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HomeMy WebLinkAbout21241-zFORM NO. 4 TOWN OF SOUTNOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23947 Date OCTOBER 12, 1995 THIS CERTIFIES that the building ALTERATION Location of Property. 1260 HORTONS LANE SOUTHOLD NY House NO. Street Hamlet County Tax Map No. 1000 Section 63 Block i Lot 11 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 24, 1993 pursuant to which Building Permit No. 21241-Z dated FEBRUARY 25, 1993 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 ALTERATION TO A ONE FAMILY DWELLING AB APPLIED FOR. The certificate is issued to MICHAEL & JANET JACKOWSKI of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 (owner) N/A N/A N/A Building Insp~r FORUM NO. ~ TOWN OP $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No-N°. ~l~lZ Date .......... ?':.. ~ ........... , 19.~..~ Permission is hereby granted to~ __ , ..... .... ,~...:~.._.~..~ ................................. at premises I~ated at ...~.~.~.......~.~...~ ......... ~.~;~ ............. County Tox Mop No. 1000 Section ,....~.~...~ ........ Block ........ ...C~...l ...... Lot No .......L.! ................ pursuant to application doted ..~.~.Rv~. ........ ..~....t~ .......... , ,9..cL..;~., and approved by the Building Inspector. Building Insl:mctor Rev. 6/30/80 Form Mo. 6 'fawn OF $OUTI1OLD BUl Lb lOC- BEP ART~IE~IT TOWN HALL 765-!802 APPLICATION FOR CERTIFICATE OF OCCUPA}~CY A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for net building or new use: l. Final survey of property with accurate location of all buildings, property lines, streets, sad 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. ~ ~. 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 installa'tions, 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 a consent to inspect signed by the applicant. If a Certificate of Occupancy is de,led, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelli,g $25.00, Additions to dwelling S25.00, Alterstions to dwelling $25.00, Swimming pool $25.O0, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existin~ Buildine - $[00.00 3. Copy of Certificate of Occupancy - $20.00 &. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 . te ....................... New Construction ........... Old Or Pre-existing Building.~. ........... Uocation or ProperW..l.~-.~O ........... ~O?..~..c~,. tc~ % .~,~.o.[~ ~ouse No. Street }]amlet Onwer or Owners of Property..~>'-~..~..OyaO6..~,Q-xV)..~..~.O~.'.~O~.~ ................... ;ou.~y Ta~ ~p ,o ~oo0, Barrio,, .......... ~.B,,,c,~ ..... I .......... tot ..... IJ ................ ilenlLh Dept, Approval .......................... U.derwriters Approval ......................... 'lan.lng Board Approvrll ........................ '!equesc for: Temporary Certificate ........... Fi,m[ Certicate ........... -ce Submitted Town Hall, 53095 Main Road P. O. Box 1179 Southold, NewYork 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD October 4, 1995 Mr. & Mrs. Michael Jackowski 1260 Hortons Lane Southold, NY 11971 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: xx An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. xx The check is not on file. $25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 21241-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. Town Hall, 53095 Main Road P. O. Box 1179 Southold, NewYork 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD September 27, 1995 Mr. & Mrs. Michael Jackowski 1260 Hortons Lane Southold, NY 11971 Re: Building Permit #21241-Z Premises: 1260 Hortons Lane, Southold Suff. Co. Tax Map #1000-63-1-11 During a review of our files it was noted that the above building permit has expired, and a Certificate of Occupancy has never been issued. According to the Code of the Town of Southold, Article XXVIII 100-284, it is unlawful to occupy or use a structure until a Certificate of Occupancy has been issued. Please contact this office as soon as possible so that we may clear up this matter. Thank you for your cooperation in this matter. Very truly yours, SOUTHOLD TOWN BUILDING DEPT. Thomas J. Fisher Senior Building Inspector 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FIREPLACE & CHIMNEY s' -- ? DATE Ii. S~OD d (PUE) '3. Nature of work (cheek which applicable): New Building. " Addition Alteration ......... Repair .............. Removal .............. Demolition ' Other Work ............... '- s · (Description) 4. Estimated Cost .... .O..O...D.C.,3. Fee : O.~. (to be paid on filing this application) 5. If dwell.lng, number of dwelling units ............... Number of dwelling units on each floor ........... If garage number of chrs 6. If business, commercial or miyed occupancy, specify nature and extent of each type of use ...................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of s~ime structure with alterations or additions: Front ................. Rear ...... ? ........... Depth ..... ' ................. Height ........... · ......... '.. Number of Stories ............... ~ ....... 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 Former Owner ............................. 1 I. Zone or use district in which premises are situated .. 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........ ' .................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ............ ;... Name of Contractor .......................... Address ................... Phone 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 ~et-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. -- ~ ...... -<:.,, ................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the .................... O. (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfo~ed the said work and to m~e ~d file this application; that all statements contained ~ thik application am true to the best of his knowledge and belief; and that the work will be perfomed in the m~ner set forth in the application filed therewith. Swbm to before me this N~aW Public, State of NowYo~ · · . .................... No. 4879505 ~ ~ .... ~Signature of applicant) Qualified in SuffOk County FORM. NO. 1 TOWN OF SOUTHOLD .BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved ~..~.-,,,~ .&.~., 19~ Permit No. Disapproved a/c ' .............................. .... (Building Inspector) APPLICATION FOR BUILDING PERM T BOA'RD OF HEALTH ....... 3 SETS OF PLANS .......... SURVEY ................... CIIEEK .................... SEPTIC. FOaH ....... . ...... cA[[ . ~.-- ............. HAIL TO: .~./>~/ .9.9 Date ................19 INSTRUCTIONS 1 ~ a~ Tiffs app ication must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of p!ans, accurate plot plan to scal~. Fee according to schedule. b. Plot plan showing location of ~ot 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 appB- 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 issued a Building Permit to the applicant, Such permit shall be kept on the premises available for inspection throughout the wt~rk. e. No building shall be occupied lot used in whol~ 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 hil applicable laws, ordinances, building code, housing code, and regulations, and to admit auth°rized inspect°rs °n pr'emises aiTd in building f°r necessary insp~n,s~- ~']./c~.~-,' ( i~ure of applic~i~lt, or name, if a corporation) ...t .~.a.o.. ~,~ .~c-m..La. ~. c. 4~o.~h. o./d.. .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~ ~' F.~ L'P.~ . ."~..O44Q...P~. (as on the tax roll or latest deed) If applicant is a ~orporation, signature of duly auth,,orized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......... i ...... Electrician's License No ' ' Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. ~..~..~a ~ hL.0 .~.~,xq......L~o....¢ 6o.0..~d d House Number . Street Hamlet County Tax Map No. 1000 Section! .... ~.~.g~ ~ ....... Block .... ]. ............. Lot .... [ .] ............. 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 oscupancy .. ,O..~..~.. y. Ce . .C~J./~lJ~J~.t~r.~...