HomeMy WebLinkAbout28666-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
NO: Z-29612 Date: 07/31/03
THIS CERTIFIES that the building ACCESSORY
Location of Property: 60 EMORY RD CUTCHOGUE
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 103 Block 4 Lot 31
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 25, 2002 pursuant to which
Building Permit No_ 28666-Z dated AUGUST 19, 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 NON-HABITABLE ACCESSORY TWO CAR GARAGE WITH UNHEATED AND UNFINISHED
STORAGE ABOVE AS APPLIED FOR.
The certificate is issued to WILLIAM J JACOBS & WF
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. 1096824 11/25/02
PLUMBERS CERTIFICATION DATED N/A
y- 24r
hor' ed 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. 28666 Z Date AUGUST 19, 2002
Permission is hereby granted to:
WILLIAM JACOBS
DEPOT LA
CUTCHOGUE,NY 11935
for
CONSTRUCTION OF AN ACCESSORY GARAGE IN THE REQUIRED REAR YARD
AS APPPLLoIED FOR
t premises loc.ted at 60 EMORY RD CUTCHOGUE
County Tax Map No. 473889 Section 103 Block 0004 Lot No. 031
pursuant to application dated JULY 25, 2002 and approved by the
Building Inspector to expire on FEBRUARY 19, 2004 .
Fee $ 231 . 00
Authorized Signature
COPY
Rev. 5/8/02
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TO)"HALL JUL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPAWY__
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 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.
1 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
Date. C� 7-0 0
New Construction: Old or Pre-existing Building:
(check one),
Location of Property: 60 W fvl�_
House No*Ajj�? �k Street/ Haniftet
Owner or Owners of Property:
*73
Suffolk County Tax Map No 4-WO, Section 0 3 Block 0 0 0 Ll Lot 0
Subdivision Filed Map. Lot:
Permit No. Date of Permit. VO 1/0 1- Applicant: Vw-a�
Health Dept. Approval: Underwriters Approval: 2
Planning Board Approval
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $ C�Sc:��
CT;3 ?__ _�.C,�0 I i g �0
a�c. �aL4_-�A � Applicant WatWe
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5
BY THIS CERTIFICATE OF COMPLIANCE THE 5
5 NEW YORK BOARD OF FIRE UNDERWRITERS 5
5 BUREAU OF ELECTRICITY 5
55 40 FULTON STREET — NEW YORK, NY 10038 C�
5 CERTIFIES THAT
5 Upon the application of upon premises owned by 5
5 55
5 5 ROSLAK ELECTRIC WILLIAM JACOBS
P.O. BOX 164 60 EMORY RD
5 CUTCHOGUE, NY 11935-2453, CUTCHOGUE, NY 11935
5
5� Located at 60 EMORY RD CUTCHOGUE, NY 11935 C�
Application Number: 1096824 Certificate Number: 1096824
.lc Section: Block: Lot: Building Permit-28666 BDC: NS11
5 Described as a Residential occupancy, wherein the premises electrical system consisting of
5 electrical devices and wiring, described below, located in/on the premises at:
5 First Floor, Second Floor,Detached Garage,Outside, 5
5 5
5 was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below, was 5
found to be in compliance therewith on the 25th Day of November,2002. 5
5 Name OTY Rate Rating Circuit Type 5
5 Wiring and Devices 5
5 Receptacle 7 0 General Purpose 5
5 Switch 7 0 General Purpose 5
5 Fixture 7 0 Incandescent 5
5 Receptacle 6 0 GFCI 5
5 Service
5 1 Phase 3W Service Rating 100 Amperes 5
5 e5 Service Disconnect: 1 100 cb III'5
Meters: 1
5 5
5 5
5 5
5 5
5 5
5 seal 5
5 5
5 1 of I 5
5 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated.
5 5
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Town Hall,53095 Main Road $ • ,F Fax(631)765-9502
P.O. Box 1179 y fit' Telephone (631)765-1802
Southold,New York 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
April 10, 2003
William Jacobs
550 Depot Lane
Cutchogue, NY 11935
Dear Mr. Jacobs:
Thank you for your prompt attention to violations associated with permit#2866Z, at 60
Emory Road. However, it is imperative that you stop work immediately and address this
situation. You were issued a permit for a non-habitable, unheated accessory garage. It
appears you have gone beyond the scope of work. In order to address this situation, you
must submit the following:
1.) Amended construction plans. You must submit plans that show any changes
to the original permit, certified by your design professional. Also include
manufacturers specification for the propane gas furnace that has been installed
and full energy calculations from your design professional.
2.) Explanation of the scope of work. You must submit a full explanation of the
changes made to the approved construction, including intended use.
Depending on the situation, additional approvals may be required.
If you have any questions, contact this office at (631) 765-1802, between the hours of
8:00 a.m. and 4:00 p.m. to
ctfully Y rs
A ed Signature
CC: File
o�OgUFFO(,rco
o� Gyp
Town Hall,53095 Main Road 0 Fax(631)765-9502
P.O. Box 1179 A�Oj � .�� Telephone(631)765-1802
Southold, New York 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
April 1, 2003
William Jacobs
550 Depot Lane
Cutchogue, NY 11935
Dear Mr. Jacobs:
It has come to our attention that there has been additional work done to your accessory
garage, permit# 2866Z, at 60 Emory Road, which does not fall within the scope of the
work that was initially proposed. It has been brought to our attention that you have heated
the accessory garage. As you are aware, you were issued a permit to construct an
accessory, unheated non-habitable garage. If you have in fact gone beyond the scope of
work, you are required to submit any amendments to this office and the work may require
additional approvals. You will also be required to pay any additional fees associated with
this project.
Please contact this office at(631) 765-1802, between the hours of 8:00 a.m. and 4:00
P.M. to
Respectfully Yours
(f — I I
Authorize S gnature
CC: File
765-1802
BUILDING DEPT.
NSPECTION
14,1'.-FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE A CHIMNEY
REMARKS: C
c
DATE NSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] F DATION 2ND [ ] INSULATION
FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE/O//2-)/,/4i/ INSPECT0;
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG-
( ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [v] NAL
[ ] FIREPLACE A CHIMNEY
REMARKS: �f� E/�,✓i , �c ,�
DATE l9 D3 INSPECTOR
T65-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INS ATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE A CHIMNEY
REMARKS: C
DATE l °? �� INSPECTOR
FIELD INSPECTION REPORT DATE COMMENTS
FOUNDATION (IST) Jz
—
1 a
--------------------------------------
FOUNDATION(2ND
-----------------------------------FOUNDATION(2ND) — - -----
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ROUGH FRAMING& — — --
PLUMBING y
- r
INSULATION PER N.Y. -- y
STATE ENERGY CODE
.eO f jail �.4v... it<��icre
FINAL
ADDITIONAL COMMENTS
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Tc, l ON SOUTHOLD BUILDING PERMIT APPLICATION CIECKLIST
BUILA)LNG DEPARTMENT Do you have or need the following,before applying`
TOWN HALL Board of Health
SOUTHOLD,NY 11971 9 sets of Building Plans
TEL: 765-1802 Survey
PERMIT NO. 6(o 25 Check
Septic Form
N.Y.S.D.E.C.
Trustees
Examined ,yb ,200A Contact:
Approved 0-7 .20,9> Mail to:
Disapproved a/c /
Phone:
i Building Inspector
t� ij 2c s`i
2 } APPLICATION FOR BUILDING PERMIT
Date U Y 20 a�-
�c ' INSTRUCTIONS
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 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 a Certificate of Occupancy
is issued 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. 'Me
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.
(Signature ofoplicipfor name,if a corporation)
ffo� _
T (Mailing address of applie ) /(93
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder
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. /a- '�7�V k i
Plumbers License No.
Electricians License No. 7�,K
Other Trade's License No. /��C
1. Location of and on which proposed work will be don GOE�fOK f�D
1� /, ,moi ���� .� y
House Number Street 7 Hamlet 7
County Tax Map No. 1000 Section Block 4 Lot 7
Subdivision Filed Map No. Lot
(Name)
:. State existing use and occupancy of premises and intended use and occupancy of proposed construction
a. Existing use and occupancy _
b. Intended use and occupancy c-2tca4 l o c✓la�r2 rn- S ? �z . /i T77L -
Nature of work(check which applicable):New Building_ -- Addition Alteration
Repair Removal Demolition Other Work
(Description)
i. Estimated Cost `5,Co d d Fee
(to be paid on filing this application)
i. If dwelling,number of dwelling units Number of dwelling units on each floor
If garage, number of cars
i. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures,if any: Front .L'� Rear Depth c f
Height ` Number of Stories
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories.
3. Dimensions of entire new construction: Front Rear 2-- Depth 3
Height p d ` Number of Stories 5�,
3. Size of lot: Front 11 d Rear tfe7 Depth lr
10. Date of Purchase b177 ame of Former Owner `� T
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation: ®
13. Will lot be re-graded —Will excess fill be removed from premises: YES NOS
14. Names of Owner of premises sy ivx Address C Phone No. 7_4
Name of Architect Address Phone No
Name of Contracto _ Phone No. 7,;r Y —S1-1i
15. Is this property within 100 feet of a tidal wetland? *YES NO
• IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MA RED
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
Maine of individu ' otrt
sg ract) above named,
S)He is the1� ��
(Coor,Agent, Corporate Officer, etc.)
A said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application;
:hat all statements contained in this application are true to the best of his knowledge and belief; and that the work will be
?erformed in the manner set forth in the application filed therewith.
Swo.tolbefore me this
YY day of 20
Public Si e 00 pplicant
JOYCE M.WILKINS
Notary Public,State of New York
No.4952246,Suffolk County
Term Expires June 12, ��p 3
SUFFOLK CO.HEALTH DERT.APPROVAL
H 5. NO 13-SO-(65
f a, ••MOOSE COVE' .
�o ^ife NTa�a x°3237) 53 c 1 NcAc:ter.' nurrier= `.F`atc•-:- . a -=i
:ncuse� . . I - fc'Ma� of - rn.:
STATEMENT OF INTENT I
THE WATER SUPPLY AND SEWAGE DISPOSAL
W 'SYSTEMS FOR THIS RESIDENCE WILL .
CONFORM TO THE STANDARDS OF THE
SUFFOLK CO DEPT. OF HEALTH SERVICES
Al V SI
APPLICANT I
( SUFFOLK COUNTY DEPT OF HEALTH,
SERVICES - FOR APPROVAL OF
O ,�' -�'�' - - S C CONSTRUCTION ONLY
DATE:
lost) H.S.REF NO.15-5-. L �
APPROVED' I
SUFFOLK CO.TAX MAP DESIGNATION: '
GIST. SECT B0 CK L.
yy Fr
- _ 9 { a m o OWNERS ADDRESS
9 (f I
fi;,,,�. - Cud-. :-wUe• :V:.Y- f:5?5 A.
G'IRON PI PC DEED. L. .":jA P. _
O :EMO2Y - - ��p(SC - -��Sl- I''' TEST HOLE STAMP
MAP OFPoo
c -.PE2"rl'
� Ir
SEAL
�i: •s-- a a.F�ju.T� - y� L 4� - -I Srt,rvel1d JufS� f3 55
RODERICK VAN TUYL.PC f
�r' LICENSED LAND RVEYORS
f- GREE NPORT -.:; IEW YOj{�C Yy1< d
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MAP of Pith per
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APPROVED AS NOTED
DA . to� B.P.#_ iv
FEEi 31. BY!
— r NOTIFY BUILDING D PART
766-1802 9 AM 70 4 PM FOR THE
FOLLOW
NG
} 61. FOUNDATION IEC WOIREOUIRED
William J . Jacobs FOR POURED CONCRETE
n J 550 Depot Lane 2 ROUGH • FRAMING & PLUMBING
Cutchogue, l`TY l 1935 & INSULATION
4 FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL C fi ffigoTIo§HALL MEET
THE M TS OF THE N.Y.
-/� "OC, STATE CONSTRUCTION & ENERGY .J
CODES, NOT RESPONSIBLE FOR
DESIGN OR CON£Tgurmnu"gekan
iitiFICATE
REQUIRED
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OCCU P'A�NGY OR
USE IS UNLAWFUL
��� •,_ ` --__ { �. WITHOUT CERTIFICATE
OF OC�UPANCY
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William J . Jacobs
550 Depot Lane '
Cutchogue, NY. 11935
January 9, 2002
OF NEW yO
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Owners Name: Ita, .� 12ev�ewed: Z
Architect/ Date
Cngi(Zeer: Submitted. oz
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Dis(rict: 1 ,000 Secl on: 103 Mock:
Project ( Subdivision
Location. �PO �,or� RCL.". ,��-- — Name:
Single 8-, separate Required
cer(t(IGation: (Yes / No) . 4 --A
Req. � Itcy. �
7.ouing OwricURo (I,ol Sizc: —(��`'�Actual: _ (Lot coverage QJ /,,, I1rupose;f!a"
Req �/''�� Req. i Rcq
((rant Pard Pro sed; I (Side 1'aid( V _ I'roposuJ _� / f car Yard .5 I'roposcd r
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Project Description:
AGENCWERMITS Permit
REQUIRED FOR REVIEW N.A. NO YES Numbe
Suffolk County Health'Dept.
New York State D. E. C,
.Town Trustees
Town Zoning Board.approval: /
Town Planning Board.approval: ✓ T
Flood Plane Elevation???
Flood Zone:
►��-,-x,d�. �,�A,r..� �I lbloa.
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