HomeMy WebLinkAbout19379-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 224543 Date August 2, 1996
THIS CERTIFIES that the building screened deck and deck addition
Location of Property 1915 Lake Drive, Southold
House No. Street Hamlet
County Tax Map No. 1000 Section 59 Block 5 Lot 5
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated September 10, 1990 pursuant to which
Building Permit No. 19379 dated September 10,1990
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 a screened deck & deck addition as built to one family dwelling
The certificate is issued to Gerald & Selma Jacobson
(owner, lessee or tenant)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. pending July 31, 1996
PLUMBERS CERTIFICATION DATED N/A
Building Inepecto
Rev. 1/S1
aoasq No. a
TOWN OF SOUTHO6D
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 0 I ~ ~ ~ Z Date ....1~~ 19..1.0
Permission is hereby granteded
t~~
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to .
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at premises located at ../~~c-^.....~4.•~G...~.
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County Tox Map No. 1000 Section Block .......t..J`..-,.... Lot No.........`T
I
} pursuant to application doted f1 19.C~.Q., and approved by the
Building Inspector
Fee 5..~~~ir/
f ~il::.::..
uildin for
Rev. 6/30/80
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P.OUGH FRAME &
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Form No. 6 71 ~o` 1~~~(~p
TOWN OF SOUTHOLD ~~~~arJ~
BUILDING DEPARTMENT lll///
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:
L. 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 2/1,0 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. Fox 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 Buildine - $100.00
3. Copy of Certificate of Occupancy - .?SC.'
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residers/tia~l//~J$',1G5/.00, C/gommercial $15.00
/ Date .`'~~.~'/..4/:•':C-..~ ~
New Construction... U....... Old 0 P/r~e_-ex ipng Buildj ng. n q
Location of Property.. ~l~-.r~i.......~.~..1 ~I
House No. II /q/~~~.~~rr--,,~~'~ Street Hamlet
Onwer or Owners of Property...~.~.t~~l....~J~ ~ .
County Tax Map No 1000, Section....~~...,.,B1ock....S ..........Lot. ~
Subdivision F'1ed Map ............Lot.......
Permit No. .I.J.~~..f.~..Date Of Permit.../!~~~~..Applicant~~~~.Y~ Y ~~1.°J.~.`,-~:it./!.OSDiIJ
Health Dept. Approval ..........................Underwriters Approval
Planning Board Approval
Request for; Temporary Certificate........... Final Certicate...........
Fee Submi*.ted: n
~rl (~~L/Z APPLICANT
~~UZ2~_
,ir~~a1~FFi1(!'(C'
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TRUSTEES as Ira, zt«~ SCOTT L. HARRIS
4
John M. Bredeme er, III, President O, "'h`` ~ Supervisor
Y i.> 4 ~ fie,
Henry P. Smith, Vice President ~j O
Albert J. Krupski, Jr. Ol S~ ~~O Town Hall, 53045 Main Road
John L. Bednoski, Jr. P.O. Box 1179
Southold, New York 11971
John B. Tuthill BOARD OF TOWN TRUSTEES Fax (516) 765-1823
Telephone (516) 765-1892 TOWN OF SOUTHOLD Telephone (516) 765-1800
August 20, 1990
~ -
TO: THOMAS FISHER, Bldg. Dept.
FROM: JOHN M. BREDEMEYER, III, Pxeside
RE: Gerald Jacobson Violation/1000-5 - -5
The Southold Town Trustees in issuing permissions to Mrs.
Jacobson on September 29, 1989 concluded what they felt were the
violations existing at that time.
Any referral in the matter of the screen porch and deck was
intended for your processing independently and we have no
interest in these items unless enlarged since last year.
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765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ]ROUGH PLBG.
[ ]FOUNDATION 2ND [ ] INSULAT
[ ]FRAMING [ INAL
[ ] FIREPLACE ~ CHIMNEY
REMARKS:
i
DATE ~ INSPECTOR
~ ~ ~
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ]ROUGH PLBG.
[ ]FOUNDATION 2ND [ J SULATION
[ ] FRAMING FINAL
[ ] FIREPLACE A CHIMNEY
REMARKS:
i~
DATE INSPECTO
y~,~,.~
VICTOR LESSARD . „ 'ar Town Hall, 53095 Main Road
~ ~ t1:;t..;u
PRINCIPAL BUILDING INSPECTOR ~ ,
s ~'k~rs P.O. Box 1179
(516) 755-18oz ti ,v ^i Southold, New York 1 1971
FAX (516) 765-1823 a*~~
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OFFICE OF BUILDING INSPECTOR
TOWN OF SOUTHOLD
August 25, 1989
Mrs. Gerald Jacobson
75 Bellwood Drive
New Hyde Park, N.Y. 11040
Re: Enlarging deck and erecting- a screen house in
rear of house without a building permit.
Dear Mrs. Jacobson:
It has been brought to the attention of the Building
Dept. by the Board of Trustees that there may be a viola-
tion on your property. It seems that a deck extension and
screen house has been erected without a building permit.
Please contact the Building Department and apply
for a building permit to covert all work that was done.
~cerely~
Ga~~ Fis~
GJF:hkd Building Inspector
QlhLc~c~ o~- ~V
l~E-e. ~buLk¢~) n~a~~~(~
o~~FFO~K~oa
VICTOR LESSARD ~ ~ Town Hall, 53095 Main Road
PRINCIPAL BUILDING INSPECTOR 1. P.O. Box 1 179
(516) 76s-ISO2 N ~ Southold, New York 11971
FAX (516) 765-1823 ~7~01 ~ ~~0~
OFFICE OF BUILDING INSPECTOR
TOWN OF SOUTHOLD
August 2, 1990
Mr. & Mrs. Jacobson
75 Bellwood Drive
New Hyde Park, N.Y. 11040
Dear Mr. & Mrs. Jacobson:
I am enclosing with this order to remedy notice, your
personal check tout of date) and copies (2) of our previous
correspondence, one requesting information necessary to complete
your Building Permit.
Yours truly,
l
Thoma'~ J. fisher
TJF:hkd Building Inspector
Enc.
FOnni iVO. s
TOWN OF SOUTFiOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
ORDER TO REMEDY VIOLATION
Date ...AAGiIS.T...~ 19.90...
TO ..G~.R.RJ(:R.. sELMA..:FA~O$S4?Y
(owner or authorized agent of owner)
75 BELLWOOD DRIVE, NEW HYDE PARR, N.Y. 11040
(address of owner or authorized agent of owner)
PLEASE TAKE NOTICE there exists a violation of:
Zoning Ordinance ;CHAPTER 100
Other Applicable Laws, Ordinances'or Regulations
of premises hereinafter described in that ...~onstructing..additions and alterations
(stole character of violation)
to a dwelling without a Building Permit.
in violation of ARTICLE %%VIII SECTION 100-281
(State section or paragraph of applicable law, ordinance or regulation)
YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the low and to remedy the
conditions above mentioned IMMEDIATELY
The premises to which this ORDER TO REMEDY VIOLATION refers ore situated at
19 ] 5 LAKE DR . SOUTHOLD ,,,,,,,.,County of Suffolk, New Yark.
SUFFOLK COIJNTSC TA% MAP /f 1000-59-5-5
Failure to remedy the conditions aforesaid and to comply with the applicable provisions of low
may constitute an offense punishable by fine or imprisonment or both.
THOMAS J. FL'SHER ~
BUILDING INSPECTOR
(Cert. Mail)
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A large open space bwng area (560 sp. hJ highbghts the 1,444 sq)
n. Heritage. Three bedrooms and two baths occuDY the opPOSite ~1 pqN ABODE
entl of the house. A 270 sq. M. tleck olt the tlining room antl -1 C~ f~~V~E$
khchen is optional. ~ (n ~
- / 4350 Lake Washington Blvd N
Renton, Washington 98055 .
(206)255-8260
A Cut Above The CommonDtace
FORM NO. 5
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
ORDER TO REMEDY VIOLApTION Q
Dote .....Q../~°Z 19..f..
(owner or authorized agent of ner)
(address of owner or outhorized agent of owner
PLEASE TAKE NOTICE there exists a violation of:
Zoning Ordinance .:~.iF~i••:••`'..... v......
Other Applicable Laws, Ordinances~or R,e~gqula~tions
at premises hereinafter described in that ....4~P.2rr"f.~i~ri~ .....G~ti2...'.,..GQ~7..~......~....
' - _ (s ee'c~haracter of violation)
.~1,~.l~if!CIy(.....sQe:.....~AiC/.kl~
.............cry%~...P•~.,~~...
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in violation of .........5'=.~~~
.......I.~..~~..~.~a.~
(State section r paragraph of applicable law, ordinance or regulation)
YOU ARE THEREFORE DIRECTED AND ORDERED to comply with/ the law annd to remedy the
conditions above mentioned forthwith on or before the T.,~„A//.~`.~/.a,/:.1,~~~
of ~ `
The premises t which this ORDER T REMEDY VIOLATION refers are situated at
.../~,/`.5..,.~~~,..~~'~~... County of Suffolk, New York.
Failure to remedy the conditions aforesaid and to comply with the applicable provisions of law
may constitute an offense punishable by fine or imprisonment or both.
....;7...
ctor
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VICTOR LESSARD Town Hall, 53095 Main Road
PRINCIPAL BUILDING INSPECTOR ~ i , r.
, E ~ ~,°:'a ~;y ~ P.O. Box 1179
(516),765-1802 ; ' Southold, New York 11971
FAX (516) 765-1823 ~y~ ~ ~.^~J
OFFICE OF BUILDING INSPECTOR
TOWN OF SOUTHOLD
September 20, 1989
Mrs. Gerald Jacobson
75Bellwood Drive
New Hyde Park, N.Y. 11040
Dear Mrs. Jacobson:
We received your application today. It did not con-
tain a survey plot plan) indicating locations of buildings
additions and the distance from property lines, adjacent
water bodies, wetlands etc. Also there was no construction
information.
In order to issue a building permit for your proposed
construction, for buildings located on lots adjacent to tidal
water bodies and fresh water bodies and wetlands we will need
an inspection by the Board of Town Trustees for determination
and a waiver of jurisdiction or a permit from the New York
State Department of Environmental Conservation.
Yours truly,
Building Inspector
TJF:hkd Thomas J. Fisher
j riort?: t_ar '~•;Syci;~N rz~r'rk *a
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"AMC'.NUG;J` AY'.z^ 18,l9?~; FEB~14A 1_984
Gt~acNFx>~r~i.v- aM~rip~o .Jgµ•,t9r~~p7a
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. Addition • • : <.Alteration . , .
3. Nature of work (check which applicable): New Building
Repair Removal Demolition Oth 4tk;:;a c • • • • • • • • • . .
~ ~,~(LSC°scri'pYion)
t~
b. Estimated Cost Y::c'~ ...llv3g:...~.ci~aal ~M ~~;?,40,... Fee ......J'~~.......~.~.
` (to be paid on filing tR s application)
5. If dwelling, number of dwelling 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 structures, if any: Front Rear Depth .
Height ...............Number of Stories .
Dimensions of same 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]ot: Front Rear...................... Depth
10. Date of 1~'ch~s~ ...............................Name of Former Owner .
a,'
1 1. Zone or ~i9e `dtstrrct rh whrch premises are situated .
12. Does proposed construction violate any zoning law, ordinance or regulation : .
13. 1Vi11 lot be regraded ............................Will excess GII be removed from-p*emises: Yes No
14. Name of Owner of,premis~s ....................Address ...................Phone No................
Name of Architect ...........................Address ...................Phone No............... .
Name of Contractor ..........................Address Phone No................
15. Is this property located within 300 feetyyof a tigidal wetland? *Yes ..LC.. No
*Lf yes, Southold Town Trustees PermitPLOT DIAG1tAM ed.
Locate cleazly 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. ,'y/~/--
G2~/l
STATE OF NE«' YORK, S.S
Oli NTY OF .
. . being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
.;hove named.
'feisthe
(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
:.pplication; that all statements confained in this application are-true fo the best of his knowledge and belief; and that the
Mork will be performed in the manner set forth in the application filed therewith.
>worn to before me this q
rotary Public, ~Ye-K4:~V.. ~ ?~!.L-. u~:..... County
NELENK.DEVOE (Signature of applicant)
NOTARY Pll811C, Stare of New Yetk
No. 4i61S79, Su4tolk Co
iceta Expires btarch 30,1
~ ~ ~ ~~6 -a7~/a
D BOARD OF HEALTH
3 SETS OF PLANS
C~+ ' FORM NO. 1
SURVEY,.
X328.... .
- TOWN OF SOUTHOLD CHECK
• BUILDING DEPARTMENT SEPTIC FORM
. DEA7. TOWN HALL NOTIrY
0 OFS SOUTHOLD, N.Y. 11971
TEL.: 765.1802 cnLL
~ MAIL T 0 '7 S ~ r3~¢ew~a~e
Examined . ~ 197, mew- ~Q¢ ! ~
~ Ca! V j~a~0
Approved ....`7~'~......, 19 ~d Permit No. x!93 7~
' Disapproved a/c
U'IOH1f[OS d0 NMO1
/
1d30'O4"19
Gc ~ Q'~~ f~
' ( ild' , I Spector)
APPLICATION FOR BUILDING PERMIT
I~
19...
~ ~~i INSTRUCTIONS
i
' .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 sale. Fee according to schedule.
la. Plot plan showing location pf 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. I~
cs 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 m 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 Depaztment 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 re ises and in building for necessary inspe ns.
P nl
(Si nature of ap ican , or name, if a corporation)
(Mailing address of applic t) Y~
State whether applicant is owner,~'hessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
~ w.n~:~
Name of owner of premises° . ~ ~~i~ ~~G~.~S:a.N..... ?f:.. .
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
i
(Name and title of corporate officer)
ALL CONTRACTOR'S MUST '~IIE SUFFOLK COUNTY LICENSED
Builder's License No. .......L .
Plumber's License No. ......I,.... .
Electrician's License No. ....L .
_ Other Trada's License No. Z7 ~ • ..7~
1. Location of land on which proposed work will be done : .
House Number Street Hamlet
I''
County Tax Map No. 1000 Section .c~•.. 1 Block .J~................ Lot . .
Subdivision ~ Filed Map No. Lot .
•(~Nmne)
' 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a.Existinguseandoccupancy.~ .~:ZS~.~?~-'l?.~'l~`~~''
Ii~
' b. Intended use and occupancy • . • • • • •a'•"~~`^"t'~ • • &~le ~ • • • ~ • ' ' '
V