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30953-Z
FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30756 Date: 02/11/05 THIS CERTIFIES that the building ADDITIONS Location of Property: OFF ORIENTAL AVE FISHERS ISLAND (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 10 Block 11 Lot 2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 11, 2005 pursuant to which Building Permit No. 30953-Z dated FEBRUARY 11, 2005 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 ADDITIONS TO AN EXISTING SEASONAL DWELLING AS APPLIED FOR. The certificate is issued to GEORGE C MATTHIESSEN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A A riz d Sig ature Rev. 1/81 Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT r r TOWN BALL FEB 3 765-1802 i AP) LICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. 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 1%lead. 5. Commercial building,industrial building,multiple residences and similar buildings and installations, a certificate. of Code Compliance 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 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 Building- $100.00 3. Copy of Certificate of Occupancy-$.25 4. Updated Certificate of Occupancy- $50.00 '5. Temporary Certificate of Occupancy-Residential$15.00, Commercial$15.00 Date. February 2, 2005 New Construction: X Old or Pre-existing Building: (checkone) Location of Property: (no #) r/o/w off Peninsula Road Fishers Island House No. Street Hamlet Owner or Owners of Property: George Carey Matthiessen Suffolk County Tax Map No 1000, Section 010.00 Block 11.00 Lot 002.000 Subdivision n/a Filed Map. n./a Lot: n/a -1)0q52) Permit No. 9288 Date of Permit. 06/06/77 Applicant: Faulkner Health Dept.Approval: n/a Underwriters Approval: n/a Planning Board Approval: n/a Request for: Temporary Certificate Final Certificate: X (check one) Fee Submitted: $ 25.00 (� C_ Applicant Signature Stephen L. Ham, III FORM NO. 3 TOWN OF SOUI'HOLD 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. 30953 Z Date FEBRUARY 11, 2005 Permission is hereby granted to : GEORGE C MATTHIESSEN 62 HAMBURG RD LYME, CT 06371 for CONSTRUCT ADDITION TO AN EXISTING SEASONAL DWELLING AS APPLIED FOR THIS PERMIT REPLACES BP 9288 . at premises located at OFF ORIENTAL AVE FISHERS ISLAND County Tax Map No. 473889 Section 010 Block 0011 Lot No. 002 pursuant to application dated FEBRUARY 11, 2005 and approved by the Building Inspector to expire on AUGUST 111 _2-&&-6- . Fee $ 150 . 00 Aut r z re i ORIGINAL Rev. 5/8/02 FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERKS OFFICE SOUTH'OLD, N`. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 3'�° .� ...., L.. N0 9288 Z Date .........................:.. ....:::...... ............, Permission is hereby granted to: y} a LOOM. ''�•5._:�?..�..'1 S` !,..�.ti. :�.L'i C;,. . .!'..Ci:'..'�4af�.•1:''t 'S�'e1�.'A:l. . ........... . ..:':: ............1.v� ................................ yy;; ................................................................................. to 1...i.1. -J._.....:....i:..,�.�..{.u..:.'...:rriC . .,.e>,_. ...i.•Y: ti•t•a•a:}. ..�. .zV.RI(;7.s.�nJ. ' F`'x:�r ...}l�P b 1�..... ................................................................................................................................................................ at premises located at .Q::.4,:.':•4• •C ............................................................ ...........................................3. .T`.:� �..�..l•.:��,C��w�l....7:.a. .a....................................................................... pursuant to application dated ...........................T: : : ..... ............... 19..�J:�7., and approved by the Building Inspector. Fee $.-3-.'-o!:!0.......... . ........................... Building:.lnspec or 02/11/2005 10:33 FAX 631 788 7798 FIltiEPHONE 1@002 BUILDING DEPT, INSPECTION . . I_ ] :FOUNDATION 1 ST [ ] ROUGH PLBO. [ ] FOUNDATION 2ND [` ] INSULATION [ 1 FRAMING . I I1rAL FIREPLACE: & CHIMNEY .. . . AEMARKS: �. . DATE INSPECTOR TWIN OF SOUTHOLD VOPE"ITY "-AECO''-D C*4"%-D � OWNER STREET VILLAGEDIST. SUB. LOT; I C. FORM& OWNER N E ACR.' i U S W TYPE OF BUILDING C i ES. SEAS. VL. FARM COMM. CB. MISC. Mkt.iValue i LAND MMP. TOTAL DATEREMARKS 0 a /ago v e40n�;� .Z `8' � � a� ��y ,�s ".��.rek. a�. -' AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE , s FARM Acre Value Per Value Acre. 'illable 1 'illable 2 illable 3 ✓oodland wampl,and FRONTAGE ON WATER rushland FRONTAGE ON ROAD louse Plot DEPTH BULKHEAD otal DOCK - -,- ,v, "- '�-- i,_�,.-,-- - ,- ,-,,._� " -,,t�l �" —-� .. ,'�,�_- - -- . ��'. �: ....... t ,� �- 1, ,,1,1�- _y_ ., ',- :_- . - - - '.,4z_- -,- --.�-.,,-"� .: ,-� "-:�:,:��-.' , I I , ,� - � I--I- Ir_l__,__`:-,- -,�,-.." - �41: -.11 -1 . . .- , ..- �. 11 . 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Y F.-•ff E'- "''S 5 ._Tw.{ `.,y"s _,: r_'J- ���5'f% -` �,. kJr ....1_ �4 :F _ a t t_ \ _ - - - 4- Lays.1 _ - - 0 t . if$' �� .,. - .. _ 11 � _ .:. _ -, _ I -i _ - _ I � � r MW r., �- spot - 1. v.11 x - � - . _ 1. .. -,_ ff" t_ ._. t �g E i i I f " � f i ! � 7 aliz Ow , 1( �,!14Y -STIP K W- ... L� P� 1/ tt _1 t tv ( 1u p f f kt b 1'.��' }' .rt F m WA, 'r�t N Its'0 d � E t T v AA.. o Van Ks S man d FORM 1N0. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE (n SOUTHOLDD, N. Y. eel`�� Examined ....... `�.. 19... !'53 >f� G/ li / Application No. Approved .....................�.................., 19 . .. Permit Na. ..... ...................... Disapproved a/c ......... ...... ...................... ........................................................................ ......... ........................ ........(.u........................................ . . ................ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ............. . y .......�......................... 19.. 7.... INSTRUCTIONS h a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building C' Inspector. 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 application. 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 issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of 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, housin code, and regulations. !' z"n v. ...: .. J.................. - /� (Signature of a icant, or name, if a corporation) (Address of applicant) State w ether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ti.� :. ............. ........................................................................................ Name of owner of premises ......./....) -ICS.4�.��'L✓'G�. ...................................................................... If applicant is a corporate, signature of duly authorized officer. ................................................................................................. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ...... ...... ..Lot No..: '...... . .......... Street and Number � �!....... �.� unicipality .. M 2. 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 .... G..J....r�-.. ` ..... .................� .......................................................... ' V, a a 3.` Nature of work (check which applicable): New .Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition.................. Other Work (Describe) ........................................ 4. Estimated Cost ...../..f ................................Fee ........... ............................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................Number of dwelling units on each floor ............................ Ifgarage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front .......X ................. Rear ..... ..................... Depth .Z.2........... Height ....l.'................. Number of Stories ...........1:... . .......................... ..................................... .........:...... Dimensions of some structure with alterations or additions: Front ........ ~f..................... Rear ......(� ................ Depth 2 .................. Height ..../.Z.................Number of Stories 8. Dimensions of entire new construction: Front............lP � ....................... Rear ...'�.�f................... Depth ........................ Height ....i............ Number of Stories ......... ........................................................................................................... 9. Size of lot: Front .....VC).0............... Rear .......... �J. .................... Depth .....�O o ......... ... 10. Date of Purchase IV..'VI. ..........................N e of Former Owner-f' lu!!?. . .... 11. Zone or use district in which premises are situated ... ...................................................................................... Name of Owner of premises folate any zoning law, ordinance or regulation? ..:��.:........: 13. NaC✓ :................................... 12. a proposed construction � .�.�.....Address � �� .-........ Phone No. .................... Name of Architect ......�......//.............. .. �......,................Address ............................................ Phone No. .................... Name of Contractor(�!��CClr!l ..L . Address ..............`............................. Phone No.ffi'E' 611. 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. 1 611- Z r STATE OF NEWIR , ISS 1OJNTY OF .... .... . ...............l ............ . ........ ........... . ..........................being duly sworn, deposes and says that he is the applicant (Name of i ividual signin above named. He is the ........... . �a.pp �a.tio ....... ........ ...... ... ............................................. . ............................ (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 thar the work will be performed in the manner set forth in the application filed therewith. Sworn1 iefore me this .......A............... day of .... ..... .......................:..; 19 c ..................... .. . .. :.......... Notary Pu 'c, .................... .. .................. County (S' nature of applicant) EILEEN WALL ' •Notary Public, State of NeW ork No. 52- 091(35 Qualified in Suffolk County Term Expires March 30, 19