The URL can be used to link to this page

Home My WebLink About13579-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N,Y. Certificate Of Occupancy No. ZI7041 Date June 28, 1988 THIS CERTIFIES that the building One family, dwelling. Location of Propertv East End Fishers Island House No. Street ' County Tax Map No. 1000 Section ... 2. ........ Block 1 ..... Lot 7.4 Subdivision ............................... Filed IX{ap No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated Nov. 2, 1984 ..................... pursuant to which Building Permit No....I .3.5.7.9..Z ............ dated Nov. 26, '1984 ............................ was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for wlfich this certificate is issued is ......... ..... One family dwelling, attached 2 car garage. ' The certificate is issued to JOHN J. LYONS ~o¥,,'o)f~i~'a'~'~ ..................... of the aforesaid building. Suffolk County Department of Health Approval 14-S9-207 June 9, 1988 UNDERWRITERS CERTIFICATE NO. Pending slip June 4, 988 PLUMBERS CERTIFICATION DATED: Mario Zanghetti Nov. I8, 1986 Building Inspector Rev. 1/81 l~u~ NO. 0 TOWN OF SOUT~OLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERA41T (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N_~ 13579 Z Permission is hereby granted to: . .~2 ................... et premises located at ............................................................................................................................ County Tax Map No. 1000 Section ........ .,~,,. ........... Block ....... I .............. Lot No .....,,-7,,.:,~,, .......... pu~ue.t to app,,cot,o, dot,~ ..... ~.~....~... ....... .:Z. ............ . ,9.~..% a.d apb,ova, by thc Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- t802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted m~ to the Building Inspec- tor with the fo[lowing; 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. B. 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 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 requ ired 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.O. $5.00 New Building . -X'. ....... Old or Pre-existing Building ~-- Vacant Land ~" Location of Property ....... ~. House No, Street Ham/et Owner or Owners of Property ...~.~. County Tax Map No. I000 Section ............... Block ..... 6'~.~. ..... Lot... ~./ .......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. /.~..~.?.~.. Z. Date of Permit I.[/P.~/.~..~..Applicant ....... .~ O~[~..~ .-..~..~'.o..~..~ ....... Health Dept. Approval ................ abor Dept. Approval ........................ Underwriters Approval Planning Board Approval Request for Temporary Certificate .......... .-r ......... Final Certificate ..... Fee Submitted $... ~2~.'.~.O. .................. Construction on above described building and permit meets all applicable codes and regulations. COUNTY oF SUFFOLK)ss; - ' ' ~IAR~ I~ '~ ~ y~ ~ Sworn to ~efor'e me this 7th ~)[~ day of April 1988 TOWN OF SOUT~OLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN' HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No._~%~' Owner 3m~ (p~se Plumber (please print I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. STATE OF NEW YORK) COUNTY OF SUFFOLK) Sworn t~before me this I~~ d~y of k30~46~_~==, Notary Public, Notary Public County MARY B. PANKIEWICZ ~JOI'A~Y ~UBLIC, ST,~"fE OF NEW FIELD ,INSPECTION COM4ENTS FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY qODE FINAL ADDITIONAL COMMENT 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ~ ~.~.~..~'., 19'5 Approved ~)...~4.~.. >..~... ?,.~ i, 19 .~.~. Permit No. I ~ .~.~.~ .-~;.. Disapproved a/c ..................................... ,ow % 's% rhoLo , Received ........... ,19... (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. e. The work covered by this application may not be commenced before issuance of Building Permit. fl. 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 inspections. ............ '~' ~ ' '~-~'~ ..... ;';;a:; ';" ' ' ' (Signature~/~ appl~ant, ~ name, if a co p t'o / (Mailing address of applicant) o~c~c~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... .................................... Name of owner of premises .................. ~[1~.. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ........ .f~.(.~..~??..~' ..... '~-~ $.~..~.~..~ ................... ..... ..... ................... ...................... House Number Street Hamlet County Tax Map No. 1000 Section ...... ~ .......... 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 .......... D .dee9 .... ~. ......... ~ ,~ ,~ .......................... b. Intended use and occupancy ............. q ....... m...Z,,.*,'~,~[&~J ~ ................ 3. Nature of work (check which apphcable): New Building ....... Addition .......... Alteration .......... ' Rep~r~d.~ ~ ~.~ Removal Demolition Other Work , (Description) 4.' Estimated Cost ~\,(3~ ......... ............ Fee ................ ~ ' ~ · :' ~¢ ~ ~" (to be paid on filing this application) 5.If dwelling, number of dwelling 9nits ............... Number of dwelling units on each floor ................ If garage number of cars , ,. 6 It' business commercial or mixed occupancy specify nature and extent of each type of use 7 Dimensions of existing structure~ if any: Front ~ Rear Depth Height ............... Number of Stories ........................................................ Dimensions of same structure wi,th alterations or additions: Front ................. Rear .................. Depth .................... ~.. Height ........... ~ ........... Number of Stories .............. / ....... 8. D~mensmns of er~t~re new constructmn: Front .... 51 .q ........ Rear .... ~..q ........ Depth ... ~. .......... Height ....~..B ......... Num:b? of Stories ....... ~ ...... ~ ........................................ 9. Size of lot: Front ..........q.3.~/, ..........Rear .... q.~ .~'. ....... Denth ... ~.6.~.: ............. 1 1 Zone or use district in which pr6mises are situated -- 12. Does proposed construction violhte any zoning law, ordinance or regulation' i9 o ........ 13. Will lot be regraded ....... .~.~ ................. Will excess fill be removed from premises: Yes Name of Architect ~ Address Phone No Name of Contractor ~ Address Phone No PLOT DIAGRAM Locate clearly and distinctly alli buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. s'r,xT~ OF NEW~DR~'a/j ~ ~ i~ S z/ (l~~~ls~gn ngco j~'~' *-"~X'-"-~i-~--ntract' ' being duly sworn, deposes and says that he is the applicant aboYe named. (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 are true to the best of his knowledge and belief; and that the work will b~ performed in the mannqr set forth in the application filed therewith. Sworn to before me this + he water supply and sewage disposal sys%emm rom ~him residence will conform tandards of ,the Suffolk ~ounty Depar~men~ of Heal%h. 0 _LO'[' II OO~ W£ST ) ' E615,7 / LOZJ ~',- //'/'Son; /~"- /~" fln~ PLAN FOR 8oX NoN ~OOK FISHERS IS~ND~ NEW YORK SCAL~ lO0 ft. _ N~. BLOCK 26. II : NOTE: Coordinate disfcmces are measured, from U, S. COastand Geodetic, Surly Triangulation Stat on NIN" - The: wa~er Supply and aewage diepesal s2g~em~ ~er ~isi ,residence will eenform to ~he NOTE: Coerdjr~te distances am measured fr~m U. 8. CoaStand Geadetic. Sur.~y Triangulation 0~ 4" ~"qp~O/I /,~"- /02'~ f/~¢