HomeMy WebLinkAbout17199-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATR OF OCCOPANCY
No Z-24227 Date MARCH 25, 1996
THIS CERTIFIES that the building ACCESSORY
Location of Property 1425 JACOBS LANE SODTHOLD, NEW YORK
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 MAY 25, 1988 pursuant to which
Building Permit No. 17199-Z dated JOLY 11, 1988
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate ie
issued is ADD TO & RELOCATE BRISTING ACCESSORY BARN AS APPLIED FOR.
The certificate ie issued to JACK & RARIN THILBERG
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. H-048912 - FEBRIIARY 29, 1996
PLUMBERS CERTIFICATION DATED N/A
B ilding Inspector
Rev. 1/81
eosat xo. 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 ~ 01719 9 Z Date ...1... l ~ff..
Permission is hereb anted t
.~:.~.,..:{r......
at premises located at .....1 r.~ ~ . .......~~?~?r.~:.......................................................
~.-..7..q.................. , .
County Tax Map No. 1000 Section ......1.../............ Block ..........~?......y Lot No..,s'r""""".......
pursuant to application doted .........l~~sr?..~ 19R.s~, and approved by the
Building Inspector. ~G~~
Fee $...6~..~'..~ C~ v ~ 1//
7 uiidi... Inspecta~~~
i/
Rev. 6/30/80
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[~LL~~~I'l~, FormNn.6
4
F ,
` ..~.....e T•~~~" TO}JN OF SOUTIIOI,D
~ ~~96 ~ ~ _ ; BUILDING DEPART'MEN'T
1'OIJN HALL
765-1802
TOWN OF
SOUTHOLp
' APPLICATION P'OR CER1'IPICATE OP OCCUPANCY
A. This application must be filled in by typewriter OR inlc and submitted Co the building
inspector with L'he following: for new building or new use:
1. Final survey of property with accurate location of ail buildings, property lines,
streets, and unusual natural or topographic features.
2. Final Approval from Hea1Ch Dept. of water supply and sewerage-disposal (S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
G. Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of 17 lead.
5. Coimnerctal. building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Compliance Prom architect or engineer
responsible for tlhe building.
6. Submit Planning Board Approval of completed siCe plan requirements.
B. ~ For 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 consenC l'o inspect signed by the appli.canC.
If a CerCifi-cate of Occupancy is denied, Che Iuilding Inspector shall sCate the
reasons Cher.efor in writing Co Che applicanC.
C. Fees
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
A.iternt'i.ons 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 P,ullding - $100.00
3. Copy of CerCi.fi.cate of Occupancy - $S.OO over 5 years - $10.00
4. Updated Certificate of Occupancy - $SO.00
5. Temporary Certificate of Occupancy - ResidenCi.al $15.00, Commercial $15.OU
Dace ......v~C...,'~[L.f>?..~~.........
New ConstructLon,.~}'~6Z)~,,, Old Or Pre-existing Building
Location of Property..../S.G,J~
..................3F1C0~~'l.FI~.....!s~tCT/~C~~]
house No. Strc'e/C }lamlet
Onwer or Owners of Property... `:,:`?C~~„~,,,/~,f/,/~//ti ~/I~z~I~~r
-7
County Tax Map No 1000), Section... !,!,;,,,,,Bloctc....~ ..........hot~.~;~,,,,,,,,,,,,,
Subdivision.....q~ f~0W1.~/.'.~``,TfITFS..Pllgqed Map............Lot. ~.:3,,,,,,,,,,.„
Permit No...I7I ~~,,,Date Of PermiC..s.°?~.:1.~..Applicant....,~.~1~~...lfS~h?.F~~,
Nealth Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval
Request for: 'Temporary Certificate........... Final CerCicate,.~;.......
I'ee Submitted: $
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THE NEW YORK BOARD OF FIRE UNDERWRITERS 1
1P7~~ BUREAU OF ELECTRICITY
88 JOHN STREET. NEW YORK, NEW YORK 10038
Date FCk3RtJ7~RY 29,1~9G Application rvo. on file 111R7396/9G li lhtl£3!31?
THIS CEF2TIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
,T_t~C'IC H.TH71aFlEIRr, ,rl~rl)p~ Td1NIE~, ;;OU'PHOLiJ, N.Y.
in the following locotion• ? Basement L7 !at Fl. ? 2nd Fl. ~U'1" ,Sertion Block Lut
nwa examined un 7P~E3Rf1Ahy r 1396s and found to be in compliance with the National Electrical Code.
FIXTURE ECFPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTIET$ INCANDESCENT FLVORES[ENi OTHER AMT. K W. AMT. K W MIT. KW. AMT K.W. AMT. H P
DRYERS FURNACE MOTORS FUTURE APPl1ANCF FEEDERS SPECIAL REC'PT TIME CLOCKS FELL UNIT HEATERS MULTI.OUTLET DIMMERS
AMT. K. W Oll H. P. GA$ H. P. AMT N0. A. W. G AMT. AMP AMT. AMPS. TRANS. AMT, H p SYSTEMS AMi WATTS
NO.OF FEET
SlRVICE DISCONNECT NO.OF $ F R V I C E
AMT. AMP. rypE METER I 4W 1 ,B. 3W 3.a' SW 3,e' IW NO. OF CC. COND A. W. G. NO OF HbIEG A M' G. NO. Of NEVTRAIS A. G
EQUIP. PER .e' Of CC. COND. OF MLIEG Of NEUTRAL
OTHER APPARATUS:
t31~R1~d-1
"`NO V7 ~UA7:, DF,~'F7Cq`i: '"ACL c Lertr~.ca:L
survey has boeLL made of tYLe oxe~osed
e7ectr:ic;a.1 ecllaal>ment in the
{aremi.ses 117d9.rated. " "Nca obvious
urL;,aLisfcactoxy i~cTncl.itlon rT~,as for_LL7c1,
JAC'.I4 13, THT.T,CIERG G~/~~
~ 1565 JACp13S Z.r'~N7F
~QU'I'HOLI'J, NY, 17.971 GENERAL MANAGER
17 1
Per I
This certificate m not=ba. altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their' credentials.
COPY ~OR~BUI'Li7iNG DEPARTMENT. '1~HIS COPY OF CERTIFICATE MUSTNOT BE ALTERED IN ANY MANNER.
~ 'o ~ _ . r
O~~guFFOt,I-CO
c~ Gym
y 2
Town Hall, 53095 Main Road p ` ~ Fax (516) 765-1823
soutnoldONew vork911s71 y'~pl ~ ~a~~ Telephone (516) 765-1802
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
August 9, 1995
Mr. & Mrs. Jack Thilberg
1565 Jacobs Lane
Southold, NY 11471
SECOND NOTICE
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)
xx 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 # 17199-Z (MOVE BARN)
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
- ACCORDING TO THE CODE OF THE TOWN OF SOUTHOLD, IT IS
UNLAWFUL TO OCCUPY OR USE SAID STRUCTURE UNTIL A
CERTIFICATE OF OCCUPANCY HAS BEEN ISSUED. '
l TEL. 7G5-1802
~~tifo~kc
p Op TOWN OF SOUTIIOLD
`'a,.,; ~ y~ 0[' DICE Of
BUILDING INSPECTOR
a ;i.iti 'b`' ~ rn P.O. BOX 728 i
v' ~ TOWN HALL
~y~~1 ~ SOUTIIOLp, N.Y. 11971
June 5, 1990
Jack Thilberg
1425 Jacobs Lane
Southold, N.Y. 11971
To Whom This May Concern,
We are unable to complete your Certificate
oL- 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 (c34gtxc5ikL~c~C~Jknot on file.) 525.00
/ / No Flcalth Dept. T:pproval on file.
No final ins.pc:ction has been made.
Pleaae contact our office on this matter.
Thank you for your cooperation.
T3uilding Permit Ik ~ ? I 9 9 Z
Uu.ildinq Dept.
No Plumber Solcicr Certificate on file.
( all persnits involving plumbing being
insucd after April 1,1984 )
~
J. ~ "'.k'xwa(N+-. q'^mS(tiYfft:YHLH'uvYrx ..c mn3.
c'1ELD il:5i'LC:Iu;J ~~UATE I COMMENT°
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7. w
H
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FOU2IDATION (1st)
FOUNDATZOIJ (2nd) - m
- ~
2.
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P,OUGH FRAME &
PLUMBING
ti
Hr
3. ~
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H ;f~
IIJSULATIOC] PER N. Y.
STATE ENERGY
CODE
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ADDSTIOPIAL COMMENTS: ~ ~x
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THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
059020 BUREAU OF ELECTRICITY
BS JOHN STREET, NEW YORK, NEW YORK 10038
Date MARCH 15,1996 App/if:fttion No. on file 11269296/96 H 049100
THIS CERTIFIES THAT
only the electricol equipment as described below and tn[roduced by the appticont rained on the above applicotion number in the premiaea of
JACK H. THILBERG, 1565 JACOBS LANE, SOUTHOLD, N. Y.
in thefotlowinq Location; ? Basement ® lat Ft. ? 2nd Fl. .Section Block Lot
una examined an MARCH 11 , 1996 and found to be in compliance with fhe National Elactrical Code. '
NXTURE NXTURES RANGES COOKING DEGKE OVENS DISH WASHERS EXHAUST FANS
OUTUiTS ECEPTACLES SWITCHES INCANDESCENT FIUCWESCENT OTHER AMT. K. W. AMT. K. w. AMT. K.W. AMT K. W. MIT, M. P.
1 ~
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL RFC'PT TIMF CLOCKS gES4 UNIT HEATERS MUITIAUTUiT DIMMERS
AML K. W. Oll N. P. GAS H. P. AMT, NO. A, w. G. AMT. AMP. AMT. AMpE. TRANS. AMT. N, p, SYSTEMS AMT wARS
NO.OF FEET
SERVICE DISCONNECT NO. of 5 E R V I. C ~ E..
NAT. AMP. Typp METlR t NO.OF CC COND. A. w. G. " . '
EQUIP. ~ ]W 1 A JW 7 X 7W 3,a' 4W PE0. % Of CC. COND. NO. Of NFLEG ~ H, IEG~i NO. OF NEUTRAIa Gp NEUIGRAI
OTHER APPARATUS:
PADDLE FAN-1 ,
MOTORS:1-F H.P.
JACK H. THILBERG
1565 JACOBS LANE
SOUTHOLD, NY, 11971 11 o~Pt Rlu RuwACER . ,
Per
This certificote must not be altered in any manner; return to the office of fhe Board if incorrect. Inspectors. may be identified b th r credentials:"
\ i
7 ~ ~ 765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ) ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [J] FINAL
REMARKS:
DATE / INSPECTOR ~'~~/J
k
..,p ~lt}i, y'~'0 .Ip3 ~,at'., IIIIA It it 111' it i!:\1,'1'11
:,'S3'3::; 18+4
;,..,.s -{.tk, y.,wi.i c-. ;xH,e, FORM NO. I SURVEY
' TOWN OF SOUTHOLD cnt:cx - - - - - - ,
BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL NOTrFv
SOUTHOLD, N.Y. 11~J71 CALL
TEL.: 765-1802 MAIi, T0:
Examined . 19Y.~
Approved f 19~~Permit No........... .
Disapproved a/c ~Y 2 5
Y
r~LD~.oerT.
TOWN AF SOUTHOLD
~'L~..- lj/
AP RO p AS NbTED uild~nspector)
PLICATION FOR BUILDING PERMIT
NOxIFV 8 ~ ING DEPART TAT Date try 25..... • • 19 ~8.
76E++-18A'l 9 AM '1'C) 4 pM fOR THE
FOt.LOWING INSPECTIONS: INSTRUCTIONS
L FOUNDATION - TWOAEQUIRED
a. T~ ~~i~iQ(11~1~completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
sets of3p1~-~\tr~~'~1/hRbl~lN(Fee according to schedule.
b, pk?Tltt7~ in location of lot and of buildings on premises, relationship to adjoining premises or public streets
or areas,~n l7M~pETE
fO~Pk~klSiK of layout of property ;must be drawn on the diagram which is part of this appli-
' cationA C T
aT ieR~ ~~~~tion may not be commenced before issuance of BuIlding Permit.
d.S ~fa,,,,pp tart'; the Building Inspector will issued a Building Permit to the applicant. Such permit
shall 0 9ai1~Q~~~inspection throughout the work.
e,0i , R5 ed~used in whole or in pazt for any purpose whatever until a Certificate of Occupancy
shall hav~g~~ a ~~~~~spector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zane 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 inspections. ~
GoA/~'',p~,G~-Jack H. ThilberR~,,~,
(Signature of applica or name, if a corporation
Summit Road,• Southold.,• N7C, • 1171, _ , , , , - , - , ,
' (Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
• OWNRR
o ailu6,~ ~I Ur:`2 5 117 E f/o 1~~'-i' ~/YrS.~'d~~•9I~ !V~'.
Name of owner of premises , . ,Jack H. Thilberg, Summit Road, Southold, NY • 11971. • • , , . • , , , , , , , , , , , , ,
(as on the tax roll or latest deed)
' If applicant is a corporation, signature of duly authorized officer.
~!A
(Name and title of corporate officer)
- ALL CONTRACTOR'S 2LUST BE SUFFOLK COUNTX LICENS
Builder's License No. N(A ~ y~ f,
Plumber's License No. NlQ ~ ~W
Electrician's License No. . ~(A
Other Trade's License No. N(A, , , , , , , , , , , , ,
1. Location of land on which proposed work will be done . .
. W/.S.....dac4h's .4ane>..~ou>zho.>,d>. kIY .
House Number Sqtreet / Hamlet '
County Tax Map No. 1000 Section Block ret Lot .3... t7.~.' . .
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 ....Accessory,Use,Building,,,,,,;,;,,",
b. Intended use and occupancy ...Same
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