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Home My WebLink About16599-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Date November 6, 1987 DECK ADDITION THIS CERTIFIES that the building ................................................ Location of Property MADELINE AVENUE, FISHERS ISLAND, NEW YORK House No. Street Ham/et County Tax Map No. 1000 Section ...6. ........ Block 7 .Lot 2 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated October 22, 1987 16599 Z ..................... pursuant to which Building Permit No ...................... November 5, 1987 dated ............................ 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 ......... DECK ADDITION TO EXISTING ONE FAMILY DWELLING KATHARINE T. SCHMIDT The certificate is issued to ..................... io~n'o'r,~X .................... of the aforesaid building. Suffolk County Department of Health Approval ........ N./.A. ............................... UNDERWRITERS CERTIFICATE NO ................ N./.A. ............................... PLUMBERS CERTIFICATION DATED: N/A Building Inspector Rev. 1/81 FORM NO. · TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERI{IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO_l 6599 z Permission is hereby grc=nted to: ..... Building Inspector. Fee ~..~,~. ~,.~......~. Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ga Bummumm to the Building Inspec- tor with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3.Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5.Submit Planning Board approval of completed site plan requirements where applicable, B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or topographic features. 2.Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: Additions $25.00 1. Certificate of occupancy New Dwelling $25.00, Accessory ,$|0.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.0 0 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 ~ 5.Updated C.O. $ 50.00 Date ...~/~9. .-. .~. .~. .-. ?. ~. ....... NewConstruction ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ......................... .~..~:~.~. ~.../.~f_~.' .~..~, .~--~....~..~.~.'~r,~ House No. Street Hamlet Owner or Owners of Property .../~. 7~. ~..~...~. 1~.~- ..... .7. ....... .~..C..~.. ~ ~ ,/.~.T. ...... County Tax Map No. 1000 Section .... ~:2 ......... Block ..... .~. ....... Lot ..... /...~r~. ....... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./~..~.~ZDate of Permit//.~'/~,/?App[icant . .~/~~..~.. ~ Health Dept. Approval --"- .Labor Dept. Approval ~ . .......... Underwriters Approval ..... ./. ................ Planning Board Approval . ....--7~... .............. Request for Temporary Certificate ..................... Final Certificate .... ~ ............ Fee Submitted $ .~. z:~. ~. ~. ............... Construction o n above described bu ilding and permit meets all app_~_~l~ .c~e~re_gujations. Rev. 10-10-78 BOARD OF HEALTH ...... 3 SETS OF PLANS ....... 'FORMNO. 1 SURVEY .......... TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT SEPTIC FORM ............. : TOWN HALL NOTIFY SOUTHOLD, N.Y. 11971 TEL.: 765-180;3 Disapproved a/c ..................................... CALL ................ MAlL TO: APPLICATION FOR BUILDING PERMIT Date ./..~..-..'~.. ~...--..~..., 19. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, witt 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 stre or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apt 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 perr 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 Occupar 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 ~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations; or for removal or demolition, as herein describ The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit auth°rized inspect°rs °n premises and in building f°r nece-?_~/5~ ~ (Signature o~licant, or name, if a co}~;~a'ti~)' ' (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build Name of owner of premises .,ff~,,~/..~.~.~..J~.. / .~.~. ..... ~ ..... 3~ ~..d~.//P...~. ........................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSV-D Builder's License No .......................... Phimber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on wtfich proposed work will be done ........................... ltouse Number Street Hamlet SubdMsion ..................................... Filed Map No ............... Lot .............. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... /.2.,~--..S .......... ./.....! b. Intended use and occupancy ...... '.~ .......... ~/'/"~ ............................ ~ .......... 3. Nature of work (check which applicable): New Bui ding ......... Addition'S./,,)./~ .~.. Mteration ......... Repair .............. Removal .............. Demolition .............. Other V, ork .............. (1)cscription) 4. Estimated Cost . . .~.~r..~. .................... Fee.. ?(~Z':'.~.~'~? ...................... · (to bc paid on illin[,' this application) 5. If dwelling, number of dwelling units ..... : ......... Number of dwelling units on each floor ............... If garage, number of cars ....................................................................... 6. If business, com~nercial or mixed occupancy, specify nature and extent of eaqJ~ type o! use .................... 7. Dimensions of existino structures, ~fany: Front .... ,~ffi ....... Rear .............. Del th .6-~.. ......... Ileight . . . ~.t2 ........ Number of Stories . . .,,,-~-, ................................................. Dimensions of same structure with alterations or additions: Front . . . ~.. 7~. .......... Rear . . .~..2<-. ........... Depth .... ~.q~ ............... Height --'-- Number of Stories ..................... 8. Dimensions of entire new construction: Front .... ./*% ........ P, ear ... ,,/..2w. ........ l)cpth . ~...~. ........ 9. Sizcoflot: Front ...................... Rear ...................... Dcplh ..................... ]0. Date of Purchase ............................. Name of [.rmer Owner ........................... 1 1. Zone or use district in which premises are situated .................................................... 1 2. Does proposed construction violate any zoning law, ordinance or regulation: ................................ ! 3. Will lot be regraded ............................ Will excess fill be removed froln premises: Yes N~ I~.. Nmne of Owner of premises .................... Address ................... Phone No ............... Name of Architect ........................... Address ................... I'hone No ............... Name of C0ntractor .......................... Address ................... Phone No ............... 15. Is this property located within 300 feet of a tidal wetland? ~Yos ..... No ..... *If yes, Southold Town Trustees Permit maybe rertuired. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ali set-back dimensions fron property lines. Give street and block number or description according to deed, and show ':trcet names and indicate wh,Ahe interior or corner lot. ~ I'ATE OF NEW YORK, S.S COUN FY OF ................. ................................................. beiug duly sworn, deposes and says that tie is the applicau (Name of individnal signing contract) !te is the ........................................................................................ (Contractor, agent, corporate officer, etc./ ~f said owner or owners, and is duly authorized to perfom~ or have performed the said work and to make and file thi application; that all statements contained in this application are true to the best of his knowledge and belief; aod that tht wot!.: will be performed in the manner set forth in thc application filed therewith. Sworn to before me this ............... .-47 ...... day of ...... ........ , . . . . .:. ... . :. ..................H~LENtLDE~ENewYm'k Couuty~/~97 ~ Ne. 47078'18. $~1, ' .......... lermExpiresM~c! ~--~"~{ ~/ ( '~. t re of applicant