HomeMy WebLinkAbout11210-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
UPDATED
CERTIFICATE OF OCCUPANCY
No: Z-29558 Date: 07/03/03
T~IS CERTIFIES that the building NEW DWELLING
Location of Property: 530 SCHOONER DRIVE SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 71 Block 2 Lot 8
Subdivision Filed Map No. -- Lot No. --
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 26, 2001 pursuant to which
Building Pe~it No. l1210-Z dated OR/NE 26, 1981
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 ONE FAMILY DWELLING. THIS CERTIFICATE OF OCCUPANCY REPLe~CES C0#Z-10957.
The certificate is issued to GEORGE L KOCH TRUSTEE
(OWNER)
of the aforesaid building.
SUFFOLK COUN~fDEPARTMENT OF }~F~J~T}IAPPROVAL 10-S0-81
ELEC£K£CA~ CERTIFICATE NO. N 555411
PLU~BERS CERTIFICATION DATED N/A
04/09/82
03/30/82
AutHorized S/~e
Rev. 1/81
(THIS PERMIT MUST
COMPLETION OF THE WORK AUTHORIZED! i,
FORM NO, 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Buildin§ Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No..g l .~ 9,5.'~. ......... Date ........ g.p.P.i. J...h3 ............... 19[i ¢.
THIS CERTIFIES that the, building ................................................
Location of PropertyHouse' ~ .3,0No. S¢ h o.~.ne ~'. D,P. lVestreet ................ g°u't'h°ikdl:l~/e~
County Tax Map No. 1000 Section .. 0./.1 ....... Block ... 02 .......... Lot .... ~3.0.F1 .........
o .Filed Map No. 4362., .Lot No. .1 ......... ...
Subdivision .Itarb.op. · Li.~h ~7~..(.oec£..., 1 ,)... . .
conforms substantially to the Application for Building Permit heretofore filed in this office dated
.... ~,~ a~,..2.~; .........., 19 .t3 3pursuant to which Building Permit No.. J .1.,, l 0.2; ............
dated ..... d u n.~,'..E6 ............... 19 .,5 .1, 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 .........
· ,a .pr :~.v.~:~ ce. xm¢:~'.muil~..ci*,.~9.[.Tk~kag..~o..p.s.e, asonal uae only.
· l-
The certificate is issued to ...... .. .... 4t~ (t i.t.il, g p.c. l ...................................
(owner, l_e~ ~ena~t)
of the aforesaid building.
Suffolk County Department of Health Approval . t O.z-&O-- ~.I .,. · ~ / .9./.82 ,. JLa t~ t ,. Jt.. k'.t.11 a .,..P · E.
UNDERWRITER S CERTIFICATE NO ........... i~I..555 .~.1. l .............................
Rev, 1/81
Building Inspector
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
This application must be filled in typewriter OR ink, and submitted in duplicate to the Bui[ding 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-
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 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. ;
Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use
3. Copy of certificate of occupancy $1.00
$5.00
Date .......
New Building ........... Old or Pre-existing Building(Z) ........ ,~/Vacant Land .....
Location of Property .... _.~_,~..0. ...... -.-:-~. ~ .~ ?.~ .c.~. .... ~ ./..//.~..; .z....
House No. ~ -- ~ /¢~ St)~et Ham/et
Owner or Ownera of Prope,ty
County Tax Map No. lO00Section ...7.~ ........ Block ..~ ........... Lot.
Subdivision .ff~.. ~.~ (~-~...1.)., .Filed Map No.. ~ ~.Lot No. /'. ..........
~erm[t~o../.t.~t ~. Oateof~er~it ..... pplica~t .... ~ ..
Bequest for Tem~rar~ Certificat~ ..................... Final Cordficate ..............
Feo Submitted $~'~ ......................
Construction on above described building
Applicant
Rev. 10-10-7a
1ooo343 THE NEW YORK BOARD OF F[R UNDERWRITERS
BUREAU OF ELECTRI~ITY~'
85 JOHN STREET, NEW YORK NEW ~ORK lo038
THIS CE~IFIES THAT
only the e~trlcal equipment ~ described below and tntroduc~ by the apphcant na~ed on the able oppl[catlon number ~n the prem~ses of
in the /ollowing location; [] Basement
,~.s ex.,ni,,ed on March 25, 1982
[] lstFI.
16 . 21
DRYERS
[] 2nd Fl. Section Block Lot
at,d found to be in cornl~lia~ce with the r~quirements of this Board.
RANGES KING DECKS OVENS DISH WASHERS EXHAUST FANS
SYSTEMS
NO. OF FEET
OTHER APPARATUS:
2-GoF, I,
2-Fmmke Detectors
1-4.5 K.W. F~t Water Heater
E R ,V I C
NO OF CC, COND,
pER
Coodale Elec. Cone,
~I Box tSaMainl%d.
Mattituck, N.Y, 11952
A W.G. ~ NO, OF Hr-LEG
OF CC C~ND _
A.W O, NO. OF HEUTRAL$
OF HI-LEG
A, WG
OF NEUTRAL
1 2/0
~ i ~ Per~
This certificate must not be a feted n any manner; return to the office~pectocsof th Board if nco~ ecl ins eclats mayma bebe identidentifled by their cre~enf{als.
COPY~FO~ BUIJDING DEPARTMENT, THiS CO~Y: OF
P D
HENRY E. RAYNOR. Jr., Chairman
~2ED22;C~'~. ~. CC,'I. JC.~]
JAMES WALL
BENNETT ORLOWSKI, Jr.
GEORGE RITCHIE LATHAM, Jr.
William F. Mullen,
Jr.
Southold, N.Y. 11971
TELEPHONE
765-1938
April 22, 1982
George ,H. Fisher
Senior Building Inspector
Southold Town Hall
S0utkold, New York 11971
Re: Harbor Lights, I
Dear Mr. Fisher:
With reference to the above captioned subdivision, I have
enclosed a copy of the Superintendent of Highways recommen-
dation for a release of bond for the road improvements on
this property. Also enclosed is a copy of our Board's rec-
omendation to the Town Board requesting same; the Town Board
released such bond December 8, 1981.
The road improvements have been completed within this sub-
division.
Very truly yours,
HENRY E. RAYNOR, JR., CHAIRMAN
SOUTHOLD TOWN PLANNING BOARD
Enc.
By Susan E. Long, Secretary
RAYMOND C. DEAN
Superintendent
NOV S
Tel. 765-3140
734-5211
November 4, 1981
SoutholdTownPlanningBoard
Main Road
Southold, New York 11971
Gentlemen:
Re: Harbor Lights
Section I
Schooner Dr.
~ot #1
The paving at the turnaround has been completed by the
Corazzini & Sons, Inc. and I recon~end to the Town Board that
the bend be released.
Ve ly
~ yours,
RAYMOND C. DEAN
Sup't of Highways
HENRY E. RAYNOI~, Jr.. Chairman
JAMES WALL
BENNETT ORLOWSEI.
GEORGE RITCHIE LATHAM.
William F, Mullen, Jr.
Southold, N.Y. 11971
~LD
TELEPHONE
765-1938
November 25, 1981
Southold Town Board
Southold Town Hall
Southold, New York
Gentlemen:
The following action was taken at a regular meeting of the Southold
Town Planning Board, Monday, November 23, 1981:
RESOLVED that Southold Town Planning Board recommend, to the Town
Board, a release of the bond on the subdivision Harbor Lightst Sec-
tion I.
Please note the attached letter from the Superintendent of Highways.
Yours very truly,
HENRY E. RAYNOR, JR., CHAIRMAN
SOUTHOLD TOWN PLANNING BOARD
By Susan E. Long, Secrefi~-rF
Attch.
FOUNDATION (Jst)
FOUNDATION (2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N. Y.
STATE ENERGY f t/
C,ODE
FINAL
ADDITIONAL COMMENTS:
New York State Department o! Environ~en[~.t Conservation
En¥~ronmental A~alysis Unit
Bldg. 40 - SUNY
Stony Brook, N, Y, 11794
516 751-7900
Peter A. A. Berle,
Commi~sio~le;
March 7, 1978
}~r, Ernest Tarmin
474 Ocean Ave.
Lynbrook, N, Y. 11563
Re: TW 15276-0265
Construction of a one-famfly
dwelling on lot 1, Map of Harbo'
Lights, property Owners Associa i
Schooner Drive, Southold
Dear Sir:
As a result of your inquiry concerning the above referemced parcel,
this Department has conducted an on-site inspection. We have foued the
parcel to be above elevation 10' aad behind bulkhead.
Therefore, pursuant to part 660, Title 6, Official Compilation of
Codes, Rules and Regulations of the State of New York, Section 660.1 (c) (1),
no per, mit under Article 25 (Tidal Wetlands) of the Environmental Conservation
Law is required.
llome is to be at least 50' west of bulkhead.
least 100' from Mean High Water.
Cesspool must be at
DJL:cg
Yours truly,
Daniel J. Larkin
Local Tidal Wetland Permit Administrator
· ' FORM
STOP ALL WORK
TOWN OF' $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
STOP ALL WORK
ORDER TO REMEDY VIOLATION
Date ....... ~.u...Z.~...~.Z ................................. , 19....fL1
William J. Jacobs
TO .J./..q...G.¢.q z'~ ~...L.,...K.ec h ...........................
(owner or authorized agent of owner)
B..~..x.....1...9..9..B.......D..e..p.~.~...t~...L...a.~n..e..z.....C..u...t..c-h...~..g.`.u..e..~ ..N..ew York 11935 (address of owner or authorized agent of owner)
PLEASE TAKE NOTICE there exists a violation of:
Zoning Ordinance Ch. 100
Other Applicable Laws, Ordinances'or Regulations .S...t..a...t..e.....B..u..i...1..d...i..n..~....C...o..d..e
at premises hereinafter described in that .~ft~.~....En.d....czf....Eo.~zn~La.t.£oz~ ........; ............................
(state character of violation)
has developed two large cracks and wall has settled approx. 1½".
in violation of ...... .,Z..o.g.~..~...C...h..:...J..0..0-T ] 0g- 1 ~3 ...~S...~.~..e....~..'u.A..~.~qJ~....C...~..d..e...~?.~a~.~.~3.~-~.~.~' 1 ( 630 ) a, b
(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 ....... .2...8.~.,h. .....................................................
day of .....g..u...1.7. ........................................ ,
The premises to which this ORDER TO REMEDY VIOLATION refers are situated at
.~..5..3...~.~.S...c..h...~..~..~...e~.D...~..J;'?'..e.~...H.'a.?'..b.~.~.~.~.~.~;C~unty of Suffolk, New York.
Southold, New York 1197~(Co. Tax Map #1000-71-2-8)
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
Building Inspector
Curtis W. Horton
LAWRENCE M. TUTHILL
PROIrEBBIO N&L. ENelINEER
COUNCILMEN
Henry W. Drum
John J. Nickles
Lawrence Murdock Jr.
Francis J. Murphy
TOWN
SUFFOLK
Southold, L. I., N. Y. 11971
TELEPHONE
(516) 7654891
6/ll/81
Mr. Henry Raynor
Chairman of The Planning Board
Town of Southold
Dear Henry:
Mr. Harold Reese met with the Highway Superintendent, the
Town Attorney and myself on June 9th relative to 6braining
a building permit for lot#l, Sect. I of Harbor Lights.
Mr. Dean and I recommend approval of a 15 wide a~ohalt
access road from the easterly portion of the existing
paved area of Schooner Drive to lotffi. ~r. Dean will
confirm this by seperate letter. The Town Board has
previously reviewed this road end area and was prepared
to accept that road without the 100' turnaround.
It is also suggested that if the above is agreeable with
you that the owner of lot #1 be required to submit a letter
to you and the Building Department that he~undersSands a
cer~ifigate of occuppancy will n0t~be i~u~d untii, the
access roa~d ia a~rove~. __~L __
~es
~airman of The Highway
~ommittee
cc: Town Clerk
Building Dept.
Town Attorney
R. Dean
JJN:jn
KOCH-JOHNSTONE ASSOCIATES INC
INTERIOR DESIGN AND PLANNING
June 5, 1981
Mrs. Rain.s
Southold Planning Board
P.O. Box 728
Southold, New York 11971
Re: Proposed Koch"Residence
Schooner Drive
Southold, New York
Dear Mr. Rainess:
Mr. Fisher suggested that I write to you and outline my understanding with regard
to the completion of Schooner Drive.
On May 14, 1981 I spoke to Mrs. Terry, the town clerk and she advised me that Mr.
Reese the former owner and subdivider of the above property had posted a bond
several years ago to install Schooner Drive. She also told me that the Planning Board,
on January 2, 198] voted to keep this bond in effect until Mr. Reese completed
Schooner Drive. This bond is still in effect as of this date. I than called Mr. Reese
Sr. and was advised by him that he was going to complete Schooner Drive as quickly
as possible. He also told me that he had a meeting set up to see you on May 26,
1981 to discuss the completion of Schooner Drive and a new road in another section
of Harbor Lights. On May 27, 1981 I called Mr. Reese Sr. and discussed with him
his meeting with you. He advised me that he expected to start construction of
Schooner Drive within thirty days. He also told me that you advised him to meet
with the Highway Department and Mr. Fisher, the Building Inspector.
I have subsequently filed my plans with the Building Department and have been turned
down for a building permit because of lack of access to the property. Based on the
fact that the town has a bond posted to complete Schooner Drive (and can enforce this
bond with the Bonding Company) and the fact that Mr. Reese Sr. advised me that he
is going to complete Schooner Drive in the very near future. I request you advise
the Building Department to grant me the construction permit.
I trust that you will not delay in granting permission to issue the required Building
Department approval and permit.
GLK:emf
Very trj~y yours,
George L. Koch
cc: Mr. Bertram B. Daiker, Esquire
Mr. Reese, Reese Brothers, Inc. ~
Mr. Fisher, Buildinff Inspector .
-/
10 [A.~T 44t~ STF~EI, NEB/YORK, Iq. Y. 10017 (212) 986-6170
HENRY E. RAYNOR, Jr., Chairman
JAMES WALL
BENNETT ORLOWSKI. Jr.
GEORGE RITCHIE LATHAM,
Nilliam F. Mullen,
Jr.
Southold, N.Y. 11971
TELEPHONE
765 - 1938
June 24, 1981
Mr. George Fisher
S nlor Building Inspector
Town Hall
Southold, New York 11971
Dear Mr. Fisher:
The following action was taken by the Southold Town Planning
Board at a regular meeting held on June 22, 1981.
RESOLVED to approve the recon~endations set from the Highway
Committee on the subject of Harbor Lights, Section I, Lot #1. The
Southold Town Planning Board concurs with all of their findings on
amending the road turn-around.
Yours truly,
HENRY E. RAYNOR, JR., CHAIRMAN
SOUTHOLD TOWN PLANNING BOARD
By Linda Kimmins, Secretary
GEORGE L. KOCH
:::' " . /,~ C u, ._
From the Desk o]...
GEORGEL. KOCH
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
ORDER TO REMEDY VIOLATION
-~o ~...~~.....~.IC~ .....
(owner or authored agent of owner)
PLEASE TAKE NOTICE there exists a violation of:
Zoning Ordinance .... .~ ~.....~'. '~.., · .~.' ...............
at premises hereinafter described in that ...~~.~/~ ~~
(state char~er o~ol?ion) ~ '
~"'"~~ ........ z'"'~'C ............ 5 .......................... ~ .................... :"'~-: - ~
(Stot~ so~]or p~r~roph.~ oppdcqble mw,. oroin*n~e ~r roOulot~nl ~
YOU ARE THEREFORE DIRECTED AND ORDE~ to co~ witch: ~w and ,o remed~ the
conditions obove mentioned forthwith on or before the .... ~ ............ ~..~:..,,~],,,,~ ........ ~ ~
The pr~mis*s to which this ORD[R TO Rfi~[DY VIOLATIO~ re{ers ore situoted ot
~J~~ ~ ...... ~ ......... ~....Co~nty 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,
Building Inspector
FOI~M NO. 5
STOP ALL WORK
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
STOP ALL WORK
ORDER TO REMEDY VIOLATION
Date ....... ~.u...Z.~....~.Z ................................. , 19....~.1
William J. Jacobs
TO ...~./..C..,H.~.~ ~.g fi,,.L..,.,K.o,n h ...........................
(owner or authorized agent of owner)
(address of owner or authorized agent of owner)
PLEASE TAKE NOTICE there exists a violation of:
Zoning Ordinance C~ 1 O0
Other Applicable Laws, Ordinances'or ~,~, ~,~*~ State Buzldzng Code
at premises hereinafter described in that .J~.~.~.k.,.En.d.,..o.P.....Eg.~n~a.t.J,a~ ....... :: .............................
(state character of violation)
has developed two large cracks and wall has settled approx, 1½".
in violation of Zoning Ch. 100-100-143~ State Buildin~ Code Part 3-AB01(630)a,b
(State section or paragraph Of applicable law, ordinance or regulation)
YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the law and to remedy the
conditions above mentioned forthwith on or before the 28th
day of .....(u..$.y. ........................................ , 19..a.]..
The premises to which this ORDER TO REMEDY VIOLATION refers are situated at
....5..~...~..~..c~.`~.'~.?...e.~.~..D..C.~.¥..e.~...~.~...b'.~'~`~..~.~.'~.*C~unty of Suffolk, New York.
Southold, New York 11971(Co. Tax Map ~1000-71-2-8)
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
Building Inspector --
Curtis W. Horton
KOCH-JOHNSTONE ASSOCIATES INC.
INTERIOR DESIGN AND PLANNING
August 27, 1981
Mr. Fisher
Building Department
P.O. Box 728
Southold, New York
11971
Re: Koch Residence
Schooner Drive
Southold, New York ' :: /
Dear Mr. Fisher:
As you requested I have changed th~/circular stair
to 5' ~ 0". ~
AS per our discussion you adviS'~d me you would
from the 1st floor to the basement.
I have ordered this stair f~d~m i~unva
new home from 4' -10"
a 5' - 0" diameter stair
above.
If you have any questions, please do not hesitate to cglil;~i
{~Ve~y yours, L~/~_
GLK:emf f~ George L. Koch
cc: Mr. B. Duiker, Esquire
10 EAST 44th STREET, NEW YORK, N. Y. 10017 (212) 986-6170
KOCH-JOHNSTONE ASSOCIATES INC.
INTERIOR DESIGN AND PLANNING
August 27, 1981
Mr. Fisher
Department of Buildings
P.O. Box 728
Southold, New York 11971
Re: Koch Residence
Schooner Drive
Southold, New York
Dear Mr. Fisher:
This is to confirm our tele~h0~ e0nve~,][~i!(~ on July
7,
with
requard
to
the
Board of Heimlth approval sflbmi!ted- '"' to y~ with my residence on
Schooner Drive.
At your request I called
for my well and s~ptil from
approval
I spoke to Mr~ Fazio and t01d her the Health Department
required this approval translated She the file and spoke
and that Mr. Brigham
to Mr. Brigham and advised m~ that
would perfer the applicatioil·t°i!,stay as
I then called you back and advised you of my
told me that if the Health Department did not requir
Department did not require the change of thi
telephone number and asked you to verify !ion.
I was very surprised and disturbed when I was advised by Mr. ~Jacobs my Builder that
Mr. Horton told him that I could not obtain a final approval and certificate of
occupancy with out having this Board of Health approval change.
the Health Department
Inc. to my name.
with Mrs. Fazio and you
change the Building
also gave you Mrs. Fazio's
I trust that you will advise all parties concerned that this change is not required.
If you
GLK:emf
cc: Mrs. Fazio
Mr. B. Duiker, Esquire
have any questions, please do not hesitate to call.
Very z/r~y yours,
eorge . oc
10 EAST 44th STREET, NEW YORK, N. Y. 10017 (212) 986-6170
TOWN OF SOUTHOLD
BUILDING DEPARTMEN~
TOWN HALL
SOUTHOLD, N,Y. 11971
TEL,: 765-1802
Examined ...... . .~..~....,27.., 19..~.
Approved ..... ~..'~;'~ .~~ Permit No ....
Disapproved a/c ............... j ....................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
/
Application No..t. ...............
Date..~...~......~"...~. .... 19 .~. /
INSTRUCTIONS
a. This application must be completely filled in by typewriter or inlink and submitted in triplicate to the Building
Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according t6 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 diaCam 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 issue 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 fize 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
inspectors on premises and in buildings .... ~/~ ~/" ~ ~f~'~ a
admit authorized for necessary i~spectio~.
( 'g pp '
(Mailing address of applicant) ....
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.................... ........................................................
Name of owner of premises.. ~..'~.~-~... ~'X: ..... 2~O..C:b.' .....................................
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of~)ate officer)
Builder's License No ..........................~)~
Plumber s License No .........................
Other Trade's License No ......................
1 Location ofland on which re osed work will be dona ~/~/~'~ ~'~1~'
· . , P P ~ -' ../.-5 ........... ~... ...........................
House Number Street Hamlet
County Tax Map No. 1000 Section ....... .~../. ....... Block ........ ~ ....... Lot.
Subdivision.~./~..~.~.~ Z[/f.~.7~..~~.~ .FiledMapNo..~.;;,~.~.~.~ Lot ]~"~'~ ./..~-..
· ' 2"' '(Name) ...............
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction
a. Existing use and occupancy [,//'~C ,q- M.7-
b. Intended use and occupancy ' ~'~ ge~7./'~'~,~ ~
3. Nature of work (check which applicable): New Building ......... Addition .......... Alteration ..........
Repair .............. Removal .............. Demolition .............. Other Work ...............
:! , (Description)
4. Estimated Cost .~.. / . ..d.e..,~..O. ........................... 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 stmcture~, if any: Front ............... Rear .............. Depth ...............
Height Number of Stories
Dimensions of same structure with alterations or additions: Front ................. Rear ..................
Depth ...................... ,Height ...................... Nun~ber of Stories ....... ; ........ ~ .....
8. Dimensions of entire new construction: Front ...~'..~ ......... Rear . .(~.', ,C9.,. .......Depth
Height .............. {~ ~umber of Stories ...... /~. O(o ~. ~. .- ~1-o~).
9. Size of:lot: Front ................... Rear ..................... Depth .................
10. Date of Purchase ............................. Name of Former Owner .............................
11. Zone or use district in which pr~mises are situated ....
12. Does proposed construction violate any zoning law, ordinance or regulation: .............................
13. Will lot be regraded .... . .~..~?~" ~ ............ Will excess fill be removed fscom premises: ,Yes (~No)
Name of Owner of rem.i~(s, .~.~.~.,~..lfi~ ~rlrl~3~'~e~ .~.t~.,
14. P~ --~ ~n~.~- .. .... /.' ................................................................
Name of Architect /~{~..)., ~r~r.~q~-. J ~.~.. Address ................... Phone No ................
Name of Contractor ~.~,~'t~.~,~..~ J,~.~r~ ~.. Address .~.~.q.~. ~'~<. ?.-7... Phone No. 7. A.~r.5..~/.57..
PLOT DIAGRAM
Locate clearly and distinctly alll buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block aumber or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF NEW~RK~ t - ~ S.S
COUNTY 01~.~',~ ~' ~ ~ . _
.... :~..~~..~i~~~.! .......... being duly sworn, deposes and says tha~he is the applicant
(Name of i~idu~ ygning contract)
above named. ~ ~ _ r
of said owner or owne~, ~d is duly authorized to perform or have perfomed the ~a)~ work and to m~e ~d file ~is
application; that all statements contained ~ this application are true to the best off--ledge and belief', and that the
work will be perfomed ~n the m~nor se~ forth ~ the application filed therewith.
~womto before me this :
.... ...... .......
~ NOTtR? PUBLIC, 8tat~f New York ~, / (Signature of applic~t)
N0. 52-8125850, Suffolk C0un~
' ~erm Expkes March 30,
LA-~J ~
N C; ~t4 0 I-~
/., :4
~ SUFF. CO. HEALTH SEPT, APPROVAL ] H.$ NO. __
TEST hO~
SUFF. CO. DEPT. OF N~ALTH SERVICES
FOR APPROVAL OF CONSTRUCTION ONLY
DATE:
lO-So-F~
STATEMENT OF INTENT
THE WATER SUPPLY AND SEWAGE
DISPOSAr SYSTEMS FOR THIS ItESI.
[~ENCE WILL (:ONPORM TO THE
STANDARDS OF SUFFOLK CO. DEPT.
OF HEALTH. SERVICES.
APPLICANT
APPROVED:
T~TIJ~
rt. a;~,eeOvAt. I ~. s. ao..
SUPPLY AND
8TA~OA~O~OF SUFFOLK CO,
?
me sewage disposel and water supplF
facilities for this location have been
inspected bT this department and fouz].d
~ef of Gem~ral ~gi~er~
' ~~ ,~z~ ~. ~. . ·
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NO. J REVISIONS
KOCH-JOHNSTONE
INC.
INTERIOR DESIGN &
I0 EAST 44th ST. NEW YORK, N.Y.
ASSOCIATES
PLANNING
10017 212-986-6170
OAT,E
:DRAWING NO.
SCALE
SOB NO.
Kj
--I
NO. I REVISIONS
KOCH-JOHNSTONE ASSOC IAT E S
INC.
INTERIOR DESIGN & PLANNING
I0 EAST ,lath ST. NEW YORK, N.Y. 10017 212-986.6170
DATE BY
DRAWING NO.
/5,,7_
SCALE
JOI NO.