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Home My WebLink About12777-z TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19977 Date JUNE 13r 1991 THIS CERTIFIES that the buildin~ Location of Property PENINSULA ROAD House No. County Tax Map No. Subdivision ADDITION FISHERS ISLAND~ N.Y. Street Hamlet 1000 Section 10 Block 3 Lot 9 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 2~ 1983 pursuant to which Building Permit No. i2777-Z dated DECEMBER 2, i983 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 AS APPLIED FOR. The certificate is issued to ROBERT K. WHITE (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N-476538 - APRIL 30f 1980 N/A Rev. l/S1 FOEM NO. 2 ?0~ O~ $O~THO~ BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO 12777 Z Permission is hereby granted to: ~:~..:.~..~.~.,....~.~.....~...<~-,~ -~ ,- ....... , .... / /~ Bilk . ~ LotNo Coun~ Tax Mop No. 1000 Section .................................................... ~.. ............ 'Building Inspector. _~ F~o $ ...................... .......... ........... Building I~tor Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-i802 APPLICATION FOR CERTIFICATE OF OCCUPANCY \. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(s-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certifieat~ of Code Compliance from archiuect or engineer responsible for the building. 6. Submi~ Planning Board Approval of completed site plan requirements. ;. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy ia denied, the Building Inspector shall state the reasons therefor in writing to the applicant. ;. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2.Certificate of Occupancy on Pre-existing Building - $i00.00 3.Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4.Updated Certificate of Occupancy - $50.00 5.Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date June 12, 1991 ew Construction ........... Old Or Pre-existing Building ..... Private Road Fishers'i~id~d ..... ocation of Property ....... . ............................................ House No. Street Hamlet :~wer or Owners of Property ROBERT K. WHITE ~unty Tax Map No 1000, Section .... 1.~ ........ Block ..... ~ ....... Lot ..... ~ ................ ~bdivision ............ . ............. Filed Map .......... Lot .................. !~?~-~ 12/2/83 z&s CO~,~CTZ~C ~rmit No ............. Date Of Permit ................ Applicant ............................. 'alth Dept Approval · ' ..... - Underwriters Approval arming Board Approval ...................... quest for: Temporary Certificate. · . ~inal Certicate ........ 'e Submitted: $ 25.00 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~- ~l~.~L ..'~, 1.~0 8S JOHN STREET, NEW YORK, NEW YORK 10038 Date Application No. on file 0~5 THIS CERTIFIES THAT N476538 only the e~t~al ~nt~c~ b~.~t~ t~ ~plicant ~d On the a~e appli~tiOn number in t~ prem~s [] 1st Fl. [~ 2nd FI. ~ Section Block and found to be in compliance with the requirements of this Board. Lot FIXTURES RANGES =OOKING DECKS OVENS FANS FLUORESCENT DRYERS SYSTEMS NO. OF FEET E OTHER APPARATUS: E R V I C NO OF CC COND PER,e' OF CC. COND. 2 NO, OF HI-LEG A W G, NO. OFNE~T~AI~I A'W-G. OF HI-LEG OF NEUTRAL 2 Box 2O2 P'i2,he~ isLtnd, N.Y. 06390 ~'~c. 92~ 1~ GENERAL MANAGER This certiticate must not be altered in any manner;return to the office of the Board if incorrect nspectors ma,, be identified b- th*: - .~ COPY FOR BUILDING DEPARTMENT. THIS COPY OF ~ ~ ~ ~ ~' FIE, LD %~NSPECTION FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY qOD k FINAL COMMENTS ADDITIONAL COMMENTS: Top of Bonk LOT Na. monument ~c~. × PROPOSED ~ ~ i ,~DD/T/ON Por~in~ I I O.lO0 ' FOIL~Z NO. $ TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: ]. 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 installations, 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" land uses: 1. Accurate survey.of property 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 in- formation required to prepare a certificate. C. Fees: I. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date ................................. ~ .... New Building ................ Ad~Jtion ...... ~OId or Pre-existing BuiLding ................ Vacant Land .............. Lo~ation Of Property .~.....~..~,~...~...~..,~. ....... ~r/~.L..~.~.;.../?~..~ ................................... Owner Or Owners Of Property .. ~..~........~.... ................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No ..................... Date Of Permit .................... Applicant .~...~/Z .~..~....~.~.....~.~/~ ............................ Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ FinoJ Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. ....... Sworn to before me this ...... day ....... Notary Public .../~ ...... County :JOJ'A~Y ~BLIC, SIglE OF NEW ~0. ~2-8~7~0 ~ SUF~ ~UN~ _ (stamp or seal) FORM NO. 1 TOWN OP, SOUTHOLD BUILDING I~EPARTM ENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765480:3 t5~2~, 19 ~ Examined .......... "¢~"19?.' mermitNo.. /27-77Z-- Approved ................. . ......... Disapproved a/c ..... · · .~.~.. ............ ~ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted 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 appli- cation. 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 issued 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 building for necessary insm~ctions. · ...... (Signature of applicant, or name, if~ corporation) ... ..... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises.· ~5~.~..~ .... ~ .... ]..d/Q.J_O~ ........................................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ...... 7' '~Nam d ~~ 'r~o }~i~ ~i') ......... Builder's License No..~J~.../.CC? .............. Plumber's License No.. ff.....q.~-.~...-..~. ......... 7~c ~-2~X_ Electrician's License No. '~....~-.-~-.'~... r .......... Other Trade's License No ...................... 1. Location of land on which proposed work will be done· .. ~ ~ z'/°2 ~2 g/.fl House Number Street Hamlet County Tax Map No., 000 Section .......... /i.0. .... Block .......... ~ ..... Lot..~.. .............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ... ~..~ .... ~..-~x_, .... ~:~.~..... ....................... b. Intended use and occupancy . ~.~..~.......~..--~v4~ .... '..~.'~....e~. f.~... ~..~..~ .~.~ 5. If dwelling, If garage, nu 6. If business, 7. Dimensions Height .... Dimensions Depth .... 8. Dimensions Height .... 9. Size of lot: i 10. Date of Pur~ 1 i. Zone or use 12, Does propo~, 13. Will lot be r~ 14. Name of O~ Name of Ar~ Name of Co: Locate clearl~ property lines. Gl interior or corner Nature of w~ ,rk (check which applicable): New Building ' ~' Addition Alteration · Repair .............. Removal ........... ... Demolition ........... :.... ~Oth~er~.Work ............... dmatedC,st ..... ~.:. ~. .~..~. ~i~:' (Desc~ption) .......... Fee .... (~/~e'~i~'d~ ~i~'t~ ~l~idti~) ..... umber of dwelling ~units ...... / ...... Number of dwelling units on each floor ................ nber of cars ..... ........ [ .......................................................... ommercial or mixed occupancy, specify nature and extent of each type of use ..................... ~f existing structures, if any: Front .... ~q ........ Rear ... ~O ....... Depth ... ~ ....... ~ ~ ....... Number of Sto~es ....... ~ ............................................... ~f same structure with ~terafions or additions: Front .... ~ .......... Rear ..... ~ ......... ~ HeiSt . .... ~ .~ ............. Number of Stores ........ ~ ............ )f entire new construction: Front ..... ~ ........ Rear .... .~ ......... Depth .... ~ ....... .~ ........ Number of Stories ............... ~ ....................................... ;font ...................... Rear ...................... D~t~_ .~ ................. ~. hase ............................. ~e,~rOwner .~./~..~'....... district in which premises are situated... ].~ ..................... :d construction violate any zoning law, ordinance or regulation: .... ~ ........................ graded ..... ~ ..... Will exce~ll be r~moved from premises: Yes N~ ncr of premises .~ ?~ ~. Address . ~ ~.~'~ Phone No. hitect .......................... Address ., .~ ..... ~., ....... Phone No ............... ~tractor .~.~.~ ........ Address .~. ~~ Phone No. ~d. 2~Z ~. PLOT DIAG~M ~ ~d distinctly ~1: bufld~gs, whether existing or proposed, and. indicate all set-back dimensions from ye street and block 'number or description according to deed, ~d show street names and indicate whether lot. 'ORK .... ..... ~~i"~h~n~;~t ........... being duly sworn, deposes ~d says that he is the applicant (Contractor, agent, corporate officer, etc.) )wners, ~d is dul7 authorized to perform or have perfomed ~e said work ~d to m~e ~d file this 11 statements contained ~ this application are true to the best of his knowledge and belief; ~d that the reed in the m~ner set forth in the application filed therewith. this .......... day of~... PP. ff~. ~ ....... 19~ ~RY ~. PANKIE~ICZ ~v eU~uc, s~ e~ ~a[w ~0~[ ' [ ~ ' (Signature of applic~t) CO~J~ON EXPIRE8 MARCH ~, lg~ STATE OF NEW COUNTY OF t (Naif above named. He is the ...... of said owner oi application; that work will be perfc Sworn to before · Notary Public,