HomeMy WebLinkAbout32614-Z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No, Z-32181
Date, 02/05/07
THIS CERTIFIES that the building
ADDITION
Location of Property, 1220 THIRD
(HOUSE NO.)
County Tax Map No. 473889 Section 117
ST
(STREET)
Block 7
NEW SUFFOLK
(HAMLET)
Lot 15
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
JANUARY 4, 2007 pursuant to which
Building Permit NO. 32614-Z
dated
JANUARY 4, 2007
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 UNHEATED PORCH ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to ROSE & AGNES BURKHARDT
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
114327H
01/29/07
PLUMBERS CERTIFICATION DATED
N/A
~riZ~
Rev. 1/81
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Form No.6
TOWN OF SOUTHOLD
BUll-DING DEPARTMENT
TOWN HALL
765-1802
,
,
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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 huilding 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 Apploval from Health Dept. of water supply and sewerage-disposal (S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Swom statement from plumber certifying that the solder used in system contains less than 2/1 0 of I % lea~.
5. Conunercial 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 reqnirements.
B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses:
I. 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 Celiificate of Occupancy - $.25
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Conuuercial $15.00
Date.
New Construction: ___ _______ _ Old or Pre-exu.:;ting Bulldmg: >< (cl'eck nne)
Locationofrroperty: /,J;l 0 .5~d 5-1: l1I~w S(JJ fro L}::
House No. Street
Owner or Owners of Property: (f:Sl ,,/J~.f1/ES J3u ,e)(h 19 {?. d 'I
Suffolk County Tal' Map No 1000, Section 'I-~7 3 iff Block //7- 7- / SLot
Hamlet
Subdivision
Filed Map.
./ (Hi ..-
Date ofpermit. : ~ tJ ~ / 7l 5 Applicant_
Lot:
Permit No.;; d? 1./6
Health Dept. Approval:
Underwriters Approval:
Planning Board Approval:
Request for:
Temporary Certificate
Final Certificate:
t/
tf~-
( check one) I -.t-
~~.
Fee Submitted: $
Applicant Signature
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Electrical Inspection Certificate
Issue Date
1/29/07
Electrical Inspection Service, Inc.
375 Dunton Avenue
East Patchogue, New York 11772
(631) 286-6642
Application Number
114327H
Issued To:
Street:
Village:
Section:
Contractor:
Ms. Rose & Agnes Burkhardt
1220 3rd Street
New Suffolk Zip: 11956
Town: Southold
Block:
Lot:
Lie. #
Was examined and found to be in compliance with the National Electrical Code.
o Commercial
IKI Residential
o NV Defects 0 Pool
o Del Garage 0 Attic
[)(] 1st Floor 0 Indoor 0 Basement 0 Hot Tub
o 2nd Floor IKI Outdoor 0 Addition ~ Survey
Switches Receptacles Fixtures GFI Heaters AlC Fans
1 2 2
Dishwasher Washer/Amps Dryer/Amps Oven Range/Amps Microwaves
Furnace Oil Gas Circulators Smoke Detector Bell Transformer
Meter Amps Phase UGlOH Jacuzzi Television CO Detector
/
Bldg. Permit:
Other Equipment
losed In Sun Porch
H~~~kllLd
President
ROugh Irispect;on:~.
Inspector:
Final InsPeCtion: -0172412007----
Inspector: John Me Mahon III
ThiS certificate must not be altered in any manner. Inspectors may be identified by their credentials.
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.
32614 Z
Date JANUARY
4, 2007
Permission is hereby granted to:
ROSE & AGNES BURKHARDT
PO BOX 97
NEW SUFFOLK,NY 11956
for :
REMOVE EXISTING PORCH AND REPLACE WITH UNHEATED ADDITION AS
APPLIED FOR. THIS PERMIT REPLACES BP# 22746
at premises located at
1220 THIRD ST
NEW SUFFOLK
County Tax Map No. 473889 Section 117
Block 0007
Lot No. 015
pursuant to application dated JANUARY
4, 2007 and approved by the
Building Inspector to expire on JULY
4, 2008.
Fee $
150.00
/J
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,- Aut~rized Signature
ORIGINAL
Rev. 5/8/02
3 ~b I + z-
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST
[ ] FOUNDATION 2ND
[ ] FRAMING I STRAPPING
[ ] FIREPLACE & CHIMNEY
[ ] FIRE RESISTANT CONS1RUCTION
~,
~ (J-tS,OQ
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DATE
/~
1~/1-1J1
[ ] ROUGH PLBG.
[ ] INSULATION
~ FINAL
[ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT PENETRATION
~
INSPECTOR
C2 V,
~~
765.1802
BUILDING DEPT.
INSPECTION
[ ] ROUGH PLBG.
[ ] INSULATION
[ ] FINAL
[ ] FOUNDATION 1ST
[ ] FOUNDATION 2ND
[ ] FRAMING
[ ] FIREPLACE & CHIMNEY
REMARKS: U4l(/-W~ p.uJ
.f~ ell wa./L ,,( (94;r--vP'"~
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DATE ~~ft~
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INSPECTOR 7/-~~
FIELD INSPECTION REPORT DATE COMMENTS
==========='==============f========u=====~=================================================
II II
II II
ii II
II II
II
FOUNDATION ~ 1ST) - Ii :i
II II
II II
II II
11 II
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ROUGH FRAME &
PLUMBING
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INSULATION PER N. Y.
STATE ENERGY
CODE
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II II
II II
II II
II II
II II
II II
JI II
11 II
II II
================~====~~---====&===============-=======--=====================-======..=
FINAL
ADDITIONAL COMMENTS:
====================-=========================--==--=---==---===============================
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FORM NO.1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD. N.Y. 11971
TEL.: 765-1802
Examined .5';/.~........, 19rr . ~
Approved. . . .3": /t9 . . . . ., I #>;ermit No. .~.~ ? t!..~ r
_m";;:~. ----';2-'.;i, 'jvi~~- . ~I
. ~L'''''~'_'' L,' :':='''' "
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BOARD Of HEALTH .........
] StTS Of PLANS ......~..
SURVEY ....................................
ell Eel\. ......................................
SEPTIC FORM .............
.;0, >.'.
Allin 8 m5
t:(}~~~~:.. .<?~ta.-.~~.~l.....
MAIL TO:
.................................... .
Disapproved alc
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .
........ ......... ...... ........... ...
.
APPLICATION FOR BUILDING PERMIT
Date. 4/ j j.. . .. .. . .. ., 19 9r
INSTRUCTIONS
a. TWs 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 diagram which is part of this appli.
cation. .
c. The work covered by tWs 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 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 neces~~~. i.n.~::J. . . .{}:v.l~ . '" " . . . . . . . .
(Signature of applicant, or name, if a corporation)
....8;.0.. ~w~..... ~~.. .l...... .....
(Mailing dress of applicant) I
. .
State whether applicant is owner, lessee, .agent, architect, engineer, general contractor, electrician, plumber or builder.
...........~~......(p0k~I:,..;-~C...... ..........................................
Name of owner of premises . Aq.~..~ ~c:fft..-:,.. ~.~ho..~A-:.............................
\ (as on the tax roll or latest deed)
Ifapplicant is a corporation, signature of duly authoriied officer.
. . . . Fr.e.d. . . /'(It.If}U. . . . . . dJJ.R9-f. . . 0 ~~.r
. (Name and title of corporate officer)
. .t:f
Builder's License No. ..... H.-:+;. .( 9..f1.7. .. ..
Plumber's License No. ... .N!- A.-.. . ... ... . . . . .
Electrician's License No. ..... f) I t+. . . .: . . . . . .
Other Trade's License No. ..... .n! A. . . . . . . . . .
I. Location of land on which proposed work will be done. .................................................
. .. . .I tl.~ 0, .. . . . .0 rei.. . . ..S\\.-e.o1-.. .. . .. . . . .ti M . .. .5.\):-\\\0 \.K.. .... . .. . .. .. .. . .. .
House Number Street Hamlet
County Tax Map No. 1000 Section ...1: J .7 . . . . . . . . .. Block .... .7. . . . . . . . : . .. Lot.... ( ~ , . . . . . . . . .
Subdivision. . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Filed Map No. .............. Lot...............
. ~am~ .
2, State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .. .t~ \ d.~,h ~l. . . . :-J>~.E;.\\ ~~.~. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..
b. Intended use and occupancy .. .S~. . ... . .. .... ..... . ... . . ..... .. ................... . . .......
3. Nature orwork (check which appliCable): New BUildin'g ......... . Addition. .'X. . . .. Alteration )(.;..:.
Repair .............. Removal . . . . . . . . . . . . .. Demolition ...... ....... Other Work. . . . . . . . . . . . . .
. '.t:J . .. .. '. (Description)
4. Estimated Cost. . . . . . 'f.f./ 0 ~ ;<;:>09. ,; P Q . . . . . . . . . .. . . . Fee . . . . . .. .. . . . . . . . . . . . . . . . .. . . . . . . . . .. .
(to be paid on filing this application)
5. If dwelling, number of dwelling units. .. .t. . . . . . . .. .. Number of dwelling units on each floor. . ./ . . . . . . . . " .
. If garage, num ber of cars .........................................................................
6. If business, commercial or mi.xed occupancy, specify nature and extent of.each type of use . . . . . . . . . . ./ . . . . . . . . .
7 D' . f" . . cl.O I 9- 0 ( ") 6
. ImenSlOns 0 eXlstmg structures, If any: Front. . . . . . . . . . . . . . . Rear .............. Depth. P! ...........
Height ............... Number of Stories . '/-fJ-. .. . ..... ... ..... . '" . . " .. . .... ................
Dimensions of same structure with alterations or addItions: Front .. .>. ..... . . .. . .. .. Rear..................
Depth. . . . : ." . . . . . . . . . . . . . . . Height.. . . . . . . . , .. . . . . . . . " . Number of Stories. . . . .I.'j.~.. ; .. . . . . . .. .
8. Dimensions of entire new construction: Front. . . . . . . . . . . . . ., Rear..... . . . . . . . . . . Depth ...............
Height ............... Number of Stories. . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9. Size of lot: Front. . . . . . . . . , . . . . . . . . .: .. Rear...................... Depth ......................
10. Date of Purchase ............................. Name of FopneA' Owner .............................
II. Zone or use district in which premises are situated. . . . . ~~::,(~\:icJL,... . . . . . . . . . . . . . . . . . . . . . . . . . . ~ . . . . . . .
12. Does proposed construction violate any zoning law, ordinance or regulation: . .ry.~. . . . . . . . . . . . . . . . . . . . . .. ....
13. Will lot be regraded .......: 'fJ C . . . . . . . . . . . . . J(' . Will excess fill be removed from premises: Yes lili
14. Nam: ofOwnc:r ofprem~ses~.1; (\.~~ ~(f.lli\ddress ... .I.~~. /iJ. .-;).ry;{~+-.. Phone No. 73!i ;~.'.Q.;...
Name of ArchItect ........................... Address . . . . . . . . . . . . . . . . . . . Phone No. ...........'....
Name of Contractor .'F.vec\. .t':'\I~Nr:' . . . . . . . . . . . Address. . . , . . . . . . . . . . . . . . . Phe!.1e No. ...............
15.' 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 existing 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 and indicate whether
interior or corner lot. .
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. . . . ; . . . -P:'1.~.4. . . . JYI d ~ . . . . . . . . . . .. . . . . . . .. being cluly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above nam ed.
He is the ..... .~~s...... .cOll~4c..-k(:..................................... ................
. (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
........!r...:~n~0f..~......,19.~'1:r ~ Y'M~
Notary PublIc, "'~l.~h................ County ~ "
NCIlMy:~a::w~OItc ........ ~....rm... .....................
No. 4952248. SuffolkCountv .. (Signature of applicant) .
Term Elrplrea.June 12" 1~
6~~
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FORM NO.3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTH OLD, N.Y.
BUILDING PERMIT
N~
22746 Z
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED) . ....~ - ~
/.-~
. /
Date :q;.q............................................(19.9.I:
~/
Permission Is hereby granted to: ~ ~
~..~rh.. ~e;,.......... ......9!..&~ -.
/,p.~......~....' ........ ...... ............................. I
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...................................................................."............................................................................................
........,................................................................................."......................................................................
......................................................................................;:.'./.................................................................
at premises located at../:??!2.......~....~M ... ...........................................................
................._...................................~~...................,........................................................
County Tax Map No. 1000 Secfton .....//..7......... Block .....7................. Lot No. .~~.................
pursuant to application dated ....~Ir................................................ 19~::-:........ and approved by the
Building Inspector. ~ r <;/;/ ~!9,J
Fee$..7S;~
~..
Rev. 6{30{80
2-'2.- 14 V 2-
~ 0 _ · TOWN OF SOUTHOLD 'OPERTY RECORD CARD
OWNER, ';'0 " . VILLAGE DISTRICT SUB.,_, LOT
.~ · Ag~ / .' '1,. jri~,Y:;ii'JY-...:e~j.::;tf ~~IVJ'vHDII( #/r' &rL!. I ,c.'
FORMER OWNERtJlI.lf.f6.~;Yj,~)15),~:"'~'i ;;~ .;'6~-J,/(ii~:t~i A~5~E ~.
//1. c/ f" e,It()(jj-fi~iJ9fj'iJ; __~f.iI~ir:::tlJ$.~;r:c~n:r:E OF BUILbING. ;( .
RES2/0 SEAS."' vdi~;~~lltA~'mII,t~~;'K,. ,IND.. CB. . MISC.
LAN ~"., L.,;OTA;"t""i:~. ;;#ili.tb"'. ......jg,~
o IMP. "--.:;:."(fJ' . _ ~;~~ '~;~~}''8: "IC;~~;j;,~.:\.
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AGE
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NORMAL
BUILDING CONDITION
BELOW
ABOVE
Farm
Acre
Value Per Acre
Value
FRONTAGE ON WATER
FRONTAGE ON ROAD
BULKHEAD
DOCK
Tillable 1
Tillable 2
Tillable. 3
Woodland
_A~~J'
Swampland
Brushland
-
House Plot
Total
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Extension 'J. :7, :r~/tl 7i>' ft? 3,~ ~- (;tI.I J J Interior , ,( r_~.~
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Of OCCUPA~CY
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