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4
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20990 Date SEPTEMBER 2, 1992
THIS CERTIFIES that the building ADDITION
Location of Property EAST END ROAD FISHERS ISLAND NY
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 9, 1992 pursuant to which
Building Permit No. 20479-Z dated MARCH 16, 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 A BLUESTONE TERRACE & WALL 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 4A Building Inspecto~
Rev. 1/81
"RK 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)
N94? ~Z Date Pte......... 14.........
20479 1416 204,5~11
i Permission is hereby granted to: a
P.,............
4a~3yo
4 to OA....(/~ !'1.
.................:4.
i of premises located at ........l...a...
I
~./...~rLl l?
County Tax Map No. 1000 Sectioonny Block ~..........yLot No....:lt...!
pursuant to application doted ..'L./../.. elft'IE........... 4.1?........ 19.....1,,ond approved by the
Building Inspector.
Fee S•,,~'.:...t.~/11
Building Inspector
i
'r
Rev. 6/30/80
Olo
FORM NO. 6 _
i 441 -
TOWN OFtOUTHOLD a e
Building Deportment t:
Town Clerks Office
Southold, N, Y. 11971 ' - J UL
APPLICATION FOR CERTIFICATE OF OCCUPANCY tq"'"
Instructions
A• 'this application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building
pr Inspector with the following; for new buildings or new use:
yc
L Final survey of property with accurate location of all buildings, property lines, streets, and
unusual natural or topographic features.
2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal).
3. Approval of electrical installation from Board of Fire Underwriters.
A• Commercial buildings Industrial buildings Multiple Residences and similar buildings and
Installations, a certificate of Code compliance from the Architect or Engineer responsible for
the building.
5, Submit Planning Board approval of completed site plan requirements where applicable,
8. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of property showing all property lines, streets, buildings and unusual 'natural
or 'topographic- features.
21 Sworn statement of owner or previous owner as to use, occupancy and condition of buildings.
' t;-.
1;,;;.,, , . 3. bate of any housing code or safety inspection of buildings or premises, or other pertinent In-
formation required to prepare a certificate.
!C. Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use $5.00
3, Copy of certificate of occupancy $1.00
/
~Yt/11•1 e { Date 1.1. Y•j••I,f'..M1•i•l•••1.1!•. •.1. Y•..f 1I
New Building Addition Old or Pre-existing Building Vacant Land
Location Of Property „ i...,.•,..•...•...•....,..
r azs..t .....a~.d.....I3d......Etg.h.r,.is....~
§ i
'Ownef Or Owners Of Property S.11.1,.Z i t?.l~C
y... zsd',
Subdivision ,...,....•.,p,,...• Lot No.., n.. Block No. House Na =
qg'I' permit No.°,i°,. .1,.... bate Of Permit .,..Applicant, ..a~. ....,,,~r.3. ~..r!c.YS?'~
i b ,(ss „
,Ip~~'„r' 'Health Dept, Approval
Underwriters ........................Labor Dept, Approval ........,,.,,.,....,.,.,............,:.,..u.,..'
i'Underwriters Approval ..,Jk.1A ..............................Planning Board Approval .o
Request For Temporary Certificate Final Certificate
's74,';I Fee Submitted $
rdnstruttion on above described building and permit meets ppii ble c e,i. nd regulations,
Applicant
n iD boQOre me~bie-
~ S
~ h A(st&ttipho'r seal)
77
::dE"•3•pa, i• _ _ - ~46MAS F BON6RT'Y JR.
Notary u IC .l• o _ tlotery Public Maw of Now York
No,1806659
Ousiifloo.in sulioik county
` / - Term Expires 12/31/90--""
t, ~
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)
N 20331 Z Date 19.E
y~
Permission is hereby granted to: 4`6
~...a...~~'.... off'
~r'Cf
to a~..... :Y.~ 1~~~ ~ P....- 1~4. d:~•""
- ..1../f'..~/ 1.. AA~r .
at premises located at .e.«...~ 1 u•~•••....1..~
..n........ f....1:..
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
County Tax Map No. 1000 Section ......."T............ Block 1,5.......... Lot No.....f z.....f°~i~....
pursuant to application dated r . 19.471 and approved by the
Building Inspector.
Fee 56,+..3+. Ulm.
Building Inspector
1 Df)
JUL 2 4 1
Rev. 6130180
-Jii,.• X-1LNi'f
TTION (1st)
Iv
c~
?OUNDATION (2nd) cy=
2. ,
z
0
ROUGH FRAME &
.PLUMBING
3.
m
I17SULATION PER N. Y. I y
STATE ENERGY I~
CODE
r
FINAL I C `
ADDITIONAL COMMENTS: m
x~
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FORM NO. 1
TOWN OF SOUTHOLD
:I MAR - 9 1992 BUILDING DEPARTMENT
h` TOWN HALL
L_, SOUTHOLD, MY. 11971,.
TEL.: 7651802
Examined......, 19.... Received........... , 19.. .
Approved [if/I/1',.../ t,/2 199.1,11 ermit No..V
Disapproved a/c
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date ~p........... , 19,5a
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 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.
7 . K ?n~...........
(Signature of applicant, or nMie, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
C?e/9~ r1.... ty1.....[b2./
Name of owner of premises :V-,~j/....t~%l.z<,•,•••,,,••••,,,._•••••••••••••,
(as on the tax roll or latest deed)
If applicant is )icoap ra tion, zed officer.
(Nnd title of core atocer)
Builder's License No. VPF
.
Plumber's License No. S5 .y.- f7
Electrician's License No. ..Y.-
Other Trade's License No.
1. Location of land on which proposed work will bbedone . ..../.J............. .
sol~-% L/'JAJ( /I G~~i~C%C .....!?S).!/i%S ..L S/k'63C~
House Number Street / Hamlet
County Tax Map No. 1000 Section Block Lot.`T
Subdivision Filed Map No. Lot...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ....H~'.~.... K?>1/ •
b. Intended use and occupancy ...y
Nature of work (check which apl,plicable): New Building Addition ...V!...... Alteration • • • • • • •
Repair Removal , De olition . , Other Work
(Description)
4. Estimated Cost ....S.Q/fqv?3< .6V Fee'.... ad..................... .
(to be paid on filing this application)
5. If dwelling, number of dwelling units . . . . . . . . . . umber 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 . • • • •
7. Dimensions of existing structures, if any: Front Rear , Depth
Height Number ofStories
Dimensions of same structure with alterations or additions: Front Rear
Depth . . . . Height , . . Number of Stories
8. Dimensions of entire new construction: Front Rear Depth
Height . Nun}ber of Stories , .
9. Size of lot: Front Rear . . Depth , , .
10. Date of Purchase . Nin e of Former Owner , .
11. Zone or use district in which pr6ises are situated .
12. Does proposed construction violate any zoning law, ordina ce or regulation :
13, Will lot be regraded ! Will excess fill be removed from premises: Yes No
14. Name of Owner of premises : . Address Phone No............... .
Name of Architect . . : . Add ess ...................Phone No............... .
Name of Contractor , ! . Add ess Phone No............... .
L5. Is this property locatedi,within 300 feet of a tidal wetland? *Yes No X.
*If yes, Southold Town Trtistees Permit may be required.
PLOT DIACItAM
Locate clearly and distinctly all buildings, whether existi g or proposed, and, indicate all set-back dimensions from
property lines. Give street and blocki, number or description acc rding to deed, and show street names and indicate whether
nterior or corner lot.
~I
~I
',II
b I
PATE OF NEW YORIC, S.S
OUNTY OF..
• • ,al,~l being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
bove named.
Is is tile r(e?°(,..`ti:'Qy c'°!z:...................................
(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
pplication; that all statements con~ained in this application are true to the best of his knowledge and belief; and that the
vork will be performed in the manner set forth in the application filed therewith.
;worn to before me this
. .....day of a.."r-k 19 Q ~
Not Public, ` 1? , County p/
:.~f!..............
M RY B. PANKIEWICZ
WIARY PUOUC, STATE OF NEW YORK (Signature of applicant)
Nu. 52.8267wo - 30"A UN"
,:()M(S8fON EXPIRES ~2-
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POP- TTa MA51'GR. 6LCICCaM IN~~G.4TE5 sk"4N MEN T aP
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LIME of SYE:a r-R!LN r~Tlal1.__ V, SLuES7bNo-
WALL Tv fTG, m.'- 3 ar-LPw - QRhDE. C
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TERRACE. SECTION W/ MASTER 5F-P ZOOM STEPS
m w
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APPR,VED AS NOT~D~
OATEN 6~/{j/p~///,,~
FEE: `tlY: ~-rLG-eA
NOTIFY BUILDING OEPAflTMENT AT T
785-1802 9 AM TO 4 PM FOR THE
'IZ° BFZICK WALL i a " FOLLOWING INSPECTIONS: j, O 1. FOUNDATION - TWO-REQUIRED
q" BkuESToN~{ rv_ _ . rz FOR POURED CONCRETE
j ROUGH - FRAMING IS PLUMBING j .1
W97'H1ITE W.~T'e ^IsHM O, REC~SSI=D INSULATION co FINAL - CONSTRUCTION MUST CA)
"/~LC?.or A" 9c0.Et~µ •T*+.raK - BE COMPLETE FOR CA V
L. I V I N KOO M ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y.
DUeT GVER. 12~~ ' STATE CONSTRUCTION & ENERGY (D CODES. NOT RESPONSIBLE FOR -(D
I DESIGN OR CONSTRUCTION ERRORS
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A VERIFY ~DILJ Ibl FE6Lp ]0) ,
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OCCUPANCY OR
Elf USE IS UNLAWFUL' ~ QmU
WITHOUT CERTIFICATE - -
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OF OCCUPANCY
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SETTING 9ED - USE IS UNLAWFUL
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WITHOUT CERTIFICATE
LE,'.D Po^7.r-P cOPPea.. OI OF OCCUPANCY
_ r- CLEFT FINISVF P'4N -/Top HEM.MEC - EG4'E Ao4u 4^UI,-ILINq~l
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