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Home My WebLink About14036-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z14320 Date ki~.r.q h. 2.6. 19.86 THIS CERTIFIES that the building P o o 1 H o u s e Location of Property .Eciy~.~e. jR.o.a~fii. E.ak~;. E.rld. . Fishers Island House No. Street Ham/et County Tax Map No. 1000 Section ... ] (~ ....... Block ........ 5. ...... Lot ........ 8. ........ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated Nov .... 13 .............. 19 .~.~ pursuant to which Building Permit No. 14036Z dated ... J.u.q ~..1.0 ................. 19 .8.5., 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 ......... · . P~ol. H.aus e..~n ly.,..does..no~..~c ~.~e. _t~ nn.i.s..cou?_t_ ~. p.o.q~..a.nfi....~....~:.. The certificate is issued to WILLIAM HALL ..................... ?ol,;,,'d.. X .................... of the aforesaid building. Suffolk County Department of Health Approval ... N / A UNDERWRITERS CERTIFICATE NO. .$k ~ ~ 38632 Plumbers Certificate Feb. 22, 1986 Building Inspector Rev. 1/81 IPOUM' NO. ! TOWN OF SOUTHOLD BUILDING DEPARTM£NT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COARPLETIC)N OF THE WORK AUTHORIZED) Ne 14036 Z Permission is hereby granted to: '/z:....~...,a..~..~.~...~ ................................. , .... . ,o ~ ,~m,.~?~ ~, .... ~~..~ ........ ~~.~.~ ........... ..~~: ....... ~~/....~.~....~....~.~...~....~.~ .......... pursuant to application dated ......................... _/....~... ............ , 19. and approved by the Building Inspector. Fee $...~:......./.~.~. ..... Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Depa,[ment Town Hall ~[outhold, N.Y. 11971 BLDG. DEPT TOWN OF SOUTHOLD APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted-~to the Building Inspec- tor with the following; 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. 5. 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 peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 required to prepare a certificate. Co Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land use --?re-E×±st±n~; C. 0. $15 · 00 3. Copy of certificate of occupancy $1.00 Vacant land C. 0. $ 5 · O0 Date .......................... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ................................................................... Owner or Owners of Property ........ ~.~. ................................................. County Tax Map No. 1000 Section ./.~..'.~..-..~ ..... Block ...~...~. ........ Lot .... . .~'... :i[ .... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No //--V'~ ~ 7- DateofPe .... ~/~'J~f" .... .~..'.~'~.O.~..~...~.~.~.~....~---~.~.E.~.,..~..~.~t~.~.~..~?ze''- ........... liT[it . ~,../.: .... ~ppllcan~ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ~ .Planning Board Approval Request for Temporary Certificate ..................... Final Certificate Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes and regulations. App cant ~ ~'~ TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX ?28 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit NO. /~ Owner (pleacs~ print) Plumber/~/~/ (p]/eas~ 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' Notary Public~ mber's signature) Notary Publi~u County THOMAS F. DOHERTY JR. Notary Public State of New York NO. 4806559 Qualified in Suffolk County Term Expires 3/30/86 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ ,,ate 'pplicatio., o. .Sile N 7 THIS CERTIFIES THAT only the electrical equipment m ~scribed balm a~ intr~uced by t~ applicant named on the above apptlcation number in the premises of in the ~ollowing Iocation~ ~ ~ase~t ~st FI. was examined on [] 2nd FI. ~ntside Section Block Lot and found to be in compliance with the requirements of this Board. FIXTURE I C~S FIXTURES RANGES COOKING OUTLETS ECEPTA SWITCHES FLUORESCENT VAPOR DRYERS FURNACE FUTURE APPLIANCE FEEDERS TIME CLOCKS OVENS DISH WASHERS EXHAUST FANS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT OTHER APPARATUS: ]--4.okw ~ot Water H.~t~r S E R V I C E NO, O~ECR C~,CON D. A.W.O. A.W.O. NO, OF NEUTRALS A.W.O. OF CC. COND. NO. OF HI-LEG OF HI-LEG OF NEUTRAL Drawer ¢:~ " '~ "~ .~c~0~i~ce at the d~te of J~s~,.~cmior only. ~?P~!~-.g._~.,~ ~lis certificate ~xavers ~ ~ ~u ~ of ~u~! ~v~ts ~'t is advi~le to ~ve f~ent test ~nd/or re, irs, a~de by J. c~al~ied ~)e~%~)a, Lic. ;~ Per il This certificate must not be o[tere~ in ony m~nner; return to the office o( the Boord ~ incorrect, Inspectors moy be i~enti~ed by their credenfio~s. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. F1ELD INS~ECTION 1'. FOUNDATION (1st) COMMENTS FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 )isapproved a/c ..................................... (Building Inspector) Received.' .......... ,19.. APPLICATION FOR BUILDING PERI,lIT INSTRUCTIONS a. This application must be cOmpletely filled in by typewriter or in ink and submitted to the Building Inspector, with ~'ts 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 'r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appll htion. 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 nail 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'. ~all 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, uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws. Ordinances o :egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and lmit authorized inspectors on premises and in building for necessary i31spectig~,s. · .Z....4 c.,.~..~.-'.~,.5 3. L&-.z.~!t.~ ! .L ;?., .q~.q: .~'.(--. ..... ~ (Signature of applicant, or name, if a corporation) applicani)' ' ' I ........ (Mailing address of tatc whether applit.~nt is owner, i'~ssee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........... L~.,3/zg~.~./. L~,~ .~.,.e~< .rgg. ........................................................... ~'an,o of owner of premises . , (as on the tax roll or latest deed) f applicant is a cor oration, signatt, re of duly authorized officer. ............. (Name and title of corporate officer) Builder's I.icense No...---74.'~/- /1' Plumber's License No. ..../c(_~ _, /9 Electrician's License No.. v'.~. ~'/~7...':7~ ........... Other Trade's License No...//.6'../5( - J/~.~fq ......... Location of land on which propo$ed work ~vill be done ................................................. S'-' C",, ' '~-~ .,:7 ~,.~ ?. . .~. .4,. ~, ..... r.,i ~.,:,:~ :;~. . .,,,..~/~:,.~ . .,(t, .~-! . . a. O. 3.5 c tlouse Number Street " ..... '/' l~l;~n'l~; ....................... ~oun,~ Ts, Map ~o. 1000 S~ct~o,, ./0.". ~:.-. ? ....... ~oc~..Yin: ............ Lot.. ~ ............. Subdivision ..................................... Filed Map Nc) ............... Lot ............... (Name) State existing use and occupancy of premises and intended use dud occupancy of proposed construction: a. Existing use and occupancy ................. ''t ~ ,)r'''57' 5 ' .............................................. b. Intended use and occupancy'J('"O,.fox"& / / O/dj //-'/l/Oat,_- 3. Nature of work (check which applicable): New Buildin§ i.~. ........ Addition .......... Alteration ......... Repair .............. Removal , D r ' ............ emoil£1on .............. Other Work...~, .......... 4. EstimatedCost..~ ~.~..~'~ F '~~ ~scription) ............................. ee .... ~ .q.'a,.¢'. F. ..................... 5. (to be paid on filing this application) If dwelling, number of dwelling 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. Dflnensiorls of existing structures, if any: Front .............. Rear ....... Depth .............. _Height .' .............. Number of Stories ... Dimensions of same structure with alterations or additions Front ............ Depth ............... Ho;r,h~ ................. Rear . 8. Dimensions of entire new co,,~'~,iJ,:~7.'.~,' ". .... :¥(r ............. Number of. Stories ........ ........ ~-. front . . . ~., .......... Rear . . . :.~. [ Depth Height ............... 'Number of Stories ' 9, Si~eof~ot: front .............. ~;~; ............................................... !0. Date of Purchase . ' ....... ' ..................... Depth ~ - - : ........................... Name of Forme . ' I. ?,one or us~ d~st~ct m which premises are situated r Owner ........................... .:..oes proposed construction ~iolate any ~oning lawl ;;~i;L;;'o;'r;~,;l~;i;,;~ .......... ~:~ .................... 3. 4. Will lot be regraded /¥~ .............. Name of Owner of pr~di;~s ~i: ~"~.i~ ~; ' ~-3~ ii .... .~.).Vill excess t]ll?.9 removed from premile's: ..... '~,~''' Name of Arch:* · '-~' ,w '~>: .......... .r ...... ~uuress-q,.,~::~J£~t~,~ "' ;'-'l" ~tect ..,a ,. ~:~. .~')~]dr~P- . . . "g--'-' ' ', ........... t'uone No../:. ~- . .... ". . .- ...... ,q, aarcss...:l, 3.~...~ t,? ?. ;~ ....... Phone No J-?.7.. ?'.&.Q Name of Contractor ~/xha ~.~,.-~?.e4.,.,:C: ......... Address .+!~4>..~..d.~t.~.%.:. Phone No 2]'£- PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from ~roperty lines. Give street and block number or description according to deed, and show street names and indicate whether aterior or corner lot. ATE 0[7 NEW :3]/)g~,~ S S . )UNTY. OF~--~ ~... ?~' · . .... (Name of individual signi;~ 'c;~};a~}; .......... ore named. , is the ........ ~ (~Contra~e,t ~22' ' :' ' '0; ...................... ~.. ~ ..~ ~ , ' ~porate oIficer, etc.) ......... plication; that ail statements contaMed )~ this application are true ox ~s~owlffdge~;~b~Iief~ that the ;rk will be perfo~ed in the re=net set forth in the application fi~ed therewith., ~;. ~_~. · om to b~re me this 'o ~'ff~ff~ ,19 ~ TH OMASF. DOHERTYJR. /~ ''/~' /~..day' f. ~ "m.~ Public *ate Of .w York ~a~ Public, . . ~~ County sworn, depo..__ses and says that he is the applicant Qualified in Suffotk County Term Expires 3/30/86 .... (Signature of applicant) -lF ~ If-- II I1 ~MEB~ATEL¥" ENCLOSE POOL TO CODE UPON COMPLETION I~EFORE "WATER" ,~LL OCCUP/~CY OR USE IS UNLAWFUL WITHOUT CERTIFICATE l