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Home My WebLink About19029-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20107 Date JULY 25, 1991 THIS CERTIFIES that the building ACCESSORY Location of Propert~ PRIVATE RD. OFF EAST END AVE., FISHERS ISLAND, NY House No. Street Hamlet County Tax Map No. 1000 Section 4 Block 5 Lot 19.5 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY ~7, 1990 pursuant to which Building Permit No. 19029-Z dated MAY 21, 1990 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 TWO ACCESSORY POOL CABANAS The certificate is issued to MICHAEL ROTHFELD (owner) of the aforesaid building, SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A . UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 TO~VN OF SOUTHOLD BUI~.DING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is ~ereby granted to: ~ ~. _ ~ .... _ .. ................................................ ~. ............. ~.~.~..~ ............................................................. co~ To~ ~op No. ]000 Se~on ...~.~..~ ....... m~k ..fl~ ..... ~ No ...... l..Z,..~ Building Inspector, ~,, s...~<..~. Building Inspector Rev. 6/30/80 Form No. 6 TOWN OF SOUTuOLD BUILDINC DEPARTMENT TOWN ID1LL 765-1802 ,ICATION FOR CERTIFICATE OF!OCCUPANCY i. This application must he 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 1% lead· 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code C,~pliance from archiuect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. ;. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and pre-exzsting" 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 shaii state the ¢ reasons therefor in writing to the applicant. ~. Fees 1. Certificate of Occopancy ~ New dwelling $25.00~2Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool ~ 5.00, 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 Data .. JI1LY ~2, 1991 e~ Construe on ........... Old Or Pre-existing Building. . ocation of Property.. PRIVATI~ ROAD ................................................ Street Hamlet .......... Ow of Pr ~ICHAEL ROTH~LD ~wor or acrs operty ......... . . . .. ~unty Tax Hap No I000, Section. .. 4 5 ~9.5 ........... Block ...... f .... Lot ............ :bdivision ....... .................. · · Filed Map }lAY 21, 1990 A.JOtLN GADA rmit No..l~.~2~y~ ........ Date Of Permit ................ Applicant ............. alth Dept Approval · ' ........................ Underwriters ' Approval ......................... ~nning Board Approval ............. luest for: Temporary Certificate. Final Corticate ........ Submitted: $ 25.00 .. " a. oa CaSA col07 ...................... NOTIFY BUILDING ?es.18o~ s AM TO 4 PM FO~ 1. FOUNOATION · 'IWO 4. fiNAL - CONmlUCllON SE COMI'Lt'fll FOR C.O. AiL CONB'TflUC310N SHALL THE REGUlREMENTI OF THE STATE GONST~UGTiON & GQOE$, NOT mPONmlLt DESIGN Oi~ GONSImJGlI(XI OCCUPANCY OR USE IS UNLAWFUL WITHOUT CER1 OF OCCUPANCY OCCUPANC~ioR~ USE IS UNLAWFUL WITHOUT CERTIFICATE OCCUPANCY .J ~OUdD=TIOJ (1st) FOU.UDAT~ 0~1 2. ~2nd) ROUGH FRAME .PLUMBING I~SULAT%0N PER N. STATE EHERGy CODE Fi::AL ADDITIO~;A'L COMME~TS: BOARD OF HEALTH ...... 3 SETS OF PLANS ....... 'FORM NO. I SURVEY ......... , TOWM OF SOUTHOLD CHECK .......... BUIL'D. INGDEPARTMSNT SEPTIC FORH TOWN HALL NOTIFY SOU/HOLD, N.Y. 11071 ~' TEL.: 765-1802 CALLTO'': .............. MAIL Approved .... 1 PermitNo. , t'l~ ~-~'~Ls-:~L!\.~4, - fl~ · ~ · TOWN OF SOLrrHOLD, ~ ~j (Budding Inspector) APPLICATION FOR BUILDING PERMIT Date......'~... .......... 19~..~. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Bmldmg 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 a~eas, and giving a detailed description of layout of property must be drawn on the diagram which is par~ of this appli- cation. < ¢. 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 Build~ng Permit to the applicant. Such permit shJJd be kept on the premises available for inspection throughout the work. ~¢. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occuoancv 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 3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other appilcable 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 name,' if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) If apptic~jlt is a corporation, signature of duly authorized officer. ' ................. (Name and title of co,orate officer) . ALL COq!TRACTOR'S HUST BE SUFFOLK COU. NTY LICENSED Builder s L cense No · . .~.~../7' .~../~. ......... Plumber's License No. .~.~- ~ Electrician's License No ...... Other Trade's License No.. Ia~-~' House Number Street Hamlet ......... County Tax Map No. I000 Section ..... mock ._. .... Lot .... ,,. Subdivision Filed Map Lot ' (Name) ' ' ' 2. State existing USe and occupancy of premises~and intended use and o~cupancy of proposed construction: a. Existing use and occupancy . . .~.~ . . .: ..... ~ ~ ' Ruilding'('~' -' · - -"I- -/~',', Addition Alteration $. Nature of work (che~k which applicable); ~ew Rep~ Removal .... ' ......... .............. Demolition Other Work ........... 4. Estimated Cost ... ~,, ~ ....................... Fee ..................................... ' (to be paid on filing this application) 5. If dwelling, number of dwelling u~its ....... Ifgarage, numberofc~ ...... ;...:~:~: : : : Numbero~dwcff~ngunltsoncnchfloor. If business, commercial or mixed ~occupancy, specify n~ture and extent of each type of us~. Height ............... Number of Stofie~ ..., ........ :/.. ~,. Dep~ . .~ ....... ~ ............ ~. HeiSt ..................... ~umber of Sto~es & D~ensions ofe~t~ new constm,ctmn. Front ... ~.~...'. ~ ~'~ ,' ' .......... ;' L' ....... Height ...... [~ ....... ~mn~er of Stories. . ~ ........ ...... ........ ......... Size of lot: Front ............ ~ .......... Rear .......... , ............. Depth .... Zone or use district m which premises are situated... ' ' Does proposed construction violate ~ny zoning law. ordinance or reou]atio · W~I lot be re,fade ~ ., ~ ~ n.. ~ .......................... ~e of Owner or o~em~es~ ~~ ' ', wm e~e~s fil~be~moved from premises: Yes ............ Phone No.~,./; .~/;. 5, Xs r~s property Xocared wtthtn 300 fae~ of a ttda~ wetland? *Yea ..... ~o ,~..4~ · if yes, Southold To~ Trustees P~it may be reouirad. .. PLOT DIAG~M Locate cle~ly ~d distinctly ~1 ~uHd~gs, whether existing or proposed, and. indicate ~1 ~et-back d~ensions from rope~y Hnes. Give street ~d block nflmber or deschption accord~g to deed, ~d show street nines and indicate whetaer :teffior or comer lot. L\TE OF NEW YORK, S.'S DUN'TY OF . i ............... . ........ .~'.: -- ~ ': ........ -'-,~'- ~ -' ................ being duly sworn, deposes and says that he is the applicant (Name ofindMdual signing contract) Ore:named. , : is Jthe ' (Contractor, agent, corporate officer, etc.) ~.aid owner or owners, and is duly ,'author/zed to perform or have performed the said work and to make and file th.is ~licat on: that all statements contaioed in this application are true to the best of his knowledge and belief; and that the 'rk will be performed in t lc manner ~et forth in tile application filed therewith. : , > . . 9.)° ........ l .......... day tar}' Public, . . ~ ,