HomeMy WebLinkAbout20644-zFORM NO. 4
TOWN OF SOUTNOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-24237
Date MARCH 25~ 1996
THIS CERTIFIES that the building
Location of Property 1565 JACOBS LANE
House No.
County Tax Map No. 1000 Section 79
Subdivision
ADDITION
Street
Block 6
Filed Map No.
SOu'£~OLD, N.Y.
Hamlet
Lot 4.3
Lot NO.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 15~ 1992 pursuant to which
Building Permit No. 20644-Z dated MAY 21, 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 SC~EEMED ROOM ADDITION ON EXISTING DECK AS APPLIED FOR.
The certificate is issued to
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
JACK& KARIN THILBERG
N/A
H--04100 --MARCK 15, 1996
Rev. 1/81
I~OB,M NO. 0
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N. !'.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
........... ~./.. .....................
NgN.° 3054JZ Dot~, ,~ ........, ]9.~..~
Permission is hereby granted to~ . __ .
.... .........
.... ...........
// ~ /~.~ ~-~ ~ .
at prem,ses I~ated at ............~ .... ........ ~~.....~ .............................
co..w ~ ~ ~o. ~000 s.~.o. ...... ~. ........... ~k ......... ~ ......... ~o,.o ..... ~ .........
pu~uant to application dat~ ..... .~....../~ ......................... , 19.~ and approv~ by the
/
Building Inspector.
Fee $ ........................
/,~Sullcllng Insi~ector
Rev. 6/30/80
t
· BLDG. DEPT.
Form No. 6
TOWlq OF SOUTIIOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
A~PLICATION FOR CERTIFICATE OF OCCUPANCY
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 bu±lding, 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.
For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
"pre-existing" land uses:
i. 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
New Construction.~.P.~fjO Old Or Pre-existing Building .................
Location of P o eft /~ . .
rp y ................................ ~ .......................... .. . . . . .. . .
House No.~ Street Hamlet
Onwer or Owners of Property ......... '.~. /.~..~..~..././~.. .~...~./.'.~.~
................
County Tax Map No i000, Section. ~.~
............ Bi .............. Lot ..................
Subdivision ........................ Filed Map .... Lot .........
Permit No.. ~.O.~...~..~..~...Date Of Permit..~.~./.% ~..~...Applicant....~...~..~./.~.. ~..Z~../.~ .~.~./~..~..
Health Dept. Approval .................... ----- · Underwriters Approval .........................
Planning Board Approval ...................... ..
Request for: Temporary 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
February 14, 1996
Mr. Jack Thilberg
1565 Jacobs Lane
Southold, NY 11971
Re: Building Permit #20644-Z (porch add.)***
Premises: 1565 Jacobs Lane, Southold
Suff. Co. Tax Map #1000-79-6-4.3
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.
*** - ALSO BP#22278-Z EXPIRES 2/24/96 AND HAS NEVER HAD ANY
INSPECTIONS. PLEASE CONTACT US ASAP TO RECTIFY
THIS SITUATION. THIS IS FOR A SWIMMING POOL & FENCE.
FOUNDATION
Ilst)
FOUNDATIO~U (2nd)
2.
ROUGH FRAME &
.PLUMBING
INSULATION PER N.
STATE ENERGY
CODE
FI;;AL
ADDITIONAL COMMENTS:
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION2ND [ ]/!N~ULATION
[ ] FRAMING [~] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE
!1
Town Hall, 53095 Main Road
P. O. Box 1179
Southold, New York 11971
Fax (516) 765-1823
Telephone (516) 765-1802
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
February 29, 1996
Mr. & Mrs. J. Thilberg
1565 Jacobs Lane
Southold, NY 11971
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
An application for Certificate of Occupancy is
not on file. (Enclosed)
xx No Underwriters Certificate on file.
The check is (outdated/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 # 20644-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
.\pproved . · ........ 19 .~.~'. Permit No. . .
Disapproved a/c
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
· flii'u'd&'ng Inspector)
APP,L, ICATION FOR BUILDING PERMIT
CALL
THE REQUIREMENTS OF THE N.Y.
.," STATE CONSTRUCTION & ENERGY
Location of land on which proposed work will be done.
t s' .................... coDEs.
b~' ' ~0~ ok' ~6~6~ ·
.......................... · ............ ~ od~,
IIouse Number Street ' ' ' Hamlet
ConntyTaxblap No. lO00Section ...Z~. ........... Block ....~. ............. Lot ~
SubdNision ..................................... Filed Map No.
(Name) .............. Lot ...............
tare ex;sting use and occupancy of premises and in tended use and occupancy of proposed constrnction:
:. Existing use and ~ ~[< ~. ff~
occupancy ·
'. Intended use and occupancy ............... ~l,~ ~m~ 0 t~
Builder's License No.
' ' ......
Plumber's License No ........................
Electriciap,:s License No. W~J~O[~J CE~TIF~CATE
......................
Other Trade's License No ......................
1, FOUNDATION TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3. INSUL,~rlON
4. FINAL CONSTRUCTION MUST
8E COMPLETE'FOR C.O.
ALL CONSTRUCTION SHALL M~ET
INSTRUCTIONS
a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
:ts, 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
r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appLi-
atibn.
¢. The work covered by this application may not be Cbmmenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit
mil be kept on the premises available for inspection throughout the work.
e. No building shall be occupied or used in whole or in part ,%~ any purpose whatever until a Certificate of Occupancy
mi! 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
uilding 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 removal or demolition, as herein described.
he applicant agrees to comply with ail applicable laws, ordinances, building code, housing code, an~gulations, and to
lmit authorized inspectors on premises and in bmlding for necessary insnections.
.......
(~nature of applicant, or name, ifa c)~t~oration)
.... (Mailing address ;~ ap~ii~ant') .... ~"i
:ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
~me of owner of premises .'7,9.C/~.....~..~,~/4.Z.M.....~...?./(d~',,P-.-~' t~ee~m) ~$
.. (as on the t= r'o'~f ~; i&it' ~Z,K '2Z:]Te75' ,~,' ;;.;'.:
appucant is a corporation, signature of dul,, author ze" ~"'" · M~,~,~I~.R #
........................................ . NOTIFY BUILDING DEPARTMENT
(Name and title of corporate officer) 7~5~~802 9 AM TO 4 PM FOR THE
FOLLOWING ~NSPECTIONS:
3. b. Jature tSf work (check which aplplicable): New Building .......... Addition ..... klterat on .........
Repair .............. Remqval .............. Demolition .............. Other Work ...... ' .......
4. Estimated Cost .... . · " ................... Fee
If ~ (to be paid on filial: this application)
5. dwelling, numberofdwelling rots . .
Ifg ~ ............. Number of dwelling nnits on each floor ....
· arage, number of cars ..... i. · ' ...........
6 If business corn herein! m.~;~ ,' ........................................
' .........................
Di 'ex ti~2's CUpancy, spem nature and extentofcac 'peofuse ...............
7. H mensionsot is s ~,uany: Front ............... Rear ....... Dc
D~ight ............... Nmnber of Stori ptb ............
mensions of same structure wii h alterations or additions:-Front
Depth ............... · ................ Rear ....
. ~eight .....
8. Dimensions of entire new constn~ etlon: Front .~.~ Rear . .~ ~/~j~',~' ' '~ ~ ~ 7"
Height ... ~t/ .......Nmr er of Stories ..... l ............. '-~ ' '~ .... " ....--' '/~ ....
9. Size of lot: Front ........ ~ · Rear ... . - ..
10. Date of Purchase ~'~ ~ ...................... ~eptn ..... .
11. Zone or use distric~ }~ ~l~i~ ~ '~z.'~ .... - ......... Name of Former Owner ..... j ........
~ ~u p~umlse8 are situated ..... ' ..........................
12. cods proposed Construction vlola[e any zoning law, ordi~c;¥r re~t ati~n ~ ..........................
13. Will lot be regraded , · , .............................
14. Nme clowner of nremises~--~ ,1['_' '_ ' ~ ri cx~e~s fill be.re~myyc[frqm premises: Yes No
Nme of Architect [.. ~' '~'s's~ ..... Address ~.~~ Phone No. ~ .~ ....
N~e of Contractor. ~~'~ ~ ..... Address ...,..,,,,,...,,~.. '1" Phone No ................
.... ~ PLOT DIAG~
Locate clearly and distinctly fil fiuildings, whether existing or proposed, and. indicate fil set-back d~ensions from
prope~y Hnes. Give street ~d block n~ ~mber or descfiptioh accordNg to deed, and show street nines and Ndicate whether
interior or comer lot.
,, , ' ' '
7ATE OF NEW Y~K~
)U~voF.. ~.q~[ .. s.s
(Name of individual signing c ~n tract) ' '
is the ......
ontractor, agent, corporate officer, etc.)
said OWner or owners, and is duly aufimrized to perfo~ or have perfonned the said work and to make and file this
)lication that all statements contalno~ll' -. ' ·
rk'-"' ~ , .... ' ........ imm s a>pucatton are true to t ~e best of his knowledge and belief; and that the
' }~m ce peno~ca ~n tnt m~rset forth in the applicatio ~ filed therewit
~m to before me this ~ ~ h. ,
........... .......
...
~[~f}'O~u~ ~/ ...... ~q~ ..............