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Home My WebLink About18622-z FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19857 Date APRIL 16, 1991 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property #4 PETERS WAY FISHERS ISLAND, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 6 Block 2 Lot 3.6 Subdivision WALSH PARK Filed Map No. Lot No. 4 conforms substantially to the Application for Building Permit heretofore filed in this office dated SANUARY 9, 1989 pursuant to which Building Permit No. 18622-Z dated NOVEMBER 1, 1989 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 ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to WALSH PARK BENEVOLENT CORP. (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL APRIL 12, 1991-91-SO-25 UNDERWRITERS CERTIFICATE NO. PENDING - APRIL 16, 1991 PLUMBERS CERTIFICATION DATED APRIL 9, 1991 - Z & S CONTRACTING INC. Building Inspector Rev. 1/81 rows xo. s TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Np Z Date 19. Permission fs hereby g~a~teGG~~I .................................~,~..-~.~~.i~~ , to ..~~~...~........9~L.e........ .tom .......G~~~~;,tt.: of premises located at ...~~/y.~./.~l~d~r.....~/7`.... County Tax Map No. 1000 Section Block ...........z...... Lot No............~r..l... pursuant to application doted 19........, and approved by the Building Inspector. Fee $.~ab.`_____7""."~~ 6~ i ' c. 9 . ~c Buil ' or Rev. 6/30/80 Memorandum from . BUILDING INSPECTOR'S OFFICE TOWN OF SOUTHOLD TOWN HALL, SOUTHOLD, N. Y. 11971 765-1802 FINAL BOARD OF HEALTH APPROVAL MAILED FROM THE HEALTH DEPARTMENT ON MONDAY APRIL 15, 1991 TO THIS OFFICE PER TELEPHONE CALL WITH CHARLES BRIGHAM. HEALTH REFERENCE 91-SO-24 LOT Illl 91-SO-25 LOT /14 f TOWN OF SOUTIIOLD BUILDING DEPART2ICNT TOWN HALL " SOUTIIOLD, NEW YORK 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY e DATE.. ~lltL.. 8/_ ! ~,l 1_ NEW CONSTRUCTION ...OLD OR PR - ISTING BUILDING......VACANT LAND.._.._.. ~ I Location of Property.........: _ ..~F-:~~. _ _ _ _ ~H~QS ys(_~'v~.... _ HOUSE NO. STREET HAMLET' . Owner or Owners of Property.~A~SW..: :¢;u"_~£u£'~o~-'~~.~~ ,~A~O~.,, County Taa Map No. 1000 Section ~d ~ Block Lot 44 Subdivision.:^.'_~`.SN ..:.:"e~:.__.... Filed Map ........Lot....... Permit No. ......._..Date of Permit ..........ApplicanC l~d~$1.1.~~~~'~U'FUOL,~NI~ Health Dept. Approval Underwriters Approval............._ Planning Board Approval Request for Temporary Certificate Final Certificate Fee Submitted: T APPLICA ~ rev_ 10/14/88 , ~ ~ y FORM N0. 6 i TOWN OF SOUTBOLD _ BUILDING DEPARTMENT TOWN BAL. 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS A. 'This application must be~,filed in typewriter OR ink and submitted to the Building Inspector with the Eo1loFing; for new buildings or new use: i. Final survey of prope~tq with accurate location of all buildings, property lines, streets, and unusual njatural or topographic £eatures. 2. Final approval of Hea~ith Dept. of water supply and sewerage-disposal(S-9 form), 3. Approval of electrical, installation from Hoard of Fire Undervriters. 4. Sworn statement from plumber certifying that solder used in system contains less than 2/10 of 1Z lead.', 5. Comcercial buildings,'iindustrial buildings, multiple residences and similar buildings and installations, a certificate of code compliance from the Architect or Engineer responsible for the building. 6. Submit Planning Board 'Approval of completed site plan requirements. B. 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, buildings and unusual natural or topographic features. 2. A properly completed application, a consent to inspect signed by the applicant and a certified abstra~C of title issued by a title company which shall show single and separate ownership of the entire lot prior to April 9, 1957. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent information iequired to prepare a certificate. C. For Vacant Land Certificate of Occupancy: 1. An application for vacant land Certificate of Occupancy shall be submitted, and a certified abstract of title issued by a title company showing single and separate ownership of the entire lot prior to April 9, 1957 shall also accompany the application. If alCertificate of Occupancy is denied, the Building Inspector shall state the reasan$ therefor in writing to the applicant. D. FEES: 1. CERTIFICATE OF OCCUPANCY - New Dwelling $25.00, Additions to Dwelling $25.D0, Alteration to Dwelling $25.00, Swimming Pool, $25.00. Accessory building $25.00 Addition to Accessory buildings, $25.00 - Businesses $50.00, 2. Certificate of Occti~pancy on pre-existing dwelling - $100.00. 3. Copy of Certificate of Occupancy - $5.00 - over 5 years - $10.00 4. Vacant Land Certificate of Occupancy - $20.00 5. IIpdated Certificate' of Occupancy - $50.00 6. Temporary Certificate of Occupancy - $25.00 Residential $50.00 Commercial -ev,'10/14/S8 ' ~ ~ TEL. 765-.1802 ~ ~ oSpFF~L/~~pG TOWN OF SOUTd30~,D • y~ OFFICE OF BUILDING INSPEC;'I'OR ~ I z P.O. BOX 728 c°r~ ~ TOWN HALL ' I ..O~~Ol ~~0~ SOUTHOLD, N.Y. 11971 • C F, R T I F I C A T I O N ' ~ Date • ` Buildijng Permit ,A1 _ - Owner (A~n~~irS 1{~~~ ~ ~t,~ ~ ~ ~ ~ ~ (please print)' Plumber ~J/~ (please print)!!!/// , ~I T certify that the solder used iri the water supply'system ~ contains less than 2/10 of lo'l,ead. i ~ , (plumb 's signature) Swp~rn to befor me this day of Owl-- 19 _ ~ -y~!/ - Notary Public Notary Public, Ju~~-I[_ County THOMASi.DOP1Er•~TVSR ' ~ - Nottry Public Sfote of Nsw Y~Cra _ No. 4806659 ' • ~ ~ ~ ~ ~ _ ~ Ou6lHiec in 8utiolk Counry~ ~ ~ ~ Torm £xplroa t41~LC}$'~ ~ ' r JOHN SKI CONSTRUCTION ~0~11~ANY BO}C ~ FISHERS ISLAND, NEW YORK 0630 TO WHOM IT MAY CONCERN; WE INSTALLED THE SEWERAGE SYSTEM FOR LOT4 AT THE WALSH PARK AFFORDABLE HOUSING PROJECT ON FISHERS ISLAND. THIS SYSTEM WAS INSTALLED ACCORDING TO THE CRITERIA OF THE SUFFOLK COUNTY DEPARTMENT OF HEALTH, JOHN SKI PRESIDENT APRIL 8, 1991 - 1 - ~ J I I J n ? I ~ V ~I:'? I_..v 1 .h. ~iV.I4Jl ~v h. ~ C7 1 . ?,y ' M FOUIIDATIO"! (1st) c~~ FOU?lDATIO?I (2nd) _ - m C~~ z 1~ Op ROUGH FRki-lE & PLUMBING ~p~ ti H 3. ~ IIISULATI0;1 PER N. Y. " STATE EIIERGY CODs I ~1 . a r m 4. y~ r _:JAL - ~Qs o ADDITIOPIAL COMMENTS: NI1~~9/- ~n.P [).a.2P ..cQ .D~~ o~'~e-s~.e7~.r~ on 4~IG~91 _~nh%~- . x, c~ \ H . , 'n A H N O a e~. ~ - ~ E -e o(! H ~J BOARD OF HEALTH 3 SETS OF PLANS FORM NO. 1 SURVEY TOWN OFSOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORM TOWN HALL , SOUTHOLD, N.Y. 11971 NOTIFY TEL.: 765-1802 CALL Examined . ~.7.~........, 19 ~Gy /~i/ MAIL T0: Approved ....~/iJ.'.~t/......> 19~/ Permit No. /.!!f~ ~ .z'.. ~ Disapproved a/c w •JU;,rn Builds o Inspect r) "•--~-,~,,1-n APPLICATION FOR BUILDING PERMIT ~yy pq Date :..J~Idu6P~l..~....., 15 l INSTRUCTIONS 11 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 whose 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 inspection'~.'.~ (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. .....................C~ ~v. ~ . Name of owner of premises t S~-I C q (L~ b F u£ iJO L-L N~ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No . . Plumber's License No . . Electrician's License No . . Other Trades License No . . 1. Location of land on which proposed work will be done. ~/de7W ~ ~~eP'A . r,, ~'S'i GntD -jiSUL'6~! J3~U~~ Loe+~L•~. a~% ~('tnF CCScC~,~ House Number Street Hamlet ~ ~ ~ County Tax Map No. 1000 Section ..60(".'.~~ 0~ ~ nv 00 3,OU Block Lot.................. Subdivision /..C~ 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 ~'v ~ v'~~ ~l'7~f'.L~ b. Intended use and occupancy C(n~, T ~h~u~~4 U~c° ~7du g>er[- .JG6~iv~S%O~! i 3. Nature of work (check which applicable): New Building Addition Alteration--.-._-.__.,_.-..- Rgpair .Removal . Demolition Other SVork . l ' (D scription) 4. Estimated Cost • • . ~J°•~~A.P~S • • ~ • • • • • Fee ~..r~E!!~Y ~ .1.-•.. ./p~rc:xy.~:'•!lt7 ~~~V tl 0 (to be paid on filin his application) S If darallennumbeb of adsvellin units ~ Number of dwelling units on bath floor . g g ~ 6. If business, commercial or mixed occupancy, specify nature an extent of each t e o use . . 7. Dimensions of existingg structures, if any: Front Rear • • Depth . Height ..c`.~.! . !"/.A... Number of Stories . Dimensions of same~structure with alterations or additions: Front Rear . Depth .tst•~,.'." 10F Height Numl~r~ f Stories . 8. Dimensions of entire new cons ruction: Front Rear ........Depth . , . Height . Nu~ber of Stories . 9. Size of lot: Front Ae~?e ...~D• . i~ ~ 101. one or use district in which r~ • ~ • • ' ' ' ' ' ' .-I~' ame of Former Owner uue• •L, AISQNoNSL~. • • • • • • . • • • P 12. Does ro osed constructio vioemises are situated ~:~+~!~Qur?AL.......... o • . p p late any zoning law, ordinance or regulation: ~ . 13. Wi111ot be regraded Will ex es fill be removed front premises: Yes 14. Name of Owner of premises Cu p(z~. ~n?~~. ~wopa~?h~ Address : G:....rO.~`~:......... Phone No. ?fib :7~r :?~31.... . Name of Architect .....-T- Address • Phone No............... . Name of Contractor ~ ..Address .Phone No..... 15.Isc this property looted within 300 feet of a tidal wetland? *YES....NO. *If yes, Southold Towp Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly al} buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block's number or description according to deed, and show street names and indicate whether interior or corner lot. ~i APPRO ED AS NOTED E 2 Z ' DATE: B•R # FEE. BEPARTM TAT NOTIFY BUtI ING D ~ FOLLOWING NSPE70NS: FOR THE ~t~~ I ~6~ , FAR POURED CONCRETEEOUIREO ' 2. ROUGH -FRAMING & PLUMBING ~ ~ 4. FINALATIO CONSTRUCTION MUST BE COMPLETE FOR C.O. ALI_ CONSTRUCTION 5HA4L MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION 6 ENERGY ~°(tr:~ES. NOT RESPONSIBLE FOR ~ ~;t?SIIiN OR CONSTRUCTION ERRORS I ~I'~ STATE OF NEW Y~RK~ ~ u c.yr S.S COUNTY OP ~tt N C•~y lw,j, , , • • , • , , , , being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. 1 / He is the....... V,I~;L:-...... ~~'~/ZC^31h1"~~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly+ authorized to perform or have performed the said work and to make and file this application; that all statements conta}ned in this application are true to the best of his knowledge and belief; and that the work will be performed in the manneri set f th in the application filed there Sworn to before a this ayo I ~ .......,19 111111 Notary Pub • ~ . THOM,as F.OOrg' • •,Cou~ty 'pTV aA, ~ x Notary Pub11o SI+1+ of N+w YorN • • No, 480055 ~ (Signatuie•of applicant) ' Ou+itllao in Sutlolk County 1+rm fl?pira 12r,3u50