HomeMy WebLinkAbout32714-Z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
Date: 02/26/07
No: Z-32214
THIS CERTIFIES that the building ALTERATIONS
Location of Property: 3400 YOUNGS
(HOUSE NO.)
County Tax Map No. 473889 Section 55
AVE
(STREET)
Block 5
SOUTHOLD
(HAMLET)
Lot 5
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
FEBRUARY 12, 2007 pursuant to which
Building Permit No. 32714-Z
dated
FEBRUARY 12, 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 ALTERATIONS TO AN EXISTING ENCLOSED PORCH TO CREATE OPEN PORCH
AS APPLIED FOR.
The certificate is issued to JUDITH L BERGLUND
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
N/A
PLUMBERS CERTIFICATION DATED
N/A
~fB
tho ~ed Signature
Rev. 1/81
--37..'3
11_.
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
J
rle<t.s~ Wl"l; / -Iv
-J<.tci,+J., T3~r1'-<-n'"
~~-3'7 BO-th $-/-.
:rite ,~so.., /H.j. N 7.
II 3' 7 '"L.-
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:
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 certitying 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 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 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 - $25.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
.. tI""I-,,,~
New Construction:
/ Old or Pre-existing Building:
Yol..\-"""1~
House No. Street
~
Av.eV).....e
Date.
Location of Property:
Owner or Owners of Property:
;J ,....,1,+1-.
8"....,(I.U'1<'f ",-I- aV'><:>
Block
Suffolk County Tax Map No 1000, Section
Subdivision
Filed Map.
Applicant: 1/...,.~ J fl. c.h~.,/
1-(!~wLd
Permit No. "52 7/ 4 Z Date of Permit.
Health Dept. Approval: 4/.4
Planning Board Approval: /V 4-
Request for: Temporary Certificate
Fee Submitted: $ .z 5 . d 0
2/07
,
2.//th/D "'1
. ,
(check one)
So u.t I-. " 1.,(
Hamlet
Lot
Lot:
Underwriters Approval: h "
Final Certificate:
~.() 116~ f)
Co .:c 3!);) I L{
/'
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.
32714 Z
Date FEBRUARY 12, 2007
permission is hereby granted to:
JUDITH L BERGLUND
PO BOX 1501
SOUTHOLD,NY 11971
for :
ALTERATIONS TO AN EXISTING ENCLOSED PORCH TO CREATE AN OPEN PORCH
(EXISTING FOOTPRINT) THIS PERMIT REPLACES BP 26089.
at premises located at
3400 YOUNGS AVE
SOUTHOLD
County Tax Map No. 473889 Section 055
Block 0005
Lot No. 005
pursuant to application dated FEBRUARY 12, 2007 and approved by the
Building Inspector to expire on AUGUST
Fee $
150.00
:;
Authorized
ORIGINAL
Rev. 5/8/02
-
j 2..- 7 I y:- i:;-
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING I STRAPPING [ ~L
[ ] FIREPLACE & CHIMNEY ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
REMARKS: l) ! ( -'~J7 L -fd)
;1
v
DATE
1 G (6) 7
t
INSPECTOR
? d.11 L/. ../t2n
;ZCO cf7 +
~
t
j 5" tJ '<
765-1802
BUilDING DEPT.
INSPECTION
[
[ ] F NDATION 2ND
[ FRAMING
[
[ ] ROUGH PlBG.
[ ] INSULATION
[ ] FINAL
-
~L-
~
~~
DATE
,1.0 INSPECTION REPORT DATE COMMENTS I
======================w========~=====~=================================================
II II'
11 II
. ..._----Jl-------- --- ----.-------------...----------------------------
ii ~
~~------1I------- --
II II
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II II
II II
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as~====================~========&=======================================================
_______u_____n_____ ----- - ----------"--
INDATION
( 1ST)
IGU FRAME &
PLUMBING
.----- ------------~--~---
SULATION PER N _ Y.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
--======================================================================================
-----------------~---------------------------------
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c::
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AGE
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Farm
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,Ie 2
,Ie 3
lIand
lpland
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e Plat
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)
I
,
,
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-
-I'
-..r TOWN OF SOUTHOLD P'ROPERTY RECORD CARD
IMP.
LlaO
)/V(j
..{ S-O D
<igoo
NORMAL
Acre
J-q M Dy+e
VL.
FARM
TOTAL
DATE
~otJtJ
~" O. ,
F. . .'
( . .'
300 0
"-/-')/ ~/
;J / -."\ ~,' / '
~ O~_J ,3/ .2_eu
foSo 0 /a 27
BUILDING CONDITION
Sf1Lt:;. /{)/11'/75' ij~3tJc! MIIP,I/' f>
/~?/f.!._E-<L. ~ /iJ q"O /3ud." If"
-LII1~ 3'77-6
VILLAGE
DISTRICT SUB,
LOT
E
ACREAGE (/
16 a'
TYPE OF BUILDING
W
i /.
I MISe.
17: '
COMM.
t.
I CB,
I Est. Mkt. Value
REMARKS
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3017~
L-
a 4 0 0
llt.r..,,'. . '
BELOW
Value Per Acre
ABOVE
Value
FRONTAGE ON WATER
FRONTAGE ON ROAD ,..( ~D
BULKHEAD
('J .P~o _.
IG 0 Q
x 1. 10
DOCK
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.... ..~ /1:/1.0.... yt!!f.NG-[ ,( YG/Y'I( f. . ...... "jd~id'l. jj...................................
!kJuse lbIber .. ..... ~~;;,;,~ . . . . .. . . .. . . .. . .. .. . .. . . .. . .. . .. . .. . .. .1. . ~~~ . .. . . . . . . . . . . . . . . . . . . . . . . . .
Crunty Tax Map lb. I(xx) Section.. ..fi. f: .. . .... Block ..?............ lDt ..;?............
Subdivision .
...................................... FlIed Map lb. ............... lot
(NaIe) ...............
2. State existing use and nrr..nonrv f . and' .
--......-J,:" premlses mtended use and occupancy of proposed construction:
a. Existing use and occupancy .-!Xt?!/.ft..t1..!?1~/'f. ~S/eUne.J2.--
. .. ................ "~~~,,,'o;l!=1..............
b. InteOOed use and oc cf~ ..,vWOI1109'',S?..,:)!.j'h.;y.,.^.TCI4
cupancy ...................................... .-'^....Al,..~... ~n80(\- ,1 ,;i "" .0>\
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.FORM NO. I
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL: 765-1802
BOARD OF HEALTH :.Y............
3 SETS OF PLANS ...............
SURVEY .. v. . . . . . . . . . . . . . . . . . . . .
-
CHECK .........................
SEPTIC FORM ...................
Exanined.~d~?.., 19ft
AppnNed..tfdl~!..., 19..'Y
~;)/IY
Pennit ttl. ....~~
N~:::Y Z141". r;q~~ .1~} / J!J '8
MAIL TO:........ ............
Disapproved a/c ..................................
........................................::::~~
APPLICATION FOR BUILDING PERMIT
Date.J40~. {.... .., 19ft..
INSTRUCTIONS
a. This application DlISt be ~letely filled in by typewriter or in ink and sulInitted to the &1ilding Inspector wil
3 sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan sheAring location of lot and of buildings on premises, relationship to adjoining premises or p.ililic
streets or areas, and giving a detailed description of layout of property nust be drawn on the diagran ""ich is part of
this application.
c. The oori< COIIered by this application may not be C011lEnced before issuance of fuilding Pennit.
d. Upon approval of this application, the fuilding Inspector ,rill issue a fuilding Pennit to the applicant. Such
pennit shall be kept on the premises available for inspection thrwghoot the oork.
e. ttl building shall be occupied or used in ,",Ie or in part for any tlJIllOse ""atever lIDtil a Certificate of
lkcupancy shall have been granted by the fui lding Inspector.
APPLlCATIOl IS IEmIY MAlE to tbe fuilding Deparllrent for the issuance of a fuilding Penni t p.1rsuant to the
fuilding Zone Ordinance of the Town of Southold, &.tffolk County, New Yori<, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for re<lDlTal or dennlition, as herein
described. The applicant agrees to ~ly with all applicable laws'~rdi s, building code, hoosing code, and
regulati7s, and to adnit atthorized inspectors on premises and in buildi for ~sJ J~l-
..... . .~.......... ....... ........ ..........
(Signature of applicant, or na1r, if a corporat ion)
. ~ <!? ?'.~!. /ffl.1n: t.t!.1... 0:.':f. .At..?: !If 17
(Mailing address of applicant)
i
State ~ther applicant is owner J lessee, agent" architect, engineer, general COrItractor, electrician, plUIber or builder
!le~rd ctJ-Ufra ch r -
...(....................................................................................................................
HalE of <Mler of premises ...!!!/?/. r.1/.. !f~-1'.G:'.~!! I/. P...?..!f... .ELX.r.s.' If... !i.~? ~<<IC.................
(as on the tax roll or latest deed)
-'
If applicant is a corporation, signature of duly authorized officer.
.
.............................................................
(HalE and title of corporate officer)
Builders License ttl.
Plumers License No.
Electricians License lb. ......".."..............................
Other Trade's License No. ....................
I. Incation of land on ""ich proposed oori< will be done................. ..... ............................... ..... ....
.. ... .'5../IJ1.O'... yf!.tf.Ntf:f... ..l!:.fi1".tf.f.:............. .J:.~.t!.1!l~.~~... ................................
Hoose NuJiJer Street Hanlet
Coonty Tax Map ttl. 1000 Section... .~r:....... Block ..?-............ lot .. R............
&.tbdivision ... ............. ......... ....... ...... Filed Map ttl. ..... ... ....... l.ot ...............
(HalE )
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .l(!?.r.k./~1?1dv..~!.~~.1?.~....8IffOOt~~"I"r;H"..............
J. lIIo'Iwo\'lIo9"'~Z. .:)u,-, ".:.3T?11
b. Intended use and occupancy ..........~......................~1~H~*~~~~T.!'~.........
3.
v'
f'l"tlJre of work (check ",hid. applicable): New fuilding /'........ Addition ........... Alteration..........
He' .,/- Raoov 1 .. V
tfe+::rl~ ;H-~';t>,;jiy ehd:.~;; U;.;lid~d ~~~IP:;;X';h;' ~;~~le::.t..~:i"' (~~~j~~j.:.;it.. .;;..;;~;..
. / CJ tJ tJ 0 I' ,/ rc-h , If>>
Est Hoated Cost .......1................................. fee ...........................................................................
.~to be paid on filing this application)
q.
5.
If ci.....lling, lUli>er of dwelling ,mits
/
lumer of dwelling tmits on each floor ..~.........
If garage, [~ber of cars ..~...............................
6. If business, canrercial or mixed occupancy, specify nature and extent of each type of use....~.............
7. Oinensions of existing structures, if any: FrooL............... Rear ................ Depth .................
lleight ......................... tUrher of Stories ......................
Dinensions of saTe structure with alterations or additions: Front ............... Rear ...............
Depth .................... Ileight .................... tbti>er of Stories ...............
8 D' . f . . tlnchuMda/
. lUEnSlons 0 entIre new oonstructlOO: l~t ............7... Rear ............... Depth ..............
---
lleight ......................... tUrher of! Stories .....................
9. Size of lot: Front ....l.?!!........... Rear .'d-.O/............... Depth ~{l..............
10. Ilate of Purchase ..................... Nare of Fonner o.ner ........................................
I J. Zone or use district in .Jlich premises are situated ..............................................................
12. Does proposed construction violate any zoning h." ordinance or regolation: ./.vI2...................
13. Will lot be regraded ..kJ'?............. Will excess fill be rarvved fran premises: YES d9J
14. Nares of o.ner of premises ........................... Address .............................. l'hone No. ..............
Nare of lIrd.i teet .................................... Address ........................... '," l'hone No. ..............
Nare of Contractor.. 7J.q !?~~!.. f.i.5.~........... Address 7./1 7.f.ili~1!':>.g!. .(1-I(.I1(..l'hone No.:?2.!.-.-Y.t:.4..
IS. Is this property witl.in 300 feet of a tidal ""'tland? * YES_.......... m :v.':"......
*IF YES, 9J1111ID nDI TRllSTEES ffilMIT IWlIlE RElplRED.
PLOT DIAGRAM
l<>eate clearly and distinctly all buildings, '*'ether existing or proposed, and indicate all set-back dimensions
fran property lines. Give street and block rwber or description according to deed, and show street nares and indicate
\\lIlether interior or corner lot.
.
I
rl.'Lte
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sr!l:lE OF t!;;W YUlK,
WJN!Y (1' ...Y:.</.FE(:!.<.t..... 55
......?7.-:t..1: !E'.t-......L..... .F/$. (h(f.""!f............. .being duly swom,
(Nare of individual signing contract)
above nared,
lie is the ..... C.t."!/Y.T/f.!-. <;:rp.~........................................... ..............................
(Contractor, agent, corJX>rate officer, etc.)
delXJses and says that he is the applicant
of said O'Wner or woers, and is doly aothorized to perfonn or have perforned the said work and to make and file this
application; that all staterents contained in this application are true to the best of his kncMledge and belief; and
that the work will be perfonred in the lIIanner set forth in the application filed therewith.
s..om to before ne this
.... ...7"...... ...day of .d.e.?!....... J9...f..?.
Notary I\ililic ~1.4!6.t2, 0~
~~ASTATHII
No.01S=fn.~.v.a
T_ Exp/l8lJuneI,
uJ~"'.c4
(Signature of Applicant)
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