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a
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 2-23643 Date MAY 15, 1995
THIS CERTIFIES that the building ALTERATION
Location of Property 13000 MAIN ROAD MATTITUCK NY
House No. Street Hamlet
County Tax Map No. 1000 Section 114 Block 11 Lot 12
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JANUARY 15, 1993 pursuant to which
Building Permit No. 21201-Z dated JANUARY 28, 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 ALTERATIONS FOR TOILET ROOM (LAVATORY) IN EXISTING OFFICE _
& STORAGE BUILDING AS APPLIED FOR.
The certificate is issued to PETER A., PETER J., & MARY JACQUES
(owner's)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N325418 AUGUST 30, 1994
PLUMBERS CERTIFICATION DATED APRIL 13, 1995 X & K PLUMBING & HEATING
zz"z-
il~dingector
Rev. 1/81
I\
FORM NO. $
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°N9 21201 Z Date 192
Permission is hereby granted to,
~~V4..
per
?.lv r.......................
` r
to . .
at Premises I ated at 4.,Za....O!........... x
County Tax Map No. 1000 Section 1~7............ Block Lot No.../w?
! pursuant to application dated 19..x4., and approved by the
I.
I Building Inspector.
Fee S..l.......?!.
Bui(di for
Rev. 6/30/80
i
Form No. 6
4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
_ TOWN HALL
765-1802
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 fromiplumber certifying that the solder used in system contairs
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: 4
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 $5,0.00,
2. Certificate of Occupancy on Pre-existing Buildinc - $100.00
3. Copy of Certificate of Occupancy - $20.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date „ April 24, 1995
New Construction........... Old Or Pre-existing Building..., X.
Location of Property.. .7 3 ~D. A1al1Z. I~oad~ Mattituek
House No. Street ..................Hamlet.,..,.
Onwer or owners „f Property, Peter A. Jacques, Mary F. Jacques, Peter J. Jacques
County Tax Map No 1000, Section..., 114..,_,,, Block ll 12
Lot..
Subdivision... N/A N/A Described Parcel
........................Filed Map............ Lot......................
Permit No..... 212012 ,,.Date Of Permit....!/.2..... Peter A. Jac ues
8/93 ....Applicant q.
Health Dept. Approval. ,9/21 92 (C10792 .012) Underwriters Approval,. 8/,25/94
Planning Board Approval ...~,/,1?/93............
Request for: Temporary Certificate........., X
Final Certicatc...........
Fee Submitted.- $„50.00 Bruce A. Anderson (Agent)
at3
TOWN Or SOUTHOLD
OrrICG Or 11UILbINCJ INSCBCTOIt S`
1 rI ` P.O. BOX 728 • 1
' Q t!? TOWN IIALL
~~O! >w SOUTHOLD, N.Y. 11971
r .
C C tZ T I F I C A T I O N~
~f l ?31~ s ~Jrtlr~
is Date
Building
Z
4
owner
N
„f
f Piurnber
<1~~
Cuttify that the soldnr• u4nd in thr_ wattir au 1 i atd1i1
a} , ~ rYr
:COntnins-Id9d than 2/lo of It lead. pP y
I N 4 (M1 e[ `
~ °Re l "X JEL.
r ~
Fxi
Rill
o qfi fl ~"3' k
~f > Y
kf
i Nil1+f °yru
(plumber's signature) `~'~d~{~.
yri'
:5wornn b0foko ma this x~~n(~'rkjt~
,any of~ J tiK~ xTT;
19 ~ apt z~ r
yy [
o! Notary rUblias
f1
j. o1rY UUhLitlJ ounty
HELENE O. HORNS
Notary Public, State of New York No.4951384
Qualified in Suffolk County
Commission Expires May 22, 19
Si ~ r
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l ~ 3 ~i :Val J y.
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O~~SUFFO~k~o
o~
PLANNING BOARD MEMBERS T SCOTT L. HARRIS
Bennett Orlowski, Jr., Chairman Supervisor
George Ritchie Latham, Jr.
Richard G. Ward Town Hall, 53095 Main Road
Mark S. McDonald P.O. Box 1179
Kenneth L. Edwards Southold, New York 11971
PLANNING BOARD OFFICE
Telephone (516) 765-1938 TOWN OF SOUTHOLD Fax (516) 765-1823
July 13, 1993
Garrett A. Strang
Main Road
P.O. Box 1412
Southold, NY 11971
Re: Proposed site plan for
Peter Jacques
1300 Main Rd., Mattituck
SCTM# 1000-114-11-12
Dear Mr. Strang:
The following resolution was adopted by the Southold Town
Planning Board at a meeting held on Monday, July 12, 1993:
BE IT RESOLVED that the Southold Town Planning Board authorize
the Chairman to endorse the final surveys dated July 8, 1993.
All conditions of final approval have been fulfilled.
Enclosed please find a copy of the map which was endorsed by the
Chairman.
Si ere ,
f i" G2G~// 2~
. Ward
Chairman
enc. 4/RI?
L-6
199
Suffolk Environmental Consulting, Inc.
Deerfield Green, Montauk Highway, P.O. Box 958, Water Mill, New York 11976-0958
(516) 726-1919 Fax: (516) 726-4471
Bruce Anderson, M.S., President
April 24, 1995
Gary Fish, Building Inspector
Southold Town Building Department
P. O. Box 1179
Southold, NY 11971
Re: North Fork Signs APR
1300 Main Road, Mattituck z 61995
SCTM #1000-114-11-12 Q
Dear Mr. Fish,
I represent the Jacques Family who owns the above referenced site and are
seeking a Certificate of Occupancy. The improvement of subject parcel was subject to
Site Plan Approval from the Southold Town Planning Board. By way of resolution dated
July 12, 1993, the Southold Town Planning Board granted final site plan approval upon
their finding that all conditions of final approval were satisfied.
Pursuant to our earlier discussions of April 10, 1995, enclosed herewith please
find the following requested materials:
(1) Complete Application for Certificate of Occupancy;
(2) Check made payable to the Town of Southold covering the requisite
application fee;
(3) New York Board of Fire Underwriters Certificate dated 8/30/94 certifying
the buildings to be in compliance with the National Electric Code;
(4) Executed Plumbing Certificate signed by Robert Kowalski dated 4/13/95;
and
(5) Planning Board Approval Resolution dated July 13, 1993.
You had previously mentioned that the Planning Board would have to conduct
another inspection to determine that the conditions of site plan approval were satisfied.
You will note that the enclosed Planning Board Resolution declares that all conditions of
final approval have been fulfilled. Accordingly, all that remains is your inspection and
issuance of a Certificate of Occupancy.
By way of this correspondence, I hereby request that you inspect the property at
your earliest convenience and issue a Certificate of Occupancy to my clients for this site.
Please contact this office or North Fork Signs to arrange for the final inspection.
t
Thank you in advance for your cooperation.
Sincerely,
Bruce A. Anderson
APR 161995
k
CC. P. Jacques
ROBERT H_ WHELAMs P_E.
P.O. BOX 590 BUNGALOW LANE
MATTITUCK, NEW YORK 11952
516-298-5770
May 9, 1994
Town of Southold
Building Department
Main Road ;I
Southold, New York 11971
MAY I i X994
Att: Mr. Gary Fish Ref. North Fork Signs UTi10LD gp
Main Road '
Mattituck, New York 11952
Dear Sir:
Pursuant to your request, please find attached a copy of the
manufacturers literature for Manville commercial insulation
reported to be installed at the above referenced project.
It is my understanding that the material was pressed into
place between the new steel studs. In accordance with the
manufacturers literature this installation procedure is
acceptable if vapor control is not critical.
If there are any questions with regard to the above please
feel free to call me at the above referenced number. Thank you
for your cooperation on this matter.
®F IVE tai &
* ery Tru Yo ;
Y
` ~cP~ txLi Cq
644 Ato 14z obert H. Whelan, P.E.
OFESS10 -
cc: North Fork Drywall & Insulation
Manville Fiber Glass Kraft-Faced
Commercial
Insulation
Description r llrp",
Manville Kraft-Faced Commercial
Insulation is a lightweight thermal N ` plti
insulation made of resilient glass
fibers that are bonded with a A thermosetting resin, The fiber glass
i P Y sill
insulation is laminated with n ""aft Facing which can serve as an effective hl ~ry,~uV
(wil
vapor retarder when properly installed,
V it
Uses nV 8 0'
Manville Kraft-Faced Commercial
Insulation is designed particularly for I'
installation between metal studs and is
recommended where thermal efficiency ;rill ~y1t11
and water vapor co, `rol are required; y
where lightweight, r,, Wiency of ease of
b~F
installation are required; or where {a y
resistance to vibration or shakedowns is +ti S
important. The kraft vapor retarder facing
is flammable and should not be exposed to 4
open flame or other sources of ignition. It l; ma
must be covered with gy.,um board or
another approved interior finish.
,
Advantages
Strong. Bonded glass fibers utt "twine to Y'»
give high tensile strength to bl,. Ikets.
They won't pull apart during normal Available Forms
application and won't sag when properly Kraft-Faced commercial insulation is
installed, available in 48" precut batts in 16" and
24" widths with attachment flanges.
Resilient and Flexible. Resists settling,
breakdown or sagging from vibration, R•value' Nominal Thickness Widths Batt Length
Forms readily arouI`d corners and (Insulation Only) (Inches) (Inches) (Inches)
curved surfaces. Easily cut with an - - -
ordinary knife. Attachment flanges are R-19 63/4" 16 & 24 48
provided for special applications R-11 39/3° 16 & 24 _ 48
It can also be Inst?Iled with mechanical .R nmana reaiatanca to oast Sow, mu n,geor inn R wme the groat., tf,n,,edema power
fasteners or s;iw, , D ¢FP. in place
betweer, studs here vapor control is
not critical
Packaging. Kraft-F, Commercial
Insulation is compre;.- nt p,-,kaged
which means savings in sto age and
freight casts, n R R 0 M R
U LS LS U t5~
MAY 1 1 1994
TOWN F SOU HOLD
100'39tdd HH93NNId 1.1013 61:t-I t,GI S AJ1`1
jjJA it LNT^
- ~1~
rDUtlDATION (1st)
FOUNDATION (2nd)
2.
({OUGH FRAME &
.PLUMBING
cn
:11SULATION PER N. Y.
STATE ENERGY I `
CODE
FI:)AL
ADDITIONAL COMMENTS:
4,1311P 07
' H t~~W;
_cM
4
m
a
- - N
~2vc~
765-1802 -Si)f ~rv~n avv+~ e dUWMyc,
BUILDING DEPT. ~/Vc.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: 1~
19
Y ~ t C
F
/ r
DATE `l/ ~S INSPECTOR
/27 k
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST t ROUGH PLOD.
ND [ ] INSULATION
l FRAMING [)F' AL
REMARKS:
DATE ) INSPECTOR
i
, p
7'65-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST 1 ROUGH PLBG.
O FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ) FINAL
REMARKS: fir
DATE /ate INSPE
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1185077 BUREAU OF ELECTRICITY
F 8S JOHN STREET, NEW YORK, NEW YORK 10038
Date AUGUST :30,1994 Application No. on file 84161394/94 N 3:25418
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant nomedon the above application number in the premises of
PETER JAQUES, MAIN ROAD, RTE1.25, MATTTTUCK, N.X.
in thefollowing location; ? Basement ® lst Fl. ? 2nd Fl. OUT Section Block Lot
was examined on AUGUST 25 , 1994 and found to be in compliance with the National Electrical Code.
FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCANDESCENT FLUORESCENT OTHER AMT. K. W. AMT K.W MIT. KW. AMT K. W. AMT. H P.
26 27 22 19 5 2 1 F
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL RECPT TIME CLOCKS BELL UNIT HEATERS MUlT1.0UTLET DIMMERS
AMT K. W. Oll N. P. GAS H. P. AMT. NO A. W. G. AMT. AMP. AMT. AMPS TRANS. AMT H P SYSTEMS AMT. WATTS
NO.OF FEET
5 F 2 - 2 40
SERVICE DISCONNECT NO.OF S E R V I C E
AMT AMP TYPE METER EQUIP . 1,e RW 1,93W 303W 304W NO OF CC. CORD A. W. G. NO OF HI LEG A. W.O NO. OF NEUTRALS A W G.
PER0 OF CC. COND OF HI-LEG OF NEUTRAL
OTHER APPARATUS:
CONSUMER OWNED ELECTRIC METER--1
EXIT SIGNS-4
PANELBOARDS:1-7 CT.R, 100
G,F.C,I,.-8
ROSLAK ELECTRIC LIC,#3677-E
P.O.BOX 164
CUTCHOGiUEi, NY, 11935 GENERAL MANAGER
11
Per
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
BOARD OF HEALTH
FORM NO.1 3 SETS OF PLANS
TOWN OF SOUTHOLD SURVEY .
BUILDING DEPARTMENT CIIrCt
JAN 2 7'0 TOWN HALL SEPTIC FORM
SOUTHOLD, N.Y. 11971
TEL.: 765-1802 NOTIFY ;
/ CALL
Examined , 19~~
~~aa HA GG~~e.~~A I L TO
Approved 150 Permit No. v€o~1/
Disapproved a/c
(Building spe
APPLICATION FOR BUILDING PERMIT 2
Date p 3
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 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, b ding code, housin code, and regulations, and to
admit authorized inspectors on premises and in building for necessary in pe Io '/~I` P{\~\y
(Signature of applicant, or name, if a corporation)
( ailin a d T es of applicant)
S(ZAka~' 1 tqI I
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
:.......~?.w.
Name of ownerofpremises .Q,lQY,.~l., ~ ~1~C bQ
(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 .
Location of land on which proposed work will be done. . • . . . .
13000 .................i~r..................
~~?.~.}.l.uV` y. ...1
House Number Street Hamlet
County Tax Nlap No. 1000 Section 1 Ai Block ....l. I Lot L
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 , , , . , , , .
p \^I r
b. Intended use and occupancy s
3. Repair Nature . of work (check • R which e applicable): New Building Addition Alteration
oval
• • • • Demolition Other Work .
'j~ ll 1
4. Estimated Cost . Z .,,b d, , , f O,V 2 t N V 0 0 Y~ (Description)
o dl Fee
dwelling, number of dwellin~ l (to be paid on filing this application)
5. If units Number of dwelling units on each floor.
If garage, number of cars . . . .
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . . . . . . . . . • .
7. Dimensions of existing structurels, if any: Front Rear
Hei ht • , Depth , ,
S ........NumberofStories. .l•
Dunensions of same structure w(th alterations or additions: Front Rear . • .
Depth . Height . . Number of Stories .l. • • • • . . • . • .
8. Dimensions of entire new construction: Front Rear Depth . •
Height Number of Stories . . .
9. Size of lot: Front ...:l J .
Rear . .1 ~.S • Depth l.$ .
10. Date of Purchase AA1 k .G h , . , , , , , Name of Fo?~ er Owner .
11. Zone or use district in which premises are situated. . Ka M. I C.~ .'.Iy.U S . . . . . . . . . .
12. Does proposed construction viol4te any zoning law, ordinance or regulation: .N 0 .
13. Will lot be regraded • • • • • • .
5,• • • • • • • • • • • • • • • ....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 . . Phor e No. ,
15. Is this property within 3',00 feet of a tidal wetland? eyes; 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 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.
~vrjpost To PU} hp'', 3 Wells 2v,Ut ee~~~v, I~S1~1t cf i7 t, 1!1P1ltvle~
~ov 0,or, ~nl4Ca~ 10Vr as pa,r OraW+r5;
1tns~~e l~lr„er~ to1~s (5~ ~cq~ k lalbV 4k VV I~o01-
Y4 W2~I or M~~ZI J~0 ok I C 0 G ,
1'Q,2VIfly KPA JTV ~S Q, r, Ce.l Brig
~YL~: Q R2plae~ IllghC2l~IriS 2 ~~r Qvs I(, Q iv C
4 PI\iw0 (K I op ~YW2,11 C'e1~iv~5
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SO, YV1 G4 I`joX -
I
i
;TATE OF NEW YORK, S SI
OUNTY OrT~.C~k .~Y. Q.. • i.V .a. C ~ V Q~ Q .
• • • • being duly sworn, deposes and says that he is the applicant
Name of individual signing contract)
bove named.
fe is the . W ) t'K 'I,
(Contractor, agent, corporate officer, etc.)
f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
')plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the
ork will be performed in the manner s4forth in the application filed therewith.
worn to before me this
? ....day of 19 3
l/
otary Public, ounty
JOYCE M ! WILKINS W
Note~ryyr Public, State of New Y~ork
11019f1224S,Suffol~Coup Signature ofa
Term ExpiretJune 12, I87 applicant)
c POCK-~ I ; -~t-C POOL v A
k~ ce v L In t G ~ W \ / p,. LV .~SMCSII Till Y U 74 ROAD (ZS) o (ZS) V IN
CL 'A / MAIN 3
V_.EY MAP
133.0 Sol -1) HpMEM~@ MON PREMISES Q " 600,-l
w
D-_F T P1I ,~E. W
I O 2 NEW SUFFOLK N w =FOLK d
i m Ill_1-SI'_-- PHONE P~"OTH • FUND AVE. v0 W N750100E' Ln/ 1P
ptLLL HOLE r ~ry~.~~ TEST HOLE
Row oP PosT~ SUffOLM COUNTY DEPARTMENT OF HEALTH SERVICES EALTH 3ERVIM warze 02N.
OFFICE O V_ APPROVED FOR CONSTRUCTION ONLY IN ONLY Low
lo'
~n 540'SO. FT. N iZI I C/O-9a/5 ( H.S. REF. NO. FLOW FLOW / 36 5=WN 5ANDY
1 „-rv.ee- 09 1(b%lST , N.6) TYPE ~ N LOAM 3
ton d the smdeq GROWN
u - - - - I This approval is grenled tot Me construction of the sanilar U disposal and rater supply Mcillties pursuant In (Wicks YB an ._j 7 of the Sartan Crawl, -7 r mdrv PMa and is not an eppresse ntIn Articles YBmW CANE TO
is not an expressed
a, v I y li wr im,l.. mn of occupy ih Im M KCUR th, COARSE
0 struchxe(sl cNnwn. INE$ YU L cX7'InkS TWO (2) YEAR io Is I I Ll ILU. FROM 111E )M n e ritWW. ~ na two (2) YEARs
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" @ \ \ \ I -MIN A" 01A. CLA99 2400 PIGS OQ OQ IEO~~~//" G.I. COVES'
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for water distributing NOTI Y 6UIL DEPA T Al ry "17~+ p P`T~ a essi L z NHr
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pwVpE~r<Ov FOR ~~O 2 POOCH OURPRAMO,N(, 8, ~LUfNMING V! e PLUMBER CERTIFICAVON INSULATION
ON LEAD CONTENT BEFORE a. FINAL - CONSTRUCnON MUST BE COMPLETE FOR C.O.
UNDERWRITERS CERTIFICATE CERTIFICATE OF OCCUPANCY ALL CONSTRUCTION SHALL MEET IIT REQUIRED SOLDER USED IN WA FER STHE REQUIREMENTS OF THE MY
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SUPPLY SYSTEM CANNOT CODES. NOT RESPONSIBLE FOR it DESIGN OR CONSTRUCTION ERRORS I
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