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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-22421 Date JUNE 28, 1993
THIS CERTIFIES that the building ADDITION
Location of Property BELL HILL AVENUE, FISHERS ISLAND, NY
House No. Street Hamlet
County Tax Map No. 1000 Section 9 Block 3 Lot 6
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated- OCTOBER 12, 1992 pursuant to which
Building Permit No. 21020-Z dated OCTOBER 15, 1992
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 ADDITION TO ONE-FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to ANNE HYDE PATTERSON
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. PENDING JUNE 22, 1993
PLUMBERS CERTIFICATION DATED JUNE 21, 1993
Build ng Inspector
Rev: 1/81
FORM NO. s
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)
N2N9 21020Z Date (l Y 19.2A-
/4/(f a-,~ ~
Permission is hereby granted to: ~j
.
a.. .+e.:
..1~p- ,.G~.........
iGJ.1ltiJ..... ...°0..,..
to
t%..m. ....~..A ~
at premises located at ~J
` t....
.
County Tax Map No. 1000 Section Block 22
.......1 Lot No......
r
pursuant to application dated 19f.... nd approved by the
Building Inspector.
Fee $A^-0/.0..0.....
Building Inspector
Rev. 6/30/80
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NEW YORK 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Date ...June 8, 1993......
NEW CONSTRUCTION..X..OLD.OR PRE-EXISTING BUILDING..... VACANT LAND.....
Location of Property Belle Hill Ave
Owner or owners of Property .....Anne Hyde Patterson
County Tax Map No. 1000 Section ....9... Block ....3... Lot...6.......
Subdivision .....................Filed Map Lot............
Permit No...2102OZ..... Date of Permit 10/5/92.... Applicant.A.J. Gad
Health Dept. Approval ................Underwriter Approval!':~:'1:a3 93
Planning Board Approval
Request for Temporary Certificate ...........Final Certificate ...X...
Fee Submitted: $...25.00.........
Applicant A. John Gada General Contracting, Inc...
THE NEW YORK BOARD OF FIRE UNDERWRITERS
WE ARE IN THE PROCESS OF ISSUING A
CERTIFICATE OF COMPLIANCE FOR THE
ELECTRICAL INSTALLATION AS COVERED
IN AN APPLICATIO~eT BELOW. n ~~tpppyyy~(~(R(
APPLICAT N NO U
LOCATION I I+5~'
INSPECTOR DATE 2+~.( F,,, „ss,y
IBD (REV 9/90)
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c~~FF~~/(C TEL. 765.1802
o~p a OG TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
C E R T I F I C A T I O N
Date 9`3
Building Permit N~~orr.ll
Owner.Arnine 1- dQ i`GU LeesUII)
lease pr'
Plumber 044
_ please pr
/7. ~W)t~j[~Yle~"~-1?~~TG2Clr'lL~ --ls~C.
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
(plumber's sign ture)
Sworn to before me this
o2/St day of v/uhe
1953 Not ry Public
Notary Public, f1. Co /k County MARY B. PANKIEWICZ
NOTARY PURUG, $tATE OE NEW Ya,2prr
N& 52.MMO
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ESN?Y?H:'?" . CIS .a:'T_ C i T
BOARD OF HEALTH
FORMN0.1 3 SETS OF PLANS
SURVEY
TOWN OF SOUTHOLD CHECK .
OCT + 4 199Z BUILDING DEPARTMENT SEPTIC FORM .
TOWN HALL
SOUTHOLD, N.Y. 71971 NOTIFY:
diNTEL.: 7651802 CALL
Examined 19... MAIL TO:
Approved ~~~G 19~~rmit No..
Disapproved a/c
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date r ~°2 19
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
sits of plans, accurate plot plan upscale. 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 inspec~tiof s.
(Signature of applicant, or, name, iff a co oration)
(Mailing address of applican )
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
cow /~~~rc~~~
'dame of owner of premises
(as on the tax roll or latest deed)
if applicant is a corporation, signature of duly authorized officer.
, -
(Name and title of corporate officery
Builder's License No. . ~ , ff1
Plumber's License No. .
Electrician's License No. ?966 E
Other Trade's License No. "9." , . , , , , ,
Location of land on which proposed work will be done:
(louse Number Street. Hamlet
Count '
y Tax \lap No. 1000 Section Block Lot ..Q~....
Subdivision . . ~ Filed Map No. (Name)
State existing use and occupancy of premises and intended use and Occ/u~pancy of proposed construction:
A. Existing use and occupancy... 4..
. 7L.
B. Intended use and occupancy... . 0 f? f
MI 031 DJAU0
EiC dE i srJ7JfJ 8,~AJUJ MAWT
3, Nature-of work (check which applicable): New Building Addition Alteration
Repair , R~ Iimoval Demolition I .........Swimning pool........... .
Tennis Court Accessory Building . . . . . . . . . . Fence .......Other Work.........
t. Estimated Cost
Fee .......4.40........................
(to be paid on filing this application)
i. If dwelling, number of dwelling units I......... Number of dwelling units on each floor •
If garage. number of cars
i. If business, commercial or mixed occupancy, specify n~ture and extent of each Alle of use
7. Dimensions of exi ling structures, if any: Front Rear K Depth ,
Height Number of Stories A . .
Dimensions of me structure with Iterations or additions: Front A........... Rear .
Depth . . Ieight Number of Stories .
3. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories .
3. Size of lot: Front ! Rear Depth .
J. Date of Purchase . . . . . . . . . 11 Name of Former Owner , . ,
I. Zone or use district in which premises are situated .
Does proposed construction violate ny zoning law, ordinance or regulation: • ,
3, Will lot be regraded . , , , , Will excess fill be removed from premises: Yes NQ
3. Name of Owner of pre ices lPn it,,,~;/RSZ(Address ~ Phone No..y"~ f2,
Name of Architect ~ell ut~ Address ,,Dp ~ Phone No. AW f`/q
Name of Contractor~e i~` 1 fig'. .2 V. , Address VU , ?I ..Phone No. v'!(P ; rF 7 .
S.Is this property loc4ted within 300 feet of a tidal dwetland? *YES . . . . NO . . . .
a
*If yes, Southold Town Trustees Permit may be required.
i PLOT DIAGRAM
Locate clearly and distinctly.all buildings, whether existing or proposed, and. indicate all set-back dimensions from
roperty lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
I
I
TATS OF NEW O S.S~
:OUNTY O
. . -
• • ' • • • • ~l~«• • • . • . • being duly sworn, deposes and says that lie is the applicant
(flame of individual signii , contract)
bove named.
It is the
(Contractor, agent, corporate officer, etc.)
f said owner or owners, and is duly a4thorized to perform or have performed the said work and to make and file this
pplicntion: that all statements contained in this application are true to the best of his knowledge and belief; and that tl~c
'ork will be performed in the manner set forth in the application filed therewith.
wom to before me this
....dayof.. QpC' „19,~Z k.
votary Public.4 4,- r.. . W.~') , Coun y
EILEEN WALL
NOTARY PUBLIC, NEW YORK STATE / ' • • ' • ' '
NO. OIWA9609185 (Signature of applicant)
QUALIFIED IN SUFFOLK COUNTY
TERM WIRES DCTOBER 31, 199
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WITHOUT
OCCUPANCY CERTIFICATE
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C====--2 EXISTING CONSTRUCTION REMOVED`
O EXISTING CONSTRUCTION TO REMAIN APPROVED AS NOT~FD ?~1
DAT~~ P.N i~
® NEW CONSTRUCTION FEE: BY. Q
NOTIF BUILDING DEPARTMENT AT 1 , 766-1802 9 AM TO 4 PM FOR THE O ^'G7/1
FOLLOWING INSPECTIONS:
7. FOUNDATION - TWO REQUIRED
PLUMBER CERTIFICATION \ FOR POURED CONCRETE
ON LEAD CONTENT BEFORE 2. ROUGH - FRAMING & PLUMBING S. INSULATION
Y 4 FINAL - CONSTRUCTION MUST
CERTIFICATE OF OCCUPANCY/ BE COMPLETE FOR C.O.
SOLDER USED IN IAIATER ALL CONSIRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y.
SUPPLY SYSTEM CANNOT STATE CONSTRUCTION & ENERGY
EXCEED 2110 of 1 % LEAD. CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS OWN BY
CKD BY
DATE • 1013 9Z
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T TITLE
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TITLE
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& WATER LINES NEED
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REV DESCRIPTION DATE SCALE •I/4°=I••0°
TITLE
ELEVATIONS DWG NO 3
JOB NO•
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