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Home My WebLink About14424-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20322 Date OCTOBER 31, 1991 THIS CERTIFIES that the buildin~ Location of Property AVENUE B House No. County Tax Map No. 1000 Section 6 subdivision ADDITION FISHERS ISLAND, N.Y. Street Hamlet Block 2 Lot 7 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 10, 1985 pursuant to which Building Permit No. i4424-Z dated NOVEMBER 5, 1985 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 ADDITION TO EXISTING BEDROOM AS APPLIED FOR. The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED ROBERT A. CAMPBW~J. N-840536 - OCTOBER 29, 1987 SEPT. 24, 1991 - A.JOHNGADA CONTRACT.INC. Rev. 1/81 ~OB~ NO. 0 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 14424 Z Count/Tax Map No. 1000Section ......... ~. .......... Block ....... ~ ...... Lot No ........ .~ ..~.... ........ pursuant to application dated ...... .~....~ ......... /.~... ......... , 19x~..~.o and approved by the Building Inspector. Rev. 6130/80 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Date...Sept. 24, 1991... NEW CONSTRUCTION ..... OLD OR PRE-EXISTING BUILDING..X..VACANT LAND ..... Location of Property ........ Avenue.B ................................. Owner or Owners of Property ..... Robert A. Campbell ................... County Tax Map No. 1000 Section .... 6... Block .... 2... Lot .... 7 ...... Subdivision ..................... Filed Map .......... Lot ............ Permit No..14424Z ...... Date of Permit .1985 .... Applicant.A. John Gada Health Dept. Approval ................ Underwriter Approval~.~..~.~~.~ Planning Board Approval ................. Request for Temporary Certificate ........... Final Certificate...X... Fee Submitted: $...25.00 ......... Applicant A. John Gada General Contracting, Inc... co TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 CERTIFICATION TEL. 765-1802 Building Permit No. ]~'/~2./~.~- (please pri6t) P 1 umber d,~ ~i ~/~'~ ~' (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this ~' day of 19 ql Notary Public, County U~tary Public MARY I~ PANKIEWtCZ Iff~'AR¥ PUBLIC, STATE OF NEW THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY THIS CERTIFIES THAT in the fotlowing locatlon; ~ B~semet~t ~ tst FL ~ 2~ FL Secthm Bt~:k Lot ~s e~'amined on 0~ ~0~~ ~ 9 ~ ~ ~ attd found to be in cotnpliance with the require.tents of this Board. RANGES OVENS DISH WASHERS FANS DRYERS FURNACE MOTORS FUTUEE APPL~At~CE ~EEDERS TIME CLO~KS UNIT HEATERS MULTI.OUTLET DIMMERS SYSTEMS NO, OF FEET SERVICE DISCONNECT S E R V I NO, OF CC COND A W, G. NO OF HI-LEG OF CC. COHD ~OOL C E W. Ger4on Ahman-Broker P.O. Box 314 Fishers Island, I~f 06390 GENERAL MANAGER Per This certificate must not,be altered in any man~er~ return to the office of the Board if incorrect. Inspectors may be identified by their credent~aE. COP~Y FOR iBUI'LDING DEPAET~EJ'4T. THIS COPY OF ..... RED TN ANY/vL~NNER. FIELD INSPECTION FOUNDATION Ilst) C OMMEN TS FOUNDATION 2. (2nd) 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 Approved .'~/Zw2'...~...-~. ..... 1 .~fl...~ermit No../.~..~/.~..y'~ Received ........... ,19... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be c6~npletely filled in by typewriter or in ink and submitted to the Building Inspector, with 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 street 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 permi 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 Occupanc} 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 th, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o 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, a~, regulations, and t( admit authorized inspectors on premises and in building for necessa~ p~. ecti~l~s. cX (Signature of applica~!3~, or name, if a corporation) (Mailing address of applicant) State whether applicant i~,,o%ner, lessee, ag~rchitect, engineer, general contractor, electrician, plumber or builder. ................... ...... .............................................. Name of owner ofprenlises...~....~..~......~.~./,14~, f..~.. .................................................. u (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. .... .... .............. /" (Name and title of corpor~'te officer) Builder's License No. .<~..~.. Plumber's License No .................... ... · ............. Electr cmn s L~ccnse No. Other Trade's License No../.?.~f'...~..~ ......... Location of land on which proposed work will be done ............... .~ ....... ~.~ .......~ ..... .r~' ..... ........................................................ ....... House Number Street Hamlet County "Fax Map No. 1000 Section ...... ~ .......... Block .................. Lot ................. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premi~and intended(axe)and occupancy of proposed construction: , ( ' a. Existing use and occupancy ...... .'>,..)~..I~L~O ~ ........................... b. Intended use and occupancy ...... Ad.C((~a.t.a.(....'.~. ¢~. (.-0¢~. ..................................... + 10. 11. 12. 13. 14. it/ Alteration ..... Nature of work (check which applicable): New Building .......... Addition..: ............ Repair .............. Removal .............. Demolition ....... ~'.' 'i'" Other Work ............... Estimated Cost ........ .~. .................. '. Fee .. .'.<~..~. ....................... (to belpald on filing this application) If dwelling, number of dwelling units ............ Number of dwelling units on each floor ................ If garage number of cars If business, commercial or mixed occupancy, specify nature and extent of each type of use .................... Dimensions of existing structures if any: Front Rear ~ Depth Height ............... Number of Stories'. .......................... , ............................ Dimensions of same structure with alterations or additions: Front : Rear Depth ...................... Height ......... ¥ ............ Number of Stories... X .... ~. e ......... Dimensions of entire new construction: Fr°nt: i i i/al' :~i :~:i .... Rear ....... i ....... ..Depth 'i ............. }/eight ../p.e. ......... 'Number of Stories ................ i .......................... Size of lot: Front Rear ' Depth Date of Purchase ............................ ,~me of FoF,ner Owner i ............................ Zone or use. district in which premises are situated .. .'.~?..,~rh~,~.?t'~t/.. .. . . ..... i . ........................ Does proposed construction violate any zoning law, ordinance or regulation: ... [ fl'..~. ........................ Will lot be regraded .... : ¢~'~' · · ! 't/ ........... Will era:ess fill~e removed from premises: Yes Name of Owner of premises'l~'~ ..-...%~..v~0~[ ......... Address~,~.~l~ .~. ~,~./a.~... ,i .... Phone No.--cl. 1~f.'.7.4''0. .] ...... Name of Architect .... ~ .................... Address ~ ............ [ ....Phone No ................ Nme of Contractor .~.~. 0~¢...~..,.rt..e~. ?..o~. ..... Address .-ff~q .~.~-l~.~.~ Phone No. ?~.fT?.Z.g./. .... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether 'existing or proposed, and. indicate all set-back dimensions from property Iines. Give street and block number or description according to deed, and show street names and ~ndlcate whether interior or corner lot. : / STATE OF NF~V./Y.~ ~, ~,// S S C 0 U N~T Y~Q F ..'~;~..*'~.e.t.' .... · ... ~>~. ~.~t~. ~.. ~.x ....................... being duly sworn, dep:oses and says that he is the applicant (Name of individual signing contract) (Contracto~agent,~corporate~~officer ~c.) of said owner or owners, ~d is dhly authorized to perform or have perfomed the ~aid work and to m~e and file this application; that ail statements contained ~ this application are true to the best ofhts knowledge and belief; and that the work will be p~rformed in the m~ner set,th in the application filed therewith. Sworn to before ~ e this ....... ........ ' Nota. Publ/~/A~' ~No~ P0blic State of New ~rk , ' ...... . . ................. .... Qualified in Suffolk County ~ ' (S~g~a.~re of applicant) Term ~pires 3/30/86