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Home My WebLink About15753-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z17109 Date JULY 21, 1988 THIS CERTIFIES that the building Location of Propert~ 300 House No. County Tax Map No. 1000 Section ONE-FAMILY DWELLING HOLDEN AVENUE CUTCHOGUE Street Hamlet 110 Block 2 Lot 9 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 13, t987 ~ pursuant to which Building Permit No. 15753Z dated MARCH 13, 1987 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. The certificate is issued to GERARD H. & CAROLYN M. SCHULTHEIS (owner, X~) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 9-S0-119A UNDERWRITERS CERTIFICATE NO. H003157 PLUMBERS CERTIFICATION DATED 6/16/88 6/29/88 GERALD Ho SCHULTHEtS Building Inspector Rev, 1/81 FOF, M NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 15753 Z Dote c~ / ~). · Permission is hereby granted to: ,-~,. _ ~ I ..... i"" ..................... ~""/'1 .......... ; ........ ~" CounW Tax Map No. 1000 Section ....... /~/...0.. ........ Block ...... ..(~...?.'..: .... Lot No ....... .(~)...~ .......... pursuant to app, ication dat~ ...... ..~~..,.L..~ .............. 19~...~, end approv~ by the Building Inspector. Fee $...~.~.c..~.~ Rev. 6/30/80 FOlt~ NO. 2 TOWN OF $OUTHOLD BUILDING DEPART,~ENT TOWN HALL SOUTHOLD, bi. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12666 Z Permission is hereby granted to: ..~z~...~ .~... ~¢~Z.,~...../.~...~.~ //t~, ~ .~...~Z.~.....~z/.~..~. ~ ,o .....~~.~.~....~.....~.~....: ......... ~0.~: ............. ...~~...~z..~..z~.~.Z~..~ ....................... ; .................................. ................................................................................................................... Co..~ ~.~ M~, No. ~o00 Se~tio. .... lZ~, ......... m=k ...Q.~ ......... Lot No. ~..~. ......... Building Inspector. .ee ~" ulldin~ ~c or ' ............. Rev. 6130/80 FORM NO. 2 · BUILDING DEP,~RTMENT TOWN CLERK'$~ OFE!¢E $OUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP"~MISE$ U~ITIC FULL ~ CQMPLE'FION OF THE WORK AUTHORIZED): '~ ~o. ~O~Ts z ~o~....:~.:...~.Z ........... , ~.~a Permission ~s hereby granted to: ....... ..... ~.....~~......,.~.~...~...,~. ......... to ...... ,' ............................................... ' 'r ...... "'------, ......... : ............... ................. , ........................................................................................... p~r~ont t~ opplicotion datod ............. ~.~...;...~........... .... , Ond ~pprovod by the Building InSpector. Fee $ .............. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPAN~ Instructions A. This application must be filled in typewriter OR ink, and submitted m""-.----- to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic 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 property 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: Additions $25,00 POOLS $25.00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling $25.00, Accessory '$10,00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 5 0.0 0 3. Copy of certificate of occupancy $ 5.00, over 5 years $1~0.00 4.Vacant Land C.O. $ 20.00 5.updated C.O. $ 50.00 Date .~W~.%..cT.-.(,..l.:l.U~.~ ....... NewConatruc~ion ...... Old or Pre-existing Building ............ VaCant Land ............. Location of Property. ~ .0.0.. ,~0~0.[~.~..../~,.. .......... ~;r.e~t. ~ :~.'.~. ~ .~'. .................... Hou~ No. . Hamlet Owner or Owners of Property . .~/~....~. ~' ~ ~' ?~'['7 ~' '/~'''' ~' ck~ / ~-k'~! County Tax Map No. 1000 Section .. ~l./..~ ........ Block .... ~- ........ i,. Lot .... .~ .......... Subdivision ................................. Filed Map No .......... i. Lot No .............. ..', Permit No ........ Date of Permit . .Applicant . ...c v .................. Health Dept. Approval ................ Labor Dept. Approval ... , .................... Underwriters Approval ............... Planning Board Approval . i. ·. · ~..>.~ ............ Request for Temporary Certificate ..................... Final Certificate .. ..................... Fee Submitted $.. .' . .(~.. ..... Construction on above described building and. ~ermjt meets all ~apj~Jicable codes arid regulations. ~ 0'::~ ~-1-7 ' ~) q Applican t . ./.~?~..'~, .~ ..... Rev, 10-10-78 TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No. Owner (please print) Plumber G~ ~, (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber s signature) Sworn to before me this 19 ~ · Notary Public,,/~~ County Notary Public THE NEW YORK BOARD OF FI.R,E UNDERWRITERS PAGE 1 8004947 BUREAU OF ELECTRICITY ~ B5 JOHN STREET, NEW YORK, NEW YORK 10038 O. te JUNE 13,1988 Jppllcetlon No. on file 54781288/88 H 003157 THIS CERTIFIES THAT PEI~.M~[T NO. 15753 only the electrical equipment as described below a~d i~t~oduced by th~ applicant ~med on ~he above application number in the premises of GERARD H, 5CHULTHEIS, 300 HOLDEN AVENUE, CUTCHOGUE, N.Y. iN the$ollo,cl.g l.c~tlo.~ [] Rasement ~ I~t FL [] 2nd FI. ~,...Hon110 RIoc~2 Lo~ 9 ~s exa~nined on ~A¥ 27,1988 and found to be in compliance u'itb the requlre.~en~s ~f this Board. FIXTURES RANGES OVENS DISH WASHERS FIXTURE OUTLETS SWITCHES FLUOJ~E$CEN? 15 35 18 15 DRYERS FURNACE MOTORS EUTURE ~R~O~RS TINGE CLOCKS~ MULTI.OUTkRT SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT , ' S S R V I C OTHER APPARATUS: MOTORS: 1-1 H.P. G.F.C.I:-2 SMOKE DETECTOR :-2 NO, OF CC. COND PER ,~ 1 OF CC, COND E GERARD H. $CHULTHEIS 15 SOUND BAY DR. HUNTINGTON, NY, 11743 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be by their credentials. ]'65-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. ~ 1 FOUNDATION ZND [ ] IN/~ULATION [~FINAL [ ] FRAMING REMARKS= /~ ~//~ C~ DATE FIELD FOU~rDATrON (1~t) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY CODE FINAL ~DITIONAL CO~ENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION J. ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [ L~iNAL c,~. P~. REMARKS: DATE 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION DATE INSPECTO TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN ttALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 Th~s is to advise you that the job under building pormiE no, 12666Z_ New DwelIT~ on --1.0~-83 .... ~or issued~ to _G H Schultheis. completed and ~, f{nal ~nspect~on ~; ( ) ~ ~-~ ~--'been done. ' tn order to complete this file, it is necessary that a Cr~r~ificate of Occupancy be issued. Please fill out the enclosed form, return same to the above office with a cheek for $2~o00 payable to the Town of Southold. Please indicate to Whom the Certificate of Occupancy is to be mailed, and arrange with this office for an inspection date Occupancy or ese is unlawful without a Certificate of Occupancy. Please. help us to clear up thig~ matter so that }egal action does not have to be taken. Thank you for year prompt ettentlon. Very truly y~, Victor Lessard Executive Administrator VL:gar enc]. S :even Win er Associa' s, nc. $ 's erns ConsuI n s 5~00 Empire $'~a~e Bulldlng NewYork N.Y. 10001 Phone (:212) 564 5800 Building Inspector Town of ~ou%hold Southol~, N.Y. Re: Schultheis House -T~mberpeg/ ClUster' ~ed ~.n.C.o · Claremont,' N.H. The above company is a manufacturer of post and beam homes, selling models through a number of sales locations through- out New York State. Timberpeg has submitted details of its homes to our firm for analysis and evaluation with respect to the New York State Energy Conservation Construction Code's thermal requirements. Our analysis shows this model Oomplies with the above code on the basis of Section 5, whereby.the maximum allowable u-values of each component are not exceeded, as shown below, for a 8000 HDD zone or less: Component:' u-actual: u'-allowable: Floors over unheated spaces .076 .o8 Roof/ceiling .05 .05 Exterior walls Glazing.(insulated) Doors with storms .048 .08 .58,.52 .69 .28 .40 On the basis of these maintained actual u-values, (please see enclosed heat loss details)v we find that the residence analyzed herein complies with the provision of the code. page 2- STEVEN WINTER ASSOCIATES HEREBY CERTIFIES THAT EACH OF THE ABOVE MODELS OF TIMBERPEG/CLUSTER SHED, INC. CO~LIES WITH THE LETTER AND INTENT OF THE NEW YORK STATE ENERGY CONSERVATION CONSTRUCTION CODE, IN WITNESS WHEREOF THE SEAL OF STEVEN WINTER, LICENSED TO PRACTICE ARCHITECTURE IN THE STATE OF NEW YORK, IS HERETO AFFIXED.. Steven Winte~ President Sincerely yours, Steven Winter Associates . 17' .. F-.= 14¢[ PRIMED CASEMENT WINDOWS Pat. No.'s U.S. 3,566.542 Un. B03.010 ROUGH OPENING WIDTH ~1 .', I ~ ~STANDAR~ MULLION GRILLE PATTERNS ,: ~.~ -.. ~,,..i~, . .,- . . .-. ".. : ,:.: , . ._:. .. .. , .r, : i'k:: :::: ' ' :: .... :" '~"'"'' : ..... :" ""' · ' ~'.....,.. ,.. t" c: ,'c-_~,. :~.-. ~'t,..,- ';-'"?-.'~' .':~T;' . - ... , .... " '..' ~; ' ' ,". ', ' ~. ~'-'C"~ '," I ,.~ :~ .,,. ~ "-" . .$,.-X .Yl. ~.~e-UA..... ~ .--..---~-~. ~-.-,,,, .:., .,..,. 7-' · ' I .x.. ,..-. ~t,qF-- ,'-a,~t -'~ ×~,~. ~ igc, .... ' ' '' 'z · . ' ~'~_OGL C~' . .- "~.:. - . -- " . :gE~ , . .... ,::.. ~1_ .,,. CLUSTER SHED, INC. '.* "',. ~ o,;.t~ ' ' ' '1 ?,~rl~'c~ :"--c~L-~®' ::' CLUSTER'~I~ED,.INC~ ,FITLAND. VERMOiNT 05048' . ~' ; I " ' , simile, . , --. ~ · .... ,..~. . ........... . _ . .. DRAWlN~ MAY NOT BE liE-' - ~, _v ---. 4:~'~ ~-.~-- --r-'. -'- . ..... ' ..... -.-- - ~ --. FOP~M NO. 2 TOWN OF $OUTHO/D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. NOTICE OF DISAPPROVAL .'~'i'.~......~..~.z~z,..~....~e..'....., ............... .... '~z~.~.~,..~.~ ........ ~.Z....~ PLEASE TAKE NOTICE that your application dated ~.~,,...,.~,~ .......... for permit~o construct~Z~ .......... ~at the premises located at ~..~~.~~ .,~.~....~:..:~..:~...'....~q..:.:.~ ..... .......... ........................... :_'"'":' ....... .......................... TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL $OUTHOLD, N.Y. 11971 TEL. 765-1802 August 17, 1983 Carolyn M. Schultheis Sound Bay Drive R.D. #1 Huntington, N.Y. 11743 Re: B.P. #10678-Expired Dear Ms. Schultheis: We are returning your application dated July 29, 1983 and check for $40.50 to cover fee for new building permit. Please furnish the names of the plumber and the electrician and license number where asked for. This information was not on your first application. fee There has been is now $63.25. some changes in our fee schedule and the Please forward fee accordingly. Edward F. ~indermann Building & Housing Inspector Encs. EFH:sw C9'~0 55 'FORM NO. 1 TOWN OF SOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC TOWN HALL NOTIFY $OUTHOLD, N,Y, 11971 TEL.: 765-1803 CALL MAIL APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH 3 SETS OF PLANS ....... SURVEY .......... FORM ............. ~amined .... , 19 ~.'~ pproved .~~ :: .~.., 19~..'?. Permit No. J. ~*'. 7..~.~.-~7-' isapproved a/c ........................... .......... (Building Inspector) TO: Date J~.0'..~ J3 ......... (~ 19...7 a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ts 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 areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- tion. c. The work covered by thts 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 all be kept on the premises available for inspection throughout the woi'k. e. No building shall be occupied or used in whole or in part for any purpos, e whatever until a Certificate of Occupancy all 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 lilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. .~e applicant agrees to comply with all applicable laws, ordinances, building code, ho~sing code, and regulations, and to Imit auth°rized inspect°rs °n premises and in building f°r necessary~2nL[ ~. .. y,(S~T.g.n~-~t~e of,. -qa, pplicant, ....... or na~'' ;~e', 'i; ~ 'c~);~;;a'tid~) .... (Mailing address of apphcant) tare whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~ame of owner of premises .qr~ca~..{....~-~..I]o.../Y)'.. ~ .qLY.[.e.0 .............................. (as on the tax roll or latest deed) · applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ALL CONTRACTOR'S HUST~.BE SUFFOLK COUNTY LICENSED Builder's License No...~*.~ lJ~ ................... /'-"FI Plumber's License No.......'Od~'... . ............. Electrician's License No. S.~ ~7. ................ Other Trade's License No ...................... do wi icl popos d k ill bedone~ Location of lan n ~ ~ r e wor w ........................................... ' ....... ........ ltouse Number Street ~/ Hamlet County Tax Map No. 1000 Section ... 13.0. .......... Block ....Z,. .... Lot....Vi .............. Subdivision X Filed Map No. Z~ Lot (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .~);,.~. '~;iL' .~.'' 5' 'iii'; ' 'fi~';}~:'' ' '2'~ -}f'' ~: '-'' }~'~' 'J'~' '[~; b. Intended use and occupancy ...../ ................ '0 ...... J~... ,...."~.[./,~*,*. · · J-~W ~ .... ',-. go.a z~. Nature of work (check which applicable): New Building ....~. Addition i Alteration Repair ........ '. ..... Removal ............ Demolition .............. Other Work ............. '~ ~ ~!3.S,'- 00~) : (Description) Estimated Cost Fee ' .(to be paid on filing this application) If dwelling, number of dwelling units ....... [i ...... Number of dwelling units 6n each floor . If garage, number of cars ..... ~:~ ..................................... , .......................... If business, commercial or mixed occupancy, specify nature and extent of each typelof use ..................... Dimensions of existing structures, if any: Front ............... Rear ........ t ..... Depth ............... Height ............... Number of Stories ............................. i .......................... Dimensions of same structure with alterations or additions: Front ............. ~... Rear -. ................. S' Depth ............. Height ......... ~' i ..... Numb~rof ~ories ............... ! ..... Dmlens:ons o£ entire new construct,on: Front ,..'.g.O, :0.... ..... Rear . ~[.Q .' .o...; ..... Depth . f. ~o .tr.O.' t. ...... .Z.Z.%0. '. ....... .umber of Stories...I. !/.Z .... .............. i ..... raze of lot: Front .. Z Jl.~...I,!eight ............ Rear ...Z.~ · .~. ..... . ....... D,'epth Date of Purch.ase....I.l.~.0 .... . ...... : ........ ,., l>Iace of. Former Owner Zone cruse district in wfiich premmes are situated .... /~ .... ~.S.. ........... Does proposed construction violate any zoning law, ordinance or regulation: .~.0. ! .......................... Will lot be regraded ............ ,,, .............. Will excess fill be remove~ frown pr, e~ises: Yes . No Name of Owner of premises (a'L£.c~d .~, SA~I;~,.. Address J ~..~o~.~.% .0e.~..~.~d~,~i. ~'~?Pho~ No..(> .':t.7 7700.]. .... ' Name of Amhiteet : ............... ': .......... Address ................ :.. Phone No ................ Name of Contractor .......................... Address .... : ........... ... Phoni No... ~,, ........... , Is this property located within 300 feet of a tidal wetland? Yes ...... No ,)~'... · If yes, Southold Town Trustees Permit mav be required. PLOW DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate 811 set-back dimensions from ,perty lines. Give street and block number or description according to deed, and show jstreet names and indicate whether crier or corner lot. ¢\ ZO,O r '~TE OF NEW YORK,, m-.r---~/~ I S.S u! I'Y OF ...... . t4 ..'... · , · ., ................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) ,ye named. is the ............................... .~...~..g..~..( .................... : ........................... (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this. &cation; that MI statements :contamed.m thfs application,are true to the best of hisiknowledge and belief; and that the rk will be performed in the manner set forth in the applicaUon filed therewith. am to before me this ............. ~ary Public, . ......... )tar¥~obli¢ $ N,,~,,..,.= , (Signature of applicant) - tate of New York : e2-8125850, Suffolk Co Expires October 31, 1 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1805~ Examined .~... Approved ~ .~. ....... l~. .:Pe=it No. ./.dd.~ .f ........... ............. ..... INSTRUCTIONS Received .......... ,19... a. TbJs 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 Sr demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building,code, hoOgin'h cod¢~ and regulations, and to admit authorized inspectors on premises and in build~ng for necessary/f~pec~s. }/E~' · '~Y~' "~ ,. /~/_~ ~~...~ (Signaturd of applicant, or name, if a corporation) 5.::4. :'.~...S~ .... ~I.:~.:~>.L .... ~ ~ __ (Mailing address of applicant) - ~ H~-4,~ Iv.'/. W74 '~ State whether applicant is owner, lessee, agent, architect, en~,ineer, general ~ontractor, electrician, plumb~er or builder. ..... :: ................ Name of owner of premises .G...~..~'~ .......... .~....,..[ ........ ~.r-. ............ l..4~...:~. ............... If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... , elmnber's ~icense No...'?..~-.:[.~.-..( ~.~.~ J':/: .~. :}-,~/~;.-) t~ Electrician s License No ~.%.t.e:. C~ ~'. r~ 1~) Other Trade's License No ...................... Location of land on which proposed work will be done ............................................ ' .. ~.o.o..~.4J~,.a,,.~.. .................... .C.~.4?~,.~l.~. ....... ~:y., ...................... .~. House Number ' Street Hamlet ': .... County Tax Map No. 1000 Section ....... [ ~..0. ...... Block ~ Lot .~. .... ~......./ Subdivision ................ (~,l.a}~e)~ ............... Filed M~;';~i' ii i'.~iii i... I~211..¢ ...... ['~.. State existing use and occupancy of premises and intended use and occupancy of proposed construction: 3. Nature of work (check which applicable): New Building .../~ ... Addition .......... Alteration ...*~: ...,..'. Repair. ...... ~,t ..... Rem°ival .............. Demolition .............. Other Work ............... -' , -- -,,,~'~ (Description) 4. Estimated Cost ...3.~P... ......................... Fe~. ~ff ........................ ~ [ (to be paid on filing this application) ' 5. If dwelling, number of dwelling Cnits ...... I ........ Number of dwelling units on each floor .............. If garage, number of cars ..... : .......... t ............................................ . 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 ............... Numjber of Stohes ........................................................ D~ensions of ~ame ~mcmre wi'th alterations or additions: Front ................. Rear .................. Depth .... /.~ .'7 ~ ¢ {~ ........~.. Height ..... ~. ~.. ,.. ~ ....... Number~f St.ories ............ t" '~' .... 8. Dimensionsofe~tiro~ewconst~ction: Front ~0'~*( Rear ~t~[t . De~th ~ ~0 t~ Height ~ ~ ... Nu~ber of Stohes ...... I /~ ......... ~ ............. . ~ t ...... t ' ' ' ~ '~ ........ ,'t ' ' S~ze of lot: Front .... ~.I.~ ~1 ....... Rear ..... ~.. Z~ ..... Depth ..~ .t.¢. ~ ...... ;~...~.~.... DateofPurchase . II2l. , .. Nameofgo~rOwne~ ~¢g~n~* ,~el~ r · . . ' .... . .... [ ......... r~ ' '~ ........... Zone o use district ~n Wdi~r;mlses are situated ........ ~... i~... ~~ .................... Does proposed construction viol'ate any zoning law, ordinance or regulation: '~ 0 ............................. Will lot be regraded ......... 1 ......... ~. .... [ ~... Will excess fill be remQved frnB~[~es: Yes No Nme of Owner of premises G~. ~ ~. ~,¢~.1.~. Address &.~A.~ OF)~:?IY~ No.. 6.q Z 7 ~.~q/... Name of Architect .......... ~... .............. Address ................... Phone No ................ Nme of Contractor ......................... Address ................... P~one No ................ 10. 11. 12. 13. 14. PLOT DIAGRAM Locate clearly and distinctly alli bufldh~gs, 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. (Name of individual si~ing contract) above named. H~ is the ................... ~ .................... , ................................................ ~ (Contractor, agent, corporat~ officer, etc.) of said owner or owners, and is duly authorized to p~rform or have perfo~ed the said work and to m~ and file this application; that all statements contained ~ this application are tru~ to the best of his knowledge and bdi~f; and that th~ work w~l be perfo~ed in the m~n~r set forth in th~ applkation fil~d therewith. fiwom to b~fore me this ~ Notary Pub,Ii ~ ~ .. ~, ~(~ No~ Public, Stata of N~w Yo~ ~ i NO. 52-0344963 Suffolk[ Coun~ ' ' ...................... ~mmisslon Expires March,a0, i~9 (Signature of applicant) FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL TEL.: 765-1803 Examine~---~ Application No../~dg~. ........ INSTRUCTIONS a. This application must be completely filled in by Wpewrite~ or in ink and submitted in triplicate 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 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 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 constrtiction of buildings, additions or alterations, or for removal tlr demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinancesI~uildip~ ~c~te, ho~i~'~o~,/~d regulations, and to admit authorized inspectors on premises and in buildings for nece~fy~t~,/~ (Mailing address of applicant) StYe whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................... &,'~d' '14: '5' '2'; }'4k~''' t'' G ~0t~a' ~' ~'¢~ ~'~ a ............ Nme of owner of premisgs ................................. : .~ ........................................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and tit~e of corporate officer) Builder's License No .......................... Plumber's ,License No ......................... Electrician's License No ..................... .. ' Other Trade's License No ...................... ,.}~0 ~ I~lco~tiont~hfldor~hi(~hpr~p~4~rk~.b,e~done...~..O4.~ ~ ~..y ..... 1.3Oq$ r0,,~- ~0~'~ , , IO,U,'nr~.. ~ '~'t- .... ,' ..................... ................. a .... ......... q ............. County Tax Map No. 1000 Section .................. Block .................. Lot ................... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy o~i~es~4d ih e~ed~e* and occupancy, of proposed construction': a. Existing use and occupancy .... 0f't ~ h ~' ' ' · ~)}'~ ;'/'~'~'~ '"1" ''[~"~t v [d,.~ ;. .......................... .. __1 .._~_...,.~ _ _ ~. . b. Intended use and occupancy .......... ~ .......................... '.. :~. .......................... go 10. ll. 12. 13. 14. "1 Nature of work (check which applicable): New Building .r.'x.: ...... Addition .......... Alteratio~ ......... Repa~ra ........... -[' ,' R~rnOl~ll ...... A' · · Dem~ition I .-[.: ..... Other Work ........ T, ~ ~:~r,2 I . ~ -~.:,. ......... ,~ : ... , Ov~ ~t~--' (Description) Estimated Cost....~. ~ .... Q. ..... ;..) ............. Fee .~..~/7. :¥:. ......................... ! (to be paidon filing this application) If dwelling, number of dwelling }~nits ...... I..' ..... Number of. d.welling, units on e~cti fl.o_o~ .. If garage, number of cars .... ~. ........... · If business, commercial or mixed occupancy, ~pecify nature and extent of each type of use ..................... Dimensions of existing structure~, if any: Front ............... Rear .............. Depth ............... Height ............... Num~ber of Stories ........................................................ Dimensions of same structure W~th alterations or additions: Front ................. Rear .................. Depth..1'~..[O ........... i.. Height ..... ,,,.t ?,. ....... Num,.1/~r~SJpries ......... :r~,-r, ...... Dimensions of entire~}~ tonstrUction: Front :.~. ~'. ?~0 .t. Rear...~..~..~ ....... Del~~. t~. ?.. 7 ........ Height .......... t7/t~mlber of Stories .......................... [~;aC'~ 'Ah'dd, '~i' Size of lot: Front .~ . Rear . ................ Delete : ..................... Date of Purchase .... i ......... Name of Former O~v4aer ......................... Zone or use~ district in vihl~h,~, r~ mlses are situated ............ t'~ ....l~ffllrl~.,..~)t~r C~,g~t~,~, ..... Does proposed constructio~ at~ I~I~Y ~erlin$ t.a~v. ~rdinance o~r~mllalion: ~o t.~,,Prl~,~ ........... .'t"~'~' ,,.r,, ~.~ Will lot be regraded ............................ Will ex~r~ re~ve~r~m premises. ~e~ No Name Of Owner of premises ...~ ................. Address ................... Phone No.; Name of Architect ............................. Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ Locate clearly and distinctly all propert,~ 1~: Give street and block iht erioY,~rOc~5~Fner lot. PLOT DIAGRAM buildings, whether existing or proposed, and, indicate all set-back dimensions from number or description aqeording to deed, and show street names and indicate whether STATE OF NEW ~RK~ / ~ Z COUNTY OF ~ . S.S above named. He is the ~ i (Contractor, agent, corporate officer, etc.) oF said owner or owners, and is duly autho~zed to perform or have perfo~ed the said work and to m~e and file this application; that all statements contained M this application are true to the best of his ~owledge and belief; and that the work will be performed in the m~n{r set forth in the application filed ~erewith. Sworn to before me this .... ..... · .. ...... ................ ..... uz~, ~N ~ (Signature of applic~t) ~0~RY ~Bt~C, State o~ew ~a. 52.8125850, Su[f01~ Cou~tF ~ Term Ex~ires March 30~