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HomeMy WebLinkAbout16724-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 218596 Date NOV. 28, 1989 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 2125 PETE HILL RD. PVT RD #6 ORIENT House No. Street Hamlet County Tax Map No. 1000 Section 017 Block 04 Lot 19 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 7AN. l4, 1988 pursuant to which Building Permit No. 167242 dated FEB. 2, 1988 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 SINGLE FAMILY DWELLING ATTACHED GARAGE DECKS & SWIMMING POOL. The certificate is issued to GEORGE M. & MARGARET M. ALLIEGRO (owner, XxxxxxxXxxxxXxxx) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 87-SO-236 AUG. 8, 1989 SWIMMING POOL-N089087 AUG. 29, 1989 UNDERWRITERS CERTIFICATE NO. DWELLING------N103464 NOV. 16, 1989 PLUMBERS CERTIFICATION DATED EDDIE'S PLUMBING SERVICE--NOV. 21, 1989 ~LO~t~ Building Inspector Rev. 1/81 Poaai xo. s TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 0 16 7 2 ~ Z Dote ~~~~..Z 19.41 Permission is hereby granted to: i ~,em,~,c.....~~.".......... t4~ ~1~.....`~..~~..:. ~,~.~1 ro s'~rE....~''.~F •f.. ~ ~G~~ at premises located at ...rM{z>!.~ ....~'~,lf.`!)..~L..~L(...~~~1~..••'6~4••~~ County Tax Map No. 1000 Section ®f7....... Block .........f1.......... Lot No.........~.,~/.......... pursuant to application dated ........r~~~ 19..~~? and approved by the Building Inspector. Fee 3•%~~ ..ky~ric~.••...................... `o:~"~rj~~~~ 6 in I for Rev. 6/30/80 I TEL. 7GS-1802 S~FFOCltC p O,, TORN OF SOYJT~OILD " , t OFFICE OF BUILDIAIG INSPECTOR ~ ,r P.O. BOX 728 TOWN HALL "0~~ SOUTHULD, N.Y. 11971 1 r~a Y` C E R T I F I C A T I O N • Date I(J'OVE~'•1-B~+E 21r/~r84 Building Permit No. ~(or7~~}-' Owner~og~~ M. ~ Ll. ~ E 6-R..a (please print) k DD~~S tr'~L~M piuG s~,u rcE- Plumber E4_~f-iR,r~ w,4cuRZowiC~- (please print) I certify that the solder used in the water supply system contains less than 2/10 of to lead. ~~~I-~ zQ (plumber's sign ure? Sworn to before me this ~ S~- day of ~~a~f~~r,~n~_ 19~. ,.rc., o.-~o»-~. Notary Public Notary Public, S~~-/b/~ County ~J FORM NO, 6 TOWN OF SOUTIIOLD BUILDING DEPARTMENT TOWN IIALL ~ ~ ~ 765 - 1802 a APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIDNS A. This application must 'be filed in typewriter OR ink and submitted to the Building Inspector with the following; for new buildings or nev 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 IIealth DepC. 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 solder used in system contains less" than 2110 of IZ lead. 5_ Commercial buildings, industrial buildings, multiple residences avd similar. buildings and installations, a certificate of code compliance from Che 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, buildings and unusual natural or topographic features. 2. A properly completed application, a consent to inspect signed by the applicant and a certified abstract of title issued by a title company which shall show single and separate ownership of the entire lot prior to April 9, 1957. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing Co the applicant. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent information required to prepare a certificate. C. For Vacant Land Certificate of Occupancy: 1. An application For vacant land Certificate of Occupancy shall be submitted, and a certified abstract of title issued by a title company showing single and separate ownership of the entire lot prior to April 9, 1957 shall also accompany the application. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. D. FEES: 1. CERTIFICATE OF OCCUPANCY -New Dwelling $25.00, Additions to Dwelling $25.00, Alteration to Dwelling $25.00, Swimming Pool, $25.00. Accessory building $25.00 Addition to Accessory buildings, $25.00 - Businesses $50.00. 2. Certificate of Occupancy on pre-existing dwelling - $100.00. 3. Copy of Certificate of Occupancy - $5.00 - over 5 gears - $10.00 4. IIacant Land Certificate of Occupancy - $20.00 5. IIpdated Certificate of Occupancy - $50.00 6. Temporary Certificate of Occupancy - $25.00 Residential $50.00 Commercial ev, 10/14/S8 TORN OF SOUTIIOLD ry C ~n3 ~ 1~-3`~ I' BUILDING DEPART:lElJT ~ `V~ d i TONN IIALL SOUTIIOLD, NEN YORK 1 1971 ~ ~ O ~ ii 765 - 1802 6 BOEPT. ~ APPLICATION FOR CERTIFICATE OF OCCIIPANCY I DATE. NDIIEMl~c2~?°.~ 1 ~B~ NEW CONSTRUCTION . x....QLD OR PRE-E%ISTING BUZLDINC......VACANT LAND..... Location of Property...2~2:~'...~~iC..(~;LL.~URO,.........ag~~-!~:....,. . . BOUSE NO. ~ STRBET NAMLET Ovner or Ovncrs of Propcr,ty.~-`~.~0.!'~~~ M;.'Q.LL~eCaY~c~ 1~~2G,A2t~:i M:/~C-LiL-C~~2,c~ County Tax Map No. 1000 Section Block . 4 Lot'......... ~ I Subdivision..~~~~~u:°.r:p; Fil/ed Map ........Lot__1....... Permit No. .~~c./.~'~_..Date!•of Permit 2,c?~~B...Applicant~~~E.~-I,~LLJGYg~~ ~I Hea1Cb Dept. Approval ...i--•............ Undcrvriters App roval...~~......._ Planniag Board Approval L/......... RequesC for Temporary Ccrl'itificate Final Certificate i Pee Submitted: $.~a-?:~.Q.~'i............ APPLICAN I:'Li..C:" 3 8~ o ~ a z ~ ~S%~ ~ i, y re°• MO/14/88 ' _ r'lEl-7 i;:ui C:lU;7 ~ ~UAiC. ~ UUMME;N1., ~ m K a H ~ _. y -- ~ FOUNDATION (1st) ~~ C~ FOUNDATIOIJ (2nd) - ti to 2 - ~ - . ~.~- d °~ • ~ OUGH FRAME & P , // ow-T PLUMBING x~ ~ _ `fie y ,. ~~ 3. m~ IIdSULATI0P7 PER N. Y. ~, STATE ENERGY ~ ~. CODE x ~ _- A '~ ~\ ~ . . ~ FI;JAL i o z ADDITIOPIAL COMMENTS: x Z ` o-~~ ~. ~ ~. b'. ~ H , ~- ~:~y ; ., o~ O"~3.1: ~^~~ (~ ~ ~ ~ .r /A+~ ~ ~ I S' 7 e `' (/1 / _ ~ ~. dN ~- Le~iizt. .~, W H Memorandum from . BUILDING INSPECTOR'S OFFICE TOWN OF SOUTHOLD TOWN HALL, SOUTHOLD, N. Y. 11971 765-1802 ANOTHER BUILDING PERMIT APPLICATION IS ENCLOSED. ANOTHER PERMIT IS REQUIRED FOR A TENNIS COURT - SHOW MORE DETAIL AS TO SIZE AND FENCE SIZE & HEIGHT THANK YOU. j ~ ~v~ ~~sh> ~ ~eo~° r~--1(ie~ o~ 1 a ~rc~v-r~ ~ ~ ~~i~~fi - ~a~9z.~~~ ~ K, 2a~~Q - ~.~1 ~.,,:ro i u _ ~ ,gyn.- L~` ~c~- ~ ~ n V L ~ ( UU , SCHOOL 0_tOSSZ.'G, CHLitCii CItOSSIliG CR SP3uI;iI, Oi`_IC.~S TII~'i; SLIP TUi~ 1 OaH 19 1. Ii Dr1TL TT1;E A.'1TL TII•:E ~ ~ DAT1; TII•;E i I i I Signature 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN ULATION [ ]FRAMING D [ FINAL F~- REIIAARKS: c DATE ~ INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ( ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING ]FINAL REMARKS: ~ dTi,~~ G'.~LlY ~ Q~~~~~ ~ ~ ~4 DATE INSPECTO ` 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ] FRAMING ~ [~>~'FINAL REMARKS: ~ r DATE INSPECTOR / ~ ~ 765-1802 BUILDING DEPT. 1 NSPECTION [ ]FOUNDATION 1ST [UGH PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ]FRAMING [ ]FINAL 1' REMARKS: YL s~C~~l~ DATE ~ ~ INSPECTOR B DEPT. INSPECTION [ ]FOUNDATION iST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND NSULATlON [ ]FRAMING [ ]FINAL REMARKS: ~ ~ / t~1/I.c:~ c' Ff'„ ~ ?U~/!~, 4 q 1 DATE / INSPECTOR 7~~ 765-1802 BUILDING DEPT. INSPECTIAtN [ ]FOUNDATION iST [ / ] ROUG1~ PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ RAMING [ ]FINAL REMARKS: -4~,~..,,..,_o , DATE `r ~ INSPECTOR 1~7z~ 0 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 15'1' f ]ROUGH PLBG. [ ] FO RATION 2ND [ ]INSULATION [ FRAMING [ 7 FINAL R ARKS: ~ G~l~,~..~.,.z-- ~ p _ ~ ~rQ. ~X .,,~,.,~v-L DATE INSPECTOR G2~ _~~~7~ ~ ~ ~ t _ -1802 LDING DEPT. INSPECTION [ ]FOUNDATION tST [ ] ROUGH PLBG. [ ] FOU ATION 2ND [ ]INSULATION [ FRAMING [ ]FINAL . REMARKS: _ ~ _ _ _ ~ G ~ DATE ~ -2 ~ INSPECTOR ~G~z~~ 765-1802 BUILDING DEPT. INSPECTION [ ] LINDA N 1ST [ OUG PLBG. [ ] FO DATION 2ND [ ] I CATION [ FRAMIN ]FINAL REMARKS: U t?JJ. ~ F ~ ~ i .~O e2 I, S l R.Y. ~ ~~L e ~ u o ~ M,z'a DATE ~~_~INSPECTOR ~ v~ T65-1802 BU{LDING DEPT. INSPECTION [ ] FOUNDAT{ON i5T (~~R~OUGH P1~BC. [ ] FOUNDAT{ON 2ND [ ] INSULATIO [ ]FRAMING , [ ]FINAL REM RKS: 1~.~~%L!" ~ti~ . c9~ e < DATE ~ INSPECTOR rss-iso2 eu1La1NG oEPT. INSPECTION [ ]FOUNDATION iST [ ]ROUGH PLBG. [ ]FOUNDATION ZND [ ] 1 ULATION [ ]FRAMING [ FINAL REMARKS: _ ,%~~~~.,w' f DATE ~ ~ ~ INSPECTOR v k 765-1802 BUILDING DEPT. INSPECTION [ ] OUND ON 1ST f ROU PLBG. [ ~ FO DATION 2ND [ SULATION r R, E'M,A^RKS: ~,~.ol/ L~ ~ /l,Q..e~/'z ~,rr~, ~ ,U~- ~ 6/90 ~l~~go DATE ~ INSPECTOR c ~ T I THE NEW YORK BOARD OF FIRE UNDERWRITERS 1G009F,,R BUREAU OF ELECTRICITY 83 JOHN STREET, NEW YORK, NEW YORK 10038 Date 1T.lr(s`U~u'~` `1. ~9 .1.~~. APPlicatian No. un file $3 ~~~(~~i THIS CERTIFIES THAT on! the electrical gquip~ t as deacrihed 6e/ow and introduced 6y the applicant Homed on the ohova opplicotion numher in the premises of sra~~~zrrl I~irrmhs; L1.'i PF;9`E; (1I7t,T.1 Rl?, SJRT~NT', T3.Y. in the ollouin location qseem t (5i11 f Q p ? ? Lst FL ? 2nd F'l. Sertion Block Lot ACr(,Uf,"~ 1±1, 9.~~~ uos examined urz and found to be irz emrtplianre with the reyuirenterzLS q(this Board. FIXTURE ECEPTACLE$ SWITCHES FIXTURES RANGES COOKING DECKS OVENS DI'iH WASHERS EXHAUST FANS OUTLETS INCANDESCENT FLUORESCENT OTHEH PMi N W. AMT K. W AMT K W. AMT K. W AMT. H P. 1. 'J, t DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS RELL UNIT HEATERS MULTI.OUTLET DIMMERS AMT. K. W Oll H. P. GAS H P AMT. NO. A W. G. AMi AMP. AMi gMPa TRANS. AMi H. P SYSTEMS qMi. WATTS NO.OF FEET w~ SERVICE DISCONNECT NO.OF S E R V I C E MIT. AMP, TYPE METER L 1W ~ %]W 3 %3W 3 %4W NO OF CC. COND A. W G. NO OF HI{EG A W, G. NO. OF NEUTRALS A, W G ~UtP' PER % Of CC. COND OF HI~LEG OF NEUTRAL OTHER APPARATUS: '~(silzr~rFxrN~; z;oar.,) 'Ship rerei;tli.c~ta covers rc>mpl.ianc~ FtT f:he ~a,t.c~ caf inspacC zt,n c,nly. Ac~aauser of rtrfnsuxl euviraxim~nts ~.t i.s adv:i^,cf7~,l~ to have Prequa~nt I A;q1; a.otl/ax' r<3pa:i.ry madF by a ~qua`I.ifie.c3 ~~tsr•snn. y7//~C~-t'~"l "vliLl,iAPd STpt:1% T,1C, ~R39-'R C//~' 1350--5 Y,7N!'•C)TLF7 AVF,NU'(; HnI111~.C~1)K" NV, '~L 6ENERAI MANAGER 11 Per 'w^ This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. ~Fz~- 1~-u~'~ THE NEW YORK BOARD, OF FIRE UNDERWRITERS '`nl°~' F` I11(7L I°'tf"' BUREAU OF ELECTRICITY BS JOHN STREET, NEW YORK, NEW YORK 10038 Dote ?iOVh:ii4},K(*~ If+"I r3 k=`> A plirotion No. on file 'i~`•h"fF";~tl~Sj YF 7D3~`~h ik THIS CERTIFIES THAT ~}~il"'-`t i~°I Ott" It~~a err only Che electrical equipment as described below and introduced 6y the applicant nomad on the above application number in the premises of :1'P{tldkl ~9alr 31C~'1~ r 3 1 ;;tT $1s'1'N; Yi t Gfr htifllf i3ffl? ° , t)i+bl.Id`C, %i°i , y. in t e owr g ncotion; ©Basement ~ 1st FL ~ 2nd Fl. 3°f. t' CC Iti3f1° Section Black Lot was examined on iAl °V' °P?!k"~~ 13 , I ~ arzd found tribe in compli~nee with the requirements of this Roard. 1 f1XTURE fLXTURES RANGES C KING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS (EGEPTACIE$ SWITCHES INCANDESCENT FLVORESCENT OTHER AMT K.W. A T K W AMT KW AMT K W AMT. H P i 4#. '!V ii f~ t 4,~f ~ f j V' DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME C OCKS BELL UNIT HEATERS MULTI~OUTLET DIMMERS AMi K. W. OIL H. P. GAS H. P. AMT NO. A W G AMi AMP AMT. AMPS TRANS. pMT H P SYSTEMS AMT WATTS NO.OF FEET i H f, ~ 14 ' SERVICE DISCONNECT NO.OF $ ~~E R~ ~ I C E METER NO. OF CC COND. A. G A. W G. A W G. AMT. AMP. TYPE EQUIP. L ~ ]W i ~ JW B ~ 0W T'e dW PER % OF CC+.COND NO. Of H4lEG OF HIAEG NO OF NEUTRALS OF NEUTRAL 3 3110 +.:H ! a i ~idt`", S 1jiL OTHER APPARATUS: t.J;. ~'t,>~ frvrx~ t 1 i•1f1'i'i Yft:i; I U. (rr FS. Y + I !P. ,i r. El. Y.,, 2 fT. jfn i{.. i'.. r 7< h' 3f .3'., ~i II I'NdH3d}t)aR3tN;; i. ~~,1 ry}2 ttNt i ,~uxr: uf;°r~s;L: i~nfi, - ~ ~ 9`R;a C!i 7, 7 tiM"r I NC ~ ~ G ~ ~ p FI'Ctd.9'lild S'Y'U~'Iz lrl;r; , Rf zS(3<~' F; ;yrl p. t•,tFdi"t>Y.af X:1; F;Fdlir, `sTia ~ ~„`lri GENERAL MANAGER I)iih1313iK71L, , h1V. ) I';A3 ~ V ~ 1 Per .I1 .+.,1.,._, This certificate must not be o4tered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. I~ BOAKD OF HEALTH / 3 SETS OF PLANS ' FORM NO. 1 SURVEY . TOWN OF SOUTHOLD CHECK - • • • • • BUILDING DEPARTMENT SEPTIC FOR14 , • TOWN HALL NOTIFY C-~a~.~~ /k'L'~-'~~-~"~A SOUTHOLD, N.Y. 11971 CALL • •`J.'~.7%>'~-°- =5•~• TEL: 765-1802 MAIL T0: Examined ..,°'Z/y........, 19~f. Approved y.. ~ 19 ~~Permit No~~ D ~ Disapproved a/e . .MW 141988 • . TOWN OF SOUTHOLD (Build' g Inspector) APPLICATION FOR BUILDING PER~AIT Date 19 . 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 'Lone 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. 7'he applicant agrees to comply with all applicable laws,, ordinances, building code, housing code, and regulations, and to aifmit authorized inspectors on premises and in building for necessary inspe o s. (Signatur of ap licant, or name, if a rporation) P;O;,Box,~37,2,.flake .ROnkonkoma,N.Y..117.7.s..... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. OWNERS/BUILDER Name of owner of premises .George, M,,Al1legFO.and.Margat2t.M,.Alliegro (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No . . Plumber's License No . . Electrician's License No . . Other Trade's License No . . I. Location of land on which proposed work will be done. W(S,Pete,Hill,Roacj,~~QQ: ,t-.N/.O.Main.ROad, . Orient ..............Pete Hi11,Road... ~~.~.~......Q>;1$Ot............................ a,.~:5..... House Number Street Hamlet County Tax Map No. 1000 Section .017 Block .....4............ Lot ,19 , , , , , , , , , , , , , , Subdivision Filed Map No. Lot............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . b. Intended use and occupancy ..Singl@,fareily.priroa>:y.S2S]denC2 1 Alteration 3. Nature of work (check which applicable): New Building ..X....... Addition . Repair Removal , Demolition Other Work . (Description) 4. Estimated Cost .$122,000.00.1 Fee......... I (to be paid on filing this application) 5. If dwelling, number of dwelling µnits ....1 Number of dwelling units on each floor . If garage, number of cars ...3.I,. 6. I1' business, commercial or mixed occupancy, specify nature and extent of each type of use . 7. Dimensions of existing structure, if.any: Front Rear Depth . Height ...............Num~barofStories........................................................ ` Dimensions'of same structure w(th#alterations or additions: Front Rear , . De th . 8. Dimensions of ent're'n~~lst ,.Height . . . Number of Stories . - niction: Front ...79 Rear . , . 75 ! .........Depth ..55 ! -6" Height 27. ! , Nu~h~kh f Stories 2...... ' . 9. Size of,lot: Front . • ..32D.•.84;.'.. Rear Z2s. ! Depth ..43$.'..~I'Fe.9+...... . ]0. Date of Purchase ...OC~A.kle11~,::k987...........NameofFormerOwnerReid,A,.,,MQh.df,fQY........... ' 1 I. Zone or use district in which premises are situated . . 12. Does proposed construction violate any zoning law, ordinance or regulation: ....NQ . 13. Will lot be regraded ,YES , , , , , , , Wifl c s ill be e3m ved from premises: Yes No 14. Name of Owner ofpremisesMr,&Mrs;G,.Allie.grgddres~a~e.~on.~on~~.ma..PhoneNo.7.37.-3.050... Name of ContractorGeQFg:&: Sute~,,,,,,,,,,,Addr East Moriches phone No. $78'4602,,,,,, 0. Bo"'z3 12...... e M;, Allie,gro,,,,.Address'La•ke.~o•nkookoraa.PlroneNo.7~7: 349...... 15. Ls this property locatedjwithin 300 feet of a tidal wetlandY *Yes No *If yes, Southold Town Trustees Permit~may_be_rP~~~+r°'• - - Locate clearly and distinctly] arid.-indicate all set-back dimensions from property lines. Give street and bloc ,5 show street names and indicate whether interior or corner lot. - ~r. .h ~ ~.1 y ~ . k. y t k t > ~ ~ ~ k i~ ~ t ~1~., ' k 4~~~ z L ~ ~ ~ ! o a J~~J LF1 (e `~^•~S yyx,i~~' yy' 1`M ~ 3,n~ 4 ' 'fit "+'5~,'#~Y£l "'...f";Y'S,~ tl nj3dp'~",. ~ 1& ~f .fi k~.''Yd,~,uv.,~,~~~',%ni~v)t. 3-fiy"Yas,'~~V"'4 i~~ k`3' ,F _'~f;.5'4'yj~°t ~.l4,~i'k i~ ~"s ~~`~i ~ ~ , ~ ~ . t " 1~~`h. ~ ~ 1 ) rf a~~",~~x' . r ~Y y x r# ' . '}fit. STATE OF NEW YORK, S.S COUNTY OF S.UFFQLIs;..... GEf1R0E. M... A1.l.ieglrn being duly sworn, deposes and says that he is the applicant (Name of individual signing contract} above named. Heisthe.4WN.~R/.6.U.L~.4~R ' ~I (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dtjly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ~ ry ......day of . 19 .~Q Notary Pub~lic-,-~J'~//~f!/~ .L9.1'.. A.l.-/~ County ~ CE R. SCHOPPI~ , . . FLO N07ARy PUBLIC, State of NeW YMk (5ignatu of applicant) No. 4734738 - Qualified In,Suffolk County , Commission Expves ~P 0, ~1 ~9 ~ SUFFOLK CO. MIEALTM DE?T. APMROYAL . . - _ ~'~'7 f .y._~ !;KK... f[C 7 GM - r. ~ _ F ' . ~ ~i_...1.._ ~ ~1..?i t+.-i..~! ~~.NT QF INLTtTi7 # fff 1 r - THE WA1"ER f41M1~!„Y AND f61MAP~E @t8F04A1 r AT fYSTEMS FOIL THK R['S/I>~iYCE WH.I + { ~ y} C4NF'MM O THE STANp ~Itil! OF THE 1 ~ 4 IIf ~ l1,lFF C . DEr'T. H IERYICE$. ~ ~ ~ ~ u 'IL'WPd OF SGUT~t~U , ri.Y, Isl ICA - JJ(~t t ~ ~ ~ ~ _ SUFFOLK COUNTY DEPT. HEALTH ,-r"~ \ ~ ~g2 ~ \r ~ COR TRH _ FOR A~PRO~QAL OF _ J ~ , , _ N$ 1dPFONI , / / ~ / C3~ ~ +l~ DATE: It ....,,w'~8 I / ~ ~ ~ N. S. REF. NO.: ~ O Z 3 1 ~ ~ ~ ~ APPROVED: ~ ' ~ ~ %~j) tUFFOLK CO. TAX MAP D651tiNAT10M: aF .rE~ ~ II `~'~1~ D15T. 8[CT. ®IOCK PCL. t.., ~ S LE ~ _ ~ r~ ate ¢ tq ,~,y s ~ S °~/Q" ~ ~;1, 01lINE}tS ADDit ~ t . ~ ~ , 7~'"' • ~ ~i? d ar7 d ~ 5 cro A L 4F,~C ~ Fzc~.~ t ' DBCD: 5955 ~a .,e~ i ~ ' t 1 t t 4 ~ I' TE3T.NpI.E~t j ~ 11~. 4 QP t ~4~~__ ~ it _-Tr~. da'on xa~a. q 9t1019~ ~ - ~ f " fT ~ ~t ~ w. Naw York $!>in • `~.-r-/ r`1 a PPTT a ~ ~ - r ~ 't Lrit!?•1 z~N.y, :t + f~.y. ~ ~ CLAYEY *v~a.r.i b'~rtm -ri~F.. ~ ` ~ J ~ ~ ' ~ ~ .~y'f<j~jH' ~ I~ e.u~ ~Y~ 4f~~Y U 14~9~7~. ~ =~~y. ronpycr~ l Y" i. ~ . _ ~~31 ~ 1' vo '<rY n•e~n PMII r _ a-` r C~Y~ 0 amm~n;al r::.. : _ 4~ ~ ~ 1 ~1f~Ta"1 ' ~iLSTaIp ~iml•a rb, ~ ~ y nrN t ~ Gffita+BL l~AVF.L • i.,.w . ~ 1 ~ ar su q UUU ~ W L-- _ t4' sKNa 1 t ~ StAL F ~.r7~I~VG7~i.~ ~Q~. fi7 ~Y~SQF r ~ ~ ' G~3~~ f~£FF:Q WlGi~ tir1A~ iN' J ~ ~ Y N T R+UMt ~ ~ • ~ - ~ ~ A UYL P 1'~ ~ e < ~ ' r ~ ~ ~ F 1 UElNlI~B LANG 4aiR 0R4 24 s~~ cANO s~~ ct1eEENttMT NLM1 YORK t e ~ y - r-. ' Bt~FPOLK C©. ?gfA,LTH L16P#. AMItOVAL 4 H. S. NO. . . __x . _ l-~ r ~ ~ ~ -r.-•-ay.'-.. C z _ D ry. ~ . r s i r~'~ t i s zz ~ ~ ~~~r:LT_QF~TENT ~ ~ 1 l S ' TM~E,MtATERSUPM.X ANb~f~[J1tiE DISPOSAL ,ti 8YS1'l,SiS FW1 THIS RE'9tDENCE WILL ,s yf Z- ~ ~ i ~ : A~ OONFbI!#+1 7d THE STANDARDS OF THE ; F~ ~ ~ 7 ~ ~ ~..'~+~=~.1_ 9liFRg1-!C CG. ~T. OF HEALTH SERVICES. L / f 21s {'x. ,~tl~~~ 4~ r'1/I.i Y1'~~4~ F°y..S.. 4N ' V t ~ r, zt9 4 4 l { i a, nj E? 9 t< ~.t~,, -"S„ a+~ n, SUFi,OLK COl1ltTY DEPT. QF HEALTH , d~' It t '~-r ~~~~^~'a •F 32 ~ 5ERVPfLS -FOR APPROVAL OF S~. C' ~ r,' ~ 4 CONfTRUCTION ONLY _ , -•s 2 ` ~ qty. I _ DRTE: ' ~ ~ F c ~ W. S. REF: NO." ~x ,u ~ ~ APPROVES): 9 fy i.1 ~ ~ t ~ SUFFOLK CO. TAX MAP DESIGNATION: " ~ ` DIST. SECT. BLOCK PCL. si \ c` a,,,, i' a a~ OWNERS AOORE$: ~ ~ l ~ ~ I" L!?SCE 12'~fdfC171,itr,~tl?4A~N.Y~ i.?,r~. a(~, ~ ' ~ F DEED: L.:~;+°:, P. ~t:t' ~ . t! a w A L'" r , 1.1"1 a ,r nn n.' •,in ' l I .v r mot i ' , v ~ O;~ L l ~l TV r~ rt,n New rah sets L9 f' ~~Zi)1 Dyw~~ ~ 3i _ = f' - 'IX2AT+f`_ AAp ',,yaw. • ~V . _ ~ - T firc v}rvaY eu5v not Mar^p • - ~ ~ M - GG[YEY s :eve's rrdved asata • ~ ,.v ~ ~ saU 59a1 9he~l na 6e mneelBrwS / li , ~ ^ ~ I-Y' _ -'1, I, ~ , lid bua uwY ~ r- i ~ ' ~ a iF`~ _ - ~ • ..5 ~ {<l.ItsYjr"y' l ~1~';~ v r mesa ,ndwat~c hereon sh=! n ~ , • , v ~ - ~~}j y~'~ ,l i (.3 » tna Garaon irr who fha 'r~S ~ •~.I, ~ TZV'i + l ~41JV ~ ,ad. end on fiia hc-fial to[a ~ ~ ~ ~ ~ - 14'`'i ~ ~ } ~ i G ~ an ;nY, davernmen:el a r 'Y rind ~ > _ g , . ~ : I-. ~ ~ .bt'ITI+ ~ S!!S'i Q, , n xitutwn heed noru..n of ~ ~~W ~ r ,y ' 1"aA~Y~L! u e s anaaa of the la.-+emD ,s.i. / ne ~ ~ c ~ irnrtwa are net transr:<rahie ~ • ° 3i( ~ ~ 1 _ _ ae ra..:anal inaUtutioM a whsaauent - Cf3AGK' E L 1. .1 ~ ~ ~ ~SE'~? at.~= ~'{'7 i::F' .ti4.li«'~~ °fy ~ Tf A lNSUSpit2s' C&7 3J+~T+3Cr::v i ~+AhsC ' a f0~ a.rh .7..,:' r Y k:'.. l EN j'x.{ .11. " tl~e) ~ij Lr v 1'~~.`.t'~1+.3I"i ~ v \ e. ° - 'o " R RACK VAN TUYL, P. _ ~ 'o sti t a,~ 11CENSEO LANG SUR V YOBS _ I _ c 6REENPORT NEW YORK - coax wtm - ~ - L ~ _ . ~.sYt ~ Bt~Iti~1C.f0.1iEALTN OEM'T. APMEOVAL _ _ K.S. -tJO.-~T-StJ-2':~: ~ 3 _ 0° ~ ~ 1 ~ `j~'~j'. CS~Z +'7 vr`, ~ ~ __a._.._~ _ r- _ wrt *M L~~r y,~ ' 1iR81t1iliL ' ~ eF,'~ {fit' , ~ ~4'~~'AIf6 " f4yR, F~ti ~Tc . II~F{}.L , ~ ~'~,t 7Ki~R ~'A~IP~L Ri t ~"~a - . ~~E~t`1"~ _ yl ,'L"@. 1#~K. 29F 1rlli~i~"#'#~~Rilt~,.Lf. ~ ' i , i js, z~ / ' f'Ir~LK ~Ef~ITV . #Y!(~'1'. tsF w~A4Ttl • ~ . ~ $ ~A'' ~l i f„ 6 S P. C?7t IMPit R3`1/ IU, , _ ~ ~ - l.; ) . / j , r 92 ~ . DJT1Mt/CT ION ONLY ` _ _ l O ~ ~ j s. No .-~T.- e _ ..'r. . y O APIJR Yl~d ~ n _ it? ~ ~ j:tr tt~ C'-+6 'F ~ SWF3LttCEl. TAX MAP t]F~G'iNA71QN: ~r - ~ w `aq ~ - .-t - _ ~ _ DIET. 9HET. •LDGR RCL: ~ ' u pmt > ~ , ~ ` PR.E A.r.:t ~2~ A~. f: O. Bc>h 2 i-~ 'A- } M t .,,w;d. ~~tlpr ~#y.. A .y~, r ~'(~~'~~~1 T 3 na. : Mekaratan ar adSHOn . . f...l"1. g.~lc ,,.v re ~ vidneinn of pi ~ f ~ i, ~t .~R_TY' JJr»ion Eaw, tba New York Btgta t ~y~ t T - Ma' - k ~ _ 1 .~`~1~1 K ri rh nv mzn _ _ .i nor baari fy}~ - 4.1'rtY~4~`i - S i 41`U1: nJI Oe ~natdgrgQ ~ ~ ~ .Y'om' ~ ~f ~ 3~ ~ iNJ p0Y is # W ~y ik' _ tY ~ ',r,.Y''' i } a, ns h raan sAaM run fx4,.l':~.r.. ~ ..r C~YEY;: 3 c o v,n mire sur>my . " f " ~1 .(Q me~r,, of a,nncy and i \ KK ~+yrv ~ r 4M~hl`i~' r * n ! •e r• n e ~d ~y.': m ~ r~` ~ .iL~ r " 4 t ~~Gi~Yrlt~..l . {7~ ns of rie r na n 4.. 1 '?rL:~ i ~ f i j[~y@r~ysely w3.~ re not trm•sf•3rahig - i ~ ~ Y' l # ^T~~wrann4s•-r.. •,,YanS nr 9ULSa~ugrd ~ aa' ~ ~ ~k, .F~1r` ~ ~ i ~ C.G,t~i.~ ,SAL Q~ t a t~. Cl'H N.~~~ ~ t ~aR`~~ 7'~£~1..? `~^1;LT'v 41- \r ~\~K v.,~ ~'rj~ t ,y ~ ; _ vF LAS OF ,a E n < . K VJtN TUYL, P. t1i.1M# _ t ~ ~ MAG` AMFhi~}E;.,,, i v!~Afr.AM""4 ,~z, qn^£i "JC:'w !8 is V `-.a.` E ~ , s , t ,;;~i _ _ . ~ ItCEMSED LAND SItRV YOBS ,_C~',v MAi~ AN-t t v JULY 27t i~~,t ~ GREENPORT NEW YORK ~:m - = - - _ _ - _ _ _ ~ l _ - - - _ ~..wr:..., .u r.. . . ~ SUFFOLK CO. WEALTH DEPT. APPROVAL ~ _ r • . ..~..r. r . «•t ~ $~ATEME~VT OF INTE~IT~_ _ 1 ~ i ~ ' ~ . h~ f_ 1;~,~Lw.~~~; 7`HE WATER 511!°PLY BIND 5EWAGE DtSP05gL I ~ . ~r' { ! 1 ~ o i~iT SYSrEIVtS FOR TNfb RESIDI"NCE WILL ~ ?,r~ . ~ ~/i 1.'' ~ - CONf01lM TO TFIE STANOARQS OF t1iE I ~ ~ ~ ~ • , , . ~FfOLK CO. DEt~'f. OF HEALTF! 9ERYICES. i , ~1t! ,w--~.:. .....,.w APPLICAN"f I `i r ~ ~ I , ; ~ ~ ~ r.. ~ ~ ~ SUFFOLK COUNTY DEPT. OF WEALTH ' ' ~ ~ i ~ ~.,~:~~'~~,F~''~~~:'~ ~ ~ ~ ~ 5E R Y I C E S~ FOR APPR4VA.t, 0~ d . r" ON TRUCTKNd ONLY I 4'y~ ! T qtr ,'~.~f r + 1. ~ ~f~~•+i J.' :fez ` `f ''?'~11°"" ' (f„ N / ~ „L,_ ? •'1,` t~l P~~ r hF~,L~/. EiG.,1';GEs QATE: ~ ~i ~ r ,h~ ~ ' ,b' T` s / ~ ~t4 ~ ,f"~ r"~ r. ` ff1ui~i I y ~ iyH.(~ ~ ~1 4J~ ~ ,t° a ~ ~ h ~ Y / 1,• _ ; + , ^ ~ s'r4t1.1~.1~ i ; ~ N. F. NO. i ~ 0.rt •`f `~.a I` \ -U~•...... _ ~~;"~~~;~'(o APPROVED'. { ~ s, ~ ~ ~ \ k, ~ 1e ~Y~M ,4 . ' ~ 1' I~.~ ~ ~r. `e d y~ Vii: a ~r : ~ I ~ ; r - +T ~ 3~ ~ ~ ~~z` ~j 1 f R1~3 ,alt y t l' ~ ; ~ ~ . ~+`'y''°~ ~ OttJ~C.Bg~in:;d:, ~,1 ~~;~r,:(+~er ~~C,~', SUFFOLK C©. TAX MAP DEStGtNATION: ~ ~ ~ ' , ~ CIF ~ ~ t ~ DIST. j \~p~^ yV ~ SECT. BLOCK f~CL'. i• ~ r i' pM~~~-, ~ ~4 r 4~t~`~frir`Nr'{~{rR&P t~;iit ~ i ~ .T - , 3z' ~ ONtNERS ApDR'E5S' • k ~ is ~t`~ ' . . • r ~y e . ,,,i' 7, , t , _ _ r . Ste' ~ QEED: L.~;; " P: r~.1 ' fT ~ ~v: - TES H L STAMP i ~ ~ ,may ~ . ~ i _ ~ e , ~1. ' r ^ n k^ nn pf ~JIV- ~ d' , , ~ 1 ,~„T se ,on n! the ~Iaty T'ark $t~ttC ~:-N~ WfJ~'. i a ~ ` ~ _~~tL'i'`I' Jucaticn kaw. lQ ~.~f, ' L ~ ~ ~ l ~ ~ " k • tn~~ ~ Aat ''nris; r4,hir c~j.,yy rna~, not Mann ~ ~'Y'T ,.-.Z1 ~t)n.ticrs Or irte~9&1. « B ~ u . ' ~LJId'frY ~ i,xa~ r 5_a, shat! nos be maei,7ered ' ~ JI{. t., "l. -e• i; ~ .Lt}~N' r r n' a. t d irua ~apy, ~I, . ~ A~~ ~ ! ~ 'mv tG1~f'?r~ _•n, , .i rz w; n9rnar shad ran \ , '~-ew., ~ sf~~ ~ ~9~~ y r w~r r i y ; • a n on for wncmlhe sur e ' ~ 1, I, g r! ro r J ~ ~ Pp r~ of r~V n .y... E ~ u~Att19 , A Rr~mr 31 t.. nr'Cy Bnd 7:,•. .A ~ ~ < : } r . t WIJ"i~ ~ , G, r' ,r~ .yes a' cr~e Clna m h• I ~ - - : >?~i.~;4~ ti . ~ ~ ~ r'? . , ~~~t ' t "t:°, _ v Are nattra,+s't4rehle ons nr su`s+rj . s. ueni , v , ~ tip ~ ~ { ~ r~ + ~ ; r . _ ~ T ~-t~-; a ~v it r r~: EA t~P' ' , _ . 1;. , +i.~:~ t ' ~,Fh~'y~a 1~ ,r~ -~'«~I`.. ~j N T Y P. 1 ~ r R~DERICK VA U L. ~ r+ ~ o '3~ i - LICENSED L11ND SURV YOBS ~ c~:,~i_~' , MAP ~1Mkhiv`~G" JULY ~7i (gE~i ~ OREENPORT NEW YORK '