ,.., ~ ~ ~ . ~ . ~ · . , , ,:. . .,,~. ,' ,~, ,. , . ~ . , · , ~PARTME~ 4 PM FOR ¢HE - "' ' ~~'.~. ,,' ' . .~ ' lIONS: : R, C.O. ..~ ~ SHALL ~ , OF THE' ~ ON & END G~ , ;' - '. ' ~PONSIBLE JCTiON ERR~ RS Su~vE~ ~0~ ' KE/ TH FEE:_-'~O' ~-- BY: NOTI~ BUILDING D 7~5-1802 9 AM TO FOLLOWIh~G INSPEC ~OR P~RF~ CO1 ~. ROUGH -- 4, FtN~L - Co~,'ST DE C~4~Ir'TE FOR 'ALL CONSTRUCTION THE REOU~REMENTS STATE CONSTRU CODES. NOT RES DESIGN OR CONSTRU ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 BLDG, DEPT. TOWN OF SOUTHOU~ Received ........... ,19... Approved .~....~..~....~. ..... , 19~..~..~ermit No.. 1...~. · .~.'~..~ ~ Disapproved a/c ..... ~. ............................/Q ...../ ................. ........ ('.-7 ...... .... ' (Buiici .... : .... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tkis 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 Buildh~g 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 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 cod~, anal regulations, and to admit authorized inspectors on premises and in building for necessary inspections,~_.~ ~ (Signature o~5~pplicant,'or n~ a corporation) (Mailing address of applicant) State whether applicant ~see, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises...~[7..~., .~..~ .~ .&. d. ·~. .~. ~ ........................... (as gn the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........ .~. 2,. ............. \ Plumber's ~ice[lse No ....... .-~. ............. Electrician s License No ....... .~. ............ Other Trade's License No ........ .~. .......... \ 1. Location of land on which proposed workMill be done.. ~ ............................................ ..... ......... .... .... ............................... Itouse Number Street Hamlet County Tax Map No. 1000 Section .... ~..1~ .......... Block ...... ~ .......... Lot ..... ~..~..: ......... Subdivision. ~ File&Map No. Lot (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . .~l .~..~.. ~t4~. [ .~.X/....'~.. ~---~..~...?~ ~..~...~.~ .~.. "/ I I ,I, ~m~*-~:'~:.r,,;~"', ~ , . ' m intended use an~t occupancy ................................... ~,~,.. ~ .... .~..,..~ .,., ................... 3. Nature ofwork*(check which applicable): New Building ' Addition ...... Alteration ....... Repair .............. Removal .............. Demolition ........... ... Other Work ............... 4. Estimated Cost .......... .~.~. O1~.. ................. Fee .~. ................................ q' (to be paid on filing this application) 5. If dwelling, number of dwelling units . , ............ Number of dwelling units on each floor ................ If garage number of cars . 6. If business, commercial or mixed occupancy, specify ~t. ure and extent of each type of use ........... t ......... 7. Dimensions of existing structures, if any: Fr. ont 'ri' ['~' '~ ...... Rear .... ~:.t.~ . .'~..... Depth. ~.~"J ........... Height ............... Number of Stones . ~ .............. ,~..;. ~ .............. .&.:..,.~ ......... Dimensip~s/,o[ same structure ,with alterations or. additions: Front .. 7. ~. ~ .7 ........ Rear . [g~.[. ~. ,2. ......... Depth . I..~. .............. ... Height . [.2 !.. ~., ............ SumD0r qf Stories../. ........ ,~. ! ........ 8. Dimensions of entire new conslruction: Front .. ~. ~. t. ........ Rear ...[, (4..~ ........ Depth .. J.~.....' ....... ~ Helg t .. [.'7,-~ .....~,,..,~ Number of Stones . .[ .... ¢ . ~ ! .......... 10. Date of Purchase d~.t.., .... 77.. ~.~7..; ..... Name of Former Owner . ]~.,. ~..ill ........... 11. Zone or use district in which premises are situated ........................ ; ............................. 12. Does proposed construct~gn,jiolate any zoning law, ordinance or regulation: ../~F~. ...................... 13. Will lot be ~egraded ..~.e?.~.t~ ..... ~..., ..... i..Willex~essfill~berera~vedfrompremises: . Yes~,,,'(No'~ 14. Name of Owner of premises .~;t~Jf,~..l~.Jl:~..."~.. Address [...~.. ~ ~ ..... Phone No..~..~.~..~.. Name of Architect ......... . .............. - - - . ~Pho~e No ............. Name of-C,-ont~actov_.,.,-,-. ...................... Address ................... Phone No ................ 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. ~ STA'FE OF NEW_~ZD~ ~ , o o ~ ...... · ff.~..~2~~. · · · .... being duly sworn, deposes and says that he is the applicant ~(~ra~Sie of individual signing contract) He is the ..................... .................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, anal is dgly authorized to perform or have performed the said work and to make and file this application; that all statements con~alned in this application are true to the best of his knowledge and belief; and that the work will be performed in the man~er set forth in the application filed therewith. Swam to before me this .......... · ~ ....... , .....day Of ...... ~...~.. ........ , 19 Notary Public .... ~.-: ~..~.fl~...~4~__,,,... County ~~.~~,,~