HomeMy WebLinkAbout18626-Z FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 219025 Date MAY 7, 1990
THIS CERTIFIES that the building ONE FAMIY DWELLING
Location of Property PETERS WAY FISHERS ISLAND
House No. Street Hamlet
County Tax Map No. 1000 Section 006 Block 002 Lot 3.1
Subdivision WALSH PARK Filed Map No. Lot No. 8
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JANUARY 9, 1989 pursuant to which
Building Permit No. 186262 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
The certificate is issued to WALSH PARK BENEVOLENT CORP.
(owner, lessee or tenant)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 90-SO-21 APRIL 13, 1990
UNDERWRITERS CERTIFICATE NO. PENDING SLIP APRIL 17, 1990
PLUMBERS CERTIFICATION DATED Z & S CONTRACTING APRIL 18 1990
SOUTH. TOWN HIGHWAY LETTER 4/13/90
FISHERS ISLAND WATER WORKS CORP. LETTER 4/11/90
~ ~ ~
Building Inspector
Rev. 1/81
!'OBI[ N0. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. V.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N 18 6 2 6 2 Date !.1,~ 19.3
Permission is herebyt o:
.........................~'~e'i~l~~l.`~..~~ff.'..
...,G.C.~=~........G r
at premises Located of ...+..k~~i
.......................................~t~~...~..,r!-~/..Glr...... .lam .........1..'~..~~~'.~....~.~..........
County Tax Map No. 1000 Section ........IG Block ..........~.......~Lot No.........~~..~....
pursuant to application dated .......~/1~ 19.(,7?.., and opproved by the
Buildin'g' /Inspector. D
Fee S.~IC~ 8~~~
wild Inspector
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Rev. 6/30
a. ~ s~A~
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TOWN OF SOUTIIOLD
BUILDING DEPART?PENT
_ TOWN HALL
SOUTIIOLD, NEW YORK 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCIIPANCY
DATE . ~ ~ ~ •
NEW CONSTRUCTION D OR PRE-E%ISTING BUILDING......VACANT LAND..._._..
l
Location of Property.... ~/PCS. {nl~,~
HOUSE NO. .......STREET r"s
HAMLET
Owner or Owners of Property
County Taa Map No. 1000 Section 2- 3,~
Block _
Lot 66
Subdivision WA'S'H.. IIaQtZ.......... Filed Map ........Lot~t~..., .
Permit No. ..........Date of Permit
......----APPlicant
Health Dept. Approval .(~.(/.!~J~~~,.~._.. L,,~
Underwriters Approval
Planning Board Approval v,..........
Request for Temporary Certificate
. Final Certificate
Fee Submitted: $.~,(,G.~ji~.._..
APPLICA `fir'
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~oa~
ti~
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ti~
reV• 10/14/88
c.\1~F[?l~.n TEL. 7GS-! s(D2
,:,4 ° ~ TORN OI' ~~3~JT~I~d,L7
;~~.`A"~ ~ _ ~ ~P't=I~'E C3F ;1PIII.JIIvG 1?~'SPECTOR t
~ ('l~ ~ P.~. 13~X 7?S
v-O at,~
ry~,~l ~
~Q~" St;UT1:iiLD, h1.Y. 119?1 619lpcOEt~'1:
' S90iF16[@D
D C L R Z F Z C A 7' I O N
~~8~
BLDG. DEPT.
TOWN OF SOUTHOLD
Date
Building Pe/rrai} _
Owner_ ~ ! ' fax ~/D
fplti-a-a ISrit,f:D
Plutl:F;2r ~atiQ~L~tt-r~f
(please print)-
I rertyfy th~h YolcJer. used in the water supply system
contains less that ~:/10 of 1$ lead.
' ( lumbE ~ sirc3naturel
SWC~( t_^ ;]C-ZGZ•'',/t'tC 1<i]lu
Notary ,,^u;:;::~
P~atary i~uY~i~c, [/l~%t'.'>b'- County
YaAraAn r. r30?+~an~ .lfi.
N~tAry Pubtie Stt+to of N?w York
No.~909569
(~ppiifll>O IA tfyTltilk C6unty
T9rtn t3?pir~~ ~y31t90
FISHERS ISLAND WATER WORKS CORPORATION
FISHERS ISLAND
NEW YORK 08390
AREA CODE 516/788-7251
Fated ~`;~~~L~~~
Town of Southold
Building I;epartment
Fishers Island, N.Y. 06390
Gentlemen:
Please accept this letter as certification of Watery, Service provide/d
by Fishers Island Water Works to ,erl/fJG~`(T^i~U
The water service consists of supply through ainch water
line from our Island distribution system.
Sincerely yours,
Robert E. Wall
Superintendent
REW/ew
Highway Department
Town of Southold
Peconic Lane
Peconic, N.Y. 1195!3
R71Y MUND L JnC08S
Superintendent let 7G5 3140
734 52 t t
April 13, 1990 ;
s.(
11 .';FR 16 iS9G , ~ ; ;
t !
Southold Town Board Members ` , r oi;"~u ri.. I
c_= _
Southold Town Hall
Main Road
Southold, New York 11971
Re: Walsh Park - Fisher's Island ,
Dear Town Board Members:
On April 13th my Deputy inspected the road and
drainage structures in the above mentioned project
and reported to me both were constructed as specified.
Also present was Mr. Howard Hancock.
I concur and find the project acceptable.
Respec lly,
Raymo d L. Jacobs _
Supe intendant of Highways
cc:
Mr. Victor Lessard, Building Dept.
Mr. Dave Patterson
Mr. Thomas Dougherty
765-1802
BUILDING DEPT.
1 NSPECTI N
[ ]FOUNDATION 1ST [ ) ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ]FINAL
c B'C" '
REMARKS:
o~ c
3 A
DATE INSPECTOR
. _c..J jjJ„:~ Ij ~J`f:'•1k~Ni., ~1~i2~~'jL-•~N~I l'•-".~\Q
II ~ ~
r'OUIIDATI0:1 (1st) apt
a l~.
FOUIIDATIOII (2nd) _ _ m~~
2.
z ~
..°.OUGH FRAi•SE &
PLUMBING ~
3.
IIISULATIO,I PER N. Y. ~
STATE Ei1ERGY
CODE
~qq
4 . m J
•
FI:lAL
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ADDITIOIIAL COi^.MEIlTS: ~
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9
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BOARD OF HEALTH .
FORMN0.1 3 SETS OF PLANS
SURVEY
TOWN OF SOUTHOLD CHECK ~ ~ ~ ~ ' ~ ' ' '
BUILDING DEPARTMENT SEPTIC FORM ~ ~ ~ ' ' '
TOWN HALL ~ ~ " " " " " "
SOUTHOLD, N.Y. 11971 NOTIFY
' TEL.: 765-1802 CALL
Examined.I~/~....... 19(~T' MAIL TO
N
Approved 19 Permit No. ~Q kt ~ ! ~
~M
Disapproved a/c 1 ~ ~ .
~ IIJ~fj~`
' i el''
( Iding In ector) ~~U --1~~_G
i
APPLICATION FOR BUILDING PERMIT 4
• Date : ~~I.1ttA~... L 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 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 inspectio
~v A IS t-t~p ^
(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;IJ~.~I~-,-
Name of owner of premises Cl~la ~$ti . , , 4,fZr~- ~ ~ N£ 1~c,~t.v.' .
(as on the tax roll or latest deed)
1f 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 License No . .
1. Location of land on which proposed work will be done. . ~/~~?N ~ ~QPA
~ ~ ~ n
~'S'i Gx.lTj -Fs~SNLaLl yS~d.~~ ~-OQNft. o~~..
.......ti....
ouse Number Street Hamlet ~ ~ ~ ~ ~ ' ~ ' ' "
County Tax Maps,/No.~1000~ection ..6 ~ ~ U , , , • ; Block n'Z. ! ~ [J Lot 3' ~ a /
Subdivision ...~/e.~~~-~'/..~.. Filed D1ap No. .
Lot...
(Name)
2. State existing use and occupancy of premises and intended. rise and.occuPancy of proposed construction:
a. Existing use and occupancy ~~D~'v d` vd~a1 '
b. Intended use and occupancy n~,•T-... ~f~~u2,q.gecr ~7vuisK[- ~
...................~J46~iv.S :oti! .
3. Nature of work (check which applicable): New Building
Repair , v • • • • Addition Alteration .
• • • Removal Demolition Other 1Vork .
~ (D~:scription) .
4. Estimated Cost . °~~A ~ Fee . ~ , , ~~~,t,
•
/v'~S~ O O V ~ (to be paid on filin his application)
5. If dwelling, number of dwelling units ~ , , , , Number of dwelling units on each floor .
If garage, number of cars
6. If business, commercial or mixed occupancy, specify nature an¢ extent of each type o use
7. Dimensions of existin structures, if any: Front Rear ~ ~ ~ ' -
P N 4 De th . ;
Height • , c~,
, . , !~%A , , Num ber of Stories p • • ' ' ' ' ' ' '
Dimensions of same structure with alterations or additions: Front Rear .
Depth .ty~'';::, • • _ • • , , , , , ,Height . .Number of Stories . _ _ ~ • •
8. Dimensions of entire new construction: Front ~Z.. , , , , , , , Rear 3~.
Height Depth .
Number of Stories .
9. Size of lot: Front / ,d~~ ...~`.''S.. .
10. Date of Purchase ~
l • • • • • • • • • • ~~ame of Former Owner ?..~4ECNousK,
I 1. Zone or use district in which premises are situated ~~'A L , , . • • • • • • ' ' " ' ' ' ' ' ' ' -
12. Does proposed constructio violate any zoning law, ordinance or regulation: •
l3. Will lot be regraded
~S Will ex es fill be removed from premises: Yes
14 Name of Owner of premises LY'ucn./:...Address ~G ~ 6~'~ S/6-7F&-~~j/
Name of Architect "•••••••••••••••••PhoneNo .
Name of C ..........................Address ...................Phone No............... .
ontractor . .Address . .Phone No.
15.Is this property located 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.
APP~R~VE~p AS NOT
DATE: LL~I B.P. # ~
8Y:
= FEE: s:~ DEPART -
- - NOTIFY UIL G
- 765-1802 9 AM TO A• PM FOR THE
- ~ FOLLO~ItNG 41V5PECTITOWNOS'REQUIRED
' 1, FOUNDATION
FOR POURED CONCRETE
`•~6J~f; ~ ~ 2• ROlJGN -FRAMING & PLUMBING
j~ 3, INSULATION
~i`~ V ~ ~ a. FINAL - CONSTRUCTION MUST
~ q BE COMPLETE FOR C.O.
t ~ ~ ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF TENERGY
~ ~~~~F~ STATE CONSTR RESPONSIBLE FOR
t`, s'ff~ ~ 1,~ ~~R DQSIGN OR ONSTRUCTION ERRORS
STATE OF NE\V YORK,
COUNTY O~~n,cc}!'S S.S
• • • • • • being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named. 1 / ~Q
lie is the •ie_L..... d,+2~3tbc: !r~
(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 contained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manner set f h in the application filed thewit}r\-
Sworn tllo befo~ me this
d~ y of . ~ ..tS~:z'
19 i./.
Notary Public,; , , , , , , • ,
f . 1~..~.:.,County<
Not®ry Publie Stab of Naw york ' ' ' • • • • • _ , ,
No. ai06SSi r (Signatuie•of applicant)
ON~ifO~q in Suffolk County i
Tem Er:pfree 12.~i~90
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