The URL can be used to link to this page

Home My WebLink About9697-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z12.~52 Date. March 14, 1984 THIS CERTIFIES that the building Q.n.e..f..a.m.il.~( dwelling Location of Property . .T.h..e. Park Fishers Island House No. Street Ham/et County Tax Map No. 1000 Section .8 ........... Block 1 . .Lot 6.1 Subdivision ............... . ................ Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore f'ded in this office dated .... M. aT. 1 ........... , 197.8.. pursuant to which Building Permit No. 9697Z -dated May. J- ....................... 19.7.8., 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 ......... ..... ~44~.~.~.o..n..~.q, 9.n.c..~..a.m.~.!¥..d~e. ~..~.~.n.q ...................................... The certificate is issued to Aller~con & R£ta Cushman (owner, lessee or tenantJ of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... ~415007 UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, 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 complian'ce 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 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date .Z.~. ~.~..~...~..~.. ........ New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property .... .~.../~..~,.'...' .~.~..,~.~ .............. . ./~./..~.z~..~../~.~...~.' .~.-~... ~. ~.~ ..... Owner or Owners of Property ~ .-~--~4-., .~ 77..~.~...~.~. .................................. County Tax Map No. 1000Section...?. .......... Block .?. ?. .......... Lot...~..~./ ........ Subd v s on ..... ~ ................. ~ ........ Filed Map No ........... Lot No .............. Permit No. ~. ~. ~.~. ~'.. · Date of Permit~/~pplicant ~~. Health Dept. Approval ........................ Labor Dept. Approval ........................ Onde~riters Approval..~[. ~q/ ......... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate Fee Submitted $...~/.~.~ .................... Construction on above described building and permit meets all app..~ ~.c~.~n~ ~eg~lations. Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS 1~ ~'~ SUREAU OF E'ECTR,C"~ ~'~ F-- 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CE~IFIES THAT A. Cus~an, East End -Middle F~rms, Flsher~ island, B.Y, in the/oiling ~at~n; ~ B~ement ~ 1st Fl. ~ ~ FI. S~t~n B~k ~t ~ exami~d on D~ C ~b e ~ ~ ~ ~ ~ ~ 7 8 a~ fou~ to be in ~mpliance with the ~qui~.ts of ~h~ ~. 2-smoke deteotor 1-15amp. ~.P.I. Pishers Island Elec. Plzhers Island, N.Y. 06390 Per FO~M 1~0. I TOWN OF $ouTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, H. Y. Approved .................... .~..?...~...../, 1,7.~rmi, No ..... . .~...~...?...Z.....~.... Disapproved a/c .................... · · .~...~.~ .~.-..j ................................................ ...................................... :, ............................................. ...... APPLICATION FOR BUILDING PERMIT Application No. ¢~ ~ / 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, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ........ (Signature of ap~}icent, 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 ................................................................................. .~'. ...................... ; .............. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ......... J....~,...'~.., ................................ Plumber's License No. Electrician's License No....~.i.3...~....i....-~.. ............... Other Trade's License No ............................................... 1. Location of land on which~_?posed work will be done. Map No.: ........................................ Lot No ......................... Street end Number ....... .~ii ....... )......~/.....~....~/. ....... ~..../} .................................................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...... .~'~i..~......'~..)....~...~.../~...~ ........... ~.~.~..':(~...../~;~)....~.~ ................................................ b. Intended use and occupancy ........................................ ; ....................................................................................... 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior ..................... Other Work .................................................... ' .. ~'--¢~ . '~- o.? (Description) 4. Estimated Cast ........ ..~..:...~.?..~.~ ..........................Fee........... Z' '~ (to be paid on filing this application) 5. If dwelling, number of dwelling units .....J ..................... 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 ..... ../...~... .............. -~ ~ Numbe ' Stories Depth ........ ~......~... ............. Height ............................ r or ................................ 8. Dimensions of entire new construction: Front ....... .~..~. ...................... Rear ...... Z'~... ............. Depth ...~.....'~.. ............ Height .....~:.....O.. ...... Number of Stories ....... ~ ........................................................................................................ 9. Size of lot: Front (~.~.~ ...... ~....~,....j(~.(c,:,~.~.. .......... Rear .......................................... Depth ................................ 10. Date of Purchase ........... .............................. Name of Former Owner .'~...°...~..h~....,./.~..~.-~?.... ............... 11. Zone or use district in which premises are situated ....... /..~,..~....~ ............ ..~..J.~..((z(.._/~...-~,..~..,.~ ..................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... ./...~.....~. ....................................... 13. Will lot be regraded ...~..O. ................Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ...(~....:....~-..., .~...~'..I~....Y~.¢~...~.. ........ Address .....~..;..~-~..,. ............. Phone No ....................... Name of Architect~..G ./~.f)........~. ,,f~C,..~..~.¢).~..~..~..: ............. Address/.~l/~.~J~/~.~..z~.~.yPhone No ....................... Name of Contractor ....~./'~.~2...~...1..~.~-,~..~....¢.~ ..................... Address ........ ..~.....~.. ............. r'none INO ....................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and 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 NEWk~t'O~J.(,_ COUNTY~OF.__~ ~ ~..,,,~.... ~.j~..~ ~'~'~ ............ ~.~'"".'~'.....~.~.....being duly sworn, deposes and says that he is the applicam (Name of individualZ signing 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 ore 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 b.e.~ me this A ........... l..~. ...... day of ...~.~.~..~_.~ ........... , 19../...~... Notary Public, . ................... ~... County .... (,x~....~~...,~/..._..'~. ............... (")" i~ ~ , ' ~ /3 (Signat/la'r~ of applicant) Term Expires March 30, -, J A ° ~.7--~% Sa,'- ~0" W, ~O~ [~ ~o~ Wt~ THE FLAI40E ~'7-~Of'EE~--~ TO 55: ~O%-~VF--¥ED 3-0 &LLEE. TO~, ¢E~'q.D ~-JT~,M. Rinsed ~o~W~c~t, CO~ ¢-cTl~OT ? South Elev 2. FRAMING INSPECT~o~ , ~ ..... ~T REsPONSigLE F~R D r ~EQUIREMENTS', ~- _,,tull MEET "'~ AND TOWN:HOUSiNG CODE &-~ON A A ,,/ r~ £ ¥ ~ LK=VA. TI~'t4 D D