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HomeMy WebLinkAbout21775-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22764 Date DECEMBER 3, 1993 THIS CERTIFIES that the building ALTERATION Location of Property PRIVATE RD. OFF EAST END RD. FISHERS ISLAND, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 4 Block 3 Lot 3 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 20, 1993 pursuant to which Building Permit No. 21775-Z dated NOVEMBER 15, 1993 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 ALTERATIONS TO EXISTING ACCESSORY BUILDING AS APPLIED FOR. The certificate is issued to JOHN & ELENA BRIM (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Bu` din Ins ec or 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 5............ 19. j N® 21775 Z I Permission Is her y granted to, I /...0.9..!. 4V.(/ F/;. ~Vj . A? to -z~e 44z4el- -,;r :5 Irv... i j at premises located at..... T .k'C / ••••x • •r County Tax Map No. 1000 Section Block : Lot No. pursuant to application dated 19fr............ and approved by the t Building Inspector. j Fee $...G~,l`.~.~ L..... ` . ullding Inspector Rev. 6/30/80 TOWN OF SOUTHOLD BUILDING DEPARTMENT„ . s''E TOWN HALL . 765-1802 BLi1~:O4FY; TOWN OF SOU HOLD f 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. 6. Submit Planning Board Approval of completed site plan requirements. B. 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 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,gCo ercial $15.00 Date .....Y.~lct~l.W3 New Construction........... Old Or Pre-existing Building.. Location of Property I- 'E House No. Street Hamlet Onwer or Owners of Property...... N M, 2 2ounty Tax Map No 1000, Section..-I Block 3 ..........Lot... subdivision..,E I.7C,,o;.......... r........... Filed Map,T'. -'V V ...Lot.. J 'ermit Date Of Permit ...~l~~~Gi3.Applicant©~~l!~ V. 9~'E......... fealth Dept. Approval ..........................Underwriters Approval......................... Tanning Board Approval tequest for: Temporary Certificate.........,. Final Certicate...... lee Submitted: APPLICANT' P1 LD I::Si` ~TiO:J III) ATE COMMENTS - U 1 . I mV\ 7OU11DATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING 3. m INSULATION PER N. Y. y STATE ENERGY CODE 4. FINAL E ADDITIONAL COMMENTS: x M! a y H Z i m 9 r ro H BOARD OF HEALTH P 3 SETS OF PLANS FORM NO. 1 SURVEY ` ' TOWN OF SOUTHOLD CHECK _ NOV 13UILDING DEPARTMENT SEPTIC FORCt TOWN HALL SOUTHOLD, N.Y. 11971 NOTIFY; Mw_ TEL.. 7G5-180,1 CALL Examined ll ~ 19^~ MAIL T0: Approved J 1Permit No.IP'V7 7 . . Disapproved ale . (Bu'dtn^ spector) APPLICATION FOR BUILDING PERP6IT Date ..i~ ~0.~ 9 3...., 15... INSTRUCTIONS a. This application must be completely filled in4b r` sets of plans, accurate plot plan to scale. Fee according to schedule ~r in ink and submitted to the Duildit>; Inspector, with s b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which ispart 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 permit 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 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 Lam, 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 rcgtttatrons, and to admit authorized inspectors on premises and in building for necessary inspections. 1 (Signature or' applicant, or name, if a corporation) lo°j ta~sf t y !J.1..(0.0.11 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .~irZ~tt . . Name of owner of premises 3'o .H..a.G ~ 'O L-C- .e-.D,._A m . . , (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ICA FD 0 T Builder's License No. YAaOLAO .C-C. ZI ~41 • tl 1 j"` Plumber's License No. Electrician's License No. , , • • • • • T - ,yti 0 Opp 1~ Other Trade's License No . 1y I, Location of land on which proposed work will be done; " ' d tZ1~Ar1? PG~r~ASj 1 a. ;,1,ISN LS 1SLA~~ (louse Number Street Hamlet County Tax i\fap No. 1000 Section 7-.......... : Blocky Subdivision O Lot : Ts . ,i". . Filed NlapNo. 21 Lot (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing (ILAu use and occupancy . • - b. Intended use and occupancy . /.~C . ?u . . .IYA . Two fsp~ r6 l 3. Nature of work (check which applicable): New 0uilding Addition ,Utcratton f?615 Repair Riimoyal Demolition .Swimming pool. Tennis Court Accessory Building Fence .......Other Work. 4. Estimated Cost Fee .7g'•.............................. 0-0 (to be paid on filing this application) irdwclling, number of dwcllin- nits . . . . . . . . . Number of dwelling units on each floor . if garagc, number of cars . " 6. If business, commercial or mixedlroccupancy, specify nature and extent of each type of use . • . . 7. Dimensions of existing stavctures, if any: Front , , , , Rear Depth ..l r~ r: Hei lit C) Nui4cr of Stories . Dimensions of same structure with alterations or additions' Front 97AM Rear Depth ~1 . , Height . Z'3J"??0 • • • . • . . Number of Stones . • • . • • . • . S. Dimensions of entire new constn{ction: Front ....•.•......•Rear Depth Height Number of Stories • . • . 9. Size of lot: Front ...........li..... Rear .......................Depth....................... . 10. Date of Purchase . • • • , , , Name of Former Owner . 11. Zone or use district in which prcattises are situated . 12. Does proposed construction violate any zoning law, ordinance or regulation: . • • . . . 13, Will lot be regraded Will excess fill be removed from premises: Yes . • No.. 14. Name of Owner of premises A#•,F~ao. W.ty14ddress VP~p 3C *A?. W5 ~~'Pltonc No. tf 36t!•,7v7z, Name of Architect ~>:r e , . Address It11 W. C1 L~+cC: 111 ~I P) Phone No.itY. _.7.~7 122 f Name of Contractor ~9. Q flue Address 1. e l.. Pd.. 661 . , . Phone No.2O.3^. +Z G F $ . IS.Is this property located within 100 feet of a tidal wetland? *YES.... NO.... *If yes, Southold Town Trustees Permit may be required. 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 I ~Ap~(~ k 4s NotED DATE: P q /7 802 a HE r 17t_ (704r1N( INS r _CTT At T P (71i 1. F~lltNt~r3TION ONS.. ."mo 1=C.if At)F.tRE'fi tCONCr.'ETF_ ? RC3tt RE'(pulREp 61H Stu Pr f ! luTl()N3PR•A INC M& PLUnggfNG . f"INA, L Or. ('OI, - 0Ok'STRuCT!ON !tr1 dil.L (:f3A15Ti.ETi' P0R C.O. 1157 Tl•4re RUC'rlom GALL mer-T RFflltdRFENTS C0N "T`' Or THE N. Y. Tf: STRU ctCor . i)FS;GN on NOT (:ThON RFSPONSI FE ERGY DNSrRUCTION ERRORS STATE OF `EW YORK, S,II COUNTY OF . . iS ...•....(.~htV ( - • • • • • • • • • • • • • • • being duly sworn, deposes and says that he is the applicant (Name oCin(livid ual signin-con tract) above namcd. 4e is the .1.~1 (Contractor,, agent, corporate officer; etc.) ' N said owner or owners, and is duly ;authorized to perform or have performed tlir.sa d work and to make and rile this application: that all statements contained in this application are true to the be of his k ,owlcdgc and belief; and that the work will be performed in the manner set forth in the application filed therewit . 'wom to before me this .day of . ~Ypv i _ . 19 • p, 40tary blic (J \IO _ • Count ~.I Y (T~ 61 09,0¢ Q. NOONAN, JR. . Notary Public, State of NOW York • • . • ' No. 31.6001776 (Si,-nature of applicant) Ouailfied in Ne Commis sion Expire w k : 21'-44 - - ' - , - - - - - - - - -'rte-` - - - - - ~ - ~t ce a I-I Cod Dvi LIB faP t 10`~ "o~ S $~L ha~F,l ~xl S G p lj'loW IF~~I~! E. zyl`' 1'l~ 6, I f' IaE I if 1r ug tc\ ~~14Gr~'fF~47 oG'~E 'T'-o" HI4( I451PE ~V Y~ I L Oliver Cope • Architect . Dare,, mj Scale: ob No.: 109 West 17th Street Project: 6, (L 1 t-1 Ho 0 New York, New York 10011 r'ue. PIN) + Ot,6J O Tel 212-727-1225 Dwg. No.: Rev. No.: ev. Date: Fax 212-675-5979 Drawn By: pecked By: CM69bi Oliver Cota• MA6tce, 103 All RIPA, Rommel