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HomeMy WebLinkAbout11654-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. UPDATED CERTIFICATE OF OCCUPANCY No Z-25793 Date JUNE 24, 1998 THIS CERTIFIES that the building ADDITIONS Location of Property 100 MAC DONALDS CROSSING House No. Street County Tax Map No. 1000 Section 145 Block 4 Subdivision Filed Map No. LAUREL, N.Y. Hamlet Lot 15 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 25, 1982 pursuant to which Building Permit NO. 11654-Z dated MAY 12, 19S2 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 WOOD PATIO WITH GAZEBO ADDITION & GARAGE ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to RICHARD & RUTH ZEIOLEK (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. N-71659E - NOVEMBER 12, 1985 PLUMBERS CERTIFICATION DATED N/A NOTE: THIS UPDATES CO Z-14398 DA 4, ,1986. Rev. 1/81 /~ BuiSdihg Inspect~ TOWN OF $gU~*HOJ~ BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. Perrhisston'is hereby granted to: ~ (THIS PERMIT MUST BE KEPT ON THE PRE IS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) tO ,..;... ...... ; ......... , .............................................................. ~....:..: ......... ~:~i. .............. ~'~'"":"~-z:: ........ 7~'"'z;~ at premise~ located at Z~...~.....~.4~=.~.( ;~.S~E~, ~:-.C~:.~,~.~ ? ..~....~ ......... ~ ............................................................................... ~...?~.~ c~.~.=~ .... : .... ~ ~ ~. ~ ...~.Z.~..~.=.4.~ ......... ~ ' ~ o . Co~ty T~ M,p No. moo S~t~o, .d......~.....,..: O~o~k .~..~..% ...... ~.~ et N. <..O.Z~ ........ p~&.t ~ application dated .~~,:...g.~....~....~ .... 19,. nd ~pproved by the BUilding In'specter. ~; FORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z14398 Date May 14, 1986 .... THIS CERTIFIES that the building Addition Location of Property ..J..0.0..M.¢. Donalds Crossinc~ Pvt. Rd. g3 Laurel House No. Street Hamlet County Tax Map No. 1000 Section . . .1A5. ...... Block . 9.4 ............ Lot 015 , 12-13-14 Subdivision..E.d~.e.m..e.r.e..P..a.r.k. .............. Filed Map No ......... Lot mo .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... .M.a.r.c..h..2.5. ......, 19..8.2pursuant to which Building Permit No...],165~,Z ............ dated ...M.a.y..1.2. .................. 19..8.2, 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 ......... ..... ~clcli~i.o.~..cp..e..x.i.s.t.i..n~..d.w..e.~.~.i.n. ~.. ....................................... The certificate is issued to RICHARD & RUTH ZEIDLER ..................... ?o¥,,'~;, '~li~k'~×' .................... of the aforesaid building. Suffolk County Department of Health Approval ....... .N/.A. ............................... UNDERWRITERS CERTIFICATE NO ............... 3~.N. 7. .1.6 .5.9. 8. ......................... Rev. 1/81 Building Inspector TOWN OF SOUTHOLD 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 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. 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. 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-existi~g Buildin~ - $100.00 3. Copy of Certificate of Occupancy - 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ~-M~, ]99~ .......... ~ew Oonstr~ction ........... old Or Pre-existing Building ................. ]00 MacDonalds Crossing ~A~I~ ~ ~. . of Property '" ...................... .ocation ...................................... House No. Street Hamlet )nwer or Owners of Property ....... ~Qt~P~.~g~I~R~.W~F]~ ..................................... :ounty Tax Map No i000, Sectio~.~ ............ Block..~ ............ LotJ5 .................... ;ubdivision .................................... Filed Map ............ Lot ...................... 'ermit No .... ! !~ ..... Date Of Permi~.!l~112~ ........ ApplicantgI0~Agl). gglDLER .............. {ealth Dept. Approval .......................... Underwriters Approval ......................... ~lanning Board Approval · .~equest for: Temporary Certificate ........... Final Certicat~-P~AT~D ..... ~ee Submitted: $ 5~.0~ . FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted m~ 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 featu res. 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- dons, 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. 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: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15.00 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 ~.C..c~., 5. Updated C.O. $15.00 Date. . ./i~.'~ ./. ~..~.~J. ..... New Building ............. Old or Pre-existing Building .. ~ ....... Vacant Land ............. Location of Property ~,.7/ ~.~. ¢/. ,L.~,' ~,/ ... House No. Street (/ Hamlet Owner or Owners of Property ./.~..~.~..~b/.~.~. . .. .~.-57 ........................... County Tax Map No. 1000 Section .../..~.b.~', ....... Block .. O. ,z/ ......... Lot.. ~../.i~ 7 ........ Subdivision..~. ~,,,~....-c~....~,~. ....... Filed Map No. ~'.?'.~. ..... Lot ,o. ' ~ -'$ _,%z Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... ~., <cable~c.~nd regulations. ~LDP~N W. YOUNG YOUNG ~ YOUNG 400 OSTRANDER AVENUE P~IVERHE~.D, NIgW YORK H~ox HOW~,RD W. YOUNG October 24,1986 To : Mr. Richard Zeidler The total area of house and garage, a gazebo and proposed swimming pool on land of RICHARD & RUTH ZEIDLER at "Edgemere Park", Laurel, Town of Southold,N.Y. is 5146 sq. ft. The aboue area is 18% of the lot area. Alden W.~q~]n¢-j ~ NO. 5 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLDr~ N. Y. ORDER TO REMEDY VIOLATION Date June 22, ]9 87 (owner or authorized agent of owner) 55 Whippoorwill Lane, Patcbogue, New York (address of owner or authorized agent of owner) 11772 PLEASE TAKE NOTICE there exists a violation of: Zoning Ordinance CH 100 Other Applicable Laws, Ordinances or Regulations ............................................ at premises hereinafter described in that not in conformity with the provisions (state character of violation) of the application, plans and specifications. in violation of 100-1,43 - STOP ORDERS (State section or paragraph of applicable law, ordinance or regulation) YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the law and to remedy the conditions above mentioned forthwith on or before the 6th day of ..... .J..u...~..y. ........................................ , 19........87 The premises to which this ORDER TO REMEDY VIOLA/ION refers are situated at I00 MacDonalds Crossing, Laurel, ~ t ................................................................................. ~oun y of Suffolk, New York. Failure to remedy the conditions aforesaid and to comply with the applicable provisions of law may constitute an offense punishable by fine or imprisonment or both, STOP ALL WORK ~ , . , NO~ember 't~ 1985 ........ - :~::~:::~ :J~ 39: Halloc~ Rd. -Thi~z~dificOte most not be'olter~ in any ~nner; return to the office of the ~ord if incorr~t, tn}p~or~ ~oy be-idehtlfled by their cre~ntials.: ELIZABETH A. NEVTT,L~ TOWN CLERK REGISTRAR OF VITAL ~5~ATISTIC$ MARRIAGE OFFICER RECORDS MANAGIilMENT!~E[ QER FREEDOM OF INFOR~IK~N OFFICER Town Hall, 53095 Main Road P.O, Box,1179 Southold,~le~.,Y0rk 11971 Fax (516) 765-1823 Telephone (516) 765-1800 OFFICE OF THE TOWN CLERK TOWN OF SOUTttOLD APPLICATION FOR PUBLIC ACCESS TO RECORDS INSTRUCTIONS,: Please complete Section I of this form and give to Town Clerk's Office (agency Freedom of Information Officerl, One copy will be returned to you in response to your request, or as an interim response. SECTION I. (Department Or Officer, if known, that has the information you'are request'ng.) RECORD YOU WISH TO INSPECT: (Describe the record sought. If possible, supply date, file title, tax map number, and any other pertinent information.) Signature of Applicant: Mailing Addre~_ss (if different from above): i -~ Telephone Number: ~ ~-- / ~t.~._~ Date: ,. {,/-q~ [ ] APPROVED [ ] APPROVED WITH DELAY* [ ] DEIglED* Elizabi~th A. Neville Freedom ot~ Information Officer * If delayed or denied see reverse side for e×pla~ation. PORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL · ..~..~.....dEJ.~/~.~.o.d.~..r~.~.//.~'~ ...~z~.~.~..~..~,~. ~. ,~ for pe~it to construct .~~. ~d~ ~ ........................ at .~ . ~ /~a~ ~.d~ ~. ~cation of Property 9~sb County Tax Map No. 1000 Section...~.~7... Block ...~.~ ....... Lot ...~ ..... is returned herewith and disapproved on the following grounds .............. .~.~.. ~m/~,.~.Z¢~.e~e.~7. ~.. ~eZ.~.. 7 ...... .......... ~ .... ~eo.,.~. .... Z,zZ... ~.~,z~...:.E: ..... Building Inspector RV 1180 FIELD INS.PECT~ON Io FOUNDATION { 1st) COMME~ ~-a~ FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY TOWN OF SOU?HOLD ~nstrttctions A, This application must be filled in typewriter OR ink, and submitted i, ~ 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~perty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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. Fees: 1. Certificate of occupancy ~$5.00~/ 2. Certificate of occupancy on pre-e~ting dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 $15.00 Date ........ .& ........... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ............................................................. House No. Street Ham/et Owner or Owners of Property ........... County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. / ..... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 To Whom This May Concern, Please complete the enclosed application for Certificate of Occupancy and enclose a check for $5.00 (the fee for the C.O.)'and I will be able to complete the Certificate of Occupancy. We also need an Underwriters Oer~i£icate. Thank you so much for your cooperation in this matter. Dorothy Sec. s~c'no~ ?~0~ o~ z~ aeW YO.~ sT~,r~ \, OIgT. IOOO SEC~ 145 BL.04 LOT 015 ~VlSmtl$ YOUNG & YOUN6 ~/=R. aa,/.9Z9400 osr~ANOER ~VENU£, ~/V~R~AO, N. ~ A~ 19, 1~85 RLDffN ~ ~ON~ ~ ' : ~ ~W~RO ~ YOUN8 ~RICHARO ZE/OLER 8 RUTH ~EIDL~ER % NOTE: ELEVATIONS SHOWN HEREON ARE FROM .ACT~A~' SURVEY ANO ~E REFERENCED N.G,V.D~ (M.S.£. 19~9). . = APPt~OK LOCATION OF ' ~ DU~ KHEA D Southold Town Board of ACTION OF THE ZONING BOARD OF APPEALS Appeal No. 2963 Application Dated March 25, TO: Mr. Richard Zeidler 55 Whippoorwill Lane Patchogue, NY 11772 1982 [Appellant(s)] At a Meeting of the Zoning Board of Appeals held onCe'April 14, 1982, the above appeal was considered, and the action indicated below was taken on your [ ] Request for Variance Due to Lack of Access to Property New York Town Law, Section 280-a [ ] Request Article IX] Request Article [ ] Request for for Special Exception under the Zoning Ordinance , Section for Variance to the Zo'nin~ ~dinance III, Section 100-31 and Section 100-36 The public hearing concerning this appeal was held on April 14, 1982. Upon application of Richard Zeidler, 55 Whippoorwill Lane, Patchogue, NY for a Variance to the Zoning Ordinance, Article III, Sections 100-31 and 100-36 for permission to construct addition to dwelling reducing sideyard area. Location of Property: McDonald Road, Laurel, New York; bounded northeast by Chisholm; southeast by Great Peconic Bay; southwest by Brushes Creek; northwest by Mcdonald Road; Edgemere Park Subdivision Lots No. 12, 13 and 14; County Tax Map District 1000, Section 145, Block 4, Lot 15. The board made the following findings and determination: By this appeal, applicant seeks permission to construct a 44' by 58.9' addition to the existing one-family one-story dwelling for storage purposes and at one section for a proposed solar unit. Applicant's dwelling is constructed with a crawl space area and has limited storage area. The addition as requested would leave a minimum setback at the northeasterly corner to the property line of nine feet and at the southeasterly corner a minimum of six feet. It is the feeling of the board that a setback of no less than eight feet at the southeasterly corner and no less than eleven feet at the northeasterly corner of this addition to the easterly property line is more practical under the circumstances. The premises in question contains an area of approximately 28,355 ~quare feet, with road frontage of roughly 153.84 feet and a depth of 185.74 feet. This parcel is a waterfront lot with frontage along Brushes Creek and Peconic Bay. At the northwesterly corner of the premises is a triangular-shaped view easement, the base extending approximately 50.71 feet. In considering this appeal, the board determines that the (SEE NEXT PAGE) ON REVERSE DATED: May 5, 1982. Form ZB4 (rev. 12/81) CHAIRMAN, SOUTHOLD TOWN OF APPEALS ZONING BOARD Page 2 Appeal No. 2963 - Richard Zeidler Decision Rendered April 14, 1982 variance request is not substantial in relatio~ to t%e code requirements; that the circumstances herein are unique; that by allowing the variance no substantial detriment roi adjoining properties would be created; that the~difficul~y cannot be obviated by a method, feasible to appellant, o~her than a variance; that no adverse effects will be produced on available governmental facilities of any increased popul~tion;i that the relief requested will be in harmony with and p~omotei the general purposes of zoning; and that the interests of ~usticle will be served by allowing the variance. ~ ,: On motion by Mr. Goehringer, seconded byiMr. G!rigonis, it was ~ i RESOLVED, that Appeal No. 2963, application ofi Richard Zeidl.er. be and hereby is granted pemnission to construct addi- tion to dwelling, .~.~B.J.E.CT To THE. FOLLOWING CONDITIONS: (1) That the addition be constructed no~ clos~er than eight feet on the southeast corner [to the easlterly .iproperty line]; (2) That the addition be constructed not clo~er than eleven feet on the northeast corner [to the e~sterl~ property line]. Location of Property: McDonald Road, Laurel, iNY; bounded northeast by Chisholm; southeast by Great Peco~ic Bay; southwest by Brushes Creek~ northwest by McDonald Road; ~Edgem~re Park Sub- division Lots No/. 12, 13 and 14; County Tax ~ap Parcel No2 1000-145-4-15. ~ i Vote of the Board: Ayes: Messrs. Goeh~inger,i Grigonis, This resolution was unanimously Chairr~ B,~d Of App~ls Doyen, Douglass and Sawicki. adopted. RECEIVED AND FILED BY THE oOU~'~C'LD TOYTI~ CLERK ~~, To,,,m ~d ,,, l~Ol~M ~0. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ......................................... 19 ........ Approved ........................................ , 19 ........ Permit No ..................................... Disapproved a/c ................................................... ~- ........................................ Application No ................................. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plat 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 street's or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is pa~t of this application. c. The work covered by this application may not be commenced before issu(3nce of Building Permit. d. Upon approval of this application, the Building Inspector will issue (3 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 Deportment 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 a~ter(3tions,~ ren~gv(31 or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordlnance~d~uild, i6g c~.~/h'3~, p~ code, and real,ohs, and to admit authorized inspectors on premises and in buildings ~r ~s~s~m //~ ......................................... / (~ddres~ of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owne, of prem,ses ..................... .................................................................... If applicant is a corporate, 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 1'4o ...............................................S u b d z v i s 5_ o n and on wh ch proposed work bed e Map No' . Lot No /~/ / 1. Location of ¢ ~,nj (~ ~ ................ : ...................................... '.~/.. Z~ Street and Number ............................. ~ ........ .~--~'_Z.~...../.<;~......~...~'C~;~...~. ........................ ~..~.~.,~../....: .... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .................. ~~ ............ ? ......................................................... .... b. Intended use and occupancy ................................................... ~..~.~c~o/~' .... County Tax Map No. Dist. ~000 Section Block Lot 3. Nature of work (check which lapplicobJe): New Building., ................. Addition .... Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ................................................ . .... (Description) (to be paid on filing this application) 5. If dwelling, number of dwelllhg units :, ........................... Number of dwelling units on each floor ............................ If garage, number of cars ..... !.,......~........~...~.....~.,...~.K'r'~.~ ................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front :~,~....."~, .7~.~, ...... Rear .....~.."~.~. .............. Depth ~'~.. ........ Dimensions of same structur6 with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ...~ ........................ Number of Stories ................................ 8. Dimensi,,OJ~s of entire new co~structior~: Front ....7./~,~. ...................... Rear ,. ,7./<.~,. ................. Depth ..~...~..~.. .......... 10. Date of Purchase ......... ./..~/¢TZ.~..7~.. ................. Name of~Former, O~w~er ....................... '~-~' .................. 11. Zone or use district in which :premises are situated ........ /~~Z ............................................................. 12. Does proposed construction vlolate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded . .......... ~.~. ......... Will excess fill be removed from premises: ( ) Yes ()~ No ..~..C?~....~..~. ~ ........................... Address ~.~. ,~,~,~hone-- ~ /~ No. ~...~.'~7/...~..-.~. .... Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions from property lines. Give street and blbck number or description according to deed, and show street names and indicate whether interior or corner lat. STATE OF NEWC~DRK,_ ~ ]~c ¢ ....... ...... · ~,~,~n~ ........ being duly sworn, deposes and soys that he is the applicon! ~'~'er Of indi~duol si~ning co~trocf) above nome& He is the (~. ' - (~t/ac tar, agent, corporate officer, etc.) of said owner or owners and is d,uly authorized to perform or ha~erformed the said work and to make and file this appli'cation; that oil statemegts contained in this appllcat~ar~tru~)the best of his kn~le~e and belief; and that the work will be performed in,'the manher set fo~h in the~pplic~ion ~d t~th. [ / / ) ' Sworn t~efore me this ' ~ / .... ......... ......... Noto~ Public, . .......... m .............. ~Coun~ ~~F.....~:~[.7 ............................. ~~ ~~~~5' -- (~ur~ appl~ant) ~ ~ - ~~~H ANN NEVI~E ~ ~ . ~ NOTARY PUBLIC, StYe ~ New g~ ~No. 52-8125850, Suffolk Coun~ . ~T~ ~lr~ March 30, 1~ FORM NO. 1 TCWN OF SOUT',~OLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.; 7654802 Examined ..... .2'..~... 19 k.;~ Application No.< ~ ~ ...... Disapproved a/c ~/.<~e: .m ......... v ~ ., ./ z~ . ~. ~ (Building Inspector) .......... APPLICATION FOR BUtLD~NG PERMIT INSTRUCTIONS Date ..... 19 a. This application must be completely filled in by typewriter or in ink and submitted~-t-&~6ia~ to the Build 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 strc or areas, and giving a detailed dcscriptien of layout of property must be drawn on the dia~am which is part c~this ap cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon apprc,'al of this application, the Building Inspector will issue a Building Permit to the applicant. Such per, shall be kept on the premises available, for inspection throughont the work. e. No building shall be occupied or used in whole or in part for a"ny purpose whatever until a Certificate of Occupm shall have been granted by the Building Inspector. APPLICATION IS HEREBY MA DE to the Building Department for th~ issuance of a Building Permit pursuant to Building Zone Ordinance of the Town ~)f Soutbold, Suffolk C~.u. nty, Nj.e-w~k~and other applicable Laws, Ordinance.~ Regular'ions, for the construction of buildings, additions or alterat~9~, or/i~r/~moval or demolition, as herein describ The applicant agrees t~ comply with all applicable laws, ordinanf, efs, b 'u~in.~o~'~xhousin~/)code, and regulations, and admit authorized inspectors on prenlises and in buildings for n~ssa~~ ~c--~~~?a~n~o~'/~~ name, if ;'c;rporation, State whether applicant is o~vner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bulk N,-unc of owner o£ premises .' .19,. .. I ....................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of~. orate otfic,er) Builder's License No..~....-~..GJ.~..?-(qO..~..'.. Plumber's Licens: No El:~ctrician's License No.'~' ...................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done.r~.q.C.~. ~.¥..'~.~3g.3/. ~.}.O.c[.....~..4~.c.~f.~.e.. J?('~.(~. ..... ........ .... ............. House Number '~.~z--'~'-/d~-"~ ~ Street Hamlet County Tax/Vlap No. !000 Section /z/~-- 4~_ /,~-- Block Lot <14... ................ iled ,',tap ............... ............. Subdivision (Name) 2. State existing use and occupancy of premises and intended usq. and occupancy of proposed construction: a. Existing use and occupancy ,.. ~..~7-.~..7./.~..,~./x.~,/..,¢~.~..~,X,/.~.r?~5~:..,..., ...................... 5> -~>: Intended use and occupancy . ~.,).~.<-~ qC,. ;U.O ~..[;~ (oo4a ..<~q¢-.~qO;-~i o.~.~.., i~,~.~,~.. , ~ ...... .-,z.,-~, .,...,:,,? .~,.,.,,,..: .................. '"?-'"'"'"~ < "":':'-'~' -'~:'~':~ :: i''~': ~ :':~"' ,-"',' ~ '"~". ~,.- ... :':":~,' t-" '"-' ........ roperty hats. Give street and block .teNor or corner lot. 1. Nature c ' 'ork (check whlcb agplicab e) New Building .......... Addition ~ ...... Alteration ....... Repair ............. R0moval Demolition Oar ',/orr. ~ ! (Description ........... Fee .... (to be paid on filing this application) ;. If dwelling, number of dwelling units / ............... Number of dwelling units on each floor ............. If garage, immber of cars ~ ............................................................. i. If business, commercial or re{xed occupancy, specify f~ature and extent of each type of use ............... ;. Dimensions of ex st ng strt ct:'ures, if any' Front...3. .'/.'. ;5. ...... Rear .............. Depth . .,~.5i' .... Height Number of Stories /. ' Dimensions of same structural with alterations or additions: Front ~ ~. ~..~, .... Rear .... ,~. ....... Depth 7..d~. Height . Number of Stories d L Dimensions et'entire new construction: Front .... $,,~P,,.~ ...... Rear ............... Depth . .7..4;~. .... Height ............... Number of Stories... /, ........................................ ). Size oflot: Front .../~..3./~.,..'.. ......... Rear .../,O-~.i,r. ........ Depth . ./.~.ii'..'.. Date 6f Pt rc mst . /.. ?' ..... ' ......... }' ,, ~ ~ .. .'. "..', I '. ? ?. ........... ~,,NameofFormerOwner l.~ttd,/-~y/~,,~ ............. 1. /~o..~ or us~: r. ustrlct ,n wmcn )prem,'ses' are situated...~t'~.r.d~'~ Y-y~ ( ':. -- ) Does proposed constrt:ction v o ate any i ,, 1,~ ,-,,a .......... :,;~.~ '. ',;/'~; ......................... - 1. ~ I lot be r,'g,aded ~/~'5 · , ........ ' ...... ...... .............. l' ' ~,>~ · ·, ~vu, excess Iltl De removed from premises: Yes · .t.Name of Ov.'ner of pre n scs ~_a'~::o/ ~'~t,A./d'~ Address,,i-~.lo.~,,e~,.o~o~rr/d,q. ..... j..~ .. - ~ Na)ne o, Arc ntect ~.~[ ~.q~tr a. la ,,-a,./.'~trcnoc/~,A~/ ' ' ~ ~' ' ' ,,it~ ...... Phone No ............ N:mle ofContractor~.~Pye.<,,O, fi:tve.t(e.., .......... Address ~..,~.o.a?..~./. ,... Phone N~, 7. ¢:¢-- -~-~",~-~, ' ' '~'~ti'/a/~oAt tOo,e_' ' '"' ' ~ ,t. · ,*-., { . . ./, . PLOT DIAGRAM Locate clearly ~d distinctly iail et i t lags, whether existing or proposed, and, indicate all set-back dimensions ftc number or description according to deed. and show street names and indicate whet~ 'FATE OF N~dORK, ,-~ ' ' ,.. OUNTYr~r~'~~', , S.S ~ .... being duly sworn, deposes and says that he is the applicm-- is the ' (Contractor ...................................... , agent, corporate officer, etc.) said Owner or owners, and is duly autb~orized to perform or i~ave performed thc said work and to make and ~le aplication; fl~at all statements contained in this application are true to the best of his knowledge and belief; and that t~ · ork will be performed in the manner set forth h~ the application filed ', ' t~.orcwlth. worn to before me this : : " I JL ~CARI~ B, ~TOYE A.I.A~ ARCHITECT 6~i PAUI.,.AN NA AVEN U E BAYPORT, NEW YORK ARCHITECT 65 PAULANNA AVENUE bAYPORT, NE~Az YORK VA¢' ¥Oki AROHITEGT ~§PAULANNAAVENUE BAYPORT, NEW ,%¸, ,r f ,Fx 'x ARCHITECT 1~5 PAULAN NA AVENUE BAYPOR~, NEW YORK