HomeMy WebLinkAbout24589-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-25564 Date: 03/02/98
THIS CERTIFIES that the building ADDITION
Location of Property: 28545 MAIN RD ORIENT
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 18 Block 6 Lot 24.3
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated DECEMBER 4, 1997 pursuant to which
Building Permit No. 24589-Z dated JANUARY 8, 1998
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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR
"AS BUILT"
The certificate is issued to ROBERT A. & SHELLY G. KEHL
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
B ildii. Inspector
Rev. 1/81
FORM NO.3
TOWN OF SOUTHOLD
BUILDING DEPARTMEHr
TOWN HALL
SOUTHOLD,N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Date .....JANUARY........... ........................... 19..48.,..
24589 T
Permission is hereby granted to:
ROBERT A KEHL...................
28545„MA,i,N...RPAD
ORIENT�,NY„ 11457
10 .....CONSTRUCT„ADECK„ADDITIONTO„AN„EAI STING SINGLE FAMILY
.........DWELL,ING„AS... PPLI,ED... OR..............I................,..
...............................
...........................................................................................................................I.............................
.........................................................................................................................................................
at premises located at.......I.,...28545.....MAIN...RD..........................,,,, ,,,,,,,,,,,,,,,,,ORIEN.T.
.................. .... .. .. . . .. .
................ ... ...........................................................................................................................................
County Tax Map No. ,...473889 Section ..018 Block ....0006 . Lot No. 024.003
DECEMBER 4 19.....97....., and approved by the
pursuant to application dated ........................................................ .
Building Inspector,
Fee$........75.00
, .. 'u ............................ .. .
$uiiding Inspector
Rev. 6/30/80
- FoigT,No.- 6.
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL U
765-1802 FEB 0 192
F
73LOG.DEPT.
APPLICATION FOR CERTIFICATE OF OCCUPANCY "COvdw O SSOU'fHG',�,
This application must be filled in by typewriter OR ink and submitted to the building
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 Undefwriters.
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 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.
4 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 a 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.
Fees
1. ' Certificate of Occupancy - Newdwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, wimming pool $25.DOP, Accessory building $25.00,
Additions to accessory building1757 Bus nesses $50.00.
2. Certificate of Occupancy on Pre-existing Building - $100.00
3. Copy of Certificate of Occupancy - .25v
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential
$1 .00, Commercial $15.00
. . . . . . . . . . . . . . . . . . . . . . . . . .
onstruction. . . . . . . . . . . Old Or Pre-existing Building. . . . . . . . . . . . . . . . .
ion of Property. . . . . . . . . . . . . . . . . . l ! �. ��i. . . . . . . . . . . . . . QiVT . . . . . . . . . .
House No. Street `Hamlet /
or Owners of Property. . . . . 1."[oC, i?Pf. . . .f/tai�E�T. . .. . . . . . . fy17,,�K(/E./, . ;.../�E`el. . .
y Tax Map No 1000, Section. . . . ( 09. . . . .Block. . . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . .
vision.II. . .q. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . .
t No. ./.'/. 2.5 Z . .Date Of Permit. . . . . . . . . . . . . . . .Applicant. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
hDept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . .
ing Board Approval. . . . . . . . . . . . . . . . . . . . . . . .
st for: Temporary Certificate. . . . . . . . . . . Final Certicate. . � . . . . .
ubmitted: $. . . . S .�j. . . . . . . . . . . . . . . . aL
/ ( APPLICANT
co a-S.s�s
STATE OF NEW YORK:
COUNTY OF SUFFOLK: ss:
Robert Kehl being duly sworn, deposes and states:
I am the owner of the property located at 28545 Main Road, Orient,New York with
SCTM# 1000-018-6-024.003.
In 1987, I constructed a single family dwelling on the property for which I obtained a
Certificate of Occupancy Z-17501 in December 1988. In February 1989, I constructed a deck
attached to the rear of the house which had been shown on the original house plans but not
constructed. The deck was completed in February 1989.
In March 1989, I had an inground pool built on the property as an accessory structure. A
Building Permit was issued for it#17925 by the Building Department. The pool is more than 10
feet from the rear property line and is not located in either the front or side yard of the property.
This affidavit is provided with the understanding that the Town of Southold is relying
upon the truthfulness of the statements contained herein to issue certain approvals for the
structures located on the property.
bert K
Sworn to before me this a
day of March, 1998
-2w-4p:g�r�a
Notary Public
MARGARET C.RUTKOWSKI
Notary Pubk,Stat of New York
No 4CC2528
oualifiad in Suffolk County
Commission Expires June 3,19 '
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C
o��gUFFO(kC0
Town Hall, 53095 Main Road y x Fax (516)765-1823
P. O. Box 1179 • Telephone (516)765-1802
Southold, NewYoik 11971
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
February 19, 1998
Robert A. Kehl
28545 Main Rd.
Orient, N.Y. 11957
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons :
XX An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
XX The check is (not on file. ) $25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984 ) .
BUILDING PERMIT # 24589-Z (DECK)
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] IN TION
[ ] FRAMING [ FINAL
[ ] FIREPLACES CHIMNEY
REMARKS: 01� C.. U .
DATE -Z /! / INSPECTOR
BOARD OF BEALTN
DULJ� FORM NO. 1 3 SETS OF
'LAN! . . . . . . . . . .
TOWN OF SOUTHOLD SURVhY . �p
BUILDING DEPARTMENT CIIECR �.
s ` . . . . . . . . . . . . . . . .
TOWN HALL sl:r•rlc FORM . .
I ?I
SOUTHOLD, N.Y. 11971
9LDG.OEIT TEL: 765-1802 NOTIFY:
IMN
/
. CALL . . . . . . . . . . . . . . . . . .
Examined.... MAIL TO: . . . . . . . . . . . . . . . . . . . .
//. Q . .. .. 19yh9. c— 9t
Approved../ 0......... 19,1 Fermit No. .. . `..�/ `
GG ...... .........I..........................
Disapproveda/c .................j................. ....................................
................................ .....................
/*'t()r"
n
APPLICATION FOR BUTLDINC PERMIT
Date. . . . . . . . . . . . . . . . . 19. . . .
INSTRUCTIONS
a. This application mist be completely filled in by typewriter or in ink and submitted to the Milding Inspector Witt
3 sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan slowing 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 application.
c. 'Due work covered by this application may not he commenced before issuance of Building Permit.
it. Upon approval of this application, the lucilding Inspector will issue a Building Permit to the applicant. Such
permit shall he,kept on the premises available for inspection throughout the Mork.
e. No building shall be occupied or used in while or in part for any purpose whatever until a Certificate of
Occupancy shall have been granted by the Building Inspector.
•
APPLICATION IS IERM MWN 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 Taws, 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 r necessa' :•,.Pee:.tions:...•
(Sig .ure of applicant, or nam, if a corporation)
7.....
(Mailing address of applicant)
State whether applicant i owner lessee, agent, architect, enp,ineer,�general contractor, electrician, pltnber or builder.
..................................yy.,,r....................................................................................
Namof: owner of premises ...... ...........................
(as on die tax roll or latest deed)
If. applicant is a corporation, signature of duly authorized officer.
.......................
(Name and title of corporate officer)
Builders License 130. .........!................
PlumbersLicense No. .........................
Electricians License No. ..... .......
Other Trade's License No. ....!................
1. Incation of larch on which prop
?sed work will be done..............................................................
................. ...................................k!..dr
............................
House Number I Street Bamlet
Canty Tax Map No. 1000 Section ...P F....... Block ... ......... Int ...�...........
Subdivision ..................I;................... Filed Map No. ............... Int ...............
(Nave)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ........ wc. .........................................................
�GUkCL/� y
h. Intended use and occupancy L,.............................................................................
#toY "L Yc"A
', yYme�CKi ni nm£Y
3. Nnlure of work (che(k which applicable): New Building .......... Addition ,,.......P. 11&a��ot .i .. .,
Repair .... Renrncal Demalition Other Work ® "�
r
4. EsLinented Cost a d.U..'............. fee ........................... :": .....
(Lo be paid on filing thi a 6ion�°M...w.....,..„., j
5. if dwelling, nniner of dwelling units ............ Umber of chaelIing units on eacl
Ifgarage, umber of car's ......................................
G, If business, mmiercial or mixed Occupancy, specify nature awl extent of eacld type of use......................
7. Dimensions of existing structures, if any: Front....b.c......... Rear ...F'.Y........ Depth ...�5..........
y
Ilcig)ut ..,.., y............... [luniner of Stories ...... :....,....., 6
Dimensions of sae strocture with alterations or additions: Dont ...6.y...... Rear ....y.........
Depth ...5 y............. Ileiglnt ....2a T.�.........., Nnber of Stories ...[�2......,.
g. Dimensions of entire new construction: Dont ....V„y....... Rear ....J.y...... Depth ..`.l.........
Ileiglnt ......................... Umber of Stories ........,,.....,
9. Sire of lot: FrnrnC ,./. P�'.p3t1 Rear ......3.7.1.4'
. Deptb ... .Y.............
10. (late of ftnrdnase ...rg,(,/8/U.7...... Name of Former (honer .�..... ...........................
II. Zone or use district in wlnicdn premises are situated ...... ��`� �
...................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: .....
...............
13. Will lot be regraded .....lke�q8...........
Will excess fill be removed from premises: �YES
14. Nacos of Owner of premises Ae4�/.}}&..arm Z-4� Address .v 8',F,Fk A.� .'Q�0".`.. Ptnare No-9 t�: .-: "r.'�
Name of Architect .................................... Address .............................. Phone No.
..............
Nine of CO ntracLor ................................... Address ...............................I1xoe No. ..............
15. Is this property within 300 feet of a tidal wetland? * YES .......... NO .. ..... `
*IF YIS, S(70111(lln ium YRDSn.°73S PEIIt1I'1' my ISG RI((piwa).
PI.0'I' DIAGRAM
locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions
fon property lines. Give street and block number or description according to (teed, a suxxw street names and indicate
wlnedier interior or corner lot. -
3 A19
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000NIY (3171�-
.K(k./� r/q�
.............v.".:.:,.. ,f.[..,.��h. .)............being duly sworn, deposes and says that he is Lite applicant:
(Nae of individual signing contract)
above named, / , 1,^ �,
lie is Lite ®W ' L- r
I ..................................................................................................:
(Ccmntractor, agent, corporate officer, etc.)
of: said (mier or ow)ers, and is duly authorized to perform or luwe performed the said work awl to make awl file Lhia
application; that all. staterents contained in this application are too to (lie befit of bis knowledge and belief•; and
Lhat Lite work will be performed in Line manner set forth in the application filed therewith.
Sworn L I ..-.. nr_ this
ay .., .... .... 19,. ..
Notary Publ'c . . ..... .............. „ .
4tn`ia�(:Ore
..... ......... ......of Applicant)
lW"z 1FOtk
ec MMiitbn iuph"Dft a
N / O / F MAY WATSON
,. PLOT I
PLOT 3
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MAIN ROAD ( NYS ROUTE 25 )
SURVEY OF PROPERTY
AT ORIENT
TOWN OF SOUTHOLD
SUFFOLK COUNTY , N . Y.
CERTIFIED TO IODO 018 06 - P/O 24
FIRST AMERICAN TITLE
INSURANCE CO OF NEW YORK SCALE I " = 301
REM ABSTRACT CORP AUG 31 , 198 7
ROBERT A KEHL
SHELLEY G. KEHL Oct. 24 1987 ( foundation location )
TITLE NO 585 S 0131
Prepared in —,danp with the minimum
standards for title surveys as est-Mblied by
kDLANDq the L.I.A.L.S. and approved and adapted
•/
pe aA, tNc Gq� far sack ase by The New York state Land
/ '0y FC2 rade Asjatjan.
d 0 0
� { ;✓: 'N� � I'f . S. LIC N0. 49668
CONIC rV a q ` 90 ENGINEERS , PC
( 516) 765 _ FLOT NUMBERS REFER TO: INOR SUBDIVISIO N
P.O BOX 909 MADE FOR HOWARD L . YOUNG.
MAINROAD
SOUTHOLD , N.Y. 11971
87 - 669 ( 2 )
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