HomeMy WebLinkAbout17886-z FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N. Y.
CERTIFICATE OF OCCIIPANCY
No 218597 Date NOV. 28, 1989
THIS CERTIFIES that the building INCROUND POOL
Location of Property 375 PVT. RD. #10 OLD WOODS PATH SOUTHOLD
House No. Street Hamlet
County Tax Map No. 1000 Section 087 Block Ol Lot 3.2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated FEB. 1, 1989 pursuant to which
Building Permit No. 178862 dated MARCH 6, 1989
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 ABOVE GROUND WITH AN INGROUND POOL CLOSER
TO DWELLING.
The certificate is issued to KAREN & KEVIN BOERGESSON
(owner, Xxxxxxxxxxxxxx}g~j
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N074506 JUNE 1, 1989
PLUMBERS CERTIFICATION DATED N/A
A Building nspector
Rev. 1/81
FO8ffi NO, f
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
CfH15 PERMIT MU5T BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N~ ~~~8a6 Z Date ...'.!1...~irJ~ .............r.~................., 19.`x.6
Permission is hereby granted to:
to...Gl........ c'I!,i~ y~:.I~J.[.~,.(.......~~s~~ ......F.'lA..~'1.
`xt.~...~Iar.:`.'
.
ct premises located at ~
-7 L j~
Caunty Tax Map No 1000 Section , Block ..q. Lot No
pursuant to application dated ~e(~E?.... . L 19 and approved by the
Bu~ld~n Inspect~orr.
i
aBuildtnp Inspecto~
Rev 6/30/80
TORN OF SOUTIIOLD
BUILDING DEPART2ICNT
TOWN BALL
SOUTIIOLD, NEH YORK li97i
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCIIPANC7 I q
DATE. ~.I./,al ~l ~ /
NEH CONSTRUCTION Y ...OLD OR PRE-E%ISTING BUILDING.......V CA T LAND........
375 {~Q 1 d 2a . # io ° ~ ~`i°°`t°^ ~ S
Location of Property
HOUSE NO. STREET HAMLET
t i
Owner or Owners of Property..../~CV~!~..~..JSgR'~!1~..~~.E'e:~e'E5So'v..-..
3.
County Taz Map No_ 1000 Section .0~..~. Block Lot
Subdivision Filed Map ........Lot/.~'_.../.n,.._.
Permit No. ~~84~.Z.Datc of Permit :3/~:/.g9..Applicant/.L...~V~G~~
Health Dept. Approval Underwriters Approval..
Plaaaing Board Approval
Request for Temporary Certificate Final Certificate
Fee Submitted: $oZ~:QQ
APPLICANT.!:`:.-:
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FOUIIDATION (1st)
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FOUNDATI01d (2nd) ~ ~
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ROUGH FRAME &
PLUMBING -
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I2ISULATIOPI PER N. Y,
STATE ENERGY
CODE
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ADDITIONAL COMMENTS:
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FRANK A KUJAN'SKI, jR , Presrdent o ~ ~ rELLPHONE
ALBERT J KRUPSKI, JR., Vrce-President v' ~ (516) 765-1892
JOHN M BREDEMEYER, III
HENRY P SMITHKI JR y'~01 x
BOARD OF TO'YR`'N TRUSTEES
TOWN OF SOUTHOLD
Town Hall, 53095 lvlam Road t^ ~ ~ ~ Q
P O. Box 728 ~ D
Southold, New York 1 1971 I~nt
March 2, 1989
Kevin Boergessen SI.DG.DcPT.
PO Box 855 TOWNOFSOUTHOLD
Southold, N.Y.11971
Dear Mr. Boergessen:
The following action was taken by the Board of Town Trustees
during their regular meeting held on February 28, 1989 as follows:
WHEREAS the Town Trustees have conducted an on site inspection
of the subject property.
RESOLVED that the Town Trustees approve the request made by
Kevin Boergessen for a waiver to construct an in-ground pool
on property located on R.O.W. off South Harbor Road, Southold, N.Y.,
identified on Suffolk County Tax Map as 1000-87-1-3.2.
Please return to the Building Department fora determination on
the need for any other permits which may be required for this project.
Very truly yours,
Frank A. Kujawski, Jr.
President
Board of Town Trustees
FAK:jas
cc: Bldg. Dept.
Board of Appeals
file
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THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE i
- 1000378 BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10033
pau JUNE 01,1989 Applicationrvo.onftle 62235289/89 N 074506 _
THIS CERTIFIES THAT
only tha aha:trletl puipmant a dsscrihad 6aloES and introduced Gy tha applicant ponssd on thsahoue sppikaeton nawtihsr itK thepromisas q/
REVIN BOBUGE330N, 10 PRIVATE ROAD, SOUTAOLD, N.Y.
itt the,/olblcinR bcationf ? Basemene ? /st F1. ? Snd FI. OUT Section Block Lot
uNU mamined on NAY 15,1989 ~ and found to 6e in compliance with the reyuiremenG of [his Board.
IatnlQ AGaf RX tbOKINO WCKE OVlNS aIYM MAU4T AN4
WTtRE INCANOEMEM RIIOeEtpM OTHER AMT. K. W. AMT. N. W. AMT. K.W. AMT. K. W. AMT. N. r.
I 1 1
DRYNS RBNAC! MOTOa4 NTYM AMihMCR IYOYti fNOAI MC'K i1Mt GOCIIf INEIT Iehiatl Mt1Ui!gYTIR g10Ah1laf
AMT. K. W. dl N. r. OAE X. I. AMi. NO. A. W. O. AMT. AAV. AMT. AMrA TRANf. AMT. N. r. q ~T AMT. WATT6
1 40
fMVK1 0M03lpNCT NEL W S E R V 1 C E
AMT. AMr. irw Ol~ 1 / tw 1 f aw 7 s' 7W ~ ~ Aw No. o~c[. COND. d C WCOiM. NO. d HLLEO A M'' NO.OF NEOTRAIE of
NWE6 MAl
t)1MI1 MMaATUk
G.F.C.Z:-1
•{SIiINNIN6 POOL) Ibis certificate
covers co~pliance at the date of
igspection oa1y. Because of unusual
enlriron~ents it is advisable to
have frequent teat and/or repairs
cede by a qualified person.
STEVB'S ELE./STE. ALBERT. LIC.#3494-E
P.O. BO% 1268
50UTHOLD, NY, 11971 W1gRAl MANAOEI
11 E~
Psr
Thit drNficab muff not ba alMad in any maanar; return to 1M office of the 9oord if incorrect. Mtpectort moy be idsnNfi~d by Ilwir TKe_dantials.
T. TINS OPY AMlS BE ALTERlD I AMPMER ~ -
' BOARD OF HEALTH _
.~..r• 3 SETS OF PLe1NS ,
~ FORM NO. 1
1'~~ "`-•'r~~ F"`~~ ~ TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC FORM
! ~EB ~ ~ jg8g ' f y TOWN HALL
I ' `'OUTHOLD, N Y. 11~J71 NOTIFY
1'_, ,F,.....~-'~ v TEL 7651802 CALi .
'
~ ~~;~~'~~'.1D MAII. T0:
Examtncd 19
daYl7.~l. 9f~~ 1 ~~~-6 Z- ~ ~'``~'z ~rw~u
\pprovc 1 Permtt No `
Disapproved a/c , .
(Busldmg Inspector)
APPLICATION FOR BUILDING PERMIT c~
Date ~ : 154
INSTRUCTIONS
a Tlus appltcatton must be completely filled to by typewriter or in ink and submitted to the Building Inspector, wtti
sets of plans, accurate plot plan to scale Fee according to schedule.
b. Plot plan showing location of lot and oC buildings on premtses, relationship to adjoining premtses or public stre
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apl
capon.
c. The work covered by this appltcatton may not be commenced before tssuance of Building Permit.
d. Upon approval of t}us appltcatton, the Butldtn; Inspector will issued a Building Penrttt to the applicant. Such perr
shall be kept on the premtses available for inspection throughout the work.
e. No building shall be occupied or used m whole or m part for any purpose whatever until a Certificate of Occupan
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the tssuance of a Bwldtng Permtt pursuant to t
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descnb~
The appltcant agrees to comply with all appitcatile laws, ordinances, building code, housing code, and regulations, and
admit authorized mspectots on premtses and m building for necessary inspections.
( tS mature of apph name, tf a corporanon)
.
• (Mailing address of appltcant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractc,r, electrician, plumber or builds
6VJ'h,gti~
.
Name of owner of premtses Lie! { ~ . far? ~ .~£.S~~S64tJ .
(as on the tax roll or latest deed)
If appltcant u a corporation, signature of duly authorized officer.
.
(Name and title of corporate officer)
Builder's Ltcense No .
Plumber's Ltcense No .
Electrtctan's Ltcense No
Other Trade's Ltcense o .
1. Location of land on which proposed work will be done ~~~.5...j~,
. ~ , , , ~,I~, , , ~ (titOO,d S
. ~ qr Osn... Sc~c3.~o. ~ . .
House Number Street ~ Hamlet
County Tax ~fap No 1000 Seaton • • • . 1 • . Block . , , , , , , , , , , Lot'BQ~T~~r"~$~" laj,
Subdivision Filed blap No Lot .
(Nance)
Stale e~tsung use and occupancy of premtses an,~d in_t^ennded use and occupancy of proposed construction
a. Existing use and occupancy ~ . p„ ~ s'~: .
b. Intended use and occupancy .~'lYrt M • ~ , , , , , , , , , , , , , , ,
3. Nature of work (check which applicable): New Building Addrtton Alteration
Repair Removal Dem iron Other 1Vork . x .
hnoV1^r ~iw+ unt;uc~ ~ -~u~ ~ (Descnpno
4. EstimatcZiCost g0od.......... .Fee ...~.v~~~a~..
(to be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on each floor .
If garage,numbcrofcars
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .
7. Dimensigns of existing structures, rf any Front Rear Depth .
Height ...............NumberofStones....................................................
Dunensions of same structure with alterations or additions Front Rear .
Depth height Number of Stones .
8. Dimensions of enure new construction Front , ~ Rear ...............Depth . -
Herg}tt Number of Stones , .
9. Size of lot. Front `3~7.... Rear . Depth ~1.Q .
10. Date of Purchase ...tpR[1~ . I°.1`ly, . , , , , , , • , , • • , • ,Name of Former Owner~~-~?~ .~SSD9/........ .
11. Zone or use district rn which premises are situated .1KL~S .
12. Does proposed construction violate any zoning law, ordinance or regulation• ..1~1e .
13. Will lot be regraded !`~0 ...........1VilI excess fill be removed from premises: Yes
14. Name of Owner of premisesK~!Y. 1(4t*kN~e}r~59oV Address Y~hat~........... Phone No. .
Name of Architect ...Address ...................Phone No............ .
Name of Contractor ..........................Address ...................Phone No.. .
IS.Zs this property located within 300 feet of a tidal wetland? *YES.A..NO...
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAb1
Locate clearly and drsturctly all buildings, whether existing or proposed, and indicate all set-back dunensrons f
property lines. Give street and block number or description according to deed, and show street names and indicate whe
interior or comer lot.
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Ike Aa 'AOJC'i
STATE OF KEW YORK, S.S
COUNTY OF .
• • - • • • • • • • • • • • • - - • • • • • • • . • being duly sworn, deposes and says that he is the appli<
(Name of indrndual signing contract)
above named.
He is the
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perfc
fm or have performed the said work and to make and file
application, that all statements contained m this application are true to the best of his knowledge and belief, and that
work wdl be performed m the manner set forth m the application filed therewith
Swam to before me [his q
• f.. ...day of lJ~.y
Notary Public, ....hr~-~-Ei..) !4.. -.Ub?~:.... County
HELEN K DE YOE .
NOTARY PUBLIC, State of New York
Na4707878,5a4foikCourdY~ (Signature of applic
Term Expares March 30,18---