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Home My WebLink About21622-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. ~ERTIFICATE OF OCCUPANCY NO Z-23306 Date OCTOBER 26, 1994 THIS CERTIFIES that the building Location of Property 7 PETERS WAY House No. County Tax Map No. 1000 Section 6 subdivision ALTERATION FISHERS ISLAND, N.Y. Street Hamlet Block 2 Lot 3.9 Filed Map No. Lot NO. conforms substantially to the Application for Building Permit heretofore filed in this office dated I~J3GUST 20, 1993 pursuant to which Building Permit No. 21622-Z dated AUGUST 26, 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 ALTERATION TO FINISH 2ND FIXER OF EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to EDWARD & CHERYL SCROXTON (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED H-040016 - MARCH 24, 1994 N/A / ~uiiding 'Inspector Rev. 1/81 FORM NO.3 TOWN OF $OUTHOID BUILDING DEPArTMENt' TOWN I'IALL SOUTHOLD, N,Y. No 21622 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) oat. ...... ........................... Permission Is hereby granted to: ~,~,~. o,~m,~,ooo,~o, ~.....'~ ......... ~.~ ............................................ CountyTaxUap No. 1000 Section ............. ~ ........ Block ............ ...'~... ........ kotNo ....... "~..~...~.. .......... pursuant to appflcation dated ...~..,.;~?~..,,,. .................................. 1 .~,~... ......... Building Inspector. and approved by the ~ ~ing Inspector Rev. 6/30/80 , / ~]I.DG DEP'£ tOWN OF SOUTHOI.D APPLICATION TOWN OF SOUTHOLD BUILDING DEFARTHENT TOWN HALL SOUTDOLD, NEW YORK 765 -- ;802 11971 ) FOR CERTIFICATE OF OCCUPANCY NEW CONSTRUCTION - -~-...OLD OR PRE-EXISTING BUILDING ...... VACANT LAND ........ Location of Property ....... ~.. . . HAMLET Owner or Owners of Property ..~-. ...y. . Subdivision ................... p~O ~i~7 J ~7- - -.. Filed Ma ~ -Lot ........ Permit No. ---Dat~of Permit App[ Health Dept. Approval .... t~. ............ Underwriters Approval .............. Plannlmg Board Approval ...l~ ....... Request for Temporary Cert,,ificate ....... Fee Submitted: ~ Final Certificate rev. I0/14/88 FORM NO. 6 TOWN OF SOUTDOLD BUILDING DEPARTMENT TOWN IIALL 765- 1802 APPLICATION FOR 3ERTIFICATE OF OCCUPANCY INSTRUCTIONS This application must bp filed in typewriter OR ink and submitted to the Building Inspector with the foll~wing; for new buildings or new use: 1. Final survey f property wxth accurate locatzon of all buildings, property lines, s~reets, and unusual! natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. S~orn statement from; plumber certifying that solder used in system contains less' thau 2/]0 of ]Z lead.. . . . . 5. Commercial buildings!, ~ndustrlal buildings, multiple residences and s~milar. buildings and instal!latlons, a certificate of code compliance from the Architect or Engineer responsible for the building. 6. Submit Planning Boated Approval of completed site plan requirements. For existing buildings '(Prior to April 9, 1957] non-conforming uses, or buildings and "pre-existing" laud! uses: I. Accurate survey of p,roperty showing all property lines, streets, buildings and unusual natural or tlopoEraphlc features. 2. A properly completed, application, a consent to inspect signed by the applicant and a certified abstlract of title issued by a title company which shall show single and sepa?ate ownership of the entire lot prior to April 9, 1957. · If a Certificate of ~ccupaney is denied, the Building Inspector shall state the reasons therefor iu~r~t~ug' ' ' ,tO the ~pplicaut. 3. Date of any housing Icode or safety inspection of buildings or premises, or other pertinent informatio!n required to prepare a certificate. For Vacant Land Certifi~cate of OcCupancy: ~. AI~ application for vacant land, Certificate of Occupancy shall be submitted, and a certified abstlract of title issued by a title company showing slugle cud separate ownership olf ,the entire 10t prior to April 9, [957 shall also accompany the application. I~ a Certificate of Occupancy is denied, the Buildiu§ Inspector shall state the reasions therefor in ~riting to the applicant. FEES: I. CERTIFICATE OF ~CCUPANCY -- New D~elling $25.00, Additions to Dwelling $25.00, Alteration to ~elling $25.00, Swimming Pool, $25.00. Accessory building $25.00 AddiClon to Accessory buildings, $25.00 - Businesses $50.00. 2. Cert~flcate of 6ecupancF on pre-existiuE dwelling - $100.00. 3. Copy of Certlfi~ate of Occupaocy - $5.00 - over 5 years - $10.00 4. Vacant Land Cer~ificate~ of Occupancy -- $20.00 5. Updated Certificate of Occupancy - 6. Temporary Certi~'icate of Occupancy - $ 1.5 . 0.0 Residential Commercial FOUNDATION (1st) FOUNDATION {2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Exa,nn, ed .., ' ' Approved . '.. 19'~ff. Permit No Disapproved a/c ' BOARD OF HEALTH ......... 3 SETS OF PLA~tS ......... SURVEY ................... CIlCCK .................... SEPTIC FOR,*I - .. ~ .......... I:OTI FY ~ CALL ................... HAIL TO: ,NarIF¥ BUILDinG DEPART~,~PPL CATION FOR BU,LDING PEaMIT 76B4802 9 AM TO 4,PM FOR THE F()LI.(')W~N G ~NSPECT~OH~: ~.'FOUNDATOON . '[WO REQUI~ED . , "' F~[~ PO iRED CONCRETE - INSTRUCTIONS a~ ~,~p~tion must bc completely filled in by Wpew~ter or in ~nk and submitted to the Build~g Inspector, with 3 sets of. pJ~As,Aaccur~t~R~Rp~l~j~l~TFee according to schedule, b. ~ot;~t,~;~m~49,~tion of lot and of build,ss on premises, rdationship to adjoining premises or public stkeets or ar~, a~j~{~X~,~c~4~n of layou~ of property mu~t be drawn on the diagram which Js pa~ of this appH- cationb~: ~I~O~I~RFMENTS O~ THE ,, ,mAe ~9k~g.~.ca~on may not be commenced before ~ssuance of BuUdmg Pemit . d; "Upcn ~l~~*c~t~, the Building Inspector will issued a Bufld~g Pemit to the app~cant. Such pemit shal bq;~B~ R~E~&~j~l~A~¢spection throughout the work. ' . e. No building shall be occupied or used in whole or in p~t for any purpose whatever until a Ce~ificate of Occup~cy shall h~ve~b ~ g- "fin '} ector APP~IC~[O~ ~}ffl~,R~Eg~ ~tB~[~ the Build~k Dep~ment for the issuance of a Bmldmg PS~bp~rsuant to the Buildin~C~bfib~'~'fflifl'~ffh~,Town of Southold, Suffolk County, New York, ~d other appQcable Laws, Ord~ces or Regulaflofi:J~f~f~4h~)bbnst~E~f&~F~lS~gs, additions or alterations, or for removal or demolition, as here~ described. The.appQfaht[, ,. ~k~, .. ,,[~'~b~g~zth- . ,,all apphcable laws ordinances . bufld~g code, housin~o code, and reoulatio~s= , a~d to adm,, a~ t ~5~6~,~(e .'p~$~s ~. BE COMPL.Et'E FOR C(). ' (Signature of ~licant, or name, if a corporation) ALL (,ONoT~Ut,TfON SHALL MEET THE ~EOUIBEMENTS OF THE N,Y. . ~ . STATE CO~8T~OTIO~ ~ ENERGY (~ailingaddr~ssofapplicant) CC D~_.,. -~OT flESPONSIBLE ' FO~ State WA~ ~a~r~o~Et~S agent, architect, engineer, gCn~rai contractor, dectrician, plumber or builder. Name of owner of premises ....... ' .... (as on the tax roll or latest deeq) If applicant is a corporation~ signature of duly authorized officer. ........................ , ...................... 0¢C[I~PN~C¥ (Name and title of dorporate officer) Builder's License No ................. ' ......... ~l'[~0~'t' Plumber's License No ~~'~ , 0~ 0CC P CY. Electrician s License No ............ Other Trade s License No ...................... ............................ .... · Itouse Nunlber Street ~ ' 'h~'l;i .................. ' ' '~s~ ~ ~ ' .. Lot ~.1~ Connty Tax MapNo. I000 tion ...:~ ....... Bock ...... ~..L.. ....... : ...... Map NO. ~[~"¢ ..... Lot ..... (Name) · . ' ' ............. State eXlstln use and occu anc of premises and intended Use an occu c ' g . P Y d pancy of proposed constru tion: a. Existing use and occupancy . . ~} . . ~ b. Intended Use and occupancy . .~ .... · ........ ~ . ,. '~ ,' 4 · · .. Alteration ............ .3. Nature of work (check which ~pPlicable): New Building . ~ ...... Addition .......... '~- Repair .............. Removal .............. Demolition ... Other Wor/k~..,, ' '"'" ..... 4. Estimated Cost ---~, ' ...... l ..................... Fee " i a ' · (to be paid on filing this appslication) · If dwelling, numberofdwel ~gunits· ~1.,. -Numberofdwelin-unitsoaeachfloor ..M/.~. . If garage, number of cars ...... : ' ' .~.l.~ s ............. ,6. I,..f business, commercml or m~xed occupancy specify,nature and extent ,,r ~.~ ..... ,- .... Iq]{:~, ........ t. t.amensionsA)[~.xdstingstructur~s, ifany: Front....~1~. ..... Rea- ~l~/~, m ~,,h e~1'' ..... . Dimensions 9~s~[n~e structure with alterations or~d;tions' Front' i 'KI['(~?' ....... ~;~' '" '/~)'*' ' Depth '~.~ ..... ~,Cl., ' ' .................. 'si ....... ,, ~,. '. · · _ · . ..... ?.. rimgn~ ...... '-'~ ·" ........ ;.. Numb.e. rofStories ..... ~ .... ; ........ ~. ~menmons 9.[.gl~re/tew construction: Front ~ lO* ~. Iql~:~ ,-. ., Hmght ...~.t.,.~J.~... Number of Stories . I;l~ .... iJepm . . 1 .......... 10. Date of Purchase . I ........ ~ I. zone or use restrict in w'Cl~ich premises are situated . . ..... 12. Does proposed construction ¥ie]ate any zoning, law ,~-,4~',.~,,~-~, ',,',.'~' ','; ......... i,~['~k,~ ................ 1..% ~Ylll tot ce regraded · I 'xll~ . Will e~ess fill '- ' ~' ' -'. ' ' I . · ........... ue removee trom premises: Yes ........ i~'~ ................. aaaress ................. Phone No ......... Name of Contractor ."l~ ' -~- ' ...... · ' ,, . . - · ..... . .............. .,~aaress ................... Phone, No ......... ' fa. zs t~is property within ¢00 feet of a tidal wetland.9 *Yes ....... x~ "~ ....... · *If yes, Southold Town Trustees Permit may be required.' ' ~,o. ~.~, ..... .... PLOT DIAGRAM Locate clearly and distinctly ale buildings, Whether existing or Proposed, arid. indicate a/1 set-back dimensions from property lines. Give street and block interior or corner lot. ,Utll)~tTtllS ?r._RlIROhl£ ~umber or description according to deed, and show street names and indicate whether STATE OF NE}~I, YOR/~ ., S S ' ~'~ ' ' (Nam c o f individ ual'sijli ¢'oZn'/i ¢'ti ..... being duly sworn, deposes and says that he is the applicant above named. lc is the .... I (Contractor ..................................... ' ......... ; .... age. nt porate officer ere ) >f said owner or owners, and is duly ~uthorized to perform or have performed the said work and to make and file this :pplication;.that all statements contained in this'application are true to the best of his knowledge and belief; and that the york will be'performed in the manner sdt forth in the application filed therewith. ' ;worn to before me this . , '(,,],\, ~, ~ NOTARY PUBLIC NEW YORK: STATE C , ...~,,.~..~ ~ (S~gnature cfa hcant) · QUALIFIED IN SUFFOLK C~)UNTYo' .~ ' , ' ' ' ' PP ' TERM EXPIRES ~TOOE~Ri31, 19-1'z{''''- ' . ,THE NEw YORK BOARD OF FIRE UNDERWRITERS 8042647 ,, BUREAU OF ELECTRICITY ~-- ~ ~= 85 JOHN STREET, NEW YORK, NEW.YORK 10038 o~y t~ e/ectr~ ~uipmen~ ~ ~scdb~ be~w and inz~uc~ by t~ ap~icant ~ on the a~e appl~atto~ numar m the p~m~es of ',n the following &~ation~ ~ B~ement ~ Ist Ft. ~ 2nd FI. ~/~ . ~..~. ' ~ M' Section ~ Bilk Lot 7 ~ examined on ~RRCH 22~9~ and found to be in compHanCe ~itn the ~a~onal Electdcal Code- RX~U~ [ I * FIXTURES I RANGES ~C~KING DECKS ~ OVENS ]DISH WA~l~ EXHAUST FANS ' -- ' · ~ UNIT HEATERS MULTI-OUT~T DRYERS ] ~RNACE ~TORS ~ ~TURE A~IANCE ~E~RS PECIALREC ~ TIMECLOCKS~ 8E~ ]UNIT HEATERS SYSTWS M~TER W 3W 3~3W 3 4W NO OF CC'COND' A'W'G' NO OF HI'LEO O¢~L~O NO'OFNEUTRA[S SMOKE DETBCTOR:-i EDWARD J. SCROZ?ON AVENUE B,P.O. BOX 3 FISHERS ISLND, NY, 06390 This certificote must not be altered in any monner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.