HomeMy WebLinkAbout18378-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 218717 Date JAN. 12, 1990
THIS CERTIFIES that the building POOL HOUSE
Location of Property ORIENTAL AVE. FISHERS ISLAND
House No. Street Hamlet
County Tax Map No. 1000 Section 005 Block 001 Lot 001.1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 9, 1989 pursuant to which
Building Permit No. 183782 dated AUGUST 11, 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 CONSTRUCT A POOL HOUSE.
The certificate is issued to MARK ANDREWS
(owner, xxxxxxxxxxxxxxxx)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N090430 SEPT. 3, 1989
PLUMBERS CERTIFICATION DATED N/A
J
Bt~il ing Inspector
Rev. 1/81
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rows xo. 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)
N X 8 3 7 8 Z Date ..~z~~.......l...l 19~./
Permission is hereby granted~to:
..L,~.'~~.~~~~~~~ ~itwe
ct premises located at ........(/r/~..
County Tax Map No. 1000 Section Block .......1 Lot No...1..t...../.........
pursuant to application dated 19........, and approved by the
Building Inspector.
Fee S~O.S~.?..,.
Building Inspector
Rev. 6/30/80
ANd 2~ ws
. ~ _ _
TOWN OF SOUTIIOLD ~~~~~`~JmL~?'uf'~,~~i
BUILDING DEPARTMENT ~~~~~1l~~ ~I~ ~
TOWN HALL ~ ~ ~~yY - f ~
SOUTHOLD, NEW YORK 11971
BLDG.pEPT.
765 - 1802 TOWN OF SOUTMOLD
APPLICATION FOR CERTIFICATE OF OCCIIPANCY
DnTE.O,ctober, 25.,. 1989,
NEW CONSTRIICTION X.....OLD OR PRE-E%ISTING BUILDING......VACANT LAND........
Location of Pro ert Private Drive Fishers Island
P Y••---...... „
HOUSE N0. STREET HAMLET
Owner or Owners of Property.,Mdrk Andrews
County Tax Map No. 1000 Section .5.... Block Lot ..1_..1
Subdivision Filed Map ........Lot..........
Permit No. 1837.8 .....Date of Permit .$:11:$~,.Appiicant A, John,Gada General Contracting, Inc.
Health Dept. Approval Underwriters Approva1.63778589/89..
N 090A30
Planning IIoard Approval
Request for Temporary Certificate Final Certificate x
Fee Submitted: $.~Q~QQ,,,,,,,,,,,,,, .
APPLICnNT.A,_John_Gada General Contracting, Inc.
~ 3 Str'f~
I'~a ~1 ~
Co 2./87/7
rev. 10/14/88
_ -
THE NEW YORK OARD r,, I
8 O~ FIRE UNDERWRITERS
~ o ; r, a } 2 R+unE~u of rrY O O ~(3,/ y:
!5 JONN STREET, NEW YO~11~.
~ YORK 1003a ' ( _
D.n ~>:F''PBMAER 0?,19~.~' .IH?IntianlV®.MJNe F:;'!'i~:r;s;g;$9 M (!9pe?.f
THIS cERnRlEfs THAT -
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is tieJi,YsttiwRlaeadewt ? Srsawwt ? IMe fl. ? W fl. 'lUT S~rtiatt ~se# Let
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*tSWiMNT}JG PtiiOL1 Th1.s cert.ifi.catA
covers cn~,l,lianc~ 3t thc~ date ~.~f
insGertian only. P ca,.;sc ~:f ,!r,!sna'
environments it is advisable t~?
have frFgaent test andif,r r+>Fair.s
Rn:tde by a qua'.ified Ner-:rn.
GAGA COtd'fRACfc`? [,TC.A?.95 I?
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k'ISNf'ES TS},AMD, itY, ~f,iG(} YliRA rywApii
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Thw ov1(Bwi~ atop aot he afiared in teotaw; rNtee b 11N al dr iwd N ntoortest. mar be idaMi(wd by fhar credeMiak.
t r t'.^, ~U1LCI"~ C-~'".RTI~".Eh.T. THIS COPY OF CERTIFICATE MUST NOT 6E '.!.TLS ~ ~ !.!!`i !'!J!,^~ER.
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FOUNDATIOt1 (2nd) ~
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I2ISULATIOP7 PER N. Y.
STATE ENERGY
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BOARD OF HE,\LTH
FORM NO. t 3 SETS OF PLAYS .
SURVEY
TOWN OF SOUTHOLD CHECK ,
BUILDING DEPARTMENT SEPTIC FOR:Y
TOWN HALL
SOUTHOLD, N.Y. 11D77 NOTIFY
' TEL.:7G5~7302 CALL
L•xamined 19... MAIL T0:
Approved , ` 19~~Pennit No. / ~,J, ~ .
Disapproved a/
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date _ ~w--?~..g.., I~f -
INSTRUCTIONS
a. Tltis 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.
i;naturejof applicant, or name, if a corporation) ` '
- Mailing, address of applicant) ,
State whether applicant' is owner, lessee, agent, parchitect, engineer, general. Fontractor<<, electrician, plumber'or builder.
..........'.~j;2;~;~;ei,~?2~c~
,
Name of owner of premises t%P~t ~ ti`-~ ` ~ ~ ~ ~ ~ I"~ '
. ,t; ~
( the tax roll p~,lptes~;d'eed~)-~ zr,
If applicant is a corporation, signature of duly authorized officer, r° ' ~ ,t, ' ~
(Name and title of corporate officer)
Builder's License No. , , u28~ ~ " _ ~'3"~391`?'~~'s~t#
~•g,r,,,,,, ~,a, ,
Plumber's License No. ;
Electrician's License No. ....L.~~, : ~
Other Trade's License No. , , , , , , _ ,
Location of land on which proposed work will be done. ,G,` C
n
,~~:J~~
/j~,~
house Number .......................Street.. ; •!~i%~/~'.'?~...........
County Tax \tap No. 1000 Section . , 1
•~.J • • • Block / . . .
f...:: Lot ..~a I . .
Subdivision Filed flap No. .
Lot...............
(Name)
State existing use and occupancy of premises and intended use and occup~ncY of proposed construction:
a. Existing use and occupancy .
b. Intended use and occupancy .~G.Z,^~.:"e~f.4~yJ-,~;r,~Ey~~•~~~~•••..•••••.•••..••.:..•••..•
0
3. \aturc otwor}, chick whit
Re air • , • . • • • . Rh applicable): Nety [3wlding , , , Addition .Uteration
p emoval Demolition •
OthcrlVork....:......
4. Estimated Cos~~ ,1,00• • , . ~ (Dcscnption;
Fee....?.t~~J,........
(to be paid on Cling this application)
If ~ ing units . . . : Number of dwelling units on each floor .
ICdwelling,nurnberofdwcll
6. If business, con rncorc alror mjxed occupancy, specify nature and extent of each type of use , , , , , , ,
Height arcs, if any: Front •
7. Dimcnsrons of sameistructuIVumbcr of Stories ~ • • ~ ' ' ' ' ' ' ' •Rcar ; , , , , , , , , Depth , , , , , ,
Depth . , , , , , C with alterations or additions: Front • • ~ . ~ ~ • ~ ~ • • • ~ ~ • • ~ " " " " • '
• . Ilcight . Rear
8. Dimensions of entire nett' constnrction: Fron[ , ' • • • • • Nurnbcr of Stories ' '
Height ..l~, Rear Depth..../~'
9. Size of lot:Front,~~•"'N;;umbcrofStories,,,,,.~..••.•.•..•••.
IO. Date of Purchase Rcar.......... ...........•Depth
.
1 1. Zone or use district in w}ticlt ' ' ' ' ' ' ' ' ' • • • • Name of Former Owner , ' ' ' ' '
remises arc situated ,
1~, Daes proposed construction violate any zoning law, ordinance or regulation: ~ ~ ~ ~ •
l3. \Villlotberegraded
14. Name of Owner of premises~%~t~,,¢i • . 1Vi11 excess fill be removed from prcmises:.....Ycs • . .
Hama of Architect ,s~~, • ~!?~?G• Address~4-uJ~/, , .Phone No.°Zl~.d'ly,/_,/~~~
Name of Contractors Address/~~'~?.~~c .Phone No.
IS.Is this properf '~~//~~~x~Addtcss~.~~~~~GV~?l~,•,phoneNo.~!~;?~7;z~/
*If Y loq'ated within X00 feet of a tidal wetland? *YES....NO.'',<„ •
yes, Southold Toy~n Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions fror.
property fines. Give street and bloc; number or description according to deed, and show street names and indicate whethc:
interior or corner lot.
APPROVED AS IVOT~7 '
DAT B~B.p # G.~~~
~`d BY:
NO FY BUILDING OEPARTME~'
755-1$02 9 0.M TO 4 PM 'FOR THE
FOLLOWING INSPECTIONS:I OCCUPANCY OR
1. FOUNDATION ~ TWO REQUIRED ,
2. ROUGHURFRAMINGR&TPLUMBING U~E I~ UN~./"trUL
4. FINAL - CONSTRUCTION MUST
3. INSULATI°" (TOUT CERTIFICATE
BE CAMPLETE FOR C.O.
THE REQUIREAAENT9 OF !,THE N~Y 0 IJCCU''"ANCY
STATE CONSTRUC710N dt', ~NERGV
CODES. NOT RESPONSIQ fOR
DESIGN OR CONSTRUCTION ERRORS
I
~p~~
~T,1TG OF NEtV RK
=OUNTY OF S.S
/f
' • • • • • • • being duly sworn, deposes and says that !te is the applicant
(Name ofindividua signiijg contract)
above named.
fc 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
.Iplication; that all statements contained in this application are True to the best ofltis knowledge and belief; and that the
ork will be performed i,n the manner set forth in4We application lard therewith.
•varn to before me ,this
.Q.....day~o~t~..ll .~~1 'n0e" ' . ' . ~~_'~j,~1,,9
Mary Public, ~~'1~._.N, ,..Q.l:•~ R`%: ~'^'~t c~~r /"7 `.""t-
• ~ County
EILEEN G. WAL4
NotwY Public, Stale of New YoM
No. 52.9509165 ~
Qualilied in Suflolk County ~ 11L11'''~~~~~~"~~~"'
Lrm Rllprac ABM 30, IF~ • ~ • • • • .
mrf , (Signature of applicant)