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Home My WebLink About10049-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building inspector Town Hall Southold, N.Y. Certificate Of Occupancy Z12273 FEBRUARY 17 8/4 No ........ ~ ....... Date ................ '. ;'~ ............. 19... ADDITION THIS CERTIFIES that the build~ng ................................................ BRICKYARD RD. FISHERS Island Location of Property ............................................................... House No. Street Ham/et 5.9 County Tax Map No. I000 Section 01 0 ...Block 5 .Lot.: ...... Subdivision ............................... Filed Map No ......... Lot No ....... conforms substantially to the Application for Building Permit heretofore fried in this office dated 78 10049Z OCTOBER 1 0 19... pursuant to which Building Permit No. · dated DECEMBER 4 19 78 , 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 ......... FOR AN ADDITION TO A ONE FAMILY DWELLING · REYNOLDS DU PONT JR. The certificate is issued to ................................................... - ,. ...... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .N/. A .................................... UNDERWRITERS CERTIFICATE NO ~76.4~ ' Building ~spector Rev. 1/81 FORM NO. ~ 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) N? 10049 Z Permission is hereby granted to: · .~ ....... ~.!:~..'?~ ........ C.~..~.~ ........ ~:..E..·.....z~ pursuant to application]dated .{~C 7 f ~ ]9Z ~' and approved by the Building Inspector. Fee $ ........................ FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall $outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusua~ natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C.~ Fees: 1. Certificate of occupancy $5.00 / / 2. Certificate of occupancy on pre-existing dwelling ~r land use $ Is-/ $5.00 3. Copy of certificate of occupancy $1.00 ! Date.. ~--~//~ ?//~' .. New Building . ..~.. ...... { ... OId~l~-existing ~ing(Z) ........... ~/V acant Land ': ............ Location of Property..~,?~,~-~.~.i ~.'~.o~z~!'~-....~..~.D?.~. .................. ~ ....... -,:- .......... HouseNo. l[~ ~ ~ ~---~._ ~-~treet Ham/et Owner or Owners of Property ..~¥/~'~[-~ 5LJ~t!~/JJ ~ ~"~' County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map N/p~..../-~.Lot No .............. Perm.t No./~...~?...~-~... Date of Permit .......... ADp cant~ .~$?..~..A..~.~...~..' .~'.~.~. .......... Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. UnderWriters Approva ..................... i..Planning Board Approval .......... . ........ , , .~ Request for Temporary Certificate ..................... Final Certificate ................. * Fee Submitted $ .... ~._X~., ~0 Rev, 10-I0-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS L~~ [(~oq~Z i~Bi BUREAU OF ELECTRICITY ~' .... . , % , 8~ JOHN STREET. NEW YORK. NEW YORK 10038 THIS CE~IFIES THAT only the electrical equipment as describ~ ~lq~ a~d ~ntrqdqged ~ t~ ~pDllca~t ~d on ~he ~ appl~ation nuo~ber i~t the premises of in the followDtg location; ~4Basement ~ 1st FI. [~2nd FI. O~d~ Section Block and found to f)e in compliance with the requirements of this Board, Lot FIXTURE OUTLETS 44 FIXTURES RANGES DISH WASHERS EXHAUST EANS DRYERS SYSTEMS NO. OF FEET SERVICE E R V I C OTHER APPARATUS: lOOamp. FA~hex:'~ island~ ~'~.Y. Lic.1297 ~ 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. FORM NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined . / ,'~ ~.}, ...................................... 1 9._ 19 ........ ~erm~t ~o. ~isopprovod o/c .............~.~~ ......................................... .................................................................................. ........ App"cot,on .o. ................ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter ag 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 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 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 Deportment for the issuance of o 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. A, John ~ada Gerieral Contract, ina, Inc. (Signature of applicant, or name, if a corporation) FLshe~'s ~sl~d, N~ Yo~k 06390 S~ofe W~ether opp~con~ ]s owuer, lessee, cgent, orc~itec~, eng~meer, generol controctor, electr~cion, plumber or ~uHder. g~e~al ~o~e o~ owner o~ ~re~ises Re.olds ~nt, Jr. If appl~ic~//t is a corporate, signature of duly authorized officer. _ .......... (Name and~Wtle of corporate officer) Builder's License No. HZ-36 Plumber's License No .... .4~1.-.~. ................................ Electrician's License No. ..2-~6,-~ .............................. Other Zrade's License No ..... ~ .8..1..-...~..I. ............................ Location of land on which proposed work will be done. Mop No.: .]1~,.4343~...4J~. ................. Lot No .....~'/. ................. Street and Number ....... Rar~..~M~ .......................... ~:Lah~lt'~..Z~lai3l~,.;-.N~..Xo~k .................................. Municipality State existing use and occupancy of premises and in~ended use and occupancy of proposed construction: a. Exisiting use and occupancy .............. ;r~s.tLd~rl~3e ............................................................................................ b. Intended use and occupancy residence Plans and info ~L, ma~,ion not oon~l~te, es disouased between M=. Fl~hersand Mr. Cook 3. Nature of work (check which applicable): New Building'. ................. Addition ...~ ............ Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................. .., (Description) 4. Estimated Cost ..~!!..~..O...~33 ......................................... Fee ...... ~15.,.0~ ..................................................................... (to be paid on filing this application) 5. If dwe!,ling, number of dwelling units .......... 3, ................ 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 ............................ 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 ................ :.., ................ Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... c~. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 19'75 ' of Former Owner .~],.~.{Ur~QI~'...~I~G~tlt~ ................. 10,', Dote of Purchase ........................................................ 1 1. Zone or use district in which premises are situated ....Z'.IIBJ,~I~t~I~!. ...................................................................... ]2. Does proposed construction violate any zoning law, ordinance or regulation: ....... .,~,.0,. ........................................... 13. Will lot be regroded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises l~l~ol~...l~b3~3~t~,,...~,,... Address ..~...~.~.~..?..~...~....Z..~...a~..~hone No ....................... Name of Architect 3;~.~..H&3.;l~'~r. ........................... Address ..~..~...~.....~.~.~..~.~..~.~. Phone No ....................... Name of Contractor .~....,.~0 .'~**...~.,~.~ .............................. Address ..~,.~..~...~..~...~..~.....~.,,al.~.~l~hone No....:~:~, ............ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frore 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 ¥~)RK~ , , / ~c S COUNTY OF ..... ¢~. ~:L',,f.t~:. · · f ....... ..~..~.....~-?..~......~..a....l~....~i...~...~.~ ....... '. ........................................ being duly sworn, deposes and soys that he is the opplicam (Name of individual signing Contracf) above named. He is the (Contractor, agent, corporote officer, etc.) of s~id owner or owners, ~nd is duly outhorized to perfor~ or Aeve per¢ormed the seid work end to m~ke ~nd file this ~pplic~tion; t~Qt ~11 statements conf~ined in this Qpplicetion ~re true to the best of his knowledge end belief; Qnd th~ the work will be performed in the m~nner set fo~h in the epplic~tion filed therewith. Sworn to before me this . ....... /./. ........... of ....... ........... . , ............. ............ .......... ~ 6 '~ ~A~ '~ ~ (Signoture of opplicant~ MARY B. PANKIEWICZ N0~AEY P~BLtC, STATE 0F N0. 52-8267950 - SUFFOLE CDMMISSl0~ EXPIE[S REYNOLDS duPON~J~ A~E A= L 99~ BLOCK 40 il9.98'~ Lot 7 137.$3' S 155.05' FISHERS ISLAND )M,H 96.9.5 N 1958.27 NOTE: Coordinote distonces ore meosured fi'om U.S. Coost end Geodetic Survey Triongul(3tlon Stofion "NI;N" NOTE :TOTAL AREATO BE CONVEYED = 4.52* Acres PLAN OF PrOPErTY TO BE CONVEYED BY FISHERS ISLAND DEVELOPMENTCORRI TO ~ REYNOLDS du PONT, :Jr. FISHERS ISLAND, NEW YORK SCALE: I" = IOOfl. CHANDLER,PALMER~ KING ~,~, o~ ,o~ Norwich,Conn.ecticut