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Home My WebLink AboutZ-29326 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No: Z- 29326 Date: 03 24/03 THIS CERTIFIES that the building DOCTORS RESIDENCE/CLINIC Location of Property CRESCENT AVE FISHERS ISLAND (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 009 Block 0002 Lot 008 Subdivision Piled Map No. Lot No. conforms substantially to the Requirements for a STRU6TURE built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 29326 dated MARCH 24, 2003 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 DOCTORS RESIDENCE AND MEDICAL CLINIC* The certificate is issued to F.I. CIVIC ASSOCIATION (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A *PLEASE SEE ATTACHED INSPECTION REPORT. Au horize Signature Rev. 1/81 BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT IACATIOd: CRESCENT AVE FISHERS ISLAND SUBDMSION: MAP NO.: LOT (S) NAME OP OWNHR (S): ISLAND CIVIC FISHERS OCCDPAdCY: ISLAND CIVIC FISHERS ADMITTED BY: ACCOMPANIHD BY: RHY AVAILABLH: SUPP. CO. TAX MAP NO.: 9.-2-5 SOIIRCS OP RHQUB_ST: PATRICIA MOORE ATTY 11/4/02 DATE: 03 24 03 DWELLING: TYPE OP COdSTRIICTIOH: WOOD FRAME # STORIHS: 2.0 # H7CITS: 4 POI1dDATIOd: CINDER BLOCK CHLLAR: FULL CRANT. SPACH: NONE TOTAL ROOMS: 1ST FLR.: 11 2ND FLR.: 4 3RD FLR.: 0 BATHROOM(S): 2.0 TOILB•P ROOM(S): 1.0 UTILITY ROOM(S): PORCH TYPH: DHCR TYPE: PATIO TYPE: BRHHZSNAY: FIRHPLACH: ONE GARAGH: DOMHSTIC dOTMATHR: YES TYPH HHATHR: TANKLESS AIRCOdDITIONING: TYPH HHAT: OIL HARM AIR: HOTNATBR: XX OTII6R: ACCESSORY STRUCTURES: GARAGH, TYPH OF COdST.: STORAGH, TYPH COdST.: SWIMMIdG POOL: GOHST, TYPH CONST.: OTHER: VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE LOCATION ~ DESCRIPTION ART. SEC. RHMARRS: INSPHCTHD HY: DATH ON 7BSPHCTION: O1 23 03 ROBERT T]?I6 START- @7D• PATRICIA C. MOORS Attorney at Law 51020 Main Road Southold, New York 11971 Tel: (631)765-4330 Fax: (631)765-4643 Margaret Rutkowski rj~/Gj/Q ~ Secretary Ed Forrester Building Inspector Main Road, Southold, NY 11971 (By Hand) Re: Island Health Project SCTM#1000-9-2-8 Dear Ed: We hereby request a pre-existing use certificate of occupancy for the existing medical facility on Fishers Island. In 1954 the existing doctor's office and medical clinic was constructed. The Fishers Island Civic Association constructed the existing building. The Fisher's Island Civic Association hired the doctor and owned the building. The present structure consisted of the residence for the Fisher's Island doctor, the doctor's office and existing medical clinic. In 1958 the existing clinic space was renovated on the inside and the led lined x-ray room and exam room were added. The structure has remained substantially the same but it appears that no pre-c.o has ever been issued. Enclosed is a "consent to inspect", a set of the original building plans, my check in the amount of JOD-D° an affidavit by Allie Raridon, print of existing floor plan and copy of Tax Map. Please issue a pre-existing use certificate for the following: existing two story structure containing Doctor's residence, doctor's office and medical clinic ,V~/ --t~r~yours , ~P'atr~i/cia C. Moore CONSENT TO INSPECTION y`7She'r~ -~5/Cri7c/ ~rv~c l'9S5r3ctC£~C~n the undersigned, Owner(s) Name(s) do(es) hereby state: That the undersigned (is) .are the,{ owner(s) of the premises in the Town of Southold located at QY/Ci~~ ~'T7/t°nc't ~ ~/Sh~i~~-{~~/Rrnl/ which is shown and designated on the//Suffolk County tax map as District 1000, Section ~ Block Lot F~•~ That the undersigned (has) eve filed, 'or caused to be filed, an applica- tion in the Southold Town Building Inspector's Office for the following: Cam, ~,~~aLc Df /Ore - L~ishnc~ O~ That the undersigned do(es) hereby give consent to the Building Inspectors of the Town of Southold to enter upon the above described property, including any and all buildings located thereon, to conduct such inspections as they may deem necessary with respect to the aforesaid application, including inspections to determine that said premises comply with all. of the laws, ordinances, rules and regulations of the Town of Southold. _ The undersigned, in consenting to such inspections, do(es) so with the knowledge and understanding that any information obtained In the conduct of such inspections may be used as evidence in subsequent prosecutions for vio- lations of the laws, ordinances, rules or regulations of the Town of Southold. Dated: ///ay/Oa _ signature) /-C~?r,~ag /'looi^e~ Gs lC~r-rnc? (print name) (signature) ~d I , ~ ~ ~ ti.~ ~g ~ e, o ~.r}~..g ~ ~6 ~ P~ aq ~ ~ o ~ r ~ _ / .o , 2 ~ D~~ '~,~9. k'~ ~ ~ DDAAI~II[[ . x o. v-/ s p 71U ,,/~.i~ ~ v~ u hpQO Z w 20 Ooww ^ Z u ~ ~7 °j~,° G 2~ ~ s a Oj ' 2c ~ .a O a s ~ 7d ~J ~ n ~ ~ -~-1 ~ ~l l ~ ~ ! ~ . c NDV-2B-00 9:24; PA(SE 1!2 _ 631 785 4643; SENT BV: lAOORE LAW OFFICES; STATE OF NEW YORK) ss: AFFIDAVIT COTJNTY OF SUFFOLK) Allie Raridon, being duly sworn, deposes and say: 1. I reside at 1 Peter's Way, Fishers Island, NY 06390 and make this affidavit in support of an application fora certificate ofpre-existing use for the existing health care facility and residence for physician on property owned by the Fishers Island Civic Assaciation, located on Crescent Avenue, Fishers Island, New York, also known as Suffolk County Tax Map #1000-9-2-8. 2. I am a resident of Fishers Island, I am an Associate A1A, and a design professional familiar with the existing health care facility and the history of the construction ofthe existing clinic and its use. 3. In 1954 the Fishers Island Civic Association employed an architect to draw plans for a heal facility on th care their property which also included a portion of the building for a physician's residence, the physician was employed by the Fishers Island Civic Association. 4. On October 25, 1954 their architect Warren Green prepared plans for the existing building which contained on the 1" floor the existing clinic and existing living area for the doctor, the 2"a floor was unfinished but identified as future expansion. 5. The community joined together and constructed the existing building and a darter was employed for the Fishers Island Community. NOV-28-00 9:25; PAGE 2!2 _ 831 765 4643; SENT SV: lAOORE LAN' OFFICES; 6. Un April 18, 1958 their a~•chitect, Hugh Jones prepared plans for a renovation of the existing health care facility, the building was modified to providc an x-ray room. 7. The health carp facility has continuously maintained both the medical clinic and residence for the Civic Association physician. 8. Upon Information and beliefrn 1974 the Island Health Project Inc. was fot7ned to separately manage and employ the health care facility, thereafter in 1978 Island Health Project Inc. took title to the adjaocnt parcel known as Suffolk County Tax Map Number District 1000, Section 9, Block 2, Lot 6.2. 9. Annexed to this affidavit is a copy of a survey prepared by Chandler, Palmer & King ,Land Surveyors, dated December 6, 1977 which shows the split of the parcel formerly owned by the Fishers island Utility Company, Inc. 10. That 1 make this affidavit knowing that the Southold Town Building Department will rely on this affidavit to provide the pre-existing certificate of occupancy for the health care facility and residence for the doctor employed by the Island Health Project Inc. ~~,~o~ Allie Raridon S` t to befor ma this / dayo w L~ ~ ' Notary fiNAMK16 Y~ ~SN~OY`Y JN~ Notary Pubue 8tata of New York No. 4806550 Ouairfleo In Suffolk County 7arm Expires 11J37fA9 I „ J-1; '/a ' a I f I I I I I I I I ' de I 0 ° I n..law pr,r r.' ---- 0--___ - .____. TV —�- — XY'YmY' %r"?w. /+btiJ•u�- I MI I doo6f..d /o :) Qr/a., px1.� d s'YY In reil ./ I I I ..a--._._ ..- ..____._ ._ -.. / 9—'q" . . _ _._ ._ .�. _..._' -_ _-� ___- �•a _ . __.0.I�-. .—___—._____—_ Z .6 =/n " I I. r6 :/n i BA S M E N 7 PLAN WARREN GREEN •ARCHITECT' STAMFORD CONNECTICUT owx x rnmecl r{` lil{E6'S [SLANII t)VIG ASS OGIATIAN 112 Lj, 'I)Ot1'o Rr� �ir11r LQ AG61C[NGE -1 „ LL 50pFi DRAWING N0. - ASE VIENT LA 14 ;9 SCA11 OAIF UgAWx VY DATE S ISSUEp _ -I.-- ---------`---`----- --- ----------- --------..---- - - pt vli..! wpp� w -- - -------------- 1"'L � . - 1 . --, 't � h q ------ ry." .11A �.4 1-0 "A Id, -1/ 11 2- 17 728* 7 FT 6 - ji� 44 L 0 F"s 71� ,�Abtll .0 X is 42, r 47 5F7-YA CD WAITING ROOM top" p . OD yr A-37 '14 L IVIN G ROOM J 1V-, 6,A' rvY .f- -44 WARREN GREEN * ARCHITECT FIRST FLOM P'L A N STAMFORD CONNECTICUT o w ER PROMT ptHER'. IaL.6;. civic- I ppm't a14 A,,"bp"a DRAWING NO, nSVWECT F I RSr FLOOR -PLAN Sk tMIe EM. FLIT c'14 FN_ I N I N o A R 9 A —FiA—rE QRAWN�y ATE pm,. i ID 4 SSUED R'4 Y, VA r1r v - i�.# I -' COV~ ice [~Z~ ...... , ...... ' ..,, :EN GREEN .'ARC ~ " I CONNECTICUT .... ~ ~ STAMFORD , - ' ........... .... 1 ISSUED ~ SE CT L il 5ECTIQN *3, ,P,,I~HT SI. DE ~L~VATIOH LF::FT S:IDE ELEVA'!'IOkl .. WARRE'-------'~GREEN · ARCHI FECT STAMFORD CONNECTICUT DRAWING N0 $¢/~ o" /~//~/*~/ ~'; ISSUED