The URL can be used to link to this page

Home My WebLink About21516-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22524 Date AUGUST 12, 1993 THIS CERTIFIES that the building DECK Location of Propert~ 805 KERWIN BLVD. House No. Street County Tax Map No. 1000 Section 53 Block 3 GREENPORT Hamlet Lot 17.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 23, 1993 pursuant to which Building Permit No. 21516-Z dated JULY 6, 1993 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 A SINGLE FAMILY DWELLING AS APPLIED FOR The certificate is issued to of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 ERICH BOLLHORST (owner, lessee or tenant) Building Inspector TOWN OF SOUTHOLD BUILDING DEPAI~TMENT TOWN HALL SOUTHOLD, N.Y. N~ 21516 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission Is hereby granted to: e,~... ~:.,,~.,..~.~....)c~.:~...~..~,/~,, ....... ~.~...../.~.~ ................................................ ~...;. /,.4. /./.~,s'? , ../~.,~..(~,,~/./~. ............ ~ ........................ .:......: .............. to ........ ~,,~. ~:..'~.. ......... ../.........~'.(- ........... .,'~,., ,.'~..,~..~./..~....~....~............... ,'-'~.. ........ ~ ................ .............................................................. ..~.;..~.,,~..... ~.c'. ~..z.~..zz.. ........................................... CountyTax Map No. 1000 Section ...... ...~...~.. ........... Block ....... ,.~...~.. ........... Lot No ...... ../...,~.,:....'~.. ......... pursuant to application dated ............. .~../.~..~ ............................ 19... Z~.. ...... and approved by the Building Inspeotor. ee ~..~.z ................ Building Inspector Rev. 6/30/80 Form No. 6 TO,tN OF SOUTROLD BUILDIMG DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This applidaffo~'"f~ust 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 l%.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 (prior to April 9, 1957) non-conforming uses, or buildings and Ppre-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 si~ned 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 ~ 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-existing Building - $i00.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ' New Construction .......... Old Or Pre-existing Building .... ~... Location' of rop.rty..i .................. ..... iiiiiii s- ... House No. Street 'Hamlet Omwer or Owners of Property ............. .~ ................................... . . .. . . County Tax Map No I000, Section .... ~T.~ ...... Block .... ~.~ ....... Lot .... 12,~ ........... - ~ Subdivision . '; Filed Map ~ Lot ~ Permit No..Z/.~/ ...Date Of Permit...7~Z~ ..... Applicant./~A~ ..... ~. ..... Health Dept. Approval.~ ....................... . U~derwriters Approval ................ f ..... Planning Board. Approval ............. ~ .......... Request for: Temporary Certificate ........... Final Certicate..~.. ...... - Fee Submitted: $.....~'~-~--............ .......... . . ..... .............. ~UNDATIO|! (2nd) TOUGH FRAHE & -PLUMBING ,I/SULAT!O~I PER N. STATE EHERGY CODE FI;;AL ~DDITIOH~'L COMMEHTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH 'PLBG. REMARKS: Disapproved a/c ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y, 11971 TEL,: 765-1803 APPLICATION FOR BUILDING· PERMIT BOARD OF HEAl. TH ......... '~ SETS OF PL,,XNS . SURVEY ......... Date...~.0..~.~...g.Z. .... 19 ~ 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 sti'eets 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 vzill 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 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 ail applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necess~Tl~cti~,~ (]'~-~.~ ~ t~ . · (Si,,nature of appncan~, or name, ifa corporation) (Mailing address of applicant) State whether applicant is owner, lessee, 'agent, architect, engineer, generai contractor, electrician, plumber or builder. .'. .................... · ....................................... Name of owner of premises .... . .~../.d. ~....J~o/-~P] o/~;f7" ' (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 ..... /,~..7 .~.~...-~ .~../ ......... Plumber's License No ......................... ' Electrician's License No ....................... Other Trade's License No ........ ': ............. 1. Location of land on which proposed work will be'done ................................. i ................ ...... ...... · .............. .... ......... ............ - House Number Street Hamlet Tax Map No. f000Section ...;...'~ .......... Block ...... ~ ...... J... Lot.//.~.*.c~ .......... Connty Subdivision ........ . ............................ '. 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 .................................................................... b. Intended use and occupancy '3. Nature of work (check which a Repair .............. Rem >plicable): New Building . ~ ........ Addition .......... Altera oval .............. Demolition .. ' . . Other Work. ~..~.~ 4. Estimated Cost ............. Fee g ril ~ . (to be paid on fihng thru apphcatm 5 If dwelling number of dwellin~ units Number Of dwelling units on each floor · · If garage numberofcars ............... ' .............. 6. If business, commercial or mix6d occupancy, specify nature and extent of,each type of use 7. Dimensions of existing structures, if any: Front... Rear Depth Height ............... ~u~ber'of Stories ........................................................ Dimensions of shme structur,, with alterations or additions: Front ................. Rear .................. pth ! ight ' ~ ' De .... ~ .................. He ........... ; ...... .... Number of Stories ................ 8. Dimensions of entire new construction: Front .~. ~'...: Rear ...... ~ ......... Depth //,.~. '" ...... Height ,~ ~ rob ........ ' .......... ..... Nu er of Stories ......................... . 9. Size of lot: Front Rear ............ Depth ...... 10. Date of Purchase Name of Former Owner Il Zone or use district in which 'emises are situated ' . '" · Pr 1 2. Does proposed construction violate any zoning law, ordinance or regulation: ............................. 13. Will lot be regraded ....... ; .................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises . .~6Ua-/! .~..o++..':t.~..~4 ..r-. Address ................... Phone No ........... ;... Name of Architect ...... ~..~'J.~..' .............. Address ................... Phone No ............... NameofContractor././~.~..,5/.~i.~'.*.q.~....~..~. ··Address .~B~,./6o f*~o~c~ PhoneNo ~.'~..~.~7~..~.. 15. Is this property within 300 feet of a tidal wetland'? ' '*~'e's'.'.'.~.'.' ~o ...... i.'.'t' ''' . *If yes, Southold iTown 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 blocklnumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ).S COUNTY OF..,~:~.~qO Ll~. .... ........ {.~ C~l~¢,l.4:.zM~. 0.~. ~ ....... being duly sworn, deposes ~d says that he is the applicant (Name of individual signing contract) H~ is the .... . ..... . .......~ . ........................................................ I (Contractor, agent, cor'porate officer, etc.) of said owner or owne~, ~d is dul~ authorized to perfom or have perfo~ed the said work and to m~e and file this application; that all statements conta:ined~ ~ this application are true to the best of his knowledge and belief and that the work will be perfo~ed in the manne~ set forth in the application filed therewith. Sworn to before me this .. .... ................. day ofl .... ~0 03,8121250 OUALIF ED' N SUFFOLK COUN~