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Home My WebLink About11013-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z.123.5.3 . . Date March 14, 1984 THIS CERTIFIES that the building ...o.n.e...f.a.m.% .1.y..d.w..e.l.l.~..g ....................... Location Rrivate Road Fishers Island, of Property [.l[~,5.s'o ~'o2 ....................... '8't[e~[' ....................... ['t[a,:,l'e;: County Tax Map No. 1000 Section 8 .... Block 1 .Lot 006 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... t3oc ...1 .......... , 19 8.(1 pursuant to which Building Permit No. 1.1.0.1.3.Z. .............. -dated J.a.n. :..9. ..................... 19.8.1., 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 ......... to one family dwellin.~ The certificate is issued to %~lerton & Rita Cushman (owner, lessee or tenant/ of the aforesaid building. Suffolk County Department of Health Approval .... .N../.A. ................................. UNDERWRITERS CERTIFICATE NO ............ 99Y .............................. Building Inspector Rev. 1/81 FOI~M NO. 2 TOWN OF SOUTHQL BUILDING DEPARTME~NT~ TOWN H~.LL SOUTHOLD N Y. BUILDING (THIS PERMIT MUST BE KEPT ON THE PP, E~ S~S UNTIL COMPLETION OF THE WORK AUTHORIZED) 11013 Z EULL Date .... .,.,~ ~.r,~. .................... , Permission is hereby granted to: ; ...................... ..... :.. [~.g.~.~ :......../.~..~..~........~.. ..: ..... / ' ~ ~ : ~'~ ~ ~ ~ / ...... :~..~..: ....... ~&.~z~....~....x~...;~,. ...... ~t~~ ................ ~,o~a ~,....~:~ ....... ~a~.~..= ......... ~~..;..z:~.~.~.. cou~w r~ ~p ~o. ~ooo s~t,o~ ..0~.~ ........ ~k ~:.~Z ........... ~Cot ~o...~.~. ......... pursuant to application dated .~.~~....~2....' ~'~ ....... 19.~.~.~ and approved by the Fee $ ......~ ............... ................ !'"'h' ....... ?":":'~;"~ .......................... · ; Buddsng dnspector Rev 6/30/80 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLEP, K'S OFFICE SOUTHOLD, Ft. Y. NOTICE OF DISAPPROVAL PLEASE TAKE FIOTtCE that your application dated ,/, .~.~.Z~,,,.~...-~,,/.)...~..~..~.,x~.,,,...(~...?,,..., 19 ..~,,~.. for permit to construct~~ ................ at the premises located at .(~¢...~.~.. Ma ~ ~.gmgJ~. Z. J~ J( I Block ........... ~...~. ....................... Lor ........ ~.~.~.z.~..: ............... returned herewith and disa~ved on the following ground~.~.~...~.~..~.~.~.~ ......... ~.:G.~~...~,..~.¢.~.~,....~.~.~.~.~...~z~.~.~.;~.q.....: .~.~. ~.r.......~......~.~.~.~ :..~...:.~ ....... ~~.. ~......~4.~.r.~.. ~....~.z~.....~.~...~.~. ~ .................... ~. ............................... 2.~.... ........................... FOBM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, pra ed ...................... ........... ~Bul~din~ In~poctor) 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 Jn 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. t 'g at a~;)i:~cant, '~r name, if a corporati;~i ........ (Address of applicant) State whether applicant ~wner, 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 ............ .~...Z ................................. Plumber's License No......~..~.~...~......~ ........................... Electrician's License No...~.....~..'..~..~....~.~. ................ Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Mop No.: ........................................Lot No ......................... Street and Number .................................................................................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ........ ~?(~.~kZZ..~..~~ ........................................................... b. Intended use and occupancy ' - property lines. Give street and block whether interior or corner lot. 3. Nature of work (check which applicable): New Building.. ................. Addition ....~ ....... Alteration ....: ............ Repair .................. Removall .................. Demolition .................... Other Work ...................................... I ~ ~ (Description) 4. Estimated Cost ...... ~..~,....~...'~...'~- ................................ Fee ...... .~./'...~...:..~..~.. .................................................................. (to be paid on filing this application) 5. If ~weJling, number of dwel(ing 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 existing structures, if any: Front .......~.,~.. ................ Rear .....,~,,,~. ...................... Depth ./.~...~.. ......... Height........................~2~) NumBeri of Stories ................................................................................................................. Dimensions of same struct~Jr~ with alterations or additions: Front ...... ..~.,,~,.,/. ..................... Rear ...~ ./.. ............... Depth ..../...~..,~... ................. H~ight ......~.....~. ................ Number of Stories ...... .,~,.. ..................... 8. Dimensions of entire new construction: Front ....... ..~.. ......................... Rear ...................... Depth Height .../...O.. ........... Number of Stories .... ./. ............................................................................................................... 9. Size of lot: Front ~,~.~..~..~..',,_/ -~ ........... i Rear .......................................... Dep, th ................................ 10. Date of Purchase ................ i ........................................ N~,e, of Former Owner~.~ .................... 1 1. Zone or use district in which[ premises are situated ~'~c-~ · .... 12. Does proposed construction v~olate any zoning law, ordinance or regulation: ~.: ......................................... 13. Will!lot be regraded "~"l .............. Will excess fill be removed fror~ premises: ( ) Yes (~) No ~ Name of Architect~.......~...~.(...~...'~'..~ ................. Address~...,~....../~...~.... Phone No ...................... Name of Contractor ~~...,~..... AddressT~....~.~..~,; .......... Phone ~o..~.~.~....'~..~...~.~.' PLOT DIAGRAM Locate clearly and distinctly a!ll buildings, whether existing or proposed, and indicate all set-back dimensions from number or description according to deed, and show street names and indicate STATE O1~ NEW Y,~RI~,i ~ I, ~ S S COJ, J~TY ;OF .,.~....~ ' ........ ~~ ................... being duly sworn, deposes and says that he is the applicam (Name of /~dividual si~!ning contract) above named. : He is the .,,~ ....................................................................................................................................... , (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dOly authorized to perform or have' performed the said work and to make and file this application; that ali statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. . .. day of ~t~' ~;i~' ..,,;.,~..'.,,'.?.: ........ County ' .,.. ~~...,~,,,... ~,~,~~ .... t') . ~ \ / j -- (Sigr/~J/ure of applicant) ] j , ualified In SutfoJk Counly.[~'7 i ~ Expires March ~0, 19.-.I~.~'