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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-23418 Date DECEMBER 21, 1994
THIS CERTIFIES that the building ADDITIONS
Location of Property 715 SHIP'S DRIVE SOUTHOLD NY
House No. Street Hamlet
County Tax Map No. 1000 Section 79 Black 3 Lot 32
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 23, 1994 pursuant to which
Building Permit No. 22315-Z dated SEPTEMBER 12, 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 A DECK AND PERGOLA ADDITION TO EXISTING ONE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to FRANK & FLORENCE ANDERSON
(owner's)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Bui ding In pector
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)
Date SEPTEMBER.. 12.>...
N 199,'.......
D_ 22315 Z
Permission Is hereby granted to:
AL FICKEISSEN - A/C - ANDERSON, FRANK
P.O. BOX 1451
SOUTHOLD,, " !1971
CONSTRUCT DECK AND PERGOLA ADDITION TO EXISTING ONE FAMILY DWELLING AS
to
APPLIED FOR.
. .
.SHIP'S DRIVE, SOUTHOLD NY
at premises located at............IS .
County Tax Map No. 1000 Sectlon ...........79.......... Block Lot No. ..........1.32
pursuant to application dated ...........AUGUST 23, 1994..........., and approved by the
Building Inspector,
Fee $.cS%...
' Building g Insp Insp'ector.............................
Rev. 6/30/80
Form No. 6 -412aa A
TOWN OF SOUTHOLD
~ry BUILDING DEPARTMENT 7WF_.
DEC 19 19M TOWN HALL
765-1802
BLDG. DEPT.
,,.,,TOWN,QFSOUTHOLD APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. 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.
JT 6. Submit Planning Board Approval of completed site plan requirements.
OB. 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.
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 building $25.00,
Additions to accessory building $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Buildine - $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 ....~?B /995
New Construction........... Old Or Pre-existingBuilding
Location of Property... Z/5 .............i~JS _ okl/(,............... Sv 7~f~G/~N...~.......
House No. Street Hamlet
/ %F P .C...... /GE ~~s
Onwer or Owners of Property....
County Tax Map No 1000, Section..~~~° ....Block..."`6`?........ Lot. 03~
Subdivision. .......~.../Firrll1ed Map.._SyU....Lot.... .a
Permit No...? 131. ...Date Of Permit.. 91:..j.Il......Applicant..
Health Dept. Approval....... ..............Underwriters Approval.....
Planning Board Approval 1
Request for: Temporary Certificate........... Final Certicate..
Fee Submitted: $...~1/5J '
acs w~ a : .
Ono- _i~ a~l L~g APPLICANT
co Fax (516) 765-1823
Town Hall, 53095 Main Road C2
P. 0. Box 1179 Telephone (516) 765-1802
Southold, NewYork 11971
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
November 30, 1994
Mr. Albert T. Fickeissen
Box 1451
Southold, NY 11971
Re. Frank Anderson
Prem: 715 Ships Drive, Southold NY
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
xx An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
xx The check is not on file. $25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 22315-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULAT N
[ ] FRAMING [ FINAL
REMARKS:
DATE l INSPECTOR
~m .
M-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS: l^
DATE / 7 INSPECTOR
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BOARD OF REALTIt
FORM NO.1 3 SETS OF PL.1NS
TOWN OFSOUTHOLD SURVEY
BUILDING DEPARTMENT CHECK _
TOWN HALL SEPTIC roan
SOUTHOLD, N.Y. 11971 ~cK~"(SS (y
TEL.: 765-1802 t:O-, ZF'f; +y
Examined CALL
. % 19
MAIL TO:
Approved A........ , 19f/Kermit No.
,.S®f~~-~?tcl~ N. J, !!471
Disapproved a/c '
._P. . .
f r (B ildin nspec or
1 2 3 1994 APPLICATION FOR BUILDING PERMIT
TOWN OF SOUTHOLD Date .......cheapus.f., 19 2
INSTRUCTIONS
a. This application must be completely 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 Occupant}
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 ode, aad, regulations, and to
admit authorized inspectors on premises and in building for necessary insp ns.
..L•? • • .rte?
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.................~.......................p................................................
Name of owner of premises .../.-~.~'g!1k., /-~Y711~r`won
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
m~.
(Name and title of co' orate officer sty ° -
4
Builder's License No. 1.9.6,1P,y Ij- r AS 2 9 04-
Plumber's License No.
Electrician's License No .
Other Trade's License No .
1. Location of land on which proposed work will be done.
71~ .................~h_?', s.. 5 911...N..°l;..i! 7r
House Number Street
Hanilet
County Tax Map No. 1000 Section Q, ,75PPA Block... 03 r.O. P::: , • , Lot..0,3 A P.bb,p.....
Subdivision .eo. Uket? d.U~pcc~5..9$:~ -fF Filed Map No. j( p ?a~ Lot ../.Z .
(Name)
1. State existing use and occupancy
/p of premises and intended use and occupancy Of proposed construction:
Q. 1 il..: 1 N~•j! c
a. Existing use and occupancy . 0 qt• ;~GlVrt r ly. . G1!.tdJ.Nrf 'i::......c~':•a~syr;•c„ii...... .
b. Intend use and occupancy Ipt r . fx•'t''{ki
Nat ure o work (check check , , which applicable): New Building ' • • • • - • • • • Addition Alteration
Re air
(
r p Removal • , , , Demolition " " " "
OtherlVork
4. Estimated Cost u?p?SC~G,'OO (Description)
Fee
(to be paid on tiling this application)
S. If
d welling, nu umber of dwelling
If garage. number of cars ° units , , , , (3 h• e Number of dwelling units on each (]oor , .
•
6• If business, commercial or mtxc+d occupancy, specify nature and extent of.each type of use
7. Dimensions of existing structures, if any: Front ....5, 7 ' ' • • • • ' • • • • • • .
Height Number ofStorics u?e~ Rear Depth
Dimensions of same structure witll alterations or additions: Front • • • '
Depth . . } Height . Rear .
8. Dimensions of entire new construction: Front . Number of Stories , , ;
Height Number of Storics Rear Depth
.
9. Size of lot: Front J~ `!Rear , ,
10. Date of Purchasea~ V.~ r 9T6Z. Depth 4s`.O6 , ;
rY . • . . Name of Former Owner W4yVtew..~?a~cl~.~s
11. Zone or use district in which premises are situated ,
12. Does proposed construction violate any zoning law, ordinance or regulation: . .
13, Will lot be regraded • , (VO !VO. • • .
14. Name of Owner of remises ' er • • • Will excess fill be r moved from premises: Yes No
premises ~rp1k.6,14 .S VA Address 74 .,JA0,.SvAd
Name of Architect 7 ~ hone No....... J•5 T
'f:' ' ' ' ' ' • • • • dAddress~q. Phone No. , ,
Name of Contractor `T
15.' Is this property within 300 feet of a tidalwetland? . * %yes o.9.No...
*If yes, Southold Town Trustees Permit may be required. " N. "
PLOT DIAGRAM
Locate clearly and distinctly all ,buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
I
• I~
,TATE OF NEB
:OUNTY OF`y (>1~ S.S
(Name of individualsi nin ntract) being duly sworn, deposes and says that he is the applicant
)ove named.
e is the c6V4.r'i e*q e: .
(Contractor, agent, corporate officer, etc.)
said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the
irk will be performed in the mannersct~forth in the application filed therewith.
'om to before Inc this
....day of. 19 1e.
Lary Public, .
CSI L ^ County
ry Publio, of NOW
No.4878606 my
cr?? : . .
CommC on Ettp a t9et~lernber Yo 77
& 1~-~~ (Signature of applicant)