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Home My WebLink About18629-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19858 Date APRIL 16~ 1991 THIS CERTIFIES that the building. Location of Property 11 Peters Way House No. County Tax Map No. 1000 Section 6 Block 2 Subdivision WALSH PARK Filed Map No. ONE FAMILY DWELLING Fishers Island~ N.Y. Street Lot 3.13 Lot No. i1 Hamlet conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 4~ 1989 Building Permit No. 18629-Z pursuant to which dated NOVEMBER 2~ 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 AS APPLIED FOR. The certificate is issued to WALSH PARK BENEVOLENT CORP. (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL APRIL 12~ 1991-91-SO-24 UNDERWRITERS CERTIFICATE NO. PENDING - APRIL 16~ 1991 PLUMBERS CERTIFICATION DATED APRIL 9~ 1991 - Z&S CONTRACTING~ INC. Rev. 1/81 IPORM' NO. ~J 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) 18629 Z Permission is hereby granted t_o: ,,~ _ _ ~ t premises located at '~'- '/".~-:..--~.....~~i"'"'""'"'""'" '"'"'""'"'"" ............................................ i.i.ii, ii ................................................... ....... County Tax Map No. 1000 Section ...... ~. ............. Block ......... ...~T... ....... Lot No ........ ..~...'..../.. ....... pursuant to application doted ..../..J~.. ....................................... , 19.....~,., and approved by the Building Inspector. Rev. 6/30/80 TOWN OF SOUTHOLD BUILDING DEPARTHENT TOWN HALL SOUTHOLD, NEW YORK 765 - 1802 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY NEW CONSTKUCTION ~-o .... OLD OR~STiNG BUILDING ...... VACANV T LAND ......................... Coun~ Tax ................. Subdi vis ion.~L~q ~ . ' ............. -'~ ..... r~xe~ Map ........ Lot . Health Dept. Approval .................. ~nderwriters Approval .............. Planning Board Approval Request for Temporary Certificate ....... Final Certificate Fee Submitted: $..~ ...... rev. 10/14188 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL $OUTHOLD, N.Y. 11971 CERTIFICATION TEL. 765q 802 Date Building Permit No. Owner.. ~)~/~ ~ /<~] ~ // (please print) (please print ~/ I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. S~ to before, me this Notary Public, ~0~ (plumb~'s signature) County T~M~ w, ~a~ an. NE, II~/Ilubllc Stat~ of Hew York No. 4~6S$9 Oualiflea In Sutlolk Court [y T~ Expires 1~1~ JOHN SKI CONSTRUCTION COMPANY BOX C FISHERS ISLAND, NEW YORK 06390 TO WHOM IT MAY CONCERN; WE INSTALLED THE SEWERAGE SYSTEM FOR LOT11 AT THE WALSH PARK AFFORDABLE HOUSING PROJECT ON FISHERS ISLAND. THIS SYSTEM WAS INSTALLED ACCORDING TO THE CRITERIA OF THE SUFFOLK COUNTY DEPARTMENT OF HEALTH. APRIL 8, 1991 FOUNDATION ( 1 s t ) FOU!;DATION (2nd) ROUGH FRAME & .PLUMBING 0 INSULATION ?ER N. STATE ENERGY CODE ADDITIONA'L COMMENTS: ~' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 : TEL.: 765-1802 · Examined ........ , 19~'-~.... Approved...,//3~- ........ 19 ~.'Permit No../Z~..~. ?.~ Disapproved a/c ..................................... ~~Inspector) ....... APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ...................... SEPTIC FORM ................ NOTIFY CALL ..................... MAIL TO: Date :"} .~.t4.u..~...~ ...... 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 properW 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 iemoval or demolition, as herein described. The applicant agrees to comply with ali applicable laws, ordinances, building code, housin~ code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspectio/~gT"--, ...(q !*.,,, i. ....... (Signature o~ applicant, or name, if a corporanon) .... ' , (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................... ~..C..~..~.C..a~. Name of owner of premises . .~..tT)?.~.t~tq. .... ,..~,.12r..~-~.....C~..g.~. 5 ?.?.~.' .~., ...................................... (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 License No ...................... 1. Locat,onoflandonwtuchproposedworkwfllbedone...~.~..£.7.M..../-.!,[[ Ag. MA .................. ' ...... ' .............. ' ............. ~... House Number Street Hamlet County Tax-,, ,~ ,,~ ~ ,~Map No. 1000 Section . .~..D..~.,..~.~. ...... i Block ...O..~.t .O..O. ....... Lot...O.q..~.:.O.?./... Subdivision (~.~~.a, fie.)~. '. ~.-'__ __ .......... Filed Map No ............... Lot.... :.a/~. ...... '.. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... .~7.....~..gl.lf.A...t~.' .... . .-~.~.f/./x_..~ i~ ~~,'r /~['~e~,~" f'/v~,~;,~e. .,~..-.-.-. b. Intended use and occupancy .................................... 3. Nature of work (check which applicable): New Building · · .t:~..'..... Addition .......... Alteration .......... Repair .............. Removal .... ~ ......... Demolition ...' ........... Other Work ............... ! ,/ , (D~escfiption) 4. /t~.-~'/o 0 ~ ~-- (to be paid on fili;~his application) Estxmated Cost · . ............. . .-4. o.//.4..e-4. ........... 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 and extent of each tv~e oCuse ............. 7. Dimensions o~f existing structures, if any: Front...J~.'....A(/.&... Rear .....~....~,,,[.,a... Depth .... ~iii. Height . .~J~.....~.ffA.... Number of Stories .... ~ ....................................... Dimensions of same. structure with alterations or additions: Front ................. Rear .......... Depth .~.~ .~.~. ........... Height ........... ........... Number of Stories ............... ' ....... 8. Dimensi~i~so£entirenewconstruction:Front 30' · ..~ .....-----..-.. ~ ...~..........Boar 30 Denth 2J · ........ Height ..~.?. .......... NumberofStoriesiiii.~x~iiiiiiii'.-'..'''''"''"''"...-..."'..--"iiiiill 9. Size of lot: Front /,~- / ,6c~e go~ ~....... JJsptg' 11. Zone or use district in which premises are situated ~qc~ Csrm~ t 13. Will lot be regraded .... ~ ~ ,. · · .~. .... ~-~ .......~.. Will excess~qll be removed from premises: Yes 14. Name of Owner of premises .oq..~t.~...L~.,%c 6~'ue~d~,.,Address (,fO,'l~ ~oC~f Phone No Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ........... :~_... IS.Is this property located ,ithin ]00 feet of a tidal ~etland? *¥1g$ .... NO..~.. · If yes, $outhold Town Irustees Pernit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-hack dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. APPROVED AS NOTED / Nb~IFY BUIL~DING D~PARTME~I'r "AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION TWO REQUIRED FOR POURED CONCRETE 2, ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y, STATE CONSTRUCTION & ENERGY CODES, NOT RESPONSIBLE FOR Lg2$1GN OR CONSTRUCTION ERRORS STATE OF NEW Y..ORK, COUNTY OF .. b..o.l.:'.~.°.'-717.. S.S .... -~'-~ "~ C c-~x~t ~ ............................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. (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 w/Il be performed in the manner set forth in the application filed there~zithx-~_~ Sworn to before me this ~ /~.-- ~ ................................. & ' ,..,0ss, / L ('[' - ': au..~i,, i. Su.ol~ County / ~ ~ (S~gnature of apphc~t) T~m Expires 121~1/~ /