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Home My WebLink About17523-zNo Z-20701 Iis) .7u■zN7MI! TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY Date MAY 6, 1992 THIS CERTIFIES that the building ADDITION Location of Property, 1565 JACOBS LANE SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 79 Block 6 Lot 4.3 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 5, 1988 pursuant to which Building Permit No. 17523-Z dated OCTOBER 11, 1988 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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to JACK & KARIN THILBERG (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A uilding Inspector Rev. 1/81 FORK NO, a 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° 017523 Z Date ... zoll.l......... I .........................., 19A.0 Permission is hereby gra)nnteed, to: l¢ ��..�72............... ...<. ............... to.................¢��...... tee..... ........ ..... ...... .... at premises located at .......��`.a�r .. ....... PrP ........................................ ....................................................-...................................................... ................................................................................................................................................................ County Tax Mop No. 1000 Section ....7,?........... Block .......�......... Lot No. ...... K..T......... pursuant to application dated ....I�/............I................... 19(!0.., and approved by the Building Inspector. Fee $.Y.... .. r Rev. 6/30/80 �![=� Form No. 6 `§ UPn7w..c Q [ppt TOWN OF SOUTIIOLD MAY 1099?1p j � BUILDING DEPARTMENT�J- TOWN HALL 765-1802 w 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 site plan requirements. v B. For existing buildings (prior to April 9, 1957) non -conforming uses, or buildings and I "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 ......................................... New Construction........... Old Or Pre-existing Building ................. Location of Property... r.. l�': 1e .'z.. :........ % rr9i7 b ��. 1. ......... House No.' Street Hamlet Onwer or Owners of Property..... County Tax Map No 1000, Section.... :..... Block ..... 4? .........Lot........ Subdivision...............................p.....Filed Map ............ 9Lot ...................... Permit No.��r?� . Z.Date Of Permit. ./! '.J/ 4':1'4F..Applicant..� Health Dept. Approval..........................Underwriters Approval .............. I.......... Planning Board Approval ........................ Request for: Temporary Certificate........... Final Certicate. X ...... Fee Submitted: $............................. �� ► APPLIF*7. 0 S�Ff00( TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLp, N.Y. 11971 June 5, 1990 Jack Thilberg 1425 Jacobs Lane Southold, N.Y. 11971 To Whom This May Concern, TEL. 765-1802 We are unable to complete your Certificate of Occupancy because of the following reasons. /_✓/ An application for Certificate of Occupancy is not on file. (ENCLOSED) /_/ No Underwriters Certificate on file. /-/ The check is(4{XNi$XKd(&XKot on file.) $25.00 No Health Dept. Approval on file. No final ins.pection has been made. Please contact our office on this matter. Thank you for your cooperation. Building Permit it 1 7 5 2 3 2 Buildi.nq Dept. No Plumber Solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) 1)- - u •1 u C ll�. -o N S H 1 FOUNDATION (1st) c� FOUNDATION (2nd) c 2. • z � 0 ROUGH FRAME & .PLUMBING 3. H 7 ra INSULATION PER N. Y. m STATE ENERGY CODE x (, } 11 4. SAA6 _ )m H FINAL S p ADDITIONAL COMMENTS: x c ' x H � H H O i ' r x \Tip' . v m PY-4 - - -- - ------ ------ lJ ��- --- ED RS NOTED - J - -- --+--- � DAiE�B i 6� � � 0 ICE T Do T AT Al- 76CT 5-1802 j'' PQ C� - _..__.— _ 765-1802 8 AM 1D 4 PM FOR THE i► � e ------ FOLLOWING4NSPW"ONSc — --- ----- 1. FOUWATIi)M • WiO REOUIRED — 2. ROUGH - FRAMOO R KANW40 4. FINAL • CONSIRUC"W MtW ewer rM wvr w w ALL DESIGN MEET E— M.r M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ) ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS: DATE � O INAL 765-1802 BUILDING DEPT. SPECTION [ l FOUNDATION 1ST [ l ROUGH PLBG. [ l FOUNDATION 2ND [ ] INSULATION [ ] FRAMING ( ] FINAL DATE 5;V'MINSPECTOR Examine!' Approved FORM NO. 1 NN OF SOUTHOLD DING DEPARTMENT TOWN HALL THOLD, N.Y. 11971 TEL.: 765-1802 . . ., 19 ... Permit No. Disapproved a/c ..................................... BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK 40,f_k1 .............. SEPTIC FORM ................ NOTIFY CALL ..................... MAIL TO: .......................................... ( ildi Spector) APPLICATIO OR BUILDING PERMIT 00 Date ...�� ..... 15C?o 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, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary i spections. �R ..CZ . ignature of applicant, or name, if a co oration) A>�� '....f?'..... CJS ;".�i (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. O. .e�/ 1...... ................................ :................................ Name of owner of premises .V. �� C.... %fl.� re<5 ........................................ .............. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ............................. (Name and title of corporate o Irif ®er) Builder's License No. ........ .......... Plumber's License No. ....: .. .......... Electrician's License No. .....: F . Other Trade's License No. 4.11......... . 1. Loc tiionn7off land on Whichproposedwork will be done...................R................................ . .. ........................ House Number Street Hamlet County Tax Map No. 1000 Section ... 7.F......... Block ....(� ........... Lot . o.r.., y . 6 Subdivision ..................................... 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 ....�.. • ®• • • X�� /YG.'. , Q.., f' ................ b. Intended use and occupancy ..... ��• • . • • • • • • . • • . ; . �'. 3. Nature of work (check which applicable): New Building .... ,'rFe ion .C'.:�C, : 't Alteration RepairRemoval .............. Demolitt Othei'Work .�� +�', , , , , ....... J# / (Description) 4. Estimated Cost .... . / d! .................... ........................ . 5. If dwelling,number of dwellin (to be paid on filing this appllm�c tion) g its ..... ,/�� , , . , Number of dwelling units on each floor .... {.V.. %� .............................. If garage, number of cars .. ��,?.......... . .. / ' ' • • ' ' 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ....�! .� .......... . Dimensions7. of existing xittin gstructutes, if any: Front ..... :........... . .Rear ............................. Dept e t3 Height . bar 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 ofStoes. ,,..,,,• •....•.••••..• Stories 9. Size of lot: Front ....................... Rear ....`.................. Depth ..................... . ................... . Date of 01. Zone or archse district . in which .. Name of Former Owner ............................. 1 • . ch p emises are situated12. Does ....................................... . ............. proposed violate any zoning law, ordinance or regulation: . ....................... . 13. Will lot be regraded ..... , ... , . • , • • , • , Will excess fill be removed from premises: Yes No 14. Name of OwneArchir prem construction vio ..........Address...................Phone No. ............... Nameof Contractor ........ . . . . . . . . . ' ' ' ' • • Address ................... Phone No............... . Name of Owner of premises .. I . ............... . Address ................... Phone No.. . , , .., . 15.Is this property located within 300 feet of a tidal wetland? *YES .... NO.... *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly q 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. f• it� � k l o &/Z 4er7 evr STATE OF NEW V RJj 6 COUNTY OF . d4 IS.S m of indis LI�'7 ' ' ' ' • � ... Y ... being duly sworn, deposes and says that he is the applicant (Na ane contract) above named. lie is the ......... ' V (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 { ..........7.`./4'�........day of'.. CJS/'....., 19R/S'�.. County .rte (Signatu f applicant)