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Home My WebLink About13091-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICA'T'E OF OCCUPANCY No 2--19821 Date MARCH 28, 1991 THIS CERTIFIES that the building ADDITIONS Location of Property MONTAUK AVENUE FISHERS ISLAND, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 10 Block '2— Lot 25 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 25, 1984 pursuant to which Building Permit No. 13091-Z dated MAY 7, 1984 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 TWO PORCHES & UTILITY ADDITIONS TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to HANNAH C. LADD (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL NCA 'UNDERWRITERS CERTIFICATE N0. N-656933 - AUGUST 27, 1984 PLUMBERS CERTIFICATION DATED N/A r Building tn5pector Rev. 1/81 FORK NO. 5 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THISPERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13091. Z Date ........�r 1....... .�........................... 19.�••� Permission Is hereby granted to: ...j . .................... .. ............................. ..... 0,6 ..1.. . .... .... ............................. � ra...�:�.,.. . ...�::�.�`.-'5-- ......................... . ... to . + �5 }.fir. / at premises.located at .....1.�: .°Y :a. .. . ........ :. c ..JJ.a.;;. l ................ ............................................................................... ............................................................................ ................................................................................................................................................................. County Tax Map No. 1000 Section ....... .1 b........ Block ......',_ ......... Lot No. ...::z: ............. pursuant to application doted ............. .... ............. .. 192f, and approved by the Building Inspector. Fee $ .t......... I n Ab Building Inspector Rev. 6/30/80 Form No. 6 TOkrN OF SOUTHOLD BUILDING DEPARTMEN~ TOWN HALL 765-1802 ~PPLICATION FOR CERTIFICATE OF OCCUPANCY A. 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 ail 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, imdus~trial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from'architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. : B. 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 o£ Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. 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 - $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 Date .~...f~/~ New Construction .... ~...... Old Or Pre-e~xisting~~ ~/ ~ -~ ~ Building... .... ~..2~ .... _ Location of Property ............... '~~~-~L~./..~~..~ ~~.. ..... House N~~ ~/~- ~ ~ ~eet~ Hamlet Onwer County ~ax Map No 1000, Section./.~. ......... Block.....~..: .... ~ Subdi4ision ............. ~ ...... ~ ..... / ~ - - ................ ~lAe~ Map...~. ~/ ...... Lot ......... P.ermit No.Z.~.~.Z/~Date Of Permi ...ApPlicant. ~{ealth Dept. Approval .......................... Underwriters Approval.~..~..~..~3~,: Planning Board Approval for: .Te~orary Certificate ........... Final Certicate ....... Request Pee Bubmitted, .............. " ) ¥ l · ' · .............. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK oate Au&m~t 27, 19S4 Appllcatlon No. o. file 272415/84 TR,S CERT,~,ES T.AT N 656933 only the electrical equipment as described belo~v and introduced by the applicant named on the above application number iN the premises of I~ic ~ 'd Ladd~ Montauk Avenue~ Fishors Islaad, N.Y~ in the following location; [] Basement [] Ist FI. [] 2nd FI. Section Block Lot ~,se~ami,,~don Augast 14, 19~4 FIXTURE RECEPTACLES OUTLETS and found to be in compliance with the requirements of this Board. FIXTURES RANGES OVENS EXHAUST DRYERS FURNACE FUTURE APPLIANCE FEEDERS TIME CLOCKS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT OTHER APPARATUS: 1-~. 5kw. S E R V I C NO OF CC~yCOND A W. 6. OF CC. COND j AW.G, NO OF HI-LEG OF HI-LEG E NO. OF NFHTRAL: A W, G, OF NEUTRAl Edwmcds Electric Box 511 Fishers Island~ Lic. 129~ 11 Per_ This certificate must not be altered in any manner~ return to the office of the Board if inco[rect. Inspectors may be identified by their COPY UILDING THI~ OFCE THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW ~ORK 10038 THIS CERTIFIES THAT only the e~ectrlea! equipment as described below and introduced by the appllcartt named on the abo~e application nurnber in the premises of Ili~rd L~%dd,Fishers IsJ~nd,Fisl'~rz Island,N,Y. i. the yollowi~g lo~.tlo.; ~] B.~o.~e.t [] ~t rt. ~ ~.d FI. 0~ S.etio. mo~ rot .~.s~.,.i.edo. Septenber ~s ].9~0 and~ottndtobeinco,np~iancewltht~erequlrementsofti~isBoard. DRYERS SYSTEMS NO. OF FEET OTHER APPARATUS: E R V I C 1 4 1 4 Box 511 Pennin~ula Rd. Fishers, i~d,N.Y. 06390 Li~.1297 This cert}fieate must not be aJtered in any manner; return to the office of the Board if incorrect. may be identified b COPY FOR BUILDING DEPARTMENT. THIS COPY OF ~LTERED IN ANY MANNER. FIELD INSPECTION COMMENTS FOU~JDATION (1st) FOUNDATIOU 2. (2nd) FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: Approved .. 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 ., 19~. ., 19~.'f. Permit No. ).~).!L Disapproved a/c ..................................... Received ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMII INSTRUCTIONS a. Tkis 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 autli°rized inspect°rs °n premises and in building f°r necessary~~ ~.,,L~ j~ · - .t ..................... ,~,'~ .~Z% .'w~.'~.~ . (Signatg~e of applicant, orinase, if a corporation) /.~ ./....o~....~.~~,. ,~... _ (Mailing address of applicant) ~;~ ~-tfi'D . State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................... ~.~...~:¢~..~/~ ............................................................... Nameofownerofpremises' '~'~./~.~..t~.~ ...~..,2. ~--~-~ ................... (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 *frade's License No ...................... 1. Location of land on which proposed work will be done. ............i i i i i i i i i i i i House Number Street Hamlet County Tax Map No. 1000 Section ./~. ' ' '" ' '" ~ ~ .... ; ..,, .5 ...- Blogk ................ Lot .................... Subdivision ........................ ............." ' ~ile d.M~p No. ............................. Lot (Name) ~. ~ ~ 2. State existing use and occupancy of premises and ~h[~d;g{ ~s~and ~cupancy of proposed construction: a. Existing use and occupancy ........ ~ ............................................ b. Intended use and occupancy '. · ; ................ 3. Nature of work (check which ' ' ' apphcable): New Building Addition .......... Alteration .. ... Repair .............. Removal .............. Demolition .............. Other Work ......... i ' - (Description) 4. Estimated Cost ............ , .......................... Fee ...................................... ,' "~' (to be paid on filing this application) 5. If dwelling, number of dwellin~ 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 ............... Number of Stories'. ................................................. Dimensions of same structure w~th alterations or add,boris: Front ................. Rear .................. Depth , Height Number of Stories 8. Dimensions of entire new cons!ruction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot' Front ~ Bear 10. )ateofeurohase .... ...... NameofFo merOwner( .&.,r/ .Z'&. Z.Z,. ,. 11. Zone or use district in which p~emises are situated .. 12. Does proposed construction wqlate any zoning law, ordinance or regulation: ................ 13. Will lot be regraded ............................. Will excess f'~ll be r~emoy..e~t [ro¢ premises: Yes No Name of Architect Address Phone No iName of Contractor Address Phone No Locate clearly and distinctly al property lines. Give street and blocl~ interior or corner lot. PLOT DIAGRAM buildings, whether existing or proposed, and, indicate all set-back dimensions from number or description according to deed, and show street names and indicate whether STATE OF NEW YORK, COUNTY OF ........ :S.S ................................................. being duly sworn, deposes and says that he is the applicant ' (Name of individual sign .ng contract) above named· He is the ..................... (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 be performed in the manne!r set forth in the application filed therewith. Sworn to before me this ........................ day .......... NotaL?/..P.o~lic ........ .'~.....~.~'"~'"~"~ ............... ' ./ ~ ~, : (Signature of applicant) 1. ~OtJ?''~,' '~ - TWO REQuiRED FOR P"~"t'-'h CONCR. TTE 4, F!~.~ r' , N MUST THE P'-" .... ''z"x'"~fi 0~: 'T~ FLY STA~F C''~''''i RL!CT!ON ~, ~" CODES IqfT RESPONF'm' DESIGN O~ CONSTRUCTION "R~';qq