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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-24147 Date FEBRUARY 1, 1996
THIS CERTIFIES that the building ACCESSORY
Location of Property EAST END ROAD FISHERS ISLAND, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 4 Block 6 Lot 4.2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 26, 1993 pursuant to which
Building Permit No. 21293-Z dated MARCH 30, 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 ACCESSORY TENNIS COURT WITH FENCING AS APPLIED FOR.
The certificate is issued to JEFFREY & AMANDA SALZMAN
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
C/"'r r
ding Inspec r
Rev. 1/81
a ,
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-24148 Date FEBRUARY 1, 1996
THIS CERTIFIES that the building ACCESSORY
Location of Property EAST END ROAD FISHERS ISLAND, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 4 Block 6 Lot 4.2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 26, 1993 pursuant to which
Building Permit No. 21293-Z dated MARCH 30, 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 ACCESSORY PERGOLA AS APPLIED FOR.
The certificate is issued to JEFFREY & AMANDA SALZMAN
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
lding I ispector
Rev. 1/81
FORK NO.
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)
NN9 21298 Z Date ....1. . .......36
Permission is hereby granted to: I
p.lxa.: S .rte...
x....1....!
to ~f." ;e.... ..v'...~:'~.. 4.............
.,..,........?-A
at premises located at ...LA of 4....#T.,...~.
County Tax Map No. 1000 Section Q..I........ ~Block 0.6....... Lot No....:(..:.9............
pursuant to application dated Y..^J...AA cZ 1913, and approved by the
Building Inspector.
E Fee $......?S.
i
Building Inspector
.57
Rev. 6/30/80
Fora: No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
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 17 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.
3. 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 525.00,
Alterations to dwelling 525.00, Swimming pool 525.00, Accessory building $25.00,
Additions to accessory building $25.00. Businesses 550.00.
2. Certificate of Occupancy on Pre-existing Buildins - 5100.00
Copy of Certificate of Occupancy - $20.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial 515.00
Date Jan. 29 1996
New Construction....... ?PS. Old Or Pre-existing Building
ocation of Property East End,Rd.,,,,,,,,, Fis14@rf,zslan(j, X..y......................
House No. Street Hamlet
Onwer or Owners of Property........ W9W 6,AMANDA SA,I,7;W
Zounty Tax Map No 1000, Section.... 4 Block b.......... Lot ..4._2
Subdivision ....................................Filed MaD............ Lot......................
Permit No.... 21293-Z.....Date Of Permit. Marcy 3Q..199.3Applicant...Z&S.Contracting•Ina.......
Health Dept. Approval Underwri*_ers Approval.........................
" anning Board Approval
Request for: Temporary Certificate........... Final Carticate.......
Fee Submitted: 5.....2M0
6Q)3-5 7.hS CONTRACTING
C o a Nly 7
]VDT TrA\IT
Form No. c
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
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 Dent. of water sunniv 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 17 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.
Fees
1. Certificate of Occupancy - New dwelling 525.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swimming pool 525.00, Accessory building $25.00,
Additions to accessory building $25.00. Businesses 550.00.
2. Certificate of Occupancy on Pre-existin-g Buildine - $100.00
3. Copy of Certificate of Occupancy - $20.00
4. Updated Certificate of Occupancy - 550.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date San. 29>..1996
New Construction....... 7PC. Old Or Pre-existing Building
Location of Property Bast End Rd. ' Fishegri ASlald,. AI .Y' .
House No. Street Hamiet
Onwer or Owners of Property 41PTMX 6 AMANDA SALZMN
Zounty Tax Map No 1000, Section.... 4........Block.....ra Lot. .4_2
Subdivision ....................................Filed .Neap............ Lot......................
?ermit No....21293-Z..... Date Of Permit. March 30,,,1993Applicant...Z&S.Contsacting.Inc
Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval.l
Request for: Temporary Certificate........... Final Certicate...........
gee Submitted: 5..... ?5,00
Q S ? 35 ZSS.CONTRACTING
APPLIC?YVT
Z & S CONTRACTING, INC.
z
BOX 202 • FISHERS ISLAND, NEW YORK 06390 , - 1996
(516) 788-7857
FAX: (516) 788-5600
January 29, 1996
Mr. Tom Fisher
Bldg. Dept.
Town of Southold
Southold,NY 11971
Dear Tom,
Enclosed is information you requested about Thors, Stickney and the Pequot for my
brother.
Also, check enclosed for Salzman tennis court Pergola.
Yours Truly,
Thomas J. Shillo
President,
Z&S Contracting Inc.
US / rz
INTEL-CIENCE
RESEARCH ASSOCIATES, INC.
ENVIRONMENTAL PLANNING & DEVELOPMENT CONSULTANTS
RICHARD ERIK WARREN, AICP
President
March 23, 1993
Town of Southold
Building Department
Town Hall
Southold, New York 11971
RE: Property of Jeffrey Salzman, East End Road,
Fisher's Island.
Dear Sir/Madam:
On behalf of the above property owner I am herewith submit-
ting a completed Building Permit Application. This application
is a request for a permit to allow the construction of a tennis
court, a 10 foot high chain link fence around the perimeter of
the tennis court and a Pergola. I am also enclosing a check in
the amount of $35 as the application fee. The proposed project
is located beyond 300 feet from the tidal wetlands. However, the
property also contains freshwater wetlands which fall under the
jurisdiction of the NYS Department of Environmental Conservation.
Therefore, I am also enclosing a permit from the NYSDEC relative
to this tennis court.
Kindly forward the requested permit to my attention at the
address provided above. If you have any questions or require
further information, please contact me.
Yours ruly,
Timothy Collins
Principal Planner
TC:mjb
Enc.
cc: Jeffrey Salzman
Fred Stelle, AIA
POST OFFICE BOX 1201 • 36 NUGENT STREET • SOUTHAMPTON, NEW YORK 11969-1201 • 516-283-5958 • FAX: 516-283-5974
April 2, 1993
Inter-Science Research Assoc.
P.O. Box 1200
Southampton, N.Y. 11968
Re: BP #21293-Z - SALZMAN
Premises: East End Road, Fishers Island, N.Y.
Suff. Co. Tax Map #1000-4-6-4.2
Gentlemen:
Enclosed is Building Permit #21293-Z. This permit has been
written for the Tennis Court Only. Please submit an additional
$35.00 fee and detailed plans for the pergola and we will amend
the permit to include same.
Very truly yours,
SOUTHOLD TOWN BUILDING DEPT.
Victor Lessard,
Principal Building Inspector
VL:gar
encl.
Now York State Department of Environmental Conservation
Bung 40-SONY, Stony Brook, New York 11790-2356
(516) 751-1389
FAX (516) 751-3839
m d,,,~„ ! t7, I~ +3
Thomas C. Jorling
l" i c „ya ' : Commissioner
hAi~j AMENDMENT TO PERMIT
Former Permit # (if any):
Owner:
RE: Permit No. & Location: l V738`rroy6s~vuvvi-o Eu~t -I:-)a W Fi5":
SC [T-
41 14 y o C
~~reeV) .~IcC r 06636)
Dear
414Your recent request to extend the above permit has been
reviewed pursuant to 6NYCRR, Part 621. The expiration date is
extended to
xV)c Your recent request to modify the above permit has been
reviewed pursuant to 6NYCRR, Part 621. It has been determined that
the proposed modifications will not substantially change the scope
of the permitted actions or the existing permit conditions.
Therefore; the permit is amended to authorize:
C Uat, S f ./~..c ~~-1u~~ ~'~-dr" or'~a? l~t,~t q,o SLwwv. v-n rI ~G'~~ w~'Qi ~q
I/~P-nJ~S..E (X ~u-1(2 L7 .2(q-3 G--Z lJ(-°F1t - S ~R12,v+L:OJ ~Q.d-2GV' C~%t E~-j R I7c~G2~eE~ r
S Ga-~ CtT~~-Q lT~avD M"` r, CC, 60~
~*i3 barta~~c(" S~^du,R~ bwrla oG.
~ %5 {v n ,nS uf<d w e. 5pa~e far Cl-ewk eir
tic( Tln¢ w,;d S"ct6l `
This letter is an amendment to the original permit and as such,
shall be posted at the job site.
All other terms and conditions remain as written in the original
permit.
Very truly yours,
10N7-
I ' I "'"I/ .i~ 1 1 . a Y l' F ''v
T4
hav`~"L Deputy Regional Permit Administrator"'
cc: (~~p
it Wmad a+ecYCtad WV..
3. Nature of work (check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work Ten..n i . s Court .
(Description)
4. Estimated Cost Fee •$35.00
to be paid on filing this application)
5. If dwelling, number of dwelling q~s N/A
Number of dwelling units on each floor , N/A
If garage, number of cars
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ...19/A .
7. Dimensions of existing structures, if any: Front Rear Depth
Height Number ofStories 2............
Dimensions of same structure with alterations or additions: Front , ,N/A N/A
Rear......
Depth N~A........... Height ......N. A Number of Stories N.............. .
8. Dimensions of entire new construction: Front N/A Rear N/?~....... Depth N/A
Height NA Number of Stories N/A
9. Size of lot: Front 5•, 9 ,acres.... , , , Rear De th
10. Date of Purchase Unknown , . Name of Former Owner nknowri
11. Zone or use district in which premises are situated R-120
12. Does proposed construction violate any zoning law, ordinance or regulation: . No....... .
13. Will lot be regraded . . . . ....Portion of lot
. . . . . . . . . . . . . . . . . .Will excess fill be removed from premises: Yes No
14. Name of Owner of premises .Jeffrey. Salzman Address ,194 Otter RockDrPho@T9Rnwich, CT
Name of Architect ,Fred Stelle 4$ Foster Ave . 537-0019 • • " •
Address •Brl'cTgefiairip£on' . • Phone No
Name of Contractor Address Phone No............... .
15. Is this property within 300 feet of a tidal wetland? *Yes........ No...XX ,
*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.
zz'
STATE W NEW YORK, S.S
COUNTY OF .
Timothy Collins , • • , , being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the , , Agent
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
application; that all statements contained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manner set forth in the application filed therewith.
Sworn to before m
e this n
ri 4A
.........2.. ..........day of 19 .1T. .
Notary Pu Isla rVlk County r
RICHARD E. WARPEN~ .
Notary Public, State of New York (Signature of applicant)
No..r 01 W 'res 18, Suffolk County
7er^^ Expxr res Aupusr 13, 193" ^
a'~i„'R:t`•," BOARD OF HEALTH
FORM NO.1 3 SETS OF PLANS
TOWN OF SOUTHOLD SURVEY
MAR 2 619`x;3 BUILDING DEPARTMENT CHECK _ .
TOWN HALL SEPTIC FORD!
SOUTHOLD, N.Y. 11971
~OCyr~,~U.;- TEL.: 765-1802 r:oTIFYp
CALL
Examined 9A:CA..3!Q., 19 9.s MAIL TO:
Approved P., 191A Permit No. AL/~,9 3.
Disapproved a/c
(Buil mg Inspector)
APPLICATION FOR BUILDING PERMIT
Date arch 19, „ 19 93
I
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and, submitted to the Building Inspector, with 3
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of'ilot 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 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 permit
shall be kept on the premises available for inspection throughout the work.
e. No building shall be occupied for 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 necessary inspectio s. i
- (signature ofap¢licantor name, if a corporation)
/
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Agent
.
Jeff
Name of owner of promises ......r.oy Salzman
(as on the tax roll or latest deed)
If applicant is a corporation, signature!! of duly authorized officer.
Name and title of .cor or. ? V r~
( pe officer)
Builder's License No. j .
Plumber's License No.
Electrician's License No.
Other Trade's License No. ....:I' Z , ~a
1. Location of land on which proposed work will be done . . .
,,,,,,,,,,,,,,East End Read, Fisher's Island
House Number Street Hamlet
County Tax Map No. 1000 Section 04 Block 06........... Lot 4 .
Subdivision .....Milliken Subdivision , , , , . Filed Map No. Lot
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
residential
a. Existing use and occupancy, .
!Tennis court, 10' high, vinyl coated,,fenCeLapo pergola
- b. Intended use and- occupancy :+s:s:...........................
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