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Home My WebLink About12604-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22785 Date DECEMBER 14r 1993 THIS CERTIFIES that the building. Location of Property 245 RACCOON ROAD House No. County Tax Map No. 1000 Section 106 Subdivision ADDITION MATTITUCKt NEW YORK Street Hamlet Block 10 Lot 11 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTENRF~ 2r 1983 pursuant to which Building Permit No. 12604-Z dated SEPTEMBER 15r 1983 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 UNI~TED SUN PORCH ADDITTON TO EXIsTiNG ONE FAMILY DW~rJ.ING The certificate is issued to WILLIAM A. & WALTER H. JACOBS~ AS TRUSTKKR (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N-298017 - DECENRRR 7~ 1993 Rev. 1/81 TOWN OF $OUTHOLD BUILDING DEPAR?MEH? TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: . - J~-r~ ......... .[~..~.I/..~.~.~..~.:~ .................. . .... ~....~..~..~.......' ...z~.~~ _ ......M.~~~...,..~.~.y.., ........ ~.~.~.~rr~ ~ ........ ~.~.~.~,_.r_~ ....... ~.~.~.:,..,~.. ....... _~.~ ....... ~:..~.~... ............ .... ~,~,,~,~,~ ~....~ ............ ~~_~....~ ........................................ ............................................................................................................. County Tax Map No. 1000 Section ....................... Block ........ L.~ .......Lot No...~../../. ........... pursuant to application dated ...... ~1~.~...~.~.~.~...~.., 19....~.., and approved by the Building Inspector. ~.~'----- Fee $ ........................ Building In.Ixctor 6/30/80 A. This application must be filled in by Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT ·: 765-1802 z ~ ~ .~ ~ :. ToWN HALL ~ O~< Ii 7~ C U2~F ....... CERTIFICATE OF OCCUPANCY 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 I% 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. 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: 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 .... . .~..O.~..~/.~. ~ ~..k-..' '~' '~'t..L ?. ~.~. ...... New Construction/~l..r-{~'% Old Or Pre-existing Building .... ~... .......... Location of Property,... (./~'- ~ j~/'~/./YJ. ~k~. ~ ...--~. ~-~ :~.. ......~/~ ~'.~.~..Yl../~..0.~ .~.,.· . ./~...~. ~.~'. ~.I~..z '-' ', .~.~. ~/ House No. Street Hamlet -- Onwer or Owners of Property .~././.~.~ ~.~ .~..' .~.~.~.~..~...~...~.~./.~/..~.~../~.-. ~..~. ¢'.d~.~> .~f.'..~..~.~-. ~ .~.~,J- County Tax Map No 1000, Section .... ./?..~ ..... Block ................/f3 Lot.../~. ................ Subdivision .................................... Filed Map ............ Lot ...................... Permit No .... ~?r. ~.~.~..~..Date Of Permit ................ Applicant..~.~?/~'.~.~.~..~.'..~..~..~.~..~.~.... Health Dept. Approval ...... .~.../~. .............. Underwriters Approval ......................... Planning Board Approval ..... .~..~ .............. Request for: Temporary Certificate ........... Final Certicate .......... Fee Submitted: $.. INSPECTORS Victor Lessard Principal Building Inspector Curtis Horton Senior Building Inspector Thomas Fisher Building Inspector Gary Fish Building Inspector Vincent R. Wleczorek Ordinance Inspector Robert Fisher Assistant Fire Inspector Telephone (516) 765-1802 SCOTT L HARRIS, Supervisor Southold Town Hall P.O. Box 1179, 53095 Main Road Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD November 23, 1993 Mr. William Jacobs 245 Raccoon Road Mattituck, NY 11952 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: xxx An application for Certificate of Occupancy is not on file. (Enclosed) xxx No Underwriters Certificate on file. xxx 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 # BP{ 12604Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. FIELD INSPECTION FOUNDATION (1st) COMMENTS FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: VICTOR LESSARD PRINCIPAL BUILDING INSPECTOR (516) 765-1802 FAX (516) 765-1823 Town Hall. 53095 Main Road P.O. Box 1179 Southold. New York 11971 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD ADDreSS: 2q~ ~t~ccoo~v RE: BUILDING PBRHIT SEC. /0~ BLOCK This Building Permit has expired. violation of the Town of Southold Please contact corrected. /~ LOT II You are now Zoning Code. our office, this matter must be Victor G. Lessard Priocipal Inspector TOWN OF $OUTHOLD OFFICE OF I~UILDING INSPECTOR I'.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. ! 1971 TEL. 765-1802 Tl~is is to ndvlse you thag the job under building pcrrn;.C no. 12604Z issued to ,William Jacobs on _~!5/8~__._ for Addition La completed and ;, £i.,,~! in.pcctlou ha. ( ) has not ( ~ ) been done. A complete underwr£ters cert±£icate is required rn order co complete thin file, it'is necessary that :~ (;ertlficatc r,f Occupaucy be issued. PLease £11l out the enclosed form, return snmc to the above office vtth a check ~or $25.00 p;~yable to the To~n of $outhold. Pteaae indicate to ~hom thc Certificate of Occupancy is to be mailed, and arrange ~ith thin office ~or an inspection date Occupancy or .ne in unlawfu! without a CertiElcate of Oc¢~pnncy. l'leane, help un to elenr up thiR msttcr so that legal action docs not have to be taken. Thank yo. for your prompt sttcntion. Very t ru 1~, Victor Lennard Executive Admin{strator VL:gnr encl. I I I I DEER ,/// G Talbot ~/ -~ 12536'- ........... ~erly Young now or formerly W.H. Wertenberg ...... --+- ,,, ~'= ',, PATH ~ 449.50 · now or formerly W. H. 'C/er tenberg ,, ~o 0 70S-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND ~INSULATION [ ] FRAMING [ ] FINAL DATE INSPECTOR THE NEW YORK BOARD OF FIRE UNDERWRITERS t ~£~ ~4~ BUREAU OF ELECTRICITY ~-- 85 JOHN STREET. NEW YORK, NEW YORK 10038 THIS CE~IFIE$ THAT ~[LLIAN JACOBS, I~ACO,)~I kD, HA?TI~[;C~. N.Y in t~ f~low~ng l~etion; ~ B~e~nt ~ I~t FI. ~ 2nd ~]. 0[]~' ,~tlon ~ examin~ on [}~C~ ~]993 and found to be in com~nce ~th the N~on~ ~ect~ C~e. GOOOALE ELE.TR] 7355 HAIN ROAD HATTITUCE, NY, This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. 'I FORM NO. 1 TOWN OF SOUTHOLD - BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 7651802 Approved .~......! ....... 1 .9~..Permit Disapproved a/c .......... . .~T7.---~... ...... ............. :7..-7 ...... ..-75. APPLICATION FOR BUILDING PERMIT Application No. / ~"d ~' INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 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 issue 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 Depa~tmant 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 buildings for necessary inspectionS., ': · .'1. · · ." · y ..... ..~' ......................... t - ' (Mailing address of applicant) ~J~'-~-,~ State whether applicant is owner, le, g~ee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................ .- ................................. ............... Name of owner of premises ....... {~.. [. !.[ ]i .~. ~'('a} 'o'n"l~e'~ta'x ~'~c'l' ~i~l'ene'd~)')' ''' :'' '~( ............... If applicant is a corporation, signature of duly authorized officer. (Name and title i_ceQ of corporate officer Builder's License No .......... ~.. .......... .~.. Plumber's License No. Electrician s License No... O ..... Other Trade's License No. :..---~-. ................. 1. Location of land on which proposed worJ~will be done...~t/{,... !~..~.C..( .~9..~.. !.~..~... ....... ............ · .... ............. ............ House Number Street Hamlet County Tax Map No. 1000 Section ! o ~ Block / ~' Lot. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended ~se and occupancy of proposed construction: a. Existing use and occupancy ................... ./ ............................................ b. Intended use and occupancy /.7/V..~..~.,d ~.~ 3. Nature of work (check which applicable): New Building .~.. I ..... Additior~...t~..~ .... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost. ~..O.O..~ .............................. Fee ~M ~---~ (to be paid on filing this 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.. iT. ~. ......... Rear ...-7./. ........ Depth ~ .6. :-. ~. ,o. ..... Height ./.~'. .......... Number of Stories . ./. .................................................... Dimensions of~.ame structure with alterations or additions: Front ...~./. ........... Rear . '7 ( ...... Depth...~..~. .............. Height ..... /~. ............. Number of Stories .... /.iii ...... 8. Dimensions of~entire new construction: Front ................ Rear .. ~ ......... Depth .. [ .~'. .......... Height . .1.7~. ......... 2 Number of Stories .... / ......................................... :~ ........ 9. Size oflot~: Front ...t..~.~~. Rear /L~3~' Denth f'~6-./.~-.fi.. 10. Date of Purchase ,F~v~i ii'ii ~'.' .~ i~a~ ;~'o'r~e'r'l~v~;;'....~?~..~.' .t~.'~-~i..~. i~.' 1 1. Zone br use district'in which premises are situated ....... ~: · .~. ~-~..'~. .............................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ....~.o... ........................ 13. Will lot be regraded ............... ~.Q .......... Will excess fill be removed from premises: _ Yes ( 14. Name of Owner of premises .(~f. ~ ~.; ...... Addres~ .... ~ho.~ Name of Architect ........... v ............... Address ................... Phone No..~. Name of Contractor ./~.~.~ ............. . hone No Z- PLOT DIAGRAM Locate clearly 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. STATE OF NEW YORK/~. ..... ~.~ .... ~/... ~ .... x .................. ~oemg amy sworn, deposes and says that he is the applicant (Name of ir~fividu6Ysigaing contract) above named. He is the ~ (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 trne 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: ..... day of .~6~,~.~/~.~ .... 19.. ~'/~ Nota~ Public, ~4~'~. s~.. ~ T TERRY JUDITH. · Nota~ Public, S~te of N~ Y~ ';;'"' '- ~mmi~n ~ Mar~ ~, 19~~