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Home My WebLink About27857-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30953 Date: 05/31/05 T~IS CERTIFIES that the ~uildin§ ADDITION Location of Property: ORIENTAL AVE FISHERS ISLAND (HOUSE NO.) (STREET) (HAMLET) County Ta~ Map No. 473889 Section 5 Block 2 Lot 7.9 subdivision Filed Map No. -- Lot No. -- conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 23, 2001 pursuant to which Building pez~nlt No. 27857-Z dated NOVEMBER 14, 2001 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 EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to DRUSILLA R VA~CHENGEL (OWNER) of the aforesaid building. SUFFOLK COUNT"f DEPARTMEnT OF~LT~APPROVAL N/A ELECTRICAL CERTIFICATE NO. 2048889 04/08/05 PLUMBERS CERTIFICATION DA'£mU N/A Rev. 1/81 Form No. 6 TO~ OF ~OUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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 i% 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. 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-existinK Buildinm - $IO0.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ..~..l!~J.~.~ ......................... ... New'Construction ........... Old Or Pre-existing Building ................. Location of Property .... .~.~J.~.~lO.~-.f~. ~ ~,_ ~ ~z~ ~ ~lZ~LmrOp House No. Street Hamlet Onwer or Owners of Property..~ ~.~ ~..A./~ f'~, ~.J~'~ foI J~e~¢l County Tax Map No i000, Section.. ~9.-~. ...... Block..~.q.9..~ ....... Lot.~.P.~'.P~ % ........ Subdivision .................................... Filed Map ............ Lot ...................... Permit No..~.J.~.~.~f ...... Date Of Permit.(ff.!il.~l_...Applicant~.~.~......--..-...-.~..--.--C~OVaN~-'~q Z~c. Health Dept. Approval ........... ... .. . ~ ........ Underwriters Approval ........................ · Planning Board Approval ....................... . Request for: Temporary Certificate ........... Final Certicate..? ........ Fee Submitted: $ ............................ APPLICAMT BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING [ ] FIREPLACE & CHIMNEY ROUGH PLBG. INSULATION "-']"FINAL REMARKS: DATE INSPECTOR,~~~,~4~~ BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON STRE~I ~ NEW YORK, NY 10038 CERTIFIES THAT Upon the application of upon premises owned by Z & S CONTR. INC. P.O. BOX 202 FISHERS ISLAND, NY 06390, MAARTEN VAN HENGEL EAST END CASTLE ROAD FISHERS ISLAND, NY 06390 Located at EAST END CASTLE ROAD FISHERS ISLAND, NY 06390 Application Number: 2048889 Certificate Number: 2048889 Section: Block: Lot: Building Permit: BDC: ns11 Described as a Residential 0-599 square fi. occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: First Floor, A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed herein, was conducted in accordance with the requirements of the applicable code and/or standard promulgated by the State of New York, Department of State Code Enforcement and Administration, or other authority having jurisdiction, and found to be in compliance therewith on the 8th Day of April, 2005. Name QTY Rate Rating Circuit Type Amount Miscellaneous 1 room addition/renovation $0.00 Wiring and Devices Outlet 5 0 Fixture $0.00 Fixture 5 0 Incandescent $0.00 Outlet 10 0 General Purpose $0.00 Receptacle 7 0 General Purpose $0.00 Switch 5 0 General Purpose $0.00 Dimmers 2 0 $0.00 Paddle Fan 1 0 $0.00 Receptacle 1 0 GFCI $0.00 Invoice Total $85.00 seal I of 1 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. 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. 27857 Z Date NOVEMBER 14, 2001 Permission is hereby granted to: DRUSILLA R VANHENGEL 350 RIVER RD SCARBOROUGH-ON-HUDSON,NY 10510 for : CONSTRUCTION OF AN ADDITION TO A SINGLE F~4ILY DWELLING AS APPLIED FOR at premises located at County Tax Map No. 473889 Section 005 pursuant to application dated OCTOBER Building Inspector. ORIENTAL AVE FISHERS ISLAND Block 0002 Lot NO. 007.009 23, 2001 and approved by the Fee $ 150.00 Authorized Signature ORIGINAL Rev. 2/19/98 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN Hh, LL ~ SOUTHOLD, NY 11971 TEL: 765-1802 E×amined ' V / ,200 __ Approved t~ ,20 OI Disapproved wc PERMIT NO. BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying ? Board of Health 3 sets of Building Plans M/ Survey f Check t'/' Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to: Phone: { B~ilding APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS ~///oY ff~. ,20o/ a. This application MUST be completely filled in by typeva'iter 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 waterxvays. 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 a 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 pan for any purpose what-so-ever until a Certificate of Occupancy is issued 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 Count)', New York, and other applicable Laws, Ordinances or Regulations, for the consU-uction of buildings, additions, or alterations or for removal or demolition as herein described. The applicant agrees to comply with ali applicable laws, ordinances, building code, housing code, and reguiations, and to admu authorized inspectors on premises and in building for necessary inspections. (Signature of applicant~or name, it' a corporation) (Mailing address of applicant) ~$~0 State whether applicant is owner, lessee, agent, architect, engineer, general contractor electrician, plumber or builder Name of owner of premises (as on the tax roll or latest deed) If a li~_p_kL.cp~ a cor~ration~, ~i..gp~}ture of duly a, ut.hofized officer ~ (Name a~itle of corporate 6 ff~er) Builders License No. /~- c~/c0 3/.Z" Plumbers License No. ~'6"x/~ ,,~ Electricians License No. z/tTFff'- ~' Other Trade s License No. Location of land on which proposed work xvill be done: House Number Street County Tax Map No. 1000 Section Subdivision (Name) Hamlet Block ~ t (~-~ Lot ~ Filed Map No. Lot State existing use and occupancy o£premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ,,J',;~_-j~,,~,~ . b. lntcnded use and occupanc3 3. Nature of work Icheck which applicable): New Building. Addition Repair ___Removal Demolition Other VVork Estimated Cost ~,~-'~ oz,o, o'O If dwelling number ofdxxelling units If garage, number of cars O Fee Alteration (Description) (to be paid on filing this application) Number of dwelling units on each floor 6. If business, comtnercial or mixed occupancy, specify nature and exter~t of each t.,,?e of use. ?. Dimensions of existing structures, if any: Front Height Number of Stories Rear Depth Dimensions of same structure with alterations or additions: Front Rear Depth Height_ Number of Stories 8. Dimensions of entire new construction: Front Height Number of Stories Rear Depth 9. Size of lot: Front Rear .Depth I 0. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated 12. Does proposed construction x iolate an.,,' zoning lax,,', ordinance or regulation: 13. Will lot be re-graded Vvrill excess fill be remoxed from premises: YES NO Name of,4a'chitect Name of Contractor Address Phone No. Address Phone No Address Phone No. 15. Is this property within 100 feet of a tidal wetland? *YES NO ,~ _ · IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQUIRED 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must prox ide topographical data on survey. STATE OF NEW YORK) SS: COUNTY OF ~m~.,5 ~' x~/]//O being duly sworn, deposes and says that (s)he ~s the applicant (Name of individual s~gmng contract) above named, (S)He is the (Contractor, Agent, Corporate Officer, etc.) of said owner or owners, and is duly author/zed to perform or have perforated the sa d work and to make and file this application; that all statements contained in this application are true to the best of his Imowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Nota0' Public ?HOMA~ F, DOH£RTY dR, Notary Public Sfltl of New Yo~k No. 4~8559 Ouallfllu in 9uffolk County Term Expires 1~1~ Si~tu~e of Applicant · .t /-.,, 0