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Home My WebLink About3609-zFO~M NO. 4 TOWI~ OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupancy No. zl+~.l.~. ...... Date .............. Oe~.. 12 ...... , 19..? 1 THIS CERTIFIES that the building located at $4a~s.~.om. House. t)1, ........ Street Map No.. x~ ........ Block No. xz ........ Lot No...xx~...Fishers..Island ....... confoms subst~tially to the Application for B~ding Pemit heretofore fi]ed ~ ~is office ....... ~?. ~ ., ~. Ii p~u.t to w.i~ ~ui]z.~ ~e~mi~ So. ~[~ dated J~e 6 6~ . . da~ .......... ,,.. ~ ........ , lg. ~, was msued, and confo~s ~o ~l of ~e req~e- men~s of ~e applicable pro~sions of the law. The occupancy for which ~ certificate is issued ~ . P~.lva~6 .erie..Ea~.ty · D~tg ........................................... The certificate ~ issued to ... PonaId' '~ ~' ~dwa~s · · · ~er ....................... (owner, lessee or ~en~t) of ~e afores~d b~d~g. Suffo~ Cowry Dep~tment of He~ Approval ... ~,R, ............................ Building Inspeo~or FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 3609 Z Permission is hereby granted to: Dons.l~ S, rdlwaz*~l ............................ ~.~.~.~..I~ ............................ . . J4ans~o~ouse Dzq. vo Qt premises OcQTeQ or ............................................................................................................................ ............................................ ~.;Ij~4~.~...];~, ....... ]~,~, ............................................................... pursuant to application dated .................................. ..'.f~..~..~. ....... .~ ...... , 19...~.~.., and approved by the Building Inspector. Fee $~,00 FOBM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a~ Application No...~..~...~...~.. .......... ctor) APPLICATION FOR BUILDING PERMIT Date September 1, 1967 .. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. 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 p~rt of this application. 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 progress of 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 and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................................... O.w,a.e.~.....-....'a~:1.1 la r ................................................................................................................... Donald S. Edwards Name of owner of premises .................................................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ........................ Street and Number z,~nsion House Drive Fishers Island, N. ~. Munici~lity 2. State existing use and occupancy of premises and intended use and ~cupancy of propos~ construction: occu anc Residence a. ExistinG use and p y ................................................................................................................................... b. Intended use and ~cupancy ................... ~D.~..~DD.~ ........................................................................................ Dormer on existing ~oof 3. Nature of work (check which applicable): New Building .~ ................ Addition ....~. ........... Alteration ............... :.: · Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ............. ~..2.,~..0.:..O...O. .............................. Fee ......... .$~.....O..0. ..................................................................... (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 ...... ~,..f.l~... ........ Rear .....~,~..~']b., ............. Depth .3J~.'..-..8!~ ..... Height ...~...~....~..~.; ........ Number of Stories .......... ~ .................................................................................................. Dimensions of same structure with alterations or additions: Front ........... 2.~..~.~.~ ........... Rear ...~,..f.t~,. ........... Depth ...3.~.'...':J~].~. .............. Height ........ ~...~., ....... Number of Stories ....... l~ .................... 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated .................... ~.~.~.:L91,.~.~$.~{~.~. ...................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............. N.O. .......................................... 13. Name of Owner of premises ........................................ Address ............................................ Phone No ..................... Nome of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly oil 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 YO~RK, } ~ ~ COUNTY OF ........ ~.f~.l~ ....... .f °"~' Donald S. Edwards ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ............................... .Q~.~.....-:...I~..u...;i..~.~X'. ..................................................................................... (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 be fore me this '~ , .~ ~ ~,~.../.,~...~ ............ ..... ............... ....... ' · · ~ic ..~... County (Signature of applicant) FiShers Island, N. Y. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ....... ..~.. ........... , 19~.~... Approved ........................................ , 19..~!.....Permit No. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. 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 applica- tion. 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 progress of the work. e. No building shall be occupied or used in whole or in pa rt for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY M,~DE 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, alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signature of applicant, or name, if o corporation) Fishers Zslm~i~ ~ew Zoz~ (Address of applicant) Sta,te whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .................................................................................................................................................... If applicant is a, corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ...................... ~ansion House Drtv~j ~ishe~'s Zsland~ ~ew Zork Street and Number ...................................................................................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction. VacJnt, land a. Existing use and occupancy ................................................................................................................................ l~eefde~ce b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building ...~, .............. Addition .................. Alteration ......... ~.~.,~. · Repair .................. Remora! .................. Demolition .................. Other Work (Describe) .................. 4. Estimated Cost ............. ~.]~.l~}i ................................. Fee ....... ~'].0'i0~ .................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ..........0~1 ................. Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................ 6. If business, commercial or mixed occupa,ncy, specify nature a:nd 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 ....... .~2t~;~e .......... Rear ..... ..~l.,,Sm ............ Depth ...... ~.l~Om ............ Height ........ 20'~t,';' ......... Number of Stories' '"':l;j ....................... Size of lot: Front '"~5,~"~C'i ............. Rear 2~..~'~11~ .................... Depth ~.?.~..~,~.~ ................ Date of Purchase ..../IZ/~..&,.Z..~...../....~.~;.4~. .................. Name of Former Owner .~b.-li'~r~.Jul~..~,~..~ne~ ........ Zone Or use district in which premises are situated ................ ~ll;td~:lt,~,'l_ ........................................................... Does proposed construction violate any zoning law, ordinance'o[' regulation? ............... ~ ............ ,.-. .......................... Name of Owner of premisesi).;~.;~[;:~;..~l].~ ..... Address "~'~'~i~i;J~"~i;~"~";];; ........... Phone N.o?~8~76~.~ .... Name of Architect 'U'J~it'liii~i~'~ ......................... Address ................................................ Phone No .................. · Nome of Contractor ~,~%~-e~t~,~ell~) ...................... Address ¥,~te3'ford~ Co~o Phone mo .................. 10. 11. 12. 13. PLOT DIAGRAM Locate clearly and distinctly a!i buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner Jot. ~ STATE OF NEW ~l~/O~Z ) COUNTY OF ............................ ) S.S. ................................................................................................ being duly deposes and says that he is the applicant (Name of individual signing'4~°~-Ii-coti°i2}'~l, der~,~' - ,~ sworn, 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 true to the best of his knowledge a:nd belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........................ aa o? ............................................ , (Signature of applica,nt)