HomeMy WebLinkAbout21406-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-24145
Date JANUARY 30, 1996
THIS CERTIFIES that the building
Location of Property EQUESTRIAN AVE.
House No.
County Tax Map No. 1000 Section 9
Subdivision
ALTERATION
FISH~RE ISLAND, N.Y.
Street
Block 6
Filed Map No.
Hamlet
Lot 8.9
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 10, 1993 ~ursuant to which
Building Permit No. 21406-Z dated MAY 12, 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 EXIBTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to ALBERT STICKNEY III
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-358113 - JULY 17, 1995
PLUMBERS CERTIFICATION DATED JAN~3ARY 29, 1996-MARIO ZANCHETTI
Rev. 1/81
I~OB,~ NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, No Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Building Inspector
Rev. 6/30/80
Form No. 6
TOW~ OF SOUTttOLD
BUILDING DEPARTMENT
TOWN 1LALL
~65-18OZ
: APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be f'illed 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.z~ 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.
~. Commercial building, industria! 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 ~tan r'equirements.
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
I. 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 '
.... Fishers Island N Y
~tion of Property .............. ~strlan Ave. , . .
House No, Street Hamlet
f ty Mr. Albert Stickney 111
r or Owners o Proper ..., ............... . .................. ........ ...... ....-........,
ty Tax Map No 1000, Section..~ .......... Block..~ ............. Lot..~:~..' ...............
ivision File~' Map Lot
it No.~%499. ~ ....... Date Of Permit.~/~2/93 A~ticant.~S Contract'lng Inc. '
th Dept Approval Underwriters Approval
~ing Board Approval .......... 0 .............
~st for: Temporary Certificate ........ Final Certicate. X
0~/2B/1996
14:13 515-788-5600
Z & S CONTRACTING
TOWN OF SOUTHOLD
OFFICE OF ~UILDING INSPECTOR' '
P.O. BOX '/28 '
' · TOWN HALL "
'C
· Buildin. g Permit
· .,', Owne r~
,TEL. 765-1802'
PAGE
'Date
· I certify ~hat the solder.used.in the w.ater supply system
':,..contains'l~ee than 2/10 of ~% lead.
: '' ' L{~l. unI~r'/ signaturel.
~,,~0~/~-~- THE NEW YORK BOARD OF FIRE UNDERWRITERS
l~656--
BUREAU OF ELECTRICITY
~-- 85 JOHN STREET. NEW YORK, NEW YORK 10038
D. te JULY ~7,1995 ~ppl~cetion ~....f~ 86276594/94 N 358113
THIS CERTIFIES THAT
~R~' STICKILY III, FISHERS IS~ND,
~B s nt ~ Ist Fl. ~ 2nd FL
G~/O~
~y' ~ , ~ ~ Section .l~ Lot
OTHER APPARATUS:
MOTORS. 1 -F H.P.
G.F.C.I:-2
Z & S CONTRS. INC.
P.O. BOX 202
FISH~RS ISLAND, NY, 06390
LIC.#924-E
GF. NSRAL MANAGER
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR D[JILDING DEPARTM{~NT. '}'HIS COPY OF CE~,TJF~CA'TE ~'IL~ST NOT ~BE ALT{~{3ED IN ANY MANNER.
FOUNDATION
FOUNDATION
2.
ROUGH FRAME &
.PLUMBING
INSULATION PER N.
STATE ENERGY
CODE
~lst)
FINAL
ADDITIONAL
(2nd)
COMMENTS'.
l~u~! NO. B
TOWN OF/~,OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
Ne.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
20332 z Dote ...'..~.... ............ ./...3. .................. , ,,...¢../
pursuont to opplicotion doted .... L..~.../....~..~- /-- ............................ , '~.~...L---- ,nd opproved by the
Building Inspector.
Building Inspector
Rev. 6/30/80
'~: TOWN OF $OUTHOLD
BUILDING DEPARTMENT,
~ ;' TOWN HALL '
"' '~: BUILDING PE~IT'
."/'~GHIS PE~IT MUST BE KEPT ON THE PREMISES UNTIL FULL
~, C~PL~iON OF THE WORK AUTHORIZED) ,
"N~.' 18656 Z' ~t,.:...~ .: ........ : ........
Pe~lssloli II hereby gr~nt~ ~: -- ~ / ' / .
...........
.,,, ~~ ~~~ ' , ,
~n~.T,.~:~: ~op ~o, 000 ~ctlon ....... ~ ............ Bilk ................. [°t ~o
' ¢~ ' ' ~.
.............................. / ......... , 1 ,;,' and
"-gulldlng', lAmp.for, ,,, ,
Fee ~,,.,J~,~;~..,. :
~ I~tor
R~. 6/31 '/80
· o~ NO. ii
TOWN OF Sou'rHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, No Y.
BUILDING PERMIT
Ci'HIS PEP-d~IT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
NO 18656 Z
Date ....... .~/ ................... ,
Permission is hereby gra~ted top.
.,...-.,~.-~
......... ~~..~.~
.
County Tax Mop No. 1000 Section ........... ~... ........ Block ........... ~ ..... Lot No .......~.?~...~... .......
pursuant to application dated ................/~)~'..~.. ............................... . , i~...., and approved by the
Building Inspector.
Rev. 6/30/80
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N.Y.
NOTICE OF DISAPPROVAL
....4..~.. ~..~,. ~..~. ..............
PLEASE TAKE NOTICE that your application dated ....C>...~....~..... !.~. ....... 19 .~. g.,.
for permit to construct..~... ~e~.c~..T~L~. ,~7. ¢....,~-X( '.~..-~-G~o~...~..~ ......... at
Location of Property .... .~..~.~$.~...~.' .... ~.'~...~~ .......
House No. Street Hamlet
County Tax Map No. 1000 Section ..... ~. ..... Block ...~ .¢ ....... Lot .. ~.: .~ ......
Subdivision ................. Filed Map No ................. Lot No ..................
is returned herewith and disapproved on the following grounds. ~:.~..~.
~.cr..~.'...~...~. ~.~.~t~&..'~....~.....w~..~ ..............................
Building Inspector
RV 1/80
Mr. Victor Lessard
Building Department
Town of Southold
Southold, NY 11971
~ATTiqEW~ ~ I-IAM
~kTTORNE¥S AND CO~SEL~RS AT LAW
~5 ~PTON Ro~
SOUTHAMPTON, N.Y. 11968
516- ~83- 2400
October 12, 1988
Re: Notice of Disapproval
Dear Mr. Lessard:
In connection with an application to the Zoning Board
of Appeals, I will require a Notice of Disapproval relating to a
certain minor subdivision plan for Albert and Susan Stickney.
Enclosed is a copy of the plan.
Title to Parcel 1 as shown on the plan is currently
held by Susan K. Stickney. Title to Parcels 2 and 3, which
comprise Lot 3 as shown on the Minor Subdivision Map of Briscoe
Smith, is c~rrently held by Albert Stickney and Susan K.
Stickney. The Stickneys propose to transfer Parcel 2 to Susan K.
Stickney so that it will merge with Parcel 1. Parcel 3 would
thus be left with only 30 feet of road frontage, though the new
lots will both conform to the minimum area requirement. In
addition, the Stickneys propose an addition to the dwelling on
Parcel 1 which will be only 68 feet, more or less, from the edge
of a wetland. Wetland lines are shown on the plan.
Please review the plan and provide me with a Notice of
Disapproval covering the foregoing nonconformities and any other
nonconformities that would require variances from the Zoning
Code.
Sincerely,
Stephen L. Ham, III
SLH:ja
Enclosure
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N.Y.
NOTICE OF DISAPPROVAL
PLEASE TAKE NOTICE that your application dated ....C~., .~. ~,. ! .~ ....... 19 ?. ~.,.
f°rpermitt°c°nstmct"9'r'>""°'e~'ST'"~x"~"°',~'"~-~ "~"~°~"'~' "c°A~"~"', ~ ~, ^^ ~ ,,'"'i'at
Location of Property .... .~..~.~.~J .~b~'......~..~t... .... .~r.~.....,.y~.. ~ ......
, House No. Street Hamlet
County Tax Map No. 1000 Section ..... .~.~. ..... Block Q~ {,t> . Lot .
Subdivision ................. Filed Map No ................. Lot No ..................
is returned herewith and disapproved on the following grounds. ~.: .~, .'~-... ~g.~..~, .-].',/, .~ -~ (a-)
e~...~.'... ~..?.~-.~o...~.. ~ ?,,,~..~.. ~.~...~...,.~..,~ .~,¢~...
~.~...~.'....~..~. ~.o,~9~&..'~....o.~.....~....~ ..............................
Building Inspector
RV 1180
'FOR~ NO. 1
TOWN OF ~OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971..
TEL,; 765-1802
Examined .................. 19...
Disat, prov d .V/. : ..............
Received ........... ,19...
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date..
INSTRUCTIONS
a. This application must be co~npletely 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 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 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 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 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 inspections.
......... .............
(Signature of applicant, or ~/ame, if a corporation)
. . .<V' .........
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architcct, engineer, general contractor, electrician, plumber or builder.
Name o[ owner o[ premises ............... z~' ' ' ~as
the
latest
deed)
If applicant is a corporation, signature of duly authorized officer.
........ ....
(Name an~itle of co,orate officer) ·
Builder's License No... A~. ~... ~ ........
Plumber's License No ..... ~ T. Z~ ..........
Electrician's License No .... ~.~.. ~ ..........
Other Trade's License No ..... .~....2:~.~.--../~..A? .......
I. Location of land on which proposed work will be done ......... ' .........................
House Number Street Hamlet
County Tax Map No. 1000 Section ...... ~ .......... Block ........ ~ ........ Lot..~ ..........
Subdivision ...................................... Filed Map No .......... , ..... Lot ................
(Name)
2. Slate existin~ use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ....... ~.~ .... ~d~ ....................... .~ .......................
b. Intended use and occupancy .....................................................
3. Nature of work (check which apphcable): New Building ' Addition ........ Alteration ......... '. ·
Rel~fir ..... ~. ........ RemoYal .............. Demolition ............. Other Work../,~m~....,; ....
(Description)
4 E ti d C 6,~;, (yZ~O :,25 .~., .5-.d::
· s mate oat ................... ~. ........ ,.,. Fee .... ~ .........................
I ' (to be paid on filing this application)
5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................
If garage, number of cars ..... . ........................ ; ..........................................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .....................
Dimensions of existing structure~ 'if any: Front ' Rear Depth
Number of Stories '
Height ..............................................................
Dimensions of same structure with alterations or additions: Front ', ', Rear
Depth i Height Numbei'of Stories
8 Dimensions of entire new construction: Front ' Rear Depth
Height ............... Nmnber of Stories ........................................................
9 Size of lot: Front ...~, Rear Depth
10 Date of Purchase Name of Former Owner
I 1. Zone or use district in which premises are situated .....................................................
12. Does proposed construction violote any zoning law, ordinance or regulation: ................................
13. Will lot be regraded ......... : ................... Will excess fill be removed from premises: Yes No
14 Nmne of Owner of premises I' Address Phone No
Name of Architect Address Phone No
Nmne of Contractor ......... : ................. Address .... ; .............. Phone No .................
15. Is this property located ~ithin 300 feet of a tidal wetland? *Yes ..... No .,~...
· If yes, Southold Town Tru~tee~ Permit maybe required.
.. i PLOW DIAGRAM
Locate clearly and distinctly all ibuildings, whether existing or proposed, and. indicate all set-back dimensions from
property lines. Give street and block humber or description according to deed, and show street names and indicate whether
interior or corner lot.
~TATE OF NEW YORK, !S.S
7OUNTY OF ................. ; -~ .
· .
............. J .. ' . . ................... being duly sworn, deposes and says that he is the applicant
(Name ofindivid sign,h~g contract)
,bore named. !
le is the ............................................................................
(Contractor, agent, corporate officer, etc,)
~f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
~pphcatton; that all statements contomed m th; apphcat~on are true to the best of his knowledge and belief; and that the
york will be performed in the manner set/forth in the application filed therewith.
;worn to b~e me this ~
, ota. : ....... ;;:(l'O' : : ,, ,'"'
Notary Public State of New York ' · ........ ~..~.~ .~/~.... x~/q .
No, 4sO~sse /'/
Qu=l le~ in S~tfoik County
Term Expires 1~311~
(Signature of applicant)
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
.//~,, ,~,~, ~'- SOUTHOLD, N.Y. 11971
· TEL.; 765.1802
Examined . ~ ......... 19...
Approved .../¢.~ ........ 19~. · Permit No ...........
Disapproved a/c .....................................
BOARD OF HEALTH ............
3 SETS OF PLANS ............
SURVEY .....................
CHECK ......................
SEPTIC FORH ................
NOTIFY
CALL
MAIL
........................ .... ~APPLi~~l~or)' '
INSTRUCTIONS
a. Tiffs application must be completely filled in by typewriter orin 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 lot and of buildings on premises, relationship to adjoining premises or public streets
or areas, and giving a detailed descripti~)n 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 throuo~hout the work.
c. No building shall be occupied or used in whole or ~n part for a¢y 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
Re=utations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
Tile applicant agrees to comply with all applicable laws, ordinances, building code, housin~ code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections.
FISHERS ISLAND, N.Y. 06890
.......................' o~ applicant)
(Mailing address .....................
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder·
......................
Name of owner of premises ...... /~2./~.~.,~Z....~?.~..~.~.~'~...~ ........................................
/(as on the tax roil or latest deed)
Irapplicant is a corporation, signature of duly authorized officer.
( ~(nd 't e of corporate o~mer) ' '
Builder's License No .... ./'~..~9..~.M...~ .......
' ·
Plumber s L~cense No ................
Other Trade's License No .........
· Location of land on which proposed work will be done ......
. / ,/ /? .... ........ .
........ ....
tlouse Number -- ' Street, '-- / ........................ Hamtct ' ' '
County TaxMapNo. 100OSection ....... ?: ......... Block ........ /o......... Lot...~..,.~...
Subdivision ..................................... Eiled Map No ............... Lot ...............
(Name)
· State existing use and occupancy of premises and intended use and occupancy of proposed construction:
· Emstmg use and occupancy ....... . ................. , .... .
Nature of wot [ 1
..3. k (check which app icable): New Building '· .
........ Removal ........
~a .............. Demolition .............. Other Work ............
i ~ ~ ~ (D ripti ;'
4. Estimate'S Cost ...... ~..~..~.~'i ~.").-'...~. 3.S"' "sc on
F
lfd (to be paid on filing this application)
$. welling, nUmber of dwellin units .......... Number of dwelling units on each floor .....
If garage, number ofcnr~ I '. ' ' ~ ' '
6. usiness. Commercial or mix occupancy, specify nature and extent of each e of use ... .
.n b typ
7. D~ wns~onsofexistingsrmctur s, ifany: Front ............... Rear ...... ' ............
DH~lght ............... Number of Stories ............ ' ........ Depth .. .
mensions of same structure: alterations or additions Front ................. Rear
Depth .i;.'. ................ i" .Height ................ · ....
..... Number of Stories ......
Dimensions of entire new construction: Front ..... ·.
igl n~b .......... Rear. Depth
it ';:'b'ill Nu, er orSto es . · .......
Size of 1o r ..... ' ...................
· ' ........... Rear ..... ' ..............
10. Date of Purchase ... I ........... Depth ....
........ ! .................. Name of Former Owner ........... ' ....
11. one or use district in which pr mists are situated .... : .............................. · ..........
12. ~oes proposed construction violate any zonin aw, ordinance or regulation: ....................
13. 3,%'ti1 lot be regraded ....... ~...
Name of Architect .......... i. · · ........ Address ................ Phone No ..............
I · · · · ....... Phone No ...........
i5. INFe of Contractor ....... Address .... :.':
................... Address ................... Phone No ....... · ·
this property located '~it~'i'~:~OO feet of a t .............
I :]-oat wetland? *YES . NO
· I£ yea, $outhold Town Trustees ..P.e. rmlt may be required
-vLOT DIAGRAM '
LOcate clearly and distinctly all !buildings, whether existing or proposed, and. indicate all set-back d/mensions from
humber or description according to deed, and show street names and indicate whether
property tines, Give street and bloc
interior or corner lot.
?AT,E. OF NEW YORK, .
~OUNTY OF. S.S
........... . . /. , . .4&//.v. .
(N · . · . .............. being duly sworn, deposes and says that he is the applicant
bore named· amc ofmd~v dua slg~llng contract)
re is the .
.......... ~Xi ·
" . / [ (Contractor, agent, corporate officer etc.)
said owner or owners, and is duly authorized to e.rfor . ' .
~P!lca[ion. that all statelnents contained in this ar~nlPicnri,~,m~°~r have per,or,ed thc smd work and to m~e and
or~ wUl be perfo~ed in the mnnn~r ~,~ ~ .... 5~' ..... ~. ?,c true to tile ~est of his kno~vlcdee nntt hMl~r, ~ ~]e .....
-~N~J~ ~ublic $~Mo of NeW York .....
~" ":~ BOARD OF RE^LI'II ........
FOaMNO. 1. 3 SETS OF PLANS ..........
TOWN OF SOUTHOLD SURVEY ...................
BUILDING DEPARTMENT CI{~CK ....................
TOWN HALL SEPTIC FOatl ..............
SOUTHOLD, N.Y. 11971
TEL.; 765-1802
Examined ................ , 19 ...
,\pprovJd .~..~/. ,~ ..... 19 ~'.~. Per,nit No.~/
V
Disapproved a/c
.
. (Building Inspector) ~ .
APPLICATION FOR BUILDING-PERMIT
D~te
NOTIFY:
CALL ...................
HAlL TO:
INSTRUCTIONS
a. Tiffs 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
~r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part'of this appH-
:ation.
c. The work covered by this application may not be cbmmenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issued'a Building Permit to the applicant. Such permit
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
hail 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
{uilding Zone Ordinance of the To~vn of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
~egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
fhe applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
~dmit author/zed inspectors on premises and in building for necessary inspections.
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
Slate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buiIder.
General contractor
'~ame of owner ofpre~nises Albert Stickney 11 1
(as on the t~.~x roll or latest deed)
II' applicant is a corporation, signatnre of duly authorized officer.
Thomas J. Shillo, President
(Name and title of corporate officer)
Builder's License No. 13 242 ' HI
Plumber's License No....5.5.4.7? ................
Eh:ctncmn s L~cense No. 924-E
Otber.Trade's License No. 238-AR
Location of land on which proposed work will be done. Equestrian ave
West end, Fishers Island,N.Y. 06390
llonse Nnmber Street Hamlet
Cotmty Tax Map No. 1000 Section 9 131 6 ' 8.: 9.
................ ock Lot ...............
(Name) -' .''
State existing use and occupancy of premises and intended ttse and occupancy-of proposed construction:
a. Existing use andoc~upancy .......single.........fa.m.ily. ..............dwelling
b. lntended use and occupancy . single family dwelling
Repair ............ Removal .......... Demolition ........... ' Demo
·Other Work ...............
4 Estimated Cost $.SOt.O.Oq:O.O $256 35 (Description)
(to be paid on filing this application)
5. If dwelling, number of dwelling uhits
If garage number of cars ] ............... Number of dwelling units on each floor
6 If business commercial or ' ' ................................................................
· , mixed occupancy specify nature and extent of each type of use
7 Dimensions of existing structuresiif any: Frgnt
' R~Jar Depth
Height Nunll~er o f Stories ............................................
Dimensions of same structure with alterations or additions: Front
th .......... R . .
Dep ' " i Hight ~e ~{' ...... ear ..................
f ~ti ..... *' "' ' '~' '~
· mensions o entire new constru on: Front . · . '
igl ~ .............. Rdaff. .............. Depth .........
He ~t ............... Number of Stories ............... ' ......
9 fl F .........................................
· Size o ct: ront ...... ! Rear ...... De
...................... pth
10. Date of Purchase , .......... , ......................
I I Z d ............. ' ................ Name of Former Owner ..... '
· ' ' h p rq' itu d ........................
. one or use lstrlctinWhlc rc lses ares ate ........................................
12 DO sp;pe d d d ti i I ti i gl di 'itl ...........
13' Willie; ese construe onvoa eanyzonn aw, or nanceorregua os: ..... ~ .......... ~ ..............
14' Nam cfCregra e .......... ? ................. Will excess fill be removed from premises: Yes No
· e wner of premises .................... Address .............. Phone No .......
Name of Architect ........... i... Addre ..............
Nan f C ............ ss ................... Phone No ..........
~e o ontractor ......... ~ ........ Addr ......
15 thi ty itht 3'00 ....... ess ............... Phone No. . .
tid 1 d? ,y ..................
· Is ~i~roper w n feet of a a we~lan es ........ No..; ......
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 nu:mber ' · ' .
interior or coruer lot. ~ or description accordmg to deed, and show street names and indicate whether
rATE OF NE~A'~YOPK, -- ,
OUNTY OF .'~ .... ~'-t '~ ~ S.S:
....... t...~.~ .o~ .%... ,~.[' ........... being duly sworn, deposes and says that he is the applicant
(Name of individual sigmng aontract) '
ore ~alned.'
'isthe Oonornl Congracgor
~ (Contractor agent corporate officer etc ) ........
a:d owner or owners, and ls duly authorized fo perCorm or }laVe perforated the sald work and to make and file thi$
~1 cat on. that all statements contameq m this application are true to the best of his knowledge and belief; and that the
~rk will be perfomed in the m~ner set ~forth in the applicatiou flied therewith.
'om to before me this
.............. .......
Count?
EILEEN G. WALL'
NOTARY PUBLIC, NEW YORKi STATE
NO. 01WA9509185 ,,
QUALIFIED IN SUFFOLK COUNTY.=,
vE.u ,XP,REB OCTOBER t
.... : ....
(Signature of apphcant)
BOARD OF HEALTH ..........
3 SETS OF PLANS
SURVEY
CttECK
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
)/../.~. (~'- ~eOUTHOLD, N.Y. 11971 NOTIFY
TEL.: 765-1802 CALL
F'xamined .......... 19... MAIL ~TO:
Approved .......... , 19 Permit No..
' APPLIe'ATION-FOE BUILDING PERMIT
Date
· ../ ....
INSTRUCTIONS
Tlfis application must be completely filled in by typewriter orin ink and submitted to the Building Inspector', with 3
ets of plans, accurate plot plan to scale. Fee according to schedule.
h. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets
~r areas, and giving a detailed descriptibn of l~tyout of property must be drawn on the diagram which is part of this appli-
at/on. .
¢. 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
hall be kept on the premises available for inspection throuv~hout the work.
e. No building shall be occupied or used in whole or ~n~art 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
luilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
~egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
~he applicant agrees to comply with all applicable laws, ordinances, building code, housin~ code. and regulations, and to
dmit authorized inspectors on premises and in building for necessary inspections.
.... '~ .... 'Z',&'S,CONTRA{3TING {NI .... -,. ·.
· (Si=nature i~.t Opl~l~,'nj02or name, a a c~ratmnl
FISHERS ISLAND, N.Y. 063~0
'' ~ailing ;dd/e%s
:tare whether applicant is owner, lessee, agent, ~chitect, engineer, general contractor, electrician, plumber or builder.
.......
[a me of owner of pre raises ..... ~*~... ~g~,/. ~
/(as on the tax roll or latest deed) ' ''
'applicant is a corporation~ignature of duly authgrized of~cer.
(Named title of co.orate officer) ' '
Builder's License No ..... Z~.~..~ .......
.... CC r. ...........
oth= ......
Location of land on which proposed work will be done... ~.. o
~ / ~ ~ / -- ·..2 · ~3.~.~.. ~ ....
' '''''' ''''' ' '"Street, ·
House Number Hamlet '
County Tax Map No. , 000 Section ....... %..'. ...... Block ....... ~. .... Lot. ~'¢. ./
Subdivision Eilcd Map No ' .
..................................... · .............. Lot ,, .............
(Name) , ,,
St ' ' ~ '
ate existing use and occupancy of premises and intended use and occupancy of proposed construction: ,
a. Xatmg use and occupancy ......... ~ ........................ , ~ j;
b. Intended u~e and occupancy -- . ........ , , , ,
,ore of work (check which applicable): New Building ...... ~
~ i . ~ ................ Other Work .....
$. If dwelling, number of dwellin [units (to be paid on filing this application
g ............... Number of dwelling units on )
If garage, number of cars .... i .... '
6. gib===; ......... each oor . . . ...........
7. i y, amre an .................
, extent of cacti type of use .... ' ....
· ., . ~ ......... '~umoer olb/one~ ..................... Depth .
l.,tlmenslons otsame structure ..~.~, ~,_ ., ~ ...... : .................
w~., -,rotations or additions: Front ..................
new construction: ...................... ' '
Height Nmn'ber Front .............. Rear..
............. of Stories ............... Depth .
Size of lot: Front
........... ! .... Rear ....
Date of Purchase ' ' ......
~ ..................... Depth ......................
11. Zone.or use district i ~.:~;. _' ''.' ..... : ......... Name of Former ~
12. ~'' ...... -'""" premises are mUated . O.v ..........................
13. Will lot be regraded '~.,,,~ -,y ~on,ng law, ordinance or regulation: ... ' .........
..... t ..... · · ·. Will excess fill be removed from premises: . Yes No
14, Name of Owner of premi ~ ..... . Address ................... Phone No ....
Name of Architect .......... 4 ................ Address ............
· Name of Contractor ... , ................... Phone No ................
15.Is this property located .~00 feet of ,.
· I_r yes. $outhold ~Co'*n[rrustees .y.~.rmlt moy he require~e,tl'~"d?
I I'LOT 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.
· 8.
9.
I0.
FATE OF NEW YORK,
:DUSTY OF. ... ' SS!
(Name of individual s~gnmg {ontract)
~ · . .... , .......... being duly sworn, deposes ~d says that he is the applicant
ope named. _ ! , '
tile ............ o, .... ·
(c ;;;3;;fi; .............................. . ......
:' ontractor, agent, officer, etc.) - ·
said owner or owners, ~d is duly'aulhorized to perform or have performed the said Work and to m~e and file this
dication; that all statements contained' m tbi~ application-are
rk will be perfo~ed in tile m~ner set ~th in '~ ......... true to tim best of his knowledge and
am to before~ tiffs ~ [,~ -,~ .vpncatmn 01ed therewith, belief; and that the;
....
I / '"/ , k ~ ~// f ' ....''~t..
~ .~,,~ ~ ?~ ....... ~,.' ...... ~'/ ..... ~ounty ~ /
" S~ e~Couni~y (Signature of apphc~t)
:xamlned ................ , 19 . ..
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
gOARD OF HEALTII .........
3 SETS OF PLANS ..........
SURVEY ...................
CIIECK ....................
SEPTIC 1' 0 R,~I ..............
[IOT I FY:
CALL ...................
HAIL TO:
Apl'r°v;d'~' '~/, ~."'- .......... 19~'.~Permit No,~/...~. d.~ .
Disapproved a/c , ~ .......................
· ..
(BuHdino Inspector) ·
APPLICATION FOR BUILDING PERMIT
Date ................ ,
INSTRUCTIONS
a. Tiffs 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 bnildings on premises, relationship to adjoining premises or public streets
~r areas, and giving a detailed description of layout of property must be drawn on the diagram whicli is part'of this appli-
:ation.
¢. The work covered by this application may not be cbmmenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit
hall be kept on the premises available for inspection thronghout 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
luilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
~,egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
['lie applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
:dmit authorized inspectors on premises and in building for necessary inspections.
Z&S Contracbin9 Inc.
(Signature of applicant, or name, if a corporation)
9.6.3. 9.9 .........
(Mailing address of applicant)
~tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
General contractor
"/amcofownerofpremJses Albert Stickney 111
(as on tile t,T.X roll or latest deed)
if applicant is a corporation, signature of duly authorized officer.
Thomas J. Shillo, President
(Name and title of corporate officer)
Builder's License No. 13 24~ 'HI
Plumber s License No 554-P
Electrician's License No ...... .9.2.4.-: .E ...........
Other'Trade's License No ..... .238-AR
Location
of
land
on which proposed work will be done. ' ~ues~r~an av.e
West end, Fishers Island,N.Y. 06390
I louse Ntan ber Street Hamlet
Cotmty Tax [lap No. 1000 Section 9 Block 6 8 · 9
Subdivision' Filed Map No ' Lot
(Name) ,
State existing use and occupancy of premises and intended rise and occupancy of proposed Construction:
a. Existing use and oc~upancy .si.n.~.le family dwelling
b. lntended use and occupancy ....................single family .dwelling. . . ':~0-'~': '. ,." ''~_ ,.,: ,'; '}i~
3. Nature ofwork (check which applicable): New lhHhling .., Addilion X .... Alt'erotica ..........
P, epair '"' ' · .........
.............. Remolval ............. Demolition .... ' .......... Other Work Demo
(Description)
4 Estimated Cost $.50 9.Oq .09 $256 35
5 Ifd Iling numb r ofd (to be paidon filing this application)
. we , e welling Units .. N mb f dx,/
Ifg b of , ............. u er o elling units on each floor ........
· arage, hum er cars ..... I ..... ' ' ' .....
6 If hula' rci 1o mix dloc ..... · ....................................
· fy atu nd Xt tel achtyp oft ..........
7 Di s ess, comme a r e cup y spect n re a e en e e ~se .....................
nsio sofexi ting tructt anc~ ,
· H me n s tres:, fi any: Front ............... P, ear .............. De .....
eight ............... Number of Stories . . ,. pth ..........
Dhnension of sam it'h alt ......................................................
s e structure, w erations or additions: Front
Depth i Height ................. . Rear ..................
Ntlnl~er of Stories ' '
. Dmlenslons of entire new constm'chon: Front ' ' .... ' ......... * ' ' ......
' ~ Rdar..~.'... Depth '
Height Number o£ Stories .............. ' ......................
9 Size ofl~: ............. ' ............... . ......
Front .............................
' Rear. Depth ........
I0' Date ............ ~ .......... ' ................................
· of Purchase ..........
...... · ........... Name of Former Owner ................
I 1. z. one or use o~stnct m wluch premises are situated ................. ............ ' '. ...... ~ ....
12. Does proposed construction viola e any zoning law, ordinance or regulation: ..... , ..........
13. Will lot be regraded ................
I ......... Will excess fill be removcd from premises: Yes No
14. Name of Owner of premises .... ~ .............. Address ................... Phone No.
Name of Architect · ..............
............................ Address ................... Phone No ................
Nmne of Contractor ......... . . Address .................. Phone No .........
5. Is this property within 300 feet of. a tidal wetland? *Yes ........ No .........
· If yes, Southold Tolwn Trustees Permit may be required.
.... I PLOT DIAG RAbI
Locate clearly and distinctly,all b,u,ldmgs, whether existing or proposed, and. indicate all set-back dimensions from
>roperty lines· Give street and block m mber or description according to deed, and show street names and indicate whether
nterior or comer lot.
FATE OF NE~,~YOR, Kt ,~, S S
(Name of individual signing
:ontract)
being duly sworn, deposes and says bat lie is the applicant
N .... EILEEN G. WALL' i
u,~..y ~iUoB. LiO, NEW yORKISTAT~
01WAO~Og185 i
QUALIFIED IN SUFFOLK OOUNT¥~,
TERM EXP REIS OCTOBER ~1, 1~ ~ ~
(Signature of applicant)l
'.isllte ...... General Contraeltor
' (C f fi )
J ontractor, agent, corporate o cur, etc.
sa/d oxvner or owners, and is duly authorized to perform or have performed tile said work and to make and file this'
:ti cation: that all statemcnts containedl in this application are tree to the best of his knowledge and belief; and that thel
,rk will be performed in the manner set Iforth in the application filed therewith.
om to before me this '
........... "· '.a ....... day of, .: .,..t:'.~.?.~. c:) ..~
, ..... ,. ~19
ta ~W. d'~, .,, U' C~
ry Public ·,-~O~g.4,,,~. ,.,~.. :.../~,i~ ..... '.