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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-31549
Date: 05/02/06
THIS CERTIFIES that the building
DECK ADDITION
Location of Property: 735 PARK
(HOUSE NO.)
County Tax Map No. 473889 Section 70
WAY
(STREET)
Block 11
SOUTHOLD
(HAMLET)
Lot 14
Subdivision
Filed Map No.
Lot No.
conforms substantia.lly to the Application for Building Permit heretofore
filed in this office dated
APRIL 26, 2006 pursuant to which
Building Permit No. 31946-Z
dated
APRIL 28, 2006
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 "AS BUILT" DECK ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to KENNETH & MARGARET HAGERMAN
(OWNER)
of the aforesaid building.
N/A
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
N/A
PLUMBERS CERTIFICATION DATED
N/A
~/4~~
Authorized 19nature
Rev. 1/81
28
Form No.6
TOWN OF SOUTHOLD
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 Department with the following:
A. For new building or new use:
I. 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 Ere Underwriters.
4. Sworn statement from plumber certifYing that the solder used in system contains less than 2/1 0 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.
B. For existing buildings (prior to Apri19, 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 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. $.25
4. Updated Certificate of Occupancy . $50.00
5. Temporary Certificate of Occupancy. Residential $15.00, Commercial $15.00
Date. 4/2B/Cii
New Construction:
. Old or Pre-existing Building:
(check one)
Location of Property: 735 PARK W'\Y
House No.
fUrJHIJ), H.Y.
Street
Hamlet
Owner or Owners of Property:
KENNETH " I!fARGARET IlllAGERMAN
Suffolk County Tax Map No 1000, Section
70
Block
II
Lot 14
Subdivision
Filed Map..
Lot:
Pennit No.
31946-Z
Date of Pelmit._ 4/28/0~ Applicant:~ HAGERMA_.
Health Dept. Approval: _~_
_.__. Undenvriters Approval:
Planning Board Approval: '~_____.__.._
Request for:
Temporary Certificate
Final Certificate:
(check one)
Fee Submitted: $
25.00
I!fARGARET HAGERMAN
Applicant Signature
~~ 70016'
C.O?:.3iS'fl
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUILDING PERMIT
(THIS PER/,UT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO.
31946 Z
Date APRIL
28, 2006
Permission is hereby gra.nted to:
KENNETH & WF HAGERMAN
PO BOX 1176
SOUTHOLD,NY 11971
for
"AS BUILT" DECK ADDITION TO AN EXISTING SINGLE FAMILY DWELLING
AS APPLIED FOR
at premises located at
735 PARK WAY
SOUTHOLD
County Tax Map No. 47388~ Section 070
Block 0011
Lot No. 014
pursuant to application dated APRIL 26, 2006 and approved by the
Building Inspector to expire on OCTOBER 28, 2007.
Fee $
300.00
u~(~
/ Authorized Signature
ORIGINAL
Rev. 5/8/02
d-1~f9-7-
k-en. 3 \ 9 d..- \
TOWN OF SOUTHOlD BUilDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [] ROUGH PlBG.
[ ] FOUNDATION 2ND [] INSULATION
[ ] FRAMING I STRAPPING ~ FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
("
-#;2.~d
dJ'L
~' ~~V-.~\c{l
~ .~, , 12. ~7/J.
DATE i.f'-17-/)~ INSPECTOR ~ ~
0(1:l31~tt~i- ~.AJlI~~~ M mlf/J-t)()(,
Date: April 26, 2006
JAMES J. DEERKOSKI, P.E.
260 Deer Drive
Mattituck, N.Y. 11952
(631) 298-7116
To: Town of Southold Building Dept.
Re: Deck Certification
Hegerman
735 Parkway
Southold, NY 11971
!
..
To Whom It May Concern:
After a deck framing! footing inspection at the above mentioned pre built deck, it is
deemed that the deck is constructed as per plans submitted, and met all the state and local
codes at the time of construction. Any questions feel free to call.
FIELD INSPECTION REPORT DATE COMMENTS V.I
-""
-t)to;
FOUNDATION (1ST) -r:~
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I'U""
------------------------------------
'O~
FOUNDATION (2ND) ~
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ROUGH FRAMING & ~~
PLUMBING j
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INSULATION PER N. Y. \~m
~..,
STATE ENERGY CODE -
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FINAL
.
ADDITIONAL COMMENTS {...
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TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www.northfork.net/Southold/
,1/~1~=c:
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
Board of Health
4 sets of Building Plans
Planning Board approval
Survey
Check
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
PERMIT NO.
Examined
Approved
Disapproved alc
Mail to:
Expiration
10/ l--f,20~
1
Phone:
I~/--"
( Building Inspector
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
~A/f
Date ~
20 C1 b
,~
a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
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 waterways.
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 issue a Building Permit to the applicant. Such a 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 what sO ever until the Building Inspector
issues a Certificate of Occupancy.
f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of
issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the
property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an
addition six months. Thereafter, a new permit shall be required.
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 South old, 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~J~
~ (Si~atur~~a:::; if a corporation)
'j) 0 '60>C 11 7 (;, ~_SOCl"{../'ei.L i>, Iv't..; 1/97/
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
c!J w IJ ctU.
.
Name of owner of premises
(As on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
I. Location ofland on which proposed work will be done:
73;) ?fJ-1UL w 4-<-]
House Number Street
County Tax Map No. 1000 Section
Subdivision
'7()
S(Ju..'f0411 "-0
113MllAW AI'IIIT~amlet
tldf W'9~ to ..,.ttJ;': ~;II',1iJ1l'UoII
Dl".~~)~' '.~,. i 1'0'1
~9CZ\;,n"'".',,' >'
FileduMat1Nb.
IV 'f I {q.,/
(Name)
Lot / c..f.
Lot
2. State existing use and occupancy of premises and intended use and occupa cy of proposed construction:
a. Existing use and occupancy J I r y. ceIL _____
b. Intended use and occupancy
3. Nature of work (check which applicable): New Building
Repair Removal Demolition~~_
Addition
Other Work
Alteration
~ '-. '" ~--I -..
//;,I/;v,) u.., '-
(Descnption)
4. Estimated Cost
4 roOD
Fee
5. If dwelling, number of dwelling units
If garage, number of cars
(To be paid on filing this application)
Number of dwelling units on each floor__ ______ _____
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. ___
7. Dimensions of existing structures, if any: Front ;/If: /1' Rear
Height Number of Stories
2(;
, '
Depth -:a 1'6 7 '
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: Front
Height Number of Stories
Rear
Depth
9. Size oflot: Front
Rear
Depth
I a. Date of Purchase
/48'7
, .
Name of Former Owner
II. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation? YES __ NO X-
13. Will lot be re-graded? YES_ NOt- Will excess fill be removed from premises? YES__ NO-----k..
14. Names of Owner of premises i!C1i'1IV~ rll1~n;Vl;;;ress )5S-iZ: ytlJci I( Phone No.7 6':,~ ~o L :1-
Name of Architect Address --..J Phone No
Name of Contractor :).e~ Address Phone No.
15 a. Is this property within 10.0. feet of a tidal wetland or a freshwater wetland? *YES ~ NO X-
* IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQtJIRED.
b. Is this property within 30.0. feet of a tidal wetland? * YES ~ NO )Z.
* IF YES, D.E.e. PERMITS MAY BE REQUIRED. '
16. Provide survey, to scale, with accurate foundation plan and distances to property lines.
17. If elevation at any point on property is at 10. feet or below, must provide topographical data on survey.
STATE OF NEW YORK)
SS:
COUNTY OF )
being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the
(Contractor, 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 contained 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
d LO day of Apr', \
F-AD~
Notary PublIc
20~
<~~tt,;;ek~
______ ' SignatunVof Applicant
....-:!w.. r1
0uII1filId in Suffolk
Commission Expires JanuIlY~1D _
...
RIGHT ELEVATION
SCALE: 1/4" = 1'-0"
LEFT ELEVATION
SCALE: 1/4" = 1'-0"
'.
( PREBUILT PRIOR 2003 )
~ 3lCjftp?;
REAR ELEVATION
SCALE: 1/4" = 1'-0"
4" D N
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SECTION A-A
SCALE: 1/4" = 1'-0"
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PG.
1
HAGERMAN
735 PARKWAY, SOUTHOLD, NY
SCALE
April 24, 2006 1/4" - 1'0"
JDMH
.
b
I
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.
,
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FOUNDATION PLAN
SCALE: 1/4" = 1'-0'
b
,
..
b
I
..
}
}
g'-O"
17'-0"
~'-O"
21'-0"
FLOOR PLAN
SCALE: 1/4" = 1'-0'
( PREBUILT PRIOR 2003 )
PG.
2
HAGERMAN
735 PARKWAY, SOUTHOLD, NY
April 24, 2006 SCALE 1/4" = 1'0"
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