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Home My WebLink About17571-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19456 Date OCTOBER 17~ 1990 THIS CERTIFIES that the building ADDITION Location of Property 497,00 COUNTY ROAD #48 House No. Street County Tax Map No. 1000 Section 55 Block 3 subdivision Filed Map No. SOUTHOLD ~ N.Y. Hamlet Lot 4.4 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 24, 1988 pursuant to which Building Permit No. 17571-Z dated OCTOBER 31, 1988 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 ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED JOHN & MARGARET KERBS N-075491 - Jq3NE 8~ 1989 OCTOBER 9, i990-BERTSAND PLUMBING & HEAT. Rev. 1/81 / ~uilding Inspector FOB~ NO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMEHT TOWN HALL $OUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 ~17571 Z ~ ' .... ;"~' ................... fL' .......... :~ ......... ~-.::/*' -~: ..... ~.~.~.~ ....... ~,~/~.~.....~..~£ ~ ' ' '~premises Iocoted ~, ......~.-~...~..~..~..~.....;...~...~.......~..~.... ........................................ ............................................. ..................................................... ~o,,n~! ~o~ ~op ~o. ~ooo Section ........ ~L<~....... ~ ...~. ..... Lot ~o ......... ..,~...~. Building Inspector, iId~/In~ector - Rev. 6/30/80 BLD · F SOUTHOLD I'OWN~ ........ ~ Form No. 6 ~ ~.~ ~L~ TOWN OF SOUTHOLD ~ ~)9~.'/ BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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 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 "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 $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 Property...~...~.~.~...W~. ........ , .C~v~<' .... ~. ........... ~..~.~.../~....g~.~?. House No. Street Hamlet Onwer or Owners of Property..~ .................. County Tax Ma~ No 1000, Section .... ..~-.~......Block ...... ,.~.. ..... Lot .... ~..~.:.~.. ......... Subdivisio .... ed Map ........... Lot ...................... Permit No ................ Date Of Permit. cant .................... Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ..................... .. . Request for: Temporary Certificate ........... Final Certicate...~.. ..... Fee Submitted: $. , .~...~.--~f. , .e~.. ,~. ......... ~ · .............. Co 'I SC TOWN' OF SOUT~OLD OFFICE OF BUILDING INSI'EC~'OK P.O. BOX 728 TOWN HALL ~OUTHOLD, N.Y. 11971 CERTIFICATION > Date .... Building Permit NO..,, (Please prin~) (please print) I certify that the solder used in the water containa le~a th~n 2/10 of 1% lead. , Sworn to before me this 19 q~ .. Notary Public,... ~c~?,,co~' cc N EILEEN M, IK)ACHE . e~__~ufllfl[d In Suffulk ~n~ / (~lum~er's signature) Notary ~ublic -- County TOW~ OF $OUTIIOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 1179 TOWN ItALL SOUTIIOLD, N.Y. 11971 October 5, 1990 Hr. John H. Kerbs 69700 Route 48 Southold, New York 11971 EL. ,65-18(,_ To Whom This May Concern, We are unable r.o complete your Certificate of Occupancy because .of the following reasons. /_~/// An application for Certificate of Occupancy _/i.s ilot on file. (ENCLOSED) /--_~//~o Underwriters Certificate on file. · /.~_/--/'"'The check it;(~[~/0[0~/nut on file.) $25.00 /~/ NO llea].th Dept. Approval on file. /~/ No final insDection has been made. Please contact ()ur office on this matter. Thank you for your cooperation. lhtilding Permi. t I! I 7 5 7 I Z Bui 1~ Dept. **"/~/ ~lc) Plumber ~3older Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) FOUNDATION IIDATE COMM£NT~ FOUNDATION (2nd ROUGH FRAME & .FLUMBING INSULATION ?ER N. STATE ENERGY CODE FINAL ADDITIONA'L COMMENTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [,~'~SULATION FRAMING [ ] FINAL REMARKS: 765-1802 BUILDING DEPT. INSPECTION '~FOUNDATION IST [ ] ROUGH PLBG. ~J FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS: FINAL INSPECTOR 765-1802 BUILDING DEPT, INSPECTION [~/FFOUNDATION 1ST [ ] FOUNDATION 2ND FRAMING ROUGH PLBG. INSULATION FINAL DATE INSPECTOR ~765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION FRAMING [ ] ROUGH PLBG. 2ND ~'] INSULATION DATE INSPECTOR _TOWN OF $,0UTHOLD FORM NO. 1 TOWN OF SOUTHOLD 13UILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ...................... SEPTIC FORM ................ Approved.,./.~/ ..~/. ....... 19~.. Permit No./?~. 7/.. ~.. Disapproved a{c ..................................... din ' ' tor) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS NOTIFY CALL ......... NAIL TO:-- .. 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 9f buildings on premises, relationship 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 thronghout 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 all applicable laws, ordinances, b..h~J~ding code, housing code, and regulations, and to admit authorized inspectors on premises and in building for nTssa~ ,~.../.~'.~ ......... '~ff,~e'5~/p, plicant, or name, if a corporanon) State whether applicant is owner, lessee, agent, architect, en¢neer, general contractor, electrician, plumber or builder. .... ~.m ~.% ......................................................................... N~me o~ o~ner of premises... ~ e.~..../a.. :.. ~.~e'....~.) .... ~......~..Z ~ ................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer,.L,, 4--' Builder s License r~o ............... ..~.. ....... Plumber's License No ......................... l( Electrician's License No. Other Trade's License No ...................... 1. Location of land on which proposed work will be done. ' ............................... ................ ................. House Number Street Hamlet County Tax Map No. 1000 Section ...... .~. '.'".,~. ...... Block .................. Lot ............ Subdivision ........ .aF. ..... 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 . . .~, . .~. .~.~/ e?.~. . ./~. '. . .~' ' '~r'' . ...................... : ..................... b. Intended use and occupancy ', ia ~ ~a ~,,.,a' ~1~'~ i~"...~, ..... t~epaar .............. Re_~oval: ............. Demolition ..... ~'~t~r~*V ~:~] .... (.'~ ......... 4. Estimated Cost ......... . ......... ~ . F_~ ~, :'3;,~ ............. ~ (tO b.c. pe~id on filing this al~plication) 5 If dwelling number of dwelling uhits Number of dwelling units on each floor If garage, number of cars. ........................ ..... 6. If business, commercial or mixed !occupancy, specify nature and, extent of each type of use . .. 7. Dimensions of existing structures if any: Front .O.. ~.~ // g]Rea~...' '~ 'r,:_'7,.' ............. H"~' ..... ' .... .;~z. ']I~I~'~L/ ............ ~a~put ............... m~m ............... Number of Stones ...... .~1 .d~..: ~ ..... Dtmensmns of same structure wtth alterations or additions b3~,~ 2 5...... ~,;~...... i;i .... D pth ..................... :. Height ............. ;; Nu,ibt. L,gf ~q&~¢3 ......... &... 8. Dimensions of entiie new construction: Front.....i~ .... Rear... Height ..... g'..~. ....... Nu ,m~er of Stories....~..' .............. ~..~ ..... ~ e.. ~>~'.~i 10. ~aate mvurcnase ..... /.z2. 'i' ................ Na~'~f._Former Owner .... . .~4.*77.:...~.'~ ?~.~-~. ..... 11. Zone or use district in which premises are situated - · .~Y~..-X. . ' ' 12. Does proposed construction viola;re any zoning law, ordinance or regulation' . .~ .o. . 13, Will lot be regraded .. t~'~-~ , ..... '~ .... '' ::. ............ , ...... · ' -.' ' '.'CT ' ' ','.' ' ~ · } · 4. ..... mn exc,~ss flu ce removea ~rom premises: Yes 14. ,N, ame of~ ,Ow,n.e,r of premises , .~3. ;l&~ ~[,.~,C~..~.>. Address .~.~,~,~,~ .~.p$:'.'.'.~ ...... Phone No. ,..~.~.~.~. ~.O. ~.. rqame oi Arcnimct aa~ .... ;:x~x'M,Jt~'< ~- ,. ' ' ' ' .... ~ ............ ~xuul¢~ ........... ¥llone INO ................ Name of Contractor ......... i ................ Address ................... Phone No ............ i... 15.Is this property located within 300 feet of a tidal wetland? *YES...~... mil yes, Southold TowniTrustees 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 comer lot. STATE OF NEW~-~ORK_, ~-~ // COUNTY OF......,~. '~-='~. ~, d,~,. ' ............. (Name o f individual signing co~'tract) ........ being duly swom, deposes and says that he is the applicant above named. lie is the. <::5 ..~? ./~...~. ~. "i6; ................................... ntractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contfiined 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. Sworn to before me this ............ 0% .... da oi.. . .... , Notary_Public ......... ~....,.,,.i County C< "' - ~,,~,~ ...... -- t.~,'~'r,--~--~., g~o,-~-<-~i137.ABETH ANN NE~II,L~.. *. · · ,~'~'/- ~: · '5 · ':r';: ........ ~ t I~t~Publl0, St~f NewYo~4 // (Signature of applicant) \