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Home My WebLink About21850-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall southold, N.Y. CERTIFICAT~ OF OCCUPANCY No Z-23326 Date NOV~m~ 3r 1994 THIS CERTIFIES that the buildin~ ~ Location of Property 6170 ~S ~ ~O~I~O~D~ ~ House NO. Street Hamlet County Tax Map No. 1000 Section 54 Block 3 Lot 17 Subdivision Filed Map No. Lot No..... conforms substantially to the Application for Building Permit heretofore f£1ed in this office dated D~C~R 7r 1993 pursuant to which Building Permit No. 21B50-E dated D~m~t21~ 1993 was issued, and conforms to all of the requirements of the applicable provi~ions of the law. The occupancy for which this certificate is issued is AN ~B~ The certificate is issued to (owner, lessee or tenant} of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL H/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED Rev. 1/81 J' B~uil~ding Inspector rODM 140.3 TOWN OF $OUTHOLD BUILDIN~ E:)~OABTMENT TOWN IMLL SOUTHOLD, NY. NO BUILDING PERMIT (THIS PERMff MUST BE KEPT ON THE PREMISES UNRL FULL COMPLEI1ON OF THE WORK AUTHORIZED) Date ............................................................ 2~85o z /.Z./~....,~/ Permission Is hereby granted to: ...~.~....~...~.~ ......... ~..,.-..~,~ ...... ~.,....,~x...../...z,~.. ................................... .o ......... ! . . ......... .......... .... ..%./~ ......... ~.. ....... ~ ..................................... ~~.~ ............ ~. ............... .................................................................... ~~.~..,.~ ............................................ ~...".i ........ CountyTax Map No. 1000 Section......,~...,..~... ....... Block ......... ...~?..~... ...... LotNo ...... ...~..Z ............. Building Inspector, F~ ~....~..~ ..... Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 T ~-~rpp/T-catton mus illed in by typewriter OR ink and submitted to the building inspector with the following: for new building or new use: I. Final survey of property rich accurate location of all buildings, property lines, streets, and unusual natural or topographic feathres. . 2. Final Approval from Mealth 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 I% 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: 10 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 - $100.00 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, Commarcial $15.00 fY Date ..... tO ' l,....._...: ........................ / Construction .... ~. .... Old Or Pre-existing B~u~lding ........ Locstion"'W of Froperty... .t..q.O. ......... .... i ....... House No. Street Hamlet Onwer or own,rs of ...................... : ..... County Tax Map No 1000, Section ..... ~.~. .... Block ........ ~ ...... Lot. ...................... Subdivision Filed Map Lot . Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval . Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $ ............................. ~ /9 /n /o . f . ....,~. ~ Town Hall, 53095 Main Road P. O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD September 28, 1994 SECOND NOTIFICATION Norbert & Carol Bertsch P.O. Box 1720 Southold, N.Y. 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. (Ail permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 21850-Z * Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. *NOTE: ACCORDING TO THE CODE OF THE TOWN OF SOUTHOLD, IT IS UNLAWFUL TO OCCUPY OR USE SAID STRUCTURE U~rIL A CERTIFICATE OF OCCUPANCY HAS BEEN ISSUED. Town Hall, 53095 Main. Road P. O. Box 1179 Southold, NewYonk 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD March 29, 1194 Mr. Noebert A. Bertsch 6170 Horton Lane-~3'0'~Ic Southold, NY 11952 To Whom This May Concern= We are unable to complete your Certificate of Occupancy because of the following reasons= An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. The check is not on file. ($25.00) Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on File. (Ail permits involving plumbing being lssued after April 1, 1984.) BUILDING PERMIT # __BP# 21850Z Please contact our office on this matter. your cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. FOUNDATION (1st) FOUI.~DATIOU 2. (2nd) ROUGH FRAME & .PLUMBING INSULATION PER N. STATE ENERGY CODE, Ye FINAL ADDITIOn;AL COM~ENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL souTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c ..................................... (B_~d d~fg In~'pector) APPLICATrON FOR BUILDING PERMIT BOARD OF HEALTH ..~ .... 3 SETS OF PLANS .......... SURVEY SE~T~6 FORH .............. O-q ....... Date .................. , 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 streets or,areas, and giving a detailed description of layout of property must be drawn on the diag~n which is part of this appli- cation. c. The work covered by this application may not be cbmmenced 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, 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 necessary inspections. (Signature of applicant, or name, if a corporation) (Marling address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................................. Name of owner of premises ~.. ~.. ~ /~... (as on the t.ax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. Builder s License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done.. ~..l .1.0... ~. ·..~. · .~.~....~.~..~..~. · ....... ................. .... ............. ................ House Number -.~ S~.et .~. Hamlet / 7 County Tax Map No. 1000 Section Block Lot.... 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 ~r~.~.~. ....... b Intended use and occupancy .~...~..~.. ' · ....... 3. Nature of work (check which applicable): New Building .......... Addition /~ Alteration Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost .~.l! ~5~). ~ ........................... Fee ...................................... (to be paid on f'ding this applicat/on) $. If dwelling, number of dwelling units .. ~ .......... Number of dwelling units on each floor ................ · If garage, number of cars ........................................................................ 6. If bu$iness, commercial or mixed occupancy, specify nature and extent of each type of us~ ..................... 7. Dimensions of existing structures, ifany: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ......... ~, ........... Numbe~f Stories ........ ~ ............ 8. Dimensions of~ntire new construction: Front ...... u ........ Rear .... L~ ......... Depth ~ ............. Height ... ~ .......... Number of Stories ...~ ................................... ,. ................. 9. Size of lot: Front ...... [.~. ~.: .......... Rear ...].~..~.' .............. Depth . ~.~.~. ................ 10. Date of Purchase ............................. Name of Former Owner ............................. 1 1. Zone or use district in which premises are situated ..................................................... 12. 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 .................... Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone~No ................ Is this property within 300 feet of a tidal wetland? *Yes ........ No.~'~ ...... *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ~xisting or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names interior or corner lot. 15. STATE OF NEW YORK, S.S ................................................ being duly sworn, depots and says that he is the applicant (Name of individual signing contract) above named. He is the ......................................................................................... (Contractor, a~nt, corporate officer, etc.) ~f said owner or owne~, and is duly authorized to perform or have performed the said work and to make and file this ~pplication; that all statements contained in this application are true to the best of his knowled~ and I~liof; and that the ~vork will be performed in the manner set forth in the application filed therewith. Cwom to before me this N~ 4952248. S~/k/:~l~- ,~/ (Signature of applicant)