HomeMy WebLinkAbout26808-Z
FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-31855
Date: 09/25/06
THIS CERTIFIES that the building
ADDITION
Location of Property: 210
(HOUSE NO.)
County Tax Map No. 473889 Section 98
ROBINSON LA
(STREET)
Block 4
PECONIC
(HAMLET)
Lot 38
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
AUGUST 9, 2000 pursuant to which
Building Permit No. 26808-Z
dated SEPTEMBER 29, 2000
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 SCREENED PORCH ADDITION 17' X 18' TO AN EXISTING SINGLE FAMILY
DWELLING AS APPLIED FOR.
The certificate is issued to SANDRA EKBERG-JORDON
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
N-579466
12/26/01
PLUMBERS CERTIFICATION DATED
N/A
Rev. 1/81
,
Form No.6
TOWN OF SOUTHOLD
BUll,DING DEPARTMENT
TOWN HALL
765-1802 \
APPLICATION FOR CERTIFICATE OF OCCUPANCY \
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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:
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.
B. 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 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
I. 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. ~ IS:, 2..DcJ b
Old or Pre-existing Building: /
~ ~ 0bIMJU"'l L4.h<?
~I() Street
.s~'7 J ~ 1...::-lCb e~
Suffolk County Tal' Map No 1000, Section q~ Block
i
Subdivision ') I",wg
Permit No. '7) It:) .?
New Construction:
House No.
(check one) .
~~'?)'-
Hamlet
Location of Property:
Owner or Owners of Property:
';;;;-r d <L "
1-/-
Lot3i
Filed Map.
Lot:
Date of Permit.
Applicant:
Health Dept. Approval:
Planning Board Approval:
Underwriters Approval:
Request for:
Temporary Certificate
Final Certificate:
(check one)
Fee Submitted: $
~ 6"'. H
e
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CO~SlgS5\
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO.
26808 Z
Date SEPTEMBER 29, 2000
Permission is hereby granted to:
SANDRA EKBERG-JORDON
165 WEST END AVENUE
NEW YORK,NY 10023
/\( \ \'\\<"
for
NEW SCREENED PORCH ADDITION 17' X 18' TO AN EXISTING ONE FAMILY
DWELLING AS APPLIED FOR.
at prealses located at
210 ROBINSON LA
PECONIC
County Tax Map No. 473889 Section 098
Block 0004
Lot No. 038
pursuant to application dated AUGUST
9, 2000 and approved by the
Building Inspector.
Fee $
75.00
~~kro
ORIGINAL
Rev. 2/19/98
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
40 FULTON STREET, NEW YORK, NY 10038
DECEHbER 26,2001 Application No. onfile 13567701/01
1(/)'\SJ.48
1-
Date
PAGE 1
N 579466
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the aboye application number is in the premises 01
;,",NIi:1A ,:KBF:kG; 210 ROBINSON LANE, PECONIC, NY
in the following location; 0 Basement [J 1st Fl. 0 2nd Fl.
DECEl1BEH 04,2001
OUT
Section
and found to be in compliance with the National Electrical Code.
was examined on
FIXTURE
OUTLETS
FIXTURES
flUORESCENT
OTHER
RANGES
AMT. K.W.
COOKING DECKS OVENS
AMY. I.W. AMY. I.W.
RECEPTACLES SWITCHES INCANDESCE
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1
DRYERS
FURNACE MOTORS
FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS
Block
Lot
DISH WASHERS EXHAUST FANS
AMY. I.W. AMY. H.P.
BELL
TRANS.
UNIT HEATERS MULTI.OUTLET
SYSTEMS
AMY. H.P. NO. Of FEET
AMY. WAns
AMY. I.W.
OIL
H.P. GAS
H.P.
AMY.
NO.
A. W. G. AMl. AMP. AMY. AMPS.
SERVICE DISCONNECT
NO. OF
METER
EQUIP. I' 2W I' 3W 3' 3W 3. 4W
NO. Of HH..EG
S E
R
".W.G.
. Of CC. CONDo
V
NO. Of CC CONDo
'ER.
AMT.
AMI',
IV"
OTHER APPARATUS:
f'hUDLf; FAN-I
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DANIEL WILCENSKI ELEC. CaNT,
115 HOBAH1' HD.
SUU'J.'HOLD, NY, 11971
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GENERAL MANAGER
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Per
Thill certl'lcClte mu.t not be altered In any manner; return to the office of the Board If Incorrect. In.pector. mQY be Identified by their credential..
A~~og--t
765-1802
BUILDING DEPT.
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] FOUNDATION 2ND [] INS
] FRAMING [ .
] FIREPLACE & CHIMNEY
REMARKS:
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765.1802
BUILDING DEPT.
INSPECTION
7~[ ~UNDATION 1ST
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[ ] FRAMING
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[ ] ROUGH PLBG.
[ ] INSULATION
[ ] FINAL
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INSPECTOR
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UNDATION
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.FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD. N.Y. 11971
TEL: 765-1802
u\.h.lL"LI Vi' UL:oh.Lj 1:1 ...""..."......
Exanined.....0?....... ;"OA<1.
Approved.. .U.2!r......... .~()..
. ~0<6"o<6~
Pemut lb. ................
3 SETS OF PLANS ...............
SURVEY ........................
CHECK........................ .
SEPTIC FORM ...................
DEC ....... ..... ...... .........
TRUSTEES ......................
NOTIFY :
CALL ............ ......
MAIL TO:..................
j'
.................................
Disapproved alc ....... ...........................
.................................
........................:...............:~~.....
_.._... (&lilding Inspector)
p-:--:::p~,;--;~. .
I" " '
/' AUG 9 2fXXJ
I . L_.__, _"'. "--l "'! INSTRUCTIONS
a.. ~lli.iJ;.]!jJpl~tkQ,~t'\>f' ~etely filled in by typewriter or in ink and sul:mitted to the Building Inspector
3 sets of plans. accurate plOt fll~. r;6 scale. Fee according to schedule.
b. Plot plan shc>.ring location of lot and of buildings on pranises. relationship to adjoining premises or p.ililic
streets or areas. and giving a detailed description of layout of property 1llJSt be drawn on the diagran which is part of
this application.
c. 'nle "",rk covered by this application ""'y not be C011llenced before issuance of Building Pennie.
d. Upon approval of this application. the &lilding Inspector will issue a Building Pennit to the applicant. Such
. pennit shall be kept on the premises available for inspection throughout the 'WOrk.
e. lb building shall be occupied or used in ..nole or in part for any purpose lolhatever until a Certificate of
Occupancy shall have lleen granted by the Building Inspector.
APPLICATION FOR BUILDING PERMIT
Date. kJ~ f. .-!>.-. . . 20.~ P
APPLlCATICN IS HEREIlY ~WE to the Building Departnent for the issuance of a Building Pennit pursuant to the
Building Zone Ordinance of the Town of Southold. Suffolk Camty. New York. and other applicable L;lws. Ordinances or
Regulations. for the construction of buildings. additi..ru. or alterations. or for renoval or deaolition. as herein
described. The applicant agrees to CCIJ4l1y with all applicable laws. ordinances. building code. housing code. and
regulations. and to adnit authorized inspectors on premises and in building for necessary inspections.
..~...~~........................
/'fSi~~';~'~f applicant. or nate. if a corporation)
~f::$:..~~t..~~~..~!.:d~..~7.. ..
(Mailing address.. of applicant)""? fOo:zJ
, \
State \Whether applicant is owi1er, lessee, agent, architect, engineer,' general contractor, electrician, pl\.llber or buildt
........... ..... .C?U<'.-:l. ~......................................................................................... .
. ~kbe..l-.J - Jo.....d~ SiV"l~
NaTe of cx.mer of preuuses .............. . .. . .. . . .. .. . . . .. . . ..J. .. . .. .. .. . . .. . .. .. .. .. .. .. .. . . . . .. . .. .. . .. . . .. . . . .. .. ..
(as on tlle tax roll or latest deed)
If applicant is a corporation. signature of duly authorized officer.
/
.........................................................
(NaJe and title of corporate officer)
Builders License lb. ....... .f!.rd::~$eA~
Plumbers License No. ....... .................
Electricians License lb. ....
Other Trade's License lb. .
....................
I. IDeation of land on which proposed "",rk will be done............. ........... ....... ...............................
...... ~.I.~............ ./!.o; !>:.I.':'.~..::.':. .I-::~,:,,;~.. .......................... .f.~::,:!. ~...!J.j.............
Bouse !inher Street Hanlet
County Tax Map lb. Hrn Section:. CJ~ ........ Block ...... if. . . .. ... Lot $. 8.. . . . . .. . .. .
Subdivision i'~?i<(l.~~.J~'7'" P..~...... Filed Map lb. J.':I: J.t/:...... l.ot ..~!...........
(Nane )
v
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .....5J:'@.I.~..-A-:"'H}.1..~.'X{:..I.J.'~!J.................................
b. Intended use and occupancy ......B.lC~..~..J:,.~~.................:...........................
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l'l.,tllre of ""d<. (check "Md. applicable): New fuilding .......... lIddition .....~ Alteration..........
llepair. ............ Raooval ..i............ llEm::>lition ............ Other Hod<. ..................................
df (Description)
Estimated Cost ./..!./}.I!:r! P.~.':......... fee .... .7D.:.t? P...............................
(to be paid on filing this application)
If d<;elling. lUll",r of d<oelling tmits .... /...... lUTher of d<;en ing units on each floor................
If garage. nunber of cars .......~<1..........................
If business, cdm.,rcial or mi:><ed occupaocy, specify nature and extent of each ~ of use....1'I 4............
Dimensions of existing structures, if any: Front...~~.~~.~~.. Ilear ....1.~..~.~~. Depth ...$.?.~<P..~~....
l!eight ......./f..~~.~~....... lUTher of Stories ....~............~ ' 7<-''- ,.
D. . f . hI. _.u. . Fro ~ 0 ,. ... lO
menSlOl15 g,O SCIre stnJeture WIt a teratloos or tJUUltlons: nt .. -'. ......... Rear...............
21 (:) " .gl t?' 0 " L f . ~
Depth ..... ..-(...........Ilel It ................j.i1~""r_o. Stones .~.......... , A~./7;;"./.
OiIrensions of entire tlf.'W constnlCtiO:l~ Fx-oot. e~j)if~... ~~-.-:~. :~.~--""-"'
l!eight ......................... lUTher of Stories ... .1................
Size of lot: Front ..I.Jf~.... Ilear ..J"~~... Depth ../.~.?:-:~.
Date of l\rrchase ..'P.~~.J...I.'i1.~... Nare of Former ()mer ...-?~.)~....L?:JJ.~.~;j~....
Zone or use district in.lJli~ premises are.situated ..:. R.e~~.cLz.~h.~. \................................
Does proposed constructIon VIOlate any zoning law, ordinance or regulstlon: .. .I':-{t?....... .. .. .....
Will lot be regraded .....tY.Q........... Will excess fill be renxJ\1ed fran premises: YES L1>a..-~ IIJ,
Nares of ()mer of premises S4..,J~..1;:. J.;A..V" IIddress as: ~/::!;,o/.. .~1.1J(. ~lOne ~~~.i.'~
NmE of Architect.. .f.~'J.':'1..~~!::~ ........... IIddress .7:.'1. .~....!. ~~ ~~... It lOne lb. ~. ..~.~....
Nare of Contractor I'!.~. !-:.'f.~ ..s...j~~........ f1cldress .............................. .~lOO: fu. ............
Is this property within 300 feet of a tidal wetland? * Yf"s .......... N:).. ~.....
*IF YES, samnn 'ID~ 'I1lllSIEES ~IT Ml\Y IlE RECpIRED.
,
..
3.
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5.
6.
7.
8.
9.
10.
II.
12.
13.
14.
PLOT DIAGRAM
locate clearly and distinctly all buildings, \oi",tI",r existing or proposed, and indicate all set-back dimensions
fran property lines. Give street and block ...ri,.,r or description according to deed, and sh<M street lImES and indicate
- - - -..J-,,:::tbei:" j nterior or corner lot.
?/~e,
LUL-
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Srll'lE 01' I'I;W YORK,
mJNlY OF .....<<~ .51~<' SS
.......0~d.~...~.~....................I"'ing duly S\O)m, deposes and says t1k,t he is the applicant
(N.'II1e of individual signing cootracV
<llx:Ne ",,-ned,
lie is the .... C? u!. ') ~r.-.. . . . . . . . . . . .. . .. . . . . . . . , . . . .. . .. . . . . .. .. .. . . . .... . . . . . . . . . . . . . . . .. . . . . .. . . . . .. . .. . .
(Contractor, agent, corporate officer, etc.)
of said owner or <Mners, and is duly authorized to perform or have performed the said ""d<. and to make and fi I.e this
application; that all statements cootained in tllis application are true to tile hest of his knowledge and belief; arxl
that the work will I", perforlll,d in the mam",r set forth in tile application filed tI",rewitl,.
~m to before lIE this 4
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lbtary l\ID1~~~~.... .... .r.V:
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IlUALIFiED IN NEW Yllflll COUIIJr
muUlSSlON EJIJ'lRES AWlCH 15,'
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TOWN OF SOUTHOLD PROPERTY RECORD CARD
OWNER
VILLAGE
DIST.
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/2- 0 0
00
NEW NORMAL
FARM Acre
Tillable 1
Tillable 2
Tillable 3
Woodland
Swampland
B rush land
House Plot
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Total
STREET 2- I 0
SUB.
LOT /.2/
7
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8
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SEAS.
FARM
COMM. CB. MISe. Mkt. Value
IMP.
BELOW
ABOVE
Value
Value Per
Acre
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FRONTAGE ON WATER
FRONTAGE ON ROAD
DEPTH
BULKHEAD
I
135 .'
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Extension I3fU - 311' ., ,.B"asement Floors '\ '- K.
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Extension Ext. Walls Wd'sfl Interior Finish 5hEL """. lR,
Extension Fire Place CJtf' Heat i;-; . - ,.I, DR.
Type Roof ~,~ .-1 /;(' Rooms 1 st Floor SR.
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Breezeway Driveway 6Lc:: rr '(',.. ~ .iI
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