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Home My WebLink About23255-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-25234 Date SEPTEMBER 4, 1997 THIS CERTIFIES that the building Location of Propert~ MONTAUK AVENUE House No. County Tax Map NO. 1000 Section 10 Subdivision ADDITION FISHERS ISLAND, N.Y. Street Block 8 Lot Filed Map No. Lot No. H~let 1.2 conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 5, 1996 ~ursuant to which Building Permit No. 23255-Z dated FEBRUARY 22, 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 SECOND STONY ADDITION ON EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to of the aforesaid building. LISA REALE (owner) SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-410382 & N-410383 - FEB. 5, 1997 PLUMBERS CERTIFICATION DATED JANUARY 15, 1997- EMERY NEMESKAY Rev. 1/81 ild~ng Inspector FORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. N~ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date .,~.., ~'~ 23255 Z 'Z-"- .................................................. Permission is hereby granted to: . / ................... CountyTax Map No. 1000 Section ......... ./~.~. ......... Block .......... ~ ........... Lot No ....... .~..'.....'~/. ........... pursuant to application dated .......~ .................................... 1 9..~. ...... Building Inspector. Fee $ ...... and approved by the Rev, 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application mush 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. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and Ppre-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 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory buildin~ $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buitdinm - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary ~ertificate of Occupancy - Residential $15.00, Commercial $15.00 Date . .~--~.. ~{ .... (~. p. ~.?.~..~. ........... New Construction...~ ..... Old Or Pre-existing Building ................. ~ Location of Property ..... .~..p,l~..T',..O..¢~..!~....~.~,.~.~...(.:~,.~.... . ..................................... .. House No. Street Hamlet Onwer or Owners of Property .................................... COunty Tax Map No 1000, Section..ZC.?.~.~.~...Block..J..O.~.7.~.--....Lot .... ~....2~. .............. Subdivision .................................... Filed Map ............ Lot ...................... Permit No.z~zs~ ~oDate Of Permit. ~l~/?(~ .Applicant.~.(:~.O,../~ ~.~t~ Health Dept. Approval.' ......................... Underwriters Approval ........................ . Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate..~.. ...... Fee Submitted: $ ............................. TOWN OF SOUTtIOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. ~--~---~ ~ _ Owner ~ ~ ~_~ /~~ ~ ~[~ ~ (~le~se pr fnt) ~ Plu~er ~ f~ ~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber' s signature Sworn to before me this 19_.~. Notary Public, Notary Public NOTARY POBhIG, NEW~YORK~$TAY~ NO. 01WA9509185 QUALifieD ~N SOFFO[K GOUNTY~ TERM EXPIRES OCTOBER IrOI}HllATTOII (I,';T) .11 I~OU tit)AT I ()ii (2~1[) ) . COI)I~ AI)I)I't'I()ItAI, COHHENTS: FFD - ,5 '%. FEB - 5 1996' BLeG. DE[ . TC)WN OF SOH !'HO! r, Exa,ni,ed ............. i917/; /~' 7-,..,-' , ... Disapproved a/c .............. ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 APPLICATION FOR BUILDING PERMIT B~)AED OF HEALTH 3 SETS OF PLANS SURVEY ClIECK ......... HAIL TO: O6%qo Date .~fil~!~.A,..~."["..~...~. .... 19% INSTRUCTIONS /g8 a. This 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 sfi'eets 6r 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 Insp6ctor will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No bu. ilding 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 authorized inspectors on premises~ and_~in building .... for necessaw._ i~pections./.) -- (Signature of applicant, or name, if a corporation) ~ , (Mailing address of applicant) 06~O State whether applicant is owner, lessee, 'agent, architect, engineer, generai 'contractor, electrician, plumber or builder. ° Name of owner of premises ........................... (as on the tax roll or latest deed If applicant is a corporation, signature of duly authorifed officer. ' (Name and title of corporate of. ricer) ; Builder's License NO. ff'.~..[.~...O.Z 7: .~. ! ....... Plumber's License No. ~ ~ ~ ............. Electrician's License No..~...q..~.4..-'..~. ......... Other Tra, de s License No Al& d 66 t,4A ) · 1. Location of land on which proposed work will be done. Ay ltouse Street Number Hamlet,, Cou'nty Tax Map No. 1000 Section ...:...' ...... ..:. ~ Block ............ :,,J... Lot ,, .....; .............. Subdivision ........ . ............................. Filed Map No. ..... : ..... ': . . LC . tc ............ (Name) 2: Stat~ existing use and occupancy of premises and intended use and occupancy of proposed cons?u¢Iion: a. Existing use and occupancy ...~.J.d/-~'} ~.~. ~.~.~.~3 Le.'~'. ' · b I d d doc ~l ~.(.~'~.~ · nten e use an cupancy.... . . .. . .. ... ................... k ( PPli ) ' Additi .3. Nature ofwor cheek which a cable: New Building on Alteration Re r .............. Re oval ...... Demolition ..... : ......... Other Work 4 E timated Cost ' ·. . O0 cr n ~ .(~.~..~. (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 . .~J-0.~.~... " ' .......... 6. If business, commercial or mixed occu,~ancv s.~ecif ..... ' / ,- :, v y ,at?re anu exten[ oi,eacu type of use ......... 7. ,D.l.m.ensions ~o~e~xmti_n~.st.ructm-es, if any: Front .... ~,~,'.';' .O.!~.Rear . .~.5~ -C~ 0 n~,,,, '~at-' d i ..... ne~gl~t ... !.~.. 7.(~.: .~. Number or~*,,~ ~IM ~ ' " ............ ~' .... ~"~' · · ~ ....... Dimensions ofshme structure ~th - ~''~ ......... . . ' ......... iL' 'fi ............................... ' r~,~- .~,,, ~ ,~ ~ w aiteratmns or ad. dmons: Front I.~...0. . . R~r 7_.~ ~ -~ 0 U ,,. '.' ...... -~ ......... ,.. Height ...~.~· .. ,6 .... . Nu ..... '-'"'-'"' ' ' 8. -~mens~ons of entire new constructio,. ~,.t I O,' - r~, .... 2.' ' m, ~oe~r m,?~?nes .. i .e~.._ ............ Height .d?.~ .--~. ". ~,,,..~_ ~'~5'~.''' 'X~'~,' ' ~J'iq6' j?ar ..._ID .-:.t4 ...... D,~pth .'~(D~ 7'.~!.. , ,~. ~ · · · · >;.~;..,j~-~u,~rotatones .~.~...k.~., . ~'.~.C~.I~.- ~,IDDF~IOIxlI · ' 9. alze otlot Front . .'O-'~k .~,~. '. o~- ~b~./¥&~' '~%1.~' a'~.'ff ........... ~ '> .... · ..... ..... ,i ......... ~,~r ~'~ .~O...~ .t 0I 10. Date of Purchase ~ I q~r~ [,ffg~¥W~g~(e3.'~(~o.5~.a.p_~th . M.~'~).{o~(. ,g. ~.[., .... · . .... o,.,. ,~. ..... ' ......... l'~ame ofF6i6fier i3wner".~.]'.l~A~t~ao.a(%~5*~k £¢.oa 11. &one or use aistr,ct ,n which premises are situated ~,~i t~t,l-rqa, ............. ' "~rX~OTq: ..... 12. Does proposed constr~u~non v,o,late any zoning law, ordinance or regulation: ~ . ..... ]'i 'i.'~ '13. Willldt be reeraded IMO · · ........ .... ~ · ..... ,. ;..:..; · .,~ .......... Will excess fill be removed from premises: Yes ,, 14. ~ame ozuwner of premises .h-3~../},,,.~b,!~lY~. Address .t~,Q: .l~..~q~. , Phone N~..t.6.~.Yg~';~6~ . Name of Architect ......... ! .......... ,. · .' .... Address ........ :, .......... Phone No ............... · Name of Contractor .g~ .(,,~d~. ~j~,R~I..~;:x~)~,4..Q3jxl .T., . Address t~.,.O,:{~:~)~..7~.~ ..... Phone No.(r5..I.~) .q~7 15. Ip thi~i~r,o, ePserYsYouW~cth~n' ~300 f_eet o'f a '~i~al wetla~a~ *Yes ....... ~ ..... :.. '' · **, , ao~_a ~own '~'rustees Permit may be required. ' ~ ''."'.' PLOT DIAG ILkM Locate clearly and distinctly all{ buildings, Wheth&r existing or proposed, and, indicate ail set-back dimensidns from property lines. Give street and block humber or description according to deed, and show street names and indicate whether interior or corner lot. .- STATE OF NEW YORK, COUNTY OF .~'~ L.~.O~ ..... S'iS . :... i .............. (Name of individual signin~ contract) above named. being duly sworn, deposes and says that ~ ~s the applicant (Contractor ...............................' .............. ~ agent corporate officer etc ) ~f said owner or owners, and is duly 9ut~ofized to perform or have perfo~ed the said work and to m&e and file this ~pplication; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the ~ork will be perfo~ed in the manner set forth in the application filed therewith. ~wom to before ~ne this ; NOTARY PUBLIC, NEW ~ORK STATE ~ ...g.~9, ..... NO. 01WA9509~85 . . · . r ............. L.t,I