HomeMy WebLinkAbout11492-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Z13240 Date March 1 ., 19.8..5
THIS CERTIFIES that the building ...... .N.e.w..D..w.e.l.1. i..n.g ............................
ResevQir Rd.
PvL.Rd. Fishers Island -~
Location of Property ~$ b Ho .........................................................
s . Street Hamlet:
County Tax Map No. 1000 Section 004 .Block 05 .Lot P/O 004
Subdivision .............................. .-U-4He6 Map No. F.I.D..C.O...Lot No. 12
conforms substantially to the Application for Building Permit heretofore fled in this office dated
Nov. 20 19 81. pursuant to which Building Permit No. 11492Z
dated ..... .B.e.c.: .... .3 ............. 19...,81 was issued, and conforms to all of the requirements
oftheapplicableprovisionsofthelaw. Theoccupancy ~rwhichthiscertificateisissuedis .........
The certificate is issued to NELSON t ROBERT
(owner, le~
of the aforesaid building.
Suffolk County Department of Health Approval 11- S O - 125
UNDERWRITERS CERTIFICATE NO N 576172
Building Inspector
Rev. 1/81
FOEM NO;
TOW
BUiLDiNG
TOWN HALL
SOUTHOLD,
BUILDING
(THI'S PERMIT MUST BE KEPT ON-FHE P~,£~ISI ~ UNT!L
COMPLETION OF THE WORK AUTHOR[Z~ED)
F~ULL
Date
Rev.
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 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 p~operty showing all property lines, streets, buildings and unusual natura~ 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
3. Copy of certificate of occupancy $1.00
4.Vacant Land C.C. $5.00
$15.00
Date
New Building . .~.-~/~ ...... Old or Pre-existing Building ............ Vacant Land .............
House No. Street ~ ~ Ham/et
Owner or Owners of Property ..... ~--h~.. ~..~..'~. ~.. ~ ...........................
County Tax Map No. 1000 Section ~.-~.. !.~.. ..... Block ~ ~ Lot ..... /2 ........
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No. 1.1.~..cl..~, .... Date of Permit I ~.-.~ .~.~. ~.~..Applicant .... ~..U'~....~1...~.~/~ .~. · .......
Health Dept. Approval .... '~ .................. Labor Dept. Approval ........................
Underwriters Approval. ~...'~.. 9. ~.. ............. Planning Board Approval ..... r ................
Request for TemporarV Certificate ..................... Final Certificate ., .~,,~(Z~,c~. ............
Fee Submitted $...~p.%Q ~ ...................
Construction on above described building and permit meets all applicable~codes and regulations.
~kg~L~ ,~5-r'/|~j Applicant ..... . .~. ~...~.'..~f'.~.~ ................
~t~o
Rev. 10-10-78
~ tq~~
iooii~ THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRIC. ITy
~ 85 JOHN STREET, NEW YORK, NEW yORK 1OO$1~
N 576[72
THIS CERTIFIES THAT
only the e~c tricaJ equipment ~ described below and introduc~ by the appllcat~t ~ed on the above application number in the pren~ises of
in the followlng location; ~ Basement ~ 1st Fl. Lot
~.~...~.odo. SepC~ 9, 1982
FIXTURE
OUTLETS
28
RECEPTACLES
4i
[] 2nd FI. O~SLC]~ Sectiott Block
and fouttd to be it~ cotnpliance with the require~ments of this Board.
SWITCHES FIXTURES RANGES OVENS DISH EXHAUST FANS
FLUORESCENT
3i
DRYERS
UNIT HEATERS MULTI-OUTLET
SYSTEMS
NO. OF FEET
OTHER APPAEATUS:
E R V
C E
AWO
OF H~ LEG
NO, O~EUTRAL
AWG,
OF NEUTRAL
2/0
P~cors~t-~HP
J~;lec. Room Heaters;5-1 ~4, Z-.75 i~
Water Heater.
Bohr:on
1k~:506 , Fox&~resc6a%t Ave.
Fish-SA Isled, N.Y. 06390
/
This certificate must not be altered in any manner; return to the office
Board if incorrect.
by credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF ANY MANNER.
FI EL~D IN~?ECTION
FOUNDATION
(1st)
COMMEN'~S ~
FOUNDATION (2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
C,ODE
FINAL
ADDITIONAL COMMENTS:
HENRY E. RAYNOR..Ir., Chairm~n
SAMES WALL
BENNETT ORLOWSKI, ~'r,
GEORGE RITCHIE LATHAM, Jr,
William F. Mullen, Jr.
--.O~?S 0 U~{~L D
Southold, N.Y. 11971 ·
TELEPHONE
765-1938
A special meeting was held by the Southold Town Planning Board Friday,
October 30, 1981 at Fishers Island. Present were:
Chairman Henry E. RAynor, Jr.
Member William F. Mullen, Jr.
Member Bennett Orlowski, Jr.
Member James Wall
It was the decision of the board that the Building Inspector
the following lots for consideration of building per,its, by"
ing inspectors, regarding maps dated October 1981. (Fishers
release
the build~
Island)
Lot 93 Ckocomount
Lot #16-12
Lot #15-11 entitled "East Portion"
Lot #25-5
!rom information rede board regarding the~e proposed sites,
he names of DeBoisl~els?n(/~L~herford, and Bogart should correspond
o these application~rd reviewed th~' access to each lot and
oted them as-being .rou~h~/l~aded and suitable for emergency equipment.
~ I~ agreement were FI~CO directors, Peter Sang'r, Mr. Dupont, Mr. Stoepher,
~ ~lchard Baker and various citizens from Fishers Island. The maps
~ forwarded to the Planning Board office are to be revised to reflect the
corrections and additions on maps dated October 1981. They Will be
forthcoming from Chandler, Palmer, and King. Covenants and restrictions
are to be forthcoming from FIDCO with regard to properties designated
on these maps as u~determined properties of FIDCO. The covenants will
restrict any dwelling units on these areas and will run in perpetuity
with the property. A resolution is expected by the FIDCO board to this
'~-eff~ct tke first week of December.
It was the concensus of the Planning Board to have Jack Davis inspect
the access to the property of Rose DeMaio, lot #136~ On the ma~ entitled
"Cedar Beach Park", and report his findings before the November 9th
meeting.
HER/sel
Henry E. Raynor, J~., Chairman
Also discussed was a recommendation for an e~tablishment of a part~'
time Building Inspector on Fishers Island ~cause presently all
buildings, other than those on the one macadam road on the east end,
must apply to the ;ZBA for a 280-A. It would be suggested that the.
Building Departmenlt spend several days on Fishers Island to incorpor-
ate into their bas~ maps, which are being worked on through this de-
partment, those rohdways found suitable so that build%ng permits
could be applied f~r directly.
Susan E. Ldng, Secretary
Southold Town Planning Board'·
/
pg. (2)
Today's Date:
Members Absent, if any:
Appeal No. c~'~O 0
:' '' ...... P~LSON
Agenc~a Item/bIatter of:
Type of Variance or Appeal: '~CC
THURSDAY~, NOVEMBER 5,
- 280a
Resol'ution made by:
· Seconded by:
1981
Action:
( ) Approve as applied for
( ) Deny as applied for
( ) Deny
( ) Deny without prejudice
( ) Withdrawn without
Prejudice
( )
GCharles ~erae
r~goms ~o~-ey?ug~.ass ^ Gerard ose .
( ) (' V) ) .( ) ..
( ~ Approve with the following conditions:
( ) Subiect to D.E.C. radiations ( ) Other:
Findings of the Board are as follows:
OtbE
Not Within the Character of the Neighborhood ( ) Granting the Relief Requested is wi%h
Variance is Substantial in Relation to Code spif~it of the zoning code
Not .in, h ~a~..,.o. ny .with purposes of the Code ( ) Relief is not substantial
Hardship not sufiicient ( ) Burden of hardship or difficult~ shox
Circumstances are. Not Unique ' ( ) Circumstances are unique
Will set a precedent in the neighborhood ( ) Variance will not change character
Area is already very congested the Deighborhood
Interests of justice served by denying .( ) Interests o£ Justice served by granL;
( ) Othez; for Special Exceptions
of the Board : Ayes: ( )~CG (/SD" ( R~D )~)~ ( )'~JS
Nay: ( ) ( ) ( ) ( ) ( )
Abstain: ( ) ( ) ( ) ( ) ( )
Absent: ( ) . ( ) ( ) ( ) ( )
Vote
Notes:
To Choc°
c,'l ~0 om
i-o_ r~O
FORM NO, 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTNOt.D, N.Y. 11971
TEL,: 765-1802
(Buiming ,nspector)
INSTRUCTIONS
Application No..~.(.~..~.~.. ......
a. This application must be completely filled in by typewriter or in ink and submitted ip. triplicate to thc Buildi
Inspector. with 3 sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plet plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stre~
et areas, and giving a detailed description of layout of property must be drawn on the dia~am which is part of this apl:
cation.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon apprc.'al of this apphcation, thc Building Inspector will issue a Building Permit to the applicant. Such pern
q~all be kept on the premises available for inspection tl,roughout tile work.
c. No buikling shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan
shall !,ave been granted by the Buikling Inspector.
APPLIC,VFION 1S ItEP, EBY MADE to the Building Department for the issuance ora BuildiugPermit pursuant to t
Building Zone Ordinance of thc Town ;of Southold, Suffolk Connty, New York, and other applicable Laws, Ordinances
Regulations, fro' the construction o£ buik!iugs, additions or alterations, or fer removal or demolition, as herein describe
The applicant agrees to comply with all appticable laws, ordinances, building code, housing code, and regulations, and
:~dmit authorized inspectors on premises and in buiid, ings for necessary inspections.
(Signatnre of applicant, or name, if a corporation) .
(Mailing address of applicant)
State whether applicant is owner, Icssec, agent, architect, engineer, general contractor, electrician, plumber or build
(as on thc tax roll or latest deed)
If applicant is a corpon~tlon, signature of duly authorized officer.
(Name and title of co, pm'ate officer)
Builder's License No..' ..... ff' ' 'x .............
Plumber's License No. X'..J.~2. ~ ~
Electrician's License No~..~....~... ~ - --~.
O,,er r,de's ce,,so No ...................... i'.Y.e '
Location of land on which proposed work will be done ....... ¢F_4/ ...............
....... ........... .....................
House Nmnber Street Hamlet
County Tax Mai2 No. i000 Section Block \
............................. "~ ....... Lot .................
Subdivision ................................. Filed Map ,No ........... Lot .... :-. .....
(Name)
State existing use and occupancy of premises and intended usc and occupancy of proposed constrnction:
,/-~ __
......... ~. ~. .P_-,,,. . . ~.4?,.//JO././.l/. .'. ~.. ~.F.c! ¢.?r~ .l:,.,~, .....................
Existing use and occupancy
Ix. II/
b, Intended use and occupancy ..................................................................
Repair Removal D~m~oliuon i Other Work.
/K~. %' (Description)
(to ~e paid on filing this application)
;. If dwelling, munber or dwelling units ............... Number of dwelling uldts on each floor ..............
If garage number of ears ~ '
,. If business, commercial or mixed occupancy, specify ~atnre and extent of each lype of nsc .... ~. ...............
,' Dimensions of existing structures, if any: Front .... ~' Rear ..... :.: ~. . ..... Depth ......... -
lleigbt ~ Number of Stories
Dimensions of same structure with alterations or additions: Front , .~. ............. Rear . ...~ ......
Depth ............ ~... [ .... Iteight ......... ~ ........... Number ~of Stories ..... ~ .......
L Dimensions of entire new constrnction: Front,. ~ ......... Rear ..... ~.~. ..... Depth ...~J,.
Height .... ~ ~ ....... Number of Stories .... ~ .................... ~ ................... ,~..
>, s~e or~ot. Font ...a,. ~..~.:.,, ........ ~ear ...... /&~. .......... . mpt~ ~.L~.~.~.
). Date6fPurchase .~ l~l~/. ............... .Name°fF°nnerOwner. ......~/~C~C .... , ....i..
i. Zone or use district in which premises are situated ...... ........... i .. '
1. D,oes proposed construction violat~ any zoning law, ordinance' or regulation: . .i~.~ ~ ......................
~.x~ iu ~ot be r~g~aa,a ...... ~ ................ win cx,~ess fill be rmo?~d from premises: Yes
Name of Contractor ~. ~.~/~¢ ....... Address . W~~ .. Phone No ..... ; ..........
PLOT DIAGRAM
Locate clearly ~d distinctly all buildings, Whether existing or proposed, and(ineicate all set-back dimensions from
roperty lines. Give street and block number or description according to deed, and si}ow street names and indicate wh,ther
terior or corner lot. ' '
I'ATE OF NF~ORK, .Z ' - -
being duly sworn, d~poses and says that he is the applicant
is the ..................... ~t4.e~q.-g-Ak~ ........................ i ..............................
(Contractor, agent, corporale officer, et~c.)
said owner or owners, and is duly authorized to perform or have performed th~ said work and to makd and file this
)plication; flint all statements contained in this application are true to the best of:l s knowledge and belief; and that the
ork will be performed in the rammer set forth h~ the application filed therewith.
,yom to before nip this
~ ' ~ARY PUBLIC, ~ate/of, Now..Y~k ~ ..... ~
' ~, $~-81~SSO, s~ffo~k oo~ty~ ' .... ~J ........... [ ....