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HomeMy WebLinkAbout22206-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24023 Date NOVEMBER 9, 1995 THIS CERTIFIES that the building DWELLING Location of Property 3155 PINE NECK ROAD SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 70 Block 6 Lot 19 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 25, 1994 pursuant to which Building Permit No. 22206-Z dated JULY 25, 1994 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 REPLACE EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to CHARLES & PENNY BURNHAM (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. PENDING - 11/6/95 & H-046433-8/4/95 PLUMBERS CERTIFICATION DATED JULY 21, 1995-JOHN W. REICHERT PLUMB.&HEAT. ui..ding Inspector Rev. 1/81 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 AUTHORRIZZED), Date ....................1/ 19..C~?••• N® 22206 Z Permission Is hereby granted to: 1/A 5.......5? t? w? s/...........Q!"!~' /........,fie I to . .......................,s.... a....... t.,.....,.....~.~ .........o i f at premises located at > , . ~.~S {9?~,~ . I County Tax Map No. 1000 Section .....X.............. Block Lot No. ...f f pursuant to application dated .Y./.~.:C...................... 19.. ff....., and approved by the I Building Inspector. Fee $ e .,.~!P / Build ng Inspector Rev. 6/30/80 " 4~~-[SSv -Orin No. TOWN or SOUTHOLD I BUILDING DCPARTHr1,IT i OCT 13 1995 TOWN HALL 765-1802 BLDG. DEPT. TOWN OF HOI-D - . . APPLICATION FOR C7RTIr1CA-rL OF OCCUPANCY A. 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-0 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 17 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. B. For existing buildings (prior to April 0, 1057) 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. C. Fees 1. Certificate of Occupancy - New dwelling, $25.00, Additions to dwelling 525.00, 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 Building - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $)15.0/0, Commercial $15.00 Date New Construction........... Old Or Pre-existing Building Location of Property.. douse . No. . . . . . . . . . . . . cR•TAFO!-.}a...[~:~•.. AA Street Hamlet Onwer or Owners of Property... l~~•...IY~S.,,C,LfA2~~rS...U2rJ~FjH ,ounly Tax Map No 1000, Section.... 7 Q....... B l ucl...... 6 .........Lot..... ~ SubJivision/p~........." . . . . . . . F i I cd Mn1~.... . . . . . . Lot . . . . . . "erm it No. AG AZ p.6.. Z. Do t e 0f Permi t.. 7.Is •.~.!9 App l icon t. MR...~ aS dlctR!?/~!~./`~(.. (lealth Dept. Approval......./f:.19 Underwriters Approval........................ Tanning Board Approval 'tequcst for: Tempornry Certificate........... Final Certicate...... -ee Submiusddt 3.2.5 1 C 0 -;;1- Town Hall, 53095 Main Road Fax (516) 765-1823 P. O. Box 1179 Telephone (516) 765-1802 Southold, New York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD C E R T I F I C A T I O N DATE : `7 0R / S Building Permit No. R,19 0 6 Owner: 09,411-65r 6 y2/-/,yJ (please print) Plumber: `-S Gt/- ~C/G/Y~6ZT ©a Jd. (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (P mbers Signature) Sworn to before me this (Sj day of 19 Q2 Notary Public, ounty ROBERT I. SC NOTARY PUBLIC, S of N.Y. No. 4725089. Suff k Courdy_ Term Expires May 31, 1 9 z ~ ~ O H7 H C1 ~ ~ N N rm° o" M1 fl p .p O o• ~ rz ~ ~ ~ nz g 8 f o to `0 m o w r+ < V H c z ,a, g m S g ro m n c 3 D T to m L" Z3 ~ m 0-3 y S c S F s n p 2 c ~ z X g 3 ° ° z a oa im y ° 4 m o S m c Q~ mA Q O w ° N ' m s w° -4D z c 4 p ~a c Vq v j 9 ° w r <m O r o A ° 1 2 o x~ C~7 a w 7AC yIN ' Q i x H O z N O .°c $s n m N A. S' m m r irk' N o ° a < µ m z s a m z F n ~ 3 ~ .Tl ^ ~ N ~ O w ~ ~ E m ~ zs 1+ N N ~ 3 ~ F ~ zn ~m~ w In (n -j U1~~ a ~m C m ~v -1 i 2 N IA a 0 - K1 xl a$ Big ~ ~ ~ ap m z b.. ~ Kea Z t D c £ x i w ~".tl{ n 177 S' ~ C•3 Ln 03 Z7 OP m Ln to 74 21 S O ss m p mm 0 Z C l o n m q A m I 0 y I , i0 - e o y f 3 A A t~dl n `~7 A t 8 9 C 4 ~ s O1 F ~ O Z F-+: ?F z y f tj z ~ Z TiuO x N n k o- L~1 N Z : TAY F S ~ ht ch N o. ' z£ 3 ~ H ~ o £ m y LJ y h,~ O ~L uAi ~ v _ ~ , _ _ . _ ac_2..i..~#S 3:" •.».~,'1.1._ w. Yw:rc..e,.P. S.triamACm~I.-.'~•.+Q.x....,.~ _ _ h O~OgOFFO(,{-~O c~ y = Town Hall, 53095 Main Road p • Fax (516) 765-1823 P. 0. Box 91971 Telephone (516) 765-1802 Southold, NewYork 1 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD October 2, 1995 Mr. Charles Burnham P.O. Box 137 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) xx 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 # 22206-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. cz•1 L N r A7~1 OUNDATION (1st) OUNDATION (2nd) c - Y AP - s o ;OUCH FRAME & -PLUMBING C _ cn Sao 3. m m ~ _11SULATION PER N. Y. ~r STATE ENERGY II CODE FINAL 7- • o ADDITIONAL COMMFNT . m x a\ CD ~C v v i H 2~ 765.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING FINAL [ ] FIREPLACE A CHIMMNEY REMARKS: C C DATE INSPECTO M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN ULATION [ ] FRAMING FINAL [ ] FIREPLACE & CHIMNEY REMARKS: f,2 h6lzi- zt~ DATE 0 INSPECTOR M-1802 BUILDING DEPT. k ~j INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH [ ] FOUNDATION 2ND NSULATION [ ] FRAMING [ ] FINAL REMARKS: a-&A ~ of Q C DATE INSPECT e M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ I ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [44RAMING [ ] FINAL REMARKS: I DATE a.~ INSPECTOR ~ ~''``'/,r?i '`'a ah ~,°r `sFy l; ik~r. R ~i /y i. ~ i,F Y a ~ ~e. -rr RY . / ~i y . - ~".,~'".f~°_>~.t'_ti~i"~<^^w~S!,~,rC1~ ~~r~~'~ •v.y*w' ^yN..^e°t.!? ~6^S,fo~n ~I Board Of Southold Town Trustees 1~ , SOUTHOLD, NEW YORK ' PERMIT NO. 4350 DATE:... July 11, 1994 ISSUED TO Charles & Penny Burnham ¢ Aut4orization r r: Pursuant to the provisions of Chapter 615 of the Laws of { the State of New York, 1893; and Chapter 404 of the Laws of the ju 11 State of New York 1952; and the Southold Town Ordinance en- a tj titled "REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the w REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;" and in accordance with the x,11 Resolution of The Board adopted at a meeting held on June 30k. 1 I~ 19 94 , and in consideration of the sum of $ 150.00 paid by " r Charles & Penny Burnham y3., of N. ,i Terms and Conditions listed on the lreverse subject heto the i k4 of ~s reof, of Southold Town Trustees authorizes and permits the following: 5 to renovate existing residnece on same foot print except for 1i the southerly end which will be extended 30' as per survey {w dated April 22, 1993. i[d t' all in accordance with the detailed specifications as presented in the originating application. a IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. o o < Cvvr e~ , , Trustees ~ ~..L Jie..~, '~,r ~ F.r.*a.~w•B.,'..fi...s.~'e°a ,y rr ^4Ev ~ l+.ce..s.4...~,.eL9.,ra"u~y""`T leiY. ~,..m.a o ~ n ?0. ~ /bh~~ w. "lh~ aye 'fir R TERMS and CONDITIONS The Permittee Charles & Pence Burnham residing at P}ne Neck Rd, Southold IV ye as part of the consideration for the issuance of the Permit does understand and prescribe to the fol- lowing: 1. That the said ',Board of Trustees and the Town of Southold are released from any and all damages, or claims I for damages, of suits arising directly or indirectly as it result of any oper- ation performed pursuant to this permit, and the said Petmittee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold 2. That this Permit is valid for a period of 24 mos. which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. 3. That this Pertgit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that auth- orization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application, may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future', operations of the Town of Southold require the removal and/or alterations in the location of the',work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation, the said Permittee will be requited, upon due notice, to remove or alter this work or project herein stated without expenses to the Town of Southold. 8. That the said Board will be notified by the Permittee or the completion of the work auth- orized. 9. That the Permittee will obtain all other permits and consents that may be required sup- plemental to this permit which may be subject to revoke upon failure to obtain same. Albert J. Krupski, President o~pS~FFO(~ coG Town Hall John Holzapfel, Vice President 'Z yL 53095 Main Road William G. Albertson rn x P.O. Box 1179 Martin H. Garrell O Southold, New York 11971 Peter Wenzel Telephone (516) 765-1892 Fax(516)765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD July 11, 1994 George Koch Mount Beulah Ave. Southold, NY 11971 Re: Charles & Penny Burnham SCTM #1000-70-6-19 Dear Mr. Koch: The following action was taken by the Board of Town Trustees during its regular meeting held on June 30, 1994 regarding the above matter: WHEREAS, George Koch on behalf of CHARLES AND PENNY BURNHAM applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated May 23, 1994 and, WHEREAS said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and, WHEREAS, a public hearing was held by the Town Trustees with respect to said application on June 30, 1994 at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW, THEREFORE BE IT RESOLVED that the Board of Trustees approves the application of George Koch on behalf of CHARLES AND PENNY BURNHAM to renovate existing residence on same foot print except for the southerly end which will be extended 30', as per survey dated April 22, 1993. Located Pine Neck Road, Southold. Permit will expire two years from the date it is signed. Two inspections are required and the Trustees are to be notified upon completion of said project. Very truly yours, 9. 14-ea. Albert J. Krupski, Jr. President, Board of Trustee AJK:jd cc: CAC Bldg. Dept. i 4r ~~o~OgOfFO(~-~OGy o ~ Town Hall, 53095 Main Road °y Z Fax (516) 765-1823 P. O. Box 1179 W- • Telephone (516) 765-1802 Southold, New York 11971 .t. col ~ ~a OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD March 30, 1994 Charles & Penny Burnham P.O. Box 137 Southold, N.Y. 11971 In order to issue a Building Permit for your proposed construction for buildings located on lots adjacent to tidal water bodies, we will need a waiver of jurisdiction or a permit from the Board of Trustees of the Town of Southold. Also, please indicate location and condition of existing waste water system. Suffolk County Health Department approval maybe required, insofar as the entire house is being removed and a new one built in its place. Very truly yours, SOUTHOLD TOWN BUILDING DEPT. Gary J. Fish, Building Inspector Phone numbers: Town Trustees - 765-1892 BOARD OF HEALTH{ FORM NO. 1 3 SETS OF PLAYS • • • • • • TOWN OF SOUTHOLD SURVEY • , • • • . BUILDING DEPARTMENT _ _ - _ . - 2 5 TOWN HALL SEPTIC FORA . . SOUTHOLD, N.Y. 11971 TEL.: 7651802 t:oTIFY; 0E 9 CALL Exami ed j sot1TH0 MAIL TO Approved 19 Permit No. !ZCJ~.. . . Disapproved a/c _ . uildingInspector) APPLICATION FOR BUILDING PERMIT Date 19 ~ y INSTRUCTIONS 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 rr areas, and giving a detailed description of layout of property must be drawn on the diagram whisk 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 art for an 1 shall have been granted by the Building Inspector. P Y purpose whatever until a Certificate of Occupancy 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 code, and regulations, and to admit authorized inspectors on premises and in building for necessa. - h- peXS.*. (Signature of applicant, or name, if a corporation) A IX X37 Sua~~~p Ny 119-71 (Mailing address of applicant) State whether applicant is owner,.lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ©n~r?d~i ....../ry. Name of owner of premises N , i ~^t ~et2 l tdR~ O2;1:-t£ S ~ (as on 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. , Plumber's"License No. . • , 7 74 p Electrician's License No . Other Trade's License No. 1. Location of land'on which proposed work will be done . . . . r~I -r e~QttTd~oL D . House Number Street Hamlet ~ County Tax Map No. 1000 Section ...6" © . , , • Block . , fP p Subdivision Filed Map No. Lot . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: `o a. Existing use and occupancy , F a,£ b. Intended use and occupancy i R/ J4172 , , '2,r S. work i (check which Nature of • • • • , • . applicable): New Building Additi n Alteration ' Repair • • • max., , Demolition / Oth \ r" , . 9 w ~(Dcscription) 4. Estimated Cost 9 J~ Fee I... (to be pai. d~f(lin"~ fMapplication) 5. If dwelling, number of dwelling units ;I......... Number of dwelling units on, , . / , , If ara"e, number of cars ~ , 6. If business, commercial or mired occupancy, specify nature and extent of each type of use . . . . . . 7. Dimensions of existing structures, if any: Front Il~'r? , , , , , Rear , ,!'~E? . . Height ...1.4 t....... Depth .5.9........ . Number of Stories , / . . . . Dimensions of same structure with alterations or additions: Front , , .(Q. ° r Rear !a6./: ! a . Depth . . . . . a/ /.~4 . . . . 8. Dimensions of entire new construction: Nu Height , , , , , , , , , , , , , , , Niunber of Stories ...I Front Rear . A(F.'-!P . Depth Heim tuber of Stories ....C . 9. size of lot: Front J.B. ....................Depth.. • `~63 10. Date of Purchase .~ZG ,~s~w • Rear v . L `t , • ...,,y It. Zone or use district in which 7) Na~I[pe of Former Owner . i~rd.-i.1: , , . remises are situated ,A',' l .o..... , 12. Does proposed construction vi,, ate any zoning law, ordinance or regulation: . 13, Will lot be regraded' ' ' ' ' Will ex9pss fill be removed from premises: 01s.) No 14. Name of Owner of premises C~956€S iR.A4'?*4ddress !'tfllrSSf}. IA04A, , , , , , , Phone No..V$. 9"/7/, , 4 L . 'r Name of Architect ~ , , W.Z . . . . Address Address Phone No. S<7q !70~ Name of Contractor . 15. Is this ro rt within) P Pey 1300 feet of a tidal wetland? Phone No........ L....... *If yes, Southold Town Trustees Permit may be required. " No..•..•'•' PLOT DIAGRAM Locate clearly and distinctly a4 buildings, whether existing or proposed, an& indicate all set-back dimens#ons from property lines. Give street and block'Inumber or description according to deed, and show street names and indicate whether interior or corner lot. -0'j ~uc 6'~in>7,S i ~I . I STATE OF NEW YQIK, COUNTY OF... S•,S i . W.~....~. . (Nar 7c of individl signing U ' • ' ' ' • being duly sworn, deposes and says that he is the applicant contract) above named. . 7HgY gam rrte Hjz4s=tlre C? .1 . (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly :juthorized to perform or have performed the said work and to make and file this 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 manner set forth in the application filed therewith. Swom to before me this . .....day of. ......M69fLCH......., 199. Votary Public fi6s/9 L! County PHYLLIS FAV^Mq,N!1 . watery Public, tq%D k Y~~tt (Signature of applicant) CAitAIYSlRrh6%pVYB`P`J 1•'36:'70 Awl Will wo er'"wasrr~wrsrc~R~ 'A, NI, t < r'M } yt Y t 1 4 3 » TiL"~ Y~ ' a v t a t ele, rye: S a ;f i ? c (,y 9Y A INW, - AOo . 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FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. pF NEp ALL j9Mbr THE ALL CONSTRUCTION SHALL MEET, T Ptb Y° THE REQUIREMENTS OF THE N.Y. r eSa'~~~cE ~ STA STATE CONSTPUCTION i ENERGY I _ ti CO[ CODES. NOT RESPONSIBLE FOR ± _'7 4 / ^ DESIGN OR CONSTRUCTION ERRORS n _ v rs I `"'O' DES - , i' 'PBOVOCc " Phone 477'0400 e_ 1 ~o mailY Road ~6 N2s5s- 1 iRPCIHG Of ,1'nPi / 1 _ I of 1964 $U 4vEr OCCUPANCY OR n ~ D °FESSIpGRtiENPOCl I. N V 11°.4d ~+ti j ' TAUCkL 'ZED. IOpD-IO-G'~9 C i k' w5 I ITV; 44kE5 ` U USE IS UNLAWFUL CN AT Lt 4 7Ekµ Y B'U NHf N\ 2H-92'y wi WITHOUT CERTIFICATE OF OF OCCUPAN~4/y~ DWG. E4r.VA-r ~,.1, 4 -FT-pT F,.,,µ y2 - I oVAN NO, ( 392 f SCALF c r . ~ I I i 0 v a , -p I ,Q I ' I \t a~ ~ - 3f~ll ~K 3 I -C° I 3AnCF I I y 7' I I I VI'}} It I i l _ c I~ I L"tt AF aI Q _°I ~r $3~P°fpflhzDp rtol~p~ h 00. 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