HomeMy WebLinkAbout31538-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-31232
Date: 10/24/05
THIS CERTIFIES that the building NEW DWELLING
Location of Property: ORIENTAL AVE FISHERS ISLAND
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 4 Block 7 Lot 4
Subdivision
Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated OCTOBER 14, 2005 pursuant to which
Building Permit No. 31538-Z dated OCTOBER 18, 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 SINGLE FAMILY DWELLING WITH ATTACHED GARAGE AS APPLIED FOR.
: THIS DWELLING WAS CONSTRUCTED IN 1982.
The certificate is issued to LOUISE D GAUMOND
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-03-0091 08/25/05
ELECTRICAL CERTIFICATE NO. N-605550 06/10/83
PLUMBERS CERTIFICATION DATED
Rev. 1/81
N/A
Aut rize Signature
i
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPAN
1-1 } SEP 1 22005
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. Y,t _ r� f
6. Submit Planning Board Approval of completed site plan requirements.
B. For existing buildings (prior to April 9, 1957) non -conforming uses, or buildings a ``pre -�Ralti�g2 W uses
1. Accurate survey of property showing all property lines, streets, building and unusud nat` ral or topographic
features.
2. A properly completed application and consent to inspect signed by the applicant. If a CertxficateAPQ—ecupan_cis
y Ls—
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. 5eptember:.5, 2005
New Construction: X Old or Pre-existing Building: (check one)
Location of Property: (no #) East End Road Fishers Island
House No. Street Hamlet
Owner or Owners of Property: Georgette Rutherfurd (former) ; Louise D. Gaumond (current)
Suffolk County Tax Map No 1000, Section 004.00 Block 07.00 Lot 004.000
portion
Subdivision Map of Fishers Island Dev. Corp. Filed Map. A421 Lot: 15-11
Permit No. 3 15 �; 9 -& Date of Permit. I 0 1 f g' Applicant:
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: X (check one)
Fee Submitted: $ 25.00
6 q 1,33
Co ?, ►,23 �
Applicant Signature
Stephen L. Ham, III
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. 31538 Z Date OCTOBER 18, 2005
Permission is hereby granted to:
LOUISE D GAUMOND
221 MARION AVE
MILL VALLEY,CA 94941
for
CONSTRUCT NEW SINGLE FAMILY DWELLING AS APPLIED FOR. (THIS
REPLACES BP 411687-Z DATED 5/21/82.)
at premises located at ORIENTAL AVE
FISHERS ISLAND
County Tax Map No. 473889 Section 004 Block 0007 Lot No. 0'04
pursuant to application dated OCTOBER 14, 2005 and approved by the
Building Inspector to expire on APRIL 181 2007.
Fee $ 1,425.00
ORIGINAL
Rev. 5/8/02
Autho ized Signa ure
,rLl � f` •v�;
��i/: f � .,"-� _ i�•. 1575
- ' - x aS: �m��' �^ ., ' ` a "• die°*;
TOWN ® . OUTHOL® ®PRY RECORD,.
OWNER
STREET
VILLAGE.
DIST.
SUB.
LOT
�..
4� W,4
SZ- 1..
FORMER OWNERN�
/ r v
- �p
E`
ACRIf .
S.
W
TYPE OF -BUILDING
RES.. ' 7 O
SEAS.
VL. . •-
FARM
COMM.. CB. MICS. Mkt. Value
LAND
IMP.
TQtAL
DATE
REMARKS
-'
D
3Ov °�
ss
a.i i
. l
it
oat;
AGE
BUILDING CONDITION
..
-NEW
NORMAL
BELOW
ABOVE
FARM
Acre
Value Per
Acre
Value
Tillable
FRONTAGE ON WATER
Woodland
t
- l �
��
3 t%92
FRONTAGE ON ROAD_ -
Meadowlaand
DEPTH
House Plot
BULKHEAD
Total
2
DOCK
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE,
BUREAU OF ELECTRICITY
F 85 JOHN STREET, NEW YORK, NY 10038
52'7029,14`,1, Iq 38(1 -14�
Date MEW 17,.199G Application No. on file T352'7029,149,1,
THIS CERTIFIES THAT
only the electrical equipment as described belowand the applicant on the above application number in the premises of
fintroduced
gb�y$ �gynamed
MRSs .�•di�?t V�-1-T.. RiflIIT0141:.YRD, I'.'Y��SVt3ION PAi.l'L7SE, I A:•ISHFI:C4^S .4.I,J!g..jMvil N.Y.a
in the following location; ❑O Basement ❑ let Fl. ❑ 2nd Fl. OUT Section Block Lot
was examined on j -w and found to be in compliance with the National Electrical Code.
FIXTURE
FIXTURESRANGES COOKING DECKS
OVENS DISH WASHERS
EXHAUST TANS
OUTLETS
RECEPTACLES
SWITCHES INCANDESCENT1
FLUORESCENT
.OTHER AMT. I
K. W. AMT.
K. W.
AMT.
K.W. AMT. K. W.
AMT.
H. P.
DRYERS FURNACE MOTORS FUTURE
APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS
BELL UNIT
TRANS.
HEATERS
MULTI-OUTLET
SYSTEMS
NO. OF FEET
DIMMERS
AMT.
K. W. OIL
H. P.
GAS
H. P.
AMT.
NO.
A. W. G. AMT.
AMP. AMT.
AMPS.
AMT:
H. P.
AMT..
WATTS
1
ry
GL'J
SERVICE DISCONNECT
NO. OF
S E R V I' C E
AMT.
AMP.
TYPE
METER
EQUIP
I X TW
t,B' 3W
3 ,BI 3W
3.,e' 4W
NO. OF CC. COND.
..pER b'
A. W. G.
OF CC. GOND.
NO. OF HI-LEG.
A. W. G.
OF HI-LIG
NO. OF NEUTRALS:
A. W'. G.
OF NEUTRAL
•
OTHER
{�A-11'77yy**D p UB
Wild-18H 0,111 i rg L 1 C .:x92,1 r
11ONAUK�!�ao
m;" J 062'_-�o' GENERAL MANAGER
_ Per
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. ,
1001129 THE NEIN YORK BOARD OF FIRE UNDERWRITERS
hq BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
Date June 10, 3983 Application No. on file 153876-82 N 605550
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number in the, premises of
Rutherford, Fishers Island, N.Y.
in the following location; Basement GclraFe, out8i
� lst Ft. 2nd. Fl. Section Block Lot
was examined'on Jur .i� 7, 1983 and found to be inccompliance with the requirements of ,this Board.
FIXTURE
FIXTURES RANGES ICOOKING DECKS
OVENS
DISH WASHERS
EXHAUST FANS".
OUTLETS
RECEPTACLES
SWITCHES
INCANDESCENT
1E1 R1
FLUORESCENT VAPOR AMT.
K. W. I AMT.
I K.W.
AMT. K.W.
AMT. K. W.
AMT. H. P.
54
82
60
48
6
1
7.6
1 7.3
1 1.2
2 F
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS
SPECIAL REC'PT TIME CLOCKS
BELL
TRANS.
UNIT HEATERS
MULTI-OUTLET
SYSTEMS
NO. OF FEET
DIMMERS
OIL
H. P.
GAS
H.'P. .AMT.
NO.
A. W. G.
AMT.
AMPry. AMT..
AMPS:
AMT.
H. P.
AMT.
WATTS
1
F
1V
SERVICE DISCONNECT
NO. OF -- - S E R V I C E
AMT.
AMP: TYPE
METER
EQUIP 1,0' 2W
1 /B' 3W
3,,0.3W
NO. OF CC. COND.
.3 ,0' 4W PER.%
A. W. G.
OF CC.: GOND.
NO. OF HI-LEG'
A. W. G.
OF HIAEG NO. OF NEUTRALS
A. W. G.
OF NEUTRAL
1
L00 CB
1
x
1,
4/0
1
4/0
OTHER APPARATUS:
Motors :.3y-F, 1U-1/6 H.P.
.
2-,Sm6ke betector
2-15aw, G.F.Q.I.
pmelboards;1d10cir. 100 s.
r
f
Yoontan Servicesly f
Fishes Island, N.Y., 06309
GENERAL 'MANAGER
t ^L
Per '
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.,
COPY FOR BUILDINGDEPARTMENT-THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
FIELD INSPECTION
JDATE
COMMENTS
�q/i^�'-► `- , ho- '`r
MoA
1M1 T'"
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v FOUNDATION (1st),
"�
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FOUNDATION (2nd)
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ROUGH FRAME &
PLUMBING
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-T
(%
INSULATION PER N. Y.
1-3
z
STATE ENERGY
C,ODE
&11741 3
4.
FINAL
O
ADDITIONAL,COMMENTS:
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FORM NO.
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTH'OLD, N: Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N911687 Z Date...............................M ................ 19.......
Permission is hereby granted to:
/01)70/1/ Sr- r-V(c �, ....;.siv c
/�
................................................_..`.........�...
�UT Ftj7"EAc'F(Ir-_�
................................................................................
........./�C: fax >1)4 FlSHC% 0639d
CAI 4
to.... .............. ............................................. .. ......... ................
....................................
.... ..../.. /U ......................J� ..�� ... .... ............................... ...
at premises located at
.................................................................................. ... ......
j=/SNF %f Z � G A nim
..................................................................................................................................................................
..........................................................................` ...
County Tax MapNo. 1000 Section .................... Block ......... Z.......... Lot No....y.................
. ...
pursuant to application dated......................................................... 1 19.1.., and, approved by .the
Building Inspector.
� a/ Va
Fee$......... ...........
................l�f�l:..........:t'!..............................
Building Inspector
Rev. 6/30/80
PD
'LD
16� f
.FQ_L O
LSI. Y.
Southold, N.Y. 11971.'
HENRY E. RAYNOR. Jr., Chairman
>S1 Xn.Q X
JAMES WALL
BENNETT ORLOWSKI, Jr.
GEORGE RITCHIE LATHAM, Jr.
William F. Mullen, Jr.
November 2, 1981
Mr. George Fisher
Sr. Building Inspector
Southold Town Hall
Southold, New York 11971
Dear Mr, Fisher:
TELEPHONE
765-1938
1
At a board meeting held on Fishers Island, October_30, 1981 it was
the decision of the board to release the following lots for consid-
eration by the Building Inspector for building permits,-re:'FI.DCO
maps dated October 1981:
Lot #3 - Chocomount
Lot #16-12
Lot entitled "East Portion" #15-11 f'►i ��
tov�) cy_ -7_ L/
Lot #25-5
From information received by the board regarding these proposed sites,.
the names of DeBois, Nelson, Rutherford, and Bogart.should correspond
to these applications.
The board has reviewed the acc_es_s to these lots,- which have been -rough
graded and suitable for emergency equipment. The board is in agree-
ment with FIDCO directors Peter Sanger, Mr. Dupont,'Mr. Stoepher,
Richard Baker and various citizens from Fishers Island...
Yours very truly, -
HENRY E. RAYNOR, JR., CHAIRMAN
By.Sus n E. Long, Se-cre a4y
(SGC--�,2-.� - �=�-� �c-�✓ �
7L C.�
A FORM NO. 1
TOWN OF SOUTHOLD _
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
Application No.. . .....
amined ........... . l .., 19.
llm7`z
proved ........... �Af —, 19Permit No........... .
:approved a/c ............... .
........................................... �.
........ '�!???:
1t �� _ 6 2 uilding Inspector)
APPLICATION FOR BUILDING PERMIT
Date ... October, 29,..... 19 81„
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building
pector, 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
areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
:ion.
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
ill 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
ill 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
ilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
gulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein .described.
e applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
nit authorized inspectors on premises and in buildings for necessary inspections.
.... BoIto D. 5eryiees.,. 3nr-....:................. .
(Signature of applicant, or name, if a corporation)
PA... Box. 506.,. Fi shers..Is.land.,. N.. Y... 05390..... .
(Mailing address of applicant)
rte whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
General Contractor
..............................................................................................
Lne of owner of premises .....Guy Rutherfurd..... .
(as on the tax roll or latest deed)
applicant is a corporation, signature of duly authorized officer.
............................................
(Name and title of corporate officer)
Builder's License No. M. HJ ................ .
Plumber's License No. 1958-P ................... c
Electrician's License No. 2939-E ................
Other Trade's License No. .1,585 -Wel I . Dra l 1 i'ng.: .
Location of land on which proposed work will be done. ..... ...................................
East End Road
.Suffolk .County . .....Fishers .Isla.nd .. .............. .
Street Hamlet
County Tax Map No. 1000 Section e ....... Block .... #� 7 ...... Lot �...� .........
Subd
,!N
sio,g � i ��f T� cG, / 5 ...................�1 1Filed Map No . .............. Lot ...............
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
`
a. Existing use and occupancy . .......... re, c6' �................................................ .
b. Intended use and occupancy ....... Si ngl e. Fami l y. Dwnl 3 i ng....... .
3. Nature of work (check which applicable): New Building ...X ...... Addition .......... Alteration ..........
Repair .............. Removal .............. Demolition Other Work ................
(Description)
4. Estimated Cost ....$1.50'000.00 ...................... Fee ....... . �........ .
(to be paid on filing this application)
5. If dwelling, number of dwelling units ... one . . . . , , . , , Number of dwelling units on each floor ................
If garage, number of cars two under house
6. If business, commercial or mixed occupancy, specify nature and extent. of each type of use .....................
7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ................
Height ............... Number ofStories ........................................................
Dimensions of same structure with alterations or additions: Front ................. Rear ..................
Depth ....................... Height ...................... Number of Stories ......................
8. Dimensions of entire new construction: Front 50 Rear . AQ............ Depth 34'
Height 22.x..... . Number of Stories 2.
9. Size of lot: Front .... ... Rear ...1.55 ................ D pth 800
10. Date of Purchase ... 1,97.8 ... . ..... . ... . . . Name of Former Owner Fi s�ers .Island Development Cor
11. Zone or use district inwhich premises are situated ....R.es i.denti.a.l.... .
12. Does proposed construction violate any zoning law, ordinance or regulation: ... ND ..........................
13. Will lot be regraded ... N9 .... , ........ ....... Will excess fill be removed from premises: Yes X No
14. Name of Owner of premises Guy. Rutherford, , , , .. Address767, 3,rd, Ave,..,NA-C.., Phone N021-3.6:9.:9120. .
Name of Architect ghri stopher G1 ass . Address Camden,, Maine , , . Phone No?07-,2,3.6,-,8,2.15,
Name of ContractorBouton Servi.c ........ . . . . . AddressBox 506 F..I...,N..Y , , , Phone N0516; 788-7268.
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.
AS PER PLOT PLAN
STATE OF NEW YORK, S.S
COUNTY OF ..... SUFFOLK....
.. .... X J. Marshall being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the ............. Contractor............................................................... .
(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 his1nowledge and belief; and that the
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
......... 30th...........day of .. October ..... 1981.
Notary Public, ... .......Su.
IL
�`iZt1_A_0
�M,`,RB.
folk.
PANKIEVJiCZ
6
_
NOTARY PUBLIC, STATE OF NEW IuHh
NO.:,2-8267950 - SUFFOLK COUNTY
COMMISSION EXPIRES MARCH 30, 192-
.. County C
(Signature of applicant)
N/F
GEORGE IRELAND
ELISABETH W. IREL
"SINGLE FAMILY REST(
MUNICIPAL WATE
ON SITE SEPTIC S
Sl1RVCY
CNVIRDNMENTAL
CIVIL I I
N/F
THE NATURE, CONSERVANCY
"VACANT LAND"
I"
1s -o .-1-e1 Is -a
• Ran11w 1s-11
a, •
•mcax °0°COOL
LOCATION MAP SCALE 1 "=400'
1.) PLAN MADE FOR GUY G. RUTHERFORD; PROPOSED BEACH
HOUSE; =1SHERS ISLAND, NEW YORK; SCALE: 1"=40 FT,; CHANDLER,
PALMER & KING; NORWICH, CONN.; DECEMBER 1978
2.) SURVEY MAP PROPERTY TO BE CONVEYED TO GEORGE IRELAND
& ELISABETH W. IRELAND; BLOCK 15 - LOTS 8, 9, 10 & PORTION
OF 11; FISHERS ISLAND, NEW YORK; CME/CPK DESIGN GROUP;
NORWICH, CT.; DATE: MAY 4, 2001; SCALE: 1"=100'; SHEET 1 OF 1
d4IES
1.) THIS SURVEY WAS PREPARED FOR THE PARTIES AND PURPOSE
INDICATED HEREON. ANY EXTENSION OF THE USE BEYOND THE
PURPOSED AGREED TO BETWEEN THE CLIENT AND THE SURVEYOR
EXCEEDS THE SCOPE OF THE ENGAGEMENT.
2 ) IT IS A VIOLATION OF THE STATE EDUCATION LAW FOR ANY
PERSON, UNLESS ACTING UNDER THE DIRECTION OF A LICENSED
LAND SURVEYOR, TO ALTER AN ITEM IN ANY WAY.
3.) ONLY COPIES OF THIS SURVEY MARKED WITH THE LAND
SURVEYOR'S SIGNATURE AND AN ORIGINAL EMBOSSED OR INK SEAL
ARE THE PRODUCT OF THE LAND SURVEYOR.
4.) COORDINATE DISTANCES ARE MEASURED FROM U.S. COAST AND
GEODETIC SURVEY TRIANGULATION STATION "CHOCOMOUNT 2"
5.) SITE IS IN THE TOWN OF SOUTHOLD, COUNTY OF SUFFOLK TAX
MAP 1000, SECTION 004, BLOCK 7, LOT 4.
6.) TOTAL AREA = 3.56f ACRES,
7.) SITE IS LOCATED IN R-120 ZONE
CERTIFIED T0:
MARK E. & LOUISE D. GAUMOND, COMMONWEALTH LAND TITLE
INSURANCE COMPANY AND JP MORGAN CHASE BANK IN ACCORDANCE
WITH THE MINIMUM STANDARDS FOR TITLE SURVEYS OF THE NEW
YORK STATE LAND ASSOCIATION.
106 v 2005
i
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N/F NOW OR FORMERLY
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Cl CI l.,' CL' I
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