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Home My WebLink About22631-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-26430 Date: 05/06/99 THIS CERTIFIES that the building ADDITION Location of Property: 245 RACHAELS RD MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 108 Block 4 Lot 7.43 Subdivision Filed Map No. -- Lot No. -- conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 6, 1995 pursuant to which Building Permit No. 22631-Z dated MARCH 16, 1995 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 COVERED FRONT PORCH ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to JAMES & SHARON JACOBS (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A N/A N/A Rev. 1/81 FORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF 3HE WORK AU'fHORtZED) N_° 22631 Z Building Inspecton Rev, 6/30/80 TOWN OF SOUTHOLD BUILDING DEPARTMENT 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Thi~ application must be filled in by typewriter OR ink and submitted to the buildin inspector with the following: for new building or new use: 1. Final survey of .property with accurate location of ali buildings, property lines streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and s~erage-disposal(S-9 form) 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder us ~stem contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple reside~ and installations, a certificate of Code Compliance from ~ responsible for the building. ~ 6. Submit Planning Board ApproVal of completed site plan re~ '!pre-existing" land uses: ~' 1. Accurate survey of property showing ail property lines, streets, b~ unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicaw If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, ~Alterations to dwellin~wi~ing pool $25.00, Accessory building $25.00, Additions to accessory ~i-tdi~g $25.00. Businesses $50.00. 2. Certificate 'sf Occupancy on Pre-existing Buildinm - $i00.00 3. Copy of Certificate of Occupancy - 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Hate ........ New Construction .......... Old Or Pre-existing Building....~. ........ o ation of Property.i. .q. . ........ ...... a O. ...... ........ House No. Street Hamlet County Tax Map No I000, Section..-/.~..~.,.O...~)...Block..~ .~...O..d~. ...... Lot~l~)~~.~'. · · · Subdivision .................................... Filed Map ............ Lot ..... ~ ..... Permit No..~%..~..~.~ .... Date Of Permit ................ Applicant .......................... Health Dept Approval ... Underwriters Approval Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ........... 9.o. Fee Submitted: $ ..... · ................. .......APPLICANT'~'"'''~'~'' ....... FOUNDATION ' (IST) FOIINDATION (2ND) PLUMBING INSULATION PER N. Y. STATE ENERGY CODE ADDITIONAL COI~gNTS: i, ] ! I / 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION I ST [ ] FOUNDATION 2ND [ ] FRAMING ROUGH PLBG. ~ I~ATION FINAL REMARKS: ] FIREPLACE & CHIMNEY ,,INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] F/OUNDATION 2ND [ FRAMING [ ] ROUGH PLBG. ] INSULATION ] FINAL [ ] FIREPLACE & CHIMNEY DATE INSPECTOR BLDG. D~PT. ~ TOWN OF SOU'FHOLD ~ Examined 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTM ~NT: TOWN HALL SOUTHOLD, N,Y, 1197~1 TEL,: 765-180:3 ~s~Ts .O.r.~L,,~S ~...!!!!! SURVEY ..." ......... SEPTIC FORH ........ HAIL TO: Disapproved a/c ..................................... ' ',)Yff. (~diiJi~ Inspector). / .. Date ........... .~..., 19.~. INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink an'd submitted to the Building Inspector, with: 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 sti'eet or areas, and giving a detailed description of layout of property muir be drawn on the diagram which is part of this appli cation. 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 i~sued a Building Permit to the applicant. Such permi '.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 Occupanc, sMll have been granted l?y the Buildirog Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to tN Buildin'~'ZoneQtdinance of ttfeN,Tow~n of South61d, Suffolk County, New York, and other applicable Laws, Ordinances o: Regulations, .f0r, the constructmn of buildings, addmons or aiterahons, or for removal or demolition, as herein described Thi applicar/~ agrees .to ,comply with all applicable laws, ordinan,g~s, building code, housing~}de, and regulations, and tc admit authorized.in~p, eCtors on premises and in building for nec~e~ ~/~~ '. -- · ~r.e of~pph'cant,{~r name, if a corporation) ~.~ P-qc~t~ fl, ..ttO. orr,..r~...o.~. /,JY/.t..55-_~. ~. .............. 9..~ ........ (Mailing address of applicant) State whether applicant is owner, lessee, 'agent, architect, engineer, generai 'contractor, electrician, plumber or builder. N~meofgwnerofpremises "~t"aF>S N, ~-~14~/%~kJ (as on the tax roll or latest deed) If applicant is a corporatign, signature of duly authori2ed officer.' (Name and title of corporate officer) Builder's License No .......................... P1 be's L' No um r icense .......... Electrician's License No ........................ Other Trade's License No ...................... I. Location of land on which proposed work wiI1 be done. House Number Street Hamlet Couhty Tax Map No. I'000 Section i. ~)~ Block .t{. ' Lot '7 .c/.~... St bdivis on..; ................... ' ......... '. Filed Map No. Lot (Name) State existing use and occupancy of premises and intended use and occupancy'~ a. Existing use and occupancy . ./ ~ ................ { ,.~. :.:.~..': ,::~.. ::,.:,:',~. ........... 'b. Intended use and occupancy ~ ' Nature of work (check which applicable): Repair ............. Removal ... 4. Estimated Cost New BuLldlng . ~ ....... ~ ,~.ddition .......... Alteration ....... '... ........ Demolition ...... ; ......... Other (Description) (to be paid on filing this app~lt,~ation) 5. If dwelling, numb~o-f dwelling units ............. .,. Nur~ber 6f dwelling units on each floor.... If garage, number of cars .... : ............... .' .............. . .............................. . .... 6. If business, co,mm, ercial or mixed occupancy, specify na,?r,enand extent of.eachtty,p~et of use .. ' i .............. 7. Dimensions of existing structures, if any: Front' . .~l.,..O. ...... Rear . ~H?ght .. ..... . ......... Number of Stories.../~.'i~ ......... ::..'.......rI ....... ~pm. ~'/.I.¥ ........ : ~unenslons of same structure with alterations or additions: Front ~ ....... ,: ..................... ................. mear ................. Depth ~ ..... 8, DimensiOns o~' ' ~' ' · · · ~.. height .. ;:: ...... . ........ :., Number of Stories ........ '. i .... · Iennre new construction: Front'..~-..,. . *, ' ' ' · ' .Height ... ~ .......... Number nf,qt~a~ .......... r, ear ............... Depth ........ , ...... S~ze of lot: Front t qEPa , . ~^ ~_--' ^,,,~ ~ .................. .,.,. ........ i0. Date of Purchase ib ............. .,~ar,.. L" .t~-~t .'.'.,~.: .......... Depth .~.O.~.. ?.o..s ..... ,, ....... · .---' .t .... , ......... ' ........ . l~ame of Former Own~ . . 11. z, one or use aistnct in which premises are situated ~..~?. LD~Mr'/q~- ..................... ~: ...... .12. D°es pr°p°sed c°nstruction violate any zoning law, ordinar~ce or regulation: .~.~1'...... ...... 13. ~%le0tofb;~ngre;doefdn ;~n.i;;ek~)/ ~'J<~/~:~-J't~ .W. x~c,e,ss_~l,b o~ve,,,dfr .... .. flle e rem om premises: Yes i4. r ...... , .... res~ ........... , ........ Phone No ............... Name of Contractor ...... I . Address ..... . .. Phone No. ' 15.' I.s 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 ibuildings, 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 int. ~ .~ ' APPROItEI)' A$ NOTED_'.... DATe # a- N~F~ BUILDING OI~PA~JUiEN~...A,T 705 1802 9 AM TO 4"PM"FOR THE FOLLOWING INSPECTIONS: r.. 1.. FOUN'DATIDN "'lq, No REQUIREr} FOR POURED CONCRETE 2. ROUGH - FRAMING &. PLUMBING 3. iNSULATION 4. FINAL -. CONSTRUCTION MUST '. BE COMPLETE FOR C.O. ' ALL 'CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. . ST, RTE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN oR CONSTRUCTION ERRORS (Name ...... ' being duly sworn, deposes and says that he ' · ~s the apphcant of individual signing contract) . ' ~bove named. 1 : . te is the ~~ r'"-- : ' ' ' (Contractor agent cor~porate officer etc ) .... ' ............ )f said owner or owners, and is duly a,uthorized to perform or have performed the said work and to make and file this tpplication; that all statements contained ~n this'application are/rue to the best of his knowledge and belief; and that the york will be performed in the manner s~t forth in the application filed therewith. ' ' ;worn to before me this CLAIRE L. GLEW . NOTARY PUBLIC, State of New '~ork .' No. 4879505 C Qualified in Suffolk ~0un~; ommissmn Expires December'& lg.,.L. ' ( 'g ature of applicant) _~ AI Y7 ~1 VI~ ~NV7 S, HV[17J .gO clV~ I 107 [I NV'3'P'..",) , [~'ACANT] I. OT I ~AP O~ £LUAI'I'$1. ANE ESTATES EL/JAH'$ LANE