HomeMy WebLinkAbout28647-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-28773
Date: 08/23/02
T~IS CERTIFIES that the building ADDITION
Location of Property: 5610 MAIN BAYVIEW RD SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 78 Block 4 Lot 39
Subdivision Filed Map No. __ Lot No. __
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 23, 2002 pursuant to which
Building Permit No. 28647-Z dated AUGUST 12, 2002
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 STOOP ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
T~e certificate is issued to WILLIAM BURKHARDT & ANO.
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF ~IE~T~APPROVAL
ELEOrKICAL c~TIFICATE NO.
PLUMBERS CERTIFICATION DA'r~3
N/A
N/A
N/A
~' Authorized Signature
Rev. 1/81
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. 28647 Z
Date AUGUST 12, 2002
Permission is hereby granted to:
WILLIAM & ANO BURKHARDT
PO BOX 1047
SOUTHOLD,NY 11971
for :
DEMOLITION OF AN EXISTING DECK (EXPIRED PMT #16057Z) AND AN
ADDITION OF A STOOP AS APPLIED FOR
at premises located at 5610 MAIN BAYVIEW RD SOUTHOLD
County Tax Map No. 473889 Section 078 Block 0004 Lot No. 039
pursuant to application dated JULY 23, 2002 and approved by the
Building Inspector to expire on FEBRUARY 12, 2004.
Fee S 185.00~k~~u~r~~~e.~.~
Rev. 5/8/02
ORIGINAL
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 suNnitted to the Building Department with the following:
Ao
Bo
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.
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 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
New Construction:
Location of Property:
Date.
· Old or Pre-existing Building~
House No. Street
Owner or Owners of Property:
Suffolk County Tax Map No 1000, Section
Subdivision
Permit No. --~ ~>~///7 Z
Health Dept. Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $ ~ 5; ~.~o
(check one)
Hamlet
O 7 0 Block Dda /~ Lot ~7
Date ofPermit. ~_~2./d 2~
Filed Map.~/X/bO Lot:
Applicant: ' . . ~_/L~
Underwriters Approval:
Final Certificate:
(check one)
Applicant Signature
765-1802
BUILDING DEPT.
INSPECTION
] FOUNDATION 1ST
FOUNDATION 2ND
FRAMING
ROUGH PLBG.
INSULATION
FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: ~
INSPECTOR
INSPECTION REPORT DATE
FOUNDATION (iST)
FOUNDATION (2ND)
ROUGtt YRANIING &
PLLrlvI~ING
INSUI~TION PER N. Y.
STATE F-.,.NEI~.GY CODE
TOWN OF SOUTHOLD
BUILD'lNG DEPARTMENT
TOWN HALL '
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www. northfork.net/Southold/
Examined ~h~" I ,20
Approved ' ~1 ¥'~ ,20~
Disapproved a/c
PERMIT NO. ~
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
Board of Health
3 sets of Building Plans '/
Planning Bo/ard approval
s ey
Check
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
Mail to: ~d# ~j CStr'
Expiration
20_~
2002 ~ICATION FOR BUILDING
:~- "n' - / Date
............ ~-?~ INSTRUCTIONS
g n pec or
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 adjoinirtg 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 pen'nit shall be required.
APPLICATION IS HEREBY MADE to the Building Department for the issuance ora 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. /
/
(Signattfire of applic~mt or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Nameofownerofpremises ~/4'~ff'~f'///2~% ~rA~ffgr-~/7/
(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. ~- g/J~ 6' 4/_22
Plumbers License No.
Electricians License No.
Other Trade's License No.
Location of land on which proposed work will be done:
House Number Sfreet ~. H~let
County T~ Map No. 1000 Section ~ ~a'o~,~ g
Subdi~sion __. -.~ ~,'o~,~~:5~ No..
~ame)
Lot
State existing use and occupancy of premises and intended use and occupancy of propose~l con~tmction: a. ExistinguseandoccupancY g'n'/?-~nce dec/(' th$St, pd~r~ved,wa"' &~. 4l~ ']~t'_
b. Intended use and occupancy t"~r,~ee $~,R
3. Nature of work (check which applicable): New Building
Repair_ Removal
4. Estimated Cost
5. If dwelling, number of dwelling units
If garage, number of cars ,qgP
Addition v' Alteration
Demolition ~ Other Work ,'e/,v/a,.~ deete
~t'.,d'~r ~u ~.*~ ,¥""r 4 ~elt (Description)
Fee
(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..,4/~
7. Dimensions of existing structures, if any: Front /i/a- Rear Depth
Height Number of Stories
Dimensions of same structure with alterations or additions: Front
Depth Height Number of Stories
8. Dimensions of entire new construction: Front 5"/~'~,~e.. Rear 5"/~o ~ ~
Height Number of Stories
Size of lot: Front ~ 0 Rear ~' 0
9. Depth
10. Date of Purchase g~ A'~ Name of Former Owner ten k*
Rear
Depth
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation? YES~/ NO t,''/''
13. Will lot be re-graded? YES NO V/Will excess fill be removed from premises? YES__ NO f
14. Names of Owner of premisef, ~a~,,~j,a~,b~r.T;/r,&uoress~,~,/-,~t,4~ _*¢ IF,~ e~,~%
Name of Architect Address
Name of Contractor '25:'a ~, ~jet,~,- Address
p"'~ rs/'{~ ~hone No. ~'?g7 7- 2. 7 ~ 0
Phone No
Phone No.
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO v'/
* IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE.~R-'EQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES NO
* IF YES, D.E.C. 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 )
~t ~ ,~/ /---' ~ ¢/a.t ~/ being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the t~o.'}~-k,z Crib-st"
(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 tree 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.
'..aOf,t~;'~ dayof ~'-~:..~/ 20_~__~
r - No~ ~l~c Si~ature of Applicant
LINDA F. KOW~K~
NO~'ARY PUBLIC' ~ N~ YORK
NO 52~4~t
Oc~
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.......... *NOTIFY BU*ILDtNG'DEPARTMENT AT
........... ~'~65._-1802 9 AM TO 4 PM FOR THE
FOLLOWINg'INSPECTIONS:
....OCCUPANCYOR ..... "1~ FOUNDATION --T~O RE.QUIR~D ~'A'~'///'/Xt~. Y~/ -
.... ' E IS LINLAI~tFUL F. OR POURED CONCRETE
US ...... ~E ..... 2. I~OU'GH ';' I=RAM1NG'&'PLUMBING ....... .
· ' 'W|TH0[I~' CEi~:IIHC~I . .~ ~NSULAT~ON.. , ' ' // ' '
.... OF0CCUPANC¥ ~ FINAL · CONSTRLJCTI'ON' MUST' ~'4/'~Je ....
...... BE COMPLETE FOR ¢.O.- ':: -.. ' .. ~.~. ~'// -~/~'4~ ~ .
........... ALL CONSTRUCT.ION. SHALL MEET
THE REQUIREMENTS OI~ TI~E I~'.Y,'
.............. STATE CONSTRUCTION & ENERGY .~,~ ......
........... CODES,_ NOT RE. SPONSIBLE FOR
.... ,J',t-~ .Z~ ///./ ~'. ~..~..~.. GN OR C0NSTRUbTION ERRORS .............