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HomeMy WebLinkAbout12491-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N,Y, Certificate Of Occupancy Z12424 .A.p .r .i.1. 1..6 198.4 No ........... Date ....................... , . THIS CERTIFIES tt -- new al. we 11 mt the building .......................................... Locat~on of Property 905 Private Road ~16 Orient House No Street Hamlet County Tax Map No, 1000 Section 015 .Block 08 .Lot 029 Minor Subdlmmon L.z.tt.l.e..B.a.~..E.st.a..t.es ....... FHed-Map No. , 2~.1, ,Lot No .... (David Brawner} conforms substantiMly to the Apphcanon for Building Permit heretofore fded in this office dated · Oc. tp.be.r' .8 . .. ,198.2.. pursuant to wbach Braiding Permit No.. ,1.2.4,9..1..Z, ........... dated· ..... August. ,,..18 .... .. ., 19 8. .3 , was issued, andconformstoalloftherequirements of the applmabl¢ provisions of the law. The occupancy for wbach tbas certificate m issued is ......... .... .a, p.r. iy.ae, e.. pn.e.?.f,a.m.i~ .ly..a.w.e..1,1.z.n.q: .................................... JESSE C a ~.4~. RJORIE C BLACK The cerhficate is issued to · ' . .... {Ot4~er, ~'f,,n~,iij of the aforesaid building Suf£olk County Department of Health Approval . ~ .27.S O. 7 .6.9.,.. 4. ./.5./.8. 4. :..R.o.b. ?.,..b: :..V.x.3: ~ .a :..P.E. 640202 UNDERWRITERS CERTIFICATE NO ....... I~. ........................................ Building Inspector Rev 1/81 FOEI~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N- Yo BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 12491 Z Permission is hereby granted to: ........ ~Z~.~:.~....~.......~..>../~.~..~.~ ......... /.:~.× ......... .7./. ........................................ ............ ,o ...... ~.~.. .~-:.. .:.~..~.~:... ......... ~......~.~,~=~.~... ...... ~.~..C~.~...~.....~.. ......................... £~ .:..~ ....... ~.~ ....... .:..:.~..~.~.-. ~' .................................................................... ot premises Iocoted ot ...... ...~..~...~.....~...~-? ............ pursuont to application doted ........................................................ , 19 ........ , ond opproved by the Building Inspector. Fee $.../.>. ................. Rev. 6130180 ATTORNEY AT [AW 828 FRONT STREET GREENPORT, N.Y. 11944 July 18, 1983 Mr. Edward Hindermann Building Department Town of Southold Main Road Southold, New York 11971 Re: Black Application for Building Permit .SdC..Tax. May: 10'.00-020-O3-P/O 011 Dear Ed: In confirmation of our telephone conversation of this date: You have informed me that there are two (2) items remaining until my client can receive a building permit: (1) that the plans have a seal placed on them; and (2) that a DEC permit or letter that none is required be obtained and pre- sented to the Building Department. I am acting in reliance on your representations that no other items are required to be presented before the issuance of a building permit. Thank you for your courtesy and cooperation in this matter. Very truly yours, William H. Price, Jr. WHP:kk cc : Mr. David M. Mr. and Mrs. Brawner Jesse C. Black FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall $~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: I. 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- 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusUal natural or topographic featu ms. 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 requ ired to prepare a certificate. Fees: Certificate of occupancy $5.00 1. Certificate of occupancy on pre-existing dwelling 2. 3. Copy of certificate of occupancy $1.00 land use --Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date...~-~q.~.~'./· ~.~..~'.,~. ~.~ · · · New Building .... .~. ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ......................... ' .~.~,,'c~. E.. ~'~e~.J ........... ~.~'.~-/. · · House No, Street Nam/et Owner or Owners of Property .~--~:~. ~:..C0., .~...._~,j~C'J.E,.. C... ~.~.c~ ~.~:~ ........... County Tax Map No. 1000 Section ... ;2..O ........ Block ... ~ ......... Lot....~./d./! ..... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.~.~.~./. ~, Date of Permit .......... Applicant. ~"',~1¢~,.~.~J~..., .-~o/~,~/~c 0 ../~. ...... Health Dept. Approval ./..~.~,~O..........~ ~.......LaborDept. Approval ..................... · .. Underwriters Approval .~.~'..~.~...~..~.. ~,...Planning Board Approval ...................... Request for Temporary Certificate .................... Final Certificate ..... ~ ............ Fee Submitted $ ~"~ ~/ ~' Construction on above described building and permit meets all applic[ble codes and regulations. Applicant... ~..~..~..'~ ................... ATTORNEY AT LAW 828 FRONT STREET Phone (516) 477-1016 August 17, 1983 Mr. Edward Hindermann Building Department Town of Southotd Main Road Southold, New York 11971 Re: Black Application for Building Permit S.C. Tax Ma~: 1000-020-03-P/O 011 Dear Ed: Enclosed herewith please find copy of letter from DEC dated August 12, 1983 stating that no DEC permit is re- quired for the application pending in your office. It is my understanding that the sealed plans will be submitted to you within the next few days. Thank you for your courtesy and cooperation in this matter. Very truly yours, William H. Price, Jr. WHP:kk Enclosure I:~W YOI~ STATfl DEpAP, TI~NT OF ItNVIPDNt,IENTAL CONSI~ItVAT~ON Regulatory Affairs Unit A review has been made of your proposal to: I00O-- 2_0 .-- 3--el I New York St~e ~parg~ng of En~ronmen~al Conse~a~ion has found the ~ Grea~er than 300~ from in~n~oried tidal wetlands. Landward of a ~ubstantial man-made structure greater than 100' in length constructed prior to Septe~mb'er 20, 19~7. " Landward of 10' contour elevation above mean sea level on a gradual, nat- Landward of topographical crest of bluff, cliff or dune in excess of I0 feet in ciera=ion above mean ssa level. Therefore,.no permit under Article 25 (Tidal Wetlands of the Environmantal Conservation Law) is reqttired at this time since the current proposal is beyond State mandated Jurisdiction pursuant to this act. However, any additional work or modif~cations to ~he proJec~ may r~quire a permit, It is your responsibility to notify this office, in writing~ if such additional work of modifications are contemplated. IIIL:P~T~cz cry truly youra, l Daniel ~. Larkin R~glonal SuperVisor of Regulatory Affairs HENRY E. RAYNOR, Jr., Chairman JAMES WALL BENNETT ORLOWSKI, Jr. GEORGE RITCHIE LATHAM, Jr. WILLIAM F. MULLEN, Jr. Southold, N.Y. 11971 TELEPHONE 765-1938 May 6, 1983 Mr. Edward Jo Wysocki Main Road Orient, New York 11957 Re: Little Bay Estate David Brawner Dear Mr. Wysocki: The following action was taken by the Southold Town Plan- ning Board, Tuesday, May 3, 1983. RESOLVED that the Southold Town Planning Board accept Inspector John W. Davis' report #286 for the approval of the access road within the subdivision known as Little Bay Estates (David Brawner) and said access road to be maintained at or above its present state. Very truly yours, HENRY E. RAYNOR, JR., CHAIRMAN SOUTHOLD TOWN PLANNING BOARD Enc. cc: By Susan E. Long, Secretary Inspection Report #286 Building Department iproqress i [ i i i INSTRUCTIONS R~ad inamct,ons carefully and turn electricity off at main fuse box before beginning installation. EAR HANGER ~ COVER PLATE PLASTER FRAME , VERTICALz~L~IR HANGER) FiEure 1 NON-METALLIC CABLe7 OUTLET B0X7 ~ KNOCK OUT SLUG~ ~' ,, CLAMP GROUND ~--~/SCREW PIGTAIL -~-~ 1111 CL' P P~STER F~E ~ Slip LEFT NAND and RIGHT_____HAND BAR HANGERS through slots in p. LASTER FR~IE. Hold PLASTER FRAME between joists in desired location where fixture is to be installed and drive lance on end of BAR HANGER into wo~dem joists. Use NAILS through ho~s provided in BAR HANGER for additional support. Remove REAR COVER PLATE from OUTLET BOX. Knock out SLUG in top of OUTLET BOX at end, loosen CLAMP SCREW, and insert NON-METALLIC CABLE through ~pen SLUG hole. Push NON-METALLIC CABLE down between CLAMP and OUTLET BOX side and tighten CLAMp SCREW to secure (~ee Figure 2). (ALTERNATIVE METHOD) Knock out SLUG in OUTLET BOX at desired location to accept U.L. type CONNECTOR. 3- Connect WHITE FIXTURE WIRE to WHITE SUPPLy WIRE. Connect BLACK FIXTURE WIRE to BLACK SUPPLy WIRE. Connect GROUND WIRE to PIGTAIL at top of OUTLET BOX or put #8-32 NUT an~-d BoL'T through ear in top of OUTLET BOX and connect GROUND WIRE in this manner. Use WIRENUTS or ELECTR.ICAL TAPE to make connections (not furnished)." Replace COVER PLATE. 4- NOUSING may be adjusted to ceiling level by loosening three SHEET METAL SCREWS. 5- SOCKET PLATE is adjustable by loosening WING NUT to accommodate desired LAMP (LAMPS not furnlshed)~ TRIM FRAMES }'lace GLASS (if provided) in FRAME and secure with GLASS CLIPS which are part of the RETAINING RING of the FRAME. Compress SPRINGS and insert in BRACKET in HOUSING and press TRIM FRAME into place as shown in Figure NO. FOR INSTALLING OTHER TRIMS. SEE INSTALLATION INSTRUCTIONS PROVIDED WITH EACH INDIVIDUAL TRIN. WARNING (FIP~E HAZARD) NATIONAL ELECTRIC~ CODE REQUIREMENT: RECESSED PORTIONS OF ENCLOSURES, OTHER THAN AT POINTS OF SUPPORT, SHALL BE SPACED AT LEAST ½ INCH FROM COMBUSTIBLE MATERIAL. THERMAL INSUI~TION SH~.LL NOT BE INSTALLED WITHIN 3 INCHES OF TEE RECESSED FIXTURE ENCLOSURE, WIRING COMPARTMENT, OR BALi~.~% AND SHALL NOT BE SO INSTALLED ABOVE THE FIXTURE AS TO ENT'~AP HEAT AND PREVENT THE FREE CIRCUI~TION OF AIR UNLESS THE FIXTURE IS OTHERWISE IDENTIFIED FOR INSTALlaTION WITHIN THERMAL INSULATION, SPEC. NO. 023023/(3-28..83) INSTALLATION I~ OLD CONSTRUCTION Cut 6 7/S" diameter hole in ceillns material and pull power cable through opening (Figure Remove BAR HANGERS from ~LASTER FRAME. Break away wedge shaped KNOCKOUT at the end of the PLASTER FRANE (FigureB--'~-~--. gew~ove RE~ COVER PLATE £rom OUTLET BOX. Pull ~pPLY WIRES (NON-METALLIC CABLE) through ceiling openin8. Knock out SLUG in top of OUTLET BOX at end, loosen ULAHp SCREW, and ineert NON-METALLIC CABLE through open ~LUO hole. Push NON-HETALLIC,CABLE down between CLAHp and OUTLET BOX sid~ and tighten CLAMP (ALTERNATIVE METHOD) Knock out SLUG in OUTLET BOX at dealred location to accept U.L. type CONNECTOR. Connect ,_~_H_I_~TE FIXTURE WIRE to ~HITE SUPPLY WIRE. Connect BLACK FIXTURE WIRE tn BLACK SUPPLY WIR~. Connect O~qUND WIRE to PIGTAIL at top of OUTLET BO~X or put #8-32 /~T an~''~OLT through ear in top of OUTLET SOX'~d con'eot GROUND WIRE in this ~nnet. Use ~[RENUTS or ELECTR[CA~ TAPE to make connections (not furnished). Replace COVER PLATE. Remove three SHEET METAL SCREWS from RECESSED HOUSING and allo~ HOUSING to drop fro~' ~'LASTER FRAHE ~Figure C). -- Turning the PLASTER FRAME on its side, insert one leg of FPOU4E into opening in ceiling. While slightl-l'~--~'wisting the other leg) continue inserting P~LASTER FHAME until OUTLET BOX clears ce,iling opening. Push OUTLET BOX back i~to ceiling and eeat ~RAME into opening (Figure D). Push three CLIPS (Catalog No. 8607) onto edge of PLASTER ~-P,~J/E to prevent Fih~qE from going into ceiling when installing'HOUSING. Insert RECESSED HOUSING through PLASTER FRAME and secure in place ~ith three SHEET HETAL SCREWS (Figure E). -- C~AUTION - To reduce risk of fire, use only trims cross referenced on the fixture marking Or open type trims. ~n open type trim will close off no more than 10% of the fixture opening, and will not icontain or accommodate diffusers or lens materials. Trims commonly known as pinhole, eye,all and other similar types of constructions are not considered to be open trims. _ FIE~D IN~PEqTION~ COMMENTS FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & FLUMBING INSULATION PER N. Y. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: OCCllJ?,~NCY OR_ OF IDCCUP~¥' '" If coi)pet. tubing is used for water distributing sys:em; piping shall be of types K or L only HENRY E. PAYNOR, Jr., Chairman JAMES WALL BENNETT ORLOWSKI, Jr. GEORGE RITCHIE LATHAM, Jr. WILLIAM F. MULLEN, Jr. Southold, N.Y. 11971 TELEPHONE 765-1938 May 6, 1983 Mr. Edward J. Wysocki Main Road Orient, New York 11957 Re: Little Bay Estate David Brawner Dear Mr. Wysocki: The following action was taken by the Southold Town Plan- ning Board, Tuesday, May 3, 1983. RESOLVED that the Southold Town Planning Board accept Inspector John W. Davis' report #286 for the approval of the access road within the subdivision known as Little Bay Estates (David Brawner) and said access road to be maintained at or above its present state. Very truly yours, HENRY E. RAYNOR, JR., CHAIRMAN SOUTHOLD TQWN PLANNING BOARD Enc. cc: By Susan E. Long, Inspection Report #286 Building Department Secretary TO: FROM: Henry E. Raynor~ Jr.~ Chairman Southold Town! Ptannin8 Board John ~. Davis~ REPORT NO. 286 DATE: April 22, 1983 APR g 5 REC'D LITTLE BAY ESTATES AT ORIENT MINOR SUBDIVISION - ACCESS ROAD COMMENTS: I made an inspection of the above access road on April 14th with Mr. E. Wysocki, Owner's con2ractor for the the road work, The addition of loamlon the gravel surface had not been spread evenly. The contractor w!ill bring equipment to the site to correct this condition and wlll notify me when the work is completed. After notification by contractor that the road surface had been corrected, I mad~ another inspection on April 22, 1983. The loam' had been ieveledlon the gravel course and the access road is now in a satisfactory condition. D HENRY E, RAYNOR. Jr.. Chairman ~AMES WALL BENNETT ORLOWSKI. Jr. GEORGE RITCHIE LATHAM. Jr. William F. Mullen, Jr. S0uthold. N.Y. 11971 TELEPHONE 765- 1958 June 18, 1982 Mr. David M. Brawner Main Road Orient, New York 11957 Dear Mr. Brawner: The following action was taken by the Southold Town Planning Board, Tuesday, June 15, 1982. RESOLVED that the Southold Town Planning Bcard accept John Davis' report ~222 for the improvement of the access road within the subdivision of ~.ittl~ Bay Estates, located at Orient. If you have any questions concerning the above, please do not hesitate to contact this office. A copy of this report is enclosed for your information. Enc. Yours very truly, HENRY E. RAYNOR, JR., CHAIRMAN SOUTHOLD TOWN PLANNING BOARD By Susan E. Long, Secretary T0: Ue. ,,~ ,E. Raynor~ Jr.~ Chairm~u Report No. 222 Southold _~bwn Planning Board FROM.: Jo~u W. Davis Date: June ~ , 1982 RE: LITTLE ~UAY ES%%TES at ORIENT ; Minor Subdivision Access Road I met ~.~r. David Brawner~ owner, and his road contractor, ~.~. Edward ;'hysocki on t~ si+e to look at existiny ground conditions for access ro~d construction. F. ost of ~he R.O.W. area appears to be more or less leve2 (plan contcurs shcw Elev. ~.O). tais mig:~t present a drainage problem for the read. Pro,ziding the irrigation pond at Lot No. 3 is to be kept~ a low'point in ~due road p~o~i].e could be established there with _~lat plus grades to *Cae north and south ends of ~he road. A pipe could be placed under the road at the l~.~ point to carry rcnoff to *he Dond. Some field elevs*ions are necessary to shew if this p~vcedure would be wcrkable. .~nodner way to t~ke cars of road drainage using the e~sting grour~ pro_bile wculd be to excavate a t~ench at say 3 ft. in width at ~t~ sides of the road down to sar~ and gravel. Backf'~ll trenches with sand and gravel ~o act as s~nd drair~. O+her recom,mendations: 1. Strip topsoil and replace ss~ volume with suifable m~terial. 2. :~ne road width to be 16 f~o in ~ddth. ~. _~Y~ 16ft. width to be bank nm wi th ~0% of gravel ~or 6" in ~.eoth on top of ~he topsoil replacement material. h. '~e read profile should be above the adjacent grcund level. 765-1802 BUILDING DEPT. INSPECTION ]FOUNDATION 1ST [~ ROUGH PLBG.-~,~/~?~ ] FOUNDATION IND [ ] INSULATION DATE oo1375 THE ns April 12, NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 1984 Appliea,ionNo. a,f,e 245524-$3 N 64020 only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of Jesse Black, Main Rd., ~irectly S/O Orient by the sea, Orine~, N.Y. i,~ ti,~yoao~i~g to~.tion; []]] Rasement ~ ~t ~. ~ ~nd r~. ~io. mo& ~ot was e~,,,,i,,,~i on April. 5 , 1984 and found to be in compliance with the requirements of this Board. FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS FIXTURE SWITCHES DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIMECLOCKS UNITHEATSRS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R V I C OTHER APPARATUS: 2-G~F.C.I. 2-Smoke Detectors Electric Room Heaters :1-1.5 KW. .o.o~ c¢.co.o] 1 ^~_w o. PER ~' OF CC COND, NO OF HI-LEG NO. OF NEUTRALS Dennis D. Claire, Jro P. O. Box 284 Laurel, N.Y., 11948 LIC.92342 This certificate must not be altered in any manner; return to the office of the Board if GENERAL be ideatified by their COPY FOR B, UILDII~G DEPARTMENT. THIS COPy OF OERTIF! "D IN ANy MANNER. 2J2.5~ LU 2'J~ 7/ LOT 7_ DAVID SUFFOLK CO. HEALTH H.S. N~ STATEMENT O THE WATER SUPPLY AN~i SYSTEMS FOR THIS CONFORM TO THE SUFFOLK CO~DEPT. OF APPLICANT SUFFOLK COUNTY S~.V,CES - FO. CONST.UCTI~,N ONL'~ DATE: H. S. REF. ~O.:/ SUFFOLK CO. TAX MAFF DIST. SECT. ! I lC©.) OWNERS ADDRESS: '--~0 DAVID TEL. ~,-~2B - 3583 -DEED: L. p. TEST HOLE 3. Nature of work (check which applicable): New Building ... ~...... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) · ffi.~.Oy b 0 0 4. Estimated Cost ................................ Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... ]. ........ Number of dwelling units on each floor ................ If garage, 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 ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...... Height ......... Number of Stories . . 8. Dimensions of entire new construction: Front .~'O,~-6~.. ..... Rear~,,~... ....... Depth ...~,.~. ......... Height .............. Nu~aber of Stories . ............. . . 9. Size oflot: Front .... ~.~.O. ...... ""iiiiiiiiii ~);~i~'''"""d~'~- ....... Rear ...~_~ 07. O ................. 10. Date of Purchase ............................. Name of Former ~)wner 11. Zone or use district in which premises are situated.., p:. ~,i'.rr',4. p.~./'.t.,} .................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .~.tl ............................ 13. Will lot be regraded ............................ Will excess fill be removed from .premises: Yes No 14. Name of Owner of premises xY~,r¢. ~.~A~.ck¥.. Address ~,.~. ~>/]vr,~t~,e,~t~T~one No.6'O~. Name of Architect ............... _~.-,~ ......... Address ................... Phone No. Name of Contractor. ~.q~./¢.~9.. / PAo])'~/,/~f.~. h Address. ,e~6~. ~2~ ~. ~¢o~J ~,. Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give stree and block number or description according to deed, and show street names and indicate whether interior or corner lot. ,oIF STATE OF NEW YO~K//_ w// COUNTY OF..~~.cT.. S.S ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ......................................................................................... (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 that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this~ ............ .oG. · · ~ .... clay of .~. ~-,<'.~ ...... 194G'r~2, Notary Public~ ¢~.-~.Q. 7~-~..~ .~:. County Notary Public, S~ate of New York ............ Iqo, ~2.0344963 Ouf!olk Coun_t~-~ (~ignature of applicant) ~ll~imis~lon Expires March 30, ~ ~ Disapproved a/d ................ ! ..................... ~ ~Z ~' (Building Inspector) ' ~-ffy/p~ ~- APPLICATION FOR BUILDING PERMIT FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1B03 Application No., ./.c.~.~. ?./. ........ INSTRUCTIONS a. This application must be comOletely filled in by typewriter or in ink and submitted to the Building Inspectlor, with 3 sets of plans; accurate plot plan to scale. Fee according to schedule. ' b. Plot plan showing location ofl 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 appli- 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 Buildhag Permit to the applicant. Such permit shall be kept on the premises availableI for inspection throughout the work. e. No building shall be occupie& 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 Tow~ 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, housing code, and regulations, and to admit authorized inspectors on premises and hi building for necessary inspections. (Signature of applicant, or naffie, if a corporation) (Mailing address of applicant) [ [ ~ ~ ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... ~. O.'$.~..~.....t~s...~. ?.~...Ck. ~ .......................................... (as on the tax roll or latest deed) If applicant is a corporation, signatur6 of duly authorized officer. (Name and t~tle of cmporate officer) Builder's License No ....... '~i'~'~' ............ Plumber's License No ..... ~. O.o'f.'O ............. " - Electrician's License No. ., ~-. , Other Trade's License No. I 1. Location of land on which proposed work will be done .................................................. House Number . Street Hamlet "~ / I ~ County Tax gap No. 1000 Secticn .... ~,~.O. .......... Block ....... .,,,~ ......... Lot ...... t...' ......... Subdivision.. ~.,~ ..... ~a~) .............. Filed Map No.~Ag.U.d.~./... Lot... Z~2.. ......... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy i ~'~ C ~ b. Intendedl use and occupancy .: ....... . .~/,-~'.~. ~ ~¢.....~. (~.d'(q~tlL~ .~..~..: .0~.~7. ~Z~,~ ~.~.., ...... q~ ? ? 2~2:5! /Jo~ 7/ ,/, RODERICK VAN TUY~ P.C. ~. v'~,..--.-~:-.-7~~ LICENSED LAND SURVEYORS GREENPORT NEW YORK SUFFOLK CO. HEALTH DEP,'~,.APPROVAL H.S. NO. STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. OF HEALTH SERVICES. A-PPLICANT' SUFFOLK COUNTY DEPT. OF HEALTH SERVICES -- FOR APPROVAL OF CONSTRUCTION ONLY DATE: APPROVED: ~FFOLK CO. TAX MAP DESIGNATION; DIST. SECT. BL~K ~L. "SWN[RS ADDRESS; ----DEED: k. P. TEST HOLE STAMP I i G~AV~L I SUFFOLK CO. HEALTH DEPT. APPROVAL H.5. NO. -~O- , ,, 212.St q 4 q ~ ~ STATEMENT OF INTENT ~ , ~ THE WATER SU~LY AND SEWAGE DIS~SAL m ~ ~] '~' CONFORM TO THE STANDARDS OF THE ~- ~ ~FFOLK CO. DEPT. OF HEALTH SERVICES. (~oo~ ~,a~q~ ~- % ~SE I SUFFOLK COUNTY DEPT. OF HEALTH ~ m~o~ ~.9.0--[~T ~ 0~ SERVICES -- FOR APPROVAL OF ~ - s.. CONSTRUCTION ONLY , ;~-,, , , ~ ............................................... H,S. REF. NO.: ~'v'~ 1~ , . :. .~ ,,: f*~ ~ :~ A~ ' ~ ,, .. . .......... - , , General Engineertnl ~ AHEND~ DEC. ~, ~, LICENSED LAND SURVEYORS " M A ~. EI, [ 9~ GREEN~RT NEW YORK 40¢ OCI~U~^NCY OR USE[ JS UNLAWFUL WII?~T CERTIFICATE, of DCCUPANC¥ If copper tubing is used for water distributing system; piping shall be of types K or L only APP, ROVED AS 'NOTED FEE:'~ C/~5''-0 BY: NOTI~ BUILD*NG DEPABTMENT ~5-~802 9 AM TO 4 PM FO~ THE ~OLLOWlNG INSPECTIONS: J. ~OUNDATION . TWO R~UIRED FOR POURED CONCRETE 2. ~OUGH - F~M~NG & PLUMBING ~, INSULATION 4, FINAL . CONSTRUCTION MUST BE COMPL~E FOR C. O. ALL CONSTRUCTION SHALL MEET THE ~[~UIREMENTS OF T~ N.Y. ~ATE CONSTRUCTIOns& CODES. NOT DESIGN OR CONSTRUCTION