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Home My WebLink About12785-zFORM NO. 4 TOWN OF SOUTHOLD BUILDINO DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19993 Date JUNE 1~ 1991 THIS CERTIFIES that the building ADDITION Location of Property PRIVATE RD, F2~ST END, FISHERS ISLAND, N.Y. House No. Street H~mlet County Tax Map No. 1000 Section 5 Block 2 Lot 7.5 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 26~ 1983 pursuant to which Building Permit No. i2785-Z dated DECEMBER 6, 1983 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 DECK ADDITION TO EXISTING SEASONAL BEACH HOUSE. The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A FISHERS ISLAND DEVELOPMENT CORP. Rev. 1/81 -- ' Building InSpector~ lrO~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12785 Z Permission is hereby granted to: ..x~..~.~.....~..~~ .......... ~......z.~...... .................................. ~.. ~ ~c~ ............. ~....~,,....~...~.x......~ ~ ~o ot premises located at ................. ~ ...................................................................................................... .................................................................. '.~...~>. ........ ~e~ ....... .~:~ ................................ County Tax Map No. 1000 Section ............ .~...... Block ........ ~ ....... Lot No...,~,f..'.~. ............. pursuant to application dated ~/)~ c~ 19.....~ond approved by the Building Inspector. Fee $.../...~. ................ Rev, 6/30/80 Form No. 6 TOWN OF SOUTIIOLD BUILDING DEPARTMENT TOWN HALL 765-1802 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 certificate 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 is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. 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 - $100.00 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 ew Construction. . Old Or Pre xistingD~ House No. Street Hamle6 _ · ounty Tax Map No 1000,.Section .... ~ ...... Block .... ~ ........ Lot .... ~, ................ ~bdiv£sion ........................... Filed Map ............ Lot .......... ~ ........... ~rmit No./~..~.~..~Date Of Permit/~/.~/~..~ .... Applicant.~,..~.~..~ . . _alth Dept. Approval ...... ~ ............... Underwriters Approval .................. ~ ..... ~anning Board Approval ........................ ~quest for: Temporary Certificate ........ ,e Submitted: $ ......~.~. ............ ' ' ............. .............. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined .......... t.~.., 19..°~.~ Approved ......... '..~...~.., 19~. ~ Permit No. ........... Disapproved a/c ............................. ........... . .~d~. . (~. .5 ./. ?.~. ? :.~. /. . ~ (Building inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tiffs application must be completely filled in by Wpewriter 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 herejaf~escribed. The applicant agrees to comply with all applicable laws, ordinances, building co¢471~using/4~, and reguyfior~s, and to admit authorized inspectors on premises and in building for necessary~ins~ions./ I [ ] / / J · ,[2....). .... \ (Signature~.o_f apglioant, or name, if a corporation) iI~l~li~ address of applicant/ J ...... St~vhether applicant~vner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · .... ......... ................ ............................ Name of owner of premises. ~,~... ~./~.~...&9~.~. ~~ .................... (as on the hx roll or latest d~d) If applicant is.a c~poration, signature of duly authorized officer. .... ~ (Name and title oI corporate officer~ Builder's License No... ~ ~.~[~ ........... Plumber's License No... ~ ~. ~ ............. Electrician's License No. ~ ............ Other Trade's License No... Location of l~n which proposed work will be done.~.~ ............ .......... .... House Number Street Hamlet County Tax Map No. 1000 Section ........... ~... Block ...... ~ ......... Lot. ~ ?~ ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of ~mises and intend~l-u-sa4~d occupancy of ~r0Posed construction: occupancy...~J..~y .~.~4. ~. /' '~ .......,~ .~. ?../~...~. ..... z, ~ ~. · · ~¢".-- ..... '. ................... Existing use and a. b Intended use and occupancy . .~...~- ./~. .... .O..~./¥. / 3. Nature of work (check which applicable): New Building .......... Addition . .'~.. ...... Alteration ........... Repair .............. Removal .............. Demolition ....~ ........ Other Work ............... ~ ~ / (Description) Estimated Cost .//.O ~.... r; ...... 4 .............. ' ...... Fee ...... t..~ ............................. ; (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 natur~ and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front .... 3/~>. ......... Rear .............. Depth.. ,-~. ......... Iteight ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ................... i · · Height ........ r ............ Number of Stories ...................... 8. Dimensions of entire new construction: Front ...,,.~.O .......... Rear ............... Depth ...~.~. ........ tteight ............... Number of Stories ........................................................ 9. Size of lot: Front .......... i ........... Rear ...................... Depth ...................... 10 Date of Purchase ' Name of Former Owner 1 1. Zone or use district in~ which pr~mises are situated ........................... ~<) ......... tL ..... - ..... 12~ Does proposed construction yjolate any zoning law, ordinance or regulation: ~/~.~.. ~. ]~it~[...-~i~...~.. A}[~'.'. 13. Will lot be regraded ..... ~;.~O,,.~ .~, ............... Will e~. s~fill b~l r~mov~ed from premises: Yes ~qo 14. Name of Owner of premises r.~.,12J.,. ~;.C.: ~ ....... Address .':'P~i ./-~e..'d~[..a~47 ..... Phone No ................ Name of Architect ..... '-. ..... .~ ..... ; .... Address,.~- ...... r7'.' ' '/i ....Phone No ........ Name of Contractor ~:~.-.~.~.'~4..k~...~-~A~..~..~.. Address¢ .-Jfl~..~.td r.~t~.~. ..... Phone Noi~..~..~'.~..~.' ]~. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from interiorpropertYor lineS.corner Givelot.Street and block . number or ~ descri tion according· to deed, and show~met~ ~.,l.t nTes and ~.)~'vtL.indicate ~.t~ whether STATE OF NEW YORK ,,,, -- '-~0/~ '~-0 t~tl-q7 t~-'-~--~ COUNTY OF..%k)..~f'~¢,.}5~ .... ;~'b ~ .... . .............. ....... ~:. ~Pb~. ~d~.,. >)~' .............. '/] ]7'-~e~d~ duly sworu, deposes and says that he is the applicant (Name of individual signing contract) above named. .......... f0 .............................................................. (Contractor, agent, corporate officer, etc., of said own]er or owners, ~d is duly authorized to perform or have perfomed the said work ~d to m~e ~d file this application; that M1 statements contorted ~ this application are true to the best of his knowledge and belief; ~d that the work will be perfomed in the m~ne; set forth ~ the application filed therewith. Sworn to before me this ....... ]~?~ ........... day of.... ~bSY[ ....... 195~ Not~ Public, .~,~ .... D, ~kC~, ~' '*'~' ''B ~a~I[WlCZ ..... ~q(}~ .... County,.. ~~ ... ~~ , NO. 52-8267950 - SUFFO~ ~UNTY- ~MtSSiON EXPIRES MA~ ~. 1~