HomeMy WebLinkAbout18162-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20877 Date JULY 21, 1992
THIS CERTIFIES that the building ADDITIONS
Location of Property EAST END ROAD FISHERS ISLAND N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 4 Block 4 Lot 16
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 16, 1989 pursuant to which
Building Permit No. 18162-Z dated JUNE 2, 1989 I
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 & DECK ADDITION TO EXISTING ONE FAMILY DWELLING
The certificate is issued to KIM CAMPBELL
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N-200547 - AUGUST 16 1991
PLUMBERS CERTIFICATION DATED N/A
Building inspec or
Rev. 1/81
rows xo. s
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HAtL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N 18 6 2 Z DateG~ 19~~
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Permission is hereby granted to:
..~/.Il (..4....
.~"//Ma~~
to .Gl.~?!fd'i.~r..'l.S:G.. ~.c'<.~~
f/.f2... ~!.t:Y...1:...k~~!~G• lL••...Ch..~fl...~~1.~7
of premises located at--..~~.jj~•r.~l!G~L~....../C~../Q~.~.~•...~"
..................................Cl..:.......~ ..G.C~.*ra.............................................................
1.,.G.t!t/....L~~2..............,,.JJ........................................................
County Tox Map No. 1000 Section~..jy./......~..... Block Lot No.....`...~..........
pursuant to application doted .......././..:......••••••••••F.6a••••••, 19/.r.••~ond approved by the
Building/In/spector[.
Fee $~/••Qi•l~••I..~,l...?
Building Inspector
Rev. 6/30/80
~I i.i J
. .
~ ~ F(SR11i NO. 8
F~i - TOWN~P`SttlU7HOLD ~t {I '{f..
~
`~,~~9' ~ Building Depu'r~menf a ~ ~
~ Town Clerks Office ~ ~
Southold, N. Y. 11971 ~ ~ ~ ~ti~~~~'! ~ ~ ~i
~..hi `
APPLICATION FOR CERTIFICATE OF OCCUPANCY ~ ~ =°r7s~.C:,~
Instructions
A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building
Inspector with the following; for new buildings or new use: j
1. Final survey of property with accurate location of all buildings, property lines, streets, and
unusual natural or topographic features.
2. Final approvol of Health Dept. of water supply and sewerage disposal-(S-9 form or equap.
3. Approval of electrical installation from Board of Fire Underwriters.
4. 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.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
and uses:
1. Accurate survey of property showing all property ,lines, streets, buildings and unusuol noturai
or topographic features.
2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. i~
3. Date of ony housing code or safety inspection of buildings or premises, or other pertinent in- ~
formation required to prepare a certificote.
C. Fees:
1. Certificate of occupancy $5.00
2. certificote of occupancy on pre-existirg dwelling' or land use $5.00 ~
3. Copy of certificate of occupancy $1.00
J Date ~'.4.~.~.aI..9.Z
New Building Addition Old or pre-existing Building Vocant Land
a
Location Of Property .~.1.~.+c?.~....~. ~.~../....F ~:S.j1 5...~.,~.~-~ ~ S~t..... ~ ~j
o L
Owner Or Owners Of Property i..!Yt.....C~. F?"!.~.Sl.C.
Subdivision ................................................................Lot No..:.......... Block No............. House No.............
Permit No. ~.~'.~.~?t Date Of Permit ~'~~.~.~g.Y.....Applicant Z d S C o
NT Fj~q, c
{,!,fuq, .S Nc•
Health Dept. Approval ..........Labor De t. A royal
" . Underwriters Approval N.a.S.~.~1.,~....:(....~~.,........Planning BoardpApproval
Request For Temporary Certificate Final Certificate .......K......
Fee Submitted $ ..~~.:5.'..°o . .
i
Construction on above described building an rmit mee s all o icabl codes and regulotions.
i
Applicant .....ya*sci.. ~.rS.~ ~.~.!l1~ ~
5worn~before me-this
AI>;
p op
c~„~( y of (stain iN~fW
Notary Public ~it~F!ue--,,. As F,peN~p~y,lpt, I
Nsi$ry Pubila B~aq of New YOrN
q?ty/~ ~T / Ouautl a/n Sut6alk County I'
~ `1? / Y' ~ Tartu Expires t2MJ1/9~~
CO ao8'1') ~ ,
THE NEW YORK BOARD OF FIRE UNDERWRITERS V~r.~:
i 1.0006''15 9UREAU ORE4ECTRICITr ~
83 JOHN STREET, NEW YORK, NEW YORK 10038 ,
Date AUGI7ST 16,.1997 ApplioaNonNo.onjtte 6'721089090 N 2005#1
I
THIS CERTIPIE3 THAT
Doty the elecericat equipment ae described 6ebw and introduced 6y the applicant norrFed on the oboes appUcatton number ira thepremtses of
Qk.RnT.I,A A. CAMPBP;t,L, ilE5T F.ND--FRIVAT'F SFR:TION, F'1SHliR5 ISl,7lND, N. Y.
in thefollotrinp lncotio? nt ~ IAt Ff. ? Ynd Ft• OCl".' .Sertiun B(oek Lot
JlI~:Y !5, 1.9Y~te
mae eromined on and found to 6e in rnmplianre with the reyuirernenta of tha Board.
OUTNtETMf lCNTACtES fWITCIBS RXTINK RANORf COOKING DECKS ~ OVENS DISN WASNER6 EXNAUST FANS
IN[ANOESCENT FLIgRESCENT OTNER AMT. K. W. AMi. K. W. Mli. K.W. MIT. K. W. AMT. N. P.
il. J1 5 1J
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DRYERS FURNAC! MOTORS WTURE AMDANCE tNORRi E?ECIAL REC'FT Tilt! CIOCKE ~Nt UNIT IIEATEK MUITI.OUTIRT DIMlAERS
AMi, K. W. ql N. P. CMS M.I. AMI. Pq. A W. G. AMT. M11. MIi. AM/5. TRANS. AMT. N. P. SYSTEMS AMi. WAITS
NO.OF tiET
SHtVICR DISCONNKT NO.Ot S E R V i C E ~
MIT. AAV. TYPE ~ 1 / tW 1 / SW ] / 3W ] / KW KR
rCGND. d' C C ~ NO. OF NI-LFG ~ ~ H no. of NEUTtAlS O~ 'NWEUTRM4
OTItEp Ae?ARATUS:
s
5
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3
X
/(/Jt//JJ~/
_ .C~
Z ~ S CONTRS. INC. 1,<<;,#9?.6E
P.O. BOX 20Z
PISRSRS IS2,AND; NY, 05.190 Tlol~u /AANAOd
71
Psi 'fir
This certificate mast not be altered in ony manner; return ro tM office of tlr rd if iacoTnct. Mspectors rtloy be idsM•diad by their cr~sdantiab.
Z
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CER71FCATE MUST. NOT BE ALTERED IN ANY MANNER. ~
j JAMES V. RIGHTER ARCHITECTS ~~~~~Q ~QQ~~~~~~Q~
58 Winter Street
BOSTON, MASSACHUSETTS 02108 ~ `
C p p'J GATE ~ I w ~ JOB NO.
~V~7~ 1Qi11'J/QU ~AT'(EN/WT_ION vw.~a~...
TO TC'r~. L b nE. ~ O ~.l.l~
Z+ S ~..t,-rte • _ .
Fi s 1..~-s l s 1.~..~-.~9 tJ o C~ "Y3'~i o
_ WE ARE SENDING YOU ? Attached ? Under separate cover via the following items:
? Shop drawings ? Prints ? Plans ? Samples ? Specifications
? Copy of letter ? Change order ?
COPIES DATE NO. DESCRIPTION
G•Z•8 ~ 2
THESE ARE TRANSMITTED as checked below:
? For approval ? Approved as submitted ? Resubmit copies for approval
? For your use ?•.Approved as noted ? Submitcapies for distribution
? As requested ~ ' ? 'Returned for corrections ? Return corrected prints
? For review and comment ?
? F/O~R,,,BIDS DUE 19 ? PRINTS RETURNED AFTER LOAN TO US
REMARKS )"1 v~.c~l lw~-Q-i.. ~i, ~,w-t-.T 1-s~nQ~,- (.t ~7.. V1.v~2 l 'f'" ~ ~ ~rt '~`b
a Q r ~ -Kµ.a ~
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~
COPY TO ~ ~ ~ ~
SIGNED`i~ 4_~~V
PPOWCf1162 ®~m, GmW} am 0(4]1 If enclosures are not as noteC, kfntlly noelffWS at once.
lELD ic:srzc:iuN ~~u A,~ q co:KMrurs = '~M•
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~OUtJDATION (1st) ~ N
rOUNDATIOtJ (2nd) -
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ROUGH FRAME &
PLUMBING
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IIlSULATIOA! PER N. X. y~
STATE ENERGY
CODE x~
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ADDITIOtlAL COMMENTS: ~
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JAMES V. RIGHTER ~I,I~E4~__~ ~ (~~~~PC~G°3 00 ~ `~[~QC1\]~~~~~Q~
58 Winter S
BOSTON, MASSACHU 0~8_ ~ X989 UUU
DATE JOB NO,
c _ ~
(6S/, 451' QU E3I DLY ii i.t:lm~~ ATTENTION
TOWN Os- S(Jt ~T~-I~±_f)
.
J ~f
-S~~~C..o t.d1 t~J Y i ! ~ 'l ~
_ WE ARE SENDING YOU ? Attached ? Under separate cover via the following items:
? Shop drawings ? Prints ? Pians ? Samples ? Specifications
? Copy of letter ? Change order ?
COPIES DATE NO. DESCRIPTION
e¢. ~ ~o O . ,~.f
_ f _ 9• r~ 1 .ti
x t C °3
i
THESE ARE TRANSMITTED as checked below:
? For approval ? Approved as submitted ? Resubmit copies for approval
? For your use ? Approved as noted ? Submit copies for distribution
? As requested ? Returned for corrections ? Return corrected prints
? For review and comment ?
? FOR BIDS DUE 19 ? PRINTS RETURNED AFTER LOAN TO US
REMARKS
COPY TO
SIGNED~~
PPOWCI110.1 ~ Inc. Cmkn, Mm PN11 1/ DnC105We6 e/e nOt 88 ?otetl, kiDdly OotltX u8/Ot ODOR.
New York State Department of Environmental Conservation
Building 40-{SONY, Stony Brook, New York 11794 f
~UC.cb ~ i 1Q'Y~~i"~"' DATE:
.,0.VY\'~S v, ~19h~~r ItYC(11~C`~ Re: ~ll'Y~ 1`., ~Q~Pb~.~+
5 ~ ~ ~ n ~h~e r 5`~. 1 ~ - /5 "7~(~ Thomas C. Jorling
SC~~ V jj Commissioner
~os~oh, Ua~og too-ooy- y ~
Dear m~,
A review has been made of your proposal to: COns~v(vC'~ ~~U\~\!~~
d~~..+~ v.~ P~-'~ ~~~~n~e~ ~~t~~ y~~.e~~~ec9 ~(a ~ f oeai-~
Based on the information you have submitted, the New York State Department
of vironmental Conservation has determined that the parcel
project is:
Greater than 300' from inventoried tidal wetlands.
_ Landward of a substantial man-made structure
greater than 100' in length which was constructed prior to 9/20/77.
Landward of the 10' above mean sea level elevation contour on a
gradual, natural slope.
Landward of the topographic crest of a bluff, cliff or dune which is
greater than 10' in elevation above mean sea level.
Therefore, no permit is required under the Tidal Wetlands Act (Article 25
of the Environmental Conservation Law). Please be advised, however, that
no construction, sedimentation or disturbance of any kind may take place
seaward of the 10' contour or topographic crest without a permit. It is
your responsibility to ensure that all necessary precautions are taken to
prevent any sedimentation or other alteration or disturbance to the
ground surface or vegetation in this area as a result of your project.
Such precautions may, include providing adequate work area between the
10' contour or topographic crest and the project (i.e. a 15' to 20' wide
construction area) or erection of a temporary fence, barrier, or hay
bale berm.
Please note that any additional work, or modification to the project as
described, may require authorization by this Department. Please contact
this office if such are contemplated.
Please be further advised that this letter does not relieve you of the
responsibility of obtaining any necessary permits or approvals from other
agencies.
Very truly yours, n
Deputy Regiona~ermit Administrator
1
._z;f, .
James Volney Righter °r~°~~~~~
a r c h i t e c t s ^ ~If~i' i~
i n c
i~u iw, xi_-
11 May 1989
Mr. Curtis Horton
Town of Southold
Building Dept.
Town Hall
Southold NY 11971
Dear Mr. Horton:
I am enclosing a building permit application for an addition
to a house on Fishers Island belonging to Mrs. Kim K. Campbell.
The plan is to remove an existing deck and add a new room in its
place and a new deck.
The house site is on the water, but we have gotten a letter of
no jurisdiction from the D.E.C. I'm enclosing a copy.
Please let us know if there is anything else we need to provide.
Sincerely,
C~•--'
Jacob Albert
Jac o b n. A l b er 1 Cr a i g D. Gi b son James V. Nig h [ er ~ Lawrence 'C. Tho rn
58 Winter Street Boston Massachusetts 02108 telephone 617 • 451 • 5740
FORM N0. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
` SOUTHOLD, N.Y. 11971
TEL.: 765.1802
Examined........../~... .,19... Received......... ,19...
Approved 19~/. Permit No. G?. aF- Z
bfsapproved a/c
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
~ Date .M4`f......, 19 ~g
INSTRUCTIONS
a. Tlus 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 stowing 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 wilt issued a Building Permit to the applicant. Such permit
shall be kept on the premises available for inspection throughout the work.
e. No bu)tding shall be occupied or used in whole or in pazt for any purpose whatever until a Certificate of Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Buiiding Depaztment 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.compiy with all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections.
JaK+ea, l/otwe,l R;.y1.~,- Avat.; ;IevF? :
. . .
(Signature of applicant, or name, if a corporation)
5 8 W i,..'Cs,. S P twos t-ati, M A v2.1 a$
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
o.,VGl..1 "1'2 C'{'
Name of owner of premises . ~ w'... lC Comp tza. ~ ~ .
(as on the tax roll or latest deed) ,
If applicant is a corpora ion, signature of duly authorized officer.
p.c { i cla,h t; ,
(Name and ti Ie of corporate ofticer)
Builder's License No. ...1 S~ .
Plumber's License No. N : A . . . . . . .
Electrician's License No. Z:~.'; .
Other Trade's License No .
1, Location of land on which propose) work will be done. ~ 5.1.. ~d..~'.... S~'S . ~S 1'G'"'d ~
(louse Number .......................Street.......................Hamlet......,.................
County Tax btap No. 1000 Section .....4........... Dlock , Lot ~ .
Subdivision Filed Map No. Lot .
(Name)
2. State exerting ere and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy 5 ~ aq~:. , VQcai"I~o t, house.. -
s•-~..
b.lntendeduseandoccupancy . S~'M:~;,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ;i,
. .
_
3.~ Nature of work (check which applicable): New Building Additign ~ , , Alteration .
Repair • . Rem vat Demolition Other SVork .
~I O • (Description)
4.~1 Estimated Cost . ~ ~ m,,oo o . . .Fee ; ,
(to bo paid on filing this epplIgatlon)
S. If dwelling, number of dwelBgqg nits Numbet of dwelling units on each floor N ;A , , , , , , .
If garage, number iyf cars . !v,•^......... , • . .
. 6.~~ If business, commercial or mixed occupancy, specifyy nature and extent of each typo of use . N rPl•, .
= Dimensions of existing structures, if any: Front , . `t a. a:'f•.... "..Rear ..ZP, .f.'t•...... Depth .4,7," ,~i. , .
7.I °
Height d;~}c fr•........ Numiber of Stories , .
~ Dimeusions of same structure w'th alterations or additions: Front ..`'i'P. Rear : ~•C:........ , .
Depth . , .7 A FT Height . *.:4:4 ~r• Number of Stoles .~.~t.'... .
8.1 " Dimensions of entire new constr~cfion: Front . ~4 fi.•. , , ,Rear E'G....... Depth . 5:4.:Ft.•. lrsd•
I
e
Height i3. i":t} Number of Stories .
9 ~ Size of lot: Front , .G?:•.~'.'f{' Rear . ~O. ~.p : ~..-f:ri Depth ? 3$..'~T , .
10 j Data of Purchase ..........Name of 1?onner Owner EI I iQ; l; , Wc~d.~ b!e W~.~•, , , , , , , , ,
' I l.i Zone or use district in which pr mises are situated .1'4S ia~.:hG 1,-.~ !'1 ~
~i+vral . . . . . . . .
12:,, "Does proposed.cogstruction viol to any zoning law, ordinance or regulation:. YI p . .
EE' 13.I` Will lot be regraded . 1'!R. ....Will excess till be removed from premises• Yes ~ No
f'-', 14. NatneofOwnerofpremises~l. K: ~-:+rp.~~I...AddressN•~": ~"'l: F~'.. Phone No H.°.~:~a.t:`."`~~
Na:ne of Architect Jaq.;+e~ V.f1~Ilrkir , , , , , , , Address ~ ~b~'! St ,r3gsht~ rnilphone No~°!~.' `.1'Sl`'r. ~~O
i ~ 5 Gc>Kt+-ac ~ Fi la.vilsla;.;l; 5~V'~~g.:7$57.
! Nmne of Contractor - t":" j , ,Address rti. t . ....Phone No. ,
. " ~ ,PLOT DIAGitAM
I;
iLocate clearly and distinctly all buildings, whether existing or proposed, and, Indicate all set-back dlmensigns from
' pro~erty lines. Give street and block umber or description according to,deed, and show street names and Indicate whether
intgrlor or corner lot i a e2 ~ • °
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CQLINTY OF ..~V~f V.?-•1~. 1 _
t-' , , °'~///~Ll,~,y,ll,~1,/~(~1?~ being duly sworn, deposes and says that he is the applicant
~ ~ ~ ~ (Name of individual sig ling contract) '
~ ab~ve Waned. ,
Il~fsthe..........
j ~ ~ (Contractor, agent, cocporato officer, etc.)
' ~:f+sald owner or owners, and is d iy authorized to pcrfonn or have perfornted the said work-and to make and tilt this
ap~llcetion; that all statements con wined hr tills application are true to the bast of his knowledge and belief; and that the
w~rk will be performed in tits maul t sot torch in the application filed therewith. ,
S om to before me this ;
' ~ (a .I. .day of , 19 ~ q ~ ~
I -
Nptary Public, ~ County ~ ,
" FAP1FfiQ ~ . • . . . . . .
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' M~rCOrm111 eton°~ °`Ir _ (Signalurd of applicant)
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