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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-24302 Date APRIL 24, 1996<
THIS CERTIFIES that the building ADDITION
Location of Property CRESCENT AVE. FISHERS ISLAND, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 6 Block 1 Lot 10
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 30, 1994 pursuant to which
Building Permit No. 22392-Z dated OCTOBER 28, 1994
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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to ROBERT PATTERSON
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
r
B d" g I spector
Rev. 1/81
FORM NO.3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N Date ....~.~l.J.. r 19.,r./•.••
22392 Z ~
Permission Is hereby granted to:
gar...../. /
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.....ice .d~
...~...7` Z.i.
...~,p.~ .-...0.....................
at premises located at.......
County Tax Map No. 1000 Section Block Lot No. ........19............
pursuant to application dated . ~..........................119 x , and approved by the
( Building Inspector.
E
Fee 5...7c 1
W 7
uilding Inspector
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
pre-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.
Fees
1. 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 Building - $100.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date
Construction........... Old Or Pre-existing Building. .x .
ttion of Property. .,crescent'Ave., Fishers Island,N.Y.
House No. Street Hamlet
!r or Owners of Property. •Mr. Robert Patterson
ity Tax Map No 1000, Section..6........... Block ...1............ Lot...19.................
ivision ....................................Filed Map L
it No.~.239~.~....... Date Of Permit. l9:128,!94 Applicant.Z&S Contracting Inc:.
th Dept. Approval ..........................Underwriters Approval.........
ning Board Approval
est for: Temporary Certificate........... Final Certicate..~,........
Submitted: $25..00
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CENTERBROOK Date: 22 SEPI- 9,6
pATT~~~N ~Z~Sip~NGE
Architects and Planners FiSHbYiS ISLAn D Scale:
P.O. Box 955
Essex, CT 06426 Dw,
(203) 767-0175 ~~OPOS ~D If~I pOD ~C~ =S
(203) 767-8719 fax Chk l7
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INSULATION PER N. Y. H
STATE ENERGY
CODE
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4. FINAL
ADDITIONAL COMMENTS:
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CENTERBROOK Date: ?.2 SEPT 9,~
pATT~~soN I~~S~d~NGE
Architects and Planners FISH W4 154AN p Scale: QI'
P.O. Box 955
Essex, CT 06426 Dr w.
767-0175 pR oPo~ Eb Wpop ~GK~
(203) 767-8719 fax
Chk.
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nOAr.tt or HEALTH
rOHMNo.1 3 SETS OF PLANS
I; 4I ®CT'_ 7 TOWN OF SOUTi10l_D SURVEY
BUILDING DEPARTMENT CHECK
TOWN IIALL SEPTIC FORM
llLO
G. DEPT.
v.__m~TOWNOFSOUTHOLO SOUTIIOLD, N. Y. 11971 71
TEL.: 765-1802 NOT IPy
t/g CALL
Examined rL4~~~~'...... 19 ~7 MAIL TO •
01
Approved 19~ I'ernit No..g4 . a~9
Ii Disapproved a/c . .
i` (Bt ding Ills CIO
APPLICATION FOR UILDING PERMIT
go'
/J
Date 3Q/ 19
j INSTRUCTIONS
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 streets
j; )r areas, and'giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
ation.
ii 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 Buildmtg Permit to the applicant. Such permit
I; hall 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 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
'I luilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
tegulations, 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
authorized t
i nut inspectors on premises and in building for necessary inspections.
'i (Signature of applicat , or name, if a corporation)
Ny . Faso..
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
pox
! Namc of owner of premises r..................... .
(as on the tax roll or latest deed)
'l
If applicant is a corporation, signature of duly authorized officer.
(Nam nd title of cor ora a officer
Builder's License No. .
Plumber's License No.
Electrician's' License No. .
is
Other-Trade's License No. ~~&R. .
.
. Location of land on which proposed work will be done
...................C K s...... ..N
{louse Number Street Ilanllet
County Tax Map No.' 1000 Section , .....6..... , Block Lot e ~ . . .
Subdivision Filed Map-No. Lot
j. (Name)
Stale existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy S'~fp~.... ":~i .
b. Intended use and occupancy 5~~.... .
I ~
i i
c
Repair of work (check which
it
1. .
entovalable): Nr.w Ilulldina Addition Altetatiou
' ' ' ' Demolition . Other Work . . ,
4. Estimated ut~ (Description)
Cost ....S Fee
W, 6T)
, . .
•
garage, (to be paid on filiutl? this application)
5. If dwelling, number of dwelling units Number of dwelling units on each floor .
If number of cars
6. If business, commercial' or mixed occupancy, specify nature and extent of each type of use . • ' ' ' • . ' . .
7. Dimensions of existing structures, if any: Front Rear Depth .
Height Number of Stories
Dimensions of same Structure with alterations or additions: Front Rear .
Depth . I'eight , . Number of Storics , . .
8. Dimensions of entire new construction: Front • , Rear Depth • . .
Height Number of Stories . . . . . . . . . . . .
9 . Size of lot: Front .
Rear ear . Depth
,0. Date of purchase Name of Former Owner .
1. Zone or use district in which prentlses arc situated .
,2 Does proposed construction violate any zoning law, ordinance or regulation: • • • . . • , • . lY.O.. .
3. Will lot bb regraded , , , , , , , , , , , • • • , Will excess fill be removed from premises: Yes No
4. Name of Owner of premises , , , ,
Address ...................Phone No............... .
Name of Architect
............Address ...................Phone No.............
Name
of Contractor . . Address . . Phone No
property within Is this 300 !feet of a tidal wetlnndY >Myes........ No...X
*If es, Southold Town' Trustees Permit may be required.
PLOT DIAGIWI
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
iterior or corner lot,
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FOR F't'1Um-klb C01NCr,ETr-
RO UGH - FR AN04g d(3 & F'LU gWNG
4'.. 6='i1+1AL C',0N8TRUCTION MUST
RC COMPLETE fiOR C.(]
ALL CONSTRUCT10h: S14i.1 L RIVET
6'I-lE REQUIREMENTS OF THE N,A"
STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
'A'fG OF G1V Lr S.S
)UM 'Y O .
being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
bvc named.'
is tile (~~re..
(Contractor, agent, corporate officer, etc.)
:said owner or owners, and is duly au+horizcd to perform or have performed the said work and to make and file this
1lication; that all statements contained in this application are true to the best of his knowledge and belief; and that the
rk will be performed in the manner set (forth in the application filed therewith.
orn to before me 111 s
IRY~
tary Publi . ounly
i
i'Ni` MAS 6.500E 1 rY iR.
Nattlry Public Stale of Now York (Signature of applicant)
No.4606559
Ougllilea in Suffolk County
Torm Explros 12/31/gr
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- 13LDG DEPT OF SpU7HpLp ~
TOPOORAPHIG MAP
zo z PROPERTY OF
m ° 0
o N MARY DENW ARY
m
2 AND
~n
276. 10 276. 10
N 45 15'00 N 45 15'00 E> MICHAEL 5. r `{RA'1
20 10 0 o za BLOCK 8 LOT II
FISHERS ISLAND, NEW YORK
A(E OF NEw y GRAPHIC SCALE IN FEE C SCALE IN FEET
7 ,
G !EVISIONS
~ rJ m REVISIONS
DATE DESCRIPT a DESCRIPTION
0~ ,r -kc 6 1"MY°fa SET~YIG LGC C G CHANDLER, PALMER & KING - Uo BROMcture, Engineering and Surveying ll0 BROMV.Y NORVICX CT 06380 RO}111Rpy3q/ FAX !p}Nf-7111W
J~
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DATE: MARCH 15, 1995 :H 15, 1995
SCALE: 1' = 20' = 20'
SHEET 1 OF 1 OF 1