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Home My WebLink About18249-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27920 Date: 09 06 O1 THIS CERTIFIES that the building ADDITION Location of Property: PRIVATE RD. FISHERS IS. (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 9 Block 1 Lot 24 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated pursuant to which Building Permit No. 18249-Z dated JUNE 23, 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 ADDITION TO KITCHEN IN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to K. SERENA CARSON & ORS. (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO_ PENDING 09/04/01 PLUMBERS CERTIFICATION DATBD OS 24 O1 R.G. AHMAN t r' ed Si ature Rev. 1/61 1081!1 NQ f TOWN OF SOUTHOLD lUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. f6U1LDiNG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N 18 2 4 9 Z Date G%~-~n~:~............0.~.3..........., t 9.~~ Permission is hereby gmnte6d'(t/o:/..L/.f~~, c~ ~/...l.r.~e~<.SIl..Y. Nl..l/..~'t.1~...... v.i.....~..~ ./~r~.,X....la...6..' to ..............6r7:~G~r.+glwGlrtr~Y..l..... ...........,~/Q~~~4~1-.t'Z~,,......... ........................................~..y..y.~...................~....................................................................................... of premises located at ....,l..l..l..lEl!X.1eQlkl.,?~... .,~!dc~~~....~.~~..1/k~.:~:~... ~ ..rZ&'e~./~... .:/.1. . County Tox Map No. 1000 Section Block ........~.........t.1Lot No...~....:1......... pursuant to application doted ....C7.~~, 19.1[..x,, and approved by the Bui ldingt-In~sypector. F e e~i.l....K.. r..1~. ,Q. . Building Inspector Rev. 6/30/80 Form No. 6 - ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be 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 17 lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Complianne from 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, 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 shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildine - $100.00 3. Copy of Certificate of Occupancy - .251 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date New Construction..... Old Or Pre-exis ng Bu lding.~....... Location of Property. .l`9!~..~~ ~~~L~,l~'~, /il(.~W~/l~Y House No.~`,, Street H~aLml~et Onwer or Owners of Property~~~v,~.~~~?so~, )~~i~~.~y:~v~'YV~~ County Tax Map No 1000, Section....1.........B1ock.....f..........Lot.... Subdivision Filed Map ............Lot. . Permit No 1.4~ !.(....Date Of Permit v~?(......Applicant. Lc: (.'.~s~... Health Dept. Approval ......................!!!...Underwriters Approval......................... Planning Board Approval Request for: Temporary Certificate........... Final Certicate. L........ Fee Submitted: G'~„~' G ~ IOC ....APPLICANT T. s THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE I hL35043 BS JOHN STREET,4NEW YORK, NEWrcYORK 10036 Date NOVEMBER 08,1989 - TN13 CERTIFIES THAT '4ppirC°pan No. on file 63778389j89 N 101145 only the elecerleol °4uipment as described 6efo]P and introduced 6y the applicant named on the abo°e applic.tion number in the prerrtiees °f' ftS. EC HI#~1NO1VD,~'' PRIVATE ROAD, FISHERS ISLAND, N,Yc t in thefolbtcinR locoti°n9 ? BuserrEent uns exomined on OCTOBER 24.1989 ®!At Fl. ? 2nd Fl. .Section Block /,°L ®i andfound to 6e in cobtpliance with the requirements of this Board. RKTLIRE NX H OUTLETS ACLES SWITd1E5 RANGES COOK NO.OECKS OVENS INCANDF]CENi. FIVORESCENi O 'ER AMT K.W. a'~w RXNAUST FANS c 1 AMi K. W. AMT. K.W. MIT. K. W. AML X. P, r 1 1 ORXERS RIRNACE MOTORS ` AMr. K. w. ql N. P. GAS R. P. - Nt~URE ANRI ONCE NEDERE SHOAL R~ IT TRISE CLOCKS TRANS. - AMr. N. P r BFU UNIT NRAYERS ~T> ONIMlRS NO. DE AMr. wArn` ,,,PKCOBMiRCi-:-.. _ . 6_.. _ AML AMr. rrPE ,5:. ,oF CC. V... EOUI/, I /TY t A 3W ] R 3W ]1 KW NO.OF CC. COND. - --:I ~ PER / A. COND. NO. OF XI-LEG y Of ~NI l p MtUtRMt A. W G. NQ DF a Ne L OTMR AMMATUS: SUN ROOH ADDITION-1 TRACK LIGHTING:-6 l~lr3l i37~ AMOUNT `i AALSH SERVICE $25.00 'r "ROA~~W~~y MONTAUK AVE. LIC. 924E AS dSN T BY MAIL WILL BE AT RISK OF SENDER. FISHERS ISLAND, NY, 06390 11 Per TNIS IS YOUR BILL FOR SERVICE RENDERED AND IS NOT A C LATE OF COMPLIANCE. TNIS BILL PAYARU? AT THE NEW~q~K.O~~ BS IONN STREET, NFW YORK, N: l D038 _ ~ r. ~ 7idi-1662 BUN.DING DEPT. 1NSP~CTIQN [ ]FOUNDATION iST [ ]ROUGH PLBG. [ J FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ~NAL REMARKS: • ~ ~D~ G~ • D s DATE ~ ~ INSPECTOR - • - BOARD OF HEALTH 3 SETS OF PLANS FORM N0.1 SURVEY TOWN OFSOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORDS • TOWN HALL SOUTHOLD, N.Y. 11971 NOTIFY TEL.: 765-1802 CALL Bxamincd . G~. v2~ 19~ ~ p • MAIL T 0 Approved ~ 3...., 1~~. Permit No. ~Q ~ 7 Disappro eda/c (Building Inspector) APPLICATION FOR BUILDING PERMIT n Date.., ~..pL 15-1. ll.: 15~~ 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 Re;ulations, 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 necessa in ctions. n ~ ` ~ ~ n ~~~~~J-X~ . ti-i . TtC:r-r/f..t.u.JQW! L~. . (Signature of applicant, or name, if a corporation) (Mailing address of applicant) Q~, 3C~~• Stale whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...l.: Cc_J~.~. t2. . Name of owner of premises ..r ~.~'.E ~....~.1.~ .h!1.~? c:~.N.D . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized offices (Name and title of clo~rpora^terofficer)// Builder's License No. ~J..~d*-?~~. -!/.-j Plumber's License No . . Electrician's License No . I` Other Trade's License No . . I. Location of land on which proposed work will be done. . House Number Street / Hamlet County Tax btap No. 1000 Section Block , , , , , , , , , , , , , Lot • 1 Subdivision Filed ~1ap No. Lot . (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: t ' a. Existing use and occupancy ~ .~-.`7 . J ~ b. Intended use and occupancy . • r) 1 / / ~ ~ • • • •~:ll.~ ~0~~ 3. Nature of work (check which applicable): New Building Repair • • • • Addition . Y....... Alteration . • • • • • • • Removal Demolition Other 1Vork . c c- ~r ~ (Description) 4. Estimated Cost t:..t 6 Fe DU 5. If dwelling, number of dwelling units (to be paid on filing [his application) • • • • • • Number of dwelling units on each floor . If garage, number of cars . 6. if business, commercial or mixed occupancy, sperify natllrF and, extent of each type of use , , , • , , • • • • • • • 7. Dimensions of existing structures, if any: Front • , , , Rcar Height Depth............... Number of Stories (,~~`,{l•'~_ _ • Dimensions of same structure with alterations or additions: Front ~ • • • • • • ' • ' ' ' ' ' Depth........... Rear...... ..Height ......................Number of Stories ...Q . 8. Dimensions of entire new construction: Front • Height Rear Depth .......NumberofStorics...~;~~yr••,• 9. Size of lot: Front Rear........ 10. Date of Purchase Depth .............................Name of Former Owner ..1.x,1. G~F_A.i..... • . 1 1. Zone or use district in which premises are situated • • • ~ • ~ ' 12. Does proposed construction violate any zoning law, ordinance or regulation: _ _ • ~ • l3. Nill lot be regraded Will excess Illl be removed, f~9m premises: Yes No 14. Name of Owner of premises ~ ~ f ~r~}• ~/Y.)~, (~~Address ~-1$/)~' ~~S • (v. ~f.. ~j Name of Architect Phone No~~ .rt7.~a• ,'/~~f3 ...........................Address ...................Phone No. Name of Contractor .....Address . IS.Is this property located within 300 feet of a tidal wetland?n*YES....NO.~ *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property Gnes. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF \E14~ Y~j•~ COUNTY OF~~Y./.'UNL , . • • • • ~ • • HF ~'u£" ' • ~Q~~~~ • • • • • • • • • - being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. fie is the ..............Q W Nt? tti (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; [hat all statements contained in this application are true to the best of his knowledge and belief; and that the work will be pert ed in the manner t orth in the application filed Ihcrcwith. Swom too his ri+ort?s s, oaiESnr ........d of.. I N~4ry NMk tNN ~k Aww>r~r • 11~. Niiip Notary Publi , M~'~~~'~"'M' County _ / i~~+anw+ti~r~ / (Signature of applicant) [ _ . i ~ 1 ~ ~m m rtS i _ ~ ~ o..c~O m i ~ i w rt N I ~ r _ . . F C ~ /RQPP~R/RV D AS ;~OFLEn~'`~/ ° ° F j~/Ex is{i~~j },.~,ph vVaN ~DAT~~+~l-~./~.F#/_1~L ~m m ~ I _ / FEE s . - _ NOTIFY BUILDING DEPARTMENT 1 pb,,, J:2 ~ ~~QnS _ 765-1802 9 AM. TO A PM fOR TH ~ p j FOLLOWING INSPECTIONS: < ~o,p ° 1, fOUNPATION' - PNO REQUIRE ~ ~ FOR•POURED CONCRETE ~ i3~2~~ I UIa~~F~~ 2 ROUGH - FRg1NING d, PLUMBIN JL 3. INSUU4TION ~~I ,+T (~'Q~"t~yr T 4. PINA4 CQlVSTRUCTIpN ~ ° ° o . _ r~ V U 1 V LI ~ 1 1~ 1 l E, ALL E PLETE FOR CLC ME m m T _ ~ QF ~C~~IPANCI~ ~N _ _ . _ _ _ . _ DESIGN OR IESPOI~I81 - _ . CpNBiRUC?I(~111 ---/0=5 -3 F~ ~