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HomeMy WebLinkAbout22913-zFORM NO. 4 TOWN OF EOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall southold, N.Y. CERTIFICATE OF O~CUPANCY No Z-27171 Date JUNE 29, 2000 THIS CERTIFIES that the buildin~ Location of Property 110 BURGUNDY COURT House No. County Tax Map No. 1000 Section 51 Subdivision ADDITION SOUT~OLD, N.Y. Street Hamlet Block 3 Lot 3.17 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 11, 1995 pursuant to which Building Permit No. 22913-Z dated JULY 28, 1995 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 DE~K ADDITION TO EXISTING ONE FAMILY DWELLING AB APPLIED FOR. The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 STEPHEN K. & PATRICIA M. SP~ENGEL N/A N/A N/A B'ui~ding Insp~or~ FORM NO.3 BUILDING DEPARTMENT TOWN HAU. $OUTHOLD, N.Y. N_O BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) /.4 .............. ......... 22913 Z County TaxMaPNo 1000 Section ~Z Bock ~. LotNo ~'/ 7 ........... ~ ...... ;.'.'.;." ",'; ......... Building Inspector. ~ee*..7~.~ ..... Rev. 6/30/80 ...... Bulldl'~ ...... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-i802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Ao 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 Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of i% 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. For existing buildings (pr~or 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. 1. 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-existinK 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 Location of Property ..... ' ' House No, Street Hamlet ~ ty~.~.~ .~.,..~. ~.~,~. ?,~.~ ,~..~...~,~,.. .......................... Onwer or Owners of ~roper w.~.~.'~ ........ ' -- ' . _ .. ... .Subdivision. 9~,-~-~.~. ~.~.~.~/....'. ......... Filed M~p .......... Lot ................. Permit No..~-..~f'??.~.- ..~.:' .Date Of Permit. ~..~. ....... Applicant., .~.~., f~Pf~'~' .... Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ................... ''' '' ~inal Cej Request for: Temporary Certificate ........... e ........... Fee $~bmitted: $....~.-~-f.~- ........... -. Co- a?)71 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION I ST [ ] FOUNDATION 2ND [ ] FRAMING [ ] FIREPLACE & CHIMNEY [ ] ROUGH PLBG. [ ] I~I~LATION [~FINAL REMARKS: DATE ~:)//~/~ ~/~ II Town Hall, 53095 Main Road P. O. Box 1179 Southold, NewYork 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD August 23, 1995 Mr. Steven Sprengel P.O. Box 1791 Southold, NY 11971 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. $25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 22913-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. FOUNDATION ( IST) FOUNDATION (2N~D) INSULATION PER N. STATE ENERGY FINAL ADDITIONAL COMMENTS: '-I ['~)! .......... ? FOrlM NO, 1 ' f~ ' TOWN OF SOUTHOLD ' !'" I I~'~ll~ ',: BUILDING DEPARTMENT ; ,, TOWN HALL -i~ .:;... ,;,.~ ,. SOUTHOLD, N,Y, 11971 ~ ,,,',~:'~',~:~'~r~ ~ ~ TEL.: 765-1802. Approved ............... , 19 mit No. Disapproveda/c .... . ................ ~-'""~'","'~ .... ". BOARD OF HEAt. TIt ~.~.~... 3 SETS OF~I~AN$ ....... SURVEY SEPTIC FORM ........... 2 HAIL TO: Date ................... 19... INSTRUCTIONS a..~lds apPlication must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 2 segs 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 st?eet: 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 tiffs 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 permil 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 Occupan% shalI 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 et Regulations, for the construction of buildings, additions or alteratious, 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 g C/¢ TC " __ __ .7 &- Z ; , ; ;/. : qy .... i'. .... . i ............ - -' (Signature of applicant, or name, if a corpo~'atJon) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, generaJ contractor, electrician, plumber or builder. .... ..................... ; .................................. . ........................... Name of owner o,' (as on the tax roil or If applicaut is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plu nber s L cerise No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .......................................... llouse Number Street ::~ Hamlet CounWTaxM.pNo. lOOOSecfion ...:...67./ ..... '.)'Block ~. 3 ' Lot 3.,.lP ...... ' Subdivision..~.4O~,O~. ~.0& .~.f~e~a(~. Filed Map No...q.ff~%.. [.. Lot...1.9. ......... t(Name) , ' State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use anti occupancy 3. Nature of work (check which applicable). New Build n' ~ Repair ......... Remtoval . ' ....... gD;".d: .... Addition ....... ~!t;}Jteration 4. Estimated Cost. · . ' escriptio7) ........... I ...................... Fee ..................................... 'i · ! (to be paid on filing this ap I catio 5. Ifdwelling, numberofdwellingun ts . ~Vo~-.&.o.l]. ,., ' .... P. If garage nun berofcars r~O,}. ,~ ,,;/,' '.fb .... . r~umver o~owell ng un ts on each floor, riOt"all't/: . o. If business, commercial or mixed occt na~n~v '~,,,~;;c,J ' ' i ..... , ....... ~ ................... .~ ..... ~ .......... 7 Dil ......... '-.,' .... ' ., '- -, ~*-,,,-5.,y2tature {inn extent of each type of use . /'~ 0't' ~ /' Height . . Number -"" '. ' ....... : ...... ~eptn ,>.qo... . Dimensions of shine structure with alterations or additions. '~'--' '~" /:.'<:, ~ ',- ' ' '[3,~, '1 ..... 8. Dimensions of entire new constD~ction Front .J~.~. ~ 8 ..... ... Number of Stories ........... ' ....... ; Rear ..IX .......... Depth..c/ ..... Height ~. l'g i'. ......... N!,~mber of Stories . . [ I0. Date of Purchase l/lt~rj ' ' ' '. · · Depth .,,~.k/(a~ ti(. ..... ~ ........ ' ........ Name of Former Owner I 1. Zone or use district in which prem. ises are situated ...... .. ' 12. Does proposed construction violate any zoning law, ordinance or regulation: . ' ............ ' 13. Will lot be regraded [ri. O · ~.0.. ' ............ ................... Will excess fill be removed from premises: Yes 14. Name crOwner ofprentises 5;'NM~ ~I06~.~5.'~4~.. Address q.o.cha~lO.~qa.~ ... Phone Name of Arcliitect · '! ................ Address ................... Phone No. . Name of Contractor .......... i ................ Address ...... . . . ~h,,.~ . [5,' Is t:h±s property w±th±n 300 feet of a l:±dal wetland? ' ¢¢ke'~ .... · ~tT-2~,.m~,, No ................ i ~zf yes, Southold T' n .......... · ow 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 ngmber or description according to deed, and show street names and indicate whether interior or corner lot. FATE OF NEW yOYLI~ , . (Name of iudi~d ual s}g~Yn~g}~dct3 ......... )eve named. [ being duly sworn, deposes and says that he is the applicant ~ (Contractor .......................... agent 'porate officer etc ) said owner or owners and is duly authorized to perform or have performed th - ' , . . plication that all staten ents contained in this'a~,Hicaflon ~r ....... e said work and to hake and fi e this rk w' I m, a c true to tile t)est of his k , · . · dl be performed in tb;~'~rset forth in tle a'~') cation fil ,, ~ .· nowledge and belief, and that the No. 4725089, Suffolk[Couolv. : 'S n .... ,2 ' ' '. ....