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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22767 Date DECEMBER 7, 1993
THIS CERTIFIES that the building ACCESSORY
Location of Property 4S APPLE COURT SOUTHOLD, N.Y.
House No, Street Hamlet
County Tax Map No. 1000 Section 69 Block 3 Lot 17
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 31, 1993 --pursuant to which
Building Permit No. 21654-Z dated SEPTEMBER 11, 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 ACCESSORY GARAGE AS APPLIED FOR.
The certificate is issued to JOHN J. JAKLEVIC
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
lding Inspector
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)
N® 21654 Z Date
Permission Is hereby granted to: n
r.+r. ...~1
....V:.
to...1 .~n..4rtcl,...9r?Z .,...,F..........
at premises located at....... ' C
A~ y45;l....................... .................x....................
County Tax Map No. 1000 Section Block Jam.......... Lot No. 1.2.
pursuant to application dated ....j 19,......, and approved by the
Building Inspector.
{ Fee $
...IPJyYi..
/ ulidns pect or
7Rev. 6/30180
1=' D i;:SPECT;U;] JIL)AT-- COMMENTS
F - DATION (1st) [
FOUNDATION (2nd) _ n(1
2.
z ~
o,
ROUGH FRAME &
PLUMBING
H
3.
INSULATION PER N. Y. y
STATE ENERGY
CODE
4.
FINAL
z
ADDITIONAL COMMENTS: x
x\
a
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x
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a
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INSPECTORS ,
Victor Lessard
Principal Building Inspector Curtis Horton i ?a SCOTT L. HARRIS, Supervisar
'
Senior Building Inspector x5.k
Southold Town Hall
Thomas Fisher P.O. Box 1179, 53095 Main Road
Building Inspector
.c~ Southold, New York 11971
Building IFnspectorb Fax (516) 765-1823
Telephone (516) 7654800
Vincent R. Wieczorek
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
November 30, 1993
Mr. John J. Jaklevic
45 Apple Court
Southold, N.Y. 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.
%g% The check is (e> ed-not on file.)$25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # BPIF 216542
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ I INSULATION
[ ] FRAMING ( FINAL
REMARKS: co
_
DATE ll ki~__INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ FOUNDATION 1ST [ I ROUGH PLBG.
[ FOUNDATION 2ND [ ] INSULATION
[ J FRAMING [ ] FINAL
REMARKS:
DATE Al 15 /D INSPECTOR !
Form No. 6 C%/oLj . N,$ offtQ (a,-,4
' r~ I I J ,b~ t.P Yl f 119
~mv TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
5777. UU17'" 765-1802
TOWN OF 5OU"ITHOIJ4 „ r.
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OR ink and submitted to the building
inspector with the following: 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 siteplan 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 a 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 - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date P Kenn imA.... ~.l..jw
New Construction. y1 ...f.~. Old Or Pre-existing Building... NIA /
Location of Property.... ; 5 . AoP~ A. Couf{T...... ;SOL)- /loth. s !y:f 11~7l......
House No. Street Hamlet
ej -TA K 1,
Onwer or Owners of Property............
County Tax Map No 1000, Section....! 1....... Block 3 .........Lot...... 1.1
Subdivision......5®U'7hlot_D 1I1"-8.6......... Filed Map............ Lot
Permit No.. fsiOq ......Date of Permit.. ....Applicant ...,J;JFInI T. T,gblL~~/IG
Health Dept. Approval........ Xle ..............Underwriters Approval NJA
Planning Board Approval....... 141t%
Request for: Temporary Cerrtificate..kilo...... Final CerticateAr-5.....
Fee Submitted: S:~o
i
Q X02 P CANT
Peco is Proprt es Manage ent Inc.
P.O. Box 1143 • Cutchogue, New York 11935
,,gg / EORPresGEI ESER
lf'ti i ent
March 4, 1994
Town of Southold
Building Department
Thomas Fisher - Chief Bldg Inspector
53095 Main Road
Southold, New York 11971-0959
Dear Mr. Fisher:
The intent of this letter is to formally register a complaint relative to Lot 116,
properties owner name ,laclivic on the placement of a detached garage structure on said
property.
It is of opinion that this structure has been placed too closely to the property
line of Lot 1116 Phase II. It is also of opinion that the gtflicture on Lot 116 is not
of the proper grade elevation thus these two factors have now created a situation
whereas it is extremely difficult and may prove to be very expensive to correct the
up land drainage situation that currently exists.
I am requesting that the building department conduct a thorough evaluation of
the location and elevation of this structure (garage Lot 116) and also inform the
current property owner of this problem, and make recommendations as to how this matter
can be corrected.
If the garage had been properly located and elevated the existing drainage problem
would not exist.
yt"
urs, ~qnl C. ( S U-) 1 /NL+ //'11 jq'aS4z'1A4- C)1 S
er ~4~14~J1~a W' iges _ rS 3
~ ti/~"
#/eg
BOARD OF HEALTH
FORM NO. 1 3 SETS OF PLANS
TOWN OFSOUTHOLD SURVEY
AUG 3 ! ! , BUILDING DEPARTMENT CHECK . . . . .
? TOWN HALL SEPTIC FORM
SOUTHOLD, N.Y. 11971 °
El U16. 01 F'. TOW JTfafJf,i'' TEL.: 765-1802 FY F ; CALL
Examined ~y 19 9~
~j MAIL o:
Approved 19 L/. Permit No..
Disapproved a/c
(B 'din sl~ectcr)
APPLICATION FOR BUILDING PERMIT
Date 19
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
Bets 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
for areas, and giving a detailed description, of layout of property must 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 issued a Building Permit to the applicant. Such 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 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 all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections.
.
- (Signature of plic t, r name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
UwNJFIZ
Name of owner of premises rJ.....J
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No .
Plumber's License No .
Electrician's License No .
Other Trade's License No .
1. Location of land on which proposed work will be done . .
..........................F.~~J:E...~ T ...................~~~Tr;lcu u....................:
House Number Street e~ Hamlet /
County Tax Map No. 1000 Section l Block Lot. . . ° . J.7..... .
Subdivision Tr/oL/~ ...V.//., 4 f, , , , , , , , Filed Map No . Lot
(Name) ,
2: State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy PR1 VA fE b~ F +rl~, , , ,
\C~ .
b. Intended use and occupancy $
3. Nature of work (check which applicable): New Building Y.. , Addition Alteration
Repair Removal . . . Demolition Other Work .
(Description)
4. Estimated Cost .70U9..W Fee .
(to be paid on filing this application)
S. If dwelling, number of dwelling units . . . . . N ~r1....... Number of dwelling units on each floor ,e1,K1 . , , , , , , , , ,
If garage, number of cars Ql .
6. If business, commercial or mixe1d occupancy, specify nature and extent of .each type of use 4IA......
7 Dimensions of existing structures, if any: Front ' • Rear, ,2?, 3...... , Depth r , , , • . , . .
berofStories ;Z'
Dimensions of sa e structure with alterations or adyitions: Front P.,A......... Rear ,N, jl) , , , , , , ,
Depth N .A Height N A Number of Stories VIA .
8. Dimensions of entire new construction : Front . Rear ....c~........... Depth
Height . )7....... . Numbe; of Stories . , •
9. Size of lot: Front Rear . ,`.....q /,.0.3......... Depth
10. Date of Purchase .l. . p emises ~ 9r 33 . .
M ~.70 Name of Former Owner ....ecr r>.r .%~z7~renh2s..%Ylgen`l. .
11. Zone or use district in which r
aresituated...,sSPLCFhp.lc{,,,,,,,,,,,,,,,,
12. Does proposed construction violate any zoning law, ordinance or regulation: .
13. Will lot be regraded , . , , O Will excess fill be removed from premises: Yes No
14. Name of Owner of premises .~Wrn.~ r0.~tieWrf . , Address . y$,A. ~/1(Q ~4elr , . Phone No.. 7(vS ..3Agq . , .
Name of Architect OFF-T~.... KEN!-......... Address 4i3,-.m:~ +YNF4 sA". hone No. ,!1(5- S3~o
Name of Contractor . Address , , Phone No...... .
15. Is this property within 300 feet of a tidal wetland?
*Yes No..~.....
*If yes, Southold Sown Trustees Permit may be required.
PLOT DIAGRAM T
Locate clearly and distinctly all buildings, 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 lot.
A SEE. AY'/ACHED
STATE OF NE RKq S,S
COUNT OF 6Na of individual signs acv (C being duly sworn, deposes and says that he is the applicant
a ng contract)
above named. He He is the
(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 true 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.
Sworn to before me this
~ day oA*C ,19 73
Notary Public o unty
Notary Public, Statesof New%rk
(Signature of applicant)
Llueflf~!S7gS
Commission ExpireSuffolk. ebw k 1 82~
SUPrOLK CC'Sh61' DEPARTi~iLiiT Cf HEhI(H SEiNTUS
Q SII.GL'c FAMILY DY, $ D -3
The Towage ai nrd v: -'e. saoP'i
locahor N,lo Dc=r : sPe""' -Y urparn;vnt antl/or
-N- olner agenc,es and t0ura}P Ga,;@hgra.tuY .y
V Chef df OV", of Wastewater Manzgem?nt
n
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J /
CB6 V4,
s~2SF O
0
VACgNT / ~Q 13$33• /L
zsn \~C
79 O 2s/y OV
R ~ rom se / \
a 2S 3 * \ $ ti aao
~ I ~ 9 3~ rp ,NM:h
2 „ I 7 .l 2~ ~IO~O
t „ r J s3.o a o• Q~
N7S.43/O.A, I I n
1bC
?gSM~NE N0.00, R425g2,
IgNE
- 1
?L3 d.i..
AREA = 10,768 sq. ff. TOY'liN
CERTIFIED TO. SURVEY OF
THE LONG ISLAND SAVINGS BANK LOT PECONIC PROPERTIES MANAGEMENT CORP. (J
roo &&,1 //Ii3 C l 3 s' "MAP OF SOUTHOLD VILLAS"
Prepared In accordance with the minimum - FILEDJUNE25, 1992MAPNO 9237
standards for title surveys as established AT SOUTHOLD
by The L.I.A.L.S. and approved and adopted TOWN OF SOUTHOLD
for such use by The New York Slate Land
T1/le Astaalalran. SUFFOLK COUNTY, N. Y.
The water supply and sewage disposal 1000'
systems for this residence will conform 41
to the standards of The Suffolk County Scale: 1" = 30'
Department of Health Services. March 11, 1992
JUL Y 15, 1992 (foundation)
The locations of waits and cesspools shown hereon are from field Oct. 23,192(finai)
observations and or from data obtained from others.
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
FOR APPROVAL OF CONSTRUCTION ONLY r
~~~II 'T
N.Y.S. L.IC. NO. 49618
'4 ~j
DATE uS. REF. NO. 92 .SO 43 NOV 13 1992 PECONIC SURVEYORS, P.C.
!5161.765 - 5020
S.C. DEPT. OF P. O. 'BOX 909
APPROVED HEALTH SERVICES 1 MAIN "ROAD,
L st, SOUTHOCO;=aV.Y. 11971
) -7 1 -7 !s I I 1
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- - - - - - - - - - - - -
- h N k L-17 VAT 10 N L-F V f- % JON IN L F r= T
le I S~cAI_E : x,14 I ~ O° - 5 CR ~E. Icy ~~/b "
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OCCUPANGV ON `
USE ~S UC R W ICRT~
~VZO~ OCCUPANCY
2M6 Bi?r~E
rA'
NOTE Ca~IkC 7-FS
OA' nJ;m JKF_,jJfAfE AS Y'v4. ''14/.T FELT' _ 4 FELT _
i v" Ps. sLaa w/6z6 I I C' 3JIo~161cj ('3tv 1/2 CD% S14
R~~NFQk6114 4JJRE ' ~L~I s _ 10 ry~ ."ice. If2 cDx sNEMrtnr+ay Ap R ED AS NOTED
zx Ra~TEas w"aL DATE: 93 B.R a '2/du 5° r8
(NOTIFY BUILDING' DEPART- Tr~i' Ar
I 755-9802 4 AM TO 4 PM FOR THE - 'Lcp Ixw s--FKxE wriAYPee W/Awn FOLLOWING INSPECTIONS:' -
I ~ 's/y e3 B-R lelju VC{ J IZ"VIAyL SaFFJT V't Nv Fb - 1. FOUNDATION - TWOREQUIRED
FOR POURED CONCRETE -
2. ROUGH - FRAMING & PLUMBING
- VINYL SIOiNy 3. INSULATION
I I~ 'fs"A FELT 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O.
it
T/fV: Q~S,3 >NEA*µµ ALL CONSTRUCTION SHALL MEET y THE REQUIREMENTS OF THE N.Y.
= cr,y~fa~C„ STATE CONSTRUCTION & ENERGY
- - - '2r2G CCR, 54L~ CODES. NOT RESPONSIBLE FOR - DESIGN OR CONSTRUCTION ERRORS
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