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Home My WebLink About9863-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-17699 Date JANUARY 23, 1989 THIS CERTIFIES that the building ADDITION Location of Property MANSION HOUSE DRIVE FISHERS ISLAND, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 6 Block 6 Lot 15 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 16, 1978 pursuant to which Building Permit No. 9863-Z dated JULY 24, 1978 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 ADDITION TO EXISTING ONE FAMILY DWELLING The certificate is issued to LAURA M. EDWARDS ( owner ) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED PENDING - Jan. 17, 1989 N/A Building 'In~pe~or Rev. 1/81 FOP~!~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9863 Z Permission is hereby granted to: .~.:.~.....~.:...~.~.::...~. ....... ~...~,~ ~ ~ at premises located at pursuant 'ia application dated .,.:.....1 ........~:..;.:.~.~....~.....~......i./...~....., Ig':.Z~'., and approved by the, Bu ldihg Inspector. .~. --...~;. :~...t~:3.: ............ 'l~sPfct0r FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted m ~---~,- to the Building Inspec- tot with the following; for new buildings or new use: I. 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" ~and uses: 1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual 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: Additions $25.00 POOLS $25.00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling $25.00, Accessory !$10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 ~.~n /.~/.~..~.?. 5.updated c.o. $ 50.00 Date ~ ........ NewCons truction ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ...................................... House No. ~- Street Ham/et Owner or Owners of Property . L~ ~,~ ~.". ~. ,. E~.~.~ fTJ.-~ ............................... County Tax Map No. 1000 Section ............... Block ............... Lot . . ./~l ....... Subdivision ................................. Filed Map No ........... Lot No .............. __ Permit No. ~..~.~, .~,~ . . Date of Permit Y,~¢'~. ~. App cant .~.~.~,./.~/..~..~.~-~.~..~,..E,~.I~..~¢~.J ~ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .... ~ ........... Fee Submitted $.. ~;~.~.-;~. ~.."J~¢. ~.>.~. ......... Rev. 10-10-78 STATE OF NEW YORK)ss; COUNTY OF SUFFOLK) Subscribed and sworn to before me this 18th day of January 1989. 0~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT, TOWN CLERK'S OFFI¢II SOUTHOLD, N. Y. ~proved .......... ._~;...~ ............l.-.-, 19 ........ Permit No ..................................... Disapproved a/c~ .......... ~ ...................... ~ ........................... {guildino In*p~ctor) Application No ................................. APPLICATION FOR BUILDING PERMIT Dote.....~Q~....../..~:. .............. , INSTRUCTIONS a. This application must be completely filled in by typewriter o¢ 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 ofproperty 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 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, butlding code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary, inspections. ................................................... ..................................... (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. ....... ..................................................................................................................................................................... Name of owner of premises ...... ?~...~.../~...~...../.c..~......~........?:....~...~.., .C,/..~...~.....~..,.........~.~....f--~....~..~. ...................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......... .(~.'?,~/,/~.../..~....~.~:'T. ................. Plumber's License No. ~)C6/~'.C;'/~, Electrician's License No ............................................. Other Trode's License No ............................................... ]. Location of lend on which proposed work will be done.,~M~p No.: ..................................... Lot No ......................... Street and Number ........ .~.~..'~..~.~.~X..~.~.I~....~...~fffC.C....../?..~.(...~'..C ............ ..~C..:~:..~..<f:.,¢:...~:'../..~...C~:,,,~.. ....................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .................................... ~. ............. ~ ........................................................................ c"/ //, ',.., b. Intended use and occupancy ..................................... ~.. ...................................................................................... 3. Nature of work (check which applicable): New Building.. ................. Addition ....... ff.... ..... Alteration ................ Repair .................. Removal .................. Demolitior ..................... Other Work ................................................... (Description) 4. Estimated Cost ~/. ~O Fee (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 e~<isting structures, if any: Front ........~,...~..;~. ............ Rear ......... ..~'.....~...~ ........... Depth .....~....~..../...~...~' Height ..... ..-~..../. ............. Number of Stories ............./.........~z..?: .................................. ~, .......................................... x ......... Dimensions of ~ame structure with olteratior~,s or additions: Front .......... ,.~,.-~,. ................ Rear ....... ..~.....~. ............. Depth ....~....~. ...................... Height ...... .~..../. ................ Number of Stories ........./...'.~.'.'.~.'. .............. .' ... Rear ........ ../....~...."~" ......... Depth 8. Dimensions of entire new construction: Front ...._........ .......................................... Height ....?:.../.. ......... Number of Stories ...................................................... ;~ ............................................................. 9. S ze of at: Front ....... /..'?f...'.q..' ............. Rear ./.'.Z.d:..?,'~ .......... Depth ....~,:...f--/' 10. Date of Purchase ........................................................ Nome of Former Owner 1 1. Zone or use district in which premises are situated ........ ~.~..~...~.,~'..'c.~.~...~.. ................................................................. 12, Does proposed construction violate any zoning Iow, ordinance or regulation: ............ ...':~....~.. ................................... 13. Will lot be regraded ................ Will excess fill be removed from premises: ( ) Yes (~'No 14. Name of Owner of premises.~....,O.,.~-,~.,/.,~.,.,,,,~,,,c~...~.~...~...... Address .Kr2..:'~?../...':~.:...-~../..~..~..~. Phone No..~..o~'..~..~...7...~../,~ Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, end indicate all set-back dimensions frorn 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 NEVV YORK, iS S COUNTy OF ...... ~'C2.~.~.4-?..~..~ ....... ~ · .............. ~.~.~.~......~.....]~.~C~.~.~ .......................... being duly sworn, deposes and says that he is the applicam (Name of individual signing contract) above named. He is the ............... ~.~.~.~ ............................................................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove per¢ormed the said work and to make and file this application; that oil statements contained in this application are true to the best of bis knowledge and belief; and tha~ the work will be performed Jn the manner set fo~h Jn the application filed therewith. Sworn to before me this ........ o, ............ ................ . .11 .. P Nota~ Public, . ......... .~ ....... ~~.... Coun~ ................................................................................................. ~,/ ~ I~ ~/~ ~ (Signature of applicant) ~A~ ~. PANKIEWICZ N~A~y. RU~LIC,.~E. ~F NEW YORK