HomeMy WebLinkAbout23348-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF O~uupANOY
No Z-24271 Date APRIL 9~ 1996
THIS CERTIFIES that the buildin~
Location of Property A~ENUE B House No.
County Tax Map No. 1000 Section 6 Block 2
Subdivision Filed Map No.
ONE FAMILY DWELLING
FISHER~ ISLAND, N.Y.
Street Hamlet
Lot 22.3
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 27, 1996 pursuant to which
Building Permit No. 23348-S dated APRIL 8, 1996
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 ONE FAMILY DNELLING - PARTIAL ONE STORY & PAMTIAL 2 STORY
& OPEN PORCH "A~ BUILT", CONSTRUCTION CONTAINS NO AImPA~ENT DEFECTS A~
CERTIFIED BY A N.Y. STATE LICENSED PROFESSIONAL ENGINEER.
The certificate is issued to
of the aforesaid building.
MARJORIE PEDLEY
(owner)
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL LIC.$2990-P
UNDERWRITERS CERTIFICATE NO. PENDING - APRIL 3, 1996
PLUMBERS CERTIFICATION DATED N/A
dig Insp~ct6r
Rev. 1/81
FORM NO.3
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN ~
SOUTHOLD, N.Y.
Ne 23348 Z
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Date ....~ ............................................ 19....?.~..
Permission
to
Counh/Tax Map No. 1000 Section ......... ~. ............ Block ....... ~ .............. Lot No..~...~.,.,..~.. ...........
to application dated ......~..~..~.. ........................................ 19..~....~. ........ and approved by the
pursuant
/-
Building Inspector.
Fee ~.~.., .~.~
Rev, 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
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 all 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, industrial 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.
For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
Upre-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 of Occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
C. Fees
I. 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 Buildin~ - $100.00
3. Copy of Certificate of Occupancy - $20.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date . .M.~.r..c.h. ?.~. ~..1.9.9..6; ......................
.............
New Construction ........... ~ g. .X. .
Location of Property .... ~..o. ~.). ................... .A.v.e.~.l?...B. .............. ~.. ~.~.h.e.r..s.
House No. Street Hamlet
Onwer or Owners of Property ....................................................
County Tax Map No 1000, Section..0. q~.:p.0. ..... ....... ...........
· .~. ~..~ ........... · .'w4%/.~. ..... ,F>l)d M~p ............ Lot..
Permit No..?../.A .......... Date Of Permit...N./..AL/.~./?.~....Applicant ....
Health Dept. Approval ........ Underwriters Approval..N/.A. ........
Planning Board Approval...N/.A. ..................
Request for: Temporary Certificate ........... Final Certicate...X. .......
Fee Submitted: $ ......
................. .................
~ ~' , ///~..,.f'//~/' (~,~,,~. ~:lO..~ ~' ' APPLICANT
-- / CO~o~")] Stephen L. Ham, III
STEPHEN L HAM,
HAMPTON ROAD
SOUTHAMPTON, N.¥.iI9¢8
March 28, 1996
Mr. Thomas Fisher
Building Department
Town Hall
53095 Main Road
P. O. Box 1179
Southold, NY 11971
Re: As Built Dwelling at
AveDue B, Fishers Island
Dear Tom: ~
In connection with the issuance of a Certificate of
Occupancy for the single-family dwelling owned by Marjorie Pedley
and located at Avenue B, Fishers Island (SCTM No. 1000-6-2-22.3),
I have enclosed the following:
1. Application for Building Permit.
2. Application for Certificate of Occupancy.
3. Blank check to the Town of Southold to cover the
fees for both applications.
After the other documentation you believe to be necessary
has been submitted to you, please issue a Certificate of Occupancy
for the subject property to Marjorie Pedley and give me a call when
that has been done so that I may schedule the closing of the sale
of the property. Also, please advise me of the amount you complete
on my check.
Thank you for your attention to this matter.
Sincerely,
Enclosures
Stephen L. Ham, III
03-27-1996 10:31AM FROM TO
.., FIsH. ERS ISLAND WATER WOR~[$ CORPORATION
FISHERS ISLAN[~
NEW YORK 06390
AREA CODE 5161788-725l
1?6~1823 Po 0~
TO~t Of Sou~hold
FiaharB .Island, N.Y. 06390
(~etl~lemen:
Please accept thiS'letter as cer[~£[ca~on o~ ~acer Service provided
"
[i~e.£~om our 'Island dis[ribucion
5i:~cere'].y ~o~r$,
Robert g. Wall
Super £~enden~
'3':'
04/08/96 13:16 CHANDLER PALMER & KING '.~ 516 ?65 1823 Q02
GORDON C. HYDE, A.I A. ~'~ ~ n ~ ~enJ~min H. Palmer (1923-1972)
~, ~ '~,.~ ~ ~ ~ Percy Joe King (1959.1989)
Aprzi o, ~~
Mr. Thomas Fisher
Town of Southold Building Department
53095 Main Road
Southok~, NY 11971
RE:
R~idence at (no #) Avenue B,
F~.shers Island, New York :
$CTM, No. 1000-006;00-02.00-022.003
Dear Mr. Fisher:
Please be advised that I have inspected the referenced residence
from a structural point of view. In my opinion, the residence is
structurally sound and contalins no apparent structural defects.
My op2, aion is based on my own observations and also on ehe fact
that the residence has been standing in its current location for
the pa2t thirty years without having sustained any apparent
damage from settling or from the elements.
Cordie~l~/
Richard H. Strouse
RHS/md
THE NEW YORK BOARD OF FIRE UNDERWRITERS PA~E ~
1~913 .UREAU OF m.=CTRIC,TY
~- 85 ,JOHN STREET, NEW YORK, NEW YORK ~0038
0.,~ ~RIL 09, ~996 ~...~.a.. ~o, ..f~ 11421396/96 ~ 3826~
THIS CERTIFIES THAT
o~y t~ el~trieal equipment ~ ~eri~ be~w and int~uced by t~ ap~ican~ ~med on the a~ve application number in t~ p~m~es of
RONALD PEDLEY, A~NU~ B, FISH~RS IS~, N.Y.
in the fotlowlng locatlon~ ~ Basement ~ Ist Fl. ~ 2,,d ~. OUT Sec,ion Bilk Lot
~s examined on APRIL 03,1996 and fouhd to be in compliance with the NaMonal Electrical Code.
FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS
OUTLETS SWITCHES FLUORESCENT OTHER
DRYERS
)THER APPARATUS:
ENTIRE PREMISES- I
SMOKE DETECTOR: - 1
~NO VISUAL DEFECTS.' "An electr:ical
survey has been made of the exposed
electrical equipment, iii t~ie
premises indicated.," "No obvious
unsatisfactory condition was found.
E R
NO, 0 E COND' OF CC. COND.
C E
OF HI-LEO
NO OF NEUTRALS A.W.G.
OF NEUTRAL
WALL ROBERT E. ~' LIC. #2~55LE ': eN~ht ~aoi~
This certificate m~sT.~J~J~l~affe,~'e~D~ny}~pnO~;~lJ~ to the office of the Board if incorrect. Inspectors may be ~i~nfified I
COPY FOR BUILDING DEPARTMENT.' THIS COPY,OF CERTIFICATE MUST NOTBE ALI~ERED IN ANY MANNER.
IE~D' INSPECTION REPORT DATE COMMENTS
'0~ATION ( 2~ ) [ .......
ii ,z,, .... , '
STAr~ Cm~R~ II "
CODE II II
'~/II / /','I // '
ADDITIONAL COMMENTS
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
Exmnincd . .) ....... , i. '
Approved .~./l/~.. .......... Permit No..-~...~'.~'..~"..~.,j~'
Disapproved a/c ..................................... ,
·
. APPLICATION FOR BUILDING PERMIT
3 SETS
SURV£Y
CIIECK
SEPTIC
OF PLANS
FOR}I
hO~ L PY
CALL
~tAIL. TO:
Date ................... 19...
INSTRUCTIONS
a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
ets 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
~r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appLi~
:ation. .
c. The work covered by this application may not be c~mmenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issued a Building Permit to tile applicant. Such permit
halt be kept on the premises available for inspection throughout the work.
e. No building shall be occupied or used in whole or in p~rt for any purpose whatever until a Certificate of Occupancy
hall 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
luilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
',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 to
dmit authorized inspectors on premises, and in building for necessary inspe~ions. . I
(Signature of applicant, or name, If a corporation)
Stephen L. Ham, III
.4§ Hemp. ton Road~ $outhara[~ton NY 11968
(Mailing address of applicant)
;tare whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.-
,lame of owner of premises Marjorie P.e. dlex
(as on the t.at roll or latest deed)
f 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 ......................
Lo ationofl d whi I p p dwo kwillb d '
C an on c I ro ose r e one ........... , ........................
(no #) Avenue B Fishers Island
House Number Street llamlct
County Tax Map No. 1000 Section .. 006.00 Block 02.00 Lot 022.00.3
Snbdivision Filed Map No
..................................... · ........ q ...... Lot ...............
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction: "
a. Existing use and occupancy S.i.n.g~F~mi.l.y. ~%ell~g ' '
b Intended use and Single-family dwelling
· occupancy ....................................................................
-,~lc); l~c,, ..'. ........ .'~.d'.htloa .......... Alteration ..........
Repair .............. Rembval D liti .A.S BUILT
t, · ............ cmo on ............. Other Work,
~S. BUILT .ff.S.T ~2~'~ ~-e~O~ (Desc iption)
4.. Estimated Cost ......... t ......... . ........................................
i "' ! .) ! ~ :" "' (to be paid on filing this application)
5 If dwelling number of dwellingiunits Number of dwelling units on each floor
If garage, number of cars
6. If business, commercial or mixed occupancy specify nature and
7 Dimensions of existing structurqs if any FrOnt
~ _ extent of each type of use ............... . .....
· ' Rear...".".':. Depth
Height Nm~er o f S~ories ............... ''" .....
' Dimensions of Same structure with ...........................................
alterations or addihons Front Rear
8.
Depth ' Height
.................... "' Number of Stories
Dimensions of entire new construction: Front Rear ' ' ......... i i~
· Depth
Height Number of Stories ....... ~ ........... '?" ....................
Size of lot Front I ......
....... , ........... Rear .... Depth i
Date of Purchase ' '~ ' "' ............ ........................
' · · .'. Name o£ Former Owner
Zone or use district in which premises situated ' i .............................
.10.
11.
12. Do ope d ti i l~t i gl dinah
es pr se construc on v o e any Eon n aw, Or cc or regulation: ...........................
13 Will lot b graded
14' Name of e re ........... . ................... Will excess fill be removed from premises: Yes No
· Owner of premises · · ~. ·. ............. Addr "
· . ess ................... Phone No ...... ..........
Nam f A hit ' '
e o rc ecl .......... i ......... Add
........ tess .. Pt N
Name of Contractor .......................... Address .......... PI,,--,' M,-, . . ,,
: Is this property within ,~ ~ u~ a ezra± wet~anu't *Yes ........ ~,~ ~ , . ' ,
[5.. *If yes, Southold Town Trustees Permit may be required.
Locate clearly and distinctly all !buildings, whether existing or proposed, and. indicate all set-back dimensions from.
property lines. Give street and ~bl .ock, number or descriptioh according to deed, and show street names and indicate whether:
interior or corner lot. .
TATE OF NEW YORK
OUNTY OF .S.UFFOLI S.l Stephen I/.: .H.~.m.~. III
(Name of individual signing: contract)
rove named.
b ' lg dly n, deposes and says tha~ he is tim applicant
ell U swot
~ (Contractor,~ agent, corporate officer, etc.)
'said ow.ncr or owners, and is duly a)utl?orized to perform or.hav,e performed the said work and to m.ake and file this
plication, that all statements containqd m this application are true to the best of his knowledge and bebef; and that tho
)rk will be perfo~ed In' the m~ner se? forth in the application~filed therewith..
tom to before me tills '
.................. day of... ............. , .
N ~66, 6~
~Y 10~6~3
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N/F MIGHAF~ M~GoFtMtCK e~, al
S~I~FOLK COUNTY TAX M~o ,~F.
DIST. I000 S~'~. 6 BL. OI~K ~ LO~ ~.$
TO ~MMONW~ALTtt LAND
IN ACCOtN~tNC~' WFFH TH~' MINIMUM
OF ~'HK NKW YOttK
II