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Home My WebLink About26099-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28369 Date: 04/29/02 THIS CERTIFIES that the building ALTERATION Location of Property: PVT RD OFF E END RD FISHERS ISLAND (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 5 Block 1 Lot 8 Subdivision Filed Map No. Lot No_ conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 20, 1999 pursuant to which Building Permit No. 26099-Z dated OCTOBER 28, 1999 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 ALTERATION TO AN EXISTING BATHROOM IN AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to FRANCES E NIELSEN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. PENDING 03/15/02 PLUMBERS CERTIFICATION DATED 11/09/00 ROBERT E WALL //)A!khoriz9d Signature Rev. 1/81 FORM NO. 3 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) PERMIT NO. 26099 Z Date OCTOBER 28 99 Permission is hereby granted to: FRANCES E NIELSEN 925 PARK AVE NEW YORK,NY 10013 for CONSTRUCT AN ALTERATION TO AN EXISTING BATHROOM OF A SINGLE FAMILY DWELLING AS APPLIED FOR. at premises located at PVT RD OFF E END RD FISHERS ISLAND County Tax Map No. 473889 Section 005 Block 0001 Lot No. 008 pursuant to application dated SEPTEMBER 20 99 and approved by the Building Inspector. Fee $ 75 .00 Aut orized Si ature ORIGINAL Rev. 2/19/98 FROM SOUTK31-D TMNV PLANNING S1ARD FAX NO. : 516 765 3136 Nov. 08:55AM Pl •V.M .1 V 6 V TOWN OF SOUTHOLD BUILDING DgPARTMENT TOWN HALL 7 20 763-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY T7•,.,`•,1 YT; A. This application must be filled in by typewriter Olt 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 Dire underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 12 lead. 5. Comercial buildIAS, industrial building, multiple residences and similar buildings and installations, a certificate of Code Complienae from architect or engineer responsible for .the building. 6. Submit Planning Board Approval of completed site plan requirements. S. 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 accessary building 425.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - .25v1 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $L5.00 Dote . ':jL�C?z? ... . . . . . .. New Construction. . . . . .. . . Old Or P �e-existing Buuilding.... � ... .... Location of Property. .. House No. _ Street Hamlet Ce Onwer or OvneYs of Property.. ...E� (. ?. ..'... .�l�L ` :� .. ... .. ..... . .... ... .. . . .. . ... . ... ... . .. . . . .... .. . County Tax Mar No 1000, Section.. . r.C25. .. .. .Bloek.L �:�:: . .... .. .LoL.. . �� ... .. . . .. . . ... Subdivision �..... . .. ... ... . ... .. . ....... ..�.r...pFilleCd� Map...... . / 'Lot. .. .. ../. . .. .. .... Permit No�.�Nr' .46.'.�. ...Date Of Permi,tL-?.�I�A..i.4...ApplicantJ✓��L� . Health Dept. Approval....... .......9.. .. .#.....Underwriters Approval. .. .. . . .. .... .. . . . . . . .. . Planning Board Approval............4. .......... Request for: Temporary Certif.icate... .. ... . .. Final Corticate.. �... . Fte Svbmitceda ;. . ::I:,: .. .. ... ...... . . .. Z"t 5� , 0000.. . . 0896.. ......... .. . ....... �` 00P APPLIC TEL. 765-1802 �ppG TOWN OF SOUTHOLD y< OFFICE OF BUILDING INSPECTOR ,zT P.O. BOX 728 o TOWN HALL SOUTHOLD,N.Y. 11971 C E R T I F I C A T I O N Date/VOYEm6eoc Building Permit No.D-,2&D 671— Owner FPAWES E. /V IEt SEc�I (please print) Plumber J� r � Wi4L-L (please print) I certify that the solder used in the water supply system contains less than 2/10 of to lead. (plumber 's signature) Sworn to before me this Jt day of "a-Irk, .11 " �f-A 0 el'7 X902. Not y Public vERON;^A HAMILTON Notary Publi ARY : :3LIC County S TAT NO. 01HA60-'7785 ."uALIFIED IN SUFFOLK COUNTY W EXPIRES... BUILDING PERMIT REVIEW CHECK LIST Applicant/ Date Owners Nam �e� Reviewed: Architect/ _ Date J �j Engineer: /� Submitted: SCTM #: District: I A0 Section: Block: _Z Lot: Project Q Q 'Subdivision Location:J[/� �i� //� r Name: Single&separate R certification: W. Req, Zoning District [Lot siu: Actual: ] [Lot.AP Proposed: ] Req. Req. Req. [Front Yard Proposed: (Side Yar Proposed: 1 [Rear Yard Proposed: ] Project Description: AGENCY PERMITS Permit REQUIRED FOR REVIEW N.A. NO YES Number Suffolk County Health Dept. New York State D. E. C. Town Trustees Town Zoning Board approval: Town Planning Board approval: Flood Plane Elevation ??? Flood Zone: to • 04/22/2002 08:59 FAX 631 788 7798 FITELEHONE IM002 ' 765-1802 BUILDING DEPT INSPECTION [ ] FOUNDATION 1ST [ I ROUGH PLBG. [ ) FOUNDATION 2ND ] INSULATION [ ] FRAMING [�AL REMARKS: DATE o INSPECTOR Ids/ BOARD OF HEALTH . . . . . . . . . ii FORM NO. 1 3 SETS OF PLANS . . . . . TOWN OF SOUTHOLD SURVEY . . . . . . _ . . . . . . . . . . . BUILDING DEPARTMENT CIiECK . . . . . . _ . . . . . . . . . . . 3 DEPT TOWN HALL SEPTIC FORK _ . . . . • . • . .--OUTS01.0 SOUTHOLD, N.Y. 11971 TEL.: 765-1802t:o-I.Fy / ?, CALL . . . . . _ . . . . . . . . . . . . . Examined . . 19 t1AIL TO : Approved ..1 �i . . . 19 . . . Permit No. .(.Q .z . . . . . . . . . . . . . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . : . . . . . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - (Building Inspec ) LICATION FOR BUILDING PERMIT Dat . . . . . . . ., 19� INSTRUCTIONS 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 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 Lws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or dem.Wil as rein described. The applicant agrees to comply with all applicable laws, ordinances, building code, ho 'ng , an re- lations, and to admit authprized inspectors on premises and in building for necessary inspections. (Signatu p scant, name, i corporation) . P��x. 6t?4F-� (Mailing address of applicant) �O State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . Name of owner of premises . . . . . . . . . . . . Fi ANC- . .L-,•. . /.Y�l= �.s�!Y. . . . . . . . . . . . . . . . . . . . . . . . . . . (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 Trade's Licen,e No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be done. . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . House Number Street i p Hamlet County Tax Map No. 1000 Section . . .Q'.Q... . . . . . . . . . . Block . . . . p. . . . . . . . : . . . Lot' Subdivision . . . . . . . . . . . . . . . . .'. Filed Map No o. . . . . . . . . . . . . . . Lot . . . . . . : . . . . . . . . State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy . . . . . . . . ...54- le . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . -3. Nature of work (check which applicable): New BuildingAddition . Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . .. Alteration . . Demolition Other Weak . . . . . . . , • , , , , , , 4. Estimated Cost . . . . . . 30Q; , , , • • • • • . . • . , • 7C1D_ • . .,_... (Description) Fee : to be paid on filing t}iis application) S. If dwelling, number of dwelling units . . . .1 . . , • , , . •Number of dwelling units on each floor . ,NIA If garage, number of cars IYA • 6. If business, commercial or mixed occupandy, specifynature and ' * • • • ' • ' ' • ' ' ' • ' ' 7. Dimensions of existing structures,if an • Front , extent of•each type of use . , , ,/,�j/A., • , , . • • . . . Height Y• . . . . . . . . . . . Rear. . . .... . . . . . . . . . . Depth . . . . . . . . . . . . . . . • . . . . . . . . . . Number of Stories . . . Dimensions of same structure with alterations or additions: Fronto. ' • ' ' ' ' ' " Depth . . . . . . . . . Height. . . . . . . . �4-/V�f�S. Rear . . . . . . . . . . . . . . . . • . . •. . . . . . . . . Number of Stories . 8. Dimensions of entire new construction: Front . ,OJ �, Rear • • • . . . • • • . • • " " ' ' " " Height .. . . . . . . . Number of Stories . . . . . . . . .. . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . 9. Size of lot: Fro,it . . . . . . . . . . . . . . . . . .: . Rear . . . . . .10. Date of Purchase . . , . Name of Former Owner �epth �1•l •., MT 11. Zone or use district in which premises are situated . • • ' .12. Does proposed construction violate any zoning law,.ordinance or•regulation: * . • • • • • • • • 13. Will lot be regraded . . . . , .. . . . . . . . . . . . Will excess fill be removed from premises: • • • •Yes • • • • • • • 14, Name of Owner of premises . . No Name of Architect • • • • Phone N�516��85�.`'. 4 • .Address ,� . Phone No. Name of Contractor Pri ,�,. ak •Address Tom?fOl¢.1. , ,F�f�� , , , Phone No.�Slta�iz 15. • Is this property within 300 feet of a tidal wetland? 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 lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, --OUNTY O . . . . . . . . S.S . . . . . . . � �A. t�1�.. . . . . . . . . . . . . . . . . . . - being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) :hove named. p /� ,��.�, ie is the . . . . . . . . . . . . . . . . . . �1/E�iq'� . W �. . . . . . . . . . . . . . . . . . . . (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 Pplication; that all statements contained in this,application are true to the best of his knowledge and belief;and that the •ork will be perjfgjWd in the manner set th in the application filed therewith. worn to bef e - . . . . . . . . . . ., 19/•/ ota ublic, . . .. . . . . . . . . . . . ... . . . . . . . . . . . . . ' Count � Y i�MOMA!!r,DON94TY JM, Netevy Public State of Now York • • • • •. . . . . . . . . . . . . . . . . . . . N0,4006659 (Signature of applicant) Ou6nflea In Suffolk County Term Expires 12/31106 --roh Al Ali-i lgevv ? /?/?f 157A-rh Poo til C h AM3 f- UNDERWRITERS CERTIFICATE � cy � REQUIRED V ts fog��s-0�� „ / jBYpDLi 00 BCH o�j_i. w I 1 X11 Afroftf- HMOLID'S 510-788.5M PO 80X 661 FISHERS ISLAND N.Y. 06390 �r i t �`�uM81N� &WAT�a uN pND/OR TESTING BEPU ER oRs CERTIFICATION C,K pREVENjING DRE pRt1V1�E AN"� SGAID DN LE CONTENT UpA1VCY SNEgMRI SN g02.6(Kl Leul�c T/fl TE OF OCC s�o ppR1. CERATER DEVY SSA E BUILDING GGGE. D USED /NCANNOT N � SUP �YSTFM �1 XCEED /10 of 1% LE Pogo up . o ter cl. b'o fp per tU�j� �,� •• n �►-. V i I I lo 99 b Al &M �f Ari C � HAROLID's COOK M.788.6560 P.0 BOX 6Qj FAX 616-78&6649 FISHERS ISLAND N.Y, Q639p 7o )-12 _ )-e - YI ) e - _ - 7-7 O / _ _ _ _ _ ) 10 �� slo' )� 11-4 / 4M // a /0-7 / • \ M ' I i / TO FAST ENO�� • e-lo _ _ _ _ _ _ _ _ / ' / N76pg.3M1 E 1 R=75.37' m A-88.68' / MONUM 1i _ m / / N \ R-490.80' °y \ LOCATION MAP `R-299.92' ` A-50.02' \ 400 200 0 400 A-140.75' 1 / \tir 1m 9A'lA GRAPHIC SCALE IN FEET A=87.43' . \o, 4 \ MONUMENT BLOCK 8 _ LOT 4 & 4A \ \ / W / 15`06 134 W-73745 R-249.80' / 1d/ N� .0 0• A-109.10' J j 1/S21'4450E � 18.00' \ E �\ .NOT S, N72'54'40'E / 1510 �� 7 . MONUMENT 12.00' '/ 60�� - j .� ��2 I 1 COCLRDIHATE DISTAHCES APE MEASUPED FP,)M IJ S -OAST ` S-49553 BLOCK 8 S21'44'50'E 6 S• 05 Ei TRIAN�.UL TION TATIOGI EAST EHU 2 W-129570 ti LOT 8 J 3000 ,ro" ��o., > GEODETIC St1Pv A S ��.�• AREA= 2.09 ACRES± R=60 32! �4 PROPERTi IS LOCATED IPI THE TUWI1 OF E10UTTI `_uUHT( !�'(s•� A-2564' MONUMENT OF SUFFOLK, DISTRICT 10 r GD SE_TI SIJ G05, BLGCP I , LUT 8 S-530,88 18,81 W-749,28 v,J R=60 32' MONUMENT A=90.88' o BLOCK 8 \ \ LOT 7 0� \ AREA= 1.53 ACRES± 2 'T2• P � \ 0� � S;P / RESIDENCE BLOCK 98 O v COTTAGE �[b. BLOCK 8 ww\Wm. LOT 6—A / ow\'o_ AREA= 1 .16 ACRES± IRON / \ PIPE BLOCK 8 �\ LOT 6 / AREA= 1.56 ACRES± \ / 77, SEDGE OF MARSH \ / / IRON / PIPE / \ F.LD.CO. IRON \ PIPE \ SURVEY MAP N 83.04.00„ W PROPERTY TO BE CONVEYED TO 382.93 \ IRON PIP BLOCK 8 LOT 10 FRANCES E . NIELSEN 1 1 GUARENTEED T0: 40 20 0 40 FRANCES E. NIELSEN, OLD REPUBLIC NATIONAL I GRAPHIC SCALE IN FEET BLOCK 8 - LOTS 6, 6A, 7 & 8 TITLE INSURANCE COMPANY, METROPOLIS ABSTRACT FISHERS ISLAND, NEW YORK CORP. AND IBJ SHRODER BANK & TRUST COMPANY, ITS SUCCESSORS AND OR ASSIGNS IN ACCORDANCE O¢NEW WITH THE MINIMUM STANDARDS FOR TITLE SURVEYS qG YO REVISIONSCHANDLER, PALMER do KING OF THE NEW YORK STATE LAND TITLE ASSOCIATION. RP H.Bp 9M AW TITLE #14199S0 ep '90G DATE DESCRIPTION ff � �— C Nm Architecture. Engineering and Surveying 110 OOOVIWAY Ni OT Ot]W MO-rF3Hl TIM G W-7001 1 r p JQJ S DATE SEPTEMBER 24, 1998 SCALE: 1" = 40' ' SHEET 1 OF 1 � y11p