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HomeMy WebLinkAbout12168-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 2-23038 Date JUNE 14, 1994 . THIS CERTIFIES that the building ADDITION Location of Property 220 BROADWATERS ROAD CUTCHOGUE, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 104 Block 10 Lot 7 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 8, 1983 pursuant to which Building Permit No. 12168-Z dated MARCH 2, 1983 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 BEDROOM ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to ANDREW J. CARLIN & WIFE (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. B-041307 - JUNE 13, 1994 PLUMBERS CERTIFICATION DATED N/A ilding n�for Rev. 1/81 z, ii it s i FOB1K ENO. T01MN Ol; �OCIT�iA D �' BUILDING PEPARTM N TOWN=F1¢LL SOUTHO�D,,N Y. BUILDING FERMI (THIS PERMIT MUST BE KEPT ON THE PRE7 IES UNTIL FULL COMPLETION OF THE WORK AUTHORIZE�S)� ai No 12168 Z Mate :... . ......... 19. . t g �A : Pe�rnission is herebyranted t� • ••• • • •• �•• ••••••• • . .. ..... ... ... .. . ..... ..... ..v . . ... .�..� to lr + .... .. _ i .... ... .. ......... ...................... ...;0Z ..... �' :... 171 .. ,............................... atpremises located at .......................................... ... ..................................... Co+nty Tax Map No. IOOU Section .. . ' k of No. .... ............. p ..... .:.... ..., 19., ...., ond,approved by the u uant�to application dgted Oullding ;Inspector. . . s... ............... �{ttl iin Inspecto:......................... 1 JRel I � Q } b/39180 dki FUSCO, -CART�IN'& �I I�TxR1;0 A�,TO'idl Y Ax 1 At x .. JOHN J.FCsco ONE EXECUTIVE-BOI7LhI NEW JERSEY OFFICE ANDREW C. CARLIN - - /O PAHII:LO @ RCBBO I.OUIS,M. SPIZZIRRO" YONKBRS,NI•;{'P YORK 1( 70 1462 CHESTNUT AVENUE PHo :,(91A) 969480 A ; I ALLSYDEr NEW JERSEY O"7200 NDRPW S.PEENEY k. PHONE: (9O8) OSo-5500 ,OP COUNSEL FAX:(914)968-9144e - ROYPkN'A.LETSEN � OF COUNSEL 1' k r'ADMI'l"L�RD'IN NEW YORK K' AND NEW JERSEY - � �� i { �4 $ . a May 19., 1994 � town of Southold ' building .Department , 3 P.O. rBox 1179 I Southold, New York 119719LOG r . Attn: Tom Fisher r j Re: 220 Broadwater =Roads J�assau_ mint, NY Section '104 , .Block 10 Lot -7 f * ' � bear Mr. Fisher: -- Enclosed are a ( ) Certi xeate �"Ofr -occupancy applications and, a' check for 05 001i ,accordance with ,our discussions. . Arrangements are 13eing .trade �o d-iseonhect the wood stov4. Thank you. for your assistance(' -' f PYt3tir0 truly) .' NDZ R .CARLIN s ACC:pb l� tS E � � s s`.a'i. 13(20r9DWA-T-PK _ w 1 ,e Stpt?y /y I� copper tubing is usev I for voter distributing 4 'N�o° ( system; piping shall be t� , of types K or L only �. c CII 5� i i V M yU i IN � r Y 41 5N. ,ci ytr� aa�ya : a8a 14 ANQ: 1Ms V/ ✓r. 'J, .✓ �0 Nrr Ata N C� 0 �� 0 .MM. YO > mO— ZD0m l r1 Zenmnn CCSC)00m y'�itJ ua K n O m T (� y r O4ni nZ5 -n D 7 vZi Cm 7 .� m 7 D � Z �� 'y Zm n v ONR� -{ DO J � mzmr- L -' mm .. Om ea 70 Z �6 m -DI A A r l I G IV ii� J1 A's it 1 1I � i1�S✓� �i 2V/ 1i CDX. cu Y t A. Form No. 6 L TOWN OF SOUTHOLD dam' 9t _L+ �1 BUILDING DEPARTMENT TOWN HALL ��ynJ�ser0:j` 765;18 APPLICATION FOR-CERTIFICATE OF OCCUPANCY 50Jv A. 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: I. 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-disp6sal(S-9 form) . NO 3 rit 4. Sworn statement from plumber certi ying t at the solder used in system contains less than 2/10 of 1% lead. S. 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. B. 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 $23.00, 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 - $20.00 4, Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00,/Commercial $15.00, �w Date . . . . . c� � ?G.1, . . . . . . . .. . . . .. . . . . . . . . New Construction. .. A--* .. . Old Or Pre-exist,n Bu'ldingn Location of Property. . . . . . . . .. ... . . . . ..�. .... . . . . ` .-. ° ✓d o. House N.4 � .5 . . . . et of Onwer or Owners of Property. . . ".. . .. .. .,f. . . . . . . . . .. . . . . . . . . . . . . . . . . .. . . . . . . . . . County Tax Map No 1000, Section. . .1PR' .. . . . .Block. . . . . . . . ..Lot. . . . . . . ... . . .7 . . . . . . . Subdivision. . . . . . . . . . . .. . .. ... . . . .. . . . . .. . . . .. .Filed Map.. . . . . . .. . . .Lot. . . . . . . . . . . . . . . . . . . . . . Permit No. �.tri ��P.�. . . , .Date Of Permitr�J 4.3P. .. . . .Applicant. .. . .. .. . ... .. . .... ... . . . . . . . Health Dept. Approval.•. ..✓V A . . . . . . . . . .. . . . . .Underwriters Approval. . . . . . . . . . . . . . . .. . . . . . . IA Planning Board Approval..S-V R . . .. . . . .. .. . . ... Request for: Temporary Certificate. .. . .. .. .. . Final Certicate. .1.41. . . �O Fee Submitted: $. ��.. . ... . .. . ... . .. .. . . . . . 1 61,Lx-- 1Ig21•d E26T 994 9TS -ndH W10i G7VHinoS WUEb:OT b6, 6T .WW ' ' nnm nnnm± THE NEW YORK BOARD OF FIRE UNDERWRITERS rA6E .1 Z 6 BUREAU OF ELECTRIGTY _ sS JOHN STREET.NEW YOFM NEW YORK 1003E Roee JUNO 13,1994 ii 041307 p _ Till CERTIFIES THAT �t1iMa6e[risatagayounerdorvilsd 6oFeaoandiNaradared by the eplimara !Rawledan the'I apptiediala"UnI in the p,eaatiMA of t+ UI A AWN J.CMLIN, 220 BROADVATERs ROAD, CURY_lll?I:S3F:, N.'i. a h lhafaBawityT b.atianT ® fia !"t Ft. ❑ tad Ft. fa;'1T hrtiwn erark cot T1Veiaainrdm JDRF'+ 09,1994 andfnuad to be in rompffaner with 1hr Narimael MECI tar C60i "RamRK11tF6 tIANGE6 wwlNGoms C WENSdKH-WASHM ENNAYST R" MOOtNClM GrxEra NAl ..W. Awa .W µ" a.w AwA aw ao ".r C n ORNNlS IURReAc HOTew 11111E APPNAIM 111I RI WI&CWCKS tgal 11NITNEas1 MMN.OWt11111 OMRIAM>', � Ar. aW. W ar. GNi ar. 111a_ "G- ♦M.G. AMl AW. yR. A"R MAUL A"T ne- Ill FEET MT. wAm N T S�MW ifA1NGT Map S F it v 1 M0.0i CGtOMD. A.W.O. MGO IaOG •w'G aD a1M1111M11 M MYWI N1t so" so= 30w so" Rel OF MCO"U. or,PGG t0 01 lb ease 0111W11B AA W `TIU visor Diiiiii 'An electrical survey has been oade of the exposed ciec.trical equipment in the premises indicated." "No obvious urwatisfactoiy condition was found. AMO1XNT MAIN pkN*NY OOM OR Now �TM sum OF NO sp wIw FEE PAID As C"M NN IR 1R MM NEt E AT Al�iN:X� CNO IN 111R OF now. 1 EXECUTIVE BLVD. YONVERS, KY, 10701 X1 a Prr D Wal TS VOURRNITORSEll IENERDANB K NOt A CEATOICATTOPCOM111ANC11MIS I"11 PA""'AtIMF NEWYORK Office as KNIN STREE1 law veto N_T.Mall m N � e ~7/i� (i� %? /�'^%{�O'�j /�R11� 3 �rl '�/ ^'7N A�'-�' Form No. 6 .sJY.S�//O � TOWN OF SOUTHOLD, i8 �✓ vt: :"y 2;4 BUILDING DEPARTMENT � /r� TOWN HALL APPLICATION FOR CERTIFICATE OF OCCUPANCY A. 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) . /U£�D 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. B. 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-existing Buildine - $100.00 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . New Construction. . .. . . Old Or Pre-existing Building. . . . . . . . . . . . . . . . . Location of Property. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . House No. Street Hamlet Onwer or Owners of Property. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . County Tax Map No 1000, Section. . . IPIV. . . . . .Block. . . .�1.4. . . . . . . . .Lot. . . . . . . . . . . . .7 . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . .. . . .. . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . ... . . . . . . Permit No. . .. . . . . . . . . . . . .Da{{te Of Permit. . . . . . . . . . . . . . . .Applicant. . . . . . . . . . . . . . . ... . . . . . . . . . . . Health Dept. Approval. . . . ✓ ��A . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . ,X Planning Board Approval. . R . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. .e_'___� . . . o f7 Fee Submitted: $. . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . .Y ".i �, LICAN41 .., . FIELD`-INSPECTION DATE COMMENTS 1 . x H � FOUNDATION ( 1st) FOUNDATION ( 2nd 2 ) _ a 3 3 z 0 Ti N ROUGH FRAME & a PLUMBING p H 3 . e� INSULATION PER N . Y. 3 STATE ENERGY CODE x 3 r 4 . rh H olr wc- FINAL o z ADDI IONAL COMMENTS : i x. x �v H a H H O z x a ' r H x ra H ©S�FFDLI( VICTOR LESSARD Town Hall, 53095 Main Road PRINCIPAL BUILDING INSPECTOR P.O. Box 1 179 (516)765-1802 { Southold, New York 11971 FAX(516)765-1823 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD February 7 , 1989 AWJ Construction Corp. Depot Lane Cutchogue, NY 11935 Dear Mr. Jacobs: In order to complete the Certificate of Occupancy on the Andrew Carlin permit ( 121682) , we require a new check for $25.00 and an Underwriters Certificate. Enclosed please find your out- dated check. If you have any questions, please feel free to contact this office at the above number. Thank you for your cooperation in this matter. THE BUILDING DEPT. TOWN OF SOUTHOLD FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. 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: 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 peoperty 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 or land use $5.00 3. Copy of certificate of occupancy $1.00 C q Date New Building . . . . . . . . . . . . . Old or Pre-existing Buildingg((aX)J/ _.. __2 s 'Vacant Land . . . . . . . . . . . . Location of Property 1-Ox`� '?. , •� k • ��Te ;�- House No. • Street • , mlet Owner or Owners of Property . 4'fe., .`F County Tax Map No. 1000 Section . . . U.y . . . . . . Block . . . /6. . . . . . . . . Lot . . . .!. . . . . . . . . . . Subdivision . �oi . / bi Filed Map No. •.6 . , . , .Lot No. lgg.,2 . . . . . Permit No. J.`T '. . . . . Date of Permit 31Z/.�.�'. .Applicant . . . . . . . . . . . . . . . . . . . . . Health Dept. Approval . . . . . . . . . . . . . . . . . . . . . . . .Labor Dept. Approval . . . . . . . . . . . . . . . . . . . . . .,. . Underwriters Approval . . . . . . . . . . . . . . . . . . . . . . . .Planning Board Approval . . . . . . . . . • . Request for Temporary Certificate . . . . . . . . . . . . . . . . . . . . .Final Certificate . . . . .61 :. . . . . . . . . Fee Submitted $ . . t� . ... . . . . . . . I . . . . . . . . . . . . . Construction on above described building and er m ets all appl{c Lodes and regulations. Applicant . - .. ..y.-. ._ .. : . . . . . . . . ... . . . . Rev. 10-10-78 7] 1 INSPECTORS x (516) 765-1802 c�1FFULic VICTOR LESSARD,Principal Cp 3COTTL.HARRIS,Supervisor CURTIS HORTON,Senior ti� '"` s O �� Southold Town Hall VINCENT R.WIECZOREK,Ordinance rG P.O.Box 1179,53095 Main Road ROBERT FISHER,Assistant Fire Southold,New York 11971 Building Inspectors Fax(516) 765-1823 ✓ i^� = Telephone(516)765-1800 THOMAS FISHER GARY FISH OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLII ORDER TO REMEDY VIOLATION Date: December 18, 1990 TO: Andrew J. Carlin, (Owner) 220 Broadwaters Rd. Cutchogue, N.Y. 11935 PLEASE TAKE NOTICE there exists a violation of: Zoning Ordinance CHAP. 100 Other Applicable Laws, Ordinances or Regulations at premises hereinafter described in that BUILDING PERMIT #12168 13903-Z 16792-Z & #17292 HAVE EXPIRED ;AND CERTIFICATES OF OCCUPANCY HAVE NOT BEEN ISSUED WHICH IS REQUIRED BEFORE OCCUPANCY OR USE. In violation of ARTICLE XXVIII CHAP. 100-281 and 100-284. YOU ARE THEREFORE DIRECTED AND ORDERED TO comply with the law and remedy the conditions above mentioned IMMEDIATELY The premises to which this ORDER TO REMEDY VIOLATION refers are situated at: 220 BROADWATERS RD. , CIITCHOGUE, COUNTY OF SUFFOLK, NEW YORK. SUFFOLK COUNTY TAX MAP 11000-104-10-7. 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. VINCENT R. WIECZORE , ORDINANCE INSPECTOR oFOLke' VICTOR LESSARD 1 Town Hall, 53095 Main Road PRINCIPAL BUILDING INSPECTOR P.O. Box 1179 (516)765-1802 Southold, New York 11971 FAX(516) 765-1823 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD March 26, 1990 Mr. Andrew J. Carlin 19 Greenway Terrace Forest Hills, N.Y. 11375 Re: Building Permit #12168-•Z Premises: 220 Broadwaters Road, Cutchogue, N.Y. Suff . Co. Tax Map #1000-104-10-07 Dear Mr. Carlin: During a review of our files, it was noted that the above building permit has expired and a Certificate of Occupancy has never been issued. According to the Code of the Town of Southold Article XXVIII 100-281 and 100-284 a building permit is needed for construction of additions to an existing dwelling. It is unlawful to occupy or use said addition until a Certificate of Occupancy has been issued. Your final inspection was made on November 5, 1984. We had notified your builder Mr. Jacobs on two oc.casions (see attached copy of correspondence) that everything was okay for the issuance of the Certificate of Occupancy, but that we needed an Underwriters Certificate and a check in the amount of $25. 00. Kindly send us your check in the amount of $25.00 and a copy of the Underwriters Certificate so that we may issue the Certificate of Occupancy. Kindly clear up this matter as soon as possible so that legal action does not have to be taken. Thank you for your cooperation in this matter. Very truly yours, 'SOOUTHOLD TOWN BUILDING DEPT. Vincent R. wieczorek, ordinance' Inspector s VICTOR LESSARD 1 Town Hall, 53095 Main Road PRINCIPAL BUILDING INSPECTOR p , , P.O. Box 1179 (516)765-1802 Southold, New York 11971 y - ;.� � FAX(516)765-1823 ;J rid OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD February 7, 1989 AWJ Construction Corp. Depot Lane Cutchogue, NY 11935 Dear Mr. Jacobs: In order to complete the Certificate of Occupancy on the Andrew Carlin permit ( 12168Z) , we require a new check for $25. 00 and an Underwriters Certificate. Enclosed please find your out- dated check. If you have any questions, please feel free to contact this office at the above number. Thank you for your cooperation in this matter. T , THE BUILDING DEPT. TOWN OF SOUTHOLD T 1366 AWJ CONSTRUCTION CO - _ DEPOT LANE CUTCHOGUE, NY 11935 7- P1�J J 2141 AY ORDEROF THE DOLLARS CJB"'\%`TRvsTCo Fon.a OUTCHOOUE,L. .N.n935 ® 1:02L4079121: 111023,1137$52 6n' ..:a1m�EF Yi?iffiblmi".-•"' "'. '•�.�'�suYM..�.ri%viff.�fi&..i�49�iJA:§1tt,'EU+tw'SE[flA2YWJ:SCCd S^ YdYXe.�t LYG}Vffidd+,e§e�A�X .newCAroY.44[A _n'.Ys� &Yi9� AWJ CONSTRUCTION CORP. 886 DEPOT LANE, CUTCHOQUE, NY 11935 214 dMI H , CUT C UE,L I.. iiV$ Fol? me;0 2 140 79 1 2ad 1110231113M52 Depot Lane Cutchogue,N.Y. 11935 Dear. Mr.Jacobs, In order to complete the Certificate of occupancy on the Andrew Carlin Permit (12168Z) , we require a new check. Please find enclosed your original check for $5 .00 (#886 . ) We also need to schedule a final. inspect-- ion when ever will be Convenient. Please contact our office on this matter. 'Thank You, Dorothy S. Midgley Sec. Building Dept. M-1802 BUILDING DEPT, INSPECTION . , } [ ] FOUNDATION 1ST [ ] ROUGH �p a" [ ] FOUNDATION, 2ND [ ] INSULATIi N_. ] FRAMING [ ] FINAL REMARKS: a DOTE O INSPECTOR` . E x<' ws to ?3 i r�rays c t vao4,v FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined . . . . . . . . . .3/2., 19�3 Application No. . . . . . . . . . . Approved . . . . . . . . . . . . . ? 1 . . . Permit No. . . . . . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ' . .�/4. . . (Building Inspector) APPLICATION FOR BUILDING PERMIT �D Date �. . . . . . . ., 19�j INSTRUCTIONS a. This application must be completely filled in by typewriter 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 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 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 Department 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 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 in building for necessary i zm4 . . (Signature of applic or e, if a corporation) c- .. �r (Mailing address of applicant) /l9 3S- State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . . . . . . . . . . . . . . . . . . . . . 111�� .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises . . N()/}Pi�.T `�""'�� V + W ". . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Name and title of corrpp-orate officer) Builder's License No. . . . 0. ... . . .... . . . . . . . . Plumber's License No. . . .P'r7 r. . . . . . . . . . . . . . . . . . . Electrician's License No. . .l. �3. . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . , e '-/ N/o e-rw ! a J4' 640-..0�+a. d�1✓ram 4r I. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . !/V�,,,7t,op(, . . . . . . . �. . . . . . . . . 2v .w". �!J. . . .`�. . . . Ate/ /'f/IN,T W /V�. House Number Street Hamlet County Tax Map No. 1100/0 Section . . . . . . .1 P 4. . . . . Block . . . . .1.0 . . . . . . . . . . Lot . . .P9. . . . . . . . . . Subdivision . . / 7>SlI Y. . .R ,r— - - . . .,F/iile/d Map No. J��. . . . . . Lot . .1. 3 .� (Name)p/l0 p ih P.fit(.ed( okq 2. State existing use and occupancy of premises and intended us7e�anct_ocpc/u�pancy of proposed construction: a. Existing use and occupancy . . . . .1. . /!�` . . /mow f. , , ` . . . . . . . . . . . . . . . . . . 7 "Zy b. Intended use and occupancy . . . . . . . ��-5.!?•• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Nature of work (check which applicable): New,Building . . . . . . . . . . Addition . , . . . . Alteration . . . . . . . Repair Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . 4. Estimated Cost . . . . (Desc.r.ip.t on . . . . . . . . . . . . �. . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . dwelling,number of dwelling u, (to be paid on filing this application) 5. If g hits . . . . . . . , �. . . . . . Number of dwelling units on each floor . . . . . . . . . . . . . . . . Ifgarage,number of cars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . . . . . . . . . . . . 7. Dimensions f existing structures i ;if any: Front . . . .3 y . . . . . . Rear . . 3. A . . . . . . . Depth ; .�.�• . . . . . . . . . Height :. Dimensions of same structure Number of Stories , . 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �. . . . . . . . . . . . . . p h alterations or additions: Front . .�. . . . . . . . . . . . Rear . . . ,e�•-. . . . . . . . . . . . Depth . . 6. . . . . . . . . . . . . . . .:. Height . . ./G. . . . . . . . . . . . . . . . Number of Stories . /. . . . . . . . . . . . . . . . . . . . 8 Dimensions pf entire new construction: Front . . .2 r. . . . . . . . Rear . . .: . . . . . . . . Depth . . ./... . . . . . . . Height . erof Stories . . . . . . . ./�. . . . . . . . . . . . . . . . . . . . . . ... . . . . . 9. Size of lot: Front .I 10. Zone or use district in which• .re.'. . . . . . . . . . Rear . . a . . . F o r t er Ow er !D. th CIO .. . . . . . . . . . . . 10. Date of Purchase . . . . . . . . . . . . . . . . . Name of Former Owner . . . premises are situated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . � / 12. Does proposed construction violate any zoning law, ordinance or regulation: . . . . . . . . . . . . . .: . . . . . . . . 13. Will lot be regraded . . .ti!Q , . . . . . t . . . . . . . Will excess fill be removed from premises: Yes No p . . Name of Architect � �• • ����� ' ' ' ' • • Address .�4�x.G� .7�'IrR .Phone No.1rw.?�T 14. Name of Owner of remises . . . . • . . . Address . . . . . . . . . . Phone No. Name of Contractor . �!c. . . t .'J!��Ms . . . . . . . . A'ddressll� --v. .6.' To one No.�35�' 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. UN Lo r l�� STATE OF NE O S.S /� COUNTY F . . . . r • . . . . . . . . . . . . . . . . . . . . . . . . 1. g . . . . . . . . . , being duly sworn, deposes and says that he is the applicant (Name of indivi al si n contract) above n d tlHe is4` (� . . r✓ /'P^. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . (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 . . .day of. . . . . 19 Notary Public, z - �.--Oc% County JUDITHT. TrPRV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Notary Public, S1xAte oUNcw fork (S' ature of applicant) No. 52-0W,963 CuFlolk Coun ? COMM1,5slon Pxpires March 30, 196