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Home My WebLink About15260-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building inspector Town Hall Southold, N.Y. Certificate Of Occupancy No z14873 THIS CERTIFIES that the building .... A~.~ze. Kgg;Loq ...................... Location of Property Mansion House Drive FJ. shers Island House No. Street Hamlet County Tax Map No 1000 Section 9 ........ Block 4 Lot 2 Subdivision .................. Filed Map No ...... Lot No ............. conforms substantially to the Apphcation for Building Permit heretofore Fried :n tins office dated ·.. J~r~.. 3,$ .... 19.8.6pursuant to winch Bmlding Permit No . .15 2. 6. .0.~ ............ dated. Sept.. . ....10 ....... .... 19 86,wasissued, and conforms to all of the reqmrements of the apphcabte provisions of the law. The occupancy for winch tins certificate is issued ts ......... ...A.l.ter. a.t~_qn..t.o exl..~t~nc~, dw.e?_.li~$.. ......................... The certxficate is ~ssued to . Robert ~..P.a. rsons (owner, 21~lr~,~ lclltl~'F~X of the aforesaid building. Suffolk County Department of Health Approval ....N/A .......................... UNDERWRITERS CERTIFICATE NO ........... .N/.A ................................ Budding Inspector TOW'N OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PER)AlT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE. WORK AUTHORIZED) Z Permmslon is hereby granted to' /~ //' ~ /. ,,~/,~ ! JO ~..~.~.~~, - .... ~ ........ : .......... .. ..... .5~Z/~.;~7..~ .......... .'~. ..~......,.~... ...3..~..~. .............................. . . County Tax Map No 1000 Section .. ~. pursuant to apphcation dated ..~ Budding Inspector Rev 6./30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This applicatmn must be filled in typewriter OR ~nk, and submitte~l;][c=t: to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buddings, property lines, streets, and unusual natural or topographic features, 2. Final approval of Health Dept, of water supply and sewerage dlsposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commermal buildings, Industrial buildings, Multiple Residences and similar buddings and installa- tlons, 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 exist,nD buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property hnes, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of bu ddings, 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- t]on required to prepare a certificate. C. Fees' 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existmgdwelhng land use --?re-E×;s t.;ng C. 0. $15 · 00 3. Copy of cert~ficate of occupancy $1.00 ~'acant lanc~ C.0. $ 5.00 Date ; ~..z/.//, ~/~'~./'~ ~. ........ New Building /,L~"~..' ..... Old or Pre-existing Budding .... ~ .. Vacant Land ............. Location of Property . House ~Vo. Owner or Owners of Property .., ~ ................................................... County Tax Map No. 1000 Section .... .~. ....... Block ....... ~. ...... Lot ...... .~- ...... Subdivision ..................... Filed Map No ......... Lot ~. Permit No./~.~, ~--, Date of Perm,ty/Y.~/.~'~..Applicant..2 .~..~...~-- ~ Health Dept. Approval ......."---'~. ............... Labor Dept. Approval .,r.._.-,~ ,,-~..----. U de Appr I ~ ' PI ng Bo rd App oval ...... n rwrlters ova ....................... aRm a r ...................... Request for Temporary Certificate ................. Final Certificate ....................... Fee Subm,tted $.. f~..~i ...................... Construction on above described building and per. Flit meets all apphcable~.~des and regulations. .... Applicant.. ! , ,,.'* ~.(.~ ¢ .~. ?f¥.~, ............................ Rev 10 10-78~ ~ PZ O & SBoxCONTRACTING202 INC. ~/~/~ FISHERS ISLAND, N Y, 0~gO FIELD INS~ECTIO~ ~ COMME~TS ~ ~ FOUNDATION {1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c ............................... BLDG DEPT TOWN OF SOUTHOLD _ Rece3. ved ........... ,19. (Budding Inspector) APPLICATION FOR BUILDING PERMIT Date ...ff.a.n ~5, ..... 19. INSTRUCTIONS a Ttus application must be completely filled m by typewriter or in ink and submitted to the Buddzng Inspector, w,t sets of plans, accurate plot plan to scale. Fee accord,ng to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public sir. or areas, and giving a detailed descnpt,on of layout of property must be drawn on the diagram which ~s part of ttus ap cation. c. The work coven~d by thJs apphcation may not be commenced before ,ssuance of Building Permit d Upon approval of this application, the Building Inspector will issued a Bufldmg Permit to the applicant. Such 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 Occupa shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Building Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinance Regulations, for the construction of buddmgs, addltmns or alterahons, or for removal or demolmon, as herem descril The applicant agrees to comply with all applicable laws, ordinances, budding code, laousmg code, and regulations, an, admit authorized inspectors on premises and in bmld~mg for necessary mspecnons. · Z..&S .COUT. gC G ..... (Signature of apphcant, or name, ff a corporation) BOx ·292, .Fi.s. her.s..I.s..lg.nd.~N:.Y... 0.63.9.9.' (Marling address of applicant) State whether applicant is owner, lessee, agent, ~chitect, engineer, general contractor, electrician, plumber or buih General Contractor Name of owner of premises . .Ro.be?.t ..~.. Pa..~.s.o.n..~ (as on the If apphcant is a corporation, signature of duty authorized officer (NaMie and-title of corporate officer) Builder's License No ..... .15.0. ........... Plumber's License No. 554-P ..... Electrician's License No...~2.~-:E. ...... Other Trade's License No ............... tax roll or latest deed) 1. Location of land on which proposed work will be done ~.$.r.eh. qu.s9 .Sq.u.a.r.e t .W.t~ ~.t .e.n.d. 9f .I.s.l.a33d... [louse Number Street Hamlet County Tax Map No. 1000 Section . ..~. ........... Block . .q. ..... Lot... ~ ... Subdivision .................... Filed Map No ... Lot ... (Name) 2 State emsnng use and occupancy of premises and intended use and occupancy of l?Oposed construction a. Existing use and occupancy ...S.i..n~le..fam. i. ly. c]w..e.l.l.i.n.g. "' ... b. Intended use and occ.upanc,~ ....... ~ara~ ................................... a Nature ofwor,k (check which applicable) New Budding ....... Addition .......... Alteration x Repair ............. Removal ....... Demolition ........... Other Work....x ........... /r (Description) 4. Estimated Cost... F.o,~ty. ~,gh~..Tho~,a~.n~ .......... Fee . ?...~..~.:~, · .~. ..................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ............... If garage, hum ber of cars .............................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... ? Dimensions of existing structures, if any. Front ........ Rear ............ Depth . tteight ............ Number of Stones .......................................... D~rnensions of same structure with alterations or addmons. Front ............. Rear ................ Depth .................. Height ................. Number of Stories .................... 8. Drmensmns of entire new construction' Front ........... Rear ............. Depth ............ Height .............. Number of Stones ................................................. 9. Size of lot Front .................. Rear .................... Depth .................... 0. Date of Purchase ......................... Name of Former Owner ....................... 1 Zone or use district in which premises are situated ........ 2 Does proposed construction violate any zoning law, ordinance or regulation' . ............................ 3. W~I1 lot be regraded ......................... Will excess fill be removed from premises: Yes No 4. Name of Owner of premises .tRg]~.I:~; .~q....~g~.~on. ~.ddress .. F.i. ~.h.e~..s .I.s...N..YPhone No ................ Name of Architect ....................... Address Phone No.. Name of Contractor .Z.&.~, ?.q.nt.r.a.q~i.n.g..~p.c :. Address ~61~"s. .. . ...........'t~"N' Y~'Phone No. 788-:78.~,7.. . . PLOT DIAGRAM Locate clearly and &stinctly ail buddings, whether ex~stmg or proposed, and~ indicate all set-back dunensions from operty hnes. Give street and block number or descnphon according to deed, and show street names and indicate whether tenor or coruer lot rob consists of remodeling kitchen, bath and laundry on first floor, installati. one non-existant skylight, replacing of 3 exterior windows and 2 exterior door- their same location. d:)PRO. VED AS NOTE L _ F~.. ~ BY NOTI~ BUiLDiNG 765-1802 9 A~ TO 4 P~ FOE THE FOLLOWING IN~ECTIONS. J. FOUNDATION . ~O REQUIRED FOR POURED CONCRET~ 2. ROUGH - F~MING 3. INSO~TION 4, FINAL CO~TRUCTI~ 'ATE OF NEW YORK, $ S )UNTY OF (Name of ~ndiv~ual signing contract) ore named. being duly sworn, deposes and says that he ~s the apphcan is the. ~. .~-~ ... ~ .... (Contractor, agent, corporate officer, etc ) said owner or owners, and is duly authorized to perform or have performed the said work and to make and file thi ?hcation, that all statements contained m this application are true to the best of his knowledge and behef, and that th. ,rk will be performed in the manner set forth in the application filed therewith. om to before me this ........... '7 ........ day ....... tary Public, . ........ ~,. ~.. ........... County ....... ..... ,: ~~,,~ (Signature of apphcan,