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Home My WebLink About20972-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23563 Date MARCH 22, 1995 THIS CERTIFIES that the building Location of Propert~ 245 RACHELS ROAD House No. County Tax Map No. 1000 Section 108 Subdivision ACCESSORY Street Block 4 Filed Map No. MATTITUCK NY Hamlet Lot 7.43 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 18, 1995 pursuant to which Building Permit No. 20972-Z dated SEPTEMBER 23, 1992 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 AN ACCESSORY STRUCTURE IN THE HEAR YARD AS APPLIED FOR. The certificate is issued to (owner of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 JAMES & SHARON JACOBS lessee or tenant) N/A FOUnt leO. S 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-oNo. 2097~Z Permission is hereby granted to: ,o ...~.~...........o~.......~..~.~ ...... ~~,~....~ .......... at premises~ocated at .~.~.~.~..~-~.~,..~, ...... ~..~. ......... :.~.~.~ .................... Counb/ To× Map No. ~000 Section ...]....~...~ .......... Block......................~1~ Lot No.....~:..~..~. ....... pursuant to application dated ......... ~..g~k~.~...~r. ............. , 19..~.....-~, and approved by the Building Inspector. Building Insl~ector Re~ 6/30/80 Form No. 6 TOWN OF SOUTtlOLD 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 from plumber certifying that the solder used in system contairs less than 2/10 of 1% lead. f 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. Bo For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and Ppre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual naturai 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-existin~ Buildin~ - $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 ............................... New Construction .... ..~. .... Old Or Pre-existing Building ................. Location of Property ............ House No. Street Hamlet Onwer or Owners of Proper .... , ............. County Tax Map No 1000, Section...la~. ...... Block.~. ........... Lot..~.7.:?...~... Subdivision .................................... Filed Map ............ Lot ...... Permit No.. ~.Oq ~.~..~....Date Of Permit .~..~/~ .... Applicant.O~.~ .~ Health Dept. Approval ................ Underwriters Approval Planning Board Approval .............. Request for: Tempor~ary Certificate ........... Final Certicate..~.. ...... Fee 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 March 16, 1995 Mr. & Mrs. James Jacobs 245 Rachels Road P.O. Box 1209 Mattituck, NY 11952 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 # 20972-Z Please contact our office on this matter. cooperation. Thank you for $OUTHOLD TOWN BUILDING DEPT. 765-1802 BUILDING DEPT. INSPECTION FOUNDATION IST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] I~ULATION~ FRAMING [//]"FINAL OUNDATION ( 1st) OUNDATIO~4 (2nd) ,0UGH FRAME & .FLUMBING i~ISULATION FERN. STATE ENERGY CODE FI;IAL ADDITIO~;A'L COMMENTS: SEP 18 FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:2 _ . . (Bl~fding Inspector) P, PPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... 3 SETS OF PLA~S .......... SURVEY ................... CI1ECK . · ..... CALL ..-.~ ......... ~ ...... HAIL TO: INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ;ets 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 3r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ation. c. The work cover6d 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 ;hall be kept on the premises available for inspection throughout the w6rk. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy ;hall 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 3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ~egulations, for the construction of buildings, additions or alterations, or for rem, o~val or den~olition, as herein described. ['he applicant agrees to comply with all applicable laws, ordinances,~building cod/e, ~housing (~q[de, and regulations, and to tdmit authorized inspectors on premises and in building for necessa~~..~..~... --' (~Jgnature of at~licant, o~ame, if a corporation) (Mailing address of applicant) ~tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. qame of owner of premises . .~.~.t~..~.~...~......~...~. b..I .~.~..O..~....~...,... ~.~...C..~..~..~....~.~ (~.: ........... (as on the tax roll or latest deed) f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. ' ......... Plumber s Lmense No ......................... Electrician's License No ....................... Other Trade's License No ...................... · Location of land on which proposed work will be'done .................................................. IIouse Number Street Hamlet "County Tax Map No. I000 Section J~.'7.~ .......... Block ..... ./'/ ........... Lot .... .~.'..~.3 ........ '-Snbdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended Use and occupancy of proposed construction: xa. Existing use and occupancy ........................ ~ ...... -~U .... ~ ................................ .-_h. Intended use and occm~ancv property lines. Give street and block /nterior or comer lot. ~ ~ 3. Nature of work (check which a~plicable): New Building . . ddition .' ......... Alteration .......... Repair .............. RemOval .............. Demolition .............. Other Work ............... ~ .~ .~.~. '" (Description) 4. Estimated Cost ............... F (to be paid on filing this application) 5 Ifd fd ' ' welling, number o welling units ............... Number of dwelling units on each floor ................ If garage, number of cars 6.If business, commercial or mixeO occupancy, specffy..,na!.ure an,d extent of each type of use ........ ; ............ 7.Dimensions of existing stmcturels if any: Front...,'~.~:: .,,.... i Rear ~.O.;. ' De'th ' Height ............... Number of Stories ...l. !/.~. ...... ' .... " ............... Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth i Height .'... NumberofStories 8. Dimensions of entire new construction: Front ..... l;~... .....Rear .... ]~ .~:'-. ....... Depth .../. ~ ......... Height ............... Numlber of Stories .. ) " ~ - I0. Date'ofPurchase ..... i' ' '.i' ' ......... - .................... ...... Name of Former Owner . ~: .~....P'/.q ~?. ~..~.q ?..c¥ .,~..~..cfi... 1 I. Zone or use district in which prelmises are situated../~. ~t .O. ff.,~..~., .~..t.- ................................... 12. Does proposed construction violht, e ~iny zoning law, ordinance or regulation: ................................ 13; Will lot be regraded ...... .._:...C/.O~: .............. .W.~[excess fill be removed from premises: Yes ~No 14. Name of Owner of premises ~.~[~ .~. ~./,.~tt~.~..~.'~:V~a~rr~ss .... r-~.4~..~. ........ Phone No. ~'.~ Name of Architect ' Address Phone No Name of Contractor ....................... - .... Address ................... Phone No ................ 15. Is th±s property w±th±n 3'00 feet of a t±dal wetland? ~Yas ........ No..~ ..... ~If yes, Southold Town Trustees Perra±i: may be requ±red. PLOT DIAGRAM Locate clearly and distinctly all ibuildings, whether existing or proposed, an& indicate all set-back dimensions from mmber or description according to deed, and show street names and indicate whether STATE OF NEW Y.~,R~,r,, , -- S.iS ...... .... (Name of individual signin¢ contract) above named. ........ being duly sworn, deposes and says that lie is the applicant (Con/rector, agent, corporate officer, etc.) )f said owner or owners, and is duly Cuthorized to perform or have performed the said work hnd to make and file this ~pplication; that all statements contained in this applicaQon are true to the best of his knowledge and belief; and that the .york will be performed in the~mauner s~t forth in the application filed therewith. ¢Wom to before me this //~/