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Home My WebLink About21396-z FORM NO. 4 TOWN OF SOUT~HOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OC~3PANCY No Z-23324 Date NOVEMBER 2, 1994 THIS CERTIFIES that the building Location of Property 120 KORN ROAD House No. County Tax Map No. 1000 Section 64 Subdivision ADDITION SOUTHOLD, NEW YO~K Street Block 2 Lot Filed Map No. Lot No. Hamlet 2 conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 5, 1993 pursuant to which Building Permit No. 21396-Z dated MAY 7, 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 BREEZEWAY & GARAGE ADDITION~TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR- The certificate is issued to KEITH R. & TERRY A. JENSEN (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 N/A N-297380 - NOVEMBER 30, 1993 N/A lrOB~ NO. $ TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 213§8 Z ~ote ...:~ ........................................ , ,~.~ Permission is hereby grantqd to: ~ ,~ -- ~ ...... ........... · ..~d...~/./..,...~..~ ..... ~./... .... · ................ at prem,ses located at .../~.o.....~..&~...~.d.'. ............................................................................. county Tax Mop No. 1000 Section ...... ..~.[.,..~,,. ....... Block ......... ~ ....... Lot No ........ ~ ........... pursuant to application dated ..... ~,-~,. ..................................... , 19.P..-~.., and approved by the Building Inspector. / poling Inspector Re~ 6/30/80 i994 BLDG. D,,~PT, ....! 'fOWN ~,OF SOUTHO!~ APPLICATTON FOR CERTIFICATE OF OCCUPANCY TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 ~his application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building or new use: 5. 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 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. ;. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and qpre-existing" land uses: i. 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 applicanl. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. :. Fees I. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,.~_~ Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building~'66~' Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existin~ Buildin~ - $i00.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ... !,2,..¢ Eh ....... ew Construction ......... ~. Old Or Pre-exist~ng ~uildin~ ........ ocation of Pronertv ... House No. Street HJmlet nwer or Owners of Property .... ~]T~.. , .... j.~.; .. , ......... ounty Tax Map No 1000, Section ...... ~...Block ..... ~....~.. .... Lot..~.2..-~ ..... ubdivision .................................... Filed Map ............ Lot ...................... armit No...~[.~..?..~..~Date Of Permit..~[?[.O. ~..~. Applicant ~1~ · / ........ ............ ~f/A ~alth Dept. Approval .... ~.-[ ................. Underwriters Approval ..... ~. .................. lanning Board Approval...¢/4 ................ Town Hail, 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 October 13, 1994 Mr. Keith Jensen 120 Korn Road $outhold, 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 # 21396-Z Please contact our office on this matter. cooperation. Thank you for $OUTHOLD TOWN BUILDING DEPT. '~U~IDA T I 0,'! ¢ 2nd ) ~UGH FRAHE & -PLUMBING ~ISULATION PER N. Y. STATE E~;ERGY CODE FINAL 765-:i802 BUILDING DEPT. INSPECTION FOUNDATION IST FOUNDATION 2ND FRAMING [ ] ROUGH PLBG. [ ] INS~ION BUILDING DEPT. INSPECTION [~]~NDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: ~~) · I000- ~,4- 02 -0~ P THE NEW YORK BOARD OF FIRE UNDERWRITERS J. ~.11 [j~ 77 BUREAU OF ELECTRICITY [-- BB JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT o~y the electrical equipment ~ ~scrib~ be~w a~ int~uc~ by t~ applicant ~d on the a~ve appl~ation number in the premises of in thefollowing location; ~ Basement ~ Ist FL ~ 2nd ~3. dh~ / O[}~* Section Bilk Lot u~sexaminedon ~} (} %/~;} ~}4 ~ ~ ~2t19~3 and found W be in compliance with the NaO'on~ Elect~c~ Code. FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT OTHER DRYERS MULTI-OUTLET SYSTEMS NO, OF FEET E R V I C E OTHER APPARATUS: NO. OF CC COND PER ~ A. WG OF CC, COND. NO. OF HI-LEG Of: HI.LEG AWG. OF NEUTRAL I'. (). BO~: l~4 GENERAL MANAGER / This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. ~ FORM NOt 1 ',.-,' ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT ,/-a'h 3 0 ('*Q'~ TOWN HALL , '¢"'~" SOUTHOLD, N.Y. 11971\ ' TEL.: 765-1802 Examine,L ,. ...... 19 Approved.., ...~.'~ ......... 1; .~. Permit No.'~. / .~?..~./' Disapproved a/c ..................................... . (B~ldin~qspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTIt ......... 3 SETS OF' ?L,'tN$ .......... SURV£Y ................... , CIlE£K .................... SEPTIC FOR,q CALL ................... HAIL .. ...... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 se;ts o£ plans, accurate plot plan to scale· Fee according to schedule. ; b. Plot plan showing location of lot and of buildings on premises, relatiofi'ship 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 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, OrdNances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descr/bed. The applicant agrees to comply with al/ applicable laws, ordinances, building code, housing code, and regulations, and to admit author/zed inspecto~ on premises and in building for necessary inspections{//~_.~/ :'-- ' ' ' ;'~i',:,~;:~r; ' i'~ ~-'~' ~<f' ''¢"'II' .............. t o ~ e otappncan~Srn~Ine, ifa corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... d. ............................................................................... Name of owner of premises .. ~¢ ....... .. ................................ 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 .......................... P1 tuber s License No ......................... : Electric, inn's License No ...... ' ' - h ) · Ot er Trade s L~cense No ...................... Location of land on which proposed work will be'done House Number Street Hamlet County Tax Map No. 1000Section ......... .~..~. ..... Block ' ..~'~. Lot .O.'7-,~-. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) · State existing use and occupancy of premises and in tended use and occupancy of proposed construction: a. Existing use and occupancy .. 5[ [q~.L.~-..~qi.~..~. ~'~-~LI2~_.~Ci.~. ' b. Intended use and occupancy ...~J ~.{o. k455. ~::~ t L~]. 3. Nature of work (check which abplicable): New Building .......... Addition .../.. .... Alteration .......... Repair .............. Removal ............... Demolition .............. Other Work o i (Desc ption) 4 Estimated Cost .' ' Fee 5. If dwelling, number of dwellin, lnnite _ ., ., . _ (to be pa/d on filing this application) ....................... ~umoer of dwelling units on each floor .~- . · Ifgarage, numberofcars ...~1'5~.O .... ' ............. 6. ~.bumn.ess, to.mm, er.cml or m~xed occupancy, specify nature and extent of each tv~e ,~r ut- ~ ...... 7. ~J~menmons ot em,sting structur6s if any Front '"~---~ V~! ,, ,..,,,[ ............ ~,_. ~ ........ Height .... -~[ .Q .. Number of~t~.~ ' ;3~'"'" ........ l~ear ....~. ........ Depth...~79 .......... ~Dtmensmns ~_sa/ne structure with alterations or additions. Front . ~4 I)~! ' ' ~2~'"O,~'t ......... ~v ...................... riel t. ~.L ........ · · · i . gh ................. NumberofStones..~, .... 8. Dimensions of entire new construction. Front '$7- t ,, ~,..~ ~ '~4 :,.., ........ ................. lqear .... :?~. ........ Depth .-~.."~. ' Hetght .. ~ ..... ..-, · · Nmnlber of Stories .~. ....... ... ' ..... 11. .' ' 12. . . 13. .. · . 14. Name of Architect .......... I ............... Address ................... Phone No ............... Name of Contractor ..... ; ............. ~ ·. Address .................. Phon~e, iqo ................ 15. Is this property ~'it~i~ 3:00 feet of a tidal wetland? '~Yes: ....... No ..... · If yes, Southold T:own 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 &umber or description according to deed, and show street names and indicate whether interior or coruer lot. ;TATE OF NEW YORK, ........ ' .............. ' ....... being duly sworn, deposes and says that he is the applicant (Name of individual signing?ontract) bore named. ~ .... is the ' (Contractor agent corporate officer, etc ) said OWner or owners, and is duly a~thonzed to perform or have performed the said work and to make and file this ~plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ork will be performed in the manner sci forth in the application filed therewith· yom to before me this. ................... d ay..o,f .............. , 19 *tory Public ..... County Reg..No. 4906784 '; ~. '(~' ...... My Commission F.~pires~ (Signature of applicant)