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.~...